CB Landmark trials BPH epid chapter Flashcards
(27 cards)
What was the primary design and finding of the REDUCE trial?
REDUCE was a placebo-controlled trial testing dutasteride for prostate cancer prevention that found men with baseline prostate 40–80 mL had 67% higher risk of incident LUTS versus those <40 mL.
ReDustateride, placebo-> 67% higher luts risk
A 62-year-old with 45 mL prostate develops LUTS at higher rates.
What endpoint did the MTOPS trial use for BPH progression?
MTOPS defined clinical progression
1.4-point IPSS increase
2. AUR
3. incontinence
4. UTI
5. renal insufficiency
with a 17% progression rate over 4 years in placebo group.
Medical Therapy of Prostatic Symptoms, 5 words, 5 criteria
A patient on placebo develops new AUR and 6-point score rise after two years.
What IPSS and clinical result did placebo arms show in the PLESS study?
identify drug too
IPSS and flow rate improved with placebo initially then regressed to baseline, and baseline PSA predicted deterioration.
Proscar(finasteride) Long-Term Efficacy and Safety study (FLESS)
An older man with high PSA on placebo loses early symptomatic benefit by year three.
What was the key outcome in the Veterans Affairs Cooperative Study?
24% of watchful waiting patients switched to TURP, 41% had symptom improvement over 3 years, and baseline bother strongly predicted crossover.
24 watchful veteran,opts to have TURP
A bothered veteran on watchful waiting opts for surgery after 18 months.
What natural history insight did the Olmsted County Study provide?
Olmsted County Study found steady symptom, flow, and volume progression with age in unselected community men, correlating larger prostate and low flow with higher LUTS odds.
Olm the old man (age), with big prostate, higher LUTS,flow
A 70-year-old with 55 mL prostate is 3.5× likelier to have LUTS.
What is the significance of the Berry et al. (1984) autopsy series?
Berry et al. (1984) showed BPH is rare under age 30, near-universal after age 80, and prevalence patterns are similar worldwide.
Berry the 30/m has no BPH, but Berry at 80 will have on auutopsy
A 27-year-old has no hyperplasia, but his grandfather’s prostate at autopsy is classic BPH.
How did the PLCO trial improve understanding of prostate size estimation?
PLCO found DRE underestimates prostate size compared to TRUS or MRI and showed imaging-based measures are essential for accuracy.
Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial
A screening cohort demonstrates DRE misses large prostates in many seniors.
What did the BACH and EpiLUTS studies reveal about comorbidities and LUTS?
Both found higher LUTS rates and severity in men with lower income, metabolic syndrome, and among Black and Hispanic cohorts.
Poor B-l-ACH fat black hispanic has Epiluts
A low-income diabetic with metabolic syndrome reports high LUTS scores.
What is the EPIC cohort’s contribution to BPH research?
EPIC provided European data linking increased LUTS and BPH prevalence with aging and identified metabolic and lifestyle risk factors.
the EPIC of aging.. linked too LUTS and BPH
A 79-year-old in France with sedentary life reports severe storage symptoms.
Which major finding did the Framingham Heart Study and NHANES add regarding BPH risk?
Both documented that comorbidities like diabetes, obesity, and hypertension independently increase LUTS/BPH prevalence and burden.
A hypertensive, obese patient is counseled on elevated BPH risk by his PCP.
What feature united the named epidemiological studies in the chapter?
All highlighted the weak correlation between symptoms, prostate size, and flow, requiring multifactorial assessment for diagnosis and management.
A man with low IPSS but big prostate illustrates the weak parameter link.
What was a unique feature of REDUCE regarding LUTS incidence tracking?
REDUCE placebo arm followed biopsy-negative, enlarged prostate men (40–80 mL) over 4 years, reporting incident LUTS rates of 18.5/1,000 man-years for larger glands, and peak flow cutoff <15 mL/sec linked to increased LUTS—mnemonic REDUCE Raised Risk in Real-World Roster—a 58-year-old with 45 mL prostate and peak flow 9 mL/sec is at highest progression risk.
How did MTOPS analyze medication combinations for BPH progression?
MTOPS randomized over 3,000 men to doxazosin, finasteride, both, or placebo, showing combination therapy reduced progression by 66%, single agents by ≈39%, while 8% of placebo had acute urinary retention—mnemonic MTOPS: Maximum Therapy Outperforms Placebo Study—a man avoiding surgery after four years of combo meds.
sneaky MTOPS! it should be FD-OPS, combo is king.
In PLESS, which baseline patient variable independently predicted clinical endpoints?
Baseline serum PSA was the main predictor of both symptom progression and surgery/AUR risk in men on placebo, with higher quartiles showing up to 6-fold increased risk—mnemonic PLESS Predicts Progression via PSA—a 65-year-old with PSA 4.5 ng/mL in placebo arm doubles risk of needing surgery.
FLESS use FINASTERIDE,F-SA as the main predictor, so remember FLESS as E
What bias must be considered in watchful waiting or control group BPH cohorts?
Selection and regression to mean biases, plus drop-out for therapy-seeking, can falsely amplify natural ‘improvement’ rates in symptoms and flow—mnemonic Watchful Waiting Warps the Worsening—a large trial’s ‘stable’ symptoms over 2 years partly explained by loss of most severe cases.
Which landmark study used pressure-flow studies to define true obstruction endpoints?
Relatively few population studies—Kaplan et al. (1995) in a small cohort correlated transition zone index with detrusor pressure and peak flow, while most large trials accept Qmax and symptom thresholds instead—mnemonic Kaplan’s Korrelation: Kinks in the Core, not the Gross—a small group with high TZ/TPV index shows high voiding pressures.
KAPLAN used UDS to relate TPV and TZ, KAPTAIN UDS
What percentage of placebo patients in MTOPS crossed over to surgery within 5 years?
About 17% of placebo group eventually underwent surgery, highlighting real need for intervention in a significant minority under watchful waiting—mnemonic MTOPS Many Transfer to Operation—a placebo group patient worsens to IPSS 25 and seeks TURP after three years.
MTOPS-> Doxa and finastteride is the key to not going into surgery
17 foooled boys –> surgery eventually
How prevalent was symptom improvement in historical watchful waiting cohorts?
Meta-analysis of pre-modern cohorts saw ≈42.5% reported ‘improvement’ over 3–6 years, but definitions and scale use were imprecise—mnemonic Watchful Winners: Wavering and Weak—A 1940s study with no IPSS found 4/10 felt ‘better’ after five years.
What data did the PLCO and NHANES trials contribute regarding BPH detection?
PLCO validated DRE underestimation of prostate size, while NHANES linked socioeconomic status and access with LUTS/BPH diagnosis frequency—mnemonic PLCO Probes, NHANES Numbers—An uninsured rural patient in NHANES is less likely to have BPH detected than a city peer.
PLCO (PICCOLO) small prostate in dRE and nHANES(trunks?!) -> socio economic status->inc luts
Do statins significantly prevent BPH or LUTS according to recent meta-analysis?
Meta-analysis (Yang et al.) found no significant reduction in BPH incidence with statins, except a mild benefit in men >60—mnemonic Statins Show Slight Slowing—A 72-year-old on statin therapy shows stable prostate volume but unchanged LUTS.
STATINS 60 benefit
What is the primary result of the CombAT trial for acute urinary retention and surgery?
Combo therapy reduced AUR risk by 66% and surgery by 71% vs. tamsulosin alone.
Mnemonic: ‘Combo = Crisis Cut’ (Combo most effective to prevent retention/surgery in BPH patients at risk).
How did symptom score and flow rate improve with CombAT combination therapy?
IPSS reduced −7.3 (combo) vs. −6.4 (dutasteride) vs. −4.9 (tamsulosin); greatest Qmax gain with combo.
Mnemonic: ‘Combo = Maximum Move’ (Supports superior symptom control for those needing rapid, lasting results).
PLCO Main key interventions and main outcome
annual PSA and DRE vs Usual care = no mortality reduction, but more CA detected
Bully PICOLLO SCARes with cancer, but a namek so no one dies
ALTESS outcome, what drug used
Alfuzosin, susteained improvement in IPSS and Flow rates, low impact on BP
ALT-ternative Alfuzosin good effects too
