Management of patients with lower urinary tract symptoms due to benign prostatic enlargement at risk of progression treated with 5-alpha-reductase inhibitors: examining real-world clinical practice in Spain and Brazil

Background For patients with lower urinary tract symptoms due to benign prostatic enlargement (LUTS/BPE), assessing patient risk of disease progression is important to determine if treatment with 5-alpha-reductase inhibitors (5ARIs) is warranted. Clinical trials and guidelines have identified risk factors for disease progression, which affects subsequent treatment decision making; however, real-world clinical practices may differ. This non-interventional, cross-sectional study examined the management of patients with LUTS/BPE at risk of disease progression receiving 5ARIs by urologists from Spain and Brazil. Methods Urologists were randomly recruited and completed an online questionnaire comprising multiple-choice, open-ended ranking and rating questions on their clinical approach in patients with LUTS/BPE receiving 5ARIs. Urologists also provided patient record forms for two recent patients treated with 5ARIs. Results In Spain and Brazil ( n = 100 each), 66% and 75% of urologists, respectively, assessed patients for their risk of LUTS/BPE progression. The most frequent parameters used to assess risk of progression were: post-void residual volume (PVR: 79% Spain, 83% Brazil), prostate volume (PV: 78% Spain, 82% Brazil), and International Prostate Symptom Score (IPSS: 79% Spain, 79% Brazil). These were also the most frequent parameters considered before initiating 5ARIs: PVR (60% Spain, 78% Brazil); PV (87% Spain, 89% Brazil); and IPSS (66% Spain, 61% Brazil). Thresholds used to assess risk factors of disease progression were generally higher than recommended by clinical guidelines. Reasons for initiating 5ARIs included: to achieve sustained symptom relief (70% Spain, 71% Brazil) and reduce the risk of progression (63% Spain, 66% Brazil). Impact on sexual function was a barrier to 5ARI initiation (46% Spain, 67% Brazil). Conclusions Most urologists in Spain and Brazil recognized the benefits of assessing the risk of disease progression in patients with LUTS/BPE. Many urologists reported assessing fewer risk factors and using higher thresholds than recommended by international guidelines, highlighting the need for ongoing medical education.