Long-Term Risk of Surgery Following First Diagnosis of Benign Prostatic Hyperplasia in Middle-Aged Men

Objective Pharmacotherapy is often used to relieve lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH), yet surgery may be indicated for persistent bothersome symptoms. BPH is common among older men, yet the burden of BPH among middle-aged men may be under-recognized. This study examined the 5-year risk of BPH surgery among middle-aged men following the first BPH diagnosis. Methods Using the IBM MarketScan Commercial Claims and Encounters Database, males aged 35 to 64 years with a first-time primary diagnosis of BPH who were prescribed oral medication for LUTS were identified. The primary outcome was the risk of BPH surgery within five years of the first BPH diagnosis, which was analyzed using Kaplan-Meier methods. The influence of patient demographics, comorbidities, and medication use on the risk of BPH surgery was explored using a Cox proportional hazards model. Results Four thousand five hundred ten eligible men, 460 underwent BPH surgery within five years of BPH diagnosis. The most common surgical procedures were transurethral resection of the prostate and laser enucleation. The risk of BPH surgery over five years following BPH diagnosis was 10.2% (95% CI: 9.4% to 11.1%). In a multivariable Cox proportional hazards regression analysis, patient age was the primary factor associated with higher surgery risk. Compared to men aged 35 to 44 years, the hazard ratio for BPH surgery was 3.9 (95% CI: 1.9 to 8.4; p<0.001) among men aged 45 to 54 years, and 5.0 (95% CI: 2.4 to 10.6; p<0.001) among men aged 55 to 64 years. Conclusions In middle-aged men prescribed oral medication for LUTS secondary to BPH, the risk of BPH surgery was 10.2% over five years. This risk may be underappreciated and highlights the clinical need for surgical procedures with favorable risk-to-benefit profiles.