Prostate Volume and PSA Cutoff Values as Predictive Indices for Success of Doxazocin Treatment in BPH in GHRDS

Abstract

Background: Benign prostatic hyperplasia (BPH) is a non malignant enlargement of the prostate. This study was conducted to determine the pattern of presentation of BPH with and without acute urinary retention (AUR) and to determine the risk factors for acute urinary retention, in addition, to assess the results of doxazosin in the treatment of BPH with and without AUR.
Patients and methods: Ninety two patients were enrolled in this study. All patients presented to the emergency department and the referred clinic of the Gezira Hospital for Renal Disease and Surgery (GHRDS) with lower urinary tract symptoms with and without acute urinary retention suggestive of BPH were evaluated according to the European guidelines. All of them underwent trans-rectal ultra sound and measurement for the prostatic volume. Serum PSA level was estimated. Doxazosin was given to all patients and they were followed for twelve weeks. A trial without a
catheter at the end of the first week was attempted for patients with acute urinary retention. Results: The patients’ mean age ± SD at baseline was 67.8 ± 7.7 and 69.4 ± 9.9 for Non-AUR/BPH and AUR/BPH respectively. Comparing baseline clinical parameters of patients with and without
acute urinary retention revealed that IPSS, prostate volume and PSA level are significantly different between the two groups with P< 0.01, 0.01 and 0.00 respectively. In the TWOC, 65% of patients passed urine spontaneously. By the end of the study, the overall response of patients showed 78.9% successful rate (n=73) and 21.1% failure rate (n=19). Prostatic volume and PSA level were found to affect doxazosin treatment significantly. With cutoff values of 41cc and (3.45) ng/ml, prostatic
volume and PSA level influenced doxazosin treatment failure.
Conclusion: Serum PSA and prostate volume are powerful predictors of the risk of AUR. Alpha blockers are efficacious in treating retaining and non-retaining BPH patients. Knowledge of baseline serum PSA and/or prostate volume are useful tools to aid physicians and decision makers
in predicting the risk of BPH-related outcomes and choosing dexazosin as therapy for BPH.

Keywords: BPH, AUR, doxazosin, Sudanese