Benign prostatic hyperplasia in an unselected community-based population: a survey of urinary symptoms, bothersomeness and prostatic enlargement.

Objectives: To determine the prevalence of (anatomical) benign prostatic hyperplasia/enlargement (BPH/BPE) in an unselected population and to assess the relationships between BPE, urinary flow rates (UFRs) and symptoms in men with BPH.

Subjects And Methods: All men aged 40-79 years and living in three ex-mining villages in Scotland were invited to undergo a measurement of UFR, transrectal ultrasonography (TRUS) and to complete a symptom score and a previously validated lifestyle questionnaire.

Results: Of 597 eligible men, 367 (61%) completed the urinary symptom questionnaire and 310 (52%) underwent TRUS and measurement of UFR. The response rate in the age group 50-69 was > 60%. Age-specific prevalence rates for BPE (prostate size > 20 g) per 1000 men were: 40-49 years, 615; 50-59 years, 776; 60-69 years, 892; and 70-79 years, 889, giving an overall rate for all ages of 765. There was no significant relationship between prostate size and symptoms, nor between size and peak UFR, nor any clear association between size and interference with activities of daily living. However, men with a UFR of > 20 mL/s were very unlikely to have prostates > 40 g. Relationships were found between some urinary symptoms and UFR. Age, weight and the level of prostate-specific antigen (PSA) were the only independent variables associated with prostate size.

Conclusion: Compared to published studies, BPE was substantially more prevalent than assumed previously. This study further reinforces the need for the subtle and detailed evaluation of patients who have a syndrome of BPH in assigning them to intervention, be it medical or surgical, or non-intervention/watchful waiting.