Can Primary Care Physicians Manage Benign Prostatic Hyperplasia Patients As Urologists Do?

Most clinical practice guidelines (CPGs) assume that general practitioners (GPs) can manage non- complicated benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms (LUTS) as urologists do, but this has not been directly compared. Moreover, some studies have demonstrated that the initial management of BPH may vary between the urologist and the primary care physician. We conducted a prospective study to compare the diagnostic and therapeutic decisions of a group of eight GPs with those proposed for an experienced urologist in a set of consecutive, non selected, BPH patients. After some previous meetings in which different guidelines (from the EAU, AUA, and NICE) were reviewed, the GPs and the urologist reached a consensus about defining and managing five different BPH patients’ profiles. After completing the diagnostic work-up, the GPs proposed a diagnostic and therapeutic recommendation for each patient. Afterwards, the patients were sent to the urologist, who was blinded to those GP recommendations. An independent central reviewer analysed the agreement between both groups. A total of 117 consecutive patients were diagnosed. In only 31% of the patients the main cause of consultation was LUTS. The urologist confirmed the diagnosis in 81% of cases. With regard to the therapeutic decision, a kappa index of 0.651 was observed which can be considered a good agreement. Nevertheless, GPs tended to use more alpha-blockers and fewer 5-alpha reductase inhibitors even in those patients who had progression criteria. We cannot conclude that GPs can manage BPH patients without assuring enough adherence to the CPG’s recommendations, training regarding digital rectal exam, and maybe a periodic re-evaluation by urologists.