Symptom relief at the core of prostate patient management

By Sally Robertson, B.Sc.Jul 11 2012

More focus should be placed on relieving the most bothersome or "core" symptom for patients with benign prostatic hyperplasia, report Korean researchers.

Relieving the core symptom appears to be more important for improving patients' quality of life (QoL) than reducing the overall International Prostate Symptom Score (I-PSS).

In a follow-up assessment of 194 patients who underwent 8 to 12 weeks of treatment for lower urinary tract symptoms (LUTS), improvement of core symptoms in 149 individuals also led to an improvement in QoL for 129 (86.6%) of them, report Won Jae Yang (Soonchunhyang University, Seoul) and colleagues.

For 45 men who did not experience any improvement in core symptoms, only nine (20%) had an improved QoL.

The core symptom was defined as the most bothersome symptom reported during completion of the I-PSS questionnaire at baseline. The sum of other symptoms was defined as "peripheral symptoms."

As reported in Urology, the mean I-PSS score prior to treatment was 19.7 points.

Nocturia was found to be the most common core symptom (29.9%) among the patients, and weak stream (16.5%) the second most common.

Multivariate regression analysis showed that relieving the core symptom (defined as a decrease of 1 or more in core symptom score at follow-up) was significantly associated with QoL improvement, at an odds ratio (OR) of 39.2, while improvement in peripheral symptoms predicted QoL improvement, at an OR of 4.85.

Yang et al also found that patients who reported improvement displayed varying numeric changes in symptom score, depending on their baseline score.

Although the average decrease in I-PSS score was only 3.8 in those who had a moderate score (<20) at initial visit, compared with a decrease of 10.9 in those who had a severe initial score (I-PSS >20), multiple regression analysis showed that inclusion in the moderate symptom score group at baseline was still significantly associated with a 2.6-fold increased likelihood of experiencing QoL improvement.

In an accompanying editorial, Marco Blanker and Roelf Norg (Groningen Medical Center, Maastricht University Medical Center, the Netherlands) say: "In daily care, patients often consult their physician for 1 or 2 symptoms that they find obnoxious-in this study, called 'core symptoms'-and not because of their total IPSS score."

"Aiming at this reason for encounter, not at the total symptom score seems therefore logical," they add.

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