Differences in the Treatment of Benign Prostatic Hyperplasia: Comparing the Primary Care Physician and the Urologist

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Abstract

Introduction:

Benign prostatic hyperplasia is a prevalent chronic condition with expenditures exceeding $1 billion each year. Little is known about the treatment of patients by primary care physicians compared to urologists. We assessed changes in management after medication initiation in these 2 settings.

Methods:

From the Chronic Condition Warehouse 5% sample of Medicare beneficiaries linked to Medicare Part D data, we defined a cohort of men, 66 to 90 years old, with initial prescriptions for an alpha blocker and/or 5α-reductase inhibitor. We assessed the initial change in therapy for up to 4 years after medication initiation, whether adding a medication, switching medication, stopping medication or having surgery/retention. We estimated the cumulative incidence functions from competing risks data and tested equality across groups (primary care physician vs urologist).

Results:

Overall 5,714 men started medication with a primary care physician and 1,970 did so with a urologist. The most common change in treatment after medication initiation across all groups was medication discontinuation (55% alpha blocker, 46% 5α-reductase inhibitor, 30% combination therapy cumulative incidence at 3 years). Patients who started treatment with primary care physicians were more likely to discontinue benign prostatic hyperplasia related medications than those who started treatment with urologists (HR 1.19, 95% CI 1.09–1.29). The majority of patients who stopped alpha blocker therapy did not receive further benign prostatic hyperplasia therapy.

Conclusions:

Men given combination therapy are most likely to continue medication use. Surgical therapy and retention are relatively rare events. Patients who initiate care with urologists are more likely to continue medical therapy than those who initiate care with primary care providers.

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