Talk:Benign prostatic hyperplasia

Outdated reference

Reference #39 is no longer accessible (Üçer O (1 December 2011). "Giant prostatic hyperplasia: Case report and literature review". Dicle Medical Journal / Dicle Tıp Dergisi. 38 (4): 489–491. doi:10.5798/diclemedj.0921.2011.04.0072.)

Another SECONDARY SOURCE of comparable scope would be appropriate in its place. Could someone with ADMIN LEVEL access to making the appropriate reference change include the following as the new reference #39:

How to cite this article: Ojewola RW, Tijani KH, Fatuga AL, Onyeze CI, Okeke CJ. Management of a giant prostatic enlargement: Case report and review of the literature. Niger Postgrad Med J 2020;27:242-7

How to cite this URL: Ojewola RW, Tijani KH, Fatuga AL, Onyeze CI, Okeke CJ. Management of a giant prostatic enlargement: Case report and review of the literature. Niger Postgrad Med J [serial online] 2020 [cited 2022 Aug 26];27:242-7. Available from: https://www.npmj.org/text.asp?2020/27/3/242/289919 JamesRichardFishman (talk) 20:25, 26 August 2022 (UTC)

I updated the citation. MartinezMD (talk) 18:38, 27 August 2022 (UTC)

Lifestyle

The lifestyle section mentions reducing alcohol consumption, but this seems to contradict an earlier comment in the Diet section about "a strong negative association with alcohol intake". Perhaps we could add a comment about the uncertainty here. (At a guess, alcohol consumption may reduce insulin which may reduce bph) Leblam (talk) 11:10, 31 July 2023 (UTC)

I've added the lifestyle advice from the NHS Decision aid as two images (the Decision Aid is a pdf). Hope it's OK.Draljf

Prevalence

Citing the NIDDK, we say: Half of males age 50 and over are affected. After the age of 80, that figure climbs to as high as about 90% of males affected.

I'm struggling to find sources confirming these numbers. The Global Burden of Disease Study 2019 gives: "The age-specific prevalence was highest in men aged 75–79 years, at 24 300 (95% UI 18 600–31 500) per 100 000, followed by the those aged 80–84 years, at 23 500 (17 800–30 400) per 100 000, and those aged 70–74 years, at 22 200 (16 100–29 400) per 100 000." (see Figure 2).

However, they note: "The age-specific prevalence of benign prostatic hyperplasia has been estimated from autopsy studies to be 8% in the fourth decade of life, 50% in the sixth decade of life, and 80% in the ninth decade of life." And later: "Our study shows that the peak absolute benign prostatic hyperplasia burden occurred in men aged 65–69 years and the age-specific prevalence was highest in men aged 75–79 years. This trend contrasts with the age trend found in autopsy studies, where the histological prevalence continues to rise with advancing age, but was similar to the age trend found in community-based studies, where the diagnosis of benign prostatic hyperplasia was made on the basis of lower urinary tract symptoms and prostatic enlargement in clinical practice."

So which number is correct and which source should we use? a455bcd9 (Antoine) (talk) 14:49, 23 July 2024 (UTC)

The NIDDK webpage gives this as the references for the prevalence:

[2] BPH: surgical management. Urology Care Foundation website. www.urologyhealth.org External link. Updated July 2013. Accessed July 29, 2014.

Which is a bad link (and more than a decade old data). The new link is

https://www.urologyhealth.org/urology-a-z/b/benign-prostatic-hyperplasia-(bph)

But this new link as no information on prevalence. Furthermore, high quality review articles are generally better resources than unreferenced websites (although this website does appear to be a reasonable quality - could be used as a reference if no others were available and it actually had the information you were looking for)

So I think we should discount/ignore the NIDDK website as a reference.

The Lancet article is a very sound source, so is an excellent reference.

Some of the figures you cite are not the conclusions of the Lancet article, but rather figures the Lancet article cites in its Introduction, quoting from other papers.

Notably, the Lancet article highlights the very large variation in prevalence not only by age, but by nationality and genetic ancestry (e.g., race). So in writing the encyclopedia article, it is probably best not to get too specific. Or if you do, then be clear about which nationalities or subgroups the specific numbers apply to.

Figure 2 in the Lancet article appears to summarize global incidence, and is probably the best source of particular numbers. It shows prevalence peaking at about age 75 at about 25%. Jaredroach (talk) 17:09, 23 July 2024 (UTC)

I agree with you. Still, I find the autopsy studies interesting and worth mentioning as they diagnosed BPH based on histological examination of prostate tissue so they can detect changes that might only have caused light symptoms that went undiagnosed, explaining the higher reported prevalence rates. On the other hand, the Global Burden of Disease Study only includes men who presented with symptoms and sought medical care. This could explain the surprising lower rate in older people. Maybe men aged 75–79 years seek healthcare more than men >79yo and they might have a higher likelihood of intervention. a455bcd9 (Antoine) (talk) 07:05, 24 July 2024 (UTC)

I was WP:BOLD, removed the NIDDK source and edited (citing the Global Burden of Disease Study 2019 only): "The prevalence of clinically diagnosed BPH peaks at 24% in men aged 75–79 years. Based on autopsy studies, half of males aged 50 and over are affected, and this figure climbs to 80% after the age of 80." Feedback welcome. a455bcd9 (Antoine) (talk) 07:29, 24 July 2024 (UTC)

Hi. I've been working on the new NHS decision aid for BPE and we've done some graphics for prevalence (combining symptomatic and after autopsy) - I wonder if they might be helpful?

We also did graphics for the effectiveness of all the different surgical treatment options which might be helpful to include (it was a lot of work reviewing them all and tracking down the numbers). Do you think those might be helpful? (can include all the references).

https://www.england.nhs.uk/wp-content/uploads/2023/11/Decision-support-tool-making-a-decision-about-enlarged-prostate.pdf 86.24.157.218 (talk) 11:09, 30 August 2024 (UTC)

Thanks a lot, that's great! Yes feel free to add content to this article, ideally it would be better to cite the original sources rather than the NHS PDF.

For "How well do medicines work?" do you have equivalent data about PDE5 inhibitors like tadalafil taken alone or in combination with alpha-blockers or 5-ARIs?

By the way: how come tamsulosin and silodosin are still recommended given their neurotoxicity?

• Association of Terazosin, Doxazosin, or Alfuzosin Use and Risk of Dementia With Lewy Bodies in Men 2024
• Risk of Parkinson’s disease among users of alpha-adrenergic receptor antagonists: a systematic review and meta-analysis 2024
• Tamsulosin use in benign prostatic hyperplasia and risks of Parkinson’s disease, Alzheimer’s disease and mortality: An observational cohort study of elderly Medicare enrollees 2024
• Exposure to Glycolysis-Enhancing Drugs and Risk of Parkinson’s Disease: A Meta-Analysis 2024
• The impact of alpha-1-adrenergic receptor antagonists on the progression of Parkinson disease 2024
• Glycolysis-enhancing α1-adrenergic antagonists modify cognitive symptoms related to Parkinson’s disease 2023

a455bcd9 (Antoine) (talk) 11:45, 30 August 2024 (UTC)

We decided not to include tadalafil risks & benefit numbers because of the way it is prescribed within the NHS (I am not a clinician and can't remember the full discussion and details, but I think it is not universally used and not as first line therapy). Also can't speak to why some things are still used despite neurotoxicity (I could go digging back into the NICE evidence review - I bet it's in there...)

I'll try to add some things, but I've not done much editing before so may need someone to tidy up after me!! 86.24.157.218 (talk) 13:58, 30 August 2024 (UTC)

OK I understand! I can tidy up after you no worries :) Also: you don't have to but it might be easier if you create an account here. Please let me know if you have any questions. a455bcd9 (Antoine) (talk) 20:25, 30 August 2024 (UTC)

Thanks a lot for your edits @Draljf!

Images that are mostly just text (File:NHS-thingstotry.png, File:NHS-thingstoavoid.png, File:NHS-surgeries-effectiveness2.png) should be removed and integrated in the text. Others (File:NHS-medicines-effectiveness.png, File:NHS-medicines-sideeffects.png, File:NHS-surgeries-effectiveness.png, and File:NHS-surgeries-sideeffects.png) might be copyrighted (although maybe not, I don't know if that goes above the threshold of originality as the data is publicly available). a455bcd9 (Antoine) (talk) 20:24, 8 September 2024 (UTC)

Gosh - you're quick to comment! Feel free to move the text from the images into text. It felt a bit odd to do that, but you absolutely can. I'm new to editing, so apologies for any mistakes.

The images I've put in are OK, copyright-wise. We made them, and I've checked with my NHS colleagues and they're happy for them to be the CC copyright that I've given them. We're just keen that the information is shared as widely as possible to help patients. Draljf (talk) 20:30, 8 September 2024 (UTC)

Amazing! Could you please ask them to follow the steps here: Wikipedia:Requesting copyright permission? They just need to email permissions-commons@wikimedia.org with this text: https://commons.wikimedia.org/wiki/Commons:Email_templates (and the URL of the above images) a455bcd9 (Antoine) (talk) 20:33, 8 September 2024 (UTC)