Can benign prostatic hyperplasia be identified in the primary care setting using only simple tests? Results of the Diagnosis IMprovement in PrimAry Care Trial

摘要: Summary Aims:  Diagnosis IMprovement in PrimAry Care Trial (D-IMPACT) was a prospective, multicentre epidemiological study three European countries to identify the optimal subset of simple tests applied primary care diagnose benign prostatic hyperplasia (BPH) men who spontaneously present with lower urinary tract symptoms (LUTS). Methods:  Consecutive male patients aged ≥ 50 years attended their regular general practitioner (GP) office LUTS were eligible for inclusion if they had not previously undergone BPH diagnostic or received treatment BPH. Patients assessed on occasions, twice by GP (visits 1 and 2) once urologist (visit 3). The accuracy each variable determined using urologists’ final diagnosis (at visit 3) as gold-standard. Independent variables analysed follows: age; performed (yes/no); probability 1; urinalysis (normal/abnormal); prostate-specific antigen (PSA); International Prostate Symptom Score (IPSS); 2 2. Statistically significant (p < 0.1) included logistic regression model best algorithm describe test contribution. Results:  most frequent reported nocturia weak stream. prevalence 66.0% (95%CI: 62.3–69.5) 32% at risk progression (PSA > 1.5 ng/ml prostate volume ≥ 30 cm3). Among independent analysed, only age, IPSS PSA showed statistically relationship diagnosis. In including IPSS, (based physical examination symptoms), positive predictive value (PPV) 77.1%. Exclusion resulted PPV 75.7%. Conclusions:  A objective (age, PSA), easily implemented any office, allows GPs accurately approximately three-quarters reporting LUTS.