Systematic reviews in BPH
A number of reviews (more or less systematic) have been done in BPH. A brief description of each is in the table below. THis may be difficult to read if you have a small screen, and in any event for some people a paper copy may be more useful. A PDF of this table can be downloaded by clicking here . If you know of other reviews we may have missed, please let Bandolier know.
Table: Systematic reviews in BPH
|
Reference |
Question |
Searching |
Included papers |
Quality/sensitivity |
Inclusion criteria |
Treatment |
Duration |
Outcomes |
| Eri & Tveter : Alpha-blockage in the treatment of symptomatic BPH. J Urol 1995 154: 923-934 | Efficacy and harm associated with alpha-blockers in BPH | MEDLINE to Jan 95, plus reference lists and personal files | 29 randomised placebo-controlled trials with 3,464 men. Only three appeared to be double blind | No quality analysis
No sensitivity analysis |
Maximum flow rate of less than 15 mL/second in 15 studies, less than 20 in one and not reported in 13 | Seven different alpha blockers | 24 weeks or longer in five studies | Change in maximum flow rate
% change in residual volume % change in symptoms Dropout rate Adverse effects mentioned |
|
Boyle et al
. Prostate volume predicts outcome of treatment of BPH with finasteride. Urology
1996 48: 398-405.
|
Effect of finasteride on symptoms and examine predictors of outcomes | All randomised trials comparing finasteride 5 mg with placebo at one year | Six trials with 2601 men. No information about methodological quality, though unlikely to be a problem | No quality analysis
No sensitivity analysis |
Maximum flow rate of 15 or less in five studies, 12-20 in sixth.
Moderate symptoms entry criterion of all |
Finasteride 5 mg | 52 weeks | Change in maximum flow rate
% change in symptoms Analysis by prostate volume |
| Byrnes et al . Combined analysis of two multicentre studies of finasteride 5 mg in treatment of symptomatic BPH. Prostate Cancer and Prostatic Disease 1997 1: 26-31. | Analysis by age older and younger than 65 years | No searching | Two randomised placebo controlled trials with 4,732 men | No quality analysis
No sensitivity analysis |
BPH with moderate to sever symptoms (AUA scores 8 or more) | Finasteride 5 mg | 52 weeks | Change in symptom score
Adverse events PSA DHT |
| Roehrborn . Meta-analysis of randomised clinical trials of finasteride. Urology 1998 51 Suppl 4A: 46-49. | Duplicate of Boyle et al | Includes analysis of prostate size distribution | ||||||
|
Wilt et al
. Saw palmetto extracts for treatment of benign prostatic hyperplasia. JAMA 1998
280: 1604-1609
|
Efficacy and harm associated with Saw palmetto (serenoa repens) in BPH | MEDLINE, EMBASE, Cochrane Library and fields registers, plus reference lists, reviews and trialists. To mid 1997 | 18 randomised comparisons with placebo with 2,939 men lasting at least 30 days. Mean age 65 years. 16 studies were double blind. | Quality analysis (Schulz)
No sensitivity analysis |
Initial symptoms consistent with moderate BPH. Baseline mean urinary flow was 5.7 mL/sec and prostate volume was 44 mL. | No information | Mean duration was 9 weeks | Peak urinary flow rate vs placebo (8 trials, 642 men)
Nocturia vs placebo (10 trials, 634 men) IPSS vs placebo (2 trials, 1440 men) |
|
Wilt et al
. Beta-sitosterol for the treatment of benign prostatic hyperplasia: a systematic
review. BJU International 1999 83: 976-983.
|
Efficacy with beta-sitosterol in BPH | MEDLINE, EMBASE, Cochrane Library and fields registers, plus reference lists, reviews and trialists. To mid 1998 | 4 randomised comparisons with placebo in 519 men. Mean age about 65 years. All studies double-blind | Quality analysis (Schulz)
No sensitivity analysis |
Initial symptoms consistent with moderate BPH. Maximum flow rate under 15 ml/sec in two, under 20 mL/sec on one | No information | Three studies lasted 24-26 weeks, one of 4 weeks. | Peak urinary flow rate vs placebo
Symptom score vs placebo Residual volume vs placebo Mean change in above |
| Macdonald et al. A systematic review of cernilton for the treatment of BPH. BJU International 1999 85: 836-841. | Efficacy and safety of rye grass pollen extract (cernilton) for BPH | MEDLINE, EMBASE, Cochrane Library and fields registers, plus reference lists, reviews and trialists. To mid 1997 | 4 randomised comparisons (2 with placebo, 2 with other complementary therapies) in 444 men. Mean age about 65 years. Three studies double-blind | Quality analysis (Schulz)
No sensitivity analysis |
Men with BPH | No information | One study lasted 24 weeks, the others being 12-16 weeks | Peak urinary flow rate
Symptom score Residual volume Nocturia |
| Djavan & Marberger . A meta-analysis of the efficacy and tolerability of alpha1-adrenoreceptor antagonists in patients with lower urinary tract symptoms suggestive of BPH. European Urology 1999 36: 1-13. | Distinguishing between members of drug class for efficacy and harm | MEDLINE, for English language papers to mid 98 | 21 studies, "most" of which were randomised and double-blind", 6,333 men in placeb0-controlled studies. | No quality analysis
No sensitivity analysis |
No information | Any dose | 1 month to 1 year | Percentage improvement in symptom score (end vs baseline)
Percentage improvement in maximum flow rate Percentage with bothersome adverse effects Percentage with adverse effects related to vasodilator properties |
| Ishani et al . Pygeum africanum for treatment of patients with BPH: a systematic review and quantitative meta-analysis. American Journal of Medicine 2000 109: 654-664. | Efficacy and safety of Pygeum africanum for BPH | MEDLINE, EMBASE, Cochrane Library and fields registers, plus reference lists, reviews and trialists. To mid 2000 | 18 randomised trials with 1,562 men lasting at least 30 days. Mean age 66 years. 17 studies were double blind. | Quality analysis (including Schulz)
No sensitivity analysis |
Men with BPH | 14 studies used a standardise extract | Mean duration was 9 weeks | Peak urinary flow rate
Symptom score Residual volume Nocturia |
| Boyle et al . Meta-analysis of clinical trials of permixon in the treatment of symptomatic BPH. Urology 2000 55: 533-539. | Clinical efficacy of permixon (an extract of serenoa repens) versus placebo | No formal search strategy | 13 trials (11 randomised) with 2,859 men | No quality analysis
Sensitivity analysis of all versus randomised studies |
Men with BPH | 320 mg a day | Duration 3 to 26 weeks | Peak urinary flow rate
Nocturia Baseline, end, and change |
| McNeill et al . Postvoid residual urine in patients with lower urinary tract symptoms suggestive of BPH: pooled analysis of eleven controlled studies with alfuzosin. Urology 2001 57: 459-465. | Effect of alpha-blocker on residual volume and other outcomes. | No formal search strategy, but data from clinical trials | 11double blind randomised trials comparing alfuzosin with placebo. 953 men aged 42-89 years (mean 65 years). | No quality analysis
No sensitivity analysis |
Men with BPH and residual volume 50-350 mL. Peak flow rate less than 15 mL/sec | 7.5 mg (immediate release) or 10 mg (sustained release) | 4-24 weeks | Change in residual volume |
| Yang et al . Transurethral incision compared with transurethral resection of the prostate for bladder outlet obstruction: a systematic review and meta-analysis of randomized controlled trials. Journal of Urology 2001 165: 1526-1532. | Efficacy of incision compared with resection | MEDLINE, EMBASE, ISA, Cochrane Library, plus Cochrane Review Group databases, to 1999 | 9 randomised trials with 691 men. Mean ages 60s to early 70s | Two quality scores | Lower urinary tract symptoms suggestive of bladder outlet obstruction | Not applicable | Follow up at various times from 3-60 months. 12 month data analysed | Maximum flow rate (4 trials, 226 men)
Symptom score (4 trials, 243 men) Actual baseline and 3/12 month scores and flow rates where available |
| Roehrborn et al . Clinical predictors of spontaneous acute urinary retention in men with LUTS and clinical BPH: a comprehensive analysis of the pooled placebo groups of several large clinical trials. Urology 2001 58: 210-216. | Clinical predictors of acute retention | No formal search strategy, but data from clinical trials | 3,780 men, mean age 64 years, peak flow 11 mL/sec, IPSS 15 | Not applicable - all four studies randomised and double-blind. | Men with BPH. Baseline mean data given | Placebo | 2-4 years | Predictive factors for acute urinary retention. |
| Edward & Moore . Finasteride in the treatment of clinical benign prostatic hyperplasia: a systematic review of randomised trials. BMC Urology 2002 2:14. | Efficacy and adverse events | Wide, including Cochrane and PubMed | 14,720 men in placebo controlled trials | Trials had to be randomised and double blind. Sensitivity analyses doen | Men with BPH. | Placebo | 2-4 years | Symptoms, maximum flow rate, prostate volume, AUR, surgery, adverse events |
| Wilt et al. Terazosin for treating symptomatic benign prostatic obstruction: a systematic review of efficacy and adverse effects. BJU International 2002 89: 214-225. | Efficacy and adverse events | Wide, including Cochrane and specialist registers | 5151 men in 17 trials | Trials had to be randomised, and of at least 4 weeks duration | Men with symptomatic benign prostatic obstruction | Placebo and active | 4-52 weeks | Symptoms, maximum flow rate, prostate volume, adverse events |