# Management of patients with lower urinary tract symptoms due to benign prostatic enlargement at risk of progression treated with 5-alpha-reductase inhibitors: examining real-world clinical practice in Spain and Brazil

## TL;DR

This study examines how urologists in Spain and Brazil manage patients with prostate enlargement symptoms using a specific type of medication.

## Contribution

The study reveals real-world clinical practices of urologists in Spain and Brazil regarding the use of 5ARIs for LUTS/BPE.

## Key findings

- Most urologists in Spain and Brazil assess risk factors for disease progression before prescribing 5ARIs.
- Urologists often use higher thresholds for risk factors than recommended by guidelines.
- Sexual function concerns were a common barrier to initiating 5ARI treatment.

## Abstract

For patients with lower urinary tract symptoms due to benign prostatic enlargement (LUTS/BPE), assessing patient risk of disease progression is important to determine if treatment with 5-alpha-reductase inhibitors (5ARIs) is warranted. Clinical trials and guidelines have identified risk factors for disease progression, which affects subsequent treatment decision making; however, real-world clinical practices may differ. This non-interventional, cross-sectional study examined the management of patients with LUTS/BPE at risk of disease progression receiving 5ARIs by urologists from Spain and Brazil.

Urologists were randomly recruited and completed an online questionnaire comprising multiple-choice, open-ended ranking and rating questions on their clinical approach in patients with LUTS/BPE receiving 5ARIs. Urologists also provided patient record forms for two recent patients treated with 5ARIs.

In Spain and Brazil (n = 100 each), 66% and 75% of urologists, respectively, assessed patients for their risk of LUTS/BPE progression. The most frequent parameters used to assess risk of progression were: post-void residual volume (PVR: 79% Spain, 83% Brazil), prostate volume (PV: 78% Spain, 82% Brazil), and International Prostate Symptom Score (IPSS: 79% Spain, 79% Brazil). These were also the most frequent parameters considered before initiating 5ARIs: PVR (60% Spain, 78% Brazil); PV (87% Spain, 89% Brazil); and IPSS (66% Spain, 61% Brazil). Thresholds used to assess risk factors of disease progression were generally higher than recommended by clinical guidelines. Reasons for initiating 5ARIs included: to achieve sustained symptom relief (70% Spain, 71% Brazil) and reduce the risk of progression (63% Spain, 66% Brazil). Impact on sexual function was a barrier to 5ARI initiation (46% Spain, 67% Brazil).

Most urologists in Spain and Brazil recognized the benefits of assessing the risk of disease progression in patients with LUTS/BPE. Many urologists reported assessing fewer risk factors and using higher thresholds than recommended by international guidelines, highlighting the need for ongoing medical education.

The online version contains supplementary material available at 10.1186/s12894-025-01966-6.