|Year : 2015 | Volume
| Issue : 4 | Page : 128-131
Prevalence of Benign Prostatic Hyperplasia in Shanghai, China: A Community-based Study
Jun Da, Ming-xi Xu, Hai-jun Yao, Xiao-Min Ren, Ke Zhang, Zhong Wang
Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
|Date of Web Publication||28-Oct-2015|
Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011
Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011
Source of Support: None, Conflict of Interest: None
Background and Objective: The prevalence of benign prostatic hyperplasia (BPH) in Shanghai, China, has not been updated in over 20 years. Here, we conducted a study in the community health system to get current BPH prevalence. Materials and Methods: All males older than 50 years old with lower urinary tract symptoms (LUTS) in five randomly selected communities in Shanghai were included in this study and were grouped according to their age. Group A was men with ages between 50 and 59, Group B 60-69, Group C 70-79, and Group D over 80. Results of international prostate symptom scores (IPSS), urinalysis, digital rectal examination, ultrasound scan, uroflowmetry, prostate specific antigen level, and any complications related to BPH were collected and analyzed. Results: The ages ranged from 50 to 92 (68.7 ± 9.6, mean ± standard deviation). The average IPSS in each group increased with aging, from 15.13 ± 2.87 in Group A to 19.95 ± 7.43 in Group D. However the quality of life scores (QoL) did not correlate with IPSS in Group A (r = 0.263, P < 0.001). The prevalence rate of BPH increased with aging. The growth rate of the prostate slowed from 27.86% to 8.84% from Group A to Group D. Conclusions: The overall prevalence rate of BPH in our study is 11.99%, LUTS symptoms develop with aging, and the result of the single-question QoL questionnaire should be carefully considered while dealing with patients in Shanghai older than 60.
Keywords: Benign prostatic hyperplasia, lower urinary tract symptoms, population of Shanghai China, prevalence
|How to cite this article:|
Da J, Xu Mx, Yao Hj, Ren XM, Zhang K, Wang Z. Prevalence of Benign Prostatic Hyperplasia in Shanghai, China: A Community-based Study. J Integr Nephrol Androl 2015;2:128-31
|How to cite this URL:|
Da J, Xu Mx, Yao Hj, Ren XM, Zhang K, Wang Z. Prevalence of Benign Prostatic Hyperplasia in Shanghai, China: A Community-based Study. J Integr Nephrol Androl [serial online] 2015 [cited 2021 Sep 17];2:128-31. Available from: http://www.journal-ina.com/text.asp?2015/2/4/128/168541
Jun Da, Ming-xi Xu.
∗These authors contributed equally to this work.
| Introduction|| |
Benign prostatic hyperplasia (BPH) is one of the most common diseases among aging males. Most patients present with lower urinary tract symptoms (LUTS). The prevalence rate of BPH varies from 13% to 43% depending on the age range, diagnostic settings, and country. ,,, In China, the incidence rate had risen from 7.5% in the 1950s to 18.5%, in the 1990s.  However, this data was collected over two decades ago. To get a clue of the current prevalence rate of BPH, we conducted this study in Shanghai communities, one of the biggest cities in China with quick developing economy and health system as well.
| Materials and methods|| |
In Shanghai, most residents go to the Community Health Service Center for Primary Health Care Services. Each resident is registered to one general practitioner team (GPT). In addition to primary health services, GPTs are also responsible for health education in their community. We randomly selected five communities scattered throughout Shanghai and asked GPTs to carry out this study together with one experienced urologists as a supervisor.
From 2007 to 2011, the GPTs collected general information of male residents over 50-year-old in the community who complained of LUTS. The results of international prostate symptom scores (IPSS), urinalysis, digital rectal examination (DRE), type B ultrasound scan (BUS), uroflowmetry, prostate specific antigen (PSA) level, and any complications related to BPH were collected. The diagnosis of BPH was based on the Chinese guidelines for BPH. The diagnosis made by GPT was reviewed by at least one certified urologist.
The population was then divided into four groups according to age range. Group A ranged from 50 to 59, Group B 60 to 69, Group C 70 to 79, and Group D over 80. A database was compiled using EpiData version 3.1 (The EpiData Association, Odense, Denmark). The data on general information, prevalence of BPH, IPSS, and prostate volume were computed using descriptive statistics and graphs.
| Results|| |
Age composition and education composition
There were totally 26,446 males in the five selected communities older than 50 years old. There were 13,000 cases in Group A (49%), 7083 cases in Group B (27%), 4210 cases in Group C (16%), and 2153 cases in Group D (8%). A total number of 3172 cases of diagnosed BPH were included in this study. The age ranges were from 50 to 92 (68.7 ± 9.6, mean ± standard deviation). There were 678 cases in Group A (21%), 990 cases in Group B (31%), 966 cases in Group C (31%), and 538 cases in Group D (17% ) [Table 1].
|Table 1: Age composition of males in all communities older than 50 years old and BPH patients in our study. The prevalence rate of BPH increased from 5.22% in Group A to 24.99% in Group D, P < 0.001|
Click here to view
We also collected education experiences of the patients in our study [Table 2]. We found that men in Group A tended to have education levels higher than the other three groups, with more males completing university comparably. Conversely, men in Group D had more males' education stagnate at the lower end of the spectrum with many receiving only primary school education or lower (P < 0.01).
International prostate symptom score and benign prostatic hyperplasia prevalence rate
We used the IPSS to evaluate the severity of LUTS in this study. As expected, the average IPSS increased with age, from 15.13±2.87 in Group A to 19.95±7.43 in Group D, P < 0.01 [Figure 1]. Interestingly, the last question of the IPSS, which regarded the quality of life (QoL) due to urinary symptoms, did not match the IPSS curve as expected [Figure 2]. The highest scores came from Group A. However from Group B to Group D, the scores showed an increasing tendency with aging. Correlation analysis showed poor correlation between IPSS and QoL in Group A (r = 0.263, P < 0.001), but good correlations in Group B (r = 0.537, P < 0.001), Group C (r = 0.682, P < 0.001), and Group D (r = 0.593, P < 0.001).
|Figure 1: Average IPSS in each group increased with aging. The mean IPSS was 15.13 ±2.87 in Group A, 16.24 ± 5.92 in Group B, 18.25 ± 6.56 in Group C, 19.95 ± 7.43 in Group D|
Click here to view
|Figure 2: Average QoL in each group. The QoL 4.01 ± 1.38 in Group A, 3.36 ± 1.30 in Group B, 3.39 ± 1.25 in Group C, 3.55 ± 1.15 in Group D|
Click here to view
The overall prevalence rate of BPH was 11.99% in our study. The prevalence rate was 24.99% in Group D, which was significantly higher than that in Group A [5.2%, P < 0.001, [Table 1].
Prostate volume was estimated by ultrasound scan (volume = height × length × width × 0.52) and DRE. The prostate volume increased with aging at the average speed of 12.51% per decade. The growth rate of the prostate slowed from 21.19% to 8.36% starting at 50 and continued past 80 [Table 3]. Meanwhile, the results of DRE showed good correlation with ultrasound scan results (r = 0.56, P < 0.001).
Benign prostatic hyperplasia related incidences
We collected the incidences related to the increased difficulty in urination. In our study, there were 146 cases of bladder stones (4.60% in 3172 cases of BPH patients), 144 cases of urinary infection (4.54%), 83 cases of nephrohydrosis (2.62%), 247 cases of hernia (7.79%), 64 cases of vesicle diverticulum (2.02%), and 250 cases of hemorrhoids (7.88%).
| Discussion|| |
According to the Shanghai census data released in 2011, the composition of ages in our communities' population closely mimics that of Shanghai, which suggests our data is representative in Shanghai. In our study, we set our age base line to 50, because previous studies showed that men older than 50 comprise the major population of BPH. ,, During our investigation, we also collected a population under 50 years old who complained about LUTS which may have been caused by BPH. However, as this population is only 1.1% of our entire population, we will not discuss it further here.
In our study, we diagnosed BPH utilizing all information available at that time to us including patient complaints of LUTS, urinalysis, DRE, ultrasound scan, and uroflowmetry. PSA levels were used to rule out prostate cancer. Previous literature showed that the prevalence or incidence of BPH varied due to differences in age, diagnostic standard, and country, and our overall prevalence rate of 11.99% is not the same as those in other studies. It was lower than the previously reported 18.5% in the 1990s. However that study was conducted in hospitals, the data was calculated based on the number of patients admitted, and our data was a community study. Moreover, the data was calculated based on the number of male residents older than 50 years old in the communities. This data also could be a result of different study settings and diagnosis standards. Our result represents the current status of BPH in Shanghai communities.
We used IPSS as a questionnaire to evaluate the severity of LUTS in this study. The first part of this questionnaire consists of seven questions to evaluate the symptoms related to urination, include filling symptoms and voiding symptoms. As expected, from Group A to Group D, the score increased to 31.90% which means the symptoms do increase with age.
Interestingly, we also found that the last question of the IPSS, which related to the QoL, was not correlated to the total score of the first seven questions in Group A. Group A had a higher QoL score than the other three groups, while the scores of other three groups showed an increasing correlation to age. Combined with the education backgrounds in each group, we think this result is reasonable. The higher education of Group A makes them more concerned about their health, which leads to higher scores. However the patients in the other three groups have lower education and most of them take urinary problems as a facet of growing older. This data suggests that when using a simple questionnaire to evaluate QoL related to LUTS in a Chinese population, the result must be cautiously interpreted. As LUTS significantly affects the QoL of BPH patients and their families,  it should not be underestimated.  Some attempts have already been made to establish a questionnaire suitable for the Chinese population. ,
In our study, we also found that the growth rate of prostate volume decreased with aging from 21.19% to 8.36%. This result suggests that the prostate growth peak occurs before 60. This supports that in the elderly male population, 50-59 is a very important window for BPH diagnosis and treatment. During this period, most males experience rapid growth of the prostate volume and difficulty in urination, so this might be a critical period for necessary medication.  For screening enlargement of prostate in the Chinese communities, we prefer DRE rather than BUS because it is easy to perform, is economical, takes less time and has acceptable accuracy  in general practitioners who are properly trained.
Recently, the European association has renamed guidelines for BPH into guidelines for nonneurogenic male LUTS.  This renaming of nomenclature comes as the latest evidence shows that, in addition to the prostate, bladder, and kidney disease may also contribute to urination problems.  LUTS is so common in aging men that about 90% of men between 45 and 80 suffer some type of LUTS.  Sometimes it is difficult to link LUTS to BPH, hence symptom-based guidelines are expected to be more practical for clinical application. Due to the limitation of our GPT setting in communities (lack of PSA test and/or uroflowmetry etc.), it would be more applicable for GPT members to deal with LUTS rather than make the diagnosis of BPH. In this fashion, alternate causes of LUTS will not be overlooked.
As our data was collected in Shanghai only, the prevalence rate of BPH could vary among different areas, cities, and provinces. But this was also the first approach to the whole picture of BPH prevalence situation in China. We are looking forward to further epidemiology studies of BPH in different parts of China. Together, these data will show the reality of BPH in China.
| Conclusion|| |
Our study showed that in a Shanghai population, the overall prevalence of BPH is 11.99%, LUTS develop with aging, and the results of QoL portion of the IPSS questionnaire should be carefully handled when dealing with patients older than 60.
Financial support and sponsorship
This work is supported by Shanghai Shenkang Hospital Development Center (No. SHDC12007313).
Conflicts of interest
There are no conflicts of interest.
| References|| |
Berry SJ, Coffey DS, Walsh PC, Ewing LL. The development of human benign prostatic hyperplasia with age. J Urol 1984;132:474-9.
Sagnier PP, MacFarlane G, Richard F, Botto H, Teillac P, Boyle P. Results of an epidemiological survey using a modified American Urological Association symptom index for benign prostatic hyperplasia in France. J Urol 1994;151:1266-70.
Verhamme KM, Dieleman JP, Bleumink GS, van der Lei J, Sturkenboom MC, Artibani W, et al.
Incidence and prevalence of lower urinary tract symptoms suggestive of benign prostatic hyperplasia in primary care - The Triumph project. Eur Urol 2002;42:323-8.
Oztürk A, Serel TA, Kosar A, Kecelioglu M. Prevalence of benign hypertrophy of the prostate in Turkish men hospitalized in urology. Prog Urol 2000;10:568-70.
Gu F. Epidemiological survey of benign prostatic hyperplasia and prostatic cancer in China. Chin Med J (Engl) 2000;113: 299-302.
Byun SS, Jeong H, Jo MK, Lee E. Relative proportions of tissue components in the prostate: Are they related to the development of symptomatic BPH in Korean men? Urology 2005;66:593-6.
Li MK, Garcia L, Patron N, Moh LC, Sundram M, Leungwattanakij S, et al.
An Asian multinational prospective observational registry of patients with benign prostatic hyperplasia, with a focus on comorbidities, lower urinary tract symptoms and sexual function. BJU Int 2008;101:197-202.
Shao Q, Song J, Liu QJ, Tian Y. Symptomatic benign prostate hyperplasia affects the quality of life of the patients' wives. Zhonghua Nan Ke Xue 2010;16:132-6.
Wei JT, Calhoun E, Jacobsen SJ. Urologic diseases in America project: Benign prostatic hyperplasia. J Urol 2005;173:1256-61.
Guo Y, Shi J, Hu M, Sun Z. Construction and validation of a short-form quality-of-life scale for chinese patients with benign prostatic hyperplasia. Health Qual Life Outcomes 2009;7:24.
Shi J, Sun Z, Cai T, Yang L. Development and validation of a quality-of-life scale for Chinese patients with benign prostatic hyperplasia. BJU Int 2004;94:837-44.
Kaplan SA, Lee JY, Meehan AG, Kusek JW; MTOPS Research Group. Long-term treatment with finasteride improves clinical progression of benign prostatic hyperplasia in men with an enlarged versus a smaller prostate: Data from the MTOPS trial. J Urol 2011;185:1369-73.
Ahmad S, Manecksha RP, Cullen IM, Flynn RJ, McDermott TE, Grainger R, et al.
Estimation of clinically significant prostate volumes by digital rectal examination: A comparative prospective study. Can J Urol 2011;18:6025-30.
Oelke M, Bachmann A, Descazeaud A, Emberton M, Gravas S, Michel MC, et al
. Guidelines on Conservative Treatment of Non-Neurogenic Male LUTS. Euro Assoc Urol; 2011.
Chapple CR, Roehrborn CG. A shifted paradigm for the further understanding, evaluation, and treatment of lower urinary tract symptoms in men: Focus on the bladder. Eur Urol 2006;49:651-8.
McVary KT. BPH: Epidemiology and comorbidities. Am J Manag Care 2006;12 5 Suppl:S122-8.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]