A Prospective Study Of Individualized Treatment Of Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia(LUTS/BPH)

Objective: To investigate multivariate analysis of the benign prostatic hyperplasia(BPH)individualized treatment.Analysis the prospective data of the multi-center drug treatment and transurethral resection of prostate(TURP)and SNP,and estabalish the prediction models and verify them.Methods: A prospective clinical data of BPH patients from three hospitals in Shanghai were collected from September 2013 to December 2015,including 598 outpatient cases of drug treatment and 599 cases of TURP about their general condition,BPH-related symptoms,B ultrasound,urodynamics and blood samples,and the conditions after 6-12 months related to the surgery recovery.Depending on the different efficacy,the patients were divided into subgroups.We compared the differences between patients with different subgroups,and established the joint index prediction model by the logistic regression analysis,and the receiver operating characteristic curve(ROC curve)of the model was used to assess the predictive power.Meanwhile BPH patients with metabolism syndrome and small volume of benign prostatic hyperplasia,whose blood samples of SNP genetic were detected,were observed the different drug efficacy.Results:598 cases with benign prostatic hyperplasia of drug treatment were included in this study.The overall effect of drug treatment of benign prostatic hyperplasia prospective studies and clinical model validation: the previous prediction model found the area under the ROC was only 0.459,the area under the ROC of newly model was 0.618.?-blocker treatment prospective studies and clinical model validation: the previous prediction model found the area under the ROC was only 0.612,the area under the ROC of newly model was 0.983.5? reductase inhibitor therapeutic effect prospective studies and clinical model validation: the previous prediction model found the area under the ROC was only 0.705,the area under the ROC of newly model was 0.994.5? reductase inhibitor combined with ?-blocker treatment prospective research and clinical validation model: the previous prediction model found the area under the ROC was only 0.495,the area under the ROC of newly model was 0.949.Prospective clinical research of other drug treatment model validation: the previous prediction model found the area under the ROC was only 0.608,the area under the ROC of newly model was 0.984.599 BPH patients undergoning TURP were enrolled in the study,the efficiency rate after 6 months was 73.6%,efficiency rate after 12 months was 75.8%.200 cases in Our Hospital were validated by the previously established prediction model.The efficiency after 6 months by preoperative data results suggested AUC=0.901;The efficiency after 12 months by preoperative data results suggested AUC=0.907,the predictive power was good.As to 399 cases of other hospitals,we established the regression model of efficacy of 6 and 12 months by the preoperative Info.The efficiency after 6 months by preoperative data results suggested AUC=0.722;The efficiency after 12 months by preoperative data results suggested AUC=0.698,predictive power was in general.rs16902947 was association with the progression of small volume prostate hyperplasia significantly(P <0.05),and it was related closely to the changes of the IPSS,Qmax before and after the treatment of ?-blocker drugs.Conclusions: Subgroup models of BPH drugs treatment are better to predict the effect of various drugs,and the early model of TURP group can predict the curative effect better,but the predictive power of the simplified model declined.SNP predicts the disease progression and drug efficacy by the gene level.