• Vol. 38 No. 5, 451–456
  • 15 April 2009

Presentation and Progression of Benign Prostatic Hyperplasia: A Singapore Experience Profiling Ethnic Differences in a Multiracial Study Cohort



Introduction: While benign prostatic hyperplasia (BPH) incidence has been shown to vary by race and ethnicity, data is lacking among Asians. This study aimed to describe the baseline symptom profile and response to medical therapy in a multiracial Singaporean cohort with BPH. Materials and Methods: International Prostate Symptom Score (IPSS), uroflowmetry and prostate specific antigen (PSA) levels were retrospectively analysed for 887 men at presentation and on follow-up 1 year later. Following diagnosis, 150 men were managed conservatively and 586 men with drugs; 151 received surgery. Results: Overall median IPSS scores were 9.0 at baseline. Malay men most often had severe symptoms (17.3%), compared to other groups (Chinese 11.7%, Others 11.1%, Indians 10.7%). Indians most frequently showed improvement in the Quality of Life (QOL) score following intervention (64.3%). Malays had the poorest initial mean peak-flow rates (9.6 mL/s) and Chinese, the highest (12.0 mL/s). Initial post-void residual urine volume was highest in Malays (100.1 mL) but showed greatest reduction with medical treatment. Median IPSS scores decreased from 10.5 below 50 years old to 7.0 above 80 years old. Peak-flow rates were 12.6 to 7.2 mL/s respectively, with a corresponding upward trend in RU. Treatment with a combination of 5-alpha-reductase inhibitor and alpha-blocker yielded the greatest improvement in IPSS and QOL scores, and residual urine volume (71.4%, 60% and 68.8%, respectively). Indians had the lowest initial and follow-up PSA (1.5 and 1.2, P = 0.8 and 0.6, respectively). Conclusions: Inter-ethnic differences in symptom perception and quantitative assessment of BPH were evident among our multiracial urban study cohort, as well as varied degrees of response to the medical treatments instituted.

Clinical observations suggest that BPH risk may vary by racial and ethnic group. However, data on the profile of prostatic symptoms in many Asian populations is lacking.1 The majority of studies in current literature describe the ethnic variation within Western, and particularly white Caucasian populations, with only one community-based study performed in Singapore 10 years ago that compared a multiracial Singaporean study population with other international cohorts at the time.2 Early clinical observations suggested that BPH risk varied by racial and ethnic group with black Afro-American men having the highest occurrence, followed by white Caucasian men, and then Asian men.3,4 In more current studies, it has also been suggested that the incidence of benign prostate surgery varied among ethnic groups, with Asian men possibly having lower surgery rates than their black or white counterparts. More detailed differentiation of inter-ethnic variation has been characterised within the Western white population as well, with studies describing differences among Welsh versus non-Welsh, and Jewish versus non-Jewish men, for example.

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