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THE RATE OF BENIGN PROSTATE ENLARGEMENT (BPE) IS CONSTANT BETWEEN AGES 40 AND 79: LONG-TERM DATA
229 IMPROVEMENT OF SEMINAL PARAMETERS AND PREGNANCY RATES AFTER ANTEGRADE SCLEROTHERAPY OF INTERNAL SPERMATIC VEINS
P14 BPH: NATURAL HISTORY, ETIOLOGY AND EVALUATION Wednesday, 26 March, 14.30-16.00, Purple Hall 1
230
THE RATE OF BENIGN PROSTATE ENLARGEMENT (BPE) IS CONSTANT BETWEEN AGES 40 AND 79: LONG-TERM DATA
Iafrate A.1, Novara G.2, Galfano M.1, Boscolo Berto V.1, Cavalleri M. 1, Artibani S.1, Ficarra W.1
Lieber M.1, Rhodes T.2, Jacobson D., Mcgree M., Girman C.2, Jacobsen S.4, St. Sauver J. Mayo Clinic, Dept. of Urology, Rochester, United States of America, 2Merck Research Laboratories, Dept. of Epidemiology, North Wales, United States of America, Mayo Clinic, Dept. of Health Sciences Research, Rochester, United States of America, 4 Kaiser Permanente Southern California, Dept. of Research, Pasadena, United States of America 1
1
University of Padua, Dept. of Oncological and Surgical Sciences, Urology Clinic, Padua, Italy, 28QLYHUVLW\ RI 3DGXD 'HSW RI 2QFRORJLFDO DQG 6XUJLFDO 6FLHQFHV 8URORJ\ &OLQLF I.R.C.C.S. Institute Oncology Veneto (IOV), Padua, Italy Introduction & Objectives: Objective of the study is to evaluate the impact of antegrade scrotal sclerotherapy (ASS) on seminal parameters and pregnancy rates in varicocele patients with impairment of seminal parameters and/or couple infertility. Material & Methods: We prospectively collected the data of 414 consecutive patients with LPSDLUPHQWRIVHPLQDOSDUDPHWHUVXQGHUJRLQJDPRGLᚏHG$666SHFLᚏFDOO\VHPHQDQDO\VLV was considered impaired if at least one of the following features was present: a sperm count <20 million/ml, a percentage of progressive motility at 1 hour <50% and a percentage of QRUPDO VSHUPV 7KH SRSXODWLRQ ZDV VXEGLYLGHG LQWR JURXSV DFFRUGLQJ WR WKHLU LQWHUHVWLQDFKLHYLQJSUHJQDQF\ $ 3DWLHQWVุ\HDUVROGQRW\HWLQWHUHVWHGLQIHUWLOLW\ % Patients with couple infertility for at least 2 years. Pregnancies and seminal outcomes were evaluated 12 months after treatment. Results: 0HGLDQ SDWLHQW DJH ZDV 7KH YDULFRFHOH ZDV ORFDWHG RQ WKH OHIW VLGH LQ FDVHVRQWKHULJKWLQ DQGELODWHUDOO\LQ ,Q SDWLHQWVWKH YDULFRFHOHZDVFODVVLᚏHGDVVXEFOLQLFDOLQ DVJUDGHLQ DVJUDGH DQGLQ DVJUDGH$FFRUGLQJWR'RSSOHUXOWUDVRXQGUHᚐX[ZDVFODVVLᚏHGDV JUDGHLQ FDVHVJUDGHLQ DQGJUDGHLQ $FFRUGLQJWR WKHLQWHUHVWLQDFKLHYLQJSUHJQDQFLHV SDWLHQWVZHUHQRWLQWHUHVWHGLQIHUWLOLW\ ZHUHLQIHUWLOH$WPRQWKVIROORZXSSHUVLVWHQWUHᚐX[ZDVSUHVHQWLQ cases. In the 217 (52.4%) patients with a low sperm number, sperm count improved from 12 WR PLOOLRQPO S ,QWKH SDWLHQWVZLWKDVWKHQRVSHUPLDPHGLDQYDOXH of the percentage of progressive motile forms improved from 25% to 45% (p<0.001). In the 176 (42.5%) patients with teratospermia, median percentage of normal forms increased from WR S ,QWKHVXEJURXSRILQIHUWLOHSDWLHQWV SDWLHQWVIDWKHUHG RᚎVSULQJ3DWLHQWVREWDLQLQJDSUHJQDQF\SUHVHQWHGDVLJQLᚏFDQWKLJKHUVSHUPPRWLOLW\WKDQ LQIHUWLOHSDWLHQWV YHUVXV
Introduction & Objectives: To measure the rate of benign prostate enlargement (BPE). Material & Methods: The rate of BPE has been measured serially and biennially by TRUS for a randomly selected group of community white men (n = 448) with predominantly North-western European ancestral backgrounds. Follow-up ranged IURP \HDUV PHDQ 7KH DQQXDO SHUFHQW FKDQJH LQ 7586 SURVWDWH YROXPH ZDV VHHᚏJXUH 7KLVUDWHLVFRQVWDQWDQGLGHQWLFDOIRUPHQLQWKHIRXUGHFDGH measurement range. Conclusions: These data allow straightforward construction of a simple nomogram SUHGLFWLQJSURVWDWHYROXPHRU\HDUVVXEVHTXHQWWRDVLQJOHEDVHOLQH7586 measurement.
Conclusions: $66 VLJQLᚏFDQWO\ LPSURYHV VSHUP FRXQW PRWLOLW\ DQG PRUSKRORJ\ 3DWLHQWV ZLWKFRXSOHLQIHUWLOLW\DFKLHYHGDSUHJQDQF\LQRIFDVHV3DWLHQWVDFKLHYLQJSUHJQDQF\ present a better progressive motility after treatment than patients who did not father any child.
231 DOES THE PROSTATE INTERNAL ARCHITECTURE ON TRANSRECTAL ULTRASOUND PREDICT FUTURE PROSTATE GROWTH? A 15-YEAR LONGITUDINAL COMMUNITY-BASED STUDY OF BENIGN PROSTATIC HYPERPLASIA IN JAPAN
Sapporo Medical University School of Medicine, Dept. of Urology, Sapporo, Japan Introduction & Objectives: There are few data about the natural history of lower urinary tract V\PSWRPVVXJJHVWLYHRIEHQLJQSURVWDWLFK\SHUSODVLD /876%3+ LQ-DSDQ)URP WR ZH performed a cross-sectional community-based study in men aged 40 to 79 who lived in Shimamakimura, Japan, to clarify the prevalence of LUTS/BPH. In the study, we determined the internal prostate architecture on transrectal ultrasound (TRUS) and hypothesized that the architecture could predict the IXWXUHQDWXUDOKLVWRU\RISURVWDWLFJURZWK 0DVXPRUL1HWDO-8URO %ULHᚐ\LQPHQ with a visible transition zone with a clear border the prostate volume may have the potential to increase ZLWKDGYDQFLQJDJH7RFRQᚏUPWKHK\SRWKHVLVDORQJLWXGLQDOFRPPXQLW\EDVHGVWXG\ZDVFRQGXFWHG IURP)HEUXDU\WR2FWREHU \HDUVIURPWKHᚏUVWVXUYH\ /RQJLWXGLQDOFKDQJHVLQSURVWDWH volume were evaluated according to the initially determined internal architecture. Material & Methods: In the previous study, 287 participants were eligible. They were categorized into WKUHHJURXSVDFFRUGLQJWRLQWHUQDOSURVWDWHDUFKLWHFWXUHRQ7586 JURXSWUDQVLWLRQ]RQHQRWYLVLEOH JURXSWUDQVLWLRQ]RQHYLVLEOHEXWWKHERUGHUQRWFOHDUO\GHOLQHDWHGDQGJURXSWUDQVLWLRQ]RQHYLVLEOH with a clear border. They were subjects in the current study and the prostate volumes were calculated using the same method as in the initial survey. Results: 2IWKHSDUWLFLSDQWVLQWKHᚏUVWVXUYH\ KDGGLHGDQGKDGPRYHGDZD\GXULQJWKH years. Of the remaining 170, 97 men (57%) participated in the current study. Eighteen of them were excluded from analysis because of previous prostate surgery, prostate cancer history or taking antiandrogen drugs. Thus, 79 were eligible to evaluate the relationship between the internal architecture and the change in prostate volume. The prostate volume at the repeat survey increased as the current DJHLQFUHDVHGWRs Q s Q s Q DQGs PO Q LQ PHQLQWKHLUVVVDQGVRUROGHUUHVSHFWLYHO\0HQKDYLQJJURXSDUFKLWHFWXUHDWWKHLQLWLDO survey had the largest prostate volume at the repeat survey and the highest change in prostate volume over the 15 years. *URXS Q s
Group 2 (n=17) s
*URXS Q 79 (61-94) s
s
s
s
Conclusions: 7KLV LV WKH ᚏUVW VWXG\ WKDW GHPRQVWUDWHV ORQJLWXGLQDO FKDQJHV LQ SURVWDWH YROXPH DFFRUGLQJWRWKHLQWHUQDOSURVWDWHDUFKLWHFWXUH7KHORQJLWXGLQDOVWXG\FRQᚏUPVWKHK\SRWKHVLVGHULYHG IURPWKHFURVVVHFWLRQDOVWXG\WKDWWKHJURXSSURVWDWHKDVWKHSRWHQWLDOWRJURZLQWKHIXWXUH
Eur Urol Suppl 2008;7(3):128
Kok E.T.1, Schouten B.W.2, Bohnen A.M.2, Groeneveld F.P.M.W.2, Thomas S.2, Bosch J.L.H.R.1 1 UMC Utrecht, Dept. of Urology, Utrecht, The Netherlands, 2Erasmus MC, Dept. of General Practice, Rotterdam, The Netherlands
Fukuta F., Masumori N., Muto M., Miyamoto S., Igarashi M., Tsukamoto T.
n=79 Median age (range) Prostate volume (ml) PHDQs6' Change in prostate YROXPH PO PHDQs6'
232 RISK FACTORS FOR DEVELOPING CLINICAL BENIGN PROSTATIC HYPERPLASIA: THE KRIMPEN STUDY
Introduction & Objectives: Intensive epidemiological research has still not determined all possible risk factors for developing clinical BPH. In particular, this has been hampered by WKH ODFN RI FRQVHQVXV DERXW WKH GHᚏQLWLRQ RI FOLQLFDO %3+ DQG WKH XVH RI YDULRXV OHVV RSWLPDO VWXG\GHVLJQV7KHUHIRUH ORQJLWXGLQDOVWXGLHVRIWKHQDWXUDOKLVWRU\RI/876%3+LQXQVHOHFWHG populations comparing many determinants with the possibility to adjust for multiple confounders are needed. The aim of this part of the longitudinal Krimpen study is to explore risk factors for the development of clinical BPH in the open population. Material & Methods: Data (baseline 1688 men) were obtained using a self-administered questionnaire (incl. the International Prostate Symptom Score (IPSS)), a frequency-volume chart and physical and urological measurements (e.g. height, body weight, blood pressure, PSA, SURVWDWHYROXPH 39 SRVWYRLGUHVLGXDO 395 DQG4PD[ $IWHUDQDYHUDJHRI DQG \HDUVFRQVHFXWLYHIROORZXSURXQGVZHUHSHUIRUPHG$SUHYLRXVDQDO\VLVRIWKH.ULPSHQ6WXG\ has shown that a report of “an IPSS sum score > 7 following a report of an IPSS sum score < 7 in the previous round”, was best predictive for GP consultation for LUTS/BPH within 2 years. 7KHUHIRUHGHYHORSLQJFOLQLFDO%3+ZDVGHᚏQHGDVDFKLHYLQJDQ,366!DIWHUDUHSRUWRI,366 < 7 in the previous round. A Cox-proportional hazard ratio was calculated with time-dependent covariates to determine the risk factors for developing clinical BPH. Age was used as time variable and has been adjusted for. Results: 7RWDOIROORZXSZDVSHUVRQ\HDUV'XULQJIROORZXSHYHQWVRIUHDFKLQJDQ,366 > 7 occurred. Functional bladder capacity (FBC), PV, PVR, being treated for cardiac diseases, level of education, use of antidepressants, erectile (dys)function, PSA and 1st or 2nd degree IDPLO\ KLVWRU\ RI SURVWDWH FDQFHU DUH GHWHUPLQDQWV ZLWK VLJQLᚏFDQW KD]DUG UDWLRV 9LVXDOLVDWLRQ of a survival model with all the above determinants set at either low, or moderate or high risk for reaching an IPSS > 7, showed that for a 50-years-old man at baseline, a 50% chance of surviving without clinical BPH at either 79, or 67 or 52 years can be expected, respectively. An “optimally KHDOWK\PDQರ LHDPDQZLWKQRQHRIWKHDERYHULVNIDFWRUV KDVDFKDQFHRIEHFRPLQJ years without developing clinical BPH. Conclusions: In addition to age, determinants for developing clinical BPH based on multivariate analyses are FBC, PV, PVR, being treated for cardiac diseases, education higher than primary school, use of antidepressants, erectile dysfunction, elevated PSA and having a 1st or 2nd degree family history of prostate cancer. However, this study also showed that still not all risk factors for developing clinical BPH are accounted for at this moment since the survival curve shows that more than 50% of the men in optimal health still will get the diagnosis clinical BPH between age of 50 and 80.
P14 BPH: NATURAL HISTORY, ETIOLOGY AND EVALUATION Wednesday, 26 March, 14.30-16.00, Purple Hall 1
230
THE RATE OF BENIGN PROSTATE ENLARGEMENT (BPE) IS CONSTANT BETWEEN AGES 40 AND 79: LONG-TERM DATA
Iafrate A.1, Novara G.2, Galfano M.1, Boscolo Berto V.1, Cavalleri M. 1, Artibani S.1, Ficarra W.1
Lieber M.1, Rhodes T.2, Jacobson D., Mcgree M., Girman C.2, Jacobsen S.4, St. Sauver J. Mayo Clinic, Dept. of Urology, Rochester, United States of America, 2Merck Research Laboratories, Dept. of Epidemiology, North Wales, United States of America, Mayo Clinic, Dept. of Health Sciences Research, Rochester, United States of America, 4 Kaiser Permanente Southern California, Dept. of Research, Pasadena, United States of America 1
1
University of Padua, Dept. of Oncological and Surgical Sciences, Urology Clinic, Padua, Italy, 28QLYHUVLW\ RI 3DGXD 'HSW RI 2QFRORJLFDO DQG 6XUJLFDO 6FLHQFHV 8URORJ\ &OLQLF I.R.C.C.S. Institute Oncology Veneto (IOV), Padua, Italy Introduction & Objectives: Objective of the study is to evaluate the impact of antegrade scrotal sclerotherapy (ASS) on seminal parameters and pregnancy rates in varicocele patients with impairment of seminal parameters and/or couple infertility. Material & Methods: We prospectively collected the data of 414 consecutive patients with LPSDLUPHQWRIVHPLQDOSDUDPHWHUVXQGHUJRLQJDPRGLᚏHG$666SHFLᚏFDOO\VHPHQDQDO\VLV was considered impaired if at least one of the following features was present: a sperm count <20 million/ml, a percentage of progressive motility at 1 hour <50% and a percentage of QRUPDO VSHUPV 7KH SRSXODWLRQ ZDV VXEGLYLGHG LQWR JURXSV DFFRUGLQJ WR WKHLU LQWHUHVWLQDFKLHYLQJSUHJQDQF\ $ 3DWLHQWVุ\HDUVROGQRW\HWLQWHUHVWHGLQIHUWLOLW\ % Patients with couple infertility for at least 2 years. Pregnancies and seminal outcomes were evaluated 12 months after treatment. Results: 0HGLDQ SDWLHQW DJH ZDV 7KH YDULFRFHOH ZDV ORFDWHG RQ WKH OHIW VLGH LQ FDVHVRQWKHULJKWLQ DQGELODWHUDOO\LQ ,Q SDWLHQWVWKH YDULFRFHOHZDVFODVVLᚏHGDVVXEFOLQLFDOLQ DVJUDGHLQ DVJUDGH DQGLQ DVJUDGH$FFRUGLQJWR'RSSOHUXOWUDVRXQGUHᚐX[ZDVFODVVLᚏHGDV JUDGHLQ FDVHVJUDGHLQ DQGJUDGHLQ $FFRUGLQJWR WKHLQWHUHVWLQDFKLHYLQJSUHJQDQFLHV SDWLHQWVZHUHQRWLQWHUHVWHGLQIHUWLOLW\ ZHUHLQIHUWLOH$WPRQWKVIROORZXSSHUVLVWHQWUHᚐX[ZDVSUHVHQWLQ cases. In the 217 (52.4%) patients with a low sperm number, sperm count improved from 12 WR PLOOLRQPO S ,QWKH SDWLHQWVZLWKDVWKHQRVSHUPLDPHGLDQYDOXH of the percentage of progressive motile forms improved from 25% to 45% (p<0.001). In the 176 (42.5%) patients with teratospermia, median percentage of normal forms increased from WR S ,QWKHVXEJURXSRILQIHUWLOHSDWLHQWV SDWLHQWVIDWKHUHG RᚎVSULQJ3DWLHQWVREWDLQLQJDSUHJQDQF\SUHVHQWHGDVLJQLᚏFDQWKLJKHUVSHUPPRWLOLW\WKDQ LQIHUWLOHSDWLHQWV YHUVXV
Introduction & Objectives: To measure the rate of benign prostate enlargement (BPE). Material & Methods: The rate of BPE has been measured serially and biennially by TRUS for a randomly selected group of community white men (n = 448) with predominantly North-western European ancestral backgrounds. Follow-up ranged IURP \HDUV PHDQ 7KH DQQXDO SHUFHQW FKDQJH LQ 7586 SURVWDWH YROXPH ZDV VHHᚏJXUH 7KLVUDWHLVFRQVWDQWDQGLGHQWLFDOIRUPHQLQWKHIRXUGHFDGH measurement range. Conclusions: These data allow straightforward construction of a simple nomogram SUHGLFWLQJSURVWDWHYROXPHRU\HDUVVXEVHTXHQWWRDVLQJOHEDVHOLQH7586 measurement.
Conclusions: $66 VLJQLᚏFDQWO\ LPSURYHV VSHUP FRXQW PRWLOLW\ DQG PRUSKRORJ\ 3DWLHQWV ZLWKFRXSOHLQIHUWLOLW\DFKLHYHGDSUHJQDQF\LQRIFDVHV3DWLHQWVDFKLHYLQJSUHJQDQF\ present a better progressive motility after treatment than patients who did not father any child.
231 DOES THE PROSTATE INTERNAL ARCHITECTURE ON TRANSRECTAL ULTRASOUND PREDICT FUTURE PROSTATE GROWTH? A 15-YEAR LONGITUDINAL COMMUNITY-BASED STUDY OF BENIGN PROSTATIC HYPERPLASIA IN JAPAN
Sapporo Medical University School of Medicine, Dept. of Urology, Sapporo, Japan Introduction & Objectives: There are few data about the natural history of lower urinary tract V\PSWRPVVXJJHVWLYHRIEHQLJQSURVWDWLFK\SHUSODVLD /876%3+ LQ-DSDQ)URP WR ZH performed a cross-sectional community-based study in men aged 40 to 79 who lived in Shimamakimura, Japan, to clarify the prevalence of LUTS/BPH. In the study, we determined the internal prostate architecture on transrectal ultrasound (TRUS) and hypothesized that the architecture could predict the IXWXUHQDWXUDOKLVWRU\RISURVWDWLFJURZWK 0DVXPRUL1HWDO-8URO %ULHᚐ\LQPHQ with a visible transition zone with a clear border the prostate volume may have the potential to increase ZLWKDGYDQFLQJDJH7RFRQᚏUPWKHK\SRWKHVLVDORQJLWXGLQDOFRPPXQLW\EDVHGVWXG\ZDVFRQGXFWHG IURP)HEUXDU\WR2FWREHU \HDUVIURPWKHᚏUVWVXUYH\ /RQJLWXGLQDOFKDQJHVLQSURVWDWH volume were evaluated according to the initially determined internal architecture. Material & Methods: In the previous study, 287 participants were eligible. They were categorized into WKUHHJURXSVDFFRUGLQJWRLQWHUQDOSURVWDWHDUFKLWHFWXUHRQ7586 JURXSWUDQVLWLRQ]RQHQRWYLVLEOH JURXSWUDQVLWLRQ]RQHYLVLEOHEXWWKHERUGHUQRWFOHDUO\GHOLQHDWHGDQGJURXSWUDQVLWLRQ]RQHYLVLEOH with a clear border. They were subjects in the current study and the prostate volumes were calculated using the same method as in the initial survey. Results: 2IWKHSDUWLFLSDQWVLQWKHᚏUVWVXUYH\ KDGGLHGDQGKDGPRYHGDZD\GXULQJWKH years. Of the remaining 170, 97 men (57%) participated in the current study. Eighteen of them were excluded from analysis because of previous prostate surgery, prostate cancer history or taking antiandrogen drugs. Thus, 79 were eligible to evaluate the relationship between the internal architecture and the change in prostate volume. The prostate volume at the repeat survey increased as the current DJHLQFUHDVHGWRs Q s Q s Q DQGs PO Q LQ PHQLQWKHLUVVVDQGVRUROGHUUHVSHFWLYHO\0HQKDYLQJJURXSDUFKLWHFWXUHDWWKHLQLWLDO survey had the largest prostate volume at the repeat survey and the highest change in prostate volume over the 15 years. *URXS Q s
Group 2 (n=17) s
*URXS Q 79 (61-94) s
s
s
s
Conclusions: 7KLV LV WKH ᚏUVW VWXG\ WKDW GHPRQVWUDWHV ORQJLWXGLQDO FKDQJHV LQ SURVWDWH YROXPH DFFRUGLQJWRWKHLQWHUQDOSURVWDWHDUFKLWHFWXUH7KHORQJLWXGLQDOVWXG\FRQᚏUPVWKHK\SRWKHVLVGHULYHG IURPWKHFURVVVHFWLRQDOVWXG\WKDWWKHJURXSSURVWDWHKDVWKHSRWHQWLDOWRJURZLQWKHIXWXUH
Eur Urol Suppl 2008;7(3):128
Kok E.T.1, Schouten B.W.2, Bohnen A.M.2, Groeneveld F.P.M.W.2, Thomas S.2, Bosch J.L.H.R.1 1 UMC Utrecht, Dept. of Urology, Utrecht, The Netherlands, 2Erasmus MC, Dept. of General Practice, Rotterdam, The Netherlands
Fukuta F., Masumori N., Muto M., Miyamoto S., Igarashi M., Tsukamoto T.
n=79 Median age (range) Prostate volume (ml) PHDQs6' Change in prostate YROXPH PO PHDQs6'
232 RISK FACTORS FOR DEVELOPING CLINICAL BENIGN PROSTATIC HYPERPLASIA: THE KRIMPEN STUDY
Introduction & Objectives: Intensive epidemiological research has still not determined all possible risk factors for developing clinical BPH. In particular, this has been hampered by WKH ODFN RI FRQVHQVXV DERXW WKH GHᚏQLWLRQ RI FOLQLFDO %3+ DQG WKH XVH RI YDULRXV OHVV RSWLPDO VWXG\GHVLJQV7KHUHIRUH ORQJLWXGLQDOVWXGLHVRIWKHQDWXUDOKLVWRU\RI/876%3+LQXQVHOHFWHG populations comparing many determinants with the possibility to adjust for multiple confounders are needed. The aim of this part of the longitudinal Krimpen study is to explore risk factors for the development of clinical BPH in the open population. Material & Methods: Data (baseline 1688 men) were obtained using a self-administered questionnaire (incl. the International Prostate Symptom Score (IPSS)), a frequency-volume chart and physical and urological measurements (e.g. height, body weight, blood pressure, PSA, SURVWDWHYROXPH 39 SRVWYRLGUHVLGXDO 395 DQG4PD[ $IWHUDQDYHUDJHRI DQG \HDUVFRQVHFXWLYHIROORZXSURXQGVZHUHSHUIRUPHG$SUHYLRXVDQDO\VLVRIWKH.ULPSHQ6WXG\ has shown that a report of “an IPSS sum score > 7 following a report of an IPSS sum score < 7 in the previous round”, was best predictive for GP consultation for LUTS/BPH within 2 years. 7KHUHIRUHGHYHORSLQJFOLQLFDO%3+ZDVGHᚏQHGDVDFKLHYLQJDQ,366!DIWHUDUHSRUWRI,366 < 7 in the previous round. A Cox-proportional hazard ratio was calculated with time-dependent covariates to determine the risk factors for developing clinical BPH. Age was used as time variable and has been adjusted for. Results: 7RWDOIROORZXSZDVSHUVRQ\HDUV'XULQJIROORZXSHYHQWVRIUHDFKLQJDQ,366 > 7 occurred. Functional bladder capacity (FBC), PV, PVR, being treated for cardiac diseases, level of education, use of antidepressants, erectile (dys)function, PSA and 1st or 2nd degree IDPLO\ KLVWRU\ RI SURVWDWH FDQFHU DUH GHWHUPLQDQWV ZLWK VLJQLᚏFDQW KD]DUG UDWLRV 9LVXDOLVDWLRQ of a survival model with all the above determinants set at either low, or moderate or high risk for reaching an IPSS > 7, showed that for a 50-years-old man at baseline, a 50% chance of surviving without clinical BPH at either 79, or 67 or 52 years can be expected, respectively. An “optimally KHDOWK\PDQರ LHDPDQZLWKQRQHRIWKHDERYHULVNIDFWRUV KDVDFKDQFHRIEHFRPLQJ years without developing clinical BPH. Conclusions: In addition to age, determinants for developing clinical BPH based on multivariate analyses are FBC, PV, PVR, being treated for cardiac diseases, education higher than primary school, use of antidepressants, erectile dysfunction, elevated PSA and having a 1st or 2nd degree family history of prostate cancer. However, this study also showed that still not all risk factors for developing clinical BPH are accounted for at this moment since the survival curve shows that more than 50% of the men in optimal health still will get the diagnosis clinical BPH between age of 50 and 80.