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Hellwege JN, Stallings S, Torstenson ES, Carroll R, Borthwick KM, Brilliant MH, Crosslin D, Gordon A, Hripcsak G, Jarvik GP, Linneman JG, Devi P, Peissig PL, Sleiman PAM, Hakonarson H, Ritchie MD, Verma SS, Shang N, Denny JC, Roden DM, Velez Edwards DR, Edwards TL. Heritability and genome-wide association study of benign prostatic hyperplasia (BPH) in the eMERGE network. Sci Rep 2019; 9:6077. [PMID: 30988330 PMCID: PMC6465359 DOI: 10.1038/s41598-019-42427-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 03/27/2019] [Indexed: 02/07/2023] Open
Abstract
Benign prostatic hyperplasia (BPH) results in a significant public health burden due to the morbidity caused by the disease and many of the available remedies. As much as 70% of men over 70 will develop BPH. Few studies have been conducted to discover the genetic determinants of BPH risk. Understanding the biological basis for this condition may provide necessary insight for development of novel pharmaceutical therapies or risk prediction. We have evaluated SNP-based heritability of BPH in two cohorts and conducted a genome-wide association study (GWAS) of BPH risk using 2,656 cases and 7,763 controls identified from the Electronic Medical Records and Genomics (eMERGE) network. SNP-based heritability estimates suggest that roughly 60% of the phenotypic variation in BPH is accounted for by genetic factors. We used logistic regression to model BPH risk as a function of principal components of ancestry, age, and imputed genotype data, with meta-analysis performed using METAL. The top result was on chromosome 22 in SYN3 at rs2710383 (p-value = 4.6 × 10-7; Odds Ratio = 0.69, 95% confidence interval = 0.55-0.83). Other suggestive signals were near genes GLGC, UNCA13, SORCS1 and between BTBD3 and SPTLC3. We also evaluated genetically-predicted gene expression in prostate tissue. The most significant result was with increasing predicted expression of ETV4 (chr17; p-value = 0.0015). Overexpression of this gene has been associated with poor prognosis in prostate cancer. In conclusion, although there were no genome-wide significant variants identified for BPH susceptibility, we present evidence supporting the heritability of this phenotype, have identified suggestive signals, and evaluated the association between BPH and genetically-predicted gene expression in prostate.
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Affiliation(s)
- Jacklyn N Hellwege
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah Stallings
- Division of Geriatric Medicine, Meharry-Vanderbilt Alliance, Nashville, TN, USA
| | - Eric S Torstenson
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert Carroll
- Department of Biomedical Informatics Vanderbilt University, Nashville, TN, USA
| | | | - Murray H Brilliant
- Center for Human Genetics, Marshfield Clinic Research Institute, Marshfield, WI, USA
| | - David Crosslin
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle, WA, USA
| | - Adam Gordon
- Division of Medical Genetics, University of Washington, Seattle, WA, USA
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
- Medical Informatics Services, New York-Presbyterian Hospital, New York, NY, USA
| | - Gail P Jarvik
- Departments of Medicine (Medical Genetics) and Genome Sciences, University of Washington, Seattle, WA, USA
| | - James G Linneman
- Office of Research Computing and Analytics/Marshfield Clinic Research Institute, Marshfield, WI, USA
| | - Parimala Devi
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle, WA, USA
| | - Peggy L Peissig
- Center for Computational and Biomedical Informatics, Marshfield Clinic Research Institute, Marshfield, WI, USA
| | - Patrick A M Sleiman
- Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Division of Human Genetics, Department of Pediatrics, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Hakon Hakonarson
- Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Division of Human Genetics, Department of Pediatrics, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Marylyn D Ritchie
- Department of Genetics, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Ning Shang
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Josh C Denny
- Department of Biomedical Informatics Vanderbilt University, Nashville, TN, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Dan M Roden
- Department of Biomedical Informatics Vanderbilt University, Nashville, TN, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Digna R Velez Edwards
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA.
- Department of Biomedical Informatics Vanderbilt University, Nashville, TN, USA.
- Division of Quantitative Sciences, Department of Obstetrics and Gynecology, Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Todd L Edwards
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA.
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Factors associated with consultation rates in general practice in England, 2013-2014: a cross-sectional study. Br J Gen Pract 2018; 68:e370-e377. [PMID: 29686130 PMCID: PMC5916084 DOI: 10.3399/bjgp18x695981] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 12/05/2017] [Indexed: 11/16/2022] Open
Abstract
Background Workload in general practice has risen during the last decade, but the factors associated with this increase are unclear. Aim To examine factors associated with consultation rates in general practice. Design and setting A cross-sectional study examining a sample of 304 937 patients registered at 316 English practices between 2013 and 2014, drawn from the Clinical Practice Research Datalink. Method Age, sex, ethnicity, smoking status, and deprivation measures were linked with practice-level data on staffing, rurality, training practice status, and Quality and Outcomes Framework performance. Multilevel analyses of patient consultation rates were conducted. Results Consultations were grouped into three types: all (GP or nurse), GP, and nurse. Non-smokers consulted less than current smokers (all: rate ratio [RR] = 0.88, 95% CI = 0.87 to 0.89; GP: RR = 0.88, 95% CI = 0.87 to 0.89; nurse: RR = 0.91, 95% CI = 0.90 to 0.92). Consultation rates were higher for those in the most deprived quintile compared with the least deprived quintile (all: RR = 1.18, 95% CI = 1.16 to 1.19; GP: RR = 1.17, 95% CI = 1.15 to 1.19; nurse: RR = 1.13, 95% CI = 1.11 to 1.15). For all three consultation types, consultation rates increased with age and female sex, and varied by ethnicity. Rates in practices with >8 and ≤19 full-time equivalent (FTE) GPs were higher compared with those with ≤2 FTE GPs (all: RR = 1.26, 95% CI = 1.06 to 1.49; GP: RR = 1.36, 95% CI = 1.19 to 1.56). Conclusion The analyses show consistent trends in factors related to consultation rates in general practice across three types of consultation. These data can be used to inform the development of more sophisticated staffing models, and resource allocation formulae.
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van Doorn B, Kok ET, Blanker MH, Westers P, Ruud Bosch J. Determinants of Nocturia: the Krimpen Study. J Urol 2014; 191:1034-9. [DOI: 10.1016/j.juro.2013.10.105] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2013] [Indexed: 11/16/2022]
Affiliation(s)
- Boris van Doorn
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Esther T. Kok
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marco H. Blanker
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Paul Westers
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J.L.H. Ruud Bosch
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
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Prevalence of BPH and lower urinary tract symptoms in West Africans. Prostate Cancer Prostatic Dis 2011; 15:170-6. [PMID: 21912428 DOI: 10.1038/pcan.2011.43] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND BPH and lower urinary tract symptoms (LUTS) are very common among older men in Western countries. However, the prevalence of these two conditions in the developing countries is less clear. METHODS We assessed the age-standardized prevalence of BPH and/or LUTS among West Africans in a probability sample of 950 men aged 50-74 in Accra, Ghana, with no evidence of biopsy-confirmed prostate cancer after screening with PSA and digital rectal examination (DRE). Information on LUTS was based on self-reports of the International Prostate Symptom Score (IPSS). BPH was estimated using DRE, PSA levels and imputed prostate volume. RESULTS The prevalence of DRE-detected enlarged prostate was 62.3%, while that of PSA≥1.5 ng ml(-1) (an estimate of prostate volume ≥ 30 cm(3)) was 35.3%. The prevalence of moderate-to-severe LUTS (IPSS≥8) was 19.9%. The prevalence of IPSS≥8 and an enlarged prostate on DRE was 13.3%. Although there is no universally agreed-upon definition of BPH/LUTS, making comparisons across populations difficult, BPH and/or LUTS appear to be quite common among older Ghanaian men. CONCLUSIONS We found that after age standardization, the prevalence of DRE-detected enlarged prostate in Ghanaian men is higher than previously reported for American men, but the prevalence of LUTS was lower than previously reported for African Americans. Further studies are needed to confirm these findings and identify the risk factors for BPH in both Africans and African Americans.
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Cornu JN, Cussenot O, Haab F, Lukacs B. A widespread population study of actual medical management of lower urinary tract symptoms related to benign prostatic hyperplasia across Europe and beyond official clinical guidelines. Eur Urol 2010; 58:450-6. [PMID: 20554374 DOI: 10.1016/j.eururo.2010.05.045] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Accepted: 05/31/2010] [Indexed: 11/24/2022]
Abstract
BACKGROUND The estimated prevalence of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH) in men >50 yr of age is around 30%, similar in all industrialized countries. alpha(1)-Blockers and 5 alpha-reductase inhibitors (5-ARIs) are the two classes of drugs recommended by the European Association of Urology guidelines for the medical management of LUTS/BPH. OBJECTIVE To compare actual clinical practice across Europe with guidelines, we assessed the use of all BPH-related drugs (alpha(1)-blockers, 5-ARIs, and plants) among European countries with a large-scale quantitative and descriptive study. DESIGN, SETTING, AND PARTICIPANTS The amounts of BPH-related drugs prescribed in 19 European countries were obtained from the IMS Health database retrospectively from 2004 to 2008. Data were adjusted for each country by the number of people >50 yr of age. MEASUREMENTS We determined the "prescription index" related to BPH, defined for each drug per country by days of treatment sold per year divided by the number of men at risk divided by 365 d. RESULTS AND LIMITATIONS From 2004 to 2008, the yearly number of prescriptions was 11.6 million for 74 million people at risk. The global prescription index increased in all countries and was three-fold more important in southern countries than in northern ones. alpha(1)-Blockers are the most widely prescribed drugs, but the share of 5-ARIs is increasing. Phytotherapy prescription is country specific, varying from 0% to 40% of prescriptions and is not recommended by the guidelines. CONCLUSIONS Major variations were seen among European countries concerning the prescriptions related to BPH, although the prevalence of the disease and the guidelines are similar. These results underline the importance of feedback from actual clinical practice. Analysis of actual prescription levels would complement evidence-based medicine as critical material for public health analysis, recommendations, and health insurance policies.
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Affiliation(s)
- Jean-Nicolas Cornu
- Department of Urology, Tenon Hospital, Groupe Hospitalo-Universitaire EST, Assistance Publique-Hôpitaux de Paris (AP-HP), University Paris VI, Paris, France.
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Kok ET, Schouten BW, Bohnen AM, Groeneveld FPMW, Thomas S, Bosch JLHR. Risk factors for lower urinary tract symptoms suggestive of benign prostatic hyperplasia in a community based population of healthy aging men: the Krimpen Study. J Urol 2008; 181:710-6. [PMID: 19091352 DOI: 10.1016/j.juro.2008.10.025] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE We explored risk factors for lower urinary tract symptoms suggestive of benign prostatic hyperplasia in the open population. MATERIALS AND METHODS A longitudinal, population based study with a followup of 6.5 years was done in 1,688 men who were 50 to 78 years old. Data were collected on transrectal ultrasound of prostate volume, urinary flow rate, ultrasound estimated post-void residual urine volume, generic and disease specific quality of life, and symptom severity based on the International Prostate Symptom Score. Lower urinary tract symptoms suggestive of benign prostatic hyperplasia were defined as an International Prostate Symptom Score of greater than 7 after a report of a score of less than 7 in the previous round. A multivariate Cox proportional hazard model was constructed to determine risk factors for clinical benign prostatic hyperplasia after correcting for patient age. RESULTS Total followup was 4,353 person-years. During followup 180 events of attaining an International Prostate Symptoms Score of greater than 7 occurred. Multivariate analysis showed that functional bladder capacity, post-void residual urine volume, treatment for cardiac diseases, education level, antidepressant use, calcium antagonist use, erectile function or dysfunction, prostate specific antigen and a family history of prostate cancer were determinants with a significant HR. CONCLUSIONS In addition to age, we established 9 significant determinants for lower urinary tract symptoms suggestive of benign prostatic hyperplasia. However, not all risk factors for lower urinary tract symptoms suggestive of benign prostatic hyperplasia are accounted for since we can conclude that 1 of 3 men without these risk factors will still be diagnosed with lower urinary tract symptoms suggestive of benign prostatic hyperplasia between ages 50 and 80 years.
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Affiliation(s)
- Esther Tanja Kok
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands.
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Heidler S, Deveza C, Temml C, Ponholzer A, Marszalek M, Berger I, Bluhm A, Madersbacher S. The Natural History of Lower Urinary Tract Symptoms in Females: Analysis of a Health Screening Project. Eur Urol 2007; 52:1744-50. [PMID: 17822835 DOI: 10.1016/j.eururo.2007.08.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2007] [Accepted: 08/06/2007] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To analyse over 6.5 yr the natural history of lower urinary tract symptoms (LUTS) of continent women participating in a health investigation. METHODS Women participating in a health screening survey in the area of Vienna in 1998-1999 underwent a detailed health investigation and completed the Bristol Female LUTS questionnaire. In 2005, all women still living in the area of Vienna were contacted by mail to complete the Bristol LUTS questionnaire again. For the current study, only women without urinary incontinence at baseline and follow-up were eligible. RESULTS A total of 223 women (mean age, 50.3 yr; range, 21-79) were included in this 6.5-yr longitudinal study. At baseline, 80 women (35.9%) reported LUTS; this number increased to 105 (47.1%) 6.5 yr later. The calculated mean annual incidence of LUTS was 5.3% and revealed no clear dependency on age: 20-39 yr, 5.6%; 40-59 yr, 5.9%; > or =60 yr, 3.7%. The mean annual remission rate of LUTS was 4.6% without clear age dependency. Symptoms most likely to improve were "urgency"; "frequency"; "nocturia" and "feeling of incomplete bladder emptying" had the highest tendency of worsening. CONCLUSIONS This longitudinal study on the natural history of LUTS in women without urinary incontinence provides estimates for incidence and remission rates over 6.5 yr. Compared with men, LUTS in women are a dynamic rather than a necessarily progressive disorder.
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Affiliation(s)
- Stefan Heidler
- Department of Urology and Andrology, Donauspital, Vienna, Austria
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Bosch JLHR, Tilling K, Bohnen AM, Bangma CH, Donovan JL. Establishing normal reference ranges for prostate volume change with age in the population-based Krimpen-study: prediction of future prostate volume in individual men. Prostate 2007; 67:1816-24. [PMID: 17935157 DOI: 10.1002/pros.20663] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND We aim to establish the normal pattern of prostate volume change with age to provide a baseline from which accelerated prostate growth might be identified in patients with lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH). METHODS In a community-based study, prostate volume was determined at baseline and after 2.1 and 4.2 years in men without prostate cancer. A bivariate multilevel growth curve model was used to estimate the pattern of change of prostate volume with age. RESULTS The average percentage increase of total prostate volume and transition zone volume per year of follow-up was 2.2% and 3.5%, respectively. The final model showed that prostate volume was related to age only. The future prostate volume of an individual can be predicted based on his age and known history of prostate volume. The model was also used to calculate time needed for the prostate volume to increase with a certain percentage, for men with different baseline prostate volume values at different ages. CONCLUSIONS This method establishes normal prostate volume values by age using prostate volume history in men without prostate cancer. The model provides baseline data from which disease progression might be detected.
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Affiliation(s)
- J L H R Bosch
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands.
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