Panel Urges Focus on Prostate Symptoms : Health: Rules call for studying severity of problems before deciding on treatment of benign condition. Patients should have ‘the final say.’

Physicians should not automatically recommend surgery or drug therapy for the treatment of an enlarged prostate gland, especially if the condition is causing only mild or moderate symptoms, federal health officials said Tuesday.

A panel of urologists and other experts convened by the government urged physicians to focus on the severity of symptoms before deciding on the course of therapy for benign prostatic hyperplasia (BPH), a common condition in older men.

The practice guidelines were issued by the Agency for Health Care Policy and Research, part of the Department of Health and Human Resources. Established in 1989, the agency is charged with improving the quality of the nation’s health care while reducing costs.

The prostate is a male sex gland located below the bladder and in front of the rectum. Normally about the size of a walnut, it surrounds the upper part of the urethra, the tube that empties urine from the bladder.

BPH is an enlargement of the prostate gland that generally progresses slowly. It can cause frequent and urgent urination, produce a sensation that the bladder never quite empties, cause difficulty in starting to urinate and disturb sleep.

It sometimes can lead to serious complications, such as urine retention, urinary tract infections, kidney problems or bleeding through the urethra.

The condition is not directly related to prostate cancer, the second most common cancer in men after skin cancer. But both are influenced by similar hormonal factors, and aging makes men vulnerable to both.

By the age of 60, more than half of all men in the United States develop some degree of BPH. And by age 80, an estimated one in four will require treatment for the condition, the agency said.

The panel recommended that patients have “the final say” in determining the treatment, noting that the decisions should be “symptom-driven.”

“At the present time, the unfortunate scenario too often occurs of the patient going into the doctor’s office and leaving with either a prescription or a surgery date without much discussion,” said Dr. John D. McConnell, chairman of the 13-member panel and head of urology at the University of Texas Southwestern Medical Center in Dallas.

“All treatments other than watchful waiting are unnecessary in men who only have mild symptoms,” O’Connell said. “Also, in a disease like BPH, which is slowly progressive--and with most men does not interfere with their health--it is important to lay out all the options and include the patient in the decision.”

Transurethral resection of the prostate is the most frequently used treatment, and one of the most commonly performed surgeries among Medicare recipients, the agency said. In 1992, more than 221,000 such procedures were performed on men 65 or older at a cost to Medicare of more than $1 billion.

The procedure involves cutting away prostate tissue with a tool inserted through the urethra. Most patients suffer no significant problems other than temporary discomfort, although there is a small risk of urinary leakage and sexual dysfunction.

Asked if the guidelines could be used by insurance companies to deny reimbursement for surgery, McConnell said only that he believes surgery is not indicated for those men suffering only mild symptoms. “There is no benefit to (surgically) treating a patient with mild symptoms,” he said.

BPH also can be treated with other surgical procedures and with drugs. The drugs include alpha blockers, which relieve pressure on the urethra, and finasteride, a drug that reduces male hormone levels within the prostate and helps shrink the gland.

But the drugs can cause side effects, which generally disappear once the patient stops taking them. Alpha blockers can cause headaches, dizziness and fatigue, and finasteride can cause sexual problems.

The panel’s guidelines have been endorsed by the American Urological Assn., the American College of Radiology, the American Society of Radiological Technologists and the National Council for Senior Citizens.