***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: To assess the improvements in symptoms , quality of life ( QoL ) , discomfort and satisfaction in patients with symptomatic benign prostatic hyperplasia ( BPH ) treated with dutasteride in clinical practice OBJECTIVES To evaluate the effect of alfuzosin 10 mg once daily administered for 2 years on progression events in men with lower urinary tract symptoms/benign prostatic hyperplasia ( LUTS/BPH ) . PATIENTS AND METHODS In all , 1522 men at risk of having progression events from LUTS/BPH were r and omized to receive alfuzosin 10 mg once daily ( 759 ) or placebo ( 763 ) for 2 years . Endpoints assessed were the occurrence of a first episode of acute urinary retention ( AUR ; primary ) and the need for BPH-related surgery . Post hoc analyses included a deterioration in the International Prostate Symptom Score ( IPSS ) of > or = 4 points and overall clinical progression of BPH ( occurrence of AUR and /or surgery and /or symptom deterioration ) . RESULTS Over 2 years , symptom deterioration was the most common progression event ( 14.3 % ) , followed by BPH-related surgery ( 5.8 % ) and AUR ( 2.0 % ) . Alfuzosin did not reduce the risk of AUR ( alfuzosin 2.1 % vs placebo 1.8 % , P = 0.82 ) but tended to reduce the risk of surgery ( 5.1 % vs 6.5 % , P = 0.18 ) ; the reduction in risk ( RR ) and 95 % confidence interval with alfuzosin was 22 ( -18 to 48)% ; and significantly reduced the risk of symptom deterioration ( 11.7 % vs 16.8 % ; P = 0.0013 ) ; the RR was 30 (10 - 46)% . The overall clinical progression of BPH was significantly lower with alfuzosin than with placebo ( 16.3 % vs 22.1 % , P < 0.001 ) ; RR 26 (9 - 40)% . Alfuzosin also significantly improved the IPSS ( P = 0.017 ) , quality of life ( P < 0.001 ) and peak flow rate ( P = 0.001 ) compared with placebo . Baseline levels of prostate-specific antigen ( PSA ) predicted both AUR and BPH-related surgery events , while the baseline postvoid residual urine volume predicted symptom deterioration . The incidence of adverse events with alfuzosin was comparable to that with placebo . CONCLUSIONS Alfuzosin 10 mg once daily prevents the overall clinical progression of BPH , defined by the occurrence of a deterioration in IPSS of > or = 4 points and /or AUR and /or BPH-related surgery , but does not reduce the primary occurrence of AUR . Alfuzosin significantly improves LUTS and quality of life over 2 years , and is well tolerated PURPOSE There are 2 main medical preparations available for lower urinary tract symptoms result ing from benign prostatic hyperplasia ( BPH ) . Choosing between an alpha-blocker and a 5alpha-reductase inhibitor requires trade-offs between their attributes or characteristics . We investigated the relative importance of and trade-offs between the attributes of the 5alpha-reductase inhibitor dutasteride and alpha-blockers in community dwelling men using a vali date d technique . MATERIAL S AND METHODS A discrete choice experiment was administered to 211 men older than 40 years who were r and omly selected from the general United Kingdom population . Attributes investigated in the discrete choice experiment were time to symptom improvement , sexual and nonsexual side effects , the risks of acute urinary retention ( AUR ) and surgery , cost and prostate size decrease . Using regression analysis the relative importance of these attributes , the trade-offs that men are willing to make between these attributes and the willingness to pay for each attribute were estimated . RESULTS All attributes were important to respondents . The most important attribute was side effects . The least preferred side effects was impotence , followed by decreased libido and dizziness . Respondents were willing to wait 13 , 2 and 8 months longer for symptom improvement in exchange for decreased prostate size , and the risks of AUR and surgery , respectively . Men reporting moderate symptoms were less concerned about sexual side effects , time to symptom improvement and the risk of AUR compared with men reporting mild symptoms . CONCLUSIONS Given the attribute levels of BPH medical treatment , overall community dwelling men preferred the 5alpha-reductase inhibitor over alpha-blockers . In the interests of shared decision making it is important to consider the importance of eliciting the preferences of patients with BPH BACKGROUND Benign prostatic hyperplasia is commonly treated with alpha-adrenergic-receptor antagonists ( alpha-blockers ) or 5alpha-reductase inhibitors . The long-term effect of these drugs , singly or combined , on the risk of clinical progression is unknown . METHODS We conducted a long-term , double-blind trial ( mean follow-up , 4.5 years ) involving 3047 men to compare the effects of placebo , doxazosin , finasteride , and combination therapy on measures of the clinical progression of benign prostatic hyperplasia . RESULTS The risk of overall clinical progression -- defined as an increase above base line of at least 4 points in the American Urological Association symptom score , acute urinary retention , urinary incontinence , renal insufficiency , or recurrent urinary tract infection -- was significantly reduced by doxazosin ( 39 percent risk reduction , P<0.001 ) and finasteride ( 34 percent risk reduction , P=0.002 ) , as compared with placebo . The reduction in risk associated with combination therapy ( 66 percent for the comparison with placebo , P<0.001 ) was significantly greater than that associated with doxazosin ( P<0.001 ) or finasteride ( P<0.001 ) alone . The risks of acute urinary retention and the need for invasive therapy were significantly reduced by combination therapy ( P<0.001 ) and finasteride ( P<0.001 ) but not by doxazosin . Doxazosin ( P<0.001 ) , finasteride ( P=0.001 ) , and combination therapy ( P<0.001 ) each result ed in significant improvement in symptom scores , with combination therapy being superior to both doxazosin ( P=0.006 ) and finasteride ( P<0.001 ) alone . CONCLUSIONS Long-term combination therapy with doxazosin and finasteride was safe and reduced the risk of overall clinical progression of benign prostatic hyperplasia significantly more than did treatment with either drug alone . Combination therapy and finasteride alone reduced the long-term risk of acute urinary retention and the need for invasive therapy OBJECTIVE This article describes the results of an exploratory analysis of treatment satisfaction data from a phase 2 study to inform the evaluation of a new treatment for benign prostatic hyperplasia ( BPH ) . METHODS The study was a r and omized , placebo-controlled , double blind trial comparing three doses ( low , medium , and high ) of a new uro-selective alpha-blocker with an active comparator . A total of 536 men aged 40 years and older with lower urinary tract symptoms ( LUTS ) result ing from BPH were r and omized into the study . Patients ' perceptions of satisfaction with efficacy , dosing , and side effects were explored using a vali date d disease-specific instrument , the Treatment Satisfaction Scale-Benign Prostatic Hyperplasia ( TSS-BPH ) . The TSS-BPH was administered at the end of the study or at withdrawal . RESULTS Compared with placebo , the medium and high doses showed the greatest efficacy on the primary endpoint , the International Prostate Symptom Score ( IPSS ) . Patient satisfaction with efficacy at these doses was significantly better than that for placebo . Nevertheless , adverse events were most frequent in the high dose group . Satisfaction with side effects was significantly worse than placebo for this group , and this was reflected in the total scores on the TSS-BPH , with patients being most satisfied overall with the medium dose . CONCLUSIONS Exploring patients ' treatment satisfaction with medication in early trials using multidimensional measures provides an overall evaluation of efficacy and side effects , and can be used to inform the selection of doses for later trials . This is especially useful for products that require adherence with medication over long periods of time Benign prostatic hyperplasia ( BPH ) is a highly prevalent condition in aging men , which can be progressive and lead to acute urinary retention ( AUR ) and the need for surgery . It is commonly treated with alpha-blockers and 5alpha-reductase inhibitors ( 5ARIs ) , both of which improve the symptoms of BPH . Long-term treatment with 5ARIs can also reduce the risk of developing AUR and the need for surgery . The l and mark Medical Therapy of Prostatic Symptoms ( MTOPS ) trial demonstrated that over 4 years the combination of the type 2-specific 5ARI , finasteride and the alpha-blocker doxazosin was more effective than either agent alone in reducing overall clinical progression . Since the initiation of MTOPS , it has been shown that patients with larger prostates and higher prostate-specific antigen ( PSA ) levels are at greater risk of BPH progression , and are therefore arguably more likely to benefit from combination therapy . The Combination of Avodart and Tamsulosin ( CombAT ) trial is a 4-year , global , multicenter , r and omized , double-blind , parallel-group study design ed to investigate the benefits of combination therapy with the dual 5ARI dutasteride and the alpha-blocker tamsulosin compared with each monotherapy in improving symptoms and long-term outcomes in men with moderate-to-severe symptoms of BPH and prostate enlargement .  Symptoms and long-term outcomes ( AUR and surgery ) will be assessed as separate primary endpoints at 2 and 4 years , respectively . Eligible patients were at least 50 years old with prostate volume > or = 30 cm(3 ) and PSA level > or = 1.5 ng/mL. A total of 4838 subjects have been enrolled . This paper describes the rationale , design and baseline data of the CombAT study OBJECTIVE To report additional analyses of efficacy over the initial 2 years and during a 2-year open-label extension of the three pivotal phase 3 studies in which dutasteride , a dual inhibitor of type 1 and 2 5alpha-reductase , was shown to be effective and well tolerated . PATIENTS AND METHODS All patients in the placebo and active groups were eligible for entry into the 2-year open-label extension , with all receiving dutasteride 0.5 mg daily . Mean changes from baseline were calculated for the American Urologic Association Symptom Index ( AUA-SI ) score at each scheduled time in the double-blind and open-label phase . The additional analyses included a breakdown of the AUA-SI score , including stratifying patients by symptom severity , assessment by baseline age and prostate volume , and the evaluation of symptoms responders . RESULTS There was a clinical ly meaningful improvement in AUA-SI in patients on dutasteride in the double-blind phase , but not in those on placebo . At 48 months , patients on dutasteride in both study phases had greater improvements in AUA-SI score and individual question scores than those on dutasteride in the open-label phase only . The proportion of patients with severe symptoms declined in both study groups , although these changes were more profound in those receiving dutasteride for the 4-year duration of the study . CONCLUSION In men with symptomatic benign prostatic hyperplasia , long-term ( 4-year ) treatment with the dual isozyme 5alpha-reductase inhibitor dutasteride result ed in sustained and continued improvements in symptoms and flow rate . For 4 vs 2 years , longer dutasteride therapy result ed in greater symptom improvement BACKGROUND The severity of symptoms still constitutes the major indication for transurethral prostatectomy , despite the extensive utilization of medical treatments . The aim of the study presented here was to investigate the impact of doxazosin on symptoms in relation to the probability of consequent surgery in severely symptomatic patients . METHODS Patients with an International Prostate Symptom Score ( IPSS ) between 18 and 35 were included in the study . The patients received 4 mg/day doxazosin , and subjective efficacy was assessed by IPSS at the first and third months . In addition , the patients were classified at the third month according to a single question regarding satisfaction with medical treatment in terms of symptom relief as ' ineffective , no change , and effective ' . RESULTS A total of 178 patients constituted the study group .  Mean total symptom scores were 24 , 19 and 17 at baseline , first and third months , respectively ( P < 0.05 ) . According to results of the question naire , 23 % of the patients cl aim ed the treatment was ineffective , and subsequently , the majority of this group ( 93 % ) underwent prostatectomy in a year . In addition , 33 % of the patients reported no change in their symptoms , while 44 % reported that the medication was effective . However , after 1 year , 59 % and 15 % of these cases underwent surgical treatment , respectively . The probability of surgery in the ' ineffective ' group was significantly higher compared to the remaining groups ( P < 0.05 ) . CONCLUSION The majority of patients with severe symptoms who were not satisfied with the medication at the 3rd month underwent surgery . This observation may provide a predictor for subsequent probability of prostatectomy . Therefore , re assessment of patients would be a cost-effective approach for the treatment of BPH in severely sympt 
    Output:
    
Patients prefer therapies affecting long-term disease progression over those that provide short-term symptom improvement , which contrasts with the beliefs of their physicians .
The evidence to date suggests that patients ' views and beliefs and those of their physician may not always be in agreement .
Improved physician-patient communication will help determine the best treatment option for patients with BPH and may ensure greater compliance and treatment success