Future implications for the management of benign prostatic hyperplasia

Abstract

Benign prostatic hyperplasia (BPH) is a growing medical problem in terms of morbidity, mortality, and health care costs. Renewed research has highlighted the lack of standardized parameters available with which to define and evaluate BPH and its treatment. The many treatments available, ranging from surgery to watchful waiting, point to the complex pathophysiology of BPH and the subjectivity of the treatment decisions. Workup of patients with micturition disorders, coupled with use of the International Prostate Symptom Score evaluation, permits the development of criteria for evaluating treatment efficacy and acceptable treatment options. Based on double-blind, placebo-controlled trials, a-blockers and finasteride have been accepted as treatment options. The former produce relaxation of the smooth muscle by inhibiting adrenergically induced increases in intracellular calcium. The latter blocks the 5a-reductase system, which effectively stops the conversion of testosterone to dihydrotestosterone. a-Blockers improve symptoms and flow immediately while finasteride diminishes the prostate volume, specifically of glandular tissue, leading to improved symptoms and flow. All other medical and nonmedical treatments require further evaluation by randomized, prospective trials to determine their safety profile and efficacy.