Factors in Predicting Failure with Medical Therapy for BPH

Perhaps more than other common disorders, the management of benign prostatic hyperplasia (BPH) has been subject to the "reatment du jour" approach. Although pharmacotherapy has largely replaced surgery in the treatment of BPH, recommendations for optimal therapy seem to change every time a new study is published. alpha-Blockers, 5alpha-reductase inhibitors, and combination therapy with the 2 have all proved highly effective, in both trials and clinical practice. Nevertheless, medical therapy does not work for everyone, and identification of baseline factors that can help predict failure with a particular therapy is needed. Currently, the evidence supports the use of single-agent alpha-blocker therapy for patients with low prostate volumes at baseline, and combination therapy for patients with larger prostates. Symptom severity at baseline also seems predictive of success or failure.