Management of symptomatic benign prostatic hyperplasia--today

Symptomatic benign prostatic hyperplasia (BPH) is one of the commonest causes today of men presenting with lower urinary tract symptoms (LUTS). We can find this in 50% of men over the age of fifty. If BPH is not treated, then one can expect that the disease will progress in a significant number of individuals. What we need to do is try to predict based on certain baseline parameters such as International Prostate Score (IPSS), prostate volume, prostate-specific antigen (PSA) and the degree of bother, those men to whom we should offer therapy. The other consideration is that combination therapy of a 5-alpha reductase inhibitor (5-ARI) and an alpha blocker, may provide the best results in the prevention of progression of the disease or ultimately, the need for surgery. The final considerations are if, for how long and for whom should combination therapy be utilized.