Watchful waiting in benign prostatic hyperplasia

Watchful waiting is a well known approach to the management of benign prostatic hyperplasia (BPH). In recent years, several large longitudinal studies have published their findings on the natural history of BPH. In addition, several other studies reporting the outcomes of patients randomized to medical treatment versus placebo have been used to extrapolate patients who are at low risk for progression.

Both longitudinal studies and randomized placebo-controlled trials have confirmed the progressive nature of BPH, with symptom progression being the most common manifestation. Variables such as baseline prostate-specific antigen, prostate volume, symptom score and bother score, decreased flow rate, and increased postvoid residual have all been linked to progression to acute urinary retention and need for surgery.

Historically, not much has been known about the natural history of BPH and thus, who would be a good candidate for watchful waiting. In this review, we discuss the natural history of BPH and the outcomes of affected patients managed with watchful waiting, as well as variables predictive of progression.