Watchful waiting in benign prostatic hyperplasia.

Area of Science:

• Urology
• Men's Health

Background:

• Benign prostatic hyperplasia (BPH) management often involves watchful waiting.
• Recent large studies have elucidated the natural history of BPH.
• Previous trials comparing medical treatment to placebo offer insights into low-risk progression.

Purpose of the Study:

• To review the natural history of BPH.
• To discuss outcomes for patients managed with watchful waiting.
• To identify variables that predict BPH progression.

Main Methods:

• Analysis of longitudinal studies on BPH natural history.
• Extrapolation of data from randomized placebo-controlled trials.
• Identification of predictive variables for BPH progression.

Main Results:

• BPH is a progressive condition, commonly manifesting as symptom progression.
• Elevated prostate-specific antigen (PSA), larger prostate volume, and lower urinary flow rates are linked to progression.
• Predictive factors for progression to acute urinary retention and surgery were identified.

Conclusions:

• Understanding BPH natural history is crucial for selecting watchful waiting candidates.
• Specific clinical and biochemical variables can predict disease progression.
• This review provides guidance on managing BPH with watchful waiting.