The natural history of benign prostatic hyperplasia: implications for patient care and clinical trial design

Benign prostatic hyperplasia (BPH) is a nearly universal concomitant of male aging, yet its natural history is largely undocumented. Most information on the clinical course of untreated prostatism has come from a limited number of studies. This lack of information makes it difficult for urologists to know when, how, and in whom to intervene. This is reflected by the controversy surrounding surgical indications and by the considerable variability in rates of prostatectomy. Over the last 2 years, information on the natural history of BPH has been obtained from analyses of limited data from long-term, general-purpose, government-sponsored prospective studies of human aging. This paper briefly reviews these studies and discusses implications for patient care decisions and clinical trial design.