Medical Treatment of Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia

Context: Medical treatment is the primary option for most patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH; LUTS/BPH), but individual patients may have distinct treatment goals. Objective: To describe the specific effects of available treatment options on symptom relief as well as on disease progression in relation to their potential side-effects. Evidence acquisition: PubMed was screened for studies, meta-analyses, and reviews describing medical treatments of LUTS/BPH. Evidence synthesis: The two main options for medical treatment are alpha(1)-adrenoceptor antagonists (ARBs) and 5 alpha-reductase inhibitors (ARIs). ARBs cause fast and persistent symptom relief but do not reduce prostate size or prevent progression as assessed (eg, by occurrence of urinary retention). All ARBs are similarly effective; alfuzosin and tamsulosin have the best tolerability. ARIs reduce prostate size and prevent disease progression, but symptom reduction occurs more slowly and is less pronounced than with ARBs. Dutasteride and finasteride appear to be similarly effective and tolerated. Due to differential modes of action, the combination of ARBs and ARIs has additive effects against combined end points of disease progression, but they also have additive side-effects. While several other treatment options are currently under investigation, none are sufficiently well documented to allow treatment recommendations. Conclusions: We propose that ARBs and ARIs have distinct clinical effects and, hence, should be considered for distinct groups of LUTS/BPH patients based on specific treatment goals in a given patient. (c) 2009 European Association of Urology. Published by Elsevier B.V. All rights reserved.