The impact of treatment on lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) progression

The individual risk profile of every patient with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) should be taken into account for selecting the most appropriate treatment. In patients who seek help because of bothersome urinary symptoms but who have overall a low risk of progression to acute urinary retention (AUR) and/or prostatic surgery, treatment should in first instance rapidly and continuously improve these symptoms and related quality of life (QoL). In patients at an intermediate and particularly at a high risk, reducing the progression to serious complications and/or switch to other treatment (including surgery) is also an important treatment goal. This review article on medical therapy for LUTS/BPH indicates that, based on data from both randomised controlled trials (RCTs) and real life practice (RLP) studies, monotherapy of an alpha(1)-adrenoceptor (AR) antagonist such as tamsulosin is the most appropriate treatment for patients with bothersome LUTS/BPH at a low risk of progression. For patients with bothersome LUTS/BPH at a high risk of progression, combination therapy of an alpha(1)-AR antagonist and a 5alpha-reductase inhibitor may be most appropriate. However, it must be kept in mind that this may also lead to an increased risk of adverse events and increased costs. Some of these patients may benefit from immediate prostatic surgery. (C) 2004 Published by Elsevier B.V.