Medical therapy for benign prostatic hyperplasia progression.

The vast majority of patients presenting to their physicians with concerns about voiding are seeking quick resolution of a disturbed urination pattern. The primacy of their concern over symptoms is appropriate, given the current focus on amelioration of voiding complaints in the treatment of lower urinary tract symptoms. Patients also ask about the risks of symptom progression and how this should impact their decision to choose either medical or surgical intervention. The concept of benign prostatic hyperplasia (BPH) progression has recently become a growing area of interest as new information emerges concerning the natural history of BPH and the identification of risk factors for progression. The impact of medical treatment on the prevention of BPH progression is slowly becoming apparent. The Proscar Long-Term Efficacy and Safety Study trial (Proscar; Merck & Co., Whitehouse Station, NJ) revealed a reduced risk of acute urinary retention and the requirement for invasive treatment with the long-term use of finasteride. More recent data from the Medical Therapy of Prostate Symptoms trial revealed that symptomatic men with BPH who were treated with a combination of an a-blocker and a 5-a reductase inhibitor showed significantly delayed clinical progression of their symptoms compared with treatment with each drug individually. Combination therapy appears to be more effective than doxazosin or finasteride alone in producing significant improvements in American Urological Association Symptom Index and flow rate changes. Interestingly, finasteride and combination therapy reduced the long-term risk of acute urinary retention.