Roehrborn Claus G
UT Southwestern Medical Center at Dallas, Dallas, TX 75390-9110, USA.
BJU Int. 2008 Mar;101 Suppl 3:17-21. doi: 10.1111/j.1464-410X.2008.07497.x.
Benign prostatic hyperplasia (BPH) represents a significant burden in ageing men due to frequently associated lower urinary tract symptoms (LUTS), which may impair quality of life. BPH is also a progressive disease, mainly characterized by a deterioration of LUTS over time, and in some patients by the occurrence of serious outcomes such as acute urinary retention (AUR) and need for BPH-related surgery. The goals of therapy for BPH are not only to improve bothersome LUTS but also to identify those patients at risk of unfavourable outcomes, to optimize their management. In selected patients, combination of an alpha(1)-blocker and a 5alpha-reductase inhibitor is the most effective form of BPH medical therapy to reduce the risk of clinical progression and relieve LUTS. Monotherapy also significantly reduces the risk of BPH clinical progression, mainly through a reduction of LUTS deterioration for alpha(1)-blockers while 5alpha-reductase inhibitors also reduce the risk of AUR and need for BPH-related surgery. Enlarged prostate and high serum prostate-specific antigen levels have been consistently found to be good clinical predictors of AUR and BPH-related surgery in longitudinal population-based studies and placebo arms of controlled studies. High post-void residual urine (PVR) is also associated with an increased risk of LUTS deterioration and should thus be reconsidered in practice as a predictor of BPH progression. Conversely, baseline LUTS severity and low peak flow rate, initially identified as predictors of unfavourable outcomes in community setting, behave paradoxically in controlled trials, probably as a consequence of strict inclusion criteria and subsequent regression to the mean and glass ceiling effects. Lastly, there is increasing evidence that dynamic variables, such as LUTS and PVR worsening, and lack of symptomatic improvement with alpha(1)-blockers are important predictors of future LUTS/BPH-related events, allowing better identification and management of patients at risk of BPH progression.
良性前列腺增生（BPH）给老年男性带来了巨大负担，因为它常伴有下尿路症状（LUTS），这可能会损害生活质量。BPH也是一种进行性疾病，主要特征是LUTS会随着时间推移而恶化，在一些患者中还会出现诸如急性尿潴留（AUR）和需要进行与BPH相关手术等严重后果。BPH的治疗目标不仅是改善令人困扰的LUTS，还要识别那些有不良结局风险的患者，以优化他们的管理。在特定患者中，α1受体阻滞剂和5α还原酶抑制剂联合使用是BPH药物治疗中最有效的形式，可降低临床进展风险并缓解LUTS。单药治疗也能显著降低BPH临床进展风险，主要通过α1受体阻滞剂减少LUTS恶化，而5α还原酶抑制剂还能降低AUR风险以及与BPH相关手术的需求。在基于人群的纵向研究以及对照研究的安慰剂组中，一直发现前列腺增大和高血清前列腺特异性抗原水平是AUR和与BPH相关手术的良好临床预测指标。高残余尿量（PVR）也与LUTS恶化风险增加相关，因此在实践中应重新将其视为BPH进展的预测指标。相反，基线LUTS严重程度和低尿流率峰值，最初在社区环境中被确定为不良结局的预测指标，但在对照试验中表现出矛盾的情况，这可能是严格纳入标准以及随后的均值回归和天花板效应的结果。最后，越来越多的证据表明，动态变量，如LUTS和PVR恶化，以及使用α1受体阻滞剂后症状无改善，是未来LUTS/BPH相关事件的重要预测指标，有助于更好地识别和管理有BPH进展风险的患者。
