When to Treat the Prostate, the Bladder, or Both?

ContextPharmacological therapy for relieving lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) has evolved during the past years. The possible benefits of combination therapies to prevent disease progression or to treat LUTS/BPH with concomitant overactive bladder (OAB) or erectile dysfunction (ED) are currently studied.ObjectivesTo review the evidence provided in clinical trials and to assess the current medical practice concerning the pharmacological treatment of men suffering from LUTS/BPH.Evidence acquisitionThis paper is based on a presentation during the symposium “The future of LUTS/BPH: management beyond the prostate” at the European Association of Urology's 2008 annual meeting. The results of a Web survey evaluating the opinion of urologists about treatment of LUTS/BPH patients were discussed and an update lecture on medical therapy for LUTS/BPH was given.Evidence synthesisMen who are highly bothered by their symptoms but with a low risk of disease progression can achieve fast relief of symptoms with α1-adrenoceptor (α1-AR) antagonist monotherapy. Those patients at risk for LUTS/BPH progression can benefit from additional 5α-reductase inhibitor therapy. Concomitant OAB symptoms in LUTS/BPH patients can be treated with a combination of an α1-AR antagonist and an antimuscarinic agent. An α1-AR antagonist combined with a phosphodiesterase-5 inhibitor might improve symptoms in men with lower urinary tract symptoms (LUTS) and concomitant ED.ConclusionsThe pharmacological treatment of LUTS/BPH patients should be adapted to their individual risk of progression and their individual symptom profile.