Treatment of Symptomatic Benign Prostatic Hyperplasia: Current and Future Clinical Practice in Europe – What is Really Happening?

The management of symptomatic benign prostatic hyperplasia (BPH) has changed significantly over the last decade in response to the availability of new treatment options. Evidence from a large-scale, pan-European study has shown that assessment and treatment allocation for BPH varies significantly within Europe, reflecting local clinical practice preferences, and drug availability and pricing, rather than evidence-based clinical guidelines. There is now evidence from a wide range of epidemiologic and clinical studies to demonstrate that a proportion of men with BPH will have progression of their disease. Such men can be identified through prostate-specific antigen assessment. It has also become apparent that watchful waiting may not always be the optimal approach for all men with mild symptomatic BPH. Data from large-scale clinical studies have demonstrated that treatment with 5α-reductase (5-AR) inhibitors not only significantly ameliorates symptoms of BPH, but also, in contrast to α-blockers, reduces the long-term risks of acute urinary retention and BPH-related surgery. Knowledge of the clinical characteristics that may predict the progression of BPH may thus permit a proactive approach to the management of the disease, whereby men at risk of progression can be identified at an early stage and treated appropriately to reduce their risk of progression. However, it appears that 5-AR inhibitors are often under-prescribed in at-risk men in clinical practice. Therefore, there is a need for a change in clinical practice to reflect the level 1 evidence for 5-AR inhibitors in men with symptomatic BPH who are at risk of disease progression.