What are the Views of Patients and Urologists on Benign Prostatic Hyperplasia and Its Management?

A number of surveys have been published in recent years offering fundamental insight into patient and physician views of benign prostatic hyperplasia (BPH), its impact on patient well-being, and its management. Lower urinary tract symptoms (LUTS) due to BPH are highly prevalent among ageing men and have a significant impact on the quality of life of patients and their spouses. The downstream consequences of LUTS, particularly bother and impact on daily activities, are a major concern for men. When considering medical treatment for BPH, studies have found a preference among patients for treatments that reduce the risk of long-term outcomes, such as acute urinary retention (AUR) and surgery, over the need for rapid symptomatic relief, demonstrating that men are able to trade off short- and long-term risks and benefits of therapy. Despite this, physicians appear to underestimate the concerns of patients about long-term outcomes; this is reflected in a preponderance of medical therapy prescriptions aimed at achieving symptom relief. Available evidence therefore suggests that urologists need to broaden their discussions with patients to encompass both short- and long-term consequences of BPH to allow more appropriate agreement on individual goals of therapy. In doing so, patients will be better able to weigh the benefit profiles of the 5α-reductase inhibitors, which have demonstrable benefits in reducing the risks of AUR and BPH-related surgery as well as providing symptomatic relief, against the more rapid symptomatic benefits of α-blockers achieved without significant reduction of long-term progression.