Identifying patients with lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH) at risk for progression

Lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) are a slow but progressive disease. Men mainly progress due to worsening of symptoms, but they are also at risk of disease progression in terms of developing serious complications such as acute urinary retention (AUR), the need for prostate surgery and overall treatment failure or re-treatment. The major risk factors for progression based on community-based surveys and questionnaires among urologists seem to be a high post-void residual (PVR), a low maximum flow rate (Q(max)) and severe symptoms. Older age and a large prostate volume/high prostate specific antigen (PSA) level are considered as intermediate risk factors. Data from randomised clinical trials (RCTs) in LUTS/BPH patients, however, suggest that in particular, higher PSA levels, as a proxy for prostate volume are associated with an increased risk for AUR and prostate surgery. The differences among community-based surveys, urologist opinions and RCTs in the perception of risk factors for LUTS/BPH disease progression show that it is crucial to determine the risk profile for disease progression of patients from real life practice (RLP). Patients at high or low/intermediate risk for LUTS/BPH progression should be identified for optimising the treatment on an individual basis. (C) 2003 Elsevier B.V All rights reserved.