Managing the progression of lower urinary tract symptoms/benign prostatic hyperplasia: therapeutic options for the man at risk

In benign prostatic hyperplasia (BPH), increased prostate volume has been shown to be associated with future symptom deterioration and progression to acute urinary retention (AUR) or BPH-related surgery. Dihydrotestosterone (DHT) is the primary androgen responsible for prostate growth. Inhibition by 5 alpha-reductase inhibitors (5-ARIs) of the enzyme responsible for the production of DHT decreases prostate volume. This translates to an overall improvement in symptoms and a reduction in the risk of AUR and/or BPH-related surgery. Selective blockage of alpha(1)-adrenoceptors, principally in the region of the prostate, results in rapid symptom relief for the patient but this does not translate into a long-term reduction in the risk of AUR or BPH-related surgery. Given their different modes of action the rationale has always existed for using 5ARIs and alpha-blockers together in men deemed to be both symptomatic and at risk of progression. The factors that predict this progression and the methods available to reduce the risk of it occurring are the subjects of this review.