The management of benign prostatic hyperplasia: Treatment Approaches to BPH
Because benign prostatic hyperplasia (BPH) rarely causes serious complications, men usually have a choice between seeking treatment for BPH or opting for watchful waiting. The primary goals of treatment for benign prostatic hyperplasia are to improve urinary flow and to reduce symptoms. Many treatment options are available, including drug therapies, minimally invasive procedures, and major surgery. Watchful waiting involves lifestyle changes and an annual examination. Even in the case of watchful waiting, an initial examination is critical to rule out any other prostate disorders.
The decision between watchful waiting and treatment usually depends on a number of factors, such as urine flow rates, prostate size, PSA prostate specific antigen) levels, and IPSS (International Prostate Symptoms Score). The ultimate choice is often guided primarily by a man’s perception of his own symptoms.
Men with mild or no symptoms (IPSS scores of 7 or below) usually choose watchful waiting even if their prostates are enlarged. It should be noted, however, that urinary tract obstructions may be present in men with enlarged prostates even if they have no symptoms. Men with severe symptoms (IPSS scores over 20) usually choose treatment. The choice is most difficult for men with moderate symptoms (IPSS scores between 8 and 19) and how well they can tolerate symptoms. One study of men with moderate symptoms compared two groups: one selected for watchful waiting and the other for transurethral resection of the prostate (TURP). After five years, only 10% of those who had undergone TURP experienced worsened condition or a return of symptoms compared to 21% of those who had been selected for watchful waiting. This study did not include men on pharmacotherapy for benign prostatic hyperplasia.
Benign prostatic hyperplasia eventually progresses to the point of needing treatment in about 15% of men with mild symptoms who employ watchful waiting and in up to 40% of those with moderate symptoms. However, in a small percentage of patients, symptoms improve. Men with BPH who develop symptoms at a younger age (around age 50) are more likely to need treatment within their lifetimes than older men. At present, there is limited capability to determine high-risk patients.