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Should combination therapy be standard for benign prostatic hyperplasia?

Nature Clinical Practice Urology volume 2, pages 574–575 (2005)Cite this article

The treatment of benign prostatic hyperplasia (BPH) that causes lower urinary tract symptoms has advanced enormously since the days when it was a simple choice between no treatment with reassurance, and transurethral resection of the prostate (TURP). Improvements in treatment arose from our recognition that one of the commonest urologic conditions affecting men required other therapeutic options that fitted somewhere between these two extremes. This, in turn, led to a huge amount of laboratory and clinical research that increased our understanding of BPH, and the number of pharmacologic and technological treatments available. As a result, there has been a dramatic decrease in the number of patients treated by TURP, and an equally dramatic increase in the number of patients treated by pharmacologic manipulation. Drug treatment of BPH was initially viewed with suspicion by urologists, but has gradually achieved widespread acceptance, with excellent consequences for patients.

Pharmacologic treatment of BPH is based on two concepts: first, that α-adrenergic blockade reduces smooth-muscle tone in the prostate and bladder neck; and second, that 5-α-reductase inhibition causes atrophy of prostate epithelium. Studies showed that, as monotherapy, both classes of drugs produced improvements in patients' symptoms and quality of life. Although their effects were not in any way comparable to the symptomatic improvements afforded by TURP, they tipped the balance irrevocably in favor of nonsurgical treatments for BPH.1,2,3,4

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  1. Professor of Surgery and Consultant Urologist at the Mater Misericordiae Hospital, University College Dublin, Ireland

    John M Fitzpatrick

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  1. John M Fitzpatrick
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Correspondence to John M Fitzpatrick.

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Fitzpatrick, J. Should combination therapy be standard for benign prostatic hyperplasia?. Nat Rev Urol 2, 574–575 (2005). https://doi.org/10.1038/ncpuro0352

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