Benign Prostatic Hyperplasia (BPH) and its related symptoms are common in the elderly men. Better understanding the natural history and the factors associated with clinical progression of BPH are critical for optimal management. In this article, the current status of serum prostate-specific antigen (PSA) in the management of BPH is discussed.

Serum PSA predicts not only the current prostatic volume, but also the future growth rate of the gland in men with BPH. A higher serum PSA is associated with a larger gland and a higher rate of prostatic growth, and thus a higher risk of clinical progression. Serum PSA is also clinically useful in predicting the outcome of medical treatment with alpha-1 adrenergic receptor blockers and 5-alpha reductase inbitors in men with BPH-related lower urinary tract symptoms.

5-alpha reductase inhibitors result in a median 50% decrease in serum PSA in men with BPH. However, there is a significant individual variability, which would affect the clinical decision. Therefore, a better strategy other than the widely used concept “doubling serum PSA” is warranted.

Keywords: Benign Prostatic Hyperplasia; progression; prostate specific antigen; prostate volume