ABSTRACT

Benign prostatic hyperplasia (BPH) is a progressive disease that is commonly associated with bothersome lower urinary tract symptoms (LUTS) such as urinary frequency, urgency, nocturia, decreased force of stream and the sensation of incomplete bladder emptying. however, the relationship between BPH and LUTS is complex, because not all men with histological BPH will develop significant LUTS, while other men who do not have histological BPH will develop LUTS. Although many epidemiological clinical studies have been conducted worldwide over the last 20 years, the prevalence of clinical BPH remains difficult to determine. A standardized clinical definition of BPH is lacking, which makes it intrinsically difficult to perform adequate epidemiological studies. In the case of autopsy studies, no men younger than 30 had evidence of BPH and that the prevalence rose with each age group, peaking at 88% in men in their 80s.

An expert review of published evidence regarding BPH as a progressive disease defined progression as worsening of symptoms, deterioration of urinary flow rate, increase in prostate volume (PV), and outcomes such as acute urinary retention (AUR) and the need for surgery either for AUR or symptoms. Clinical trials have included renal insufficiency and recurrent urinary tract infections as additional measures of BPH progression, although these outcomes were rarely observed. Data from the placebo arm of the MTOPS trial demonstrated that men with a total PV ≥ 31 ml, PSA ≥ 1.6 ng ⁄ ml, Qmax < 10.6 ml ⁄ s, PVR volume ≥ 39 ml or age ≥ 62 years at baseline had a significantly increased risk of overall clinical progression of BPH. Prostate volume is perhaps the most extensively studied of the risk factors for BPH progression. Men with a PV of >30 ml are more likely to suffer moderate- to-severe symptoms (3.5-fold increase), decreased flow rates (2.5-fold increase), and AUR (three- to fourfold increase), compared with men with PV < 30 ml. Unfortunately, PV estimated by DRE is associated with considerable measurement error and can underestimate measured volume by as much as 55%. PSA can be used to evaluate prostatic volume and the risks of either needing surgery or developing acute urinary retention.. Serum PSA is easily measured in clinical practice and can therefore facilitate identification of those men most likely to suffer disease progression in BPH and to guide therapeutic decisions. Age ise an unhindered etiological factor in BPH and also shows correlation with BPH progression.