Facing the Current Challenges in Benign Prostatic Hyperplasia

Over the last decade, we have learnt a great deal concerning the natural history of benign prostatic hyperplasia (BPH) and the importance this has for the long-term management of this prevalent disease. We now understand that BPH is progressive in many men – a finding highlighted in the recent European Association of Urology guidelines on the assessment, therapy, and follow-up of men with BPH. This realization, coupled with an understanding that men are more concerned with long-term consequences of BPH, such as urinary retention and the need for surgery, than they are with daily symptoms, demonstrates the need for an approach designed to both manage the symptoms and reduce the risk of BPH progression in men ‘‘at risk’’. Evidence from both randomised clinical trials and new data from everyday practice demonstrate that 5-alpha-reductase inhibition can provide a combination of long-term symptomatic benefits and reduction in risk of events such as urinary retention and the need for surgery. These effects align with the progressive nature of BPH and the desire of many men to impact long-term outcomes. This supplement reviews available epidemiological and trials data, and examines ways in which treatment guidelines for BPH can incorporate approaches designed to reduce the risk of progression – and meet the wishes of patients – to optimise long-term