Prognosis

The majority of patients with BPH can expect at least moderate improvement of their symptoms with a decreased bother score and improved quality of life. Lower urinary tract symptoms, secondary to BPH, may affect sexual wellbeing including erectile function. Medical therapy for BPH may also affect sexual function, beneficially and harmfully, so this must be considered on an individual basis.[110][111][112][113] Some studies suggest that patients with a low risk for progression may be able to discontinue first-line therapy with alpha-blockers after several months of therapy.[114][115] However, the majority of patients will require ongoing therapy.

Clinical progression of BPH

Clinical progression of BPH (as defined by the International Prostate Symptom Score [IPSS] symptom progression >4 points) occurs in approximately 20% of patients as demonstrated in the Medical Therapy of Prostate Symptoms (MTOP) study.[53] Approximately 2.5% of patients will develop acute urinary retention and another 6% will require invasive therapy over a 5-year timeframe. Risk for BPH progression is increased in patients with higher prostate volumes and prostate-specific antigen levels. A 39% risk reduction of clinical BPH progression has been demonstrated in patients on doxazosin and a 34% risk reduction has been demonstrated in patients on finasteride. Patients on combination therapy had a 66% reduction in clinical BPH progression. The MTOP study also demonstrated the risk reduction in acute urinary retention was most significant with finasteride (68%) and with invasive surgery (64%). Doxazosin alone did not significantly reduce the risk of urinary retention or the need for invasive surgery. A combination of doxazosin and finasteride reduced the risk of acute urinary retention by 81% and invasive surgery by 69%.[53] A long-term study that evaluated combination therapy with dutasteride plus tamsulosin showed similar benefits in time to clinical progression of BPH, IPSS, maximum urinary flow rate, quality of life, and reduced prostate volume in both Asian and Caucasian patients when compared with tamsulosin monotherapy.[116]

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