Benign prostatic hyperplasia (BPH) can be a progressive disease for some men with significant
impact on their quality of life due to worsening of symptoms, risk of acute urinary retention (AUR)
and surgery. Certain clinical parameters such as age, prostate volume and PSA are able to predict those
patients with BPH-associated LUTS that are at risk of disease progression. These patients will likely
benefit most from medical therapy that provides symptom relief while at the same time may prevent
disease progression. Studies have shown that a-blockers, although able to rapidly alleviate symptoms,
have no effect on prostate volume, risk for AUR and BPH-related surgery. On the other hand 5ARIs
have proven their efficacy in reducing prostate size, the risk of AUR and prostate surgery. Therefore combination therapy
with an a-blocker and a 5ARI can be the mainstay of treatment for those patients at risk of BPH progression. Patients’ perspective
and their needs and expectations from treatment are other crucial parameters to consider in order selecting the optimal
management of BPH. Therefore physicians should take into consideration the drug properties and also the patients’
preferences before deciding on the optimal pharmacological treatment for BPH-associated LUTS.
Keywords: 5-a reductase inhibitors, a-blockers, benign prostatic hyperplasia (BPH), benign prostatic obstruction (BPO), combination
therapy, urinary retention.
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