Medical management of benign prostatic hyperplasia--are two drugs better than one?

The prostate is a complex organ composed of epithelial cells and fibromuscular stroma. Benign prostatic hyperplasia is a true hyperplastic process, with an increase in the number of cells arising initially in the transition zone of the gland. Complex stromal– epithelial interactions lead to benign prostatic hyperplasia in 50 percent of men by the age of 50 years. This process requires testicular androgens and progresses with age. Aging is accompanied by an increase in symptoms of bladder obstruction or irritation attributable to benign prostatic hyperplasia. A prospective study showed that 24 percent of men with moderate symptoms of benign prostatic hyperplasia who were randomly assigned to watchful waiting needed surgery within three years. 1 In addition, a community study showed that over 50 percent of men with benign prostatic hyperplasia had an impaired ability to perform daily activities, a problem that would potentially improve with medical management. The importance of this information is reflected by the fact that the 2000 U.S. Census included 14 million men over 65 years of age, with the number estimated to rise to 17 million by 2010. Benign prostatic hyperplasia can lead to obstructive nephropathy, bladder decompensation, acute urinary retention, recurrent bacterial urinary tract infections, or bladder calculi. However, as early as 1989, a review of more than 3000 men undergoing surgery noted that over 80 percent had “bothersome” symptoms, in addition to the complications just listed. 2