When to Treat the Prostate, the Bladder, or Both?

Context: Pharmacological therapy for relieving lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) has evolved during the past years. The possible benefits of combination therapies to prevent disease progression or to treat LUTS/BPH with concomitant overactive bladder (OAB) or erectile dysfunction (ED) are currently studied. Objectives: To review the evidence provided in clinical trials and to assess the current medical practice concerning the pharmacological treatment of men suffering from LUTS/BPH. Evidence acquisition: This paper is based on a presentation during the symposium ‘‘The future of LUTS/BPH: management beyond the prostate’’ at the European Association of Urology’s 2008 annual meeting. The results of a Web survey evaluating the opinion of urologists about treatment of LUTS/BPH patients were discussed and an update lecture on medical therapy for LUTS/BPH was given. Evidence synthesis: Men who are highly bothered by their symptoms but with a low risk of disease progression can achieve fast relief of symptoms with a1-adrenoceptor (a1-AR) antagonist monotherapy. Those patients at risk for LUTS/BPH progression can benefit from additional 5a-reductase inhibitor therapy. Concomitant OAB symptoms in LUTS/BPH patients can be treated with a combination of an a1-AR antagonist and an antimuscarinic agent. An a1-AR antagonist combined with a phosphodiesterase-5 inhibitor might improve symptoms in men with lower urinary tract symptoms (LUTS) and concomitant ED. Conclusions: The pharmacological treatment of LUTS/BPH patients should be adapted to their individual risk of progression and their individual symptom profile. # 2008 European Association of Urology. Published by Elsevier B.V. All rights reserved.