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Benign Prostatic Hypertrophy: A Progressive Pathology. Hypothesis for a Preventive Therapy

The purpose of this review is to enhance prevention as a new key aspect in the treatment of BPH. The concept of BPH as a progressive disease helps to adopt new approaches to patient evaluation and treatment. The disease progression, with respect to the risk of bladder function complications and alterations, to the progression of symptoms, and to the deterioration of the quality of life, leads to new ways of treating patients through a preventive as well as a symptomatic approach, thanks also to the identification of some parameters associated with the risk of BPH progression, i. e. the prostate volume and the serum PSA. Furthermore, the concept of progression helps the clinician to identify different classes of BPH patients with different indications of medical treatment. The PLESS, ARIA and MTOPS multicentric studies point out the preventive potential of the therapy based on 5 alpha-reductase inhibitors (finasteride and dutasteride) or their combination with alpha-1 adrenergic blockers. Only a long term evaluation (4 years or more) can lead to the identification of statistically and clinically significant outcomes for the BPH preventive therapy.