The long-term outcome of medical therapy for BPH.
OBJECTIVE
The lack of cure with medical therapy implies life-long treatment emphasising the need for a thorough understanding of the long-term outcome. We review the natural history, markers for progression, placebo effect, efficacy, pharmacoeconomic aspects, and preventive measures.


METHODS
Literature review with particular reference to long-term controlled studies using plant extracts, alpha1-blockers, 5alpha-reductase inhibitors (5-ARIs), and combination therapy.


RESULTS
There is a long-lasting (>or=12 mo) placebo response of symptoms (20% decrease) and maximum flow rate (10% rise). The five long-term controlled trials of plant extracts are inconclusive and therefore their role in contemporary medical management is still controversial. The alpha1-blockers provide fast amelioration of symptoms yet have no relevant impact on the risk of acute urinary retention or surgery. Combination therapy should be reserved for moderately or severely symptomatic patients with a high risk of progression; in the majority of patients the alpha1-blocker can be safely stopped after 6-12 mo. The preventive use of 5-ARIs in men with no or mild symptoms at risk of progression is scientifically sound yet not generally accepted mainly for economic reasons.


CONCLUSIONS
A sharp contrast exists between the duration of the longest controlled trial (4.5 yr) and the situation in real life with treatment periods up to one or two decades of life. Real-life and registry data will be the only source of this important information in the future.
Madersbacher
Stephan
S
Department of Urology, Danube Hospital, and Medical University of Vienna, Austria. stephan.madersbacher@wienkav.at
Marszalek
Martin
M
Lackner
Jakob
J
Berger
Peter
P
Schatzl
Georg
G
D000317:Adrenergic alpha-Antagonists / Q000191:economics / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D018450:Disease Progression; D004359:Drug Therapy, Combination; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics / Q000627:therapeutic use*; D008297:Male; D015990:Placebo Effect; D010936:Plant Extracts / Q000191:economics / Q000627:therapeutic use*; D011470:Prostatic Hyperplasia / Q000188:drug therapy* / Q000191:economics; D018570:Risk Assessment; D016896:Treatment Outcome
D000317:Adrenergic alpha-Antagonists; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010936:Plant Extracts