Prevention of benign prostatic hyperplasia disease

Purpose: We reviewed the evidence that benign prostatic hyperplasia is a progressive condition and men at risk for benign prostatic hyperplasia disease can be identified, treated and protected to a meaningful extent regardless of symptom status. Materials and Methods: The MEDLINE database was searched in 4 areas of interest relating to benign prostatic hyperplasia, including 1) progression of clinical manifestations with age, especially in regard to baseline symptom status, 2) the incidence of complications due to disease progression, 3) the use of predictive factors that may help identify men at risk for disease progression and 4) the prevention of benign prostatic hyperplasia disease with medical therapy. Results: Tissue changes in the prostate (benign prostatic hyperplasia) are inevitable consequences of aging. However, benign prostatic hyperplasia disease, which we define as a life altering urinary condition requiring medical intervention, is predictable and preventable. Benign prostatic hyperplasia disease progression is associated with increasing prostate volume, decreasing urinary flow, symptomatic deterioration often to the point of major life-style interference and serious complications, eg acute urinary retention and the need for surgery. The risk of benign prostatic hyperplasia disease progression was found to be directly related to prostate volume and its surrogate marker, serum prostate specific antigen, after prostate cancer is excluded. Other factors, eg baseline symptoms and the flow rate, were found to be less relevant compared with prostate specific antigen greater than 1.5 ng/ml for predicting benign prostatic hyperplasia disease morbidity. Conclusions: Men at risk for benign prostatic hyperplasia disease can be identified using prostate specific antigen greater than 1.5 ng/ml as a surrogate marker of prostate volume. In men at risk with prostate specific antigen greater than 1.5 ng/ml 5 alpha-reductase inhibitors have potential value for benign prostatic hyperplasia disease prevention regardless of symptom status.