Benign prostatic hyperplasia: natural evolution versus medical treatment.

The epidemiology and natural evolution of benign prostatic hyperplasia (BPH) are important when considering the topic of natural evolution versus medical treatment. The incidence of BPH increases with age; it is thought that about 75% of men over 50 years of age suffer from some symptoms commonly associated with BPH. There are also differences in the incidence of BPH between various racial and ethnic groups. For example, it is considerably less common amongst Japanese men compared with Caucasians. Evidence from prospective studies, retrospective studies and the placebo arms of randomised, controlled studies regarding the natural evolution of BPH suggests that a strategy of 'watchful waiting' may be considered as a treatment option as the majority of patients do not show a worsening of symptoms over time. However, the chance for improvement of symptoms and the degree of symptom improvement has been shown to be higher with alpha 1-blocker therapy than with 'watchful waiting'. As both symptoms and treatment have an impact on the patient's quality of life, there is now a strong case for involving the patient in making quality-of-life decisions based on his own preferences and attitudes.