Natural history of benign prostatic hyperplasia

Background: Lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) are a major problem impairing the quality of life in elderly men. The objective of the study was to investigate the natural history of BPH/LUTS to provide the appropriate treatment strategy for BPH/LUTS. Methods: We performed a cross-sectional community-based study in Japan in 1992. Of 682 men aged 40 to 79 years, 319 (47%) participated in the study. Prostate volume determination and symptomatic evaluation of the participants were preformed using the International Prostate Symptom Score (IPSS). In 2007, 15 years after the initial study, a longitudinal study for the survivors was conducted using the same methods as in the initial study. Of the 185 survivors, 135 (73%) participated in the longitudinal study. Results: The median prostate volume for total participants significantly increased from 17.4 to 23.9 ml during the 15 years. Men having prostates with a visible transition zone and a clear border at the baseline showed a prominent increment of prostate growth from 20.0 to 39.6 ml. The average IPSS increased from 6.9 to 8.5 during the 15 years. Also in the IPSS index, urgency, weak stream and nocturia increased significantly. Conclusions: Although BPH/LUTS is a progressive disease, there are various natural histories. Since men with prostates with a visible transition zone are likely to show marked prostate growth in the future. In addition, prostate volume reduction by a 5 alpha-reductase inhibitor is aggressively indicated, if men with LUTS have large prostates or prostates with a visible transition zone. (c) 2011 WPMH GmbH. Published by Elsevier Ireland Ltd. All rights reserved.