Recent progress in the medical treatment of benign prostatic hyperplasia

The objectives of medical treatment for benign prostatic hyperplasia (BPH) are multiple: improvement of quality of life, reduction of symptoms, improvement of urine output, and reduction of the risk of acute urinary retention. In addition to validated treatments (alpha 1-blockers, 5 alpha-reductase inhibitors, plant extracts), new molecules have been added to the therapeutic armamentarium, and combinations of the various available treatments have been tested. The combination of alpha 1-blockers and 5 alpha-reductase inhibitors has been evaluated, with a significant benefit on symptoms and urodynamic parameters, especially when the prostatic volume exceeds 25 mL. The adverse effects of the combination appear to be comparable to those of monotherapy. The combination of alpha 1-blockers and anti-muscarinics appears to be effective in patients with BPH with marked irritative symptoms poorly controlled by alpha 1-blockers alone. Finally, a new LH-RH antagonist, improving symptoms and maximum urine flow rate in patients with BPH, could rapidly be made available to urologists.