Medical therapy for BPH: expanding our treatment paradigm?

Medical therapy for relief of symptoms of benign prostatic hyperplasia (BPH ) is now a clinical reality. The challenge for urologists treating BPH with medical therapy is how to rationally employ the two proven classes of medi cations, the alpha blockers and finasteride, in their practice. To accompli sh this, we must critically examine the results of multiple important clini cal BPH trials published over the last decade and examine the short and lon g term effect of the various available medical therapies on symptoms, objec tive progression and consequences of the disease process and whether eviden ce based indicators will allow us to choose appropriate therapies. It appea rs that we can rationalize our medical therapy decisions, taking into consi deration severity of disease, prostate size (and perhaps PSA) and most impo rtantly, the patients' longterm expectations for treatment outcome. But fir st physicians must decide for themselves whether to expand their treatment paradigm beyond short term symptom relief to encompass long term durability and even prevention of the consequences of the long term progression of BP H.