Changing therapeutic regimens in benign prostatic hyperplasia - Clinical and economic considerations

About one-quarter of men aged 50 years and older experience voiding problem s due to benign prostatic hyperplasia (BPH). Until about 10 years ago, surg ery (particularly transurethral resection of the prostate) was the only eff ective treatment for symptomatic BPH. Over the last decade, several new tre atments have been introduced. These include different types of medication ( alpha -blockers and finasteride), thermotherapy, laser prostatectomy, needl e ablation and vaporisation methods. The diffusion of these less invasive t reatment modalities has resulted not only in a decrease in the age-adjusted surgery rates, but also in an increase of the total number of men treated for BPH. A large number of studies on clinical benefits and risks reveal th at the conventional types of surgery remain the most effective treatments, whereas new interventional therapies require a shorter hospital stay and re sult in fewer short term complications. The efficacy of medication is lower than that of interventional treatments. Adverse effects include dizziness and orthostatic hypotension (alpha -blockers) and decreased sexual function (finasteride), but are generally mild. There is some evidence that medication and minimally invasive treatments ma y preclude eventual surgical treatment, but the precise effect is difficult to estimate because of differences in the study populations and the relati vely short study periods. As a result of the dynamic nature of BPH treatmen t and the lack of long term data, the cost effects of the introduction of t he various new treatments are also difficult to assess. Given the aging of the population and the growing percentage of patients with BPH for whom any type of treatment can be considered, a considerable increase of total cost s can be expected. Long term prospective studies are necessary to gain insi ght into the most cost-effective treatment for different patient groups.