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Clinical Implications for the Early Treatment of Benign Prostatic Enlargement (BPE): a Systematic Review

Abstract

Purpose of review

Therapeutic options for the management of lower urinary tract symptoms (LUTS) secondary to benign prostatic enlargement (BPE) have considerably increased in recent years. However, the ideal timing to initiate medical treatment of LUTS/BPE has not been fully established. The aim of this review was to systematically collect available evidence on the influence of early treatment on the natural history of LUTS/BPE patients.

Recent Findings

A systematic literature search from January 1996 until April 2018 was performed by combining the following MESH terms: Lower Urinary Tract Symptoms, Benign Prostatic Enlargement, male, medical treatment, surgical treatment, early treatment/intervention, and early intervention/treatment. The Medline, PubMed, and Scopus databases were searched. Each article title and abstract was reviewed for relevance and appropriateness with regard to the topic of this review. In recent years, the medical armamentarium for the management of LUTS secondary to BPE has been extensively implemented, significantly improving treatment outcomes and markedly reducing the need for BPE surgery. Early intervention in patients at risk for disease progression may offer better clinical outcomes compared to a deferred approach. However, evidences supporting early treatment are scarce, and criteria to discriminate patients that could mostly benefit from immediate treatment remain poorly defined. Moreover, as a result of delayed surgery after prolonged medical treatment, patients undergoing surgical relief show larger prostates, older age, and comorbidities. Nevertheless, technological advancements in surgical techniques have largely counterweighed this critical scenario, and commonly, a non-pejorative trend has been reported in perioperative complications.

Summary

The timeliest moment to start a medical treatment in LUTS/BPE patients is still undefined, and unexpectedly, peer-reviewed evidence remains scarce. Further studies are awaited to better discriminate patients who mostly benefit from early treatment of LUTS/BPE.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major Importance

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Correspondence to Fabrizio Presicce.

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Conflict of Interest

Fabrizio Presicce, Cosimo De Nunzio, and Andrea Tubaro each declare no potential conflicts of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Benign Prostatic Hyperplasia

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Presicce, F., De Nunzio, C. & Tubaro, A. Clinical Implications for the Early Treatment of Benign Prostatic Enlargement (BPE): a Systematic Review. Curr Urol Rep 19, 70 (2018). https://doi.org/10.1007/s11934-018-0823-y

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  • DOI: https://doi.org/10.1007/s11934-018-0823-y

Keywords

  • Benign prostatic hyperplasia
  • LUTS
  • Prostate
  • Pharmacological treatment
  • Early treatment
  • Surgery
  • Outcomes complications