Moderate BPH symptoms: When is lifestyle advice enough?

This study examined predictors of treatment success of drug therapy or watchful waiting in men with moderate benign prostatic hyperplasia (BPH). Authors reported that a low degree of moderate BPH symptom bother is a relevant indicator for watchful waiting as a management option.

BPH can lead to bothersome urinary symptoms that can significantly affect quality of life. Many men with minimal symptoms benefit from watchful waiting. This involves no active treatment and, instead, focuses on lifestyle advice. One study reported equal improvements in BPH symptoms with watchful waiting when compared to drug therapy in men with moderate BPH. Common drug therapies include 5 alpha-reductase inhibitors, such as dutasteride (Avodart) and alpha-blockers, such as tamsulosin (Flomax). Since drug therapies are associated with various side effects, predicting success with watchful waiting may avoid unnecessary adverse effects.

This study analyzed the results of a trial comparing outcomes with drug therapies and watchful waiting in men with moderate BPH symptoms. The aim was to find factors important for treatment success. 742 men with moderate BPH were given lifestyle advice. 369 of these men then received treatment with tamsulosin and dutasteride (combination therapy). The rest of the men underwent watchful waiting. 229 men undergoing watchful waiting later initiated treatment with tamsulosin. Therefore, a total of 144 men underwent watchful waiting alone. Patients were followed for 2 years.

Improvements in urinary symptoms at 2 years were similar between combination therapy and watchful waiting. Men undergoing watchful waiting or combination therapy, in turn, showed greater improvements than men receiving tamsulosin.

Overall, men with the greatest degree of symptom bother before the study benefited more from combination therapy than from watchful waiting. Younger men (aged less than 65 years) also showed greater symptom improvements than older men (aged 65 years or more) following combination therapy or watchful waiting. PSA levels (prostate specific antigen; an indicator of prostate growth) and prostate size did not affect outcomes of watchful waiting.

Authors concluded that men with moderate BPH symptoms, who are not greatly bothered by the symptoms, can benefit from lifestyle advice alone.