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Management of BPH

BPH Guidelines

Guidelines for the management of BPH have been produced at an international level and within individual countries. The majority of country-specific guidelines are based on the IC-BPH guidelines, which were last updated in 2001.⁹ EAU guidelines were revised in March 2004 and can be accessed via their website at: http:/anti-infectives/Paris-Event/Live-Webcast.cfmwww.uroweb.org/.

Both sets of guidelines recommend the use of digital rectal examination (DRE), prostate-specific antigen PSA level measurement and symptom questionnaires as diagnostic procedures. In terms of treatment recommendations, both sets of guidelines are in agreement as to the patients most suitable for watchful waiting, drug treatment and surgery. However, they differ in their approach to the use of other interventional therapies, with those of the EAU being more conservative in their recommendations.

A recent review compared and contrasted 15 sets of guidelines, including those from the IC-BPH and the EAU, and found a number of shortcomings.⁷⁷ Most importantly, there is insufficient information on the latest reported findings relating to the management of BPH. For example, there were no treatment recommendations on long-term patient follow-up, long-term management (including the use of 5ARIs to reduce the risk of longterm complications), or the use of combination therapy. Since this review was conducted,the AUA guidelines have been revised to include recommendations for the appropriate use of combination therapy (see Combination Therapy).⁵³ An algorithm showing the recomendations for the management of symptomatic BPH outlined in the AUA guidelines is shown below. The EAU guidelines are due to be updated in March 2004.

A recent review compared and contrasted 15 sets of guidelines, including those from the IC-BPH and the EAU, and found a number of shortcomings.⁷⁷ Most importantly, there is insufficient information on the latest reported findings relating to the management of BPH. For example, there are no treatment recommendations on long-term patient follow-up, long-term management (including the use of 5ARIs to reduce the risk of longterm complications), or the use of combination therapy.

Guidelines have a role in establishing the optimal treatment of patients. The continued regular update of practice guidelines is imperative to translate the huge amount of scientific information on new technologies into meaningful treatment recommendations for daily clinical practice.