Management of Benign Prostatic Hyperplasia and Associated Symptoms

Benign prostatic hyperplasia (BPH) is a non-malignant enlargement of the prostate gland that commonly affects men over 50 and is a leading cause of lower urinary tract symptoms (LUTS). Symptoms encompass urinary frequency, nocturia, slow stream, hesitancy and incomplete emptying, and present a substantial burden on quality of life and health systems worldwide. Management strategies begin with lifestyle interventions such as fluid management, bladder training and reduction of caffeine and alcohol intake. First-line pharmacotherapy comprises α₁-adrenoceptor antagonists, which relieve smooth muscle tension to improve urinary flow, and 5α-reductase inhibitors, which reduce dihydrotestosterone production and prostate volume over months. Combination therapy of both drug classes is reserved for men at higher risk of progression or with moderate to severe symptoms. Minimally invasive procedures, including transurethral microwave thermotherapy and steam injection, offer symptom relief with lower morbidity. Surgical options such as transurethral resection of the prostate remain the standard for refractory or complicated cases. Recent emphasis has been placed on patient stratification based on prostate size, symptom severity, comorbidities and risk of progression. Emerging approaches target cellular pathways implicated in stromal proliferation and fibrosis, with the aim of more durable symptom control and reduction of adverse events. The global ageing population ensures that BPH will remain a major contributor to urological morbidity, driving the need for cost-effective and patient-centred management algorithms.

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Management of Benign Prostatic Hyperplasia and Associated Symptoms publication trend

The graph below shows the total number of articles in management of benign prostatic hyperplasia and associated symptoms across all publications each year (not limited to Nature Index journals).

Technical terms

Benign prostatic hyperplasia (BPH): Non-malignant enlargement of the prostate gland leading to urinary tract obstruction and LUTS.

Lower urinary tract symptoms (LUTS): A spectrum of urinary storage and voiding disturbances including frequency, urgency, hesitancy and nocturia.

α₁-adrenoceptor antagonist (α-blocker): A drug class that relaxes prostatic and bladder neck smooth muscle to improve urine flow.

5α-reductase inhibitor: A medication that inhibits the conversion of testosterone to dihydrotestosterone, reducing prostate volume over time.

Epithelial–mesenchymal transition (EMT): A biological process in which epithelial cells acquire mesenchymal traits, contributing to fibrosis and tissue remodelling in BPH.

References

1. YAP1 Recognizes Inflammatory and Mechanical Cues to Exacerbate Benign Prostatic Hyperplasia via Promoting Cell Survival and Fibrosis. Advanced Science (2023).
2. Aberrant activation of TGF-β/ROCK1 enhances stemness during prostatic stromal hyperplasia. Cell Communication and Signaling (2024).
3. Treatment of Benign Prostatic Hyperplasia by Natural Drugs. Molecules (2021).