Introduction

INTRODUCTION New Perspectives on Benign Prostatic Hyperplasia Herbert Lepor, MD Department of Urology, New York University School of Medicine, New York, NY [Rev Urol. 2003;5(suppl 4):S1-S2] © 2003 MedReviews, LLC p until the early 1990s, the only accepted treatment for men with benign prostatic hyperplasia (BPH) was prostatectomy. The menu of options currently available for the treatment of BPH includes medical therapies, minimally invasive therapies, and prostatectomy. Because the overwhelming majority of men with BPH seek treatment for bothersome lower urinary tract symptoms (LUTS), medical therapy has emerged as the most widely offered first-line intervention. Over the past decade, we have learned a great deal about the pathophysiology and natural history of BPH, as well as the role of medical therapy for treatment of the condition. The objective of this CME-accredited supplement to Reviews in Urology is to provide an update for the urologist on new perspectives in the management of BPH. This supplement brings together many of the key thought leaders who conducted the pivotal studies that have extended our knowledge and understanding of BPH. I am grateful for their scholarly contributions to this project. In this supplement, Kevin McVary, MD, discusses a rational approach to the clinical evaluation of men with LUTS and BPH. There has been tremendous controversy over the past decade as to whether the size of the prostate has any clinical significance. J. Curtis Nickel, MD, provides a review of the clinical material demonstrating that prostate size influences response to medical treatment as well as risk of disease progression. Over the past decade, clinical studies have focused on examining the effectiveness of medical therapy to relieve LUTS and bladder outlet obstruction. The Proscar Long-Term Efficacy and Safety Study (PLESS) provided the initial insights into the use of finasteride as a strategy to prevent BPH disease U VOL. 5 SUPPL. 4 2003 REVIEWS IN UROLOGY S1 Introduction continued progression. Claus G. Roehrborn, MD, was intimately involved in the design and interpretation of this study. Here, Dr Roehrborn reviews the new information learned from this study. At the present time, medical therapy is designed to “treat,” and not cure, BPH. Therefore, an important characteristic of medical therapy for BPH is the drug’s durability. E. Darracott Vaughan, MD, one of the earliest investigators of finasteride for the treatment of BPH, presents a 12-year clinical experience with the agent, which represents the longest published experience of any medical therapy for BPH. To date, numerous randomized, double-blind, placebocontrolled trials have been published examining the effectiveness of both -blockers and 5--reductase inhibitors. Herbert Lepor, MD, was the principal investigator of the first randomized, double-blind, multicenter trial examining the safety and effectiveness of terazosin for the treatment of BPH, as well as of the S2 VOL. 5 SUPPL. 4 2003 Veterans Affairs Cooperative Study, which compared treatment with terazosin, finasteride, combination therapy, or placebo. Dr Lepor summarizes 5 landmark BPH studies and demonstrates the consistency of the clinical information that has been amassed. The Medical Therapy of Prostatic Symptoms (MTOPS) study was the first, randomized, double-blind, placebo-controlled trial designed to determine the role of medical therapies in the progression of BPH. The MTOPS study provides a wealth of information regarding medical therapy and its impact on BPH progression. Results of this landmark study are expected to be published in The New England Journal of Medicine in the fall of 2003. Results have previously been presented at the 2002 and 2003 national meetings of the American Urological Association. Kevin Slawin, MD, principal investigator for the MTOPS Baylor College of Medicine site, discusses what we will learn from this important study. Because REVIEWS IN UROLOGY of the current embargo on the data set, the scope of Dr Slawin’s article is limited to data previously discussed at the national meetings. There is a tremendous amount of new and important information in this supplement for the urologist to digest. Several of the authors and a primary care physician agreed to discuss the topic of new perspectives in BPH using a “fireside” chat venue. Included with this supplement is a CD-ROM that features the highlights of this discussion. Many of the controversies surrounding the management of BPH are discussed and debated. Several of the participants in the fireside chat were key figures in the design, implementation, and interpretation of the MTOPS study. The fireside chat provides the opportunity to synthesize the “take home message" of the MTOPS study. Equipped with the supplement and enclosed CD-ROM, the urologist will be at the cutting edge of medical service as it relates to the management of BPH.