An Overview of the Current Treatment Landscape for BPH

BPH Treatment Landscape Summary

The current treatment approach for BPH follows a tiered system beginning with conservative management for mild symptoms. Traditional first-line approaches include watchful waiting or active surveillance, combined with lifestyle modifications such as fluid restriction, timed voiding, and avoiding bladder irritants. This conservative approach allows patients with minimal symptoms to avoid medication while managing their condition through behavioral changes.

Medical therapy serves as the primary treatment for moderate BPH symptoms, with α-blockers being the most commonly prescribed first-line medications. However, these medications do not alter disease progression and require long-term adherence. 5α-reductase inhibitors offer the advantage of reducing acute urinary retention risk and the need for future surgery, but they have a slower onset of action and carry significant sexual adverse effects. Tadalafil presents a viable option particularly for men experiencing both BPH and erectile dysfunction, whereas anticholinergics and β3 agonists are frequently used for storage-predominant symptoms, though some clinicians express concern about potentially masking underlying issues.

The treatment landscape has evolved significantly over the past decade with the emergence of minimally invasive therapies that bridge the gap between lifelong medications and more invasive surgical procedures such as TURP or holmium laser enucleation. Office-based, anesthesia-sparing options including prostatic urethral lift, water vapor therapy, and temporary transprostatic urethral nitinol stents have been adopted. These interventions are specifically designed to preserve sexual function while offering the possibility of a one-time treatment that eliminates the burden of lifelong medication adherence. Although these minimally invasive options demonstrate somewhat less efficacy compared to gold-standard surgical procedures, they provide an attractive middle-ground option for appropriate candidates.