Patient risk profiles for progression of lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH)

Lower urinary tract symptoms suggestive of benign prostatic disease (LUTS/BPH) wax and wane over time but overall there is a slow worsening of symptoms in the long term. Although the majority of patients progress due to symptomatic worsening, some patients are also at risk of developing acute urinary retention (AUR) and/or will need prostatic surgery. In the day-to-day management of LUTS/BPH patients, it is important to know which patients will progress and/or which factors/clinical variables can predict which progression. This is necessary in order to determine "who to treat and how to treat". This review article on risk factors/clinical variables indicates that for the overall risk of disease progression, a high post-void residual (PVR) and low maximum flow rate (Q_max; factors believed to be predictive for obstruction) are the most important risk factors followed by severe symptoms and a large prostate volume/high prostate specific antigen (PSA). A large prostate volume/high PSA (factors believed to be associated with prostate growth) are most predictive for the occurrence of AUR.