The natural history of patients with benign prostatic hyperplasia as diagnosed by North American urologists

Purpose: We defined outcomes for men with a clinical diagnosis of benign prostatic hyperplasia. Materials and Methods: We followed for 4 years 500 candidates for elective prostatectomy treated nonoperatively in 5 North American urology practices. Results: There were 371 survivors with complete data at 4 years. Of 60 men with mild, 245 with moderate and 66 with severe baseline symptoms 10, 24 and 39%, respectively, had undergone surgery; 27, 31 and 27%, respectively, were on pharmacological therapy, and 63, 45 and 33%, respectively, were off active treatment at 4 years. Mild or moderate symptoms were noted at 4 years in 83, 59 and 23% of the patients, respectively, while 17, 41 and 77%, respectively, had severe symptoms or had undergone surgery. Conclusions: Outcomes for men with a clinical diagnosis of benign prostatic hyperplasia depend on initial symptom severity. However, the course of symptoms also varies among patients even with the same initial symptom severity.