Publication:

Recent advances in medical management of benign prostatic hyperplasia: narrative review

Benign prostatic hyperplasia (BPH) is a prevalent condition in aging men, commonly linked with lower urinary tract symptoms (LUTS) such as frequency, urgency, nocturia, and weak urinary stream, all of which significantly impact quality of life. Pharmacological therapy remains the first-line management, yet conventional agents like alpha-1 blockers and 5-alpha reductase inhibitors (5-ARIs) often face challenges due to poor adherence, sexual side effects, and suboptimal symptom control. Given the progressive nature of BPH and its increasing prevalence in the elderly worldwide, including India, there is a need for more effective and better-tolerated treatment options. A comprehensive literature review was performed using PubMed, Cochrane Library, Wiley Online Library, Google Scholar, and ClinicalTrials.gov. Studies published between 2020 and 2025 were included to capture recent therapeutic innovations. References from selected articles were also cross-examined to ensure completeness. Pharmacological advances: While α-blockers and 5-ARIs remain standard, they inadequately target BPH’s multifactorial pathophysiology involving inflammation, hormonal imbalance, and increased smooth muscle tone. Emerging therapies include phosphodiesterase-5 (PDE-5) inhibitors, which relax prostate and bladder smooth muscle, improving both LUTS and erectile function; β3-adrenoceptor agonists for bladder storage symptoms; and gonadotropin-releasing hormone antagonists that reduce prostate volume without hormonal flare. Additionally, COX-2 inhibitors show promise in managing inflammation-driven LUTS such as nocturia. BPH represents a complex age-related condition beyond prostate enlargement. Although traditional therapies offer benefit, newer agents-targeting hormonal, inflammatory, and metabolic pathways-expand treatment options. Future care will rely on personalized, minimally invasive, and biologically informed strategies to enhance efficacy, safety, and patient quality of life.