Evaluation of benign prostatic hyperplasia treatments: how can we improve the outcome measures and success criteria?

Treatment evaluation in benign prostatic hyperplasia (BPH) is complicated by a number of interdependent factors. The evaluation of the individual patient is influenced by the risk:benefit ratio and health related quality of life and this, in turn, is interrelated with the evaluation of therapeutic options. Current outcome measures include subjective measurements (e.g. symptom scores and patient reports) and objective measurements (e.g. uroflow and prostate volume). In order to improve outcome measures it is important to use health-related quality-of-life scales and symptom- and bother-associated scores. In addition, the patient should complete frequency and volume charts, and possibly use home flowmetry; transitional zone measurements may also play a role in finding a better treatment strategy. It is also important to consider the adverse effects and complication rates of invasive and pharmacological treatments (including their influence on quality of life) and economic factors such as the cost of treatment, the cost of following guidelines and the durability and failure rate associated with treatment. In order to manage the increasing number of BPH patients who seek care effectively it is important to share care with the GPs, but this will require improved guidelines, better data and better outcome measurements.