BPH in the next millennium:a glimpse to the future

Abstract

Benign prostatic hyperplasia (BPH) is a highly prevalent, age-related disease. As the world population continues to grow and life expectancy increases, the population of men suffering from BPH will expand. A greater emphasis will be placed on quality of life. The BPH patient of the future will also have greater expectations regarding therapy, which will need to be effective in a shorter period of time. New technologies for the treatment of BPH are anticipated. Already, robot-operated vaporisation of the prostate is being undertaken. With regard to medical therapy, more selective and hence, more effective drugs are under development. With the identi®cation of new a 1 -adrenoceptor subtypes, a-blocker therapy should target the prostate more accurately. Gene-based therapies will have an important role in the future. It is envisaged that technology will exist whereby defective genes can be replaced and gene expression controlled to overcome the disease process. Through pharmacogenomics, drugs will be tailored to the individual, which will, in turn, result in more economical use of medical therapy. Similarly, the development of nanotechnology will allow sitespeci®c delivery of drugs. Together, these advances will make the treatment of BPH even more effective in the new millennium.Keywords: benign prostatic hyperplasia; treatment; pharmacogenomics; nanotechnology; a-blockers Prevalence of BPHBenign prostatic hyperplasia (BPH) is an age-related disease that is highly prevalent, with approximately 90% of men aged over 80 y having histological evidence of the disorder. 1 Community-based studies have evaluated the prevalence of symptomatic BPH or lower urinary tract symptoms (LUTS) by age in several European countries, 2 ± 5 the US 6 and Japan. 7 Results show that one in four men aged 50 y have LUTS, increasing to one in two men aged 65 y.The world population continues to grow by approximately 80 million each year, the equivalent to the current population of Germany, and it is expected to double by the year 2060, reaching a total of 10 billion people (Table 1). 8 This is partly explained by the fact that the world population is ageing, with people enjoying a greater life expectancy. It is currently estimated that each month the population aged b 65 y increases by 800 000. 8 In addition, a signi®cant percentage of men, particularly those living in developed countries, will reach a century. As nearly 50% of men b 65 y are at risk of LUTS suggestive of BPH, with the ageing population, LUTS is set to become even more prevalent in the future. The projected increase in the world male population aged b 65 y, leads to the assumption that, by the year 2010, 115 million men will have LUTS (Table 2). 8 This means that in just 50 years time, there will be three times as many men suffering from BPH. The changing populationWith the technological developments that are ongoing, patients will become better informed about their disease conditions. The Internet as a source of information will continue to evolve and patients will have incre...