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Natural history of BPH


Clinical bottom line

Symptoms of BPH are common, and become more common and more severe with age. The rate of change is higher in older men and men with larger prostates.


SJ Jacobsen et al. Natural history of benign prostatic hyperplasia. Urology 2001 58: Suppl6A: 5-16.


This paper is a non-systematic review that nonetheless draws together the major studies that can help us understand the natural history of BPH. It is a very detailed paper, and only a brief precis is given here.



Studies show a high prevalence of moderate to sever symptoms as measured by the AUA symptom score, with rates of 26% to 46% in men aged 40 to 79 years. Symptoms get worse with age, and get worse more rapidly with age.

Urinary flow rate

Maximum urinary flow rates tend to decline with age, and 24% of men aged 40-44 years have flow rates below 15 mL/second. Flow rates tend to decrease faster in older men.

Prostate volume

Prostatic volume is strongly associated with age, and 88% of men have prostate volumes larger than 20 mL. Prostate volume increases at about 0.6% to 1.6% a year, but the rate of increase is greater in men with larger prostates.

Acute retention

The 10 year cumulative incidence of acute retention is very variable, but in large studies it is about 7 per 1000 person years, or about 1% a year. A 60 year old man with moderate to severe symptoms would have a 1 in 7 chance of developing acute retention in the following 10 years. Older age, more severe symptoms and low flow rate all make acute retention more likely.


Though this paper neither has a systematic search strategy nor attempts any data pooling, it is a useful descriptive paper with a fine bibliography.