Background: Benign prostatic hyperplasia (BPH) is often associated with enlargement of the prostate gland, lower urinary tract symptoms, decreased urinary flow and a reduced quality of life. Furthermore, if the symptoms associated with BPH are left untreated, serious complications, such as acute urinary retention, may ensue. Evidence is emerging from long–term clinical studies to suggest that BPH is a progressive disease, with some patients progressing much more rapidly than others. Objective: This article aims to explore the natural history of BPH progression from a molecular, pathological and clinical perspective, with emphasis on the key clinical evidence to support the progressive nature of this disease. How our increased understanding of the disease and of the risk factors for BPH progression might be applied to improve current management practices are also discussed. Conclusion: Strategies to identify patients most at risk and guidelines directed towards long–term management, in addition to short–term treatment, may be useful in helping to prevent BPH progression.

Keywords:
Benign prostatic hyperplasia, Progression, Dihydrotestosterone, 5α–Reductase inhibitors
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