Serum prostate-specific antigen as a biomarker for disease progression in benign prostatic hyperplasia

Recent advances in understanding of the natural history of benign prostatic hyperplasia (BPH) and the development of new treatment options are enabling a shift in approach to treatment from palliative to preventive strategies. Studies of the natural history of BPH reveal that it is a progressive condition with a predictable course. Furthermore, with the introduction of 5α-reductase inhibitor pharmacotherapy, it may be possible to prevent progression of BPH and to reduce the risk of serious sequelae. Symptomatic BPH does not progress in all patients; therefore, progression-modifying intervention is not always warranted. To tailor therapeutic and/or preventive approaches appropriately, it is valuable to differentiate patients at high risk of progression from those at low risk of progression. A considerable body of evidence shows that serum prostate-specific antigen (PSA), a commonly used screening test for prostate cancer, can also be useful in predicting disease progression in BPH when considered in conjunction with other clinical indicators. Specifically, patients with PSA of at least 1.5 ng/mL, in the presence of an enlarged prostate and lower urinary tract symptoms, are at increased risk of disease progression. These patients may benefit from close monitoring and may be good candidates for pharmacotherapy to arrest the disease process. On the other hand, patients with a small prostate gland, low serum PSA, and bothersome lower urinary tract symptoms might benefit most from symptomatic treatment but should be periodically monitored to assess changes in clinical status. The strong predictive utility of PSA - combined with the fact that it, unlike other clinical markers of BPH status, can be accurately and easily measured - renders it an important tool for the clinician seeking to optimize outcomes for patients with BPH.