The approach to clinical medicine has evolved over the last 20 years to incorporate therapeutic strategies to prevent long-term negative outcomes rather than simply treat acute events. As a result, new treatment paradigms have been developed in various disease areas. These paradigms arise from clinical trials that show a correlation between risk reduction and decreases in painful, traumatic, or fatal events. The field of urology has been relatively slow to adopt the concept of disease prevention. Several areas of clinical urology do employ prophylactic or metaphylactic
therapies, although these are generally for
secondary prevention after a primary event (e.g.,
secondary prevention of recurrent
bladder cancer or recurrent
kidney stones). There is, however, growing interest in the primary prevention of
prostate cancer with a variety of interventions, ranging from
dietary modifications to
selenium and
finasteride. Traditionally, clinical trials of agents for the treatment of symptomatic
benign prostatic hyperplasia (BPH) have studied improvements in
lower urinary tract symptoms, urinary flow rate, and reduction in prostate volume over relatively short periods of 6 weeks to 1 year. More recently, with the availability of long-term data from community-based studies of the natural history of BPH and placebo-controlled clinical trials, interest is shifting beyond short-term effects on symptoms to reducing the risk of long-term negative outcomes and
disease progression. This signals an important reorientation of clinical investigation in BPH.