Antifibrotic therapy for Lower Urinary Tract Symptoms secondary to Benign Prostatic Hyperplasia

BACKGROUND: Lower Urinary Tract Symptoms secondary to Benign Prostatic Hyperplasia (LUTS/BPH) are a ubiquitous condition estimated to affect over 50% of men over the age of 50 years. Various treatment options exist for men presenting with LUTS/BPH, including lifestyle and behavioral modification and medical or surgical treatment. Although multiple medical treatments exist, innovation for the medical treatment of BPH has not significantly progressed. METHODS: A comprehensive narrative review was performed to evaluate prostate fibrosis as a contributor to LUTS/BPH and to identify potential antifibrotic therapies that may be applicable to the treatment of LUTS/BPH. A literature search was conducted in PubMed and ClinicalTrials.gov for molecular, translational, and clinical studies relevant to fibrosis in benign prostatic diseases. Keyword searches included "benign prostatic hyperplasia", "lower urinary tract symptoms", "prostate fibrosis", "fibrosis", "antifibrotics", as well as combinations of these terms. RESULTS: In this narrative review, we review the rationale and evidence for pursuing antifibrotic therapy as a novel treatment strategy for LUTS/BPH. We discuss potential antifibrotics that could be used for the treatment of LUTS/BPH. Finally, we discuss diagnostic studies that could be used in the future to identify patients with LUTS secondary to prostate fibrosis. CONCLUSIONS: Emerging evidence suggests that prostate fibrosis contributes to the development of LUTS. No antifibrotic therapies are currently being used, leaving LUTS secondary to fibrosis untreated. Antifibrotics are a novel medication class that could be used to treat patients who progress on current BPH medications.