The short-term goal of pharmacotherapy for patients with prostatic hyperplasia (BPH) is to relieve patients’ lower urinary tract symptoms, and the long-term goal is to delay the clinical progression of the disease and prevent comorbidities. Maintaining a high quality of life while reducing the side effects of pharmacotherapy is the overall goal of pharmacotherapy for BPH. 1, alpha-blockers (1) alpha-blocker mechanism of action and urinary tract selectivity: alpha-blockers are used to relieve bladder outlet power obstruction by blocking adrenergic receptors distributed on the smooth muscle surface of the prostate and bladder neck and relaxing smooth muscle. Alpha-blockers can be classified according to urinary tract selectivity as non-selective alpha-blockers (phenoxybenzamine, Phenoxybenzamine), selective alpha1-blockers (Doxazosin, Alfuzosin, Terazosin) and highly selective alpha1-blockers (Tamsulosin- α1 A> α1 D, nafpodil Naftopidil- α1 D> α1 A). (2) Recommendation: α-blockers are indicated for patients with BPH with lower urinary tract symptoms. Tamsulosin, doxazosin, alfuzosin and terazosin are recommended for the pharmacological treatment of BPH. Nafpydir can be selected for the treatment of BPH. Prazosin and the non-selective alpha-blocker phenobarbital are not recommended for the treatment of BPH. (3) Clinical efficacy: The clinical use of alpha-blockers for the treatment of lower urinary tract symptoms caused by BPH began in the 1970s. improved patients’ symptoms, resulting in a 30-40% improvement in symptom scores and a 16-25% increase in maximum urinary flow rate. Phenobarbital, which was initially used, had significant side effects and was therefore difficult for patients to accept. Symptom improvement can be seen 48 hours after α-blocker treatment, but assessment of symptom improvement using the I-PSS should be done after 4-6 weeks of drug use. Continuous use of alpha-blockers for 1 month without significant symptom improvement should not be continued. The results of a clinical study of tamsulosin for BPH for up to 6 years showed that long-term use of alpha-blockers maintained a stable efficacy. The MTOPS study also confirmed the long-term efficacy of alpha-blockers alone. Baseline prostate volume and serum PSA levels in BPH patients did not affect the efficacy of alpha-blockers, and alpha-blockers did not affect prostate volume or serum PSA levels. The results summarized by the American Urological Association BPH Guidelines Development Committee using a special Bayesian technique showed that the clinical efficacy of various alpha-blockers was similar, with some differences in side effects. For example, tamsulosin has a lower incidence of cardiovascular side effects, but a higher incidence of retrograde ejaculation. (4) Alpha-blockers for acute urinary retention: The results of clinical studies show that patients with acute urinary retention BPH treated with alpha-blockers have a significantly higher chance of successful removal of the urinary catheter than placebo treatment. (5) Side effects: Common side effects include dizziness, headache, weakness, sleepiness, postural hypotension, retrograde ejaculation, etc. Postural hypotension is more likely to occur in elderly and hypertensive patients. 2, 5-alpha reductase inhibitors (1) mechanism of action: 5-alpha reductase inhibitors inhibit the transformation of testosterone to dihydrotestosterone in the body, which in turn reduces the content of dihydrotestosterone in the prostate, achieving the therapeutic purpose of reducing the volume of the prostate and improving urinary difficulties. The 5-alpha reductase inhibitors currently used in China include Finasteride and Epristeride. (2) Recommendation: Finasteride is indicated for the treatment of patients with BPH who have enlarged prostate volume with lower urinary tract symptoms. For patients at high risk for clinical progression of BPH, finasteride may be used to prevent clinical progression of BPH, such as the development of urinary retention or surgical treatment. Patients should be informed of the risk of clinical progression of BPH if they do not receive treatment, and the side effects and longer duration of treatment with finasteride should be fully considered. (3) Clinical efficacy: The results of several large-scale randomized clinical trials have confirmed the effectiveness of finasteride, reducing prostate volume by 20% to 30%, improving patients’ symptom scores by about 15%, increasing urinary flow rates by about 1.3 to 1.6 ml/s, and reducing the risk of acute urinary retention and the need for surgical intervention by about 50% in patients with BPH. Studies have shown that finasteride is more effective in treating patients with larger prostate volumes and/or higher serum PSA levels. The long-term efficacy of finasteride has been demonstrated, with results from randomized controlled trials showing maximum efficacy after 6 months of finasteride use. The efficacy of continuous drug treatment for 6 years has remained stable. Several studies have shown that finasteride reduces the incidence of hematuria in patients with BPH. Data from studies have shown that finasteride (5 mg/d for more than 4 weeks) applied prior to transurethral resection of the prostate reduces intraoperative bleeding in patients with BPH with large prostate volumes. (4) Side effects: The most common side effects of finasteride include erectile dysfunction, abnormal ejaculation, low libido and others such as gynecomastia and mastalgia. (5) Finasteride affects serum PSA level: Finasteride can reduce serum PSA level. Taking Finasteride 5mg daily for 1 year can reduce PSA level by 50%. Doubling the serum PSA level in patients with finasteride did not affect its efficacy in detecting prostate cancer. (6) Epristeride: Epristeride is a non-competitive 5-alpha reductase inhibitor. A 4-month multicenter open clinical trial in China containing 2006 cases showed that epristeride reduced I-PSS score, increased urinary flow rate, reduced prostate volume and decreased residual urine volume. There is no evidence from randomized clinical trials. The combination therapy is a combination of alpha-blockers and 5-alpha reductase inhibitors for the treatment of BPH. (1) Recommendation: Combination therapy is indicated for patients with BPH who have increased prostate volume and lower urinary tract symptoms. patients at greater risk of clinical progression of BPH are more suitable for combination therapy. The risk of clinical progression of BPH in a specific patient, the patient’s wishes, economic status, and the increase in costs associated with combination therapy should be fully considered before using combination therapy. (2) Clinical efficacy: The current study results confirm the long-term efficacy of combination therapy. the results of the MTOPS study showed that both doxazosin and finasteride significantly reduced the risk of clinical progression of BPH compared to placebo; and the combination of doxazosin and finasteride further reduced the risk of clinical progression of BPH. Further analysis of the results revealed that when the prostate volume was greater than or equal to 25 ml, the combination therapy was significantly better than doxazosin or finasteride monotherapy in reducing the risk of clinical progression of BPH. 4. Chinese medicine and botanical preparations Chinese medicine has made an indelible contribution to the development of medicine and health in China as well as to the health of the Chinese nation. There are many kinds of Chinese herbal medicines applied in the clinical treatment of BPH, please refer to the recommendations of the Society of Traditional Chinese Medicine or Integrative Chinese and Western Medicine to carry out the treatment. Botanical preparations, such as Pulsatilla, have obtained certain clinical efficacy in relieving BPH-related lower urinary tract symptoms and have achieved wider clinical application both at home and abroad. Since the components of Chinese medicine and botanical preparations are complex and their specific biological mechanisms of action have not been elucidated, active basic research on various drugs including Chinese medicine is beneficial to further consolidate the international status of Chinese medicine and botanical preparations. Meanwhile, large-scale randomized controlled clinical studies based on the principles of circulatory medicine are of positive significance to further promote the clinical application of herbal and botanical preparations in the treatment of BPH.