The BPH Treatment Outcomes Pilot Study (BTOPS) is a four-center pilot study to determine the feasibility of a large twelve-center technology assessment network jointly planned by the American Urological Association and the Agency for Health Care Policy and Research's Patient Outcomes Research Team on Prostatic Diseases. The twelve-center technology assessment network envisioned for the future would compare the effectiveness of new treatment strategies for benign prostatic hyperplasia with standard treatment strategies already available in clinical practice. Outcome measures would include BPH symptom severity measured with the AUA Symptom Index, and non- invasive measures of the severity of disease from a physiologic perspective, including peak urinary flow rates and post void residual volumes. The design of the study would involve ongoing randomization of patients to standard and new treatment technologies with long-term follow- up for the determination of patient outcomes. The pilot study is designed to streamline the protocol for the main study, to develop final versions of data forms and an operations manual, and to determine whether patients are willing to be randomized at a rate sufficiently high to allow the main study to be completed efficiently. In addition, BTOPS data will be used to further validate the outcome measures for the full-scale study. The BTOPS timeline calls for randomization of 100 patients at the four centers over calendar year 1991. Patients will be randomized to the following treatment strategies: transurethral prostatectomy, expectant management ("watchful waiting"), the alpha adrenergic blocker terazosin, and balloon dilation. This project, and the main technology assessment trial that will follow, should provide critical information necessary for the development of sound guidelines for the optimal treatment of this common disease, which results in over 400,000 major operations annually in Medicare-age men.