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We aimed to investigate the difference in efficacy of medical treatment of symptomatic benign prostatic hyperplasia (BPH) between normal and obese patients with BPH; obesity was determined by either body mass index (BMI) or waist circumference (WC).In this 12-week prospective observational study,a total of 175 patients aged >,40 years with International Prostate Symptom Scores (IPSS))12 points and prostate volume ≧20ml were prospectively enrolled.The patients were divided into two groups according to BMI orWC.Patients received the doxazosin gastrointestinal therapeutic system (GITS) at a dose of 4 mg once per day for 12 weeks.The changes from baseline in the IPSS,maximal urinary flow rate (Qmax),post-void residual volume,quality of life (QoL) scores and adverse events (AEs) were analysed.Of the 175 enrolled patients,132 completed the study.Sixty-seven patients had BMI >23kg m-2,and 43 had WC>90 cm.Obese patients represented by WC>90 cm or BMI≧23kg m-2 had a significantly greater prostate volume compared with non-obese patients at baseline.Total IPSS was significantly higher in the WC >90 cm group compared to the WC≦90 cm group.Total IPSS was positively correlated with prostate volume (P=0.031) and WC (P=0.045).All groups showed significant improvements in total I PSS and QoL at 12 weeks.However,the improvement of total IPSS was greater in the high-BMI and high-WC groups.The most frequent AE was dizziness (n=13),and it was significantly lower in the obese BPH patients.Obesity was associated with increased prostate volume and lower urinary tract symptoms.Alpha-blockers appear to be efficacious for controlling symptoms,especially in obese men.