BACKGROUND: We have considered trends in mortality from benign prostatic hyperplasia (BPH) over the last decades in Europe and, for comparative purposes, the USA and Japan. METHODS: Cancer death certification data for benign prostatic hyperplasia were derived from the World Health Organisation database. RESULTS: Between the early 1950s and the late 1990s, overall mortality from BPH in the European Union (EU) fell from 5.9 to 3.5 per million, and the decline since the late 1950s was over 96%. Comparable falls were observed in the USA and Japan, and BPH mortality rates in the late 1990s were lower than in the EU (1.8/10(6) in the USA, 1.4 in Japan). BPH mortality trends were downwards also in the Eastern Europe, although rates in the late 1990s were about fourfold higher than in the EU. CONCLUSION: BPH rates have been steadily declining in developed countries. The excess BPH mortality in Eastern Europe indicates the scope for further reduction too.