From the Guidelines
Treatment for benign prostatic hyperplasia (BPH) should start with alpha-blockers, such as alfuzosin, doxazosin, silodosin, tamsulosin, or terazosin, as they are effective in relieving moderate to severe lower urinary tract symptoms (LUTS) (1).
Medical Management
The choice of alpha-blocker should be based on patient age and comorbidities, considering their adverse event profiles, such as ejaculatory dysfunction and changes in blood pressure (1).
- Alpha-blockers are relatively equally effective in terms of improving the International Prostate Symptom Score (IPSS).
- For larger prostates, 5-alpha reductase inhibitors like finasteride or dutasteride can be used to shrink the prostate over 3-6 months (1, 1).
- Combination therapy with both an alpha-blocker and 5-alpha reductase inhibitor is often more effective for moderate to severe symptoms.
Surgical Interventions
For patients not responding to medications, minimally invasive procedures include:
- Transurethral resection of the prostate (TURP)
- Laser therapies
- Prostatic urethral lift (UroLift)
- Water vapor therapy (Rezūm) Treatment choice depends on prostate size, symptom severity, comorbidities, and patient preference (1, 1, 1, 1).
Additional Considerations
- Patients with overactive bladder symptoms alongside BPH may benefit from anticholinergics or beta-3 agonists like mirabegron.
- The patient's quality of life, morbidity, and mortality risk should be considered when selecting a treatment option.
From the FDA Drug Label
1.1 Monotherapy Finasteride tablets are indicated for the treatment of symptomatic benign prostatic hyperplasia (BPH) in men with an enlarged prostate to:
- Improve symptoms
- Reduce the risk of acute urinary retention
- Reduce the risk of the need for surgery including transurethral resection of the prostate (TURP) and prostatectomy.
Treatment for BPH: Finasteride is indicated for the treatment of symptomatic benign prostatic hyperplasia (BPH) in men with an enlarged prostate. The goals of treatment with finasteride include:
- Improving symptoms
- Reducing the risk of acute urinary retention
- Reducing the risk of the need for surgery 2
From the Research
Treatment Options for BPH
- Alpha-blockers are a first-line treatment for benign prostatic hyperplasia (BPH), aiming to relieve lower urinary tract symptoms (LUTS) 3, 4, 5
- There are several alpha-blockers available, including terazosin, doxazosin, tamsulosin, and alfuzosin, which have comparable dose-dependent effectiveness 5
- Tamsulosin is considered a highly convenient and efficacious way to treat LUTS with a low cardiovascular safety risk 4
Combination Therapies
- Combination therapy with 5-alpha reductase inhibitors (5-ARIs) and alpha-blockers is considered a gold standard intervention for medical management of LUTS/BPH 6, 7
- The alpha-blocker + 5-ARI combination is ideal for enlarged prostates, reducing clinical progression risk compared to monotherapy 6
- Combination therapy with phosphodiesterase-5 (PDE5) inhibitors and alpha-blockers may be beneficial for men with concomitant erectile dysfunction 6