From the Guidelines
Benign Prostatic Hyperplasia (BPH) treatment should prioritize a combination of alpha-blockers and 5-alpha reductase inhibitors for men with moderate to severe symptoms and enlarged prostates, as this approach has been shown to be more effective in reducing symptoms and preventing disease progression than either medication alone 1.
Symptoms of BPH
The symptoms of BPH can vary, but common symptoms include:
- Urinary frequency and urgency
- Weak or interrupted urine flow
- Straining to urinate
- Dribbling after urination
- Nocturia (waking up multiple times at night to urinate)
Treatment Options
Treatment options for BPH include:
- Watchful waiting: Monitoring symptoms and adjusting lifestyle habits to manage symptoms
- Medical therapy: Alpha-blockers (such as tamsulosin or alfuzosin) to relax the muscles in the prostate and bladder neck, and 5-alpha reductase inhibitors (such as finasteride or dutasteride) to shrink the prostate
- Minimally invasive therapies: Transurethral microwave heat treatments, transurethral needle ablation, and urethral stents
- Surgical therapies: Transurethral resection of the prostate (TURP), transurethral electrovaporization, and open prostatectomy
Lifestyle Modifications
Lifestyle modifications can help manage symptoms of BPH, including:
- Limiting fluid intake before bedtime
- Avoiding caffeine and alcohol
- Avoiding medications that can worsen symptoms (such as decongestants and antihistamines)
- Engaging in regular exercise and maintaining a healthy weight
Recent Guidelines
Recent guidelines from the American Urological Association (AUA) recommend that combination therapy with an alpha-blocker and a 5-alpha reductase inhibitor be offered as a treatment option to patients with LUTS associated with demonstrable prostatic enlargement, as judged by a prostate volume of >30cc on imaging, a PSA >1.5ng/mL, or palpable prostate enlargement on DRE 1.
Key Considerations
When treating BPH, it is essential to consider the individual patient's symptoms, prostate size, and overall health. Regular follow-up is crucial to monitor symptom progression and treatment efficacy. Additionally, patients should be informed about the potential benefits and risks of each treatment option, including the risk of sexual side effects with 5-alpha reductase inhibitors 1.
From the FDA Drug Label
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.
The symptoms of Benign Prostatic Hyperplasia (BPH) are not explicitly listed in the provided drug labels. However, the treatment options for BPH are mentioned, which include:
- Finasteride: a medication that can improve symptoms, reduce the risk of acute urinary retention, and reduce the risk of the need for surgery.
- Combination therapy with alpha-blocker: finasteride administered in combination with an alpha-blocker, such as doxazosin, can reduce the risk of symptomatic progression of BPH.
- Alpha-blocker: medications like alfuzosin can help relax the muscles in the prostate and bladder, lessening the symptoms of BPH and improving urine flow. Treatment options may include medications, such as finasteride and alpha-blockers, and surgery, such as transurethral resection of the prostate (TURP) and prostatectomy. 2 2 3
From the Research
Symptoms of Benign Prostatic Hyperplasia (BPH)
- Symptomatic BPH is a common condition in older men and has a significant impact on their daily lives 4, 5, 6
- Symptoms of BPH include obstructive voiding symptoms, such as decreased urinary flow and increased resistance to urine flow through the prostatic urethra 6
Treatment Options for BPH
- Transurethral resection of the prostate (TURP) or open prostatectomy are currently the most effective therapies for BPH, but TURP is associated with clinically significant adverse events in 20% of patients 4
- Minimally invasive procedures, such as electrovaporisation, laser prostatectomy, transurethral needle ablation, high intensity focused ultrasound, transurethral microwave therapy, and insertion of prostatic stents, can be performed instead of standard surgical procedures 4
- Medical therapy is becoming increasingly important in the treatment of patients with moderate symptoms of BPH, including:
- Combination therapy with 5-alpha-reductase inhibitors and alpha-blockers may be effective for treating BPH, especially in patients with larger prostates 8
- Selective alpha 1-adrenoceptor antagonists, such as terazosin, doxazosin, and tamsulosin, are well tolerated and effective in improving urinary flow and reducing symptoms 5, 7