What are the symptoms and treatment options for Benign Prostatic Hyperplasia (BPH)?

From the Guidelines

Benign Prostatic Hyperplasia (BPH) can be effectively managed through a combination of lifestyle changes and medical treatments, with the most recent and highest quality study 1 recommending a combination of alpha-blockers and 5-alpha reductase inhibitors for patients with LUTS associated with demonstrable prostatic enlargement. The symptoms of BPH include:

• Urinary frequency and urgency
• Weak or interrupted urine flow
• Straining to urinate
• Nocturia (waking up to urinate during the night)
• Painful urination The treatment options for BPH include:
• Lifestyle modifications: limiting fluid intake before bedtime, avoiding caffeine and alcohol, and practicing double voiding
• Alpha-blockers (e.g., tamsulosin 0.4 mg daily) to relax prostate muscles and improve urine flow
• 5-alpha reductase inhibitors (e.g., finasteride 5 mg daily) to shrink the prostate over time
• Combination therapy with alpha-blockers and 5-alpha reductase inhibitors for patients with LUTS associated with demonstrable prostatic enlargement, as recommended by the 2021 AUA guideline 1
• Minimally invasive procedures or surgery for severe cases, with surgical treatment being the best option for patients who have developed complications of BPH, as stated in the 2003 AUA guideline 1 The recommended approach is to start with lifestyle changes and alpha-blockers, adding 5-alpha reductase inhibitors if symptoms persist, as this combination provides comprehensive relief for most men with BPH, according to the study by 1. Some key points to consider when managing BPH include:
• Patients with mild symptoms or moderate to severe symptoms without bother may not benefit from therapy, as the risks of medical therapy outweigh the benefits of symptom improvement in this group of men, as stated in the 2003 AUA guideline 1
• Patients with bothersome moderate to severe symptoms should be offered treatment options, including watchful waiting, medical, minimally invasive, or surgical therapies, as recommended by the 2003 AUA guideline 1
• The benefits and harms of all therapeutic interventions should be discussed with the patient, using the Simplified Outcomes Tables presented in Appendix 1-C of the 2003 AUA guideline 1
• Optional diagnostic tests, such as pressure-flow urodynamic studies, urethrocystoscopy, and ultrasound, may be considered for patients who choose invasive therapy, as stated in the 2003 AUA guideline 1

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.

The symptoms of Benign Prostatic Hyperplasia (BPH) are not explicitly listed in the provided drug labels, but the treatment options include:

• Monotherapy: Finasteride tablets to improve symptoms, reduce the risk of acute urinary retention, and reduce the risk of the need for surgery.
• Combination therapy: Finasteride tablets administered in combination with the alpha-blocker doxazosin to reduce the risk of symptomatic progression of BPH.
• Tamsulosin Hydrochloride Capsules: 0.4 mg once daily is recommended as the dose for the treatment of the signs and symptoms of BPH. Treatment options may include surgery, such as transurethral resection of the prostate (TURP) and prostatectomy, but this is not a medication-based treatment. 2 2 3

From the Research

Symptoms of Benign Prostatic Hyperplasia (BPH)

• Lower urinary tract symptoms (LUTS) such as weak urine flow, frequent urination, and difficulty starting urination 4, 5, 6
• Acute urinary retention (AUR) and the need for surgery in severe cases 4
• Bothersome storage symptoms such as urgency and nocturia 6

Treatment Options for BPH

• Watchful waiting for patients with mild symptoms 6, 7
• Medical therapy with alpha-blockers (e.g. tamsulosin) and 5alpha-reductase inhibitors (5ARIs) (e.g. dutasteride) for patients with mild-moderate symptoms 4, 5, 6, 8
• Combination therapy with dutasteride and tamsulosin for patients with moderate-to-severe symptoms 4, 8
• Surgery (e.g. transurethral resection of the prostate) for patients who failed medication or conservative management and who have moderate-severe symptoms, and/or complications of BPH which require surgery 6, 7
• Transurethral microwave thermotherapy as a non-surgical treatment option for patients who prefer to avoid surgery or who no longer respond favourably to medication 7

Efficacy and Safety of Treatment Options

• Tamsulosin has been shown to be effective in improving LUTS and has a low risk of hypotensive effects 5
• Combination therapy with dutasteride and tamsulosin has been shown to be highly efficacious in patients with moderate-to-severe LUTS and can be safely tolerated for ≥ 4 years 8
• Alpha(1)-adrenoceptor antagonists (e.g. tamsulosin) have been shown to improve both voiding and storage symptoms and have a considerable impact on quality of life 6