From the Guidelines
Benign Prostatic Hyperplasia (BPH) treatment should prioritize a combination of alpha-blockers and 5-alpha reductase inhibitors for patients with moderate to severe symptoms, as this approach has been shown to be effective in reducing symptoms and improving quality of life 1.
Treatment Options
- Watchful waiting for mild symptoms
- Medications, including:
- Alpha-blockers like tamsulosin (0.4 mg daily) for quicker symptom relief
- 5-alpha reductase inhibitors such as finasteride (5 mg daily) or dutasteride (0.5 mg daily) to shrink the prostate over 3-6 months
- Combination therapy with both medication types for larger prostates
- Lifestyle modifications, including:
- Limiting fluid intake before bedtime
- Reducing alcohol and caffeine consumption
- Avoiding medications that worsen urinary symptoms like decongestants
Surgical Interventions
- Minimally invasive procedures like transurethral resection of the prostate (TURP) or newer techniques such as UroLift for severe symptoms or medication failure
- Surgical intervention is an appropriate treatment option for patients with moderate-to-severe LUTS and for patients who have developed acute urinary retention or other BPH-related complications 1
Diagnostic Tests
- Serum PSA measurement and ultrasound can predict the natural history and progression of LUTS and BPH, as well as the therapeutic response to 5 alpha-reductase inhibitors 1
- Pressure-flow urodynamic study can directly measure the relative contribution of the bladder and bladder outlet and the contributions of the prostate to lower urinary tract function, dysfunction or symptoms, but is not indicated to predict the response to medical therapy 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.
BPH Treatment: Finasteride is indicated for the treatment of symptomatic Benign Prostatic Hyperplasia (BPH) in men with an enlarged prostate. The treatment aims to improve symptoms, reduce the risk of acute urinary retention, and reduce the risk of the need for surgery. 2
From the Research
Benign Prostatic Hyperplasia (BPH) Overview
- BPH is a common condition that increases in prevalence with age 3
- Symptoms of BPH include frequent urination, urgent tenesmus and urination at night, a weak and interrupted urine flow, and a sense of incomplete emptying of the bladder 4
Diagnosis and Management of BPH
- A history should include onset, duration, and severity of lower urinary tract symptoms and medication use to rule out other causes of symptoms 3
- Physical examination includes a digital rectal examination and assessment for bladder distention or neurologic impairment 3
- Recommended tests include serum prostate-specific antigen measurement and urinalysis to help identify infection, genitourinary cancer, or calculi as an alternative cause of lower urinary tract symptoms 3
- BPH severity is assessed using validated, self-administered symptom questionnaires such as the American Urological Association Symptom Index or International Prostate Symptom Score 3, 5
Treatment Options for BPH
- Alpha blockers are first-line medications for BPH 3
- Combination therapy with alpha(1)-adrenergic-receptor antagonists and 5 alpha-reductase inhibitors is beneficial in the treatment of BPH and the associated symptoms 5, 6
- Surgical referral is indicated if BPH-related complications develop, medical therapy fails, or the patient chooses it 3
- Lifestyle modifications and medications are used to manage bothersome symptoms 3
Interactions between Medications and Food
- Pharmacokinetics of extended-release forms of alfuzosin, doxazosin, tamsulosin, and silodosin is well known to be food-sensitive 4
- Alpha-1 adrenergic receptor antagonists are known to interact with alcohol, leading to orthostatic hypotension 4
- Grapefruit juice and citrus fruits may intensify adverse effects of alpha-1 adrenergic receptor antagonists 4