From the Guidelines
Tamsulosin is generally better for quick symptom relief in patients with BPH, while finasteride is more effective for long-term reduction of prostate size and prevention of clinical progression, particularly in men with significantly enlarged prostates (>30cc or PSA >1.5ng/mL) 1.
Comparison of Tamsulosin and Finasteride
Both tamsulosin and finasteride are effective treatments for benign prostatic hyperplasia (BPH), but they have different mechanisms of action and may be better suited for different patient populations.
- Tamsulosin is an alpha-blocker that relaxes smooth muscles in the prostate and bladder neck, improving urine flow and providing quick symptom relief within days to weeks 1.
- Finasteride, on the other hand, is a 5-alpha-reductase inhibitor (5-ARI) that blocks the conversion of testosterone to dihydrotestosterone, leading to a reduction in prostate size and a decrease in the risk of clinical progression, including acute urinary retention, urinary tract infections, and the need for surgical intervention 1.
Key Considerations
When choosing between tamsulosin and finasteride, several factors should be considered, including:
- Prostate size: Finasteride is more effective in men with significantly enlarged prostates (>30cc or PSA >1.5ng/mL) 1.
- Symptom severity: Tamsulosin may be preferred for patients with severe symptoms who require quick relief, while finasteride may be better suited for patients with moderate symptoms who can tolerate a slower onset of action 1.
- Side effects: Tamsulosin can cause dizziness, retrograde ejaculation, and orthostatic hypotension, while finasteride may lead to sexual dysfunction, decreased libido, and rarely gynecomastia 1.
Treatment Recommendations
Based on the most recent and highest quality evidence, finasteride is recommended for patients with BPH who have significantly enlarged prostates (>30cc or PSA >1.5ng/mL) and are willing to tolerate a slower onset of action, while tamsulosin is recommended for patients who require quick symptom relief and have smaller prostates 1. In some cases, combination therapy with both tamsulosin and finasteride may be considered, particularly for patients with moderate to severe BPH who have not responded adequately to monotherapy 1. Regular follow-up with a healthcare provider is essential to monitor the effectiveness of treatment and adjust the therapeutic plan as needed.
From the Research
Comparison of Tamsulosin and Finasteride for BPH
- Tamsulosin is a subtype-selective alpha(1A)- and alpha(1D )-adrenoceptor antagonist that has been shown to be effective in improving maximal urine flow and alleviating lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH) 2.
- Finasteride, a potent 5 alpha-reductase inhibitor, has also been shown to be effective in improving LUTS and reducing prostate size, but its efficacy is dependent on prostate size and may take 6-12 months to achieve maximum benefits 3.
- A systematic review of 14 studies involving 4,122 subjects found that tamsulosin improved symptoms and peak urine flow relative to placebo, with a weighted mean difference of -1.1 points for the Boyarsky symptom score and 1.1 mL/sec for peak urine flow 4.
- A cost and effectiveness analysis of treatments for BPH found that tamsulosin combined with finasteride was the better pharmaceutical option for BPH patients, and that transurethral 2 micron laser resection of the prostate was a safe and effective surgery with lower costs than pharmaceuticals 5.
- The latest pharmacotherapy options for BPH include silodosin, tadalafil, and mirabegron, which have shown promising results in improving LUTS and targeting specific symptoms such as erectile dysfunction and detrusor overactivity 6.
Efficacy and Safety of Tamsulosin and Finasteride
- Tamsulosin has been shown to be effective in improving LUTS and peak urine flow, with a rapid onset of action and minimal effects on blood pressure 2, 4.
- Finasteride has been shown to be effective in improving LUTS and reducing prostate size, but its efficacy is dependent on prostate size and may take 6-12 months to achieve maximum benefits 3.
- Tamsulosin has been associated with adverse events such as dizziness, abnormal ejaculation, and hypotension, but these events are generally mild and well-tolerated 2, 4.
- Finasteride has been associated with adverse events such as decreased libido, erectile dysfunction, and gynecomastia, but these events are generally rare and reversible 3.