From the Guidelines
Prostafence is not a recommended treatment for benign prostatic hyperplasia (BPH) as it lacks sufficient scientific evidence supporting its effectiveness. For BPH management, established treatments include alpha-blockers like tamsulosin (0.4 mg daily) or alfuzosin (10 mg daily), which relax prostate muscles to improve urine flow, typically showing results within 1-2 weeks 1. 5-alpha reductase inhibitors such as finasteride (5 mg daily) or dutasteride (0.5 mg daily) reduce prostate size over 3-6 months by blocking testosterone conversion. For moderate symptoms, combination therapy using both medication classes may be more effective, particularly in patients with demonstrable prostatic enlargement 1. Lifestyle modifications like limiting evening fluids, avoiding caffeine and alcohol, and scheduled voiding can help manage symptoms. Severe cases may require minimally invasive procedures like TURP or newer options such as UroLift or Rezum. Patients should consult healthcare providers for proper diagnosis and personalized treatment plans, as BPH symptoms can mimic other conditions including prostate cancer, which requires different management approaches.
Treatment Options
- Alpha-blockers: tamsulosin, alfuzosin, silodosin, terazosin
- 5-alpha reductase inhibitors: finasteride, dutasteride
- Combination therapy: alpha-blocker + 5-alpha reductase inhibitor
- Minimally invasive procedures: TURP, UroLift, Rezum
- Lifestyle modifications: limiting evening fluids, avoiding caffeine and alcohol, scheduled voiding
Diagnostic Tests
- Serum PSA measurement
- Ultrasound
- Uroflowmetry
- Pressure-flow urodynamic studies (optional)
- Urethrocystoscopy (optional)
- Transrectal or transabdominal prostate ultrasound (optional)
Important Considerations
- Patients with LUTS should be evaluated for other conditions that may cause similar symptoms, such as prostate cancer 1.
- The choice of treatment should be based on patient age, comorbidities, and different adverse event profiles 1.
- Combination therapy should only be offered to patients with LUTS associated with demonstrable prostatic enlargement 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 treatment approach for prostate health issues, such as Benign Prostatic Hyperplasia (BPH), when considering Prostafence (which is not directly mentioned in the provided drug labels but can be inferred to be related to finasteride based on the context), involves the use of finasteride tablets to improve symptoms, reduce the risk of acute urinary retention, and reduce the need for surgery.
- Key benefits of finasteride tablets include:
- Improvement of BPH symptoms
- Reduction in the risk of acute urinary retention
- Reduction in the risk of needing BPH-related surgery
- Combination therapy with an alpha-blocker like doxazosin may be considered to reduce the risk of symptomatic progression of BPH. 2
From the Research
Treatment Approach for Prostate Health Issues
The treatment approach for prostate health issues, such as Benign Prostatic Hyperplasia (BPH), involves a combination of medical options.
- Medical options for treatment of symptomatic BPH include:
- 5alpha-reductase inhibitors, such as finasteride and dutasteride, which reduce prostate volume, improve lower urinary tract symptoms, increase peak urinary flow, and decrease the risk of acute urinary retention and need for surgical intervention 3, 4
- Alpha1-adrenergic antagonists, such as doxazocin, terazosin, tamsulosin, and alfuzosin, which relax the smooth muscle of the bladder neck and prostate, thereby decreasing the resistance to urine flow and increasing peak urinary flow and improving lower urinary tract symptoms 3
- Combination of a 5alpha-reductase inhibitor and a alpha1-adrenergic antagonist, which significantly reduces the clinical progression of BPH over either drug class alone 3, 5, 6, 7
Combination Therapy
Combination therapy using alpha-1 adrenergic receptor antagonists (ARAs) and 5-alpha reductase inhibitors (5-αRI) is a reasonable approach for patients with male LUTS/BPH who are at increased risk of disease progression or have incomplete response to monotherapies 5, 7.
- The results of combination therapy have been shown to be more effective than monotherapy in improving international prostate symptom score (IPSS), quality of life (QoL), post-residual urinary flow rate (PUF), and clinical progression 7
- Fixed dose combination (FDC) is also cost-effective and its side-effects profile resembles that of monotherapy 7
5-Alpha Reductase Inhibitors
5-alpha reductase inhibitors (5-ARIs) are a mainstay of BPH management, and have been demonstrated to decrease prostate volume, improve LUTS and urinary flow rates, which ultimately reduces the risk of AUR and BPH-related surgery 4, 5.
- Two 5-ARIs are currently available for the treatment of BPH: finasteride and dutasteride 4