From the Guidelines
Tamsulosin is generally preferred as the initial treatment for Benign Prostatic Hyperplasia (BPH) over finasteride. Tamsulosin, an alpha-1 blocker, provides faster symptom relief (usually within days to weeks) by relaxing the smooth muscles in the prostate and bladder neck, improving urine flow. The typical dosage is 0.4 mg once daily, taken approximately 30 minutes after the same meal each day. Finasteride, a 5-alpha reductase inhibitor, works more slowly (3-6 months for full effect) by shrinking the prostate gland through hormonal mechanisms. Tamsulosin is particularly beneficial for patients with moderate to severe symptoms who need quick relief. However, finasteride may be more appropriate for men with significantly enlarged prostates (>40 grams) or elevated PSA levels, as it can reduce prostate size by about 20-30% over time. For men with severe symptoms or very large prostates, combination therapy with both medications might be recommended, as suggested by the 2021 AUA guideline 1. Side effects differ between the medications: tamsulosin commonly causes ejaculatory dysfunction and orthostatic hypotension, while finasteride may cause sexual side effects and requires at least 6 months of use before determining effectiveness.
Some key points to consider when choosing between tamsulosin and finasteride include:
- The patient's symptom severity and need for quick relief
- The size of the prostate gland and PSA levels
- The potential side effects of each medication
- The patient's overall health and medical history
According to the 2021 AUA guideline 1, combination therapy with an alpha blocker and a 5-ARI should be offered 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. This guideline provides strong evidence for the use of combination therapy in select patients, and should be considered when making treatment decisions.
From the Research
Treatment Options for Benign Prostatic Hyperplasia (BPH)
- The choice between Tamsulosin and Finasteride as the first-line treatment for BPH depends on various factors, including the patient's symptoms, prostate size, and overall health.
- According to a study published in 2017 2, Tamsulosin monotherapy and combination therapy with Finasteride appear to be equally effective in treating lower urinary tract symptoms (LUTS) associated with BPH, while Finasteride monotherapy is less effective.
- Another study from 2016 3 suggests that alpha-blockers, such as Tamsulosin, represent the first-line treatment for most men with BPH, with the primary objective of relieving bothersome LUTS.
Comparison of Tamsulosin and Finasteride
- A study published in 2015 4 found that combination therapy with Tamsulosin and Finasteride is more effective than monotherapy with Tamsulosin in decreasing irritative and obstructive symptoms in patients with BPH.
- However, the same study noted that combination therapy is associated with more side effects than monotherapy.
- A review of alpha-blocker therapy for BPH published in 2007 5 highlights the effectiveness and tolerability of Tamsulosin in relieving LUTS, with comparable dose-dependent effectiveness to other alpha-blockers.
Patient Profile and Treatment Choice
- A study from 2006 6 emphasizes the importance of considering individual patient profiles and treatment goals when choosing a first-line treatment for BPH.
- The study suggests that treatment goals should include reducing LUTS and relieving associated morbidities, and that the decision should be made in consultation with the patient and their urologist.
- Another review from 2016 3 supports the use of alpha-blockers as a first-line treatment for most men with BPH, with the primary objective of relieving bothersome LUTS.