What are the causes and treatment options for borderline prostatomegaly?

From the Guidelines

Borderline prostatomegaly treatment should prioritize lifestyle modifications and medication, with combination therapy considered for patients with demonstrable prostatic enlargement, as recommended by the most recent guidelines 1. The main causes of borderline prostatomegaly include age-related hormonal changes, genetic factors, metabolic syndrome, obesity, and inflammatory processes.

• Treatment options depend on symptom severity and may not be necessary if the condition is asymptomatic.
• For mild symptoms, lifestyle modifications are recommended first, including:
  • Reducing fluid intake before bedtime
  • Limiting alcohol and caffeine
  • Performing pelvic floor exercises
• Medication options include:
  • Alpha-blockers like tamsulosin (0.4 mg daily) to relax prostate muscles and improve urine flow
  • 5-alpha-reductase inhibitors such as finasteride (5 mg daily) or dutasteride (0.5 mg daily) to shrink the prostate by blocking testosterone conversion
• Combination therapy, specifically 5-ARI in combination with an alpha blocker, should be offered as a treatment option only 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 1.
• Regular monitoring through annual prostate exams is important as borderline prostatomegaly can progress to more significant enlargement over time.
• Patients should discuss any urinary symptoms with their doctor promptly, as these could indicate progression requiring treatment adjustment. The most recent guidelines from 2021 provide the strongest evidence for treatment recommendations, superseding earlier guidelines from 2003 1.

From the FDA Drug Label

In A Long-Term Efficacy and Safety Study, efficacy was also assessed by evaluating treatment failures Treatment failure was prospectively defined as BPH-related urological events or clinical deterioration, lack of improvement and/or the need for alternative therapy. BPH-related urological events were defined as urological surgical intervention and acute urinary retention requiring catheterization.

The causes of borderline prostatomegaly are not directly addressed in the provided drug labels. However, the treatment options for borderline prostatomegaly, which is related to Benign Prostatic Hyperplasia (BPH), include:

• Finasteride tablets: which have been shown to improve symptoms of BPH, reduce the risk of acute urinary retention, and decrease the need for BPH-related surgery 2.
• The improvement in BPH symptoms was seen during the first year and maintained throughout an additional 5 years of open extension studies.
• Key benefits of finasteride tablets include:
  • Reduction in symptom score
  • Decrease in prostate volume
  • Increase in maximum urinary flow rate
  • Lower risk of acute urinary retention and BPH-related surgery It is essential to consult a healthcare professional for proper diagnosis and treatment of borderline prostatomegaly.

From the Research

Causes of Borderline Prostatomegaly

• Benign prostatic hyperplasia (BPH) is a frequent cause of lower urinary tract symptoms, urinary tract infection, and acute urinary retention requiring surgical intervention 3
• The development of BPH is driven by the androgen dihydrotestosterone (DHT), which is formed from testosterone under the influence of 5-alpha reductase 4
• Stromal and epithelial hyperplasia in the region of the prostate that surrounds the urethra begins in the fourth decade of life and by the sixth decade, the prevalence is 50% 3

Treatment Options for Borderline Prostatomegaly

• Medical options for treatment of symptomatic BPH include:
  • 5alpha-reductase inhibitors (finasteride and dutasteride) 3, 5, 4
  • Alpha1-adrenergic antagonists (doxazocin, terazosin, tamsulosin, and alfuzosin) 3, 5
  • Combination of a 5alpha-reductase inhibitor and a alpha1-adrenergic antagonist 3, 6
• Watchful waiting is recommended for patients with BPH whose clinical symptoms do not affect their quality of life 7
• Surgery is considered for patients with severe obstructive symptoms who have not benefited from medical therapy or who prefer surgery as first-line treatment 7
• Long-term combination therapy with alpha-blocker and 5-alpha reductase inhibitor can suppress the progression of BPH more efficiently than alpha-blocker monotherapy 6