From the Guidelines
Treatment for Benign Prostatic Hyperplasia (BPH) symptoms should be individualized based on symptom severity, prostate size, comorbidities, sexual function concerns, and patient preferences, with options including watchful waiting, medications such as alpha-blockers and 5-alpha reductase inhibitors, minimally invasive procedures, and surgery. For patients with BPH symptoms, the following treatment options are available:
- Watchful waiting with lifestyle modifications for mild symptoms
- Medications:
- Alpha-blockers (tamsulosin 0.4mg daily, alfuzosin 10mg daily, or silodosin 8mg daily) for rapid symptom relief
- 5-alpha reductase inhibitors (finasteride 5mg daily or dutasteride 0.5mg daily) to reduce prostate size
- Minimally invasive procedures:
- Transurethral resection of the prostate (TURP)
- Laser procedures (HoLEP, GreenLight)
- UroLift
- Rezum water vapor therapy
- Surgery: prostatectomy for very large prostates According to the most recent guideline 1, combination therapy with an alpha-blocker and a 5-alpha reductase inhibitor 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. The choice of treatment should be based on the patient's specific needs and circumstances, taking into account the potential benefits and risks of each option, as well as the patient's preferences and values. It is essential to consider the patient's overall health, including any comorbidities, and to discuss the potential impact of treatment on sexual function and quality of life. Ultimately, the goal of treatment is to alleviate symptoms, improve quality of life, and prevent complications, while minimizing the risk of adverse effects.
From the FDA Drug Label
Finasteride tablets USP are indicated for the treatment of symptomatic benign prostatic hyperplasia (BPH) in men with an enlarged prostate to: -Improve symptoms -Reduce the risk of the need for surgery including transurethral resection of the prostate (TURP) and prostatectomy.
Tamsulosin Hydrochloride Capsules 0.4 mg once daily is recommended as the dose for the treatment of the signs and symptoms of BPH.
The treatment options for patients presenting with Benign Prostatic Hyperplasia (BPH) symptoms include:
- Finasteride (PO): to improve symptoms and reduce the risk of surgery 2
- Tamsulosin (PO): to treat the signs and symptoms of BPH, with a recommended dose of 0.4 mg once daily 3 and 3
From the Research
Treatment Options for BPH Symptoms
The treatment options for patients presenting with Benign Prostatic Hyperplasia (BPH) symptoms include:
- Surgical procedures such as Transurethral Resection of the Prostate (TURP) or open prostatectomy, which are currently the most effective therapies for BPH 4
- Minimally invasive procedures, such as electrovaporisation, laser prostatectomy, transurethral needle ablation, high intensity focused ultrasound, transurethral microwave therapy, and insertion of prostatic stents, which can be performed instead of standard surgical procedures 4
- Medical therapy, which is becoming increasingly important in the treatment of patients with moderate symptoms of BPH, including:
- Androgen-suppressing therapy
- Alpha-adrenoceptor blockade, which can be administered once daily, such as terazosin, doxazosin, and tamsulosin 4, 5
- 5alpha-reductase inhibitors, such as finasteride and dutasteride, which decrease production of dihydrotestosterone within the prostate, resulting in decreased prostate volumes, increased peak urinary flow rates, and improvement of symptoms 6, 7
Considerations for Treatment
When considering treatment options for BPH symptoms, the following factors should be taken into account:
- Patient preference after being informed of the different options 4
- Prostate size, as finasteride is more effective in patients with larger prostates 4
- Presence of hypertension, as nonselective alpha-blockers may be preferable in hypertensive patients with BPH 4
- Potential side effects and interactions with other medications, as tamsulosin has been shown to be well-tolerated with minimal side effects 8
Efficacy of Treatment Options
The efficacy of different treatment options for BPH symptoms has been studied, with results showing:
- Combination therapy with dutasteride and tamsulosin offers significant improvements from baseline compared with either drug alone 6
- 5alpha-reductase inhibitors, such as finasteride and dutasteride, are effective in reducing prostate volume, improving lower urinary tract symptoms, and decreasing the risk of acute urinary retention and need for surgical intervention 7
- Alpha 1-adrenergic antagonists, such as tamsulosin, are effective in improving urinary symptoms and increasing peak urinary flow rates, with minimal side effects 8, 5