What is the best way to treat benign prostatic hyperplasia (BPH)?

From the Guidelines

The most effective approach to treating benign prostatic hyperplasia (BPH) is a combination of medical therapies, including alpha-blockers and 5-alpha reductase inhibitors, which can help improve symptoms and prevent disease progression. According to the American Urological Association (AUA) guidelines 1, 5-alpha reductase inhibitors (5-ARIs) such as finasteride and dutasteride are recommended for patients with LUTS/BPH and prostatic enlargement, as they can help reduce the size of the prostate and improve symptoms.

Some key points to consider when treating BPH include:

• The use of alpha-blockers such as tamsulosin, alfuzosin, and silodosin to relax prostate muscles and improve urine flow 1
• The use of 5-ARIs to shrink the prostate and prevent disease progression, particularly in patients with prostatic enlargement 1
• The importance of informing patients of the risks of sexual side effects and other uncommon physical side effects associated with 5-ARIs 1
• The consideration of combination therapy with alpha-blockers and 5-ARIs for patients with moderate to severe symptoms, as it may provide additional benefits in terms of symptom improvement and prevention of disease progression 1

It's also important to note that lifestyle changes, such as regular exercise, dietary modifications, and maintaining proper hydration, can help manage symptoms and improve overall prostate health [@Example@]. However, for moderate to severe symptoms, consultation with a healthcare provider is necessary to determine the best course of treatment, which may include minimally invasive procedures or surgery if lifestyle changes and medications prove insufficient.

From the FDA Drug Label

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.

Finasteride tablets administered in combination with the alpha-blocker doxazosin is indicated to reduce the risk of symptomatic progression of BPH

The best way to treat benign prostatic hyperplasia (BPH) is with finasteride to improve symptoms and reduce the risk of complications, or in combination with an alpha-blocker like doxazosin to reduce the risk of symptomatic progression of BPH 2. Alternatively, tamsulosin, an alpha-blocker, can be used to treat the signs and symptoms of BPH 3.

From the Research

Treatment Options for Benign Prostatic Hyperplasia (BPH)

The treatment of BPH can be managed through various methods, including:

• Lifestyle modification
• Smooth muscle relaxant alpha blocker therapy, which usually takes effect quickly within 3-5 days and has minimal side effects 4
• 5-alpha reductase inhibitor class, which works effectively to shrink prostate stroma resulting in improved voiding, especially in patients with larger prostates 4, 5
• Phosphodiesterase-5 (PDE-5) inhibitor class, which may be considered for treating BPH, with once daily 5 mg tadalafil shown to improve BPH-related symptoms 4

Combination Therapy

Combination therapy with alpha-blockers and 5alpha-reductase inhibitors may be more effective in relieving and preventing the progression of symptoms than either of the two drugs alone, especially in patients with larger glands and higher prostatic specific antigen values 6, 7

• The Medical Therapy of Prostatic Symptoms (MTOPS) study found that combination therapy with the alpha-blocker doxazosin and the 5alpha-reductase inhibitor finasteride was significantly more effective than either component alone in reducing BPH-related symptoms and lowering the rate of overall clinical progression 7
• Patients with an enlarged prostate, more severe symptoms, and higher PSA levels may benefit the most from combination therapy 7

Referral to a Urologist

Referral to a urologist can be considered for patients with:

• A rising prostate-specific antigen (PSA), especially while on 5-ARI
• Failure of urinary symptom control despite maximal medical therapy
• Suspicion of prostate cancer
• Hematuria
• Recurrent urinary infections
• Urinary retention
• Renal failure 4