From the Guidelines
To reduce benign prostatic hyperplasia (BPH) size, a combination of 5-alpha reductase inhibitors (5-ARIs) and alpha blockers is the most effective approach, with 5-ARIs such as finasteride or dutasteride reducing prostate size by about 25% over 6-12 months, as supported by the American Urological Association (AUA) guideline 1. The AUA guideline recommends offering 5-ARI in combination with an alpha blocker 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. Key points to consider when treating BPH include:
- 5-ARIs, such as finasteride and dutasteride, inhibit the conversion of testosterone to dihydrotestosterone (DHT), leading to a reduction in prostate size and improvement in symptoms 1
- Alpha blockers, such as tamsulosin, provide symptom relief by relaxing the muscles in the prostate and bladder neck, improving urine flow 1
- Combination therapy with 5-ARIs and alpha blockers has been shown to be effective in reducing clinical progression of BPH, including a decrease in the risk of acute urinary retention and the need for surgical intervention 1
- Lifestyle changes, such as maintaining a healthy weight, exercising regularly, and limiting fluid intake before bedtime, can also help alleviate symptoms of BPH 1
- Regular prostate exams are essential to monitor for prostate cancer, as BPH can sometimes be a precursor to cancer 1 The most effective treatment approach will depend on the individual patient's symptoms, prostate size, and PSA level, and should be guided by the AUA guideline recommendations 1.
From the FDA Drug Label
Dutasteride capsules 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 (AUR), and reduce the risk of the need for BPH-related surgery. 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 best way to reduce benign prostatic hyperplasia (BPH) size is to use medications such as dutasteride or finasteride, which are indicated to improve symptoms and reduce the risk of BPH-related surgery 2 3. These medications work by inhibiting the production of dihydrotestosterone (DHT), a hormone that contributes to the growth of the prostate gland. However, the exact effect on prostate size reduction is not explicitly stated in the provided drug labels.
From the Research
Reducing Benign Prostatic Hyperplasia (BPH) Size
To reduce BPH size, several treatment options are available, including:
- Lifestyle modification
- Smooth muscle relaxant alpha blocker therapy, which can take effect quickly within 3-5 days and have minimal side effects 4
- 5-alpha reductase inhibitor class, which can effectively shrink prostate stroma resulting in improved voiding, reduce the need for future BPH-related surgery, and reduce the risk of future urinary retention 4, 5, 6, 7, 8
- Phosphodiesterase-5 (PDE-5) inhibitor class, which may improve BPH-related symptoms 4
Treatment Options
The following treatment options are available to reduce BPH size:
- Alpha blockers, such as tamsulosin, alfusosin, and silodosin, which can improve symptoms and flow rate by inducing relaxation of the smooth muscle neck and prostate area 4, 6, 7
- 5-alpha reductase inhibitors, such as finasteride and dutasteride, which can improve symptoms and flow rate by shrinking the transition zone of the prostate through hormonal mechanisms 4, 5, 6, 7, 8
- Combination therapy with alpha blockers and 5-alpha reductase inhibitors, which may be more effective in relieving and preventing the progression of symptoms than either of the two drugs alone, especially for patients with larger glands and higher prostatic specific antigen values 7
Benefits of 5-Alpha Reductase Inhibitors
The benefits of 5-alpha reductase inhibitors include: