Combination Therapy with Tamsulosin and Finasteride for BPH
Yes, combination therapy with tamsulosin (Flomax) and finasteride is recommended for patients with enlarged prostates (>30cc) and moderate-to-severe BPH symptoms, as it provides superior outcomes in reducing disease progression compared to either medication alone. 1, 2
Rationale for Combination Therapy
Combination therapy offers several advantages over monotherapy:
- Reduces risk of BPH progression by 67% compared to 34% with finasteride alone and 39% with alpha blockers alone 2
- Decreases symptom score progression by 64% compared to placebo, which is superior to finasteride (30%) or alpha blockers (46%) alone 2
- Provides complementary mechanisms of action:
- Tamsulosin: Rapid symptom relief through alpha-1 receptor blockade
- Finasteride: Long-term prostate volume reduction (20-30%) and disease modification 1
Patient Selection Criteria
Combination therapy is most appropriate for patients with:
- Prostate volume >30cc (finasteride is ineffective for smaller prostates) 3
- PSA >1.5ng/mL (indicates sufficient prostate volume) 3
- Moderate-to-severe symptoms (IPSS score ≥8) 1
- Risk factors for disease progression (larger prostate, higher PSA) 3
Expected Outcomes
With combination therapy, patients can expect:
- Greater symptom improvement (-7.4 points on IPSS) compared to finasteride (-5.6) or tamsulosin (-6.6) alone 2
- 67% reduction in acute urinary retention risk 2
- 64% reduction in need for BPH-related surgery 2
- Prostate volume reduction of 20-30% over 6 months 1
Important Monitoring Considerations
- PSA monitoring: Finasteride reduces PSA by approximately 50%; double measured PSA values after 1 year of therapy 3
- Evaluate patients at 4-12 weeks initially to assess symptom improvement and side effects 1
- Follow-up at 3-6 months to evaluate efficacy with IPSS score, uroflowmetry, and post-void residual 1
Side Effect Management
Be aware of potential side effects:
- Tamsulosin: Orthostatic hypotension, dizziness, ejaculatory dysfunction, nasal congestion 4
- Finasteride: Sexual dysfunction (decreased libido, ejaculation disorders, impotence) in 2-3% of patients, gynaecomastia (0.4%) 5
- Combination therapy: Higher overall side effect profile than either medication alone 6
Clinical Pearls
- Delayed onset of finasteride effect: Counsel patients that finasteride benefits may take 3-6 months to become apparent 3
- Long-term therapy required: Prostate regrowth occurs upon discontinuation 7
- Surgical preparation: Consider finasteride before TURP to reduce intraoperative bleeding 3
- Post-void dribbling management: Recommend pelvic floor exercises and urethral milking technique 1
Combination therapy with tamsulosin and finasteride represents an evidence-based approach for BPH management that addresses both immediate symptom relief and long-term disease modification, particularly in patients with enlarged prostates and moderate-to-severe symptoms.