From the Guidelines
Benign Prostatic Hyperplasia (BPH) can be effectively managed through a combination of lifestyle changes and medical treatments, with the goal of improving symptoms and preventing disease progression, as recommended by the most recent guidelines 1.
Symptoms of BPH
The symptoms of BPH include weak stream, frequency, urgency, and nighttime urination, which occur due to the compression of the urethra by the enlarged prostate.
- These symptoms can significantly impact a patient's quality of life, making it essential to initiate treatment promptly.
- The symptoms are often assessed using the International Prostate Symptom Score (IPSS), which helps guide treatment decisions.
Treatment Options
Treatment options for BPH include:
- Lifestyle modifications, such as reducing fluid intake before bedtime, limiting alcohol and caffeine consumption, and practicing double voiding.
- Medications, including alpha-blockers like tamsulosin (0.4mg daily) or alfuzosin (10mg daily), which relax prostate muscles and provide quick symptom relief.
- 5-alpha reductase inhibitors, such as finasteride (5mg daily) or dutasteride (0.5mg daily), which can shrink the prostate over 3-6 months and are recommended for patients with prostatic enlargement as judged by a prostate volume of >30cc on imaging, a prostate-specific antigen (PSA) > 1.5ng/mL, or palpable prostate enlargement on digital rectal exam (DRE) 1.
- Combination therapy using both alpha-blockers and 5-alpha reductase inhibitors may be more effective for moderate to severe symptoms, especially in patients with a prostate volume of >30cc on imaging, a PSA > 1.5ng/mL, or palpable prostate enlargement on DRE 1.
- Minimally invasive procedures, such as transurethral resection of the prostate (TURP) or newer laser therapies, can provide long-term relief for men who do not respond to medications.
Recent Guidelines
The most recent guidelines from 2021 recommend the use of 5-alpha reductase inhibitors alone or in combination with alpha blockers to prevent progression of LUTS/BPH and reduce the risks of urinary retention and need for future prostate-related surgery 1.
- These guidelines also emphasize the importance of informing patients of the risks of sexual side effects and certain uncommon physical side effects associated with 5-alpha reductase inhibitors.
- The guidelines suggest that combination therapy with an alpha blocker and a 5-alpha reductase inhibitor 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.
From the FDA Drug Label
1.1 Monotherapy 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 symptoms of Benign Prostatic Hyperplasia (BPH) are not explicitly listed in the provided drug labels, but the treatment options include:
- Monotherapy with finasteride to improve symptoms, reduce the risk of acute urinary retention, and reduce the risk of the need for surgery 2
- Combination therapy with finasteride and an alpha-blocker (doxazosin) to reduce the risk of symptomatic progression of BPH 2
- Tamsulosin to treat the signs and symptoms of BPH, with a recommended dose of 0.4 mg once daily 3
From the Research
Symptoms of Benign Prostatic Hyperplasia (BPH)
- Weak urine stream and hesitancy are the cardinal obstructive features in BPH 4
- Other signs and symptoms include:
- Inability to terminate micturition abruptly
- Sensation of incomplete emptying
- Occasionally, urinary retention 4
- Lower urinary tract symptoms (LUTS) may be a sign of aging rather than a consequence of benign prostatic enlargement (BPE) or benign prostatic obstruction (BPO) 5
Treatment Options for BPH
- Medical management has become a common step in the treatment of BPH, often postponing or eliminating the need for surgical intervention 6
- Alpha-blockers and 5-alpha-reductase inhibitors are the two drug classes used in the medical management of BPH 6, 7, 5
- Combination therapy with alpha-blockers and 5-alpha-reductase inhibitors may be beneficial in the treatment of BPH, particularly in patients with greater symptom severity, larger prostate volume, and higher prostate-specific antigen (PSA) levels 7
- Surgical options are available, including Transurethral Resection of the Prostate (TURP), which remains the "gold standard" for surgical treatments 5
- Alternative therapies, such as phytotherapy (e.g. saw palmetto, pumpkin seed) and physical therapy (e.g. acupuncture, aquablation), may be used in the management of BPH 8
- Lifestyle modification and medication may be sufficient for many men with prostate enlargement, but if symptoms persist, a urology consultation may be necessary 4