From the Guidelines
Finasteride should be considered over tamsulosin for the treatment of benign prostatic hyperplasia (BPH) in patients with a prostate volume greater than 30cc or a PSA level greater than 1.5ng/mL, as it addresses the underlying cause of the condition and can prevent disease progression, as recommended by the AUA guideline 1. When deciding between finasteride and tamsulosin, it's essential to consider the patient's prostate size, symptom severity, and treatment goals. Finasteride, a 5-alpha-reductase inhibitor (5-ARI), reduces prostate size by blocking the conversion of testosterone to dihydrotestosterone (DHT), leading to a decrease in prostate volume and an improvement in symptoms over time 1.
- Key differences between finasteride and tamsulosin include:
- Onset of action: Tamsulosin works quickly, providing relief from urinary symptoms within days to weeks, while finasteride takes 3-6 months to show full effects.
- Mechanism of action: Tamsulosin relaxes prostate and bladder neck muscles, while finasteride shrinks the prostate gland.
- Side effects: Tamsulosin may cause dizziness, retrograde ejaculation, and orthostatic hypotension, while finasteride can cause sexual dysfunction, reduced libido, and requires PSA monitoring.
- The AUA guideline recommends combination therapy with an alpha-blocker (such as tamsulosin) and a 5-ARI (such as finasteride) for 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.
- Studies have shown that finasteride can reduce the risk of clinical progression, including acute urinary retention and the need for surgical intervention, in men with BPH 1.
- It's crucial to counsel patients on the slower symptom improvement with finasteride and the importance of regular follow-up and PSA monitoring to assess treatment efficacy and potential side effects 1.
From the Research
Comparison of Finasteride and Tamsulosin
- Finasteride and tamsulosin are two different types of medications used to treat benign prostatic hyperplasia (BPH) symptoms 2, 3, 4, 5, 6.
- Finasteride is a 5-alpha reductase inhibitor that reduces prostate size, while tamsulosin is an alpha 1-adrenergic receptor antagonist that relaxes the muscles in the prostate and bladder neck 3, 4, 6.
Efficacy of Finasteride and Tamsulosin
- Finasteride has been shown to improve urinary symptom scores and reduce the risk of BPH progression, but its effectiveness may take 6-12 months to achieve maximum benefits 3, 4.
- Tamsulosin has been shown to improve urinary symptoms and quality of life, with a faster onset of action compared to finasteride 2, 3, 5.
- Combination therapy with finasteride and tamsulosin may provide additional benefits in improving urinary symptoms and reducing the risk of BPH progression 2, 5.
Comparison of Finasteride and Tamsulosin in Clinical Trials
- A study comparing finasteride and tamsulosin found that both medications improved urinary symptoms, but finasteride was associated with a lower risk of surgical intervention 4.
- Another study found that combination therapy with tadalafil and finasteride improved urinary and sexual outcomes, while combination therapy with tamsulosin and finasteride provided better average flow rates 5.
- A review of clinical trials found that finasteride and tamsulosin were both effective in improving BPH symptoms, but finasteride may have a slower onset of action and more side effects 3, 4, 6.
Side Effects and Safety
- Finasteride has been associated with side effects such as impotence, erectile dysfunction, decreased libido, and ejaculation disorder 4, 5.
- Tamsulosin has been associated with side effects such as dizziness, postural hypotension, and asthenia, but these side effects are generally less common than with finasteride 3, 4, 6.