My prostate volume decreased from 28.5 g to 20.8 g (now normal) while taking tamsulosin for benign prostatic hyperplasia; should I continue the medication?

Should You Continue Tamsulosin After Prostate Volume Normalization?

You should continue tamsulosin if your lower urinary tract symptoms remain bothersome, as alpha-blockers like tamsulosin treat symptoms rather than prostate size, and discontinuation is appropriate only when symptoms have adequately improved.

Understanding Tamsulosin's Mechanism and Indication

The critical point here is that alpha-blockers do not affect prostate size—they work by relaxing smooth muscle in the prostate and bladder neck to improve urinary flow 1. Your prostate volume reduction from 28.5g to 20.8g likely occurred due to natural variation or other factors, not from tamsulosin itself 1.

The decision to continue or discontinue tamsulosin should be based entirely on your symptom burden, not prostate size 2, 1.

Decision Algorithm for Continuing or Stopping Tamsulosin

Continue Tamsulosin If:

• You still have bothersome moderate-to-severe lower urinary tract symptoms (hesitancy, weak stream, incomplete emptying, frequency) 1
• Your International Prostate Symptom Score (IPSS) remains elevated or symptoms affect your quality of life 2
• You report satisfaction with symptom improvement and wish to maintain this benefit 2

Consider Discontinuation Trial If:

• Your IPSS has improved to <10 or quality of life index to ≤3 3
• You have minimal or no bothersome urinary symptoms 2
• You are experiencing intolerable side effects (ejaculatory dysfunction, dizziness, rhinitis) 4, 5

Evidence for Discontinuation Trials

A pilot study specifically examined discontinuation of tamsulosin in men who achieved symptom improvement 3. The results showed:

• 68.9% of patients successfully remained off tamsulosin at 24 weeks after discontinuation 3
• Temporary symptom worsening occurred at 4 weeks but recovered to near post-treatment levels by 24 weeks 3
• This suggests that continuous treatment is not always necessary in patients who achieved good symptom control 3

Practical Approach

If you decide to attempt discontinuation:

• Monitor your symptoms closely at 4,8,12, and 24 weeks after stopping 3
• Expect possible temporary worsening around 4 weeks that may improve 3
• Restart tamsulosin if bothersome symptoms return 2

If you continue tamsulosin:

• Long-term use up to 4 years has been shown to be safe and well-tolerated, with only 5% discontinuing due to side effects 6
• Sustained symptom improvement is maintained throughout long-term therapy 6
• Schedule follow-up at 4 weeks initially to reassess symptom response 7

Important Caveats

• If you are planning cataract surgery, inform your ophthalmologist about tamsulosin use due to intraoperative floppy iris syndrome risk, and consider timing of discontinuation with your surgeon 2, 7, 1
• Your "normal" prostate size of 20.8g does not eliminate the indication for alpha-blocker therapy if symptoms persist 1
• The 0.4mg dose is standard and increasing to 0.8mg provides minimal additional benefit with substantially increased side effects 6, 4