Is finasteride or tamsulosin more effective?

From the Guidelines

Finasteride is the preferred treatment option for men with larger prostates and moderate-to-severe symptoms, as it reduces prostate size over time and can prevent disease progression, as shown in the most recent study from 2021 1. The choice between finasteride and tamsulosin depends on symptom severity, prostate size, and patient preferences. Tamsulosin is an alpha-blocker that relaxes smooth muscles in the prostate and bladder neck, providing relatively quick symptom relief by improving urine flow, typically dosed at 0.4 mg once daily. Finasteride, on the other hand, is a 5-alpha reductase inhibitor that shrinks the prostate by blocking the conversion of testosterone to dihydrotestosterone, but takes 3-6 months to show full effects, and is dosed at 5 mg daily. Some key points to consider when choosing between these medications include:

• Symptom severity: Tamsulosin works faster for symptom relief, but finasteride reduces prostate size over time and can prevent disease progression.
• Prostate size: Finasteride is more effective for men with larger prostates, as it can reduce prostate size and prevent disease progression.
• Patient preferences: Patients should be counseled on the slower onset of action of finasteride and the potential side effects of both medications.
• Combination therapy: For men with larger prostates and moderate-to-severe symptoms, combination therapy with both finasteride and tamsulosin may be more effective than either alone, as shown in studies such as the MTOPS and CombAT trials 1. It's also important to note that finasteride can cause sexual dysfunction, and patients should be counseled on this potential side effect, as well as the need for at least 6 months of use to evaluate effectiveness, as reported in the 2009 study 1. Overall, the choice between finasteride and tamsulosin should be based on a thorough evaluation of the patient's symptoms, prostate size, and medical history, as well as their individual preferences and concerns.

From the Research

Comparison of Finasteride and Tamsulosin

• Finasteride is a 5-alpha reductase inhibitor that reduces prostate size and improves urinary symptoms in men with benign prostatic hyperplasia (BPH) 2, 3, 4.
• Tamsulosin is an alpha-blocker that relaxes the muscles in the prostate and bladder neck, making it easier to urinate 5, 6, 4.
• Studies have shown that finasteride is effective in improving urinary symptoms and reducing the risk of BPH progression, but its effects may take longer to become apparent (at least 6 months) 2, 3, 4.
• Tamsulosin has been shown to improve urinary symptoms and peak urine flow, and its effects are often seen sooner than finasteride 5, 6, 4.
• Combination therapy with dutasteride (a 5-alpha reductase inhibitor similar to finasteride) and tamsulosin has been shown to be more effective than either medication alone in improving urinary symptoms and reducing the risk of BPH progression 5, 6.

Efficacy and Safety

• Finasteride has been shown to be generally well-tolerated, with common side effects including sexual dysfunction (decreased libido, ejaculation disorders, and impotence) 2, 3, 4.
• Tamsulosin has also been shown to be generally well-tolerated, with common side effects including dizziness, headache, and orthostatic hypotension 5, 6, 4.
• The combination of dutasteride and tamsulosin has been shown to be well-tolerated, with a similar side effect profile to either medication alone 5, 6.

Treatment Options

• Finasteride is a first-line treatment option for men with moderate to severe BPH symptoms, especially those with a large prostate (> 40 ml) 2, 3, 4.
• Tamsulosin is also a first-line treatment option for men with BPH symptoms, and may be preferred for those who need quicker relief of symptoms 5, 6, 4.
• Combination therapy with a 5-alpha reductase inhibitor (such as finasteride or dutasteride) and an alpha-blocker (such as tamsulosin) may be considered for men with more severe symptoms or those who do not respond to monotherapy 5, 6, 4.