From the Guidelines
Dutasteride and tamsulosin are generally not recommended following a TURP procedure, as the obstructing prostate tissue has already been surgically removed, eliminating the need for these medications in most patients. After TURP, the primary goal is to manage any potential complications and ensure a smooth recovery, rather than continuing medications that were used to manage symptoms prior to surgery 1. Tamsulosin, an alpha-blocker, works by relaxing smooth muscle in the prostate and bladder neck to improve urine flow, while dutasteride, a 5-alpha reductase inhibitor, reduces prostate size by blocking the conversion of testosterone to dihydrotestosterone. Since TURP physically removes the obstructing tissue, continuing these medications typically provides no additional benefit in terms of reducing morbidity, mortality, or improving quality of life.
Some key points to consider when deciding whether to recommence dutasteride and tamsulosin after TURP include:
- The patient's pre-operative symptoms and prostate size, as those with larger prostates or more severe symptoms may have benefited from these medications prior to surgery 1
- The presence of any residual prostate tissue or persistent lower urinary tract symptoms after TURP, which may require continued medical management
- The potential side effects and risks associated with long-term use of these medications, such as erectile dysfunction, decreased libido, and increased risk of high-grade prostate cancer
- The results of studies such as the REDUCE trial, which showed that dutasteride can reduce the risk of clinical progression in men with BPH, but may not be necessary for all patients after TURP 1
In general, patients who were taking these medications before surgery should consult with their urologist about discontinuing them after recovery from TURP, usually within 4-6 weeks post-procedure. The decision should be individualized based on post-operative symptoms, prostate size, and urodynamic parameters, with the goal of minimizing morbidity, mortality, and improving quality of life.
From the Research
TURP Procedure and Medication
- The provided studies do not directly address whether dutasteride/tamsulosin are generally recommenced following a TURP procedure 2, 3, 4, 5, 6.
Post-TURP Treatment
- A study from 2015 found that 5α-reductase inhibitors (5αRIs) improved prostate volume, PSA, maximum flow rate, and hematuria in patients with large benign prostatic hyperplasia (>80 mL) after TURP 5.
- Another study from 2021 evaluated the effect of delayed start of combination therapy with dutasteride and tamsulosin on the risk of acute urinary retention or BPH-related surgery in patients with moderate-to-severe LUTS/BPH, but did not specifically address post-TURP treatment 6.
Medication Use
- A 2017 study reviewed the combined treatment of BPS with tamsulosin and finasteride, and found that clinical studies on this combination showed improvement in LUTS, maximum urinary flow rate, prostate volume, and PSA 4.
- The same study noted that tamsulosin and finasteride are commonly used in the treatment of BPS in Germany, and that the combination of tamsulosin and finasteride accounts for about 50% of all α1-blocker/5AR-inhibitor combinations 4.