From the Guidelines
The treatment of benign prostatic hyperplasia (BPH) should be individualized based on symptom severity, prostate size, comorbidities, and patient preferences, with medications such as alpha-blockers and 5-alpha reductase inhibitors being the first-line treatment for mild to moderate symptoms, and minimally invasive procedures or surgery reserved for more severe cases 1.
Treatment Options
- For mild symptoms, watchful waiting with annual follow-ups may be appropriate.
- Medications are typically the first-line treatment, with alpha-blockers like tamsulosin (0.4 mg daily) providing quick symptom relief by relaxing prostate muscles.
- 5-alpha reductase inhibitors such as finasteride (5 mg daily) or dutasteride (0.5 mg daily) can shrink the prostate over 3-6 months and are particularly effective for larger prostates.
- Combination therapy using both medication classes may provide better results than either alone.
Minimally Invasive Procedures
- For moderate to severe symptoms unresponsive to medications, minimally invasive procedures like transurethral resection of the prostate (TURP), laser therapies, or newer options such as prostatic urethral lift (UroLift) or water vapor therapy (Rezūm) can be considered.
Surgical Options
- Traditional surgical options like open prostatectomy are reserved for very large prostates.
Lifestyle Modifications
- Lifestyle modifications including limiting evening fluids, avoiding caffeine and alcohol, and scheduled voiding can help manage symptoms regardless of treatment approach.
Diagnostic Tests
- Optional diagnostic tests, such as pressure-flow urodynamic studies, urethrocystoscopy, and ultrasound (transrectal or transabdominal), are not recommended in the initial evaluation of LUTS or in a setting other than those described above 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. 1.2 Combination with Alpha-Blocker Finasteride tablets administered in combination with the alpha-blocker doxazosin is indicated to reduce the risk of symptomatic progression of BPH (a confirmed ≥ 4 point increase in American Urological Association (AUA) symptom score).
The treatment of BPH includes:
- Monotherapy with finasteride to improve symptoms, reduce the risk of acute urinary retention, and reduce the need for surgery.
- Combination therapy with finasteride and an alpha-blocker (doxazosin) to reduce the risk of symptomatic progression of BPH 2.
From the Research
Treatment Options for BPH
The treatment of Benign Prostatic Hyperplasia (BPH) can be categorized into medical and surgical options.
- Medical therapy is the primary treatment for most symptomatic patients, with various classes of pharmacotherapy available, including alpha-blockers, 5-alpha reductase inhibitors, phosphodiesterase-5 inhibitors, and beta-3 agonists 3.
- Alpha-blockers are considered first-line treatment for men with small prostates, while 5-alpha reductase inhibitors are recommended for men with large symptomatic prostates 4.
- Surgical options, such as transurethral resection of the prostate, may be appropriate for patients with severe symptoms or those who have failed medical therapy 5.
Medical Therapy
Medical therapy for BPH has expanded in recent years, with various medications available to manage symptoms.
- Alpha-blockers, such as tamsulosin, provide rapid relief of symptoms but can cause dizziness and orthostatic hypotension 5.
- 5-alpha reductase inhibitors, such as finasteride and dutasteride, slowly reduce prostatic volume but may not be as effective as alpha-blockers, especially in men with smaller prostates 5, 4.
- Phosphodiesterase-5 inhibitors and beta-3 agonists may also be used to manage BPH symptoms, particularly in patients with "bothersome" symptoms 3.
Alternative Therapies
Phytotherapy, including herbal agents such as saw palmetto, pygeum africanum, and beta-sitosterol, may also be used to treat BPH.