How Is BPH Treated?


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“How is BPH treated?” is a common question for men who receive a diagnosis of BPH (benign prostatic hyperplasia). BPH also is called enlarged prostate.

In some cases, BPH can be a side effect of medications or lifestyle choices. These can be changed to correct the condition. When BPH isn’t related to these issues, medications can be an option for treatment.

Medications for BPH can be effective in helping to treat its symptoms. Typically, symptoms include a change in urination. Men may have an urge to urinate more frequently, a need to awaken from sleep to urinate, and a reduction in urine flow.

Using drugs to treat BPH can be an effective choice for men who want to avoid BPH surgery. However, to keep symptoms under control, patients may have to take these medications for the rest of their lives.

How Is BPH Treated with Drugs?

Men asking “How is BPH treated?” will find that there are different kinds of drugs that can be effective. They typically are taken once daily at bedtime.

Two classes of BPH medications are alpha-blockers and 5-alpha reductase inhibitors. They can be prescribed alone or together. In addition, Cialis (tadalafil), a phosphodiesterase 5 inhibitor used for erectile dysfunction, also can treat BPH.

Alpha-blockers loosen or relax the smooth muscle cells in the prostate and bladder. When these cells are relaxed, urine flows more easily out of the bladder so that the bladder can be emptied.

Men taking alpha-blockers can improve relatively quickly. Though alpha-blockers can lessen urinary symptoms within days, they won’t prevent BPH from getting worse.

Use of 5-alpha reductase inhibitors relieves BPH symptoms differently. These drugs can reduce the size of an enlarged prostate back to its normal size. When the prostate becomes smaller, problems with urinating improve.

For some men, the most effective treatment for BPH involves combination therapy. This is using both an alpha-blocker to relieve symptoms and a 5-alpha reductase inhibitor to shrink the prostate. By attacking BPH with two different approaches, the medications taken together can offer the best alternative to BPH surgery.

Studies on How Is BPH Treated?

The Medical Therapy of Prostatic Symptoms (MTOPS) is a clinical research study that examined how BPH is treated. The uses of alpha-blockers, 5-alpha reductase inhibitors, and combination therapy were examined.

The MTOPS study included 3,047 men who were followed for almost five years. Researchers looked at the effectiveness of the drugs when used alone and together to treat BPH.

An article in The New England Journal of Medicine reported that men in the MTOPS study who used both drugs together had less risk of their BPH getting worse. There also was a reduced need for surgery for men who took the combination therapy. Those who took only the 5-alpha reductase inhibitor also required less surgery.

Another study, called Combination of Avodart and Tamsulosin (CombAT), also examined the effects of combination therapy. The four-year study observed 4,844 men with a prostate size greater than 30 grams. Avodart (dutasteride) is a 5-alpha reductase inhibitor; tamsulosin (Flomax) is an alpha-blocker.

An article in BJU International reported on the findings of the CombAT study. The results showed that men who took a combination of the two drugs had better relief from symptoms than those using the alpha-blocker alone. The benefits of combination therapy also exceeded those of the 5-alpha reductase inhibitor alone for men whose prostate size was between 30 grams and 58 grams.

The benefits for the combination group in the CombAT study included having better control over storing urine and eventually releasing it.

 

References

McConnell JD et al. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. The New England Journal of Medicine 2003 Dec 13; 349(25): 2387-98.

Montorsi F et al. The effects of dutasteride or tamsulosin alone and in combination on storage and voiding symptoms in men with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH): 4-year data from the Combination of Avodart and Tamsulosin (CombAT). BJU International 2001; 107(9): 1426-31.

 


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