Benign Prostatic Hyperplasia (BPH)
Part 3: Treatment
This is the third of my 4-part series in BPH, a common condition as men get older; last week I discussed diagnosis.
The most common medications prescribed for mild to moderate BPH symptoms are Alpha blockers and 5-alpha reductase inhibitors (5-ARI’s) either separately or as a combination therapy.
Ideal for patients with obstructive symptoms (difficulty urinating) as they relax the bladder neck muscles and relax the prostate also. This easing of tension improves urinary flow. Types include alfuzosin, tamsulosin, doxazosin and silodosin.
One of the advantages of using alpha blockers is benefits are seen after few weeks (especially compared to 5-ARI’s, which can be months). In addition, there may be benefits for patients who also have high blood pressure. Alpha blockers are also less likely to effect sexual function or to impact on PSA score, which may prove useful if future prostate cancer screenings.
Side effects may include dizziness, tiredness, headache, hypotension (low blood pressure), retrograde ejaculation (semen not released) and nasal congestion. Postural hypotension (low blood pressure which can cause risk of falls when standing up) can also occur with tamsulosin but this can be reduced by prescribing the slow release version.
5-alpha reductase inhibitors
These include Finasteride and dutasteride. They improve BPH symptoms by reducing the volume of the prostate through prevention of hormonal changes that stimulate prostate growth. This benefit can be particularly useful for patients with large prostates i.e. >40g. Unlike alpha blockers, they may take up to 6 months for maximum benefit, however as much as 20-30% decrease in size can be achieved after 6 – 12 months. Medication needs to be continued to maintain this reduction, so they are considered a more long-term solution. Side effects related are mostly sexual in nature: decreased libido (sex drive), impotence and a reduction in both ejaculate and semen count.
It is also important to note that both these drugs pass through in semen, so, condoms should be used during intercourse. Women who are pregnant or likely to become pregnant should avoid handling broken or crushed tablets / capsules. Unlike alpha blockers, 5-ARI’s also reduce PSA levels, potentially altering the relationship between prostate cancer screening (tumour development) and PSA scoring so doctors must take this into account when doing PSA tests.
Two large studies studied the possible benefits of combining alpha blockers and 5-ARI’s. Both studies found that there was a reduced risk of BPH related surgery in those who took the combination. Both studies reported a greater improvement in lower urinary tract symptoms against those with a single drug. Combodart® (0.4mg Tamsulosin / 0.5mg Dutasteride capsule) can be given once daily ideally 30 mins after food.
More commonly prescribed for the treatment of erectile dysfunction (ED), the longer lasting PDE-5 Tadalafil (Cialis) is indicated for both BPH and ED and has been shown to be effective in the treatment of lower urinary tract symptoms due to BPH. A 5mg daily dose, when used in combination with an alpha blocker gave good results. It can also assist in counteracting the ED side effects of 5-ARI’s.
To be continued next week...I discuss surgical options.
For comprehensive and free health advice and information call in to Whelehans Pharmacies, log on to www.whelehans.ie or dial 04493 34591 (Pearse St) or 04493 10266 (Clonmore).