Medical therapy for benign prostatic hyperplasia: A review of the literature

Objective: To review the existing evidence regarding the efficacy and safet y of medical therapy for lower urinary tract symptoms (LUTS) indicative of benign prostatic hyperplasia (BPH). To assess randomised controlled trials investigating the six alpha-adrenergic receptor antagonists (alpha-blockers ), prazosin, alfuzosin, indoramin, terazosin, doxazosin, and tamsulosin, th at benefit patients by relaxing prostatic smooth muscle, and the anti-andro gen, finasteride, that mediates its more long-term benefits by reducing pro state size. Results: This review suggests that both classes of drug offer significant i mprovement in criteria used to evaluate symptomatic BPH and can be effectiv e whilst being acceptably safe. Furthermore, the therapeutic efficacy of al l contemporary alpha-blockers appear similar, both in terms of symptom reli ef and urodynamic improvements. Randomised controlled trials have additiona lly demonstrated that finasteride therapy can provide improvement in terms of quality of life indices, prostate volume, and risks of progressing to ac ute urinary retention or prostatic surgery. While alpha-blockers have a rap id onset of action, likely to produce a therapeutic result within weeks, re gardless of whether prostatic enlargement or bladder outlet obstruction is present, finasteride appears to be effective for more long-term therapy for up to 4 years, but only in alleviating symptoms when they are associated w ith a significantly large prostate. Neither finasteride nor the alpha(1a)-r eceptor-selective blocker, tamsulosin, are associated with the lowering of blood pressure and incidence of cardiovascular side effects that are appare nt with other less selective alpha-blocker therapies such as dizziness and postural hypertension. They are, however, both associated with an increased risk of sexual dysfunction, albeit less than those associated with surgica l intervention. Whereas tamsulosin is associated only with ejaculatory dysf unction, finasteride is additionally linked to decreased libido and impoten ce. Copyright (C) 2000 S. Karger AG, Basel.