Tag: medications to treat an enlarged prostate

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Enlarged Prostate

BPH Medication: Combination Therapy

Evidence suggests that combining alpha-blockers and 5-alpha reductase inhibitors, is the most effective medication-based treatment for BPH.

Of all of the medication-based treatments for an enlarged prostate, there is evidence to suggest that combination therapy of alpha-blockers and 5-alpha reductase inhibitors, is the most effective.

Alpha-blockers are medicines that are used to relax muscle tissue thereby helping to relieve pressure and urinary symptoms associated with an enlarged prostate, such as tamsulosin (Flomax) or terazosin (Hytrin).

While 5-Alpha Reductase Inhibitors such as dutasteride (Avodart) and finasteride (Proscar), are medications that can shrink the prostate.

One study, in particular, found that the combination therapy of alpha-blockers and 5-alpha reductase inhibitors reduced the risk of urinary retention and the need for prostate surgery by 66% when compared to the impact of the alpha-blocker tamsulosin alone.

Using a combination of alpha-blockers and 5-alpha reductase inhibitors in the treatment of an enlarged prostate has shown promising results, however, it is not without its own set of side effects and risks.

According to a meta-analysis study published in the medical journal Aging Male, entitled “Impact of combination therapy 5-alpha reductase inhibitors (5-ARI) plus alpha-blockers (AB) on erectile dysfunction and decrease of libido in patients with LUTS/BPH: A systematic review with meta-analysis,” the overall prevalence of erectile dysfunction and reduced libido was found to be significantly greater for men treated with the combination therapy of alpha-blockers and 5-alpha reductase inhibitors.

In fact, they found that combination therapy not only increased the risk of erectile dysfunction significantly, compared to the prevalence of this side effect during monotherapy with just alpha blockers or 5-alpha inhibitors- but they also found that combination therapy resulted in more reported cases of reduced libido than monotherapy.

Other potential side effects of these medications are:

Dizziness, headache, and fatigue (most common)
Decrease in sex drive
Erectile dysfunction
Retrograde ejaculation
Decreased volume of ejaculate
Dry mouth, stuffy nose, and swelling of the ankles
Breast disorders (painful or enlarged breasts)
Low blood pressure

Both alpha-blockers and 5-alpha reductase inhibitors have their side effects, as well as their benefits.

The primary benefit of alpha-blockers is that they offer quick relief from BPH symptoms – usually in days to weeks. Whereas with 5-alpha reductase inhibitors, a benefit is that they can shrink the prostate and potentially avoid the need for prostate surgery, however, it can take anywhere from three to six months to experience any signs of improvement.

Even though combination therapy shows more promising results in the treatment of BPH, alpha-blockers are still the most commonly prescribed treatment. However, alpha-blockers are only effective in the short term, and symptoms will most likely return once the medication is stopped.

For men that wish to avoid taking medication for an enlarged prostate due to the risks and side effects of these drugs, they may wish to explore the option of a non-invasive surgical procedure that we specialize in here at MidAtlantic Vascular and Interventional called Prostate Artery Embolization.

In our next article, we will take a look at what the research says about the efficacy of Prostate Artery Embolization and compare it to the efficacy of medication therapy in the treatment of benign prostate hyperplasia.

Categories
Enlarged Prostate

Medications for an Enlarged Prostate

Selective alpha-blockers and 5-Alpha reductase inhibitors are usually the first choices of medication to treat benign prostate hyperplasia.

Selective alpha-blockers and 5-Alpha reductase inhibitors are usually the first choices of medication to treat benign prostate hyperplasia.

Alpha-Blockers are a type of blood pressure medication, that work by “blocking” the hormone norepinephrine (also known as noradrenaline) and thereby prevent the muscles in the walls of veins and smaller arteries from constricting. This allows these vessels to remain open and relaxed, and as a result, blood flow is improved and blood pressure is lowered.

Due to their ability to relax the muscles in the prostate and around the bladder, men taking this alpha-blocker may have an easier time urinating.

In fact, according to some studies, it is estimated that around 3 out of 5 men that take alpha-blockers find that their urinary symptoms improve within the first month of treatment.

In clinical studies, alpha-blockers have shown promising results in their ability to improve urinary symptoms related to BPH, and have proven to do so faster than another commonly prescribed medication for BPH, which is 5-alpha reductase inhibitors.

5-alpha reductase is what drives both normal and abnormal prostate growth. It is influential in the formation of dihydrotestosterone, also known as DHT, which is an androgen formed from testosterone.

Administering a 5-Alpha Reductase Inhibitor, such as finasteride and dutasteride, can inhibit the production of DHT and result in a decrease in prostate volume, as well as improvement in urinary issues.

In clinical studies, alpha-blockers have shown an ability to improve lower urinary tract symptoms related to an enlarged prostate and work faster than the 5-alpha reductase inhibitors at relieving these symptoms. However, alpha-blockers have not provided clinical evidence to support their effect on reducing the long-term risk of acute urinary retention, as well as the risk of needing to have prostate surgery.

Both alpha-blockers and 5-alpha reductase inhibitors result in different actions in the body, and the combination of these two types of medications is oftentimes considered synergistic.

According to a study published in Science Direct, which was originally published in The Journal of Urology, researchers found that combination therapy with an alpha-blocker and 5-alpha-reductase inhibitor provided a greater improvement in lower urinary tract symptoms compared to using one or the other medication solely.

In another study published in Science Direct,  researchers found that the combination of the alpha-blocker, tamsulosin, and the 5-alpha reductase inhibitor dutasteride, significantly reduced the risk of acute urinary retention, as well as reduced the need for prostate surgery.

This particular study followed 3195 men over a 4 year period and found that combination therapy reduced the risk of urinary retention and the need for prostate surgery by 66% when compared to the impact of the alpha blocker tamsulosin alone, and by 20% compared to dutasteride alone.

Though numerous studies have shown that combination therapy is more effective in treating both the symptoms and the prostate condition itself, combination therapy of alpha-blockers and 5-alpha reductase inhibitors does come with its increased risks of adverse effects.

In our next article, we will take a look at some of the side effects and risks associated with the combination therapy of alpha-blockers and 5-alpha reductase inhibitors.