Medical Therapies for Treatment of BPH: Special Considerations in Elderly Men
- 14 Downloads
Purpose of Review
Benign prostatic hyperplasia (BPH) is among the most common diseases worldwide, manifesting clinically with lower urinary tract symptoms (LUTS). The prevalence of BPH and LUTS increases with age. There has been an increase in the types of medication available for treatment. The purpose of this review is to examine the recent literature on medication for the treatment of BPH and LUTS as it relates to older adult men.
Although many different medication classes have studies showing benefits in the older male population for those with BPH, careful attention needs to be paid to their side effects. Only three medications for BPH (fesoterodine, finasteride, dutasteride) were rated as “beneficial” by the FORTA classification scale.
While many medical options exist for the treatment of BPH, their safety and efficacy as it relates to older adults are still under evaluation. Future studies need to examine more closely the effects of these medications on the older male specifically and if the benefits outway the side effects.
KeywordsBenign prostatic hypertrophy Elderly Medical therapy Alpha-blockers 5-alpha-reductase inhibitors; PDE-5 inhibitors Anticholinergics
Compliance with Ethical Standards
Conflicts of Interest
There are no conflicts of interest to report for any of the authors.
Human and Animal Rights
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 10.Kramer G, Steiner GE, Handisurya A, et al. Increased expression of lymphocyte-derived cytokines in benign hyperplastic prostate tissue, identification of the producing cell types, and effect of differentially expressed cytokines on stromal cell proliferation. Prostate. 2002;52(1):43–58.CrossRefGoogle Scholar
- 12.• Duan Y, Grady JJ, Albertsen PC, Helen Wu Z. Tamsulosin and the risk of dementia in older men with benign prostatic hyperplasia. Pharmacoepidemiol Drug Saf. 2018;27(3):340–8 Tamsulosin is one of the most common medications used to treat Benign Prostatic Hyperplasia and associated Lower Urinary Tract Symptoms. This study raises new concerns that Tamsulosin may have increased risks of dementia in the older male. CrossRefGoogle Scholar
- 13.Jung JH, Kim J, MacDonald R, et al. Silodosin for the treatment of lower urinary tract symptoms in men with benign prostate hyperplasia. Cochrane Database Syst Rev. 2017;22:11.Google Scholar
- 14.MacDonald R, Brasure M, Dahm P, et al. Efficacy of newer medications for lower urinary tract symptoms attributed to benign prostatic hyperplasia: a systematic review. Aging Male. 2018;2:1–11.15.Google Scholar
- 15.•• Oelke M, Becher K, Castro-Diaz D, et al. Appropriateness of oral drugs for long-term treatment of lower urinary tract symptoms in older persons: results of a systematic literature review and international consensus validation process (LUTS-FORTA). Age and Ageing. 2015;44(5):745–55 This study reviews the results of the FORTA classification system for medications commonly used to treat Benign Prostate Hyperplasia and Lower Urinary Tract Symptoms. Only three medications for BPH (Fesoterodine, Finasteride, Dutasteride) were rated as “Beneficial” by the FORTA classification scale. CrossRefGoogle Scholar
- 17.Oelke M, Wagg A, Takita Y, Buttner H, Viktrup L. Efficacy and safety of tadalafil 5mg once daily in the treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia in men >75 years: integrated analyses of pooled data from multinational, randomized, placebo-controlled clinical studies. BJUI. 2017;119(5):793–803.CrossRefGoogle Scholar
- 18.American Geriatrics Society 2015 Beers Criteria Update Expert Panel: American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2015Google Scholar
- 22.Roehrborn CG, Barkin J, Siami P, et al. Clinical outcomes after combined therapy with dutasteride plus tamsulosin or either monotherapy in med with benign prostatic hyperplasia (BPH) by baseline characteristics: 4-year results from the randomized, double-blind Combination of Avodart and Tamsulosin (CombAT) trial. BJUI. 2011;107(6):946–54.CrossRefGoogle Scholar
- 23.Singh DV, Mete UK, Mandal AK, Singh SK. A comparative randomized prospective study to evaluate efficacy and safety of combination of tamsulosin and tadalafil vs tamsulosin or tadalafil alone in patients with lower urinary tract symptoms due to benign prostatic hyperplasia. J Sex Med. 2014;11(1):187–96.CrossRefGoogle Scholar
- 24.Casabe A, Roehrbron CG, Da Pozzo LF, et al. Efficacy and safety of the coadministration of tadalafil once daily with finasteride for 6 months in men with lower urinary tract symptoms and prostatic enlargement secondary to benign prostatic hyperplasia. J Urol. 2014;191(3):727–33.CrossRefGoogle Scholar
- 26.Drake MJ, Chapple C, Sokol R, Oelke M, Traudtner K, Klaver M, et al. Long-term safety and efficacy of single-tablet combinations of solifenacin and tamsulosin oral controlled absorption system in men with storage and voiding lower urinary tract symptoms: results from the NEPTUNE Study and NEPTUNE II Open-label Extension. Eur Urol. 2015;67(2):262–70.CrossRefGoogle Scholar