Advertisement

Medical Therapies for Treatment of BPH: Special Considerations in Elderly Men

  • Eric BortnickEmail author
  • Vannita Simma-Chiang
  • Olamide Omidele
  • Steven A. Kaplan
Geriatric Urology (T Griebling, Section Editor)
  • 14 Downloads
Part of the following topical collections:
  1. Topical Collection on Geriatric Urology

Abstract

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.

Recent Findings

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.

Summary

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.

Keywords

Benign prostatic hypertrophy Elderly Medical therapy Alpha-blockers 5-alpha-reductase inhibitors; PDE-5 inhibitors Anticholinergics 

Notes

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.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Auffenberg GB, Helfand BT, Mcvary KT. Established medical therapy for benign prostatic hyperplasia. Urol Clin North Am. 2009;36(4):443–59, v-vi.CrossRefGoogle Scholar
  2. 2.
    Maserejian NN, Chen S, Chiu GR, Wager CG, Kupelian V, Araujo AB, et al. Incidence of lower urinary tract symptoms in a population-based study of men and women. Urology. 2013;82(3):560–4.CrossRefGoogle Scholar
  3. 3.
    Sexton CC, Coyne KS, Thompson C, Bavendam T, Chen CI, Markland A. Prevalence and effect on health-related quality of life of overactive bladder in older Americans: results from the epidemiology of lower urinary tract symptoms study. J Am Geriatr Soc. 2011;59(8):1465–70.CrossRefGoogle Scholar
  4. 4.
    Kupelian V, Wei JT, O'leary MP, et al. Prevalence of lower urinary tract symptoms and effect on quality of life in a racially and ethnically diverse random sample: the Boston Area Community Health (BACH) Survey. Arch Intern Med. 2006;166(21):2381–7.CrossRefGoogle Scholar
  5. 5.
    Coyne KS, Wein AJ, Tubaro A, et al. The burden of lower urinary tract symptoms: evaluating the effect of LUTS on health-related quality of life, anxiety and depression: EpiLUTS. BJU Int. 2009;103(Suppl 3):4–11.CrossRefGoogle Scholar
  6. 6.
    Rhodes T, Girman CJ, Jacobsen SJ, Roberts RO, Guess HA, Lieber MM. Longitudinal prostate growth rates during 5 years in randomly selected community men 40 to 79 years old. J Urol. 1999;161(4):1174–9.CrossRefGoogle Scholar
  7. 7.
    Litman HJ, Mckinlay JB. The future magnitude of urological symptoms in the USA: projections using the Boston Area Community Health survey. BJU Int. 2007;100(4):820–5.CrossRefGoogle Scholar
  8. 8.
    Lee AJ, Garraway WM, Simpson RJ, Fisher W, King D. The natural history of untreated lower urinary tract symptoms in middle-aged and elderly men over a period of five years. Eur Urol. 1998;34(4):325–32.CrossRefGoogle Scholar
  9. 9.
    Lee KL, Peehl DM. Molecular and cellular pathogenesis of benign prostatic hyperplasia. J Urol. 2004;172(5 Pt 1):1784–91.CrossRefGoogle Scholar
  10. 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
  11. 11.
    Nickel JC. Inflammation and benign prostatic hyperplasia. Urol Clin North Am. 2008;35(1):109–15; vii.CrossRefGoogle Scholar
  12. 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. 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. 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. 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
  16. 16.
    Welk B, McArthur E, Ordon M, Anderson KK, Hayward J, Dixon S. Association of Suicidality and Depression with 5-Alpha Reductase Inhibitors. JAMA Intern Med. 2017;177(5):683–91.CrossRefGoogle Scholar
  17. 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. 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
  19. 19.
    Risacher SL, McDonald BC, Tallman EF, West JD, Farlow MR, Unverzagt FW, et al. Association between anticholinergic medication use and cognition, brain metabolism, and brain atrophy in cognitively normal older adults. JAMA Neurology. 2016;73(6):721–32.CrossRefGoogle Scholar
  20. 20.
    Wagg, et al. Flexible-dose fesoterodine in elderly adults with overactive bladder: results of the randomized, double-blind, placebo controlled study of fesoterodine in an aging population trial. Journal of American Geriatric Society. 2013;61(2):185–93.CrossRefGoogle Scholar
  21. 21.
    McConnell JD, Roehrborn CG, Bautista OM, Andriole GL Jr, Dixon CM, Kusek JW, et al. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. NEJM. 2003;349(25):2387–98.CrossRefGoogle Scholar
  22. 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. 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. 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
  25. 25.
    Kaplan, et al. Tolterodine and tamsulosin for treatment of men with lower urinary tract symptoms and overactive bladder: a randomized controlled trial. JAMA. 2006;296(19):2319–28.CrossRefGoogle Scholar
  26. 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

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Eric Bortnick
    • 1
    Email author
  • Vannita Simma-Chiang
    • 1
  • Olamide Omidele
    • 1
  • Steven A. Kaplan
    • 1
  1. 1.Department of UrologyMount Sinai Hospital, Icahn School of MedicineNew YorkUSA

Personalised recommendations