One in three men will experience moderate-to-severe lower urinary tract symptoms in their lifetime, including frequent urination, difficulty starting urination, and a weak urine stream. Although these are common symptoms in older men, they can significantly impact quality of life.
The majority of male urinary symptoms are attributed to an enlarged prostate (benign prostatic hyperplasia or BPH), which is a non-cancerous growth of the prostate that occurs as most men age and can obstruct the flow of urine. BPH is commonly treated with medications that attempt to relieve the obstruction by shrinking the prostate or relaxing the prostatic smooth muscle with an Alpha-1 adrenergic receptor antagonist (α1-blocker) such as Tamsulosin.
While Tamsulosin can be used to successfully treat urinary symptoms in many patients, for some, the uncertain or modest benefits can be outweighed by the harms, which include sudden drops in blood pressure, dizziness, falls, fractures, and medication burden. Still, 1 in 5 older men with BPH receive Tamsulosin and often continue treatment with the medication after their symptoms have resolved due to a fear of recurrence.
Benefits vs. harms may change over time
To assess the individualized benefits and harms of Tamsulosin therapy, UCSF researchers conducted a proof-of-concept, randomized clinical trial comparing continuation of long-term Tamsulosin treatment with a matching placebo among older men with BPH. Their study found that approximately 1in 3 participants receiving Tamsulosin therapy for BPH had minimal or no effect from the Tamsulosin therapy versus a placebo on urinary symptoms.
Their study appears in JAMA Network Open on July 6.
“Tamsulosin is widely prescribed, but clinicians have little evidence to support whether it is providing meaningful benefit to an individual patient several years after treatment begins,” said study first author Scott R. Bauer, MD, ScM, UCSF associate professor of Medicine, Urology, Epidemiology and Biostatistics. “Our findings suggest that long-term Tamsulosin therapy should be periodically