First-Line Medical Treatment for Bothersome Moderate-to-Severe LUTS in BPH
Men with bothersome, moderate-to-severe lower urinary tract symptoms (LUTS) attributable to benign prostatic hyperplasia (BPH) are candidates for pharmacological therapy. The selection of first-line agent is guided by the individual clinical picture, including any comorbid conditions.
Bothersome moderate-to-severe LUTS attributed to BPH in a patient considered for initial pharmacological management. Comorbid erectile dysfunction is a relevant factor in agent selection.
First-line therapy involves an alpha blocker or tadalafil, with combination approaches also available depending on the clinical situation. The complete agent selection, criteria, and decision logic are contained in the full protocol.
A reduction of more than 3 points on the IPSS from baseline, evaluated at 4–12 weeks after initiating treatment.
References
DOI: 10.1097/JU.0000000000003698
- Clinicians should offer one of the following alpha blockers as a treatment option for patients with bothersome, moderate to severe LUTS/BPH: alfuzosin, doxazosin, silodosin, tamsulosin, or terazosin.
- For patients with LUTS/BPH irrespective of comorbid erectile dysfunction (ED), 5mg daily tadalafil should be discussed as a treatment option.
- Clinicians may offer the combination of low-dose daily 5mg tadalafil with alpha blockers for the treatment of LUTS/BPH.
- Patients should be evaluated by their providers 4–12 weeks after initiating treatment (provided adverse events do not require earlier consultation) to assess response to therapy.
- For IPSS this is a difference of >3 points.