Management of Benign Prostatic Hyperplasia: Defining the Role of Tamsulosin
Katherine F. Croom
Antona J. Wagstaff
Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) are common among older men, and can reduce their quality of life considerably. The disease also has substantial economic implications for healthcare providers and society in general, particularly in view of the aging of populations in developed countries. The management of patients with LUTS associated with BPH can include watchful waiting, medical therapy, or surgery, and disease management programs may use shared care approaches that involve both primary and secondary providers. Patient preference is important when making treatment decisions, and many patients will prefer medical treatment over surgery. This form of treatment is often managed within the primary-care setting. Among medical therapies, the alpha1-adrenoceptor antagonists are the preferred option for patients requiring rapid symptom relief. The efficacy of these drugs is sustained over a number of years. Generally, alpha1-adrenoceptor antagonists provide better symptom relief than 5alpha-reductase inhibitors, and although they do not reduce the long-term risk of acute urinary retention or need for prostatic surgery (in contrast to 5alpha-reductase inhibitors), they do delay the time to acute urinary retention, and are likely to reduce referrals to secondary care. Although generally well tolerated, hypotension-related events are the most common adverse events for most alpha1-adrenoceptor antagonists. Compared with the other drugs in its class, tamsulosin appears to have a lower propensity to interfere with blood pressure regulation, particularly in the elderly. This may reduce the amount of monitoring by physicians required during the initial period of treatment, and also the risk of hypotension-related falls and associated secondary care. The increasing importance of pharmacologic interventions in the long-term management of BPH, together with the efficacy and tolerability profile of tamsulosin, suggest that the drug may be useful as part of a disease management program, although the long-term economic impact of tamsulosin remains to be determined.
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