An Overview of Treatment Approaches to BPH and LUTS


Expert perspective on the treatment landscape of benign prostatic hyperplasia and lower urinary tract symptoms.


Bilal Chughtai, MD: BPH, benign prostatic hyperplasia, is an extremely common condition that affects 50% of men above the age of 50, and nearly 100% of men as they approach the age of 80. This condition is plagued by lower urinary tract symptoms, which include things like frequency and nocturia, getting up at night due to urgency. Patients can be significantly bothered. Now, when it comes to this condition as a whole, there is a tremendous prevalence to it. There are a lot of patients who suffer with this condition, and it comes in sort of a spectrum. There are patients who have some mild symptoms and do well with things like watchful waiting, time voiding, and dietary changes. There are other patients who will require either medical therapy, minimally invasive surgical therapy, or even surgical therapies for their condition.

Medications for BPH come in a few classes. We have alpha blockers and 5-alpha reductase inhibitors, such as finasteride and dutasteride. We have the PDE5 [phosphodiesterase-5] inhibitors, like tadalafil, and bladder-specific drugs that come in 2 varieties of antimuscarinics and beta-3 agonists. Data from specific classes of drugs show that alpha blockers have been associated with potential conditions such as dementia or even congestive heart failure. When it comes to 5-alpha reductase inhibitors, there are data on their effect on depression, long-term pelvic pain, as well as sexual function issues that can last after the drug has been stopped. Ultimately, when it comes to these medications, a lot of patients may be on them; approximately 14 million men are on these medications. At the same time, there is a fair number of men who start these medications and will stop due to adverse events, fear of long-term effects, as well as intolerance to them.

Over the last year or two, there’s been a tremendous change in the urologist’s armamentarium in treatment options for benign prostatic hyperplasia. There is a need for treatments that are more natural, based on herbal medicine or alternative treatments, in addition to the thorough treatments that we’ve seen in the minimally invasive realm. When it comes to supplements, I can tell you from personal experience, that patients are always very interested. They inquire whether there are things that can help modulate or reduce the burden of their disease or reduce progression. Are there things that they can do with their diet to improve their condition as well? There’s definitely a clear need for alternative therapies when it comes to BPH.

When it comes to options for alternative and complementary medicine for BPH, a simple search on Amazon will yield approximately 30,000 products. The point is, this is a large market where patients have tremendous interest, but there is little oversight. There’s a slew of options when it comes to nutraceuticals, all the way from saw palmetto to pygeum and stinging nettle. There are supplements that have been looked at for prostate and prostate-specific health conditions. When we talk about data, we’ll see that a lot of these supplements don’t necessarily have the strongest data, but some of them do have some compelling mechanism of action and promising worldwide data.

Transcript edited for clarity.

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