Urol. praxi, 2012; 13(4): 148-153

Combination drug therapy of the benign prostate hyperplasia

prof.MUDr.Jan Dvořáček, DrSc.

Urologická klinika VFN a 1. LF UK v Praze

Combination drug therapy (CDT) of α-blockers and 5 α-reductase inhibitors is widely used for treatment of lower urinary symptoms

in men with benign prostatic hyperplasia, The modes of action these drugs is different and complementary. Both provide sustainable

reductions in International Prostate Symptome Score, delay the acute urinary retention and need for invasive BPH therapy. Only the

5-ARIs reduce the long-term risk of acute urinary retention and invasive BPH therapy. MTOPS (Medical Therapy of Prostate Symptoms)

study a CombAT (Combination of Avodart and Tamsulosin) trial provided evidence that the prostate volume threshold for benefit of

the CDT is lower (>25/30 ml) than previosly thought. In addition CDT significantly improves disease specific Quality of Life. CombAT

suggests that long-term treatment with CDT [dutasteride plus tamsulosin] is significantly superior to monotherapy with tamsulosin but

not dutasteride at reducing relative risk of AUR or BPH-related surgery. CDT is significantly also superior at reducing the relative risk of

BPH clinical progression and provides significantly greater reduction in IPSS. Many men wish to avoid surgery, and for them, CDT offers

significant benefits over α-blocker monotherapy, where no long-term reduction in the risk of AUR or surgery have been demonstrated.

Current evidence suggests that CDT should be considered in men with prostatic enlargement, elevated prostatic specific antigen level,

lower urinaty tract symptoms, and moderate or severe borther.

Keywords: benign prostatic hypeplasia, adrenergic alpha-antagonists, 5-alpha-reductase inhibitors, combination drug therapy

Published: August 1, 2012  Show citation