Efficacy of α-blocker or 5α-reductase inhibitor withdrawal to continued combination therapy in the management of LUTS with BPH

According to a recent study, in men with benign prostatic hyperplasia (BPH)/ lower urinary tract symptoms (LUTS) who are unwilling to continue combination therapy, they may be presented with either α1-adrenergic receptor blocker (AB) or 5α-reductase inhibitor (5ARI) withdrawal if there is a minimum improvement of seven points in International Prostate Symptom Score-total (IPSS-T) and a reduction of at least 20% in prostate volume (PV). This research findings were published in the journal, The Prostate.

This randomized trial included 222 patients with BPH/LUTS who experienced a minimum seven-point improvement[S.1]  in IPSS-T and a ≥ 20% decrease in PV after commencing combination therapy. Patients were randomly assigned to continued-combination, AB-withdrawal, and 5ARI-withdrawal groups in a 1:1:1 ratio. Various parameters such as IPSS, EuroQol-five-dimensional questionnaire (EQ-5D-5L), overactive bladder symptom score, EuroQol-visual analog scale (EQ-VAS), PV, postvoid residual urine (PVR), maximal flow rate, and prostate-specific antigen level were assessed every 6 months over a 24-month period and the predictors of IPSS-T deterioration were evaluated.

At month 24, 27.8% of patients in the AB-withdrawal group and 26.4% in the 5ARI-withdrawal group experienced a deterioration of ≥2 points in IPSS-T. Among the patients, 5.6% and 5.7% necessitated the reintroduction of the previously withdrawn medication. EQ-VAS showed improvement in the continued combination group at month 24 compared to baseline (p = 0.028). The AB-withdrawal group displayed enhancements in EQ-VAS, EQ-5D-5L, and PVR at month 24 (all p < 0.005), while the 5ARI-withdrawal group demonstrated improvement in IPSS-S (p = 0.011). Diabetes was associated with a decrease in IPSS-T at the 24-month mark (p = 0.020)

Therefore, for men diagnosed with BPH experiencing LUTS who are unwilling to continue combination therapy may be offered the choice of either discontinuing AB or 5ARI treatment. This option is available if there is a minimum improvement of seven points in the IPSS-T and a reduction of at least 20% in PV.