Comparison of tadalafil and tamsulosin with 5-alpha reductase inhibitors for benign prostatic hyperplasia

A recent study found that both the combinations of tamsulosin/finasteride and tadalafil/finasteride are comparably effective in enhancing lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) within 3 months. Tamsulosin/finasteride demonstrated a significantly better maximum urinary flow rate (Qmax) only during the fourth week. Tadalafil/finasteride improved sexual performance compared to the alternative combination. This study’s results were published in the World Journal of Urology.

In this study, the selection criteria included prostate volume greater than 40 ml and IPSS scores exceeding 7. Patients with severe erectile dysfunction (IIEF-erectile functions ≤ 10) were not included in the study. The patients were randomly assigned to two groups: tamsulosin/finasteride (Group I) and tadalafil/finasteride (Group II). The primary endpoint of the study included the changes in urinary and sexual function within each group, as measured by IPSS, urinary flow rates, IPSS-quality of life, and IIEF domains. The secondary endpoint involved comparing the treatment-induced changes between the two groups.

The number of patients in each group was 131 and 127 at the 4th and 12th weeks, respectively. Significant improvement in LUTS was observed in both groups, with IPSS changes of - 4.9 ± 2.7 and - 4.3 ± 2.9 at the 4th week, and - 6.1 ± 3 and - 5.4 ± 2.8 points at the 12th week in both groups, respectively. Group I showed improved average flow rates during both follow-up sessions. At the 12th week, maximum flow rates were comparable in both groups (13.5 ± 3.9 vs 12.6 ± 3.7). In group I, all IIEF domains showed a significant decrease at both visits. During the 4th and 12th weeks, Group II displayed a significant improvement in IIEF-erectile function scores (1.3 ± 1.1 and 1.8 ± 1.2, respectively). However, there was a temporary reduction in IIEF-orgasm and sexual desire, which was only observed at the 4th week (- 0.8 ± 0.4 and - 0.6 ± 0.4, respectively).

The above study demonstrated that within a span of 3 months, both the tamsulosin/finasteride and tadalafil/finasteride combinations have demonstrated equal effectiveness in enhancing LUTS associated with BPH. During the fourth week, tamsulosin/finasteride exhibited a significantly better Qmax. The combination of tadalafil/finasteride showed a positive impact on sexual performance when compared to the alternative combination.