Study Suggests α-Blocker or 5ARI Withdrawal May Be a Viable Option for Men with BPH/LUTS

A recent randomized trial has found that men with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) may successfully withdraw from α-blocker (AB) or 5α-reductase inhibitor (5ARI) therapy after achieving symptom improvement.

The study, which included 222 men who showed significant improvements in their International Prostate Symptom Score (IPSS) and reduced prostate volume (PV) following combination therapy, compared the effects of continued combined treatment versus withdrawal of either AB or 5ARI.

At the 24-month follow-up, 27.8% of patients in the AB-withdrawal group and 26.4% in the 5ARI-withdrawal group reported slight symptom deterioration (IPSS-T increase of ≥2 points).

Despite this, very few patients (5.6% in the AB group and 5.7% in the 5ARI group) required readdition of the withdrawn drug. Notably, both withdrawal groups showed improvements in quality-of-life measures, including the EuroQol-visual analog scale (EQ-VAS), and reduced post-void residual urine.

The results indicate that, for men unwilling to maintain long-term combination therapy, withdrawal of either AB or 5ARI may be possible, provided they have showed considerable improvement in symptoms and prostate size. However, careful monitoring is essential, particularly for those with diabetes, which was associated with symptom deterioration.