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Management of Benign Prostatic Hyperplasia

Defining the Role of Tamsulosin

  • Drugs in Disease Management
  • Published:
Disease Management & Health Outcomes

Abstract

Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) are common among older men, and can reduce their quality of life considerably. The disease also has substantial economic implications for healthcare providers and society in general, particularly in view of the aging of populations in developed countries.

The management of patients with LUTS associated with BPH can include watchful waiting, medical therapy, or surgery, and disease management programs may use shared care approaches that involve both primary and secondary providers. Patient preference is important when making treatment decisions, and many patients will prefer medical treatment over surgery. This form of treatment is often managed within the primary-care setting.

Among medical therapies, the α1-adrenoceptor antagonists are the preferred option for patients requiring rapid symptom relief. The efficacy of these drugs is sustained over a number of years. Generally, α1-adrenoceptor antagonists provide better symptom relief than 5α1-reductase inhibitors, and although they do not reduce the long-term risk of acute urinary retention or need for prostatic surgery (in contrast to 5α1-reductase inhibitors), they do delay the time to acute urinary retention, and are likely to reduce referrals to secondary care.

Although generally well tolerated, hypotension-related events are the most common adverse events for most α1-adrenoceptor antagonists. Compared with the other drugs in its class, tamsulosin appears to have a lower propensity to interfere with blood pressure regulation, particularly in the elderly. This may reduce the amount of monitoring by physicians required during the initial period of treatment, and also the risk of hypotension-related falls and associated secondary care.

The increasing importance of pharmacologic interventions in the long-term management of BPH, together with the efficacy and tolerability profile of tamsulosin, suggest that the drug may be useful as part of a disease management program, although the long-term economic impact of tamsulosin remains to be determined.

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Notes

  1. The use of trade names is for product identification purposes only and does not imply endorsement.

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Authors and Affiliations

  1. Adis International Inc, 770 Township Line Road, Suite 300, Yardley, Pennsylvania, PA 19067, USA

    Katherine F. Croom & Antona J. Wagstaff

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Correspondence to Katherine F. Croom.

Additional information

Various sections of the manuscript reviewed by: C.R. Chapple, Department of Urology, Royal Hallamshire Hospital, Sheffield, England; J.J.M.C.H. De la Rosette, Department of Urology, Academic Medical Centre, Amsterdam, The Netherlands; S. Madersbacher, Department of Urology, Donauspital, Vienna, Austria; M.C. Michel, Department of Pharmacology and Pharmacotherapy, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; J.C. Nickel, Department of Urology, Queens University, Kingston General Hospital, Kingston, Ontario, Canada; J. Nordling, Department of Urology, Herlev Hospital, University of Copenhagen, Herlev, Denmark.

Data Selection

Sources: Medical literature published in any language since 1980 on tamsulosin, identified using Medline, supplemented by AdisBase (a proprietary database of Adis International). Additional references were identified from the reference lists of published articles. Bibliographical information, including contributory unpublished data, was also requested from the company developing the drug.

Search strategy: Medline search terms were ‘benign prostatic hyperplasia’ and (‘guidelines’ or ‘decision-making’ or ‘health-policy’ or ‘managed-care-programmes’ or ‘epidemiology’ or ‘outcome-assessment-health-care’ or ‘clinical-protocols’ or ‘guideline in pt’ or ‘polic* in ti’ or ‘expert panel’ or ‘utilization review’ or ‘algorithms’ or ‘disease management’ or ‘quality of life’), or ‘tamsulosin’ and ‘review in pt’. AdisBase search terms were ‘benign prostatic hyperplasia’ and (‘guideline’ or ‘guideline-utilisation’ or ‘practice-guideline’ or ‘disease-management-programmes’ or ‘treatment-algorithms’ or ‘reviews-on-treatment’ or ‘drug-evaluations’ or ‘epidemiology’ or ‘cost-of-illness’ or ‘pathogenesis’), or ‘tamsulosin’ and (‘review’ or ‘clinical-study’). Searches were last updated 31 August 2004.

Selection: Studies in patients with benign prostatic hyperplasia who received tamsulosin. Inclusion of studies was based mainly on the methods section of the trials. When available, large, well controlled trials with appropriate statistical methodology were preferred. Relevant pharmacodynamic, pharmacokinetic, pharmacoeconomic and epidemiological data are also included.

Index terms: Benign prostatic hyperplasia, disease management, review on treatment, tamsulosin.

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Croom, K.F., Wagstaff, A.J. Management of Benign Prostatic Hyperplasia. Dis-Manage-Health-Outcomes 12, 337–350 (2004). https://doi.org/10.2165/00115677-200412050-00005

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