Men's Health: Two drugs better than one for enlarged prostate symptoms

Men with bothersome urinary problems caused by prostate enlargement may find relief with a two-drug combination treatment.

More than half of men in their 60s and as many as 90 per cent of men age 70 and older have symptoms of noncancerous enlargement of the prostate, also known as benign prostatic hyperplasia (BPH). These symptoms can include frequent or difficult urination, and a sensation of not emptying the bladder after urinating.

In some men, these problems may become bothersome enough that long-term drug treatment is needed. The standard medications are 5-alpha-reductase inhibitors, which reduce the production of a hormone involved in prostate enlargement, and alpha blockers, which relax muscle tissue in the prostate and bladder.

Doctors have known for the past several years that a combination of these two medications taken over several years not only improves urination but also reduces the risk the BPH will become so severe that surgery is needed. That information came from a study sponsored by the U.S. government involving the 5-alpha-reductase inhibitor finasteride (brand name Proscar) and the alpha blocker doxazosin (sold under Cardura and other names).

Now, a study focusing specifically on men with moderate to severe BPH has shown that a combination of the newer drugs dutasteride (Avodart) and tamsulosin (sold under Flomax and other names) also improves symptoms better than either drug alone. However, the ongoing study hasn't yet shown whether this combination also reduces the risk of severe complications and surgery. It was funded by GlaxoSmithKline, the makers of Avodart.

Dr. Jack Barkin, one of the principal study investigators and chief of staff at the Humber River Regional Hospital in Toronto, says combination therapy is best for men with an enlarged prostate and at least moderate symptoms of BPH. "If they have a small prostate, you're not going to see the same type of response with the combination therapy."

He notes there are studies suggesting men can drop the alpha blocker after an initial period of combination therapy and keep taking the 5-alpha-reductase inhibitor alone. This may be particularly appealing for men bothered by side-effects, which can include erection problems and decreased libido.