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Cover of Benign Prostatic Hyperplasia (BPH) Management in Primary Care

Benign Prostatic Hyperplasia (BPH) Management in Primary Care

Screening and Therapy

Evidence-based Synthesis Program

Investigators: , MD, MPH, FACP, , PharmD, and , MD.

Author Information
Washington (DC): Department of Veterans Affairs (US); .


Benign prostatic hyperplasia (BPH) causes urinary hesitancy and intermittency, weak urine stream, nocturia, frequency, urgency, and the sensation of incomplete bladder emptying. These symptoms, collectively called “lower urinary tract symptoms,” or LUTS, can significantly reduce quality of life. Men with no symptoms or mild symptoms (AUA Symptom Index [SI] score of <7 points), and those who tolerate moderate symptoms well, may be managed without pharmacotherapy (“watchful waiting”). For those who have moderate or severe symptoms, medical treatments include alpha-1-selective adrenergic receptor (a-1-AR) antagonists, 5-alpha-reductase inhibitors (5-aRIs), or a combination therapy with one drug from each of these classes.

This report addresses the following questions about treatment for BPH: For patients with BPH, what are the comparative benefits, harms, and efficacy of combination therapy with a 5-alpha-reductase inhibitor plus an alpha blocker versus either treatment alone? What are the comparative efficacy and harms of alpha-1-adrenergic antagonists? Are there subgroups of patients based on demographics (age, racial groups), other medications, or co-morbidities for which one treatment is more effective or associated with fewer adverse events?


The purpose of this report is to make available information regarding the comparative effectiveness and safety profiles of different drugs within pharmaceutical classes. Reports are not usage guidelines, nor should they be read as an endorsement of, or recommendation for, any particular drug, use or approach.

Portland VA Medical Center does not recommend or endorse any guideline or recommendation developed by users of these reports.

Bookshelf ID: NBK49208PMID: 21155213


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