For benign prostate enlargement, a combination of drugs may be better

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A combination of drugs is better than either one alone for treating benign prostatic hyperplasia or BPH, an enlargement of the prostate gland that impedes normal urinary functions, researchers reported in the journal European Urology. The study is the first to analyze such a combination of therapies, said Dr. Claus Roehrborn of the University of Texas Southwestern Medical Center in Dallas, the lead author of the report.

BPH is a common urologic condition that affects about half of men between the ages of 50 and 60 and more than 90% of those over the age of 80. The enlargement of the prostate creates pressure on the urethra, which makes it difficult to urinate. That, in turn, can lead to acute urinary retention, which produces extreme discomfort and often is associated with recurrent infections.

The two most common medications used to treat BPH are tamsulosin (best known as Flomax) and dutasteride (best known as Avodart). If they don’t shrink the prostate, surgery may be necessary to reduce its volume and restore urinary flow, but that can often lead to the same complication — incontinence and impotence — encountered after prostate cancer surgery.

Roehrborn and his colleagues enrolled more than 4,800 men with BPH at centers in the United States and Europe. A third of them received dutasteride alone, a third received tamsulosin alone, and a third received a combination of the two drugs.

The researchers found that patients taking the combination were 67% less likely to have acute urinary retention and 70% less likely to require surgery than those taking tamsulosin alone. They were 19% less likely to suffer either problem than those taking dutasteride alone. Patients taking the combination also reported fewer side effects and were less likely to drop out of the study, the team found.

The study was funded by GlaxoSmithKline, which manufactures dutasteride.

— Thomas H. Maugh II