The difference in the IPSS attributable to withdrawing

tamsulosin was only about 1 symptom unit. It has also been previously demonstrated that when a drug is randomly withdrawn in a placebo-controlled trial design, the severity of LUTS does not return to baseline, suggesting a persistent residual nondrug effect in the placebo group. Therefore, one Inhibitors,research,lifescience,medical cannot assume that the residual response after withdrawing tamsulosin was entirely a dutasteride effect. Ideally, the study should have included both a randomized withdrawal of tamsulosin and dutasteride and not just tamsulosin. In summary, men with clinical BPH are best treated initially with α-blocker monotherapy to relieve LUTS. The benefits of indiscriminately initiating the treatment of men with clinical BPH on combination therapy will add little to symptom improvement. Although combination therapy does decrease disease progression relative to monotherapy, the clinical relevance and cost-effectiveness of this outcome in an Inhibitors,research,lifescience,medical unselected group of men with clinical BPH are highly questionable. In the subset of men with large prostates, both α-blockers and 5-ARIs significantly Inhibitors,research,lifescience,medical decrease LUTS, and this clinical benefit appears to be additive.14 In men with large prostates, 5-ARIs are superior to α-blockers at preventing AUR and BPH surgery; however, one has to treat a large cohort

of men for 4 years with the addition of a 5-ARI to prevent a single episode of AUR or BPH surgery. Even in this highly Inhibitors,research,lifescience,medical selected cohort, the clinical significance of a 5-ARI for preventing disease progression is marginal. learn more anticholinergic and α-Blocker Historically, anticholinergic (ACH) agents were considered a contraindication in men suffering from BPH owing to a concern for precipitating AUR. A subset of men with LUTS and BPH has very troublesome symptoms that would fulfill the criteria for a diagnosis of OAB and BPH. The coexistence of these conditions raised the possibility that combination therapy with an α-blocker and anticholinergic agent might be efficacious in this challenging group of men Inhibitors,research,lifescience,medical often refractory to α-blocker therapy. Kaplan and colleagues reported a 12-week, multicenter, randomized, placebo-controlled study comparing the safety and

efficacy enough of the α-blocker tamsulosin, the anticholinergic tolterodine, the combination of these drugs, and placebo in 879 men fulfilling the criteria of both OAB and BPH.41 The interpretation of the study depends on the outcome measure under consideration. At 12 weeks, the IPSS score of the tamsulosin group was significantly lower than placebo (Figure 8). The IPSS scores of the combination and tamsulosin groups were virtually identical, indicating that combination therapy is no better than tamsulosin monotherapy at relieving LUTS in men with OAB and BPH. The percentages of men qualitatively exhibiting an improvement in LUTS in the placebo, tamsulosin monotherapy, tolterodine monotherapy, and combination groups were 62%, 65%, 71%, and 80%, respectively.