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Drugs that work for enlarged prostate

Posted by medconsumers on October 13, 2010

Good news for men with an enlarged prostate, aka benign prostatic hyperplasia (BPH) from a new Cochrane review of all relevant clinical trials. Blood pressure drugs, alone or in combination, are best at improving the distressing urinary symptoms. And finasteride (brand name: Proscar), the first drug to be marketed solely for BPH, has the added advantage of slowing the enlargement of the prostate gland which crowds the urethra and causes the urinary symptoms. All have been on the market for decades and all are available generically, which means they are likely to be well-tested, inexpensive drugs.

NOTE: The generic names of all drugs in this article are in lower-case initial caps; the brand names are in upper-case initial caps.

Brace yourself for some this-works-better-than-that information. The review concluded that the best at alleviating BPH symptoms are the blood pressure drugs—doxazosin (some brand names: Cardura, Doxadura, Cascor) and terazosin (Hytrin). Each was shown to be better than finasteride at improving urine flow and cutting down on the nighttime trips to the bathroom. But finasteride (Proscar) becomes even more effective at reducing urinary symptoms when taken with doxazosin. When taken alone, doxazosin is more effective than finasteride alone. Finasteride and the widely advertised tamsulosin (Flomax) are equally, though modestly, effective. Got it?

These are the highlights of the Cochrane review of 23 randomized clinical trials with a total of almost 21,000 men. Several combinations of the aforementioned drugs were compared, often with a placebo, to see what works best. Unfortunately, there is no single trial that did a head-to-head comparison of all BPH drugs and the various combinations.

The Cochrane review team, led by James Tacklind of the Veterans Affairs Medical Center, Minneapolis, found that men needed to take finasteride for at least a year to see improvement. And the drug was effective in men with a large prostate but not for those with a small prostate. Drug-related adverse effects were reported only in the finasteride vs. placebo trials. The men taking finasteride were at a slightly increased risk of impotence, decreased libido, and ejaculation disorder.”

Some men reading this might be on Flomax, which is currently the most heavily advertised of all BPH drugs. But that promotional campaign will end shortly because the FDA approved the first generic version of Flomax last March. And don’t expect a multi-billion dollar promotional campaign to trumpet the results of this new Cochrane review to doctors and the public. Drug companies only do that while their drugs are still protected by a patent, the prices are high, and there’s no competition from generic drug makers.

This new Cochrane review shows that men might benefit from trying different drugs to see what works best for their particular symptoms. The review might also raise a question in the mind of any man on brand-name Flomax. Why am I taking this expensive drug when the generic versions are now available? As the drug ads usually suggest, “Ask your doctor…”

Maryann Napoli, Center for Medical Consumers(c)

2 Responses to “Drugs that work for enlarged prostate”

  1. W. A. Shapiro said

    The article does not mention the widely-used BPH drug “Avodart”, or how other antitensive drugs such as Verpamil might be expected to influence the effectiveness of BPH drugs.

    W. A. Shapiro

    • medconsumers said

      Avodart (generic name: dutasteride) is a newer BPH drug. There are no studies comparing it to finasteride (Proscar) to determine whether the newer drug has any significant benefit over the older one. There is a similar lack of comparison trials for Verpamil. This article does not address all drugs prescribed for BPH. Rather it is based entirely on a Cochrane review of all BPH drugs with the best quality research support. This means the drugs were subjected to clinical trials that go beyond the minimal requirements of the Food & Drug Administration (FDA). To gain FDA approval, all a drugmaker has to do is prove its drug is better than nothing (i.e., a placebo). The pre-approval trials usually last only a few months at best; whereas men typically take BPH drugs for years. The Cochrane review evaluated the trials that went beyond the low bar set by the FDA. The trials were conducted after the drugs went on the market. Some like finasteride lasted as long two to four years; others compared one BPH drug to another and/or to a placebo.

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