Safety and Tolerability of Treatment for BPH

Treatment options for benign prostatic hyperplasia (BPH) include watchful waiting, pharmacologic therapy, and surgery. For individual patients, treatment choice depends on disease severity, comorbidity, patient preferences, and the comparative efficacy and adverse effects (AEs) of the available therapies. Disease-related symptoms and treatment-related factors influence health-related quality of life (HRQOL), and treatment discontinuation occurs due to lack of efficacy or the occurrence of AEs. This review explores the safety and tolerability of current treatment options. Pharmacologic therapies include α1-adrenergic antagonists and 5α-reductase inhibitors (5ARIs). The α1-adrenergic antagonists have comparable efficacy but tolerability profiles that differ according to vasodilatory AEs and ejaculatory abnormalities. Alfuzosin and tamsulosin are better tolerated than terazosin and doxazosin; tamsulosin causes fewer vasodilatory AEs than alfuzosin but causes more ejaculatory abnormalities. AEs associated with 5ARIs are mainly sexual (eg, erectile dysfunction, reduced libido, and gynaecomastia) and tend to be confined to the first year of therapy. Surgery has the potential for short- and long-term complications. Open surgery has been largely replaced by less invasive approaches, particularly transurethral resection of the prostate (TURP). Short-term complications of TURP include death, bleeding, clot retention, transurethral resection syndrome, urinary tract infection, and inability to void; long-term complications include failure to void, retrograde ejaculation, erectile dysfunction, incontinence, and retreatment. More recent approaches (eg, transurethral needle ablation, thermotherapy, and laser therapy) have promising efficacy and safety. Patient expectations of therapy and AEs should be considered to ensure that treatment is tailored to individual patient needs and that HRQOL is maximised.