Home' Australian Pharmacist : Australian Pharmacist May 2016 Contents Australian Pharmacist May 2016 I ©Pharmaceutical Society of Australia Ltd. 37
decreased ejaculate volume occur in
about 5--10% of patients, and breast
enlargement and nipple tenderness
may occur in 1--2% of patients.3 The
5-alpha-reductase inhibitors may reduce
a patient's PSA level by approximately
50% after taking them for 6 months or
more, even if prostate cancer is present,
and doubling of the PSA value of men
on these medications is necessary
to preserve the usefulness of PSA in
screening for prostate cancer.12
Given their differing modes of action,
combining 5-alpha-reductase inhibitors
and alpha-1 blockers represents a
rational treatment approach in BPH.14
Indeed, combination treatment is more
effective than monotherapy, and should
be considered for men with enlarged
prostates who have moderate or severe
symptoms and are at increased risk of
disease progression.1,14,16,27--31 Dutasteride
co-administered with tamsulosin (Duodart)
improves urinary flow, and reduces the
incidence of acute urinary retention
and prostate surgery compared with
dutasteride monotherapy or tamsulosin
monotherapy.14,27--30 In the Combination
of Avodart and Tamsulosin (CombAT)
trial, health-related quality of life and
treatment satisfaction were also improved
to a significantly greater extent with
dutasteride plus tamsulosin than with
dutasteride or tamsulosin alone.29,30
Duodart is PBS-listed for treating LUTS due
to BPH, where treatment has been initiated
by a urologist. Sexual adverse effects with
the combination therapy are relatively
common, occurring in up to 10% of men.
Dutasteride may cause birth defects and
men taking dutasteride should avoid
donating blood, until 6 months after
stopping the drug, to avoid transmission
to pregnant women.27 Dutasteride has
an elimination half-life of about 5 weeks
and is detectable in serum for up to
4--6 months after stopping treatment.3
Also, using a condom is recommended if
the patient's sexual partner is pregnant
or likely to become pregnant, as
dutasteride is excreted in semen.27
Tadalafil, a phosphodiesterase type 5
inhibitor, was recently approved for
the treatment of BPH associated with
moderate to severe LUTS.28 Cost, and the
risk of adverse vasodilatory effects and
drug interactions, limit its applicability
for this indication.32 Tadalafil 5 mg daily
as monotherapy is primarily considered a
valid option for men with both LUTS and
Surgery may be necessary for up to
30% of men with moderate to severe
LUTS if other treatment options
(medication, lifestyle adjustment, and
fluid management) are not sufficiently
effective, or if there are complications
(e.g. urinary retention).Various surgical
methods are available, of which
transurethral resection of the prostate
(TURP) is the most common.3,15
Saw palmetto extract (Serenoa repens)
has often been used in the past for
BPH. However, a number of trials and
meta-analyses have now consistently
demonstrated that it is no more effective
than placebo in improving the symptoms
or objective measures of BPH.25,36--39
LUTS associated with BPH is a highly
impactful condition that is often
undertreated. LUTS/BPH have a major
impact on men, their families, health
services and society. Men with LUTS
secondary to BPH should not simply
accept their symptoms as part of ageing,
but should be encouraged to consult
their physicians if they have bothersome
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