Systematic review of clinical considerations for prescribing Tamsulosin and Dutasteride combination therapy in men with Moderate-to-Severe LUTS due to BPH. 

<h2 id="background">Background</h2><ul><li>For moderate-to-severe lower urinary tract symptoms secondary to benign prostatic hyperplasia (LUTS/BPH), the goal of combination therapy is to ease both the dynamic and static symptoms by using agents with complementary mechanisms of action.</li><li>LUTS/BPH combination therapy has been affected by multiple factors of which inidividual perspectives that influence administration of combination therapy is discussed in previous studies.</li></ul><h2 id="aim">Aim</h2><ul><li>This systematic review aimed to identify the clinical considerations that influence the decision to prescribe combination therapy of tamsulosin 0.4 mg+ dutasteride 0.5 mg in men with LUTS/BPH.</li></ul><h2>Methods</h2><ul><li>A systematic and citation search was performed in databases Medline, CINAHL, the Cochrane Library, and Embase from inception until January 2024.</li><li>Five English-language primary randomized controlled trials (RCTs) were included in the narrative analysis using the Critical Appraisal Skills Program (CASP) checklist.</li></ul><h2 id="results">Results</h2><ul><li>Significant improvement in IPSS, Qmax, and Qol was observed in combination therapy.</li><li>A significant relationship was identified between prostate volume (PV) and prostate-specific antigen (PSA) levels, indicating that a greater secretion of PSA is necessary for the enlargement of each unit of the prostate, thereby elevating the risk of moderate-to-severe lower urinary tract symptoms (LUTS).</li><li>Furthermore, baseline variables associated with BPH may result in varying responses to combination therapy, particularly related to the differences in prostate volume (PV) and prostate-specific antigen (PSA) levels.</li></ul><h2 id="recommendation">Recommendation</h2><ul><li>Shared-decision making {SOM) results in individuals making high-quality decisions, experiencing greater satisfaction, adhering better to medication regimens, and achieving improved clinical outcomes as per research.</li><li>It is necessary to discuss the options with the patient and acknowledge the optimized and individualized treatment.</li><li>It enables healthcare professionals to make informed decisions based on the patient's circumstances and context.</li><li>Thus, for men with moderate-to-severe LUTS/BPH, SOM is highly recommended when the physician is prescribing combination therapy.</li></ul><h2 id="conclusion">Conclusion</h2><ul><li>Tamsulosin 0.4 mg + dutasteride 0.5 mg combination therapy has been extensively prescribed for men with moderate-tosevere LUTS/BPH in a long-term treatment.</li><li>Initiation of combination therapy, especially dutasteride, depends on a larger PV (30 ml);hence earlier PV and PSA examinations and baseline variables assessments ought to be performed by physicians before the combination therapy prescription.</li><li>Patient who prefers an active pattern of sexual activity during their BPH combined pharmacotherapy,alternative treatment options may be considered.</li><li>These clinical considerations may influence the prescription of tamsulosin 0.4 mg + dutasteride 0.5 mg combination therapy for men with moderate-to-severe LUTS/BPH.</li></ul>

Urology Update   Issue 6   Nov 2024

<ul><li><a href="#background">Background</a></li><li><a href="#aim">Aim</a></li><li><a href="#methods">Methods</a></li><li><a href="#results">Results</a></li><li><a href="#recommendation">Recommendation</a></li><li><a href="#conclusion">Conclusion</a></li></ul>

Systematic review of clinical considerations for prescribing Tamsulosin and Dutasteride combination therapy in men with Moderate-to-Severe LUTS due to BPH.

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