Combination Pharmacotherapy for Benign Prostatic Hyperplasia: Evaluation of Existing Literature on Combination Therapies for Lower Urinary Tract Symptoms Associated with BPH.

Abstract

Objective: Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) significantly impact quality of life in aging men. While monotherapies, including alpha-blockers, 5-alpha reductase inhibitors (5-ARI), or phosphodiesterase type 5 inhibitors (PDE5i), are widely used, the potential benefits and risks of combination pharmacotherapies remain less well-documented. This study reviews and assesses the current evidence regarding the use of combination pharmacotherapies in the management of BPH-related LUTS to provide a comprehensive overview of their efficacy and safety profiles.

Methods: A literature search was conducted in PubMed, including randomized controlled trials (RCTs) published up to June 2024. Studies were selected on the basis of predefined inclusion criteria, focusing on clinical outcomes such as International Prostate Symptom Score (IPSS), urinary flow rate (Q_max), and quality of life. Data from 22 eligible studies were analyzed and summarized.

Results: Combination therapies, particularly those involving alpha-blockers and 5-ARI, demonstrated significant reductions in clinical progression, improvements in urinary flow, and symptom relief compared with monotherapies. Therapies combining alpha-blockers with anticholinergics, beta-3 agonists, or phytotherapeutic agents showed potential for targeting mixed symptoms, though evidence remains limited. Triple therapy studies are scarce, with benefits observed only in highly symptomatic or refractory cases.

Conclusions: Combination therapies for LUTS/BPH offer superior efficacy over monotherapy in certain cases, particularly with alpha-blockers and 5-ARI, which significantly reduce disease progression and symptoms. Other combinations, including alpha-blockers with anticholinergics, beta-3 agonists, or PDE5 inhibitors, provide potential benefits for patients with mixed symptom profiles, though evidence remains heterogeneous. The level of evidence among studies varies significantly, ranging from high-quality RCTs to lower-level observational data, requiring careful interpretation. While combination treatments improve outcomes, they also present challenges in adherence and side effects. A personalized and evidence-based approach is essential to optimize treatment selection and balance efficacy with tolerability.