The study did not show that the qualitative assessment of symptoms was significantly greater in the combination therapy group relative to tamsulosin alone. Figure 8 Changes from baseline in International Prostate Symptom Score. Values are adjusted means (ie, leastsquares means). ER, extended release; IPSS, International Prostate Symptom Score. † P < .01 tversus placebo. Reproduced with permission ... The natural history of AUR in men with BPH

indicates the risk increases with duration of follow-up.14,15 The risk of AUR is greatest in men with large prostates. Interestingly, men in the tolterodine/tamsulosin study had very small prostates Inhibitors,research,lifescience,medical and therefore a relatively low risk of AUR. A study of 3 months’ duration Inhibitors,research,lifescience,medical is inadequate to examine the true effect of ACH on promoting AUR in men with BPH. In summary, the tolterodine/tamsulosin study falls short of demonstrating, or even suggesting, the safety and efficacy of the combination of an α-blocker and ACH for the treatment of BPH. Other Combination Therapies There is no doubt that any combination of drugs with different mechanisms

of action will likely show additive clinical effectiveness. When and if PDE5 inhibitors and other novel drugs are approved for the treatment of BPH, the next step will be to examine the benefit of combination therapy with an α-blocker or 5-ARI. The cost of combination must Inhibitors,research,lifescience,medical be considered owing to a long-term commitment to medical therapy. It is likely that only subsets of men will benefit from a specific combination and therefore the challenge will be to identify that subset instead of treating all men with expensive combination therapies. Inhibitors,research,lifescience,medical Main Points Medical therapy for the treatment of benign prostatic hyperplasia (BPH) became an accepted standard

of care in the 1990s following the reports of randomized, double-blind, placebo-controlled studies showing that finasteride, a 5-α reductase inhibitor (5-ARI), and Inhibitors,research,lifescience,medical terazosin, an α-blocker, significantly improved lower urinary tract symptoms (LUTS) and increased peak urinary flow rates in men with BPH. The evolution of α-blockers for the treatment of clinical BPH has involved the development of subtype-selective α-antagonists and novel formulations that ultimately allow for a single, daily-dose administration without the requirement for dose titration. Of all α-blockers, MTMR9 only silodosin exhibits any degree of αLY2157299 clinical trial -adrenoceptor subtype selectivity that can be leveraged in the clinical setting. Initial data support the clinical benefit of phosphodiesterase type 5 (PDE5) inhibitors for the treatment of LUTS secondary to BPH. Four large, double-blind, placebo-controlled trials have examined the effectiveness of sildenafil, tadalafil, and vardenafil in men with LUTS and BPH; all of the studies consistently demonstrated that this class of drugs improves LUTS in men with BPH.