Flomax. Avodart. Proscar. Do these drug names sound familiar? If you have seen a doctor for benign prostatic hyperplasia—or BPH, for short—the chances are good you’ve heard about them. Maybe you’re already taking one of them, or even a combination. Results of a new, large-scale study suggest these medications are linked with risk of cardiac failure. Is it time to revisit drug treatment with your doctor?

Managing BPH with pills

BPH is a common and noncancerous enlargement of the prostate gland. As the gland enlarges, it puts mechanical pressure on the urethra. This restricts urine flow and results in symptoms like difficulty starting flow, incomplete bladder emptying, frequent nighttime urination that disrupts sleep, etc. When symptoms get bad enough, a desperate man makes a doctor appointment.

The general approach to managing BPH starts with pills. There are two classes of oral drugs for BPH:

• Alpha blocker (brand names such as Flomax, Hytrin, Uroxatral, Cadura)
• 5-alpha reductase inhibitors (brand names such as Avodart, Proscar)

Alpha blockers work by relaxing the prostate muscles, which helps make urine regulation easier. They don’t shrink the gland, but symptom relief comes pretty quickly. Since they are acting on other systems in the body as well, there are possible side effects such as lowered blood pressure, headaches, weakness, dizziness; sexual dysfunction, including ejaculation difficulty, can also result.

5-alpha reductase inhibitors work to shrink the prostate by blocking production of a male hormone called dihydrotestosterone, which is believed to play a part in gland enlargement. As the gland size diminishes, urine flow gradually improves. However, this class of drugs also has potential sexual side effects including erectile dysfunction (ED), low libido and mood changes.

Thus, for men who choose the pharmaceutical route to manage their BPH, their doctor will consider their overall health and any co-existing conditions that might contraindicate either drug class.

A new study brings up a greater concern

Some research studies have found evidence that long-term use of alpha blockers can have a negative impact on heart health. In fact, a new, large-scale study out of Canada raises concern about a very dramatic potential side effect: death by heart failure. The May, 2021 issue of the Journal of Urology published a paper by Lusty, et al. titled “Cardiac Failure Associated with Medical Therapy of Benign Prostatic Hyperplasia: A Population Study.”^[i]

The size of the study population was large-scale. It involved data on 175,201 men over age 66 who had been diagnosed with BPH between 2005-2015. The number of men who were treated medically (that is, by medication) vs. those who were not were:

• 8,339 who used 5-alpha reductase inhibitors at any time
• 55,383 who used alpha blockers at any time
• 41,491 who used a combination of the two classes at any time
• 69,988 who did not use these medications at any time.

Here’s the scary part: after taking into account other variables (the amount of exposure to the medications, which formulations were used, age, and co-existing conditions associated with cardiac disease), the authors found that BPH patients who used the drugs, alone or in combination, had a “statistically increased risk of being diagnosed with cardiac failure compared to no medication use.”

They note that heart failure risk was greatest for those who used alpha blockers alone (nonselective formulations had higher cardiac failure risk than selective formulations); risk was intermediate for combination use; and risk was lowest for 5-alpha reductase inhibitors alone.

Again, if you are taking either/both type of medication for BPH, we recommend that you bring up this study with your doctor, and in consultation with him/her, re-examine your options.

Alternative to medication

If drugs are not right for you, the Sperling Prostate Center offers an alternative. Our Focal Laser Ablation (FLA) is a precise MRI-guided outpatient treatment to reduce compression on the urethra by selectively ablating tissue enlargement. This is a different type of laser treatment than vaporization done by inserting a probe through the penis into the prostatic urethra. Also, nothing is implanted in the prostate to artificially widen the passage. Instead, the treated tissue gradually shrinks as harmless scar tissue forms and is reabsorbed by the body. Side effects are minimal-to-none, and the results are durable.

If you have BPH, why take pills that may not be in the best interest of your cardiac health when there’s a one-day treatment to alleviate symptoms and restore quality of life? For more information, or to arrange a consultation, visit our website.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Lusty A, Siemens DR, Tohidi M, Whitehead M et al. Cardiac Failure Associated with Medical Therapy of Benign Prostatic Hyperplasia: A Population Based Study. J Urol. 2021 May;205(5):1430-1437. https://pubmed.ncbi.nlm.nih.gov/33616451/