Hi Fred.Safety and efficacy of tamsulosin, alfuzosin or silodosin as monotherapy for LUTS in BPH – a double-blind randomized trial
(2017, Full Text)
Currently alpha1-adrenoceptor blockers (AB) are widely used as first-line therapy to improve lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). We compared the efficacy and safety profile of tamsulosin, alfuzosin and silodosin in LUTS due to BPH.
Material and methods
Consecutive consenting male patients (N = 269) undergoing medical management of BPH with AB from February 2012 to October 2015 were enrolled. Patients were randomized to a 0.4 mg tamsulosin (group T), 10 mg alfuzosin (group A) or a 8 mg silodosin (group S) by double-blind randomization. All patients were assessed for improvements and post-void residual urine (PVR) and for adverse drug events (ADE).
IPSS showed significant improvement in Group S at the first week (11.7 ±4.18, p = 0.027) and at 3 months (7.97 ±3.84, p = 0.020). QOL showed significant improvement at 1 (2.2 ±0.76, p = 0.020), 4 (1.47 ±0.63, p <0.001) and 12 (1.2 ±0.66, p <0.001) weeks in Group S. The mean Qmax improvement was the maximum (13.76 ±2.44, p = 0.028) in Group S at 1 week. Reduction in PVR was the maximum in Group S, but it was not statistically significant. Adverse drug events (ADE) were observed in 20.07% (54/269) patients and distribution was similar in the three groups with decreasing incidence with progression of time.
ConclusionsSilodosin is the most efficacious AB with rapid onset of action. Silodosin also improves the quality of life in patients with LUTS due to BPH and objectively improves maximum flow rate. However, silodosin has more adverse events when compared to tamsulosin and alfuzosin.
(See Full Text; tamsulosin is Flomax, silodosin is Rapaflo, and alfuzosin is Uroxatral
Effectiveness and adverse effects aside, I think as far as the length of time any of these works, it just depends
. My uro/surgeon explained that BPH symptoms are not always proportional to prostate size. In one guy the extra growth is directed inward, constricting the urethra; in another, growth is directed outward, with no or light symptoms. Logically, the more pressure your BPH is inward, and the more rapid your prostate growth, the shorter the time that medication (in general) may work for you.
If one drug stops working, you could switch to another and see how effective it is at that point.
Flomax (with finasteride) worked very well for me for many years (eventually I went to 2 capsules/day); but my prostate nonetheless slowly went up to 90 g, at which point I chose to have a TURP (which restored urine flow and reduced my size to 30 g). My doc gave me a photo looking up the urethra at the start of surgery -- my urethra was almost totally pinched off on three sides like a triangle with each side bulging inward. He said he didn't know how I was able to pee at all. (At the time of my RP for PCa, four years later, my prostate had grown back up to 64 g.)