Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
To monitor a patient on long-term treatment for benign prostatic hyperplasia (BPH) to assess treatment efficacy and side effects, regular reviews are essential NICE CKS,NICE CG97.
- General Monitoring Principles:
- During reviews, you should re-assess the patient's symptoms and quality of life, for example, by using the International Prostate Symptom Score (IPSS) questionnaire NICE CKS.
- It is also crucial to assess for any adverse effects of the treatment NICE CKS,NICE CG97.
- Specific Review Schedules by Drug Type:
- Alpha-blockers: Review men taking alpha-blockers at 4 to 6 weeks initially, and then every 6 to 12 months NICE CKS,NICE CG97. While generally well-tolerated, potential side effects can include orthostatic hypotension, dizziness, fatigue or weakness, and rhinitis NICE CKS.
- 5-alpha reductase inhibitors (5-ARIs): Review men taking 5-alpha reductase inhibitors at 3 to 6 months initially, and then every 6 to 12 months NICE CKS,NICE CG97. Common side effects associated with 5-ARIs include decreased libido, erectile dysfunction, and breast enlargement NICE CKS.
- Antimuscarinic drugs: Review men taking antimuscarinics every 4 to 6 weeks until their symptoms are stable, and then every 6 to 12 months NICE CKS,NICE CG97. During these reviews, re-assess symptoms, quality of life, adverse effects, and the ongoing need for treatment NICE CKS.
- Combination Therapy: Men on combination treatment with an alpha-blocker and a 5-alpha reductase inhibitor are more likely to experience adverse effects such as decreased libido, ejaculatory abnormalities, and erectile dysfunction compared to alpha-blocker monotherapy NICE CKS.
- When Treatment Fails:
- If drug treatment fails to be effective or is not tolerated, consider offering an alternative drug NICE CKS.
- If treatment ultimately fails, the man should be referred for specialist urological assessment and management NICE CKS,NICE CG97.