Despite evidence from randomized controlled trials showing that combination therapy has better efficacy in patients with benign prostatic hyperplasia (BPH), a population-based study found that monotherapy with alpha-blockers or 5alpha-reductase inhibitors (5ARIs) is the most common approach to medical treatment of BPH.

The study, from the University of Montreal Health Centre in Canada, analyzed previously acquired data from the PROtEuS study, conducted between 2005-2012. The study covered 3,927 men of which 1,933 had newly diagnosed prostate cancer and 1,994 of whom were randomly-selected control individuals from the general population.

Now, researchers selected only men who reported they had received a BPH diagnosis at some time point in their life – a total of 1,120 people from both the prostate cancer and control groups.

Findings, published in the Canadian Urological Association Journal, showed that more individuals in the control group had received medication for managing BPH than in the patient group.

The study, “Medical management of benign prostatic hyperplasia: Results from a population-based study,“ also showed that men who received medication were older when they received their BPH diagnosis, and had a longer history of BPH. The 601 medicated individuals also reported a lower annual income and more visits to the physician. This finding indicates that income might not be a barrier to BPH treatment.

Researchers had access to detailed medical information for 460 of the included subjects, and said treatment was most often initiated with a single drug. Just 12.4 percent of the medicated participants received combination therapy as their first treatment. The men in the cancer group reported they received monotherapy more often than controls – 91.2 percent compared to 82.7 percent.

Alpha-blocking drugs were the most frequently used single drug, followed by 5ARIs. These drugs in combination were also the most frequently reported combination therapy.

The study shows that actual treatment patterns in a Canadian population setting have not been adapted to findings from clinical trials that indicate the superiority of combination treatments in managing lower urinary tract symptoms related to BPH.