title: α1-blocker tamsulosin as initial treatment for patients with benign prostatic hyperplasia: 5-year outcome analysis of a prospective multicenter study.
abstract: OBJECTIVE
  To comprehensively analyze the 5-year outcomes of tamsulosin treatment for patients with benign prostatic hyperplasia.
  
  
  METHODS
  Tamsulosin (0.2 mg/day) was given to 112 patients who had International Prostate Symptom Scores ≥8. They were prospectively followed for 5 years with periodic evaluation. If tamsulosin had to be discontinued, the reason was determined. Treatment failure was considered in the case of disease progression (postvoid residual urine volume ≥200 mL, acute urinary retention, febrile urinary tract infection or hydronephrosis as a result of bladder outlet obstruction), conversion to other α1-blockers or need for surgery. An intention-to-treat analysis was carried out.
  
  
  RESULTS
  A total of 34 patients (30.4%) continued the same medication for the overall study period, whereas 78 patients (69.6%) discontinued the medication. International Prostate Symptom Scores, Benign Prostatic Hyperplasia Problem Index and Quality of Life Index were significantly improved over the 5-year period. Treatment failure was observed in 21 patients (18.8%). Baseline prostate volume and postvoid residual urine volume were independent factors to predicting treatment failure. A total of 21 patients (18.8%) discontinued tamsulosin because of an improvement of symptoms. They were younger and had lower prostate-specific antigen levels than the remaining 91 patients. Their symptoms were stable even 1 year after termination of therapy.
  
  
  CONCLUSIONS
  Long-term efficacy of tamsulosin was observed, although only a small portion of patients continued the treatment. α1-blocker monotherapy might be not appropriate for achieving a good long-term outcome in patients with a large prostate volume and a large amount of postvoid residual urine volume. Persistent improvement of symptoms, even after termination of tamsulosin, was observed in young patients with low prostate-specific antigen levels.
authors.affiliation: Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan. masumori@sapmed.ac.jp
authors.forename: Naoya
authors.initials: N
authors.lastname: Masumori
authors.forename: Taiji
authors.initials: T
authors.lastname: Tsukamoto
authors.forename: Hiroki
authors.initials: H
authors.lastname: Horita
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Sunaoshi
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Koh
authors.initials: K
authors.lastname: Takeyama
authors.forename: Eiji
authors.initials: E
authors.lastname: Sato
authors.forename: Noriomi
authors.initials: N
authors.lastname: Miyao
mesh_terms: D058668:Adrenergic alpha-1 Receptor Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D000368:Aged; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010352:Patient Dropouts; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011470:Prostatic Hyperplasia / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D013449:Sulfonamides / Q000008:administration & dosage* / Q000009:adverse effects; D000077409:Tamsulosin; D016896:Treatment Outcome; D016055:Urinary Retention / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D014555:Urination Disorders / Q000188:drug therapy / Q000473:pathology / Q000601:surgery
chemical_list: D058668:Adrenergic alpha-1 Receptor Antagonists; D013449:Sulfonamides; D000077409:Tamsulosin