How should I monitor a patient on long-term treatment for BPH to assess efficacy and side effects?

To monitor a patient on long-term treatment for benign prostatic hyperplasia (BPH) to assess treatment efficacy and side effects, regular reviews are essential ¹,².

• 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 ¹.
• It is also crucial to assess for any adverse effects of the treatment ¹,².
• 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 ¹,². While generally well-tolerated, potential side effects can include orthostatic hypotension, dizziness, fatigue or weakness, and rhinitis ¹.
• 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 ¹,². Common side effects associated with 5-ARIs include decreased libido, erectile dysfunction, and breast enlargement ¹.
• Antimuscarinic drugs: Review men taking antimuscarinics every 4 to 6 weeks until their symptoms are stable, and then every 6 to 12 months ¹,². During these reviews, re-assess symptoms, quality of life, adverse effects, and the ongoing need for treatment ¹.
• 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 ¹.
• When Treatment Fails:
• If drug treatment fails to be effective or is not tolerated, consider offering an alternative drug ¹.
• If treatment ultimately fails, the man should be referred for specialist urological assessment and management ¹,².