Many men notice changes in their urination as they grow older. They may need to urinate more often, wake up several times during the night, have trouble starting to urinate, or notice that their urine stream is weaker than it used to be.
These problems are called lower urinary tract symptoms and become increasingly common with age. Studies suggest that about one in three men will experience moderate to severe symptoms during their lifetime.
Although these symptoms are not usually life-threatening, they can interrupt sleep, reduce confidence, affect travel and social activities, and lower overall quality of life.
The most common cause of these symptoms is an enlarged prostate, also known as benign prostatic hyperplasia or BPH. The prostate is a small gland below the bladder that surrounds part of the urethra, the tube that carries urine out of the body. As men get older, the prostate often grows larger.
This growth is not cancer, but it can squeeze the urethra and make it harder for urine to flow normally.
Doctors often prescribe a medicine called tamsulosin to help relieve these symptoms. Tamsulosin works by relaxing muscles around the prostate and bladder so urine can pass more easily. Millions of men around the world take this medicine, and many find it helpful.
However, like all medicines, it can also cause side effects. Some people may experience dizziness, sudden drops in blood pressure when standing, falls, broken bones, or simply the burden of taking another daily medicine.
Even after symptoms improve, many patients continue taking tamsulosin because they worry that stopping it will make their symptoms return.
Researchers at the University of California, San Francisco wanted to find out whether long-term users were still receiving real benefits from the medicine. Their study, published in JAMA Network Open, tested whether some men might safely stop taking tamsulosin without their symptoms becoming worse.
The researchers designed an unusual clinical trial. Each participant took both tamsulosin and a matching placebo during different two-week periods without knowing which one they were receiving. Because every participant acted as his own comparison, the scientists could clearly see whether the medicine continued to provide meaningful relief.
Thirty-one older men joined the study. The results showed that the benefits varied greatly. About one-third of the participants experienced little or no difference between tamsulosin and the placebo.
Another one-third experienced only moderate benefit. Only a small group had strong improvement from the medicine, while another small group found that their symptoms became worse when switched to the placebo and therefore could not continue that part of the study.
Lead author Dr. Scott R. Bauer said the findings suggest doctors should not automatically assume that patients need to stay on tamsulosin forever. Instead, treatment should be reviewed from time to time because the balance between benefits and risks may change as people age.
The researchers believe this personalized approach may be especially valuable for older adults who already take several medicines every day. Carefully reducing unnecessary medicines, sometimes called deprescribing, may lower the risk of side effects while keeping symptoms well controlled.
The study was relatively small, so larger clinical trials are still needed. Future research will examine whether these findings apply to more patients and whether doctors can identify in advance who is most likely to benefit from long-term treatment.
Overall, the study suggests that many men may be able to reduce their medication without losing symptom control, but this should only be done under medical supervision.
Rather than stopping treatment on their own, patients should discuss their symptoms and medicines with their doctor. The findings support more personalized care instead of using the same long-term treatment for everyone.
If you care about prostate cancer, please read studies about 5 types of bacteria linked to aggressive prostate cancer, and new strategy to treat advanced prostate cancer.
For more information about prostate cancer, please see recent studies about new way to lower risk of prostate cancer spread, and results showing three-drug combo boosts survival in metastatic prostate cancer.
The research was published in JAMA Network Open.
Source: University of California, San Francisco.
