Use of PDE-5 inhibitors and beta-3 agonists in treating BPH

In this video, Eiftu S. Haile, MD, discusses the use of PDE-5 inhibitors and beta-3 agonists in the treatment of BPH. She is first author of the recent Cleveland Clinic Journal of Medicine paper “Medical management of benign prostatic hyperplasia.” Haile is a urology resident at Cleveland Clinic Glickman Urological and Kidney Institute, Cleveland, Ohio.

Transcription:

What did you learn regarding the use of phosphodiesterase-5 inhibitors and beta-3 agonists for BPH?

Similar to much of the work in this space, our findings are quite promising for these treatments. Phosphodiesterase-5 inhibitors, like tadalafil, for example, they not only help with prostate symptoms by relaxing the smooth muscle, but they also help improve erectile function. They're particularly useful for those who may not tolerate alpha blockers or 5-ARIs. As for beta-3 agonists, such as mirabegron, they are highlighted for their potential to relax the detrusor muscle of the bladder, improving storage symptoms like urgency and frequency, and then they don't have as many of those cognitive side effects that are associated with anticholinergics.

What other key points were raised in this paper?

Within this paper, we discussed the importance of conservative management and lifestyle modifications as initial steps in managing BPH. We also highlight that combination therapy can be more effective than monotherapy in certain clinical scenarios, especially for patients, for example, with larger prostates or more severe symptoms. Moreover, in the paper, we touched upon the potential of newer agents and even natural products, though we stressed the need for further research to validate their effectiveness and their safety. And then within the paper, we also addressed the growing importance and acceptance of procedural and surgical options as viable first-line treatments for some patients. This sort of underscores a shift toward more personalized care in BPH management, which we've been seeing more and more of, and really, it goes back to this adage that, at least for us in training, we continuously learn, which is that we should take care to match the right procedure with the right patient, or in this case, the right procedure for the right prostate.

This transcription was edited for clarity.