Mega Doctor News
by University of California, San Francisco (UCSF)
Newswise – One in three men will experience moderate-to-severe lower urinary tract symptoms in their lifetime, with symptoms including frequent urination, difficulty starting urination, nocturia and a weak urine stream. Although these are common symptoms, in older men, they can significantly impact quality of life.
The majority of male urinary symptoms are attributed to an enlarged prostate (benign prostatic hyperplasia or BPH), which is a non-cancerous growth of the prostate that occurs as most men age and can obstruct the flow of urine. BPH is commonly treated with medications that attempt to relieve that obstruction by shrinking the prostate or relaxing the prostatic smooth muscle, such as Tamsulosin, an Alpha-1 adrenergic receptor antagonist (a1-blocker).
While Tamsulosin can be used to successfully treat urinary symptoms in many patients, for some, the uncertain or modest benefits can be outweighed by the harms, which include sudden drops in blood pressure, dizziness, falls, fractures, and medication burden. Still, 1 in 5 older men with BPH receive Tamsulosin and often continue treatment with the medication after their symptoms have resolved due to a fear of recurrence.
To assess the individualized benefits and harms of Tamsulosin therapy, UCSF researchers conducted a proof-of-concept, randomized clinical trial comparing continuation of long-term Tamsulosin treatment with a matching placebo among older men with BPH. Their study found that approximately 1 in 3 participants receiving Tamsulosin therapy for BPH had minimal or no effect from the Tamsulosin therapy versus a placebo on urinary symptoms.
Their study appeared in JAMA Network Open on July 6, 2026.
“Tamsulosin is widely prescribed, but clinicians have little evidence to support whether it is providing meaningful benefit to an individual patient several years after treatment begins,” said study first author Scott R. Bauer, MD, ScM, UCSF associate professor of Medicine, Urology, Epidemiology and Biostatistics. “Our findings suggest that long-term tamsulosin therapy should be periodically reassessed because the balance between benefit and harm may change over time,”
Their unique clinical trial design was a randomized, double-blind, placebo-controlled, multiple crossover trial (N-of-1) with each participant receiving both Tamsulosin and placebo. Each participant served as their own control, allowing researchers to compare urinary symptoms during two-week treatment periods randomly alternating between Tamsulosin and placebo.
Among the 31 participants who attempted the N-of-1 protocol, 36.7% had minimal or no effect from the Tamsulosin and another 36.7% had only a moderate effect. While 13.3% had strong effect from Tamsulosin, and another 13.3% did not tolerate the one-week placebo due to worsening symptoms, the study results suggest that a substantial number of patients may be candidates for Tamsulosin deprescribing.
“We found that tamsulosin treatment response varied substantially from person to person and that an N-of-1 deprescribing trial can precisely measure how much benefit an individual is receiving from continued treatment,” said Bauer. “The results of this small clinical trial suggest that we should reconsider the assumption that long-standing BPH medications should automatically be continued. For many older men, especially those taking several medications, periodically reassessing whether tamsulosin is still providing meaningful benefit is an important part of age-friendly, personalized BPH care.”
The researchers acknowledge the small size of this proof-of-concept study and believe larger studies are needed to confirm generalizability across clinical settings and patient populations, to identify predictors of Tamsulosin response, and to test the effect of N-of-1-guided deprescribing on clinical outcomes.
Additional UCSF Authors: Stacey A. Kenfield, ScD; Akinyemi Oni-Orisan, PharmD, PhD; Michael G. Shlipak, MD, MPH; Kaiwei Lu, MS; Natalie Rios, BS; Robert Pearce, BS; Joseph Harmon, BS; Charles E. McCulloch, PhD; Liusheng Huang, PhD; Michael A. Steinman, MD; and Benjamin N. Breyer, MD, MAS.
Funding: This work was supported by grants to B.N.B. from the University of California, San Francisco (UCSF) Academic Senate Committee Resource Allocation Program. The pharmacodynamics substudy was funded by a Team Science Award to S.R.B. and A.O. from the UCSF Clinical and Translational Science Institute, which is part of the Clinical and Translational Science Award program funded by the National Center for Advancing Translational Sciences (UL1 TR991872). S.R.B. was also funded by grants from the National Institute of Diabetes, Digestive, and Kidney Disorders (1K12DK111028) and the National Institute on Aging (1RO3AG067937 and 1K76AG074903). M.A.S. was funded by grants from the National Institute on Aging (K24AG049057, P30 AGO44281, and R33AG086944).
Disclosures: S.A.K. reported holding stock options in Fellow Health outside the submitted work. M.G.S. reported receiving grants from Bayer and personal fees from Bayer and Boehringer Ingelheim outside the submitted work. C.E.M. reported receiving grants from the National Institutes of Health (NIH) to his institution during the conduct of the study.
About UCSF Health: UCSF Health is recognized worldwide for its innovative patient care, reflecting the latest medical knowledge, advanced technologies and pioneering research. It includes the flagship UCSF Medical Center, which is a highly-ranked hospital, as well as UCSF Benioff Children’s Hospitals, with campuses in San Francisco and Oakland; two community hospitals, UCSF Health Stanyan Hospital and UCSF Health Hyde Hospital; Langley Porter Psychiatric Hospital; UCSF Benioff Children’s Physicians; and the UCSF Faculty Practice. These hospitals serve as the academic medical center of the University of California, San Francisco, which is world-renowned for its graduate-level health sciences education and biomedical research. UCSF Health has affiliations with hospitals and health organizations throughout the Bay Area. Visit http://www.ucsfhealth.org/. Follow UCSF Health on Facebook, Threads or LinkedIn.
