Clinician’s perspectives and preferences in the management of benign prostatic hyperplasia in Indian settings

Objective: To assess current clinical practice and treatment preferences among clinicians involved in the management of benign prostatic hyperplasia (BPH) in India, with a particular focus on first-line therapy selection, combination treatment approaches, and symptom-specific therapeutic strategies. Methodology: This cross-sectional study was conducted among 98 clinicians in India using a 24-item structured questionnaire and explored their clinical observations on BPH management, such as clinical characteristics of their patients, diagnostics, treatment practices, and associated challenges. Data were analyzed using descriptive statistics. Results: The survey included 98 physicians, with the majority (56.12%) preferring silodosin as the first-line treatment for BPH. Silodosin was also favored by 52% of respondents for patients with ureteric stones and by 83% for those with predominant nocturia. Approximately 48% cited prostate volume reduction as a key benefit of long-term dutasteride use, while 39% preferred the combination of tamsulosin and dutasteride for reducing the risk of BPH progression. Silodosin combined with either mirabegron or dutasteride was considered highly beneficial by 72% and 79% of experts, respectively. About 48% reported patient shifts from tamsulosin to silodosin due to improved symptoms, and 45% indicated that 25-50% of their BPH patients are currently on silodosin therapy, with 63% noting a significant improvement in quality of life. Conclusion: The survey highlights silodosin as the preferred first-line therapy for BPH, recognized for its rapid symptom relief and efficacy in both voiding and storage symptoms. Its increasing use, particularly in patients with nocturia and ureteric stones, indicates a shift from tamsulosin. Combination regimens with dutasteride or mirabegron are gaining preference for enhanced symptom control and long-term disease management.