Clinicians can choose from multiple ABs when selecting appropriate medical therapy for their patients. Multiple studies, systematic reviews and meta-analyses, have shown effectiveness of AB therapy in the treatment of LUTS/BPH. Most agree that the medications are relatively equally effective in terms of IPSS improvement. A large meta-analysis shows an absolute effect, or mean change from baseline symptoms to study end, ranging from -3.69 to -7.06 points with most uroselective ABs (also known as subtype [alpha-1a]-selective) demonstrating a >5-point IPSS improvement.149 Clinicians should not change between different ABs if patients fail to have sufficient improvement with the initiation of drug therapy, however, they may consider a change when patients respond to medications but have intolerable side effects that may be ameliorated with a different AB. In a large population-based cohort study (n=24,626), discontinuation rates at 12 months were as high as 65%.150   Newer, uroselective ABs (i.e., alfuzosin, silodosin, tamsulosin) have a higher affinity for the alpha-1A receptor subtype in the prostate and bladder neck. Several studies evaluating uroselective ABs demonstrated inconsistency in overall symptom improvement when comparing one drug to another. Silodosin versus alfuzosin was compared in two RCTs; one showed greater symptom improvement with silodosin and the other with alfuzosin. The quality of life and withdrawal due to adverse events were not different between the two drugs.146, 147 Silodosin versus tamsulosin was studied and showed similar improvement in LUTS, however quality of life improvement favored silodosin while it simultaneously had a higher rate of withdrawal due to adverse effects.148 Finally, there was no change in LUTS or withdrawal of the medication for adverse events when comparing alfuzosin with tamsulosin, however, quality of life favored alfuzosin at 12 weeks.146, 147, 151