<p><strong>In patients with LUTS/BPH and an estimated prostate volume >30 cc and/or PSA >1.5 ng/mL, with or without ED, clinicians may offer the combination of daily 5 mg tadalafil with a 5-ARI. (<em>Conditional Recommendation; Evidence Level: Grade C</em>)</strong></p>
Discussion
Discussion
<p>Combination therapy utilizing 5 mg tadalafil with finasteride demonstrates a small, but statistically significant improvement in IPSS compared to finasteride alone for prostates >30 cc. Furthermore, patient satisfaction was greater with combination therapy as were IIEF-Erectile Function (EF) scores (see <strong>Appendix II)</strong>.</p>
<p>One RCT evaluated combination therapy using 5 mg tadalafil combined with 5 mg finasteride versus finasteride alone. The findings of this were reported in one systematic review and a primary publication with two other articles. Companion analyses that add additional outcomes to the same patient cohort were included in the meta-analysis conducted for this Guideline.<sup>141, 197, 198</sup> Combination therapy improved IPSS more than finasteride alone, however, quality of life improvement was similar in both groups. Furthermore, combination treatment resulted in improved erectile function for patients with or without baseline ED compared to monotherapy. The results of the RCT as well as companion analyses for the same trial are included in <strong>Appendix II</strong>.</p>