Condition

Benign Prostatic Hyperplasia

BPH - Enlarged prostate gland

1.1B
People Affected
100
Active Trials
13.8M
New Cases/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

1
Transurethral Resection of the Prostate (TURP)
80% Effectiveness• 95% Confidence• 35% Safety• 86 trials• 100K participants
HIGH EvidenceGood Value
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Comparative Safety Scale(Higher is safer)

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35
DangerousModerateSafe

Time to Effect

1-3 months (post-recovery)

Duration

Single procedure (long-lasting effects >10 years)

Response Rate

87%

Remission Rate

%

Number Needed to Treat (NNT)

2

Number Needed to Harm (NNH)

1.5

Common Side Effects:

Retrograde ejaculation: 70%
Erectile dysfunction (new onset or worsening): 7%
Bleeding requiring transfusion: 7%
Urinary tract infection: 7%
Urinary incontinence (persistent): 2%

Annual Cost of Care

Drug Cost

$0

Monitoring

$200

Side Effects

$250

Total Annual

$1,525

Cost-Effectiveness

GOOD

QALYs Gained

0.08

ICER

$50,000/QALY

Cost per Responder

$1,753

Treatment Outcomes
Primary Outcomes
International Prostate Symptom Score (IPSS)22 points (0-35 scale)
-65% (-14.3 points)
Peak Urinary Flow Rate (Qmax)10 mL/s
+120% (+12 mL/s)
Post-Void Residual (PVR) Urine Volume150 mL
-80% (-120 mL)
Quality of Life (QoL) Index (IPSS-QoL)4.5 points (0-6 scale)
-55% (-2.5 points)
Secondary Benefits
Nocturia (frequency of nighttime urination)3.5 voids/night
-45% (-1.6 voids/night)
Bladder Outlet Obstruction Index (BOOI)50 points (obstructed, >40)
-70% (-35 points)
Common Side Effects
Retrograde ejaculation
+70%
Erectile dysfunction (new onset or worsening)
+7%
Bleeding requiring transfusion
+7%
2
Combination Therapy (Tamsulosin + Finasteride)
75% Effectiveness• 90% Confidence• 62% Safety• 7 trials• 20K participants
HIGH EvidenceGood ValueDose: Tamsulosin 0.4mg daily + Finasteride 5mg daily
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Comparative Safety Scale(Higher is safer)

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62
DangerousModerateSafe

Time to Effect

2 weeks (initial) to 6 months (full effect)

Duration

Lifetime

Response Rate

75%

Remission Rate

%

Number Needed to Treat (NNT)

8

Number Needed to Harm (NNH)

8

Common Side Effects:

Dizziness: 18%
Abnormal ejaculation (retrograde): 12%
Erectile dysfunction: 12%
Decreased libido: 6%
Orthostatic hypotension: 4%
Breast tenderness/enlargement: 1%

Annual Cost of Care

Drug Cost

$60

Monitoring

$250

Side Effects

$175

Total Annual

$485

Cost-Effectiveness

GOOD

QALYs Gained

0.15

Cost per Responder

$647

Treatment Outcomes
Primary Outcomes
International Prostate Symptom Score (IPSS)22 points (on 0-35 scale)
-29.5% (-6.5 points)
Peak Urinary Flow Rate (Qmax)9.0 mL/s
+27.8% (+2.5 mL/s)
Prostate Volume45 mL
-22.2% (-10.0 mL)
Secondary Benefits
Post-Void Residual (PVR) Volume70 mL
-28.6% (-20 mL)
BPH-related Quality of Life (QoL) Index4.0 points (on 0-6 scale, higher is worse)
-37.5% (-1.5 points)
Risk of BPH Progression (composite endpoint)Annual incidence of BPH progression events: 3.5%
-66% (-2.3 percentage points)
Common Side Effects
Dizziness
+18%
Abnormal ejaculation (retrograde)
+12%
Erectile dysfunction
+12%

Clinical Trial Phases:

Phase 3Phase 4
3
UroLift System (Prostatic Urethral Lift)
70% Effectiveness• 90% Confidence• 55% Safety• 5 trials• 5K participants
HIGH EvidenceExcellent Value
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Comparative Safety Scale(Higher is safer)

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55
DangerousModerateSafe

Time to Effect

2 weeks to 1 month

Duration

Single procedure (effects >5 years)

Response Rate

75%

Remission Rate

%

Number Needed to Treat (NNT)

3

Number Needed to Harm (NNH)

4

Common Side Effects:

Dysuria: 25%
Hematuria: 15%
Pelvic pain: 7%
Urge incontinence (transient): 7%

Annual Cost of Care

Drug Cost

$0

Monitoring

$200

Side Effects

$100

Total Annual

$2,170

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.09

ICER

$25,000/QALY

Cost per Responder

$2,893

Treatment Outcomes
Primary Outcomes
International Prostate Symptom Score (IPSS)22 points (Scale: 0-35)
-40.9% (-9 points)
Peak Urinary Flow Rate (Qmax)8.5 mL/s
+41.2% (+3.5 mL/s)
Post-Void Residual (PVR) Volume120 mL
-45.8% (-55 mL)
Secondary Benefits
International Prostate Symptom Score (IPSS) Quality of Life Index4.5 points (Scale: 0-6)
-44.4% (-2.0 points)
BPH Impact Index (BII)7.5 points (Scale: 0-13)
-40% (-3.0 points)
Common Side Effects
Dysuria
+25%
Hematuria
+15%
Pelvic pain
+7%

Clinical Trial Phases:

Phase 3Phase 4
4
Rezum Water Vapor Thermal Therapy
70% Effectiveness• 88% Confidence• 52% Safety• 16 trials• 4K participants
HIGH EvidenceExcellent Value
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Comparative Safety Scale(Higher is safer)

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52
DangerousModerateSafe

Time to Effect

2 weeks (initial) to 3 months (full effect)

Duration

Single procedure (effects >4 years)

Response Rate

75%

Remission Rate

%

Number Needed to Treat (NNT)

3

Number Needed to Harm (NNH)

4

Common Side Effects:

Dysuria: 25%
Urinary retention (temporary, catheterization): 15%
Hematuria: 15%
Urgency: 7%
Pelvic pain: 7%

Annual Cost of Care

Drug Cost

$0

Monitoring

$200

Side Effects

$100

Total Annual

$2,050

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.09

ICER

$35,000/QALY

Cost per Responder

$2,733

Treatment Outcomes
Primary Outcomes
International Prostate Symptom Score (IPSS)22.6 points (0-35 scale)
-49.6% (-11.2 points)
BPH-related Quality of Life (QoL) Index4.5 points (0-6 scale)
-51.1% (-2.3 points)
Maximum Urinary Flow Rate (Qmax)9.5 mL/s
+47.4% (+4.5 mL/s)
Post-Void Residual (PVR) Urine Volume120 mL
-58.3% (-70 mL)
Secondary Benefits
Prostate Volume70 mL
-17.1% (-12 mL)
Erectile Function (IIEF-5 score)18.5 points (5-25 scale)
+2.7% (+0.5 points)
Ejaculatory Function (MSHQ-EjD score)11.0 points (0-20 scale)
+1.8% (+0.2 points)
Common Side Effects
Dysuria
+25%
Urinary retention (temporary, catheterization)
+15%
Hematuria
+15%

Clinical Trial Phases:

Phase 3Phase 4
5
Tamsulosin (Alpha-blocker)
65% Effectiveness• 92% Confidence• 72% Safety• 19 trials• 50K participants
HIGH EvidenceExcellent ValueDose: 0.4-0.8mg once daily
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Comparative Safety Scale(Higher is safer)

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72
DangerousModerateSafe

Time to Effect

Within days to 2 weeks

Duration

Lifetime

Response Rate

65%

Remission Rate

%

Number Needed to Treat (NNT)

4

Number Needed to Harm (NNH)

12

Common Side Effects:

Dizziness: 18%
Abnormal ejaculation (retrograde): 7%
Rhinitis: 7%
Orthostatic hypotension: 4%

Annual Cost of Care

Drug Cost

$30

Monitoring

$250

Side Effects

$75

Total Annual

$355

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.08

Cost per Responder

$546

Treatment Outcomes
Primary Outcomes
International Prostate Symptom Score (IPSS)20 points (moderate-severe, on 0-35 scale)
-35% (-7 points)
Maximum Urinary Flow Rate (Qmax)9.5 mL/s
+26% (+2.5 mL/s)
Post-Void Residual (PVR) Volume110 mL
-23% (-25 mL)
Secondary Benefits
Quality of Life (QoL) due to BPH (IPSS Question 8)4 points (on 0-6 scale)
-38% (-1.5 points)
Nocturia Episodes3.5 episodes/night
-29% (-1.0 episodes/night)
Common Side Effects
Dizziness
+18%
Abnormal ejaculation (retrograde)
+7%
Rhinitis
+7%

Clinical Trial Phases:

Phase 3Phase 4
6
Finasteride (5-alpha-reductase inhibitor)
55% Effectiveness• 90% Confidence• 62% Safety• 13 trials• 30K participants
HIGH EvidenceExcellent ValueDose: 5mg once daily
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Comparative Safety Scale(Higher is safer)

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62
DangerousModerateSafe

Time to Effect

3-6 months

Duration

Lifetime

Response Rate

55%

Remission Rate

%

Number Needed to Treat (NNT)

15

Number Needed to Harm (NNH)

15

Common Side Effects:

Erectile dysfunction: 7%
Decreased libido: 4%
Ejaculatory dysfunction: 3%
Breast tenderness/enlargement: 1%
Depression: 0.5%

Annual Cost of Care

Drug Cost

$30

Monitoring

$250

Side Effects

$125

Total Annual

$405

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.12

Cost per Responder

$736

Treatment Outcomes
Primary Outcomes
International Prostate Symptom Score (IPSS)19 points (range 0-35, moderate to severe symptoms)
-18.4% (-3.5 points)
Maximum Urinary Flow Rate (Qmax)9.5 mL/s
+17.9% (+1.7 mL/s)
Prostate Volume45 mL
-25% (-11.25 mL)
Serum Prostate-Specific Antigen (PSA)2.0 ng/mL
-50% (-1.0 ng/mL)
Secondary Benefits
Risk of Acute Urinary Retention (AUR) over 4 years7% incidence
-57% (-4.0 percentage points (risk reduction))
Risk of BPH-related Surgery (e.g., TURP) over 4 years10% incidence
-55% (-5.5 percentage points (risk reduction))
Benign Prostatic Hyperplasia Impact Index (BII)8 points (range 0-13, moderate impact)
-30% (-2.4 points)
Common Side Effects
Erectile dysfunction
+7%
Decreased libido
+4%
Ejaculatory dysfunction
+3%

Clinical Trial Phases:

Phase 3Phase 4