Tamsulosin and the Risk of Dementia

The journal Pharmacoepidemiology and Drug Safety published and reviewed in the online journal Primary Care which examines whether men with enlarged prostates and symptoms of prostatism develop dementia more frequently if they take the drug tamsulosin to relieve the symptoms. As men age, under the influence of male hormones, the three lobed prostate normally increases in size. As the prostate enlarges, it impedes the flow of urine as it attempts to leave the bladder. Patients feel urgency, hesitancy, dribbling, sometimes leaking and a diminished stream. Sleep-awakening night time urination becomes an issue as well as difficulty fully emptying the bladder.  Minimal night time urine production produces the urge to void.

There are many non-pharmacological surgical treatments for this normal, age related, condition. Medications have been used for years to try to prevent surgery or defer it to a later date. tamsulosin works by inhibiting certain receptors on the muscle in the prostate causing relaxation of smooth muscle and increased flow of urine. The study authors used Medicare data to look at men aged 66 and older taking tamsulosin to reduce symptoms of an enlarged prostate. They compared these men to others taking no medication for BPH and to those taking medications that work by a different mechanism of action including terazosin, doxazosin, alfuzosin, dutasteride and finesteride. The data was collected from years 2006 – 2012.

The results showed that men taking tamsulosin had a propensity for negative changes in cognitive function at a higher rate than men taking other products. This was clearly not a straight cause and effect study proving that tamsulosin causes cognitive dysfunction. The authors and reviewers in accompanying editorials point out the many variables and flaws which may have contributed to the conclusion but emphasize that further defining studies need to be started to clear up the doubt raised by this review.

A VA study done years ago comes to mind in which Veterans who ultimately switched from medications for an enlarged prostate underwent surgery and were interviewed one year later about their feelings about the results and function after surgery. Almost 100% of the study group felt better after surgery and relieved that the side effects of their medications for an enlarged prostate were a thing of the past. They wondered why they waited so long to have surgery and felt they would have asked for it sooner had they realized the many ill effects the medication was causing. It may be time for a more aggressive approach to prostate surgery as opposed to medical treatment?