Study Tests Tamsulosin Deprescribing in Older Men

A randomized clinical trial published in JAMA Network Open found that older men taking long-term tamsulosin for lower urinary tract symptoms attributed to benign prostatic hyperplasia did not all experience the same level of symptom benefit from continued therapy.

The study examined whether individualized, placebo-controlled N-of-1 trials could help identify patients who may be able to stop tamsulosin with little worsening of symptoms. The authors focused on men who had been taking the medication chronically, a group in which the continued benefit of therapy may not always be clear.

The double-blind, placebo-controlled, multiple-crossover trial was conducted at a single academic urology department from September 2021 to July 2022. Participants were men aged 55 to 80 years who had used tamsulosin continuously for at least 12 months. They alternated between 2-week treatment periods with tamsulosin, dosed at 0.4mg or 0.8mg, and matching placebo, with 1-week washout periods between each treatment period. The primary outcome was the daily American Urological Association Symptom Index (AUASI), assessed using a 24-hour recall period.

Among 30 participants who attempted the full protocol, 11 (36.7%) showed minimal or no apparent benefit from tamsulosin, 11 (36.7%) had a moderate benefit, and 4 (13.3%) had a strong benefit. Another 4 participants (13.3%) could not tolerate the placebo run-in because of worsening symptoms. Individual estimated differences in daily AUASI scores between tamsulosin and placebo ranged from −10.9 to 2.1, while the group-level mean difference was −2.96.

The authors reported that the findings support further study of individualized deprescribing trials for older men receiving chronic tamsulosin therapy. They noted that larger studies are needed to determine whether this approach can be generalized and whether it improves clinical decision-making and patient outcomes.

Sources: Bauer SR, Kenfield SA, Oni-Orisan A, et al. Tamsulosin deprescribing for lower urinary tract symptoms in older men: a randomized clinical trial. JAMA Netw Open. 2026;9(7):e2621639. doi:10.1001/jamanetworkopen.2026.21639