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Prostate

Nine in ten Korean men newly diagnosed with an enlarged prostate start a drug within sixty days

In 1,445,144 patients, 92.4 percent were on treatment inside two months. Watchful waiting is a guideline option for mild symptoms and it is barely visible in the national data.

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In short

In a cross-sectional analysis of Health Insurance Review and Assessment Service data from 2015 to 2020 covering 1,445,144 South Korean men aged 40 or over newly diagnosed with benign prostatic hyperplasia and no prior history of it, 1,336,695 — 92.4 percent — initiated pharmacotherapy within 60 days of diagnosis, of whom 54.9 percent received alpha-blocker monotherapy and 17.9 percent a 5-alpha-reductase inhibitor and alpha-blocker combination, with combination use rising steadily by age from 8.0 percent in men in their forties to 25.4 percent in men aged 80 and over.

Key takeaways

  • 1,445,144 South Korean men aged 40 or over were newly diagnosed with benign prostatic hyperplasia between 2015 and 2020 with no prior history of it.
  • 1,336,695 of them — 92.4 percent — started drug treatment within 60 days of diagnosis.
  • Among those treated, 54.9 percent received alpha-blocker monotherapy.
  • 17.9 percent received a 5-alpha-reductase inhibitor plus alpha-blocker combination.
  • Combination therapy rose with age: 8.0 percent in the forties, 25.4 percent at 80 and over.
  • Tamsulosin, dutasteride and mirabegron were the most frequently prescribed agents.
  • American Urological Association guidance recommends combination therapy for reducing BPH-related complications in appropriate patients, so the age gradient runs in the guideline-concordant direction.

What happens in the two months after a Korean man is told his prostate is enlarged has been measured across the whole insured population, and the answer is close to unanimous.

Diagnosis is followed by a prescription

92.4%

of 1,445,144 newly diagnosed Korean men started drug treatment within 60 days of diagnosisKim YH, Je NK, Lower Urinary Tract Symptoms, 2025

Alpha-blocker monotherapy accounted for 54.9 percent of first prescriptions and the combination of a 5-alpha-reductase inhibitor with an alpha-blocker for 17.9 percent. Tamsulosin, dutasteride and mirabegron were the individual agents prescribed most often.

The part that is guideline-concordant

Combination therapy climbed steadily with age — 8.0 percent among men in their forties, 25.4 percent among men aged 80 and over. That gradient is the one guidelines would predict: a 5-alpha-reductase inhibitor shrinks the gland over months and earns its place in men with larger prostates and a longer horizon of risk, which correlates with age. Korean prescribing is tracking the recommendation rather than defaulting to the simplest drug for everyone.

The part nobody comments on

The honest limit here is that a claims database records the diagnosis and the dispensing, not the symptom score that justified either. A man with an IPSS of 20 and a man with an IPSS of 6 appear identically in these records, and only one of them is a candidate for observation.

Why the speed matters

Starting an alpha-blocker is not a neutral act. Korean national data put the odds of a fall in the year of initiation at 1.80 among users against matched non-users, with nearly half of those falls occurring on the first day of the drug. Beginning treatment quickly is reasonable when symptoms warrant it, and it carries a cost that is concentrated at exactly the moment the prescription starts.

That is not an argument against treating. It is an argument for knowing which of the two men described above is sitting in front of you, and the national prescribing record suggests the question is often skipped.

Sources

  1. 1

    Kim YH, Je NK

    Prescription trends of initial pharmacotherapy for benign prostatic hyperplasia among treatment-naïve patients in South Korea: a retrospective analysis

    Lower Urinary Tract Symptoms 2025;17(5):e70030

    doi:10.1111/luts.70030 · PMID:40908864

    https://doi.org/10.1111/luts.70030
  2. 2

    Seo JH, Han JS, Lee Y, Myong JP, Ha US

    Fall risk related to subtype-specific alpha-antagonists for benign prostatic hyperplasia: a nationwide Korean population-based cohort study

    World Journal of Urology 2022;40(12):3043-3048

    doi:10.1007/s00345-022-04195-w · PMID:36315286

    https://doi.org/10.1007/s00345-022-04195-w