Non-hormonal pharmacological treatments for benign prostatic obstruction: a systematic review of trials published between 2005 and 2025

Background and objective Benign prostatic obstruction (BPO) is a common condition primarily affecting men over the age of 60. The associated lower urinary tract symptoms (LUTS) vary from mild to severe and are often pervasive, significantly impacting quality of life. There have been many pharmacological treatments developed to treat BPO. This review aims to assess the efficacy of different non-hormonal, pharmacological treatment options at alleviating the symptoms of BPO. Methods A descriptive systematic review of studies published between January 2005 and March 2025 was conducted across MEDLINE, Cochrane, Web of Science and Scopus according to PRISMA guidance. Studies evaluating non-hormonal pharmacological therapies in adult men with BPO were included. Primary outcomes were IPSS, IPSS QoL, Qmax, and PVR. Secondary outcomes were adverse effects and rates of discontinuation. Treatment arms were grouped by pharmacological class, monotherapy and combination therapy, and arm-level outcomes were summarised descriptively without meta-analysis. Results 42 studies involving 10,066 participants were included. 7,916 participants were allocated to receive the following treatments; a1-adrenergic receptor antagonists (a1-blockers) ( n = 1,911), phosphodiesterase type 5 inhibitors (PDE5-i) ( n = 4,579), combination of a1-blockers and PDE5-i ( n = 1,206), and an antimuscarinic in combination therapy ( n = 220). The use of a1-blockers, PDE5-i, the combination of a1-blockers and PDE5-i, and its use alongside antimuscarinics yielded reductions in IPSS. Improvements in Qmax were modest with monotherapy. Use of a1-blocker + PDE5-i combination therapy showing the greatest improvements across all primary outcome parameters. Conclusion In contemporary trials, non-hormonal pharmacological therapies were associated with symptomatic improvement in men with LUTS secondary to BPO, with the largest numerical improvements in arms combining an a1-blocker with a PDE5-i. These unadjusted, descriptive observations do not establish comparative superiority. The evidence base remains limited by short follow-up and the near absence of progression endpoints; future trials should report long-term outcomes such as acute urinary retention and the need for surgery, and should stratify by patient characteristics such as storage symptoms, erectile dysfunction and prostate volume.