Medications for Benign Prostatic Hyperplasia
Benign prostatic hyperplasia (BPH) medications or pharmacological management is as given below.
There are two major components of prostate- stroma and epithelium- have potentially different susceptibility to drug therapies (anti-androgens and 5-alpha-reductase inhibitors act mainly on epithelium; whereas alpha-blockers, aromatase inhibitors and anti-estrogens affect largely the stomal component of the benign hypertrophy of the prostate).
There is a good theoretical basis for testing combination therapies in disease.
- Cyproterone acetate- is a synthetic anti-androgen with additional progestational activity, which has been shown to inhibit prostatic growth in experimental animals.
- In BPH, this drug has shown to improve urinary flow and to alleviate the symptoms of bladder outflow obstruction.
- Flutamide- is a non-steroidal anti-androgen which is effective orally and is metabolized in the body to hydroxylated derivative that competes directly with testosterone and DHT (dihydro-testosterone) for androgen binding sites.
- In a study where flutamide is used in people with BPH, after 3mths there was 25% reduction in prostate volume as measured by trans-rectal ultrasonography.
- LHRH analogues- are now available, which act by transiently stimulating and then blocking pituitary receptors controlling the secretion of leutinizing hormone, thereby reducing testicular androgen secretion to castrate levels.
- It has shown that 30% prostatic volume reduction in people with BPH after treating with either LHRH analogue or creptoterone acetate.
- 5-alpha-reductase inhibitors which inhibit the conversion of testosterone to DHT which is considered to be causing hyperplasia of prostate along with the local peptide growth factors are introduced in this disease. 25% of the prostate gland shrinks with one year of treatment.
- Only one drug in this group- Proscar (finasteride) group is quicker in action, though have more side effects.
- Phenoxybenzamin, a combined alpha-1 and alpha-2-adrenoreceptor blocker, reduces prostatic urethral pressure profile and significantly improve both symptoms of prostatism and urinary flow rates.
- Side-effects such as orthostatic hypotension, dizziness, tiredness has led to discontinuation of therapy.
- Another alpha-1 selective adrenoreceptor blocker prazocin has been used in hypertrophic prostate. Both improvement of symptoms and increased urine flow is noticed.
- Another second generation alpha-blocker, doxazosin in an increasing dose has shown improvement of symptoms and flow.
- Aromatase inhibitors and anti-estrogen have also been used in this condition. The best known and widely used aromatase inhibitors are amino-glutethimide and ketoconazole. However, use of these drugs has led to certain side-effects like lassitude, depression and gynecomastia (swelling of breast).
- Perhaps the more logical approach is to block the effect of estrogen at the level of the prostate by means of anti-estrogen therapy (an estrogen receptor antagonist).
- Tamoxifen is the best in this group, though its use demonstrates no useful effect.
- Recently new anti-estrogen ICI- 183720, which is more potent than tamoxifen has been used. It seems that it becomes more useful if used in combination with a 5-alpha-reductase inhibitor like finasteride.
- A neuro-transmitter drug has been used which blocks alpha-adrenergic receptor. This is under trail. Probably it relaxes the internal sphincter for better drainage of the bladder.
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