What medications are available for benign prostatic hyperplasia treatment?
The two primary drug classes used for benign prostatic hyperplasia are the following:
These drugs relax smooth muscles, especially in the urinary tract and prostate. They include terazosin (Hytrin), doxazosin (Cardura), tamsulosin (Flomax), and alfuzosin (Xatral). Alpha-blockers are more likely to reduce symptoms of benign
prostatic hyperplasia and are often the first choice, particularly in men with smaller prostates.
Alpha-blocker are drugs that relax smooth muscles. Those used for benign prostatic hyperplasia specifically affect muscles in the urinary tract and prostate. By relaxing the muscles in and around the prostate, alpha-blockers increase urinary flow and improve symptoms, sometimes significantly. Improvement occurs within days to weeks. Because these drugs are short acting, symptoms return very quickly once a man stops taking the medication. They do not affect PSA levels. Research also indicates that they may even promote a natural process called apoptosis, in which cells in the prostate gland self-destruct.
Alpha-blockers are prescribed for most men with benign prostatic hyperplasia symptoms whose prostates are not significantly enlarged. Because they work fairly quickly, have no effect on sexual drive, and are the least expensive benign prostatic hyperplasia treatment, even men with moderately enlarged prostates might try them before undertaking more intense treatments. Some experts now recommend alpha-blockers as first-line treatment for patients with moderate to severe symptoms. These agents are generally referred to as either nonselective or selective alpha-blockers. Drugs in both categories are similar in effectiveness for reducing symptoms and improving urinary flow. There are some differences, however. Patients should discuss the appropriate alpha-blocker for their individual condition with their doctors.
Nonselective alpha-blockers (also referred to as alpha-specific antagonists) include terazosin (Hytrin) and doxazosin (Cardura). They relax all smooth muscles, not only in the prostate but also those that surround any blood vessel in the body. These agents work within four to six weeks, are inexpensive, and produce long-lasting benefits. Selective alpha-blockers (sometimes called alpha1A-urospecific antagonists) include tamsulosin (Flomax) and alfuzosin (Xatral). Tamsulosin appears to have a more rapid effect than alfuzosin. Naftopidil is a similar agent under investigation that may be more effective than tamsulosin for improving nighttime urination (although not for improving urine flow). These agents target only the smooth muscles of the prostate. They increase urinary flow rate and appear to be more effective than finasteride or herbal drugs (beta-sitosterol) and had fewer side effects than finasteride. It is not clear if they reduce long-term complications of benign prostatic hyperplasia.
These are a group of anti-androgens. In other words, they block male hormones, particularly dihydrotestosterone. The standard agent is finasteride (Proscar.) Anti-androgens may help men with significantly enlarged prostates.
The prostate gland contains an enzyme called 5 alpha-reductase that converts testosterone to another androgen called dihydrotestosterone. Finasteride (Proscar), known as a 5-alpha-reductase inhibitor, blocks this enzyme and so suppresses dihydrotestosterone and reduces the size of the prostate. Dutasteride (Avodart) is a newer agent that actually inhibits two types of the 5-alpha-reductase enzyme and achieves a more rapid suppression of dihydrotestosterone than finasteride,
Finasteride does not appear to be as effective as alpha blockers -- the other major benign prostatic hyperplasia agents -- for many men with benign prostatic hyperplasia and urinary tract symptoms, but they can be helpful in specific cases. For example, the 5 alpha-reductase inhibitors are very effective in reducing the size of large prostates. Studies on finasteride also suggest it reduces the risk of acute urinary retention and the need for surgery, especially in men with large prostates. They also control bleeding in the urine that is related to benign prostatic hyperplasia. (A side benefit of finasteride is reduction of hair loss related to male hormones and in some cases hair growth in men with mild to moderate male pattern baldness.) Comparison studies are needed to determine if the dual actions of dutasteride offer significant benefits over those of finasteride.
More information on benign prostatic hyperplasia (BPH)
What is benign prostatic hyperplasia (BPH)? - Benign prostatic hyperplasia (BPH), also known as benign prostatic hypertrophy, is a noncancerous enlargement of the prostate gland that occurs in almost all men as they age.
What causes benign prostatic hyperplasia (BPH)? - Benign prostatic hyperplasia (BPH) is probably a normal part of the aging process in men, caused by changes in hormone balance and cell-growth factors.
What are the symptoms of benign prostatic hyperplasia? - Initial symptoms of BPH include difficulty starting to urinate and a feeling of incomplete urination. Urinary tract infections cause burning or pain during urination, and possibly fever.
How does the doctor diagnose benign prostate hyperplasia? - Patients will be asked about their symptoms and may also be asked to fill out a symptom questionnaire to let the doctor know the nature of the symptoms and how troublesome they are.
Who is associated with benign prostatic hyperplasia? - Age is the major risk factor. A family history of BPH appears to increase a man's chance of developing the condition. Diabetes, in any case, worsens urinary tract symptoms in men with BPH.
How is benign prostate hyperplasia treated? - Treatment for benign prostatic hyperplasia (BPH) focuses on reducing your symptoms. Treatment is based on how severe your symptoms are, how much they bother you, and whether complications are present.
What're lifestyle measures for managing benign prostate hyperplasia? - Certain lifestyle changes can help relieve symptoms and are particularly important for men who choose to avoid surgery or drug therapy. Men with BPH should avoid, if possible, the many medications for colds and allergy that contain decongestants, such as pseudoephedrine (Sudafed).
What kinds of medicines are used for benign prostatic hyperplasia (BPH) treatment? - Alpha-blockers relax smooth muscles, especially in the urinary tract and prostate. They include terazosin (Hytrin), doxazosin (Cardura), tamsulosin (Flomax), and alfuzosin (Xatral). 5-alpha-reductate inhibitors are a group of anti-androgens. In other words, they block male hormones, particularly dihydrotestosterone.
What are alternative medicines for benign prostatic hyperplasia (BPH) treatment? - Some herbal medicines may be helpful, but no one should take any herbal medication or attempt to treat BPH without first consulting a physician.
What kind of surgery is available for benign prostatic hyperplasia (BPH) treatment? - An operation on the prostate will involve the removal of parts of the enlarged tissue. The most effective surgical procedures, transurethral resection of the prostate (TURP) and open prostatectomy, are also the most invasive.
Are there other more gentle surgical treatments for benign prostatic hyperplasia (BPH)? - Microwave thermotherapy reduces the size of the prostate by causing cells in the centre of the prostate to die. Another endoscopic treatment, in which part of the prostate tissue is removed with laser energy.
How to choose between treatment and watchful waiting for benign prostatic hyperplasia (BPH)? - The choice between watchful waiting and treatment usually depends on a number of factors, such as urine flow rates, prostate size, and PSA levels.
How to decide between surgery and medication for benign prostatic hyperplasia (BPH)? - If a man opts for treatment, there are a number of choices. Medications are the best choice for patients with mild symptoms who decide to have their condition treated. Men with moderate to severe symptoms still have good choices among drugs and surgeries.