Medical Management Of Benign Prostatic Hyperplasia (BPH)/Lower Urinary Tract Symptoms (LUTS)

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology
Article Date: 11 Aug 2008 - 0:00 PDT

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UroToday.com - Benign Prostatic Hyperplasia (BPH) is the most common benign tumor in the aging male. The Symptoms associated with BPH, termed LUTS can be bothersome enough to significantly impact the life of men and their families. While the gold standard for BPH treatment is TURP, over the past 20 years effective medical treatment has been developed.

The first line of medical treatment is the class of alpha adrenergic inhibitors and include the prostate specific agents: alfuzosin and tamsulosin. These agents which inhibit contraction of the smooth muscle tissue of the prostate transitional zone relieve obstructive and irritative symptoms. These agents, however, do not impact the course of the condition. Side effects include dizziness, orthostatic hypotension and ejaculatory dysfunction.

5 alpha reductase inhibitors (5ARI) have also been developed to reduce prostate volume and thus reduce the obstructive symptoms. These agents act by inhibiting the enzyme that converts testosterone to the highly active form dihydrotestosterone (DHT) which is responsible for prostate enlargement. 5ARI treatment is slow in onset taking as much as 6 weeks to have effect; they do delay the progression of histological BPH. The two agents currently available include: dutasteride and finasteride. Dutasteride inhibits both type I and type 2 5 alpha reductase while finasteride inhibits only type 2. Side effects are primarily sexual with decreased ejaculate volume and libido.

Many men also have significant overactive bladder with LUTS which is not resolved by either of the BPH agents. In these men combination therapy with an antimuscarinic agent may be helpful. Data available for combinations with tolterodine have been shown to further improve the irritative, storage symptoms without risks of urinary retention. Side effects include: dry mouth and eyes and constipation.

Recent data have focused on the use of phosphodiesterase type 5 inhibitors (PDE 5i). As there is a high concentration of PDE 5 in the prostate and bladder neck, PDE 5i reduce the symptoms of LUTS. All three currently available PDE 5i agents have been show to have improvement of symptoms but not in urinary flow rates.

Presented by: Culley C. Carson, MD, at the Masters in Urology Meeting - July 31, 2008 - August 2, 2008, Elbow Beach Resort, Bermuda

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