Journal List > J Korean Med Assoc > v.47(2) > 1080350

Chang: Medical Treatment of the Benign Prostatic Hyperplasia

Abstract

The search for non-hormonal pharmacological agents capable of reducing out flow obstruction caused by benign prostatic hyperplasia (BPH) began in the 1970s when alpha-adrenergic receptors were demonstrated within the smooth muscle element of prostatic adenomas, the prostatic capsule, and the bladder neck. Recently, many studies have confirmed that the alpha-adrenoceptor blockade subjectively and objectively reduces symptoms and urodynamic parameters in bladder outflow obstruction. Very long-term effects of the alpha blockade upon the prostate are not yet known. There is no direct evidence of a decrease in the stromal smooth muscle bulk or in the total prostate volume after long-term treatment with alpha-adrenoceptor blockers in man. The endocrine-based therapies, such as stilbestrol, luteinizing hormone-releasing hormone analogues, antiandrogens flutamide, and cyproterone acetate, have sometimes been used to treat BPH, but with a limited efficacy and prominent side-effects such as loss of libido, impotence, hot flushes, and gynecomastia. Although it has been shown that some of these therapies may shrink the prostate, the side-effects are intolerable to most patient. On the other hand, new 5 alpha-reductase-inhibiting agents are able to block the effects of androgen within the prostate without a systemic antiandrogen activity. Since the effects of androgens are particularly directed at the glandular element of the prostate rather than at the smooth muscle, the combined use of alpha-adrenoceptor blockers and 5 alpha-reductase inhibitors could theoretically produce an additive effect in the treatment of BPH. The indications of medical treatment for BPH include patients with mild to moderate symptoms, especially if they are reluctant to undergo surgery, and those who are not medically eligible to surgery.

Figures and Tables

Table 1
jkma-47-163-i001

References

1. Jardin A, Bensadoun H, Delauche-Cavallier MC, Attali P. Alfuzosin for the treatment of benign prostatic hypertrophy. Lancet. 1991. 337:1457.
2. Peters CA, Walsh PC. The effect of nafarelin acetate a luteinizing-hormone-releasinghormone agonist on benign prostatic hyperplasia. N Engl J Med. 1987. 317:599.
crossref
3. Bosch RJ, Griffiths DJ, Blom J, Schroeder FH. Treatment of benign prostatic hyperplasia by androgen deprivation: Effects on prostate size and urodynamic parameters. J Urol. 1989. 141:68.
crossref
4. Eri LM, Tveter KJ. A prospective, placebo-controlled study of the luteinizing hormone-releasing hormone agonist leuprolide as treatment for patient with benign prostatic hyperplasia. J Urol. 1993. 150:359.
crossref
5. Kumar VL, Dewan S. Alpha adrenergic blockers in the treatment of benign hyperplasia of the prostate. Int Urol Nephrol. 2000. 32:67.
6. Cuellar DC, Kyprianou N. Future concepts in the medical therapy of benign prostatic hyperplasia. Curr Opin Urol. 2001. 11:27.
crossref
7. Stuart JD, Lee FW, Simpson Noel D, Kadwell SH, Overton LK, Hoffman CR. Pharmacokinetic parameters and mechanism of inhibitor of rat type-1 and 2 steroid 5-alpha-reductase:determinants for different in vivo activities of G1198745 and finasteride in the rat. Bioch Pharmacol. 2001. 62:933.
TOOLS
Similar articles