Journal List > Urogenit Tract Infect > v.14(3) > 1142159

Choi, Kim, Cho, and Min: Clinical Course of the Benign Prostate Hyplasia Patients during the Intermittent Use of 5-Alpha Reductase Inhibitors

Abstract

Purpose

5-Alpha reductase inhibitors (5ARI), inhibit the conversion of testosterone to dihydrotestosterone, which is essential in prostate hyperplasia, and decreases the prostate volume directly. On the other hand, 5ARI have a range of side effects, such as sexual dysfunction. After the discontinuation of 5ARI, prostate regrowth occurs rapidly until it reaches the baseline size. This study examined the effects of 5ARI when used intermittently.

Materials and Methods

Between March 2009 and May 2017, patients who visited one physician's outpatient clinic and were diagnosed with BPH underwent transrectal ultrasonography. The selected patients began to take 5ARI until the prostate size decreased at least 10% of the baseline (the first medication). After confirming adequate prostate shrinkage, the patients stopped medication until prostate regrowth reached 50% of the decreased size. After regrowth, they restarted medication for one year (second medication). The prostate size, serum prostate specific antigen (PSA) levels, international prostate symptom score (IPSS) scores, and maximum flow rate (Qmax) in uroflowmetry were collected after the first and second medication and compared using paired t-tests.

Results

Sixty patients with a mean age of 65.1 years were included in the study. The prostate size and serum PSA level increased after the second medication compared to the first, and the prostate reduction and Qmax in uroflowmetry decreased significantly. On the other hand, the symptoms felt by the patients surveyed by the IPSS scores showed no significant difference.

Conclusions

5ARI appear to be less effective in reducing the prostate volume and improving uroflowmetry after discontinuation.

References

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Fig. 1.
Flow chart of the study course and patient selection. BPH: benign prostate hyperplasia, TRUS: transrectal ultrasonography, 5ARI: 5-alpha reductase inhibitors.
uti-14-93f1.tif
Table 1.
Changes in the clinical features during the 1st medication, discontinuation, and 2nd medication (n=60)
Parameters Initial After 1st medication After discontinuation After 2nd medication
Prostate volume (ml) 32.3±4.0 23.5±3.3 34.9±5.8 27.2±6.3
Serum PSA (ng/ml) 0.87±0.57 0.57±0.42 1.1±0.7 1.37±2.7
IPSS scores        
Total 11.4±4.4 9.7±5.9 10.4±5.7 9.6±6.0
QOL 3.1±1.3 2.5±1.2 3.6±1.3 2.4±1.6
Qmax (ml/s) 18.2±8.2 24.5±8.6 17.6±5.4 20.6±5.9

Values are presented as mean±standard deviation.

PSA: prostate specific antigen, IPSS: international prostate symptom score, QOL: quality of life, Qmax: maximum flow rate.

Table 2.
Results of statistical analysis between 1st and 2nd medication
Parameters After 1st medication After 2nd medication p-value
Prostate volume (ml) 23.5±3.3 27.2±6.3 <0.001
Prostate volume reduction      
Size (ml) 8.8±4.1 7.7±7.3 0.027
Ratio (%) 27±0.1 21±0.19 <0.001
Serum PSA 0.58±0.42 1.37±2.7 <0.001
IPSS scores      
Total 9.7±5.9 9.6±6.0 0.473
QOL 2.5±1.2 2.4±1.6 0.388
Qmax (ml/s) 24.5±8.6 20.6±5.9 <0.001

Values are presented as mean±standard deviation.

PSA: prostate specific antigen, IPSS: international prostate symptom score, QOL: quality of life, Qmax: maximum flow rate.

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