Benign prostatic hyperplasia. Current pharmacological treatment.

Abstract

During the past decades, pharmacological treatment of symptomatic benign prostatic hyperplasia (BPH) has become a fairly established modality. Approaches include blockade of alpha-adrenoreceptors and suppression of androgens. Patients eligible for drug treatment are those with mild to moderate symptoms of BPH and no strong indications for surgery. alpha-Receptor blockers generally improve urinary symptoms and peak urinary flow rates 2 to 4 weeks after introduction of therapy. Because of minor adverse effects, selective alpha 1-blockers are preferred over nonselective drugs. Prazosin, terazosin and alfuzosin are extensively studied and widely used in BPH treatment. Terazosin might be preferred to prazosin and alfuzosin because it can be administered once daily, but a disadvantage is higher cost. Doxazosin and tamsulosin (amsulosin; YM 617) are drugs currently under clinical investigation in the treatment of BPH. Antiandrogen therapy induces reduction in prostate volume and relief in symptoms of bladder outlet obstruction. However, the only drug which seems to be of major interest in BPH treatment is finasteride. Other drugs [gonadotrophin-releasing hormone (GnRH) agonists, progestogens and flutamide] are associated with frequent and sometimes severe adverse effects, such as impotence, flushing and loss of libido. Finasteride has fewer adverse effects and is well tolerated, but needs to be administered for at least 6 to 12 months to obtain maximum effect. Future approaches in medical treatment of BPH might be combination therapy of alpha 1-blockers and finasteride.