Nonsurgical treatment of benign prostatic hypertrophy

Abstract

Drug therapy has never been widely used in benign prostatic hypertrophy (BPH), partly because the introduction of safe and radical surgical techniques provides rapid improvement of symptoms of outflow obstruction. However, some patients hesitate to undergo surgical intervention, and others are in poor condition, making them less than ideal candidates for surgery. A conservative means by which outflow problems could be relieved should be of benefit for a significant number of patients. Drugs from primitive cultures, usually herbal, have been reported to be of benefit; however, in double-blind controlled studies none seems to be superior to placebo. α1-Blockers do not influence prostate size but may still be of value in patients with dysuria, bladder neck sclerosis, and mild prostatic enlargement. Endocrine therapy appears to be effective in reducing prostate size and hence improving urinary outflow. The most promising agents thus far used include progestational antiandrogens and LHRH agonists as an alternative to pure castration. The drugs must be provided for the patient's lifetime, since the prostate rapidly regains its enlarged size following termination of the treatment. A combination of progestational antiandrogens and antiprolactin seems to be an efficient remedy for symptoms of prostatism when surgery is not applicable or wanted. Recent research has introduced new drugs with endocrine effects such as aromatizing inhibitors and 5α-reductase inhibitors; their efficacy has not as yet been confirmed in randomized clinical trials.