Benign Prostatic Hyperplasia: Symptoms & Conservative Treatment

Benign Prostatic Hyperplasia: Symptoms & Conservative Treatment . Benign prostatic hyperplasia (BPH), as the name suggests, is benign (non cancerous) enlargement of prostate gland in men. Men above the age of 50 or 60 may suffer from this disorder. Prostate is a small walnut shaped gland located at the base of bladder and near the entrance of male urethra. No one knows why prostate gland enlarges in some males.

The symptoms of benign prostatic hyperplasia are frequent urge to pass urine, straining during urination, weak stream while urinating, recurrent urinary tract infection, acute retention of urine, passage of blood in urine etc.

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Mild cases of benign prostatic hyperplasia can be treated with medications. If obstruction and retention of urine is major problem, patient may require surgical removal of prostate gland. Benign prostatic hyperplasia medications or pharmacological management is as given below.

There are two major components of prostate- stroma and epithelium. They have potentially different susceptibility to drug therapies (anti-androgens and 5-alpha-reductase inhibitors act mainly on epithelium; whereas alpha-blockers, aromatase inhibitors and anti-estrogens affect largely the stomal component of the benign hypertrophy of the prostate).

Medication For Benign Prostatic Hyperplasia

There is a good theoretical basis for testing combination therapies in disease.

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• Cyproterone acetate- is a synthetic anti-androgen with additional progestational activity, which has been shown to inhibit prostatic growth in experimental animals.
• In benign prostatic hyperplasia, this drug has shown to improve urinary flow and to alleviate the symptoms of bladder outflow obstruction.
• Flutamide- is a non-steroidal anti-androgen which is effective orally and is metabolized in the body to hydroxylated derivative that competes directly with testosterone and DHT (dihydro-testosterone) for androgen binding sites.
• In a study where flutamide is used in people with BPH, after 3 months there was 25% reduction in prostate volume as measured by trans-rectal ultrasonography.
• LHRH analogues- are now available, which act by transiently stimulating and then blocking pituitary receptors controlling the secretion of luteinizing hormone, thereby reducing testicular androgen secretion to castrate levels.
• It has shown that 30% prostatic volume reduction in people with BPH after treating with either LHRH analogue or creptoterone acetate.
• 5-alpha-reductase inhibitors which inhibit the conversion of testosterone to DHT which is considered to be causing hyperplasia of prostate along with the local peptide growth factors are introduced in this disease. 25% of the prostate gland shrinks with one year of treatment.
• Only one drug in this group- Proscar (finasteride) group is quicker in action, though have more side effects.
• Phenoxybenzamin, a combined alpha-1 and alpha-2-adrenoreceptor blocker, reduces prostatic urethral pressure profile and significantly improve both symptoms of prostatism and urinary flow rates.
• Side-effects such as orthostatic hypotension, dizziness, tiredness has led to discontinuation of therapy.
• Another alpha-1 selective adrenoreceptor blocker prazocin has been used in hypertrophic prostate. Both improvement of symptoms and increased urine flow is noticed.
• Another second generation alpha-blocker, doxazosin in an increasing dose has shown improvement of symptoms and flow.
• Aromatase inhibitors and anti-estrogen have also been used in this condition. The best known and widely used aromatase inhibitors are amino-glutethimide and ketoconazole. However, use of these drugs has led to certain side-effects like lassitude, depression and gynecomastia (swelling of breast).
• Perhaps the more logical approach is to block the effect of estrogen at the level of the prostate by means of anti-estrogen therapy (an estrogen receptor antagonist).
• Tamoxifen in this group, though its use demonstrates no useful effect.
• Recently new anti-estrogen ICI- 183720, which is more potent than tamoxifen has been used. It seems that it becomes more useful if used in combination with a 5-alpha-reductase inhibitor like finasteride.
• A neuro-transmitter drug has been used which blocks alpha-adrenergic receptor. This is under trial. Probably it relaxes the internal sphincter for better drainage of the bladder.