Medications for the treatment of prostate adenoma help relieve lower urinary tract symptoms. According to the recommendations of the European Urological Association, medicines used to treat prostate adenoma are used in patients who have moderate symptoms.
Currently, two classes of drugs are most widely used: alpha-blockers and 5-alpha-reductase inhibitors. Phosphodiesterase inhibitors and anticholinergic drugs and others are used less frequently.
Alpha-blockers relax the smooth muscle fibers that make up the prostate and bladder, which reduces the pressure on the wall of the urethra and dilates the lumen. This makes it easier for urine to flow out of the bladder. Alpha-blockers are given to patients with moderate to severe symptoms of BPH. It is worth noting that alpha-blockers relieve lower urinary tract symptoms, butdo not slow or stop further growth of the prostate.
Most men reported relief of lower urinary tract symptoms, as reflected by a decrease in the I-PSS prostate symptom index.on an international scaleassessment of prostate symptoms) 4-6 units.
The effect of taking alpha-blockers develops after 2-3 weeks.
In the human body, we distinguish several types (alpha-1 and alpha-2) and subtypes of alpha-adrenergic receptors (alpha-1a, alpha-1b, alpha-1d, etc. ) that are not found only in muscle. in the cells of the prostate, but also in other structures of the body, such as the heart, blood vessels, lungs. Previously, alpha-blockers have been used to treat BPH, acting on all types of receptors, both alpha-1 and alpha-2 adrenergic receptors. Complications were often observed in men in this regard. Scientists have found that alpha-1α-adrenergic receptors are found in the prostate. Following the development of drugs that selectively block alpha-1-adrenergic receptors (selective alpha-blockers), the number of side effects associated with the use of non-selective drugs (angina, arrhythmia, etc. ) has been reduced.
Short-acting alpha-1 blockers
Prazosin was the first selective alpha-1 blocker to be approved for the treatment of BPH. Disadvantages of prazosin as well as other short-acting drugs were the need for multiple daily dosing and severe arterial hypotension.
Long-acting selective alpha-1 blockers
The European Urological Association recommends the use of the following long-acting alpha-blockers: tamsulosin, alfuzosin, terazosin and doxazosin. These drugs have approximately the same efficacy and side effects. These drugs for the treatment of prostate adenoma require a single dose during the day.
The most common side effects with alpha-blockers are headache, dizziness, weakness, loss of pressure when moving from a horizontal position to a vertical position (usually seen only at the beginning of treatment - effect of the first dose), drowsiness, nasal congestion and retrograde ejaculation. Although alpha-blockers do not cause erectile dysfunction or reduce libido, these side effects have been reported with these medications. But a more common complication, such as retrograde ejaculation, is when sperm enters the bladder during ejaculation rather than the penis. However, it is harmless.
Function related to taking alpha-blockers
If you are taking medicines that cause erectile dysfunction, such as Viagra, you should be aware that the combination of these with alpha-blockers may cause a significant drop in blood pressure, including collapse and loss of consciousness. Remember to take your Viagra tablet no sooner than four hours after taking your alpha-blocker.
5-alpha reductase inhibitors
5-alpha reductase inhibitors are a second group of drugs used to treat BPH that help relieve the symptoms of lower urinary tract symptoms. Two drugs from this group are used to treat prostate adenoma: finasteride and dutasteride. These drugs block the enzyme 5-alpha reductase, which converts testosterone to dihydrotestosterone, which plays an important role in the development of prostate adenoma. The result is a slowdown in the growth and size of the prostate, leading to relief of lower urinary tract symptoms. Finasteride inhibits the conversion of testosterone to dihydrotestosterone by 70% and dutasteride by 95%. However, finasteride and dutasteride are not clinically effective in the treatment of prostate adenoma.
The greatest effect of treatment of prostate adenoma with 5-alpha reductase inhibitors is seen in men whose prostate gland is significantly enlarged before treatment (more than 30 cm3). Men taking a 5-alpha reductase inhibitor reported a 3-point decrease in I-PSS prostate symptom index. Patients with a small pre-treatment prostate (less than 30 cm3) show no significant improvement in the I-PSS prostate symptom index.
The effect of treatment with 5-alpha reductase inhibitors occurs 6 to 12 months after the start of treatment. As we know, the size of the prostate does not always correlate with the severity of the symptoms of prostate adenoma, so treatment with finasteride or dutasteride does not always bring the expected results. 30-50% of patients develop a clinical response to treatment with 5-alpha reductase inhibitors.
The most common side effects of 5-alpha reductase inhibitors are decreased libido (6. 4%), impotence (8. 1%), ejaculation (3. 7%), erectile dysfunction, rash in less than one percent of cases, increased size andcompaction of the mammary glands.
Characteristic associated with the use of 5-alpha reductase inhibitors
Ingestion of finasteride changes the concentration of prostate-specific antigen in the blood to decrease it. Patients taking 5-alpha reductase inhibitors may have a 50% reduction in prostate-specific antigen levels. Prostate-specific antigen is a non-specific marker of prostate cancer. An increase in the level of prostate-specific antigen in the blood may be the first sign to allow the tumor to be suspected at an early stage and measures to be taken for further diagnosis and treatment. Underestimation of prostate-specific antigen levels in the blood can lead to false negative results in prostate cancer screening.
To get a true result of a prostate-specific antigen test in the blood of a patient taking finasteride or dutasteride, your doctor will multiply the number by two.
It is also known that taking finasteride reduces the risk of developing non-aggressive prostate cancer in men, but increases the risk of developing very aggressive prostate cancer.
Previously, tadalafil (a phosphodiesterase inhibitor) was used to treat erectile dysfunction in men. In 2011, this drug was approved for the treatment of benign prostatic hyperplasia. A scientific study showed that daily intake of tadalafil resulted in a significant improvement in lower urinary tract symptoms in men with BPH.
The use of tadalafil with nitrates (nitroglycerin), alpha-blockers and other antihypertensive agents may cause severe hypotension. In addition, tadalafil is restricted in patients with renal and hepatic impairment. The most common side effects are headache and gastrointestinal disorders, less commonly - hearing and vision problems, muscle aches, etc.
Anticholinergic drugs used to treat prostate adenoma help relieve symptoms such as urinary incontinence, frequent urination, urgency that could not be controlled with an alpha-blocker. Doctors sometimes prescribe anticholinergic drugs in combination with alpha-blockers to better control the symptoms of BPH. The use of anticholinergic drugs carries a risk of acute urinary retention. In addition, the following side effects have been reported: blurred vision, constipation, dizziness, dry eyes, dry mouth, headache, gastrointestinal pain, abdominal pain, urinary tract infections.
Anticholinergic drugs for the treatment of prostate adenoma: tolteridone and oxybutynin.
A combination of drugs used to treat prostate adenoma
Medication for the treatment of benign prostatic hyperplasia often requires the appointment of a combination of drugs. Men taking the combination of dutasteride and tamsulosin experience a greater reduction in the symptoms of BPH than those taking these medicines alone.
Dosage forms have been developed that contain both an alpha-blocker and a 5-alpha-reductase inhibitor. This dosage form is convenient and requires a single dose.
Treatment with combination drugs is generally well tolerated by patients. The adverse reaction profile contains a combination of adverse reactions that are specific to the medicinal product. The most common adverse events in combination therapy are erectile dysfunction (7, 4%), retrograde ejaculation (4, 2%), decreased libido (3, 4%).
As a general rule, long-term use of drugs is required and symptoms may return if discontinued.
Many men refuse to take medications to treat prostate adenoma because they are terribly afraid of developing side effects, especially those related to sexual function.
Patient history:"The doctor advised me to start treatment for BPH with one or more medications. I can urinate, but my urine flow is poor and it sometimes hurts to urinate in large quantities. I read online about two main groups of drugs for the treatment of BPH: alpha-blockers and 5-alpha-reductase inhibitors. Some men describe a significant improvement in symptoms due to taking one of the medications, but most talk about the negative effects of the medications.
If I understand correctly, both groups of drugs affect sexual function to some extent. . . I'm afraid to even think about it. "
Stories of men taking drugs to treat BPH
"I am taking the medications my doctor has prescribed for me and so far I have not had any of the side effects described in the instructions. . . I've been taking it for about three years. There was a time when it seemed to me that the drug wasn’t working, I had to double the dose and everything was back in place. . . ".
"I've been taking medications recommended by my doctor for a long time and they help, but I can only have a 'dry' orgasm, which I really don't like. "
"I took alpha-adrenergic blockers and they provided good urination. Side effects included a decrease in ejaculate volume and terrible dizziness with a sharp increase. When I stopped taking it, urination became more frequent from 13 to 15 a day, the amount of sperm increased significantly. I am now 45 years old and my urologist has been given an alpha-blocker. Sometimes I get dizzy when I get up sharply, my nose always clogs and yes, a "dry" orgasm. When it first happened, I thought there was only one cramp and one orgasm along the way. I was wrong. But the worst was priapism! priapism is a prolonged, long-lasting, sometimes painful erection that occurs without prior excitement. ) At first I was sure the surgical treatment wasn’t for me, but now I’m thinking about it. "
"Hi, I’ve been taking medication to treat my prostate adenoma for a long time. . . Among the side effects, I was periodically worried about dizziness and nasal congestion. My symptoms of prostate adenoma have been significantly reduced, I’m glad I did that because I managed to avoid surgery! "
As you can see, not all people have side effects, and different patients may experience different side effects. No doctor can tell if this or that side effect occurs with a one hundred percent guarantee.
If you make an appointment with a doctor, you can discuss the therapy that is best for you. At the consultation, you must inform the doctor without secrecy about your health condition, co-morbidities and the medicines you are taking. This will help your doctor decide which treatment plan is best for you.