Medications for treating prostate adenoma help relieve lower urinary tract symptoms. According to the recommendations of the European Association of Urology, drugs for the treatment of prostate adenoma are used if patients have moderately severe symptoms of the disease.
Currently, two groups of drugs are the most used: alpha-blockers and 5-alpha-reductase inhibitors. Less commonly used are phosphodiesterase inhibitors and anticholinergic and other drugs.
alpha blockers
Alpha-blockers relax the smooth muscle fibers that make up the prostate and bladder neck, resulting in reduced pressure on the walls of the urethra and expanding its lumen. This makes it easier for urine to come 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, but theydoes not slow down or stop prostate growth.
Most men report relief from lower urinary tract symptoms, reflected by a decrease in the I-PSS Prostate Symptom Index.international scaleassessment of prostate symptoms) for 4-6 units.
The effect of taking alpha-blockers develops after 2-3 weeks.
In the human body, several types (alpha-1 and alpha-2) and subtypes (alpha-1a, alpha-1b, alpha-1d, etc. ) of alpha-adrenergic receptors are distinguished, located not only in muscle but also in prostate cells. , but also in other structures of the body, for example, in the heart, blood vessels, lungs. Previously, alpha-blockers were used to treat BPH, which act on all types of receptors, both alpha-1 and alpha-2-adrenergic. In this regard, the development of complications was often observed in men. Scientists have discovered that alpha-1a-adrenergic receptors are located in the prostate. After the development of drugs that selectively block alpha-1-adrenergic receptors (selective alpha-blockers), it was possible to reduce the number of side effects associated with the use of non-selective drugs (angina attack, arrhythmia, etc. ).
Short-acting alpha-1 blockers
Prazosin was the first selective alpha-1 blocker approved for the treatment of BPH. The disadvantages of prazosin, like other short-acting drugs, were the need for multiple doses during the day and severe hypotension.
Long-acting selective alpha-1 blockers
The European Association of Urology recommends the use of the following long-acting alpha-blockers: tamsulosin, alfuzosin, terazosin and doxazosin. These drugs have approximately the same effectiveness and range of side effects. These drugs for treating prostate adenoma require a single dose during the day.
The most common side effects associated with the use of alpha-blockers are: headache, dizziness, weakness, decrease in pressure that occurs when moving from a horizontal to a vertical position (usually observed 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 decreased libido, these side effects have been reported in some cases of using these drugs. But a complication like retrograde ejaculation, when sperm during ejaculation moves to the bladder rather than the penis, is more common. However, it is harmless.
Feature associated with the use of alpha-blockers
If you are taking erectile dysfunction medication such as Viagra, you should be aware that its combination with alpha blockers can lead to a significant decrease in blood pressure, even collapse and loss of consciousness. Remember that you can take a Viagra pill no earlier than four hours after taking an alpha blocker.
5-alpha reductase inhibitors
5-alpha reductase inhibitors are the second group of drugs used to treat BPH and help relieve the symptoms of lower urinary 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 of the prostate and a decrease in its size, which in turn leads to relief from lower urinary tract symptoms. Finasteride blocks the conversion of testosterone to dihydrotestosterone by 70% and dutasteride by 95%. However, finasteride and dutasteride are not clinically effective in treating prostate adenoma.
The greatest effect of treating prostate adenoma with 5-alpha-reductase inhibitors is experienced by men whose prostate was significantly enlarged before treatment (greater than 30 cc). Men taking 5-alpha-reductase inhibitors report a 3-point decrease in the I-PSS prostatic symptom index. Patients with a small pre-treatment prostate (less than 30 cc) do not show significant improvement in the I-PSS Prostate Symptom Index.
The effect of treatment with 5-alpha-reductase inhibitors develops after 6-12 months of starting medication. As we know, prostate size does not always correlate with the severity of prostate adenoma symptoms, so treatment with finasteride or dutasteride does not always give the expected results. 30-50% of patients develop a clinical effect from 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 disorder (3. 7%), erection problems, rash in less than one percent of cases, increase in size and compaction of the mammary glands.
Resource associated with the use of 5-alpha reductase inhibitors
Taking finasteride changes the concentration of prostate-specific antigen in the blood towards decreasing it. In patients taking 5-alpha reductase inhibitors, the concentration of prostate-specific antigen may decrease by 50%. Prostate specific antigen is a non-specific marker of prostate cancer. An increase in the level of prostate-specific antigen in the blood can be the first sign that allows you to suspect an early-stage tumor and take further diagnostic and treatment steps. Underestimation of the level of prostate-specific antigen in the blood can lead to false-negative results of screening tests for prostate cancer.
To get a real result of the analysis of prostate specific antigen in the blood of a patient using finasteride or dutasteride, the doctor multiplies the result by two.
It is also known that taking finasteride reduces a man's risk of developing non-aggressive prostate cancer, but increases his risk of developing a highly aggressive prostate tumor.
Phosphodiesterase Inhibitors
Previously, the substance tadalafil (a phosphodiesterase inhibitor) was used to treat erectile dysfunction in men. In 2011, this medication was approved for the treatment of benign prostatic hyperplasia. A scientific study found that taking tadalafil daily resulted in a significant improvement in lower urinary tract symptoms in men with BPH.
Using tadalafil with nitrates (nitroglycerin), alpha-blockers, and other antihypertensive medications can cause a marked decrease in blood pressure. In addition, the use of tadalafil is limited in patients with renal and hepatic impairment. Among the side effects, the most common are headaches and disorders of the gastrointestinal tract, less often - hearing and visual disturbances, muscle pain, etc.
anticholinergic drugs
Anticholinergic drugs for treating prostate adenoma help relieve symptoms like urinary incontinence, frequent urination, urgency, which cannot be leveled with alpha-blockers. Doctors sometimes prescribe anticholinergic drugs in combination with alpha blockers to better control the symptoms of BPH. The use of anticholinergics is associated with the risk of developing acute urinary retention. In addition, the following side effects may be observed: blurred vision, constipation, dizziness, dry eyes, dry mouth, headache, gastrointestinal disturbances, abdominal pain, urinary tract infections.
Anticholinergic drugs for the treatment of prostate adenoma: tolteridone and oxybutynin.
Combination of drugs for the treatment of prostate adenoma
Often, drug treatment of benign prostatic hyperplasia requires the appointment of a combination of drugs. Men who take the combination of dutasteride and tamsulosin experience more significant relief from BPH symptoms than patients who take these drugs alone.
Currently, dosage forms have been developed that include an alpha blocker and a 5-alpha reductase inhibitor. This dosage form is convenient, it requires a single dose.
As a rule, treatment with combination drugs is well tolerated by patients. The side effect profile includes a combination of adverse reactions that are characteristic of drugs separately. The most common adverse events in combination therapy are erectile dysfunction (7. 4%), retrograde ejaculation (4. 2%), decreased libido (3. 4%).
As a rule, prolonged use of medications is required, and when they are canceled, symptoms may return.
Many men refuse to take drugs for the treatment of prostate adenoma, as they are too 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 stream is weak and sometimes it hurts when I want to urinate in large volumes. On the Internet, I read about two main classes of medication for treatment of BPH: alpha-blockers and 5-alpha-reductase inhibitors Some men describe a significant improvement in symptoms when taking one of the drugs, but most talk about the negative effects of the drugs.
As I understand it, both groups of drugs affect sexual function to one degree or another. . . . I'm scared to even think about it. "
Stories of men taking medication to treat BPH
"I take the drugs the doctor prescribed me and so far I haven't had any side effects described in the instructions. . . I've been taking them for about three years. There was a time when the drug didn't seem to work, so I had to double the dose and everything has returned to its place . . . . "
"I've been taking medication for a long time that my doctor recommended me and they help me, but I can only feel a "dry" orgasm, which I really don't like . . . "
"I took alpha-adrenergic blockers and they gave me good urination. Side effects were a decrease in ejaculation volume and terrible dizziness with a sharp increase. . . . When I stopped taking it, urination became more frequent until 13-15 times a day, sperm volume has increased significantly. I am now 45 years old and my urologist has put me on an alpha blocker. Periodically, I get dizzy when I get up suddenly, my nose is always stuffy, and oh, yes, a "dry" orgasm. The first time it happened, I kept thinking it was just a spasm and an orgasm along the way. I was wrong. But worst of all was priapism! (Priapism is a prolonged, persistent, and sometimes pain that occurs without prior arousal). At first I was sure that surgical treatment was not for me, but now I am thinking about that option. "
"Hello, I have been taking medication for the treatment of prostate adenoma for a long time . . . From the side effects, I periodically worried about dizziness and nasal congestion. My prostate adenoma symptoms have significantly decreased and I am happy about it because I was able to avoid surgery ! "
As you can see, not every man develops side effects, and different patients may experience different adverse reactions. No doctor can say with a hundred percent guarantee whether you will develop this or that side effect.
By making an appointment with a doctor, you can discuss the therapy that is most suitable for you. At the consultation, you must inform the doctor without concealment of all information about the state of health, concomitant diseases, the medications you are taking. This will help your doctor decide which treatment plan is best for you.