Medications for the treatment of prostate adenoma help relieve symptoms of the lower urinary tract. According to the recommendations of the European Urological Association, drugs are used to treat prostate adenoma if patients have moderate symptoms of the disease.
Currently, two groups of drugs are most commonly used: alpha-blockers and 5-alpha-reductase inhibitors. Less commonly used are phosphodiesterase inhibitors and anticholinergic drugs, among others.
Alpha blockers
Alpha-blockers relax the smooth muscle fibers that make up the neck of the prostate gland and bladder, resulting in reduced pressure on the walls of the urethra and dilation of the lumen. This makes it easier for urine to pass out of the bladder. Alpha blockers are given to patients with moderate or severe symptoms of BPH. It should be noted that alpha-blockers relieve symptoms of the lower urinary tract, but theyDo not slow down or stop the prostate from growing further.
Most men report a reduction in lower urinary tract symptoms, which is reflected in a decrease in the I-PSS Prostatic Symptoms Index (internationallyassessment of prostate symptoms) 4-6 units.
The effect of taking alpha-blockers develops after 2-3 weeks.
There are several types of alpha-adrenergic receptors (alpha-1 and alpha-2) and subtypes (alpha-1a, alpha-1b, alpha-1d, etc. ) in the human body, not only in muscle. Prostate gland cells, but also in other structures of the body, such as the heart, blood vessels, lungs. In the past, alpha-blockers have been used to treat BPH, affecting all types of receptors, both alpha-1 and alpha-2-adrenergic receptors. In this regard, the development of complications in men was often noted. The researchers found 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 pectoris, arrhythmias, etc. ).
Short-acting alpha-1-blockers
Prazosin was the first selective alpha-1 blocker approved for the treatment of BPH. The disadvantages of prazosin, as well as other short-acting drugs, were the need for multiple doses during the day 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 effectiveness and side effects. For the treatment of prostate adenoma, these drugs require one dose per day.
The most common side effects associated with alpha-blockers are: headache, dizziness, weakness, decreased pressure when moving from a horizontal position to a vertical position (usually observed only at the beginning of treatment - the effect of the first dose), drowsiness, nasal congestion and retrograde discharge. Although alpha-blockers do not cause erectile dysfunction or decreased libido, these side effects have been reported in some cases while taking these drugs. However, a complication such as retrograde ejaculation is more common when sperm move to the bladder rather than the penis during ejaculation. However, it is harmless.
Feature associated with the reception of alpha-blockers
If you are taking erectile dysfunction medications such as Viagra, you should be aware that their combination with alpha-blockers can cause a significant drop in blood pressure, depression, and fainting. Remember that you can take Viagra no later 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 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 delay in the growth and reduction of the size of the prostate gland, which in turn leads to the elimination of symptoms of the lower urinary tract. Finasteride blocks 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 observed in men with significantly enlarged prostate gland (more than 30 cc) before treatment. Men taking 5-alpha-reductase inhibitors reported a 3-point decrease in the I-PSS prostate symptom index. No significant improvement in the I-PSS Prostate Symptoms Index was observed in patients with small prostates before treatment (less than 30 cc).
The effect of treatment with 5-alpha-reductase inhibitors develops 6-12 months after starting the drug. As we know, the size of the prostate does not always correspond to the severity of the symptoms of prostate adenoma, so treatment with finasteride or dutasteride does not always give the expected result. Clinical effects occur in 30-50% of patients treated with 5-alpha reductase inhibitors.
The most common side effects of 5-alpha reductase inhibitors are decreased libido (6. 4%), impotence (8. 1%), ejaculatory disorders (3. 7%), erection problems, rashes in less than one percent of cases, increased size and compression. mammary glands.
Feature associated with the reception of 5-alpha reductase inhibitors
Taking finasteride changes the concentration of prostate-specific antigen in the blood in the direction of its decrease. In patients receiving 5-alpha reductase inhibitors, the concentration of prostate-specific antigen may be reduced 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 may be the first sign that a tumor can be suspected at an early stage and that measures can be taken for further diagnosis and treatment. Improper assessment 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 receiving finasteride or dutasteride, the doctor doubles the result.
It is also known that taking finasteride reduces the risk of developing non-aggressive prostate cancer in men, but increases the risk of developing highly aggressive prostate cancer.
Phosphodiesterase inhibitors
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. One 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 drugs can cause a sharp drop in blood pressure. In addition, the use of tadalafil in patients with impaired renal and hepatic function is limited. Among the side effects, the most common are headaches and disorders of the gastrointestinal tract, less often - hearing and vision disorders, muscle pain, etc.
Anticholinergic drugs
Anticholinergic drugs for the treatment of prostate adenoma help relieve symptoms such as urinary incontinence, frequent urination, and first aid, which cannot be corrected with alpha-blockers. Doctors sometimes prescribe anticholinergic drugs in combination with alpha blockers to better manage BPH symptoms. The use of anticholinergic drugs is associated with a 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 disorders, 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 receiving a combination of dutasteride with tamsulosin have a significant reduction in BPH symptoms compared with patients taking the drug alone.
Dosage forms containing both an alpha blocker and a 5-alpha reductase inhibitor are currently being developed. This dosage form is convenient, one dose is required.
As a rule, treatment with combined drugs is well tolerated by patients. The side effect profile also includes a combination of adverse reactions characteristic of the drug. The most common adverse events during combination therapy are erectile dysfunction (7. 4%), retrograde ejaculation (4. 2%), and decreased libido (3. 4%).
As a rule, long-term use of drugs is required, and when they are discontinued, symptoms may return.
Many men refuse to take medication for the treatment of prostate adenoma because they are very afraid of the development of side effects, primarily those associated with sexual function.
Patient history:"The doctor advised me to start treatment for BPH with one or more drugs. I know urine, but my urine flow is weak and sometimes it hurts when I want to urinate a lot. I read on the Internet about two main classes of drugs for treating 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 side effects of the drug.
As I understand it, both groups of drugs affect sexual function to one degree or another. . . . I'm afraid to even think about it. "
Stories of men taking medication to treat BPH
"I am taking the medication prescribed by my doctor and so far I have not had any of the side effects described in the instructions. and everything returned to its place. . ".
"It's been a long time since I've taken the medication my doctor recommended, and they help me, but I can only have a 'dry' orgasm, I really don't like it. "
"I took alpha-adrenergic blockers and they allowed me to urinate well. The side effects were a decrease in ejaculation volume and severe dizziness with a sharp increase. . . . I am now 45 years old and my urologist has prescribed me an alpha-blocker. I was wrong. But the worst was priapism! (Priapism is a long, continuous, sometimes painful erection that occurs before waking up. ) At first, I was convinced that surgical treatment was not for me, and now I am thinking about this option. "
"Hello, I have been taking medication for the treatment of prostate adenoma for a long time.
As you can see, not every man develops side effects, and different patients may experience different adverse reactions. No doctor can say for sure that you will have any side effects.
By making an appointment with a doctor, you can discuss the most appropriate therapy for you. During the consultation, you should inform the doctor without hiding all the information about your health condition, accompanying diseases, medications you are taking. This will help your doctor decide which treatment plan is best for you.