Drugs for the treatment of prostate adenoma help relieve symptoms of the lower urinary tract. According to the recommendations of the European Urological Association, drugs for the treatment of prostate adenoma are used if patients have moderately severe symptoms of the disease.
Currently, two groups of drugs are most widely 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, which reduces pressure on the walls of the urethra and the expansion of its lumen. This allows urine to flow more easily from the bladder. Alpha blockers are given to patients with moderate to severe symptoms of BPH. It should be noted that alpha-blockers relieve lower urinary tract symptoms, but theydoes not slow or stop prostate growth.
Most men report relief from lower urinary tract symptoms, as evidenced by a decrease in the I-PSS index of prostate symptoms (international scaleassessment of prostate symptoms) by 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 the muscleprostate 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 receptors. In this regard, the development of complications was often noted 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, as well as other short-acting drugs, were the need for multiple doses during the day and severe low blood pressure.
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 about the same effectiveness and the same range of side effects. These drugs for the treatment of prostate adenoma require a single dose during the day.
The most common side effects associated with taking alpha-blockers are: headache, dizziness, weakness, decrease in pressure that occurs when moving from a horizontal to an upright position (usually seen onlyat the beginning of treatment - the 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 taking these drugs. But such a complication as retrograde ejaculation, when sperm during ejaculation move into the bladder, and not into the penis, is more common. However, it is harmless.
Feature associated with taking alpha-blockers
If you are taking erectile dysfunction drugs such as Viagra, you should be aware that their combination with alpha-blockers can cause a significant decrease in blood pressure, up to and including 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 symptoms of lower urinary symptoms. Two drugs in 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 slower prostate growth and a decrease in size, which in turn leads to relief of 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 the treatment of prostate adenoma.
The greatest effect of treatment of prostate adenoma with 5-alpha-reductase inhibitors is felt by men whose prostate gland was significantly enlarged before treatment (more than 30 cc). Men taking 5-alpha-reductase inhibitors report a 3-point decrease in the Prostate Symptom Index I-PSS. Patients with a small pre-treatment prostate (less than 30 cc) show no significant improvement in the I-PSS Prostate Symptom Index.
The effect of treatment with 5-alpha-reductase inhibitors develops 6-12 months after the start of taking the drugs. As we know, the size of the prostate is not always correlated with the severity of the symptoms of prostate adenoma, so treatment with finasteride or dutasteride does not always give the expected results. 30-50% of patients develop a clinical effect following 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 disorders (3. 7%), erection problems, skin rashes in less than 1% of cases, increased size and compaction of the mammary glands.
Feature associated with taking 5-alpha reductase inhibitors
Taking finasteride changes the concentration of prostate-specific antigen in the blood towards its decrease. 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 for prostate cancer. An increase in the level of prostate-specific antigen in the blood can be the first sign to suspect a tumor at an early stage and take steps for further diagnosis and treatment. Underestimating the level of prostate specific antigen in the blood can lead to false negative results of prostate cancer screening tests.
To obtain a real result of the analysis for prostate-specific antigen in the blood of a patient taking finasteride or dutasteride, the doctor multiplies the obtained figure by two.
It is also known that taking finasteride reduces the risk of developing non-aggressive prostate cancer, but increases the risk of developing a very aggressive prostate tumor.
Phosphodiesterase inhibitors
Previously, the substance 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 found that taking tadalafil daily 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 lead to a sharp decrease in pressure. Also, the use of tadalafil is limited in patients with impaired renal and hepatic function. Of the side effects, the most common are headaches and disorders of the gastrointestinal tract, less often - impaired hearing and vision, muscle pain, etc.
Anticholinergic drugs
Anticholinergic drugs for the treatment of prostate adenoma help relieve symptoms such as urinary incontinence, frequent urination, urgency, which could not 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 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 taking the combination dutasteride with tamsulosin experience greater relief from BPH symptoms than patients taking these drugs alone.
Currently, dosage forms have been developed that include both an alpha-blocker and a 5-alpha reductase inhibitor. This dosage form is convenient, requires a single dose.
As a rule, treatment with combination drugs is well tolerated by patients. The side effect profile includes a combination of side effects characteristic of drugs separately. The most common adverse events in combined treatment are erectile dysfunction (7. 4%), retrograde ejaculation (4. 2%), decreased libido (3. 4%).
As a rule, long-term use of medications is necessary, and when they are canceled, symptoms may return.
Many men refuse to take drugs for the treatment of prostate adenoma, because they are terribly afraid of the development of side effects, primarily those related to sexual function.
Patient history:"The doctor advised me to start treatment for BPH with one or more drugs. I can urinate, but my urine stream is weak and sometimes it hurts when I want to urinate in large quantities. On the Internet, I read about two main classes of drugs for the treatment of BPH: alpha-blockers and 5-alpha-reductase inhibitors. Some men describe a significant improvement in symptoms after 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 even scared to think about it. "
Stories of men taking medication to treat BPH
"I take the medications that the doctor prescribed me and so far I haven't had any side effects as described in the instructions. . . I've been taking it for about three years. There was a moment when it seemed to me that the medicine was not working, then I had to double the dose and everything returned to its place. . . ".
"I've been taking medications recommended by my doctor for a long time and they've been helping me, but I can only feel a 'dry' orgasm, which I really don't like. . . "
"I took alpha-adrenergic blockers and they provided me with good urination. Side effects were decreased volume of ejaculate and terrible dizziness with a sharp increase . . . . When I stoppedtaking it, urination has become more frequent up to 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. dizziness when I stand up suddenly, my nose is still stuffy, and oh yes, a "dry" orgasm. The first time it happened, I kept thinking it was just a spasm andan orgasm along the way. I was wrong. But worst of all was priapism! (Priapism is a prolonged, persistent, sometimes painful erection that occurs without prior arousal. ) At first I was sure thatsurgical treatment was not for me, but now I am already thinking about this option.
"Hello, I have been taking medication for the treatment of prostate adenoma for a long time. . . Among the side effects, I periodically worried about dizziness and nasal congestion. My prostate adenoma symptoms have reduced significantly, and I'm glad I was able to avoid surgery! »
As you can see, not all men develop side effects and different patients may experience different side effects. 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 most appropriate therapy for you. During the consultation, you must inform the doctor without concealment of all information about the state of health, concomitant diseases, medications that you are taking. This will help your doctor decide which treatment plan is best for you.