Medications to treat 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 moderate symptoms of the disease.
Currently, two groups of drugs are most widely used: alpha-blockers and 5-alpha-reductase inhibitors. Phosphodiesterase inhibitors and anticholinergic drugs and others are less commonly used.
Alpha-blockers relax the smooth muscle fibers that make up the prostate and bladder neck, reducing the pressure on the walls of the urethra and dilating its lumen. This facilitates the flow of urine from 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 theydo not slow down or stop further growth of the prostate.
Most men report relief of lower urinary tract symptoms, which is reflected in a reduction in the I-PSS index of prostate symptoms (international scaleassessment of prostate symptoms) with 4-6 units.
The effect of taking alpha-blockers develops after 2-3 weeks.
In the human body there are several types (alpha-1 and alpha-2) and subtypes (alpha-1a, alpha-1b, alpha-1d, etc. ) alpha-adrenergic receptors, which are found not only in prostate muscle cells, but also in other structures of the body, such as 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 is often observed in men. Scientists have found that alpha-1a-adrenergic receptors are found 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, arrhythmia, etc. ).
Short-acting alpha-1 blockers
Prazosin is the first selective alpha-1 blocker approved for the treatment of BPH. Disadvantages of prazosin, as well as other short-acting drugs, are the need for multiple doses during the day and severe arterial hypotension.
Selective long-acting 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 efficacy and set 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 the use of alpha-blockers are: headache, dizziness, weakness, decreased pressure, which occurs when moving from horizontal to vertical position (usually observed only at 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 when taking these drugs. But such a complication as retrograde ejaculation, when sperm during ejaculation move in the bladder rather than the penis, is more common. However, it is harmless.
Characteristics related to the intake of alpha-blockers
If you are taking medicines for erectile dysfunction such as Viagra, you should be aware that their combination with alpha-blockers can lead to a significant reduction in blood pressure, 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 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 slowing of the growth of the prostate gland and a reduction in its size, which in turn leads to relief of the 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 the treatment of prostate adenoma with 5-alpha-reductase inhibitors have men whose prostate gland was significantly enlarged before treatment (more than 30 cc). Men taking 5-alpha-reductase inhibitors have reported a 3-point decrease in the I-PSS prostate symptom index. Patients with a small prostate before treatment (less than 30 cc) did not show a significant improvement in the prostate symptom index of I-PSS.
The effect of treatment with 5-alpha-reductase inhibitors develops after 6-12 months from the start of medication. 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 give the expected results. 30-50% of patients develop a clinical effect of 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, rash in less thanone percent of cases increase in size and thickening of the mammary glands.
Characteristics associated with the use of 5-alpha reductase inhibitors
Finasteride changes the concentration of prostate-specific antigen in the blood towards its reduction. In patients taking 5-alpha reductase inhibitors, the concentration of prostate-specific antigen may be reduced 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 may be the first sign that allows you to suspect a tumor at an early stage and take measures for further diagnosis and treatment. Underestimation of the level of prostate-specific antigen in the blood can lead to false-negative results from prostate cancer screening tests.
To obtain a real result from the analysis of prostate-specific antigen in the blood of a patient taking finasteride or dutasteride, the doctor multiplies the figure by two.
It is also known that taking finasteride reduces a man's risk of developing non-aggressive prostate cancer, but increases the risk of developing a highly aggressive prostate tumor.
Tadalafil (a phosphodiesterase inhibitor) has previously been used to treat erectile dysfunction in men. In 2011, this drug was approved for the treatment of benign prostatic hyperplasia. One scientific study found that daily intake of tadalafil led to 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 is limited in patients with impaired renal and hepatic function. Among the most common side effects are headaches and disorders of the gastrointestinal tract, less common - disorders of hearing and vision, muscle pain and more.
Anticholinergic drugs for the treatment of prostate adenoma help relieve symptoms such as urinary incontinence, frequent urination, urgency, which can not be equated with alpha-blockers. Doctors sometimes prescribe anticholinergic drugs in combination with alpha-blockers to better control the symptoms of BPH. The use of anticholinergic drugs is associated with a risk of developing acute urinary retention. In addition, the following side effects may occur: 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.
A combination of drugs to treat prostate adenoma
Often, medical treatment of benign prostatic hyperplasia requires the appointment of a combination of drugs. Men taking the combination of dutasteride and tamsulosin experienced more significant relief of BPH symptoms than patients taking these drugs alone.
Dosage forms are currently being 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 that are specific to the drugs. The most common side effects with combination therapy are erectile dysfunction (7, 4%), retrograde ejaculation (4, 2%), decreased libido (3, 4%).
Prolonged use of medications is usually required, and when they are discontinued, symptoms may return.
Many men refuse to take drugs to treat prostate adenoma because they fear the development of side effects, mainly 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 flow is weak and sometimes it hurts when I want to urinate in large volumes. I read on the Internet 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 the symptoms of taking any 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 afraid to even think about it. "
Stories of men taking drugs 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. . . I have been taking them for about three years. There was a time when it seemed to me that the drug did not work, then I had to double the dose and everything fell into place. . . ".
"I've been taking medications my doctor has recommended for a long time and they help me, but I can only experience a 'dry' orgasm that I really don't like. "
"I took alpha-adrenergic blockers and they provided me with good urination. The side effects were a decrease in ejaculate volume and terrible dizziness with a sharp rise. When I stopped taking it, urination became more frequent up to 13-15 times a day, the volume of semen increased significantly. I am now 45 years old and my urologist prescribed me an alpha blocker. I get dizzy from time to time when I get up abruptly, my nose is always stuffy and oh, yes, a "dry" orgasm. The first time it happened, I always thought it was just a spasm and orgasm on the way. I was wrong. "Priapism is a long, stubborn, sometimes painful erection that occurs without arousal. " At first I was sure that surgery was not for me, but now I'm thinking about it. "
"Hello, I've been taking drugs to treat prostate adenoma for a long time. . . From the side effects I periodically worried about dizziness and nasal congestion. My symptoms of prostate adenoma have significantly decreased and I am happy because I managed to avoid surgery! "
As you can see, not every man develops side effects and different patients may experience different side effects. No doctor can say with a one 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. At the consultation you should inform the doctor, without hiding all the information about the health condition, concomitant diseases, medications you are taking. This will help your doctor decide which treatment plan is best for you.