CURRENT TRENDS IN THE MEDICAL MANAGEMENT OF BENIGN PROSTATIC HYPERPLASIA

Abstract

Symptomatic benign prostatic hyperplasia (BPH) is a common
condition in older men and has a significant effect on their daily lives. Medical treatment of BPH has undergone
many changes in the last decade. For patients presenting with minimal bothersome symptoms watchful waiting
is an acceptable first line strategy. Many placebo controlled double blind trials have confirmed the efficacy of
alpha blockers and 5 alpha reductase inhibitors in the medical management of BPH. The therapeutic efficacy
of all contemporary alpha- blockers appear similar both in terms of symptomatic relief and urodynamic
improvements in urine flow rate. Alpha blockers have a rapid onset of action and are likely to produce a
therapeutic result within weeks, regardless of prostatic volume. There is well documented evidence of reduction
in LDL cholesterol and serum triglyceride levels. In addition some patients on alpha blockers experience
improvement in sexual function and quality of their erectile response. There is a small risk of hypotension,
asthenia and dizziness with alpha blockers therapy. Finesteride, a potent 5-alpha reductase inhibitor, must be
given for 6 months before its effectiveness in a given patient can be assessed and for at least 12 months to
achieve maximum prostate shrinkage and the full extent of its other beneficial effects. This may be considered
as a disadvantage when compared with the rapid relief afforded by surgery or alpha blockers. The efficacy of
finesteride is also dependant on the prostate size. Finesteride is more effective in patients with prostate size
greater than 40 gram. However on the long term it may reverse the disease progression and reduce the risk of
urinary retention or prostate surgery. Side effects associated with finesteride therapy include decrease libido,
impotence and interference with PSA estimation. In selected patients combination therapy with alpha adrenergic
blocker and finesteride can be offered to relieve urinary symptoms and prevent BPH progression. When
medical treatment fails and in those patients presenting with complications surgical treatment should be
considered.