Prostate adenoma treatments help relieve lower urinary tract symptoms. According to the recommendations of the European Association of Urology, prostate adenoma medications are used if patients have moderately severe symptoms of the disease.
Currently the two most widely used groups of drugs are: alpha-blockers and 5-alpha-reductase inhibitors. Less commonly used are phosphodiesterase inhibitors and anticholinergic drugs and others.
Alpha-blockers relax the smooth muscle fibers that form in the prostate and bladder neck, reducing pressure on the walls of the urethra and enlarging its lumen. This makes it easier for urine to drain from the bladder. Alpha blockers are given to patients with moderate to severe BPH symptoms. It should be noted that alpha-blockers relieve lower urinary tract symptoms, but theyDo not slow or stop further growth of the prostate.
Most men report relief of lower urinary tract symptoms, which is reflected in a decrease in the I-PSS prostate symptom index. InternationallyEvaluation of prostate symptoms) 4-6 units.
The effect of taking alpha-blockers develops after 2-3 weeks.
In the human body, there are several types of alpha-adrenergic receptors (alpha-1 and alpha-2) and subtypes (alpha-1a, alpha-1b, alpha-1d, etc. ), which are located not only in muscle. 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, acting on all types of receptors, both alpha-1 and alpha-2-adrenergic receptors. In this regard, the development of complications has often been observed in men. Scientists have found that alpha-1a-adrenergic receptors are located in the prostate. Following the development of drugs that selectively block alpha-1-adrenergic receptors (selective alpha-blockers), it has become possible to reduce the number of side effects associated with the use of non-selective drugs (angina, arrhythmia, etc. ).
Prazosin was the first selective alpha-1 blocker in the treatment of approved BPH. The downside of prazosin, like other short-acting drugs, was 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 efficacy and 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, decreased blood pressure, which manifests itself in the transition 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 of taking these drugs. But complications such as retrograde ejaculation, when sperm move into the bladder rather than the penis during ejaculation, are more common. However harmless.
Feature related to the reception of 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 drop in blood pressure, leading to collapse and loss of consciousness. Remember that Viagra pills can be taken no earlier than four hours after taking the 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 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 a slowing down of the prostate gland and a reduction in its size, which in turn alleviates 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 treating prostate adenoma.
The greatest effect of treatment with prostate adenoma 5-alpha-reductase inhibitors is experienced by men whose prostate gland was significantly enlarged before treatment (more than 30 s). Men taking 5-alpha-reductase inhibitors report a 3-point decrease in the I-PSS prostate symptom index. Patients who have had small prostate pretreatment (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 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 results. 30-50% of patients develop a clinical effect when treated 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, less than one percent of rash cases, increased size, and compression. Mammary glands.
Properties associated with the administration of 5-alpha reductase inhibitors
Taking finasteride changes the concentration of prostate-specific antigen in the blood to reduce it. In patients receiving 5-alpha reductase inhibitors, prostate-specific antigen concentrations may be reduced by 50%. Prostate-specific antigen is a nonspecific marker of 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 steps for further diagnosis and treatment. Underestimation of prostate-specific antigen levels in the blood can lead to false-negative results in prostate cancer screening tests.
To get a real result of a prostate-specific antigen analysis in a patient's blood that receives finasteride or dutasteride, the doctor multiplies the rate obtained by two.
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.
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. One scientific study showed that daily intake of tadalafil causes a significant improvement in lower urinary tract symptoms in men with BPH.
The use of tadalafil in combination 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. The most common side effects are headaches and disorders of the gastrointestinal tract, less often - hearing and vision disorders, muscle aches, etc. Sh.
Anticholinergic drugs for the treatment of prostate adenoma help relieve symptoms such as urinary incontinence, frequent urination, urgency that can not be treated 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 the risk of developing acute urinary retention. In addition, the following side effects may be noted: 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 prostate adenoma treatment drugs
Often, drug treatment of benign prostatic hyperplasia requires the appointment of a combination of drugs. Men taking dutasteride in combination with tamsulosin experience a 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 effects profile includes a combination of adverse reactions that are characteristic of individual medications. The most common side effects of combination therapy are erectile dysfunction (7. 4%), retrograde ejaculation (4. 2%), decreased libido (3. 4%).
Long-term use of medications is usually required and if they are discontinued the symptoms may return.
Many men refuse to take prostate adenoma medications because they are terribly afraid of developing side effects, primarily related to sexual function.
Patient History:"The doctor advised me to start treatment for BPH with one or more drugs. I can urinate, but the urine flow is weak and sometimes it hurts when I want to urinate in large volumes. I read on the internet about two major classes of drugs used to treat BPH: alpha-blockers and 5-alpha-reductase inhibitors. Some men describe a significant improvement in symptoms by taking any medication, but most talk about the negative effects of the medication.
As I understand it, both groups of drugs affect sexual function to some degree. . . I'm even scared to think about it. "
Stories about men taking medications to treat BPH
"I am taking the medication prescribed by my doctor and I have not had any side effects described in the instructions yet. . . I have been taking it for about three years. There was a time when it seemed to me that the medication was not working, then I had to double the dose and everything went back to its place. . . ".
"I've been taking medication for a long time, which the doctor advised and helped me, but I only had a 'dry' orgasm, which I really do not like. "
"I took alpha-adrenergic blockers and they gave me good urine. Side effects were a decrease in ejaculation volume and terrible dizziness with sharp increases. When I stopped taking it, urination increased 13-15 times a day, sperm volume increased significantly. I am now 45 years old and my urologist made me an alpha blocker. Periodically, when I get up sharply, I get dizzy, I always have a stuffy nose and yes, a "dry" orgasm. The first time it happened, I just thought it was just a spasm and an orgasm on the way. I was wrong. "Sometimes a painful erection that occurs without prior arousal. ) At first I was convinced that surgical treatment was not for me, but now I am thinking about this option. "
"Hello, I have been taking medication for the treatment of prostate adenoma for a long time. . . From the side effects I periodically suffered from dizziness and nasal congestion. The symptoms of prostate adenoma were significantly reduced and I am happy because I was able to avoid the surgery! "
As you can see, not all men develop side effects and different patients may have different side effects. No doctor can tell you with a one hundred percent guarantee whether you will develop this or that side effect.
By meeting with your doctor, you can discuss the therapy that is most suitable for you. At the consultation, you should inform your doctor about your health condition, concomitant diseases, medications that you are taking, without being covered. This will help your doctor decide which treatment plan is best for you.