Prostate adenoma treatment medications 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 moderately severe 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, anticholinergic drugs and others.
Alpha blockers
Alpha blockers relax the smooth muscle fibers that make up the prostate and bladder neck, resulting in a reduction in pressure on the walls of the urethra and expansion of its lumen. This makes it easier for urine to flow out of 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 from lower urinary tract symptoms, as evidenced by a decrease in the I-PSS prostate symptom index (international scaleevaluation of prostatic symptoms) of 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, which are found not only in the muscle cells of the prostate , 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 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 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 arterial hypotension.
Long-acting selective 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 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 switching from a horizontal to a vertical position (usually observed only at the beginning of treatment - the effect of the first dose), sleepiness, 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 the sperm during ejaculation moves to the bladder and not the penis, is more common. However, it is harmless.
Characteristic associated with the intake of alpha-blockers
If you are taking erectile dysfunction medications such as Viagra, you should be aware that their combination with alpha blockers can lead to a significant decrease in blood pressure, 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 the symptoms of lower urinary symptoms. Two drugs in this group are used to treat prostate adenoma: finasteride and dutasteride. These drugs block the 5-alpha-reductase enzyme, which converts testosterone into dihydrotestosterone, which plays an important role in the development of prostate adenoma. The result is a slowdown in the growth of the prostate gland and a decrease in its 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 treating prostate adenoma with 5-alpha-reductase inhibitors is found in men whose prostate gland was significantly enlarged before treatment (more than 30cc). Men taking 5-alpha-reductase inhibitors report a 3-point decrease in the I-PSS prostatic symptom index. Patients with a pretreatment small prostate (less than 30cc) show no significant improvement in the I-PSS prostatic 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 is not always related 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 from 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 disorder (3. 7%), erection problems, less rash in 1% of cases, enlargement and compaction of the mammary glands.
Characteristic associated with the intake of 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 of prostate cancer. An increase in the level of prostate specific antigen in the blood can be the first sign that allows you to suspect a tumor at an early stage and to take measures 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 get a real result from testing for prostate specific antigen in the blood of a patient taking finasteride or dutasteride, the doctor multiplies the resulting 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 highly aggressive prostate cancer.
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 cause a sharp decrease in blood pressure. Furthermore, the use of tadalafil is limited in patients with impaired renal and hepatic function. Among the side effects, the most common are headaches and disorders of the gastrointestinal tract, less often - impaired hearing and vision, muscle aches, etc.
Anticholinergic drugs
Anticholinergic drugs for the treatment of prostate adenoma help relieve symptoms such as urinary incontinence, frequent urination, urgency, which cannot be leveled with alpha blockers. Doctors sometimes prescribe anticholinergic drugs in combination with alpha blockers to better control BPH symptoms. The use of anticholinergic drugs is associated with the risk of developing acute urinary retention. In addition, the following side effects can be observed: blurred vision, constipation, dizziness, dry eyes, dry mouth, headache, gastrointestinal upset, 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 dutasteride combination with tamsulosin experience more significant relief of BPH symptoms than patients taking these drugs alone.
Dosage forms have been developed that include both an alpha blocker and a 5-alpha reductase inhibitor. This dosage form is convenient, it requires a single dose.
As a rule, treatment with combination drugs is well tolerated by patients. The side effect profile includes a combination of adverse reactions that are characteristic of the drugs separately. The most common adverse events in combined therapy are erectile dysfunction (7. 4%), retrograde ejaculation (4. 2%), decreased libido (3. 4%).
As a rule, long-term use of drugs is required, and when they are reversed, symptoms can recur.
Many men refuse to take drugs for the treatment of prostate adenoma, as they are terribly afraid of the development of side effects, mainly 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 volumes. I have read about two main classes on the Internet. of drugs for the treatment of BPH: alpha-blockers and 5-alpha-reductase inhibitors. Some men describe a significant improvement in symptoms resulting from 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 in one way or another. . . . I'm afraid even just thinking about it. "
Stories of men taking drugs to treat BPH
"I take the medications my doctor prescribed and so far I have not had any side effects described in the instructions. . . I have been taking it 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 is back in its place… ".
"I have been taking the medications my doctor recommended for a long time and they help me, but I can only experience a" dry "orgasm, which I just don't like. . . "
"I took some 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 increase. . . . When I stopped taking it, the urination became more frequent up to 13-15 times a day, the sperm volume has increased significantly. I am now 45 years old and my urologist has put me on an alpha blocker. Periodically, I feel dizzy when I get up abruptly, my nose it's always closed and oh yeah, a "dry" orgasm. The first time it happened, I kept thinking it was just a spasm and orgasm along the way. I was wrong. But the worst part was the priapism! (Priapism it is a prolonged, persistent, sometimes painful erection that occurs without a previous awakening). At first I was sure that the surgical treatment was not for me, but now I am already thinking about this option. "
"Hi, I have been taking drugs for the treatment of prostate adenoma for a long time. . . Of the side effects, I was periodically worried about dizziness and nasal congestion. My symptoms of prostate adenoma have significantly decreased and I am happy, because I was able to avoid surgery!
As you can see, not all men develop side effects, and different patients can experience different adverse reactions. 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 therapy that is best for you. At the consultation, you must inform the doctor without hiding all information on the state of health, concomitant diseases, medications you are taking. This will help your doctor decide which treatment plan is best for you.