Drugs for the treatment of prostate adenoma help relieve symptoms of the lower urinary tract. 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 widely used: alpha-blockers and 5-alpha-reductase inhibitors. Less commonly used are phosphodiesterase inhibitors and anticholinergic drugs and others.
Alpha blockers
Alpha-blockers relax the smooth muscle fibers that make up the prostate and bladder neck, resulting in reduced 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 of lower urinary tract symptoms, as reflected by a decrease in the I-PSS Prostatic Symptoms Index (international scaleevaluation of prostatic 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, which are located not only in the muscle cells of the prostate, but also in otherstructures 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 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 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, decreased pressure that occurs when moving from a horizontal to a vertical position (usually observed only at the beginning of treatment - the effect of the first dose), drowsiness, nasal congestion and retrogradeejaculation. Although alpha-blockers do not cause erectile dysfunction or decrease in 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 moves 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 lead to a significant decrease in blood pressure, up to 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 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 slowdown in the growth of the prostate gland and a decrease 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 from the treatment of prostate adenoma with 5-alpha-reductase inhibitors is experienced 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 I-PSS prostatic symptom index. Patients with a small pre-treatment prostate (less than 30 cc) do not show a significant improvement in the I-PSS Prostatic Symptoms Index.
The effect of treatment with 5-alpha-reductase inhibitors develops after 6-12 months from the start of taking the drugs. 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 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, rash in less than one percent of cases, increasedin 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 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 measures for further diagnosis and treatment. Underestimation of the level of prostate-specific antigen in the blood can lead to false-negative results of screening tests for prostate cancer.
To obtain a real result of the analysis of the 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 a man's risk of developing non-aggressive prostate cancer, but increases the risk of developing a highly 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. One 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 pressure. In addition, 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 - hearing and vision disorders, 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 anticholinergic drugs 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 of dutasteride with tamsulosin experience greater relief of symptoms of BPH 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 combined drugs is well tolerated by patients. The side effect profile includes a combination of adverse reactions that are characteristic of drugs separately. The most common adverse events in combination 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 canceled, symptoms may return.
Many men refuse to take drugs for the treatment of prostate adenoma, as 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 volumes. 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 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 to one degree or another . . . . I'm scared to even think about it. "
Stories of men taking drugs to treat BPH
"I take the drugs that the doctor prescribed for me 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 returned to its place . . . ".
"I have been taking medications that my doctor recommended to me for a long time and they help me, but I can only experience a "dry" orgasm, which I really don’t like . . . "
"I took alpha-adrenergic blockers and they provided me with good urination. Side effects were a decrease in the volume of ejaculate 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 sperm increased significantly. I am now 45 years old and my urologist has put me on an alpha blocker. Periodically, I get dizzy when I get up sharply, my nose is always stuffy, and oh yes, a "dry" orgasm. The first time it happened, I kept thinking it was just a spasm and an orgasm along the way. I was wrong. But the worst of all was priapism! (Priapism is a prolonged, persistent, sometimes painful erection that occurs without prior arousal). At first I was sure that the surgical treatment was not for me, but now I am already thinking about this option. "
"Hello, 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 prostate adenoma symptoms have significantly decreased, and I am glad about it, because I was able to avoid surgery! "
As you can see, not every man develops side effects, and different patients may experience different adverse reactions. No doctor can say with a hundred percent guarantee whether you will develop this or that side effect.
By making an appointment with your doctor, you can discuss the most suitable therapy for you. At the consultation, you must inform the doctor without concealment of all information about the state of health, concomitant diseases, and the drugs you are taking. This will help your doctor decide which treatment plan is best for you.