Medications for the treatment of 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 moderately severe symptoms of the disease.
Currently, two groups of drugs are the 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, reducing pressure on the walls of the urethra and expanding 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 should be noted that alpha blockers relieve lower urinary tract symptoms, butnot slow or stop prostate growth.
Most men report relief of lower urinary tract symptoms, as reflected by a decrease in the I-PSS prostate symptom index (international scaleassessment of prostate symptoms) for 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 muscle cells. of the prostate, but also in other structures of the body, for example, in the heart, the blood vessels, the lungs. Previously, alpha-blockers were used to treat BPH, which act on all types of receptors, both alpha-1 and alpha-2-adrenergic. In this regard, the development of complications is often observed in men. Scientists have discovered that alpha-1a-adrenergic receptors are found in the prostate. After the development of drugs that selectively block alpha-1-adrenergic receptors (alpha-selective 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.
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 about 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, drop in pressure that occurs when moving from a horizontal to a vertical position (usually seen 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 such a complication as retrograde ejaculation, when sperm during ejaculation move into the bladder and not the penis, is more common. However, it is harmless.
Feature associated with taking alpha blockers
If you are taking drugs for erectile dysfunction such as Viagra, you should be aware that its combination with alpha-blockers can cause a significant drop in blood pressure, even 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 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 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 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 prostate symptom index. Patients with a small prostate before treatment (less than 30 cc) do not show a significant improvement in the I-PSS prostate symptom index.
The effect of treatment with 5-alpha-reductase inhibitors develops after 6 to 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 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 disorder (3. 7%), erection problems, rash in less than one percent of cases, enlargement and compaction of the mammary glands.
Feature associated with taking 5-alpha reductase inhibitors
Taking finasteride changes the concentration of PSA in the blood towards its decrease. In patients taking 5-alpha reductase inhibitors, the PSA level can 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 steps for further diagnosis and treatment. Underestimation of the PSA level in the blood can lead to false-negative results in prostate cancer screening tests.
In order to obtain a real result of the test for prostate-specific antigen in the blood of a patient taking finasteride or dutasteride, the doctor multiplies the resulting figure by two.
Taking finasteride is also known to reduce 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. A scientific study found that taking tadalafil daily resulted in 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 pressure. In addition, the use of tadalafil is limited in patients with renal and hepatic insufficiency. 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 cannot be leveled by alpha-blockers. Doctors sometimes prescribe anticholinergic medications 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 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 more significant relief of BPH symptoms 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, requiring only one dose.
As a general rule, patients tolerate treatment with combination drugs well. The side effect profile includes a combination of adverse reactions that are characteristic of the individual drugs. 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, the 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, mainly those related to sexual function.
Patient History:"The doctor advised me to start BPH treatment with one or more medications. 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 medications for the treatment of BPH: alpha-blockers and 5-alpha-reductase inhibitors Some men describe a significant improvement in symptoms when taking one of the medications, but most report negative effects of the medications.
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 medicine to treat BPH
"I take the drugs prescribed by the doctor 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 went back to its place. . . ".
"I've been taking medications for a long time that my doctor recommended 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 helped me to urinate well. The side effects were a decrease in ejaculate volume and terrible dizziness with a sharp increase. . . When I stopped taking it, urination became more frequent until 13-15 times a day sperm volume increased significantly I am now 45 years old and my urologist prescribed an alpha blocker Periodically I get dizzy when I get up suddenly my nose is always stuffy and oh yes a "dry" orgasm first time it happened I kept thinking it was just a spasm and orgasm on the way. I was wrong. But worst of all was priapism! (Priapism is a prolonged, persistent, sometimes painful erection that occurs without arousal In the beginning I was sure that surgical treatment was not for me, but now I am already 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 worried about dizziness and nasal congestion. My symptoms of prostate adenoma have decreased significantly and I am glad that I was able to avoid surgery! "
As you can see, not all men develop side effects and different patients may experience different adverse reactions. No doctor can say with a hundred percent guarantee whether he 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 must inform the doctor without concealment of all information about the state of health, concomitant diseases, medications you are taking. This will help your doctor decide which treatment plan is best for you.