Medications to treat prostate adenoma help relieve lower urinary tract symptoms. According to the recommendations of the European Society of Urology, medicines 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 and other drugs.
Alpha blockers
Alpha-blockers relax the smooth muscle fibers that make up the neck of the prostate and bladder, resulting in lowering the pressure on the walls of the urethra and widening its lumen. This makes it easier for urine to flow out of the bladder. Alpha blockers are given to patients with moderate to severe BPH symptoms. 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 Prostate Symptoms Index (international scaleevaluation of prostate symptoms) with 4-6 units.
The effect of taking alpha-blockers develops after 2-3 weeks.
In the human body there are several types (alpha-1 and alpha-2) and subtypes (alpha-1a, alpha-1b, alpha-1d, etc. ) of alpha-adrenergic receptors, which are located not only in muscle. prostate cells, but also in other structures of the body, for example, in the heart, in blood vessels, in the lungs. Previously, alpha-blockers were used to treat BPH, which act on all types of receptors, such as alpha-1 and alpha-2-adrenergic receptors. In this regard, the development of complications was often observed in men. Scientists have discovered that alpha-1a-adrenergic receptors are located in the prostate. With the development of drugs that selectively block alpha-1-adrenergic receptors (selective alpha-blockers), it became possible to reduce the number of side effects associated with the use of non-selective drugs (angina attack, arrhythmia, etc. ).
Alpha-1-short-acting blocker
Prazosin was the first selective alpha-1 blocker approved for the treatment of BPH. Disadvantages of prazosin, as well as other short-acting drugs, were the need for multiple doses during the day and severe hypotension.
Selective long-acting alpha-1 blockers
The European Society 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, pressure drop 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 a complication such as retrograde ejaculation, when semen during ejaculation moves into the bladder, and not into the penis, is more common. However, it is harmless.
Features associated with receiving alpha-blockers
If you are taking erectile dysfunction medication like Viagra, you should be aware that combining them with alpha-blockers can lead to a significant reduction 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 the symptoms of low urinary incontinence. 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 slowing of prostate gland growth 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 treating prostate adenoma.
The greatest effect of treating prostate adenoma with 5-alpha-reductase inhibitors is experienced by men whose prostate gland is significantly enlarged before treatment (more than 30 cc). Men taking 5-alpha-reductase inhibitors report a 3-point drop 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 6-12 months from the start of taking the drug. As we know, prostate size is not always related to the severity of prostate adenoma symptoms, 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 sexual desire (6. 4%), impotence (8. 1%), erectile dysfunction (3. 7%), erection problems, redness in lessthat one percent of cases, increase in size and compression 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 lowering it. In patients receiving 5-alpha reductase inhibitors, the concentration of prostate specific antigen may be reduced 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 level of prostate specific antigen in the blood can lead to false-negative test results for prostate cancer.
To get a realistic result of the prostate specific antigen analysis 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 in a man, but increases the risk of developing a very 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 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 drop 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 - hearing and vision disorders, muscle aches, etc.
Anticholinergic drugs
Anticholinergic drugs for the treatment of prostate adenoma help relieve symptoms such as urinary incontinence, frequent urination, urgency, which can not be equated 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 more significant relief of BPH symptoms than patients taking these drugs alone.
Currently, dosage forms have been developed that include 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 side effects that are characteristic of individual drugs. The most common side effects in combination therapy are erectile dysfunction (7. 4%), retrograde ejaculation (4. 2%), decreased sexual desire (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 medication to treat prostate adenoma, as they are terribly afraid of developing 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 may urinate, but my urine flow is poor and sometimes it hurts when I want to urinate in large volumes. On the internet, I read about two main classesof drugs for the treatment of BPH: alpha-blockers and 5-alpha-reductase inhibitors Some men describe a marked 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 afraid to even think about it. "
Stories of men taking drugs to treat BPH
"I take the medication prescribed by my 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 medicine did not work, then I had to doublethe dose and everything returned to its place… ".
"I've been taking medication recommended by my doctor for a long time and they help me, but I can only experience a 'dry' orgasm, which I do not like very much…"
"I took 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, urination became more frequent until 13-15 times a day, sperm volume increased significantly. I am now 45 years old and my urologist has put me on alpha-blockers. Periodically, I get dizzy when I get up hard, my nose is always stuffy and oh yes, a "dry" orgasmThe first time it happened, I kept thinking it was just a spasm and an orgasm along the way. I was wrong. But worst of all was priapism! (Priapism is a prolonged, persistent, sometimes painful erection that happens"without waking up. ) At first I was sure that surgical treatment was not for me, but now I'm 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 was periodically bothered by dizziness and nasal congestion. My prostate adenoma symptoms have decreased significantly and I feel good about it because I was able toavoid surgery! "
As you can see, not every male develops side effects, and different patients may experience different adverse reactions. No doctor can say with a one hundred percent guarantee whether you will develop this or that side effect.
By leaving an appointment with a doctor, you can discuss the therapy most suitable for you. At the consultation you should inform the doctor without hiding all the information about your health condition, concomitant diseases, medications you are taking. This will help your doctor decide which treatment plan is best for you.