Treating BPH with Drug Therapy
BY TODD BREAUX, M.D.
Alpha-adrenergic receptor blockers (Hytrin ®, Cardura ®, Flomax ®)
Originally used to treat high blood pressure, Cardura and Hytrin relax smooth muscle around blood vessels and
within the prostate and bladder. By doing so, they may help increase urinary flow and relieve symptoms of uri-
nary frequency and nocturia. Use of all three drugs has been shown to significantly decrease AUA symptoms
scores and increase urinary flow rates when compared to placebo. They tend to work immediately and side
effects include orthostatic hypotension (fall in blood pressure upon standing, causing dizziness), fatigue, and
Flomax is an alpha-adrenergic receptor blocker that is more specific to the prostate and tends to have fewer
side effects than Hytrin or Cardura, as it has less effect on blood vessels and blood pressure. Flomax has also
been less effective in some studies than Cardura or Hytrin. An advantage of this medication is the ability to start
off with the most effective dose (0.4 mg per day) rather then gradually increasing the dose to avoid side effects.
5-alpha reductase inhibitors (Proscar)
Finasteride (Proscar) blocks the conversion of testosterone to dihydrotestosterone, the major male sex hormone
found within cells of the prostate. By doing so, it may help to actually shrink the size of the prostate and, in
some people, decrease BPH symptoms and increase urinary flow rates. Approximately one-third to one-half of
patients have experienced clinically significant improvements, but it must be used indefinitely to prevent recur-
rence of symptoms and may take as long as 6 months to achieve the maximum benefit. Finasteride may be best
suited for men with relatively large prostates (those greater than 50 cubic centimeters in size, with normal
prostate size being 25 cubic centimeters). Side effects include: impotence and decreased libido in 3% to 4% of
patients and decreased volume of ejaculate in 2% to 3% of patients. These side effects resolve with cessation of
the drug. Finasteride tends to lower by about 50% PSA (prostate specific antigen) levels produced by benign
prostatic tissue. This is important to realize when screening for prostate cancer.
Use of herbal medications has come into vogue recently. These agents, collectively called phytotherapeutic
agents, are derived from plants. The most popular one used to treat BPH is Saw Palmetto. Another agent, often
used with Saw Palmetto, is the herbal agent Pygeum. Mechanism of action is unclear but some postulate the
action is anti-inflammatory, therefore reducing prostate swelling. Another assertion is that the plant causes inhi-
bition of hormones controlling the growth of prostate cells. It is currently believed that the effects of Saw
Palmetto seem to involve relief of some symptoms with no increase in urinary flow rates. However, only limited,
controlled studies have been performed to date on these agents.
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