Emerging drug therapies for benign prostatic hyperplasia.
Benign prostatic hyperplasia (BPH) is the nonmalignant enlargement of the prostate gland caused by increases in number of both epithelial and stromal cells. Clinically, BPH leads to voiding dysfunction, which is most often referred to as lower urinary tract symptoms (LUTS). Historically, the only treatments for LUTS due to BPH were watchful waiting or surgery (transurethral or open prostatectomy). However, over the last 20 years medical therapy has taken a prominent role in the management of BPH. Current medical treatments for BPH include alpha-adrenergic receptor antagonists, inhibitors of the 5-alpha reductase enzyme and various phytotherapies. These agents are generally effective and safe; however, many patients are unable to tolerate the side effects or are refractory to medical management and require surgery. In light of this, many potential new therapies for the treatment of BPH are under development. Some represent a variation of current treatments, whereas others target novel molecular pathways within the prostate. The aim of this review is to examine current pharmacotherapies as well as to highlight emerging drugs that may improve our treatment of patients with LUTS secondary to BPH.
Bullock
Travis L
TL
Division of Urology, Washington University School of Medicine, St. Louis, MO 63110, USA. tlbullock@hotmail.com
Andriole
Gerald L
GL
D013741:3-Oxo-5-alpha-Steroid 4-Dehydrogenase / Q000378:metabolism; D058891:5-alpha Reductase Inhibitors; D058668:Adrenergic alpha-1 Receptor Antagonists; D000317:Adrenergic alpha-Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000494:pharmacology / Q000627:therapeutic use; D002117:Calcitriol / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use; D049109:Cell Proliferation / Q000187:drug effects; D004359:Drug Therapy, Combination; D004791:Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D018120:Finasteride / Q000494:pharmacology / Q000627:therapeutic use; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives / Q000037:antagonists & inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D006727:Hormone Antagonists / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D007191:Indazoles / Q000494:pharmacology / Q000627:therapeutic use; D008297:Male; D009281:Naphthalenes / Q000494:pharmacology / Q000627:therapeutic use; D008517:Phytotherapy; D010879:Piperazines / Q000494:pharmacology / Q000627:therapeutic use; D010936:Plant Extracts / Q000494:pharmacology / Q000627:therapeutic use*; D011470:Prostatic Hyperplasia / Q000188:drug therapy* / Q000201:enzymology / Q000473:pathology; D016032:Randomized Controlled Trials as Topic; D018340:Receptors, Adrenergic, alpha-1 / Q000378:metabolism; D028024:Serenoa
D058891:5-alpha Reductase Inhibitors; D058668:Adrenergic alpha-1 Receptor Antagonists; D000317:Adrenergic alpha-Antagonists; D000970:Antineoplastic Agents; C487049:BXL628; D004791:Enzyme Inhibitors; D006727:Hormone Antagonists; D007191:Indazoles; D009281:Naphthalenes; D010879:Piperazines; D010936:Plant Extracts; D018340:Receptors, Adrenergic, alpha-1; D007987:Gonadotropin-Releasing Hormone; D018120:Finasteride; D013741:3-Oxo-5-alpha-Steroid 4-Dehydrogenase; D002117:Calcitriol; C040972:saw palmetto extract; C062876:cetrorelix; C064357:naftopidil; C016371:lonidamine