Progression, risk factors and subsequent medical management of symptomatic benign prostatic hyperplasia.
Benign prostatic hyperplasia (BPH) is a chronic common disease in many men and is often associated with bothersome lower urinary tract symptoms (LUTS). In many men the disease presents with a progressive course that can result in complications such as acute urinary retention (AUR) and BPH-related surgery. Several factors have been associated with progression such as age and prostate volume (PV). Serum prostate-specific antigen (PSA) level, closely correlated with PV is another useful parameter for determining the risk of BPH progression. Medical therapy is the first and the most frequently used treatment for BPH; surgical treatments represent a second-line option when medical therapy is non effective or when complications are associated. Alpha-blockers achieve rapid symptom relief but do not reduce the overall risk of AUR or BPH-related surgery, presumably because they have no effect on PV. 5alpha-reductase inhibitors (5ARIs) display their effectiveness at long distance decreasing PV; this results in improved symptoms, urinary flow and quality of life, and a reduced risk of AUR and BPH-related surgery. Combination therapy provides greater and more durable benefits than either monotherapy and is a recommended option in treatment guidelines. The Combination of dutasteride and Tamsulosin (CombAT), at a pre-planned 2-year analysis, has shown sustained symptom improvement with combination therapy, significantly greater than with either monotherapy. CombAT is also the first study to show benefit in improving BPH symptoms for combination therapy over the alpha-blocker, tamsulosin, from 9 months of treatment. PubMed database has been used to identify publications on the epidemiology of BPH, risk factors for BPH progression and drug treatment options for the management of BPH.
Pinto
Francesco
F
Department of Urology, Catholic University School of Medicine, Rome. francesco.pinto@libero.it
Racioppi
Marco
M
Sacco
Emilio
E
Totaro
Angelo
A
Brescia
Antonio
A
Volpe
Andrea
A
Gardi
Mario
M
Bassi
Pier Francesco
PF
D058891:5-alpha Reductase Inhibitors; D058668:Adrenergic alpha-1 Receptor Antagonists; D000317:Adrenergic alpha-Antagonists / Q000008:administration & dosage; D000367:Age Factors; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001378:Azasteroids / Q000008:administration & dosage; D014408:Biomarkers, Tumor / Q000097:blood; D018450:Disease Progression; D000068538:Dutasteride; D004791:Enzyme Inhibitors / Q000008:administration & dosage; D019317:Evidence-Based Medicine; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D017430:Prostate-Specific Antigen / Q000097:blood; D011470:Prostatic Hyperplasia / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology*; D011788:Quality of Life; D012307:Risk Factors; D013449:Sulfonamides / Q000008:administration & dosage; D000077409:Tamsulosin; D016896:Treatment Outcome; D016055:Urinary Retention / Q000209:etiology
D058891:5-alpha Reductase Inhibitors; D058668:Adrenergic alpha-1 Receptor Antagonists; D000317:Adrenergic alpha-Antagonists; D018931:Antineoplastic Agents, Hormonal; D001378:Azasteroids; D014408:Biomarkers, Tumor; D004791:Enzyme Inhibitors; D013449:Sulfonamides; D017430:Prostate-Specific Antigen; D000077409:Tamsulosin; D000068538:Dutasteride