title: Hormonal manipulation of benign prostatic hyperplasia.
abstract: OBJECTIVE
  We provide new viewpoints of hormonal control of benign prostatic hyperplasia (BPH). The latest treatment findings with 5-alpha reductase inhibitors (5-ARIs) finasteride and dutasteride, refined indications, efficacy, and safety are discussed and compared. We also discuss potential new 5-ARIs and other hormonal treatments.
  
  
  RESULTS
  Finasteride and dutasteride have equal efficacy and safety for the treatment and prevention of progression of BPH. 5-ARIs are especially recommended for prostates greater than 40 ml and PSA greater than 1.5 ng/ml. Combination therapy is the treatment of choice in these patients, but with prostate volume greater than 58 ml or International Prostate Symptom Score of at least 20, combinations have no advantage over 5-ARI monotherapy. Updates on the recent developments on BPH therapy with luteinizing hormone-releasing hormone (LHRH) antagonist are also reviewed and analyzed. Preclinical studies suggest that growth hormone-releasing hormone (GHRH) antagonists effectively shrink experimentally enlarged prostates alone or in combination with LHRH antagonists.
  
  
  CONCLUSIONS
  New 5-ARIs seem to be the promising agents that need further study. Preclinical studies revealed that GHRH and LHRH antagonists both can cause a reduction in prostate volume. Recent data indicate that prostate shrinkage is induced by the direct inhibitory action of GHRH and of LHRH antagonists exerted through prostatic receptors. The adverse effects of 5ARIs encourage alternative therapy.
authors.affiliation: Veterans Affairs Medical Center, South Florida Veterans Affairs Foundation for Research and Education, University of Miami, Miller School of Medicine, Miami, Florida, USA.
authors.forename: Ferenc G
authors.initials: FG
authors.lastname: Rick
authors.forename: Seyed H
authors.initials: SH
authors.lastname: Saadat
authors.forename: Luca
authors.initials: L
authors.lastname: Szalontay
authors.forename: Norman L
authors.initials: NL
authors.lastname: Block
authors.forename: Amir
authors.initials: A
authors.lastname: Kazzazi
authors.forename: Bob
authors.initials: B
authors.lastname: Djavan
authors.forename: Andrew V
authors.initials: AV
authors.lastname: Schally
mesh_terms: D058891:5-alpha Reductase Inhibitors / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D001378:Azasteroids / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D000068538:Dutasteride; D018120:Finasteride / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D007987:Gonadotropin-Releasing Hormone / Q000037:antagonists & inhibitors; D013007:Growth Hormone-Releasing Hormone / Q000037:antagonists & inhibitors; D006801:Humans; D008297:Male; D011470:Prostatic Hyperplasia / Q000188:drug therapy* / Q000191:economics / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D058891:5-alpha Reductase Inhibitors; D001378:Azasteroids; D007987:Gonadotropin-Releasing Hormone; D018120:Finasteride; D013007:Growth Hormone-Releasing Hormone; D000068538:Dutasteride