Medications to treat prostate adenoma help relieve lower urinary tract symptoms. According to the recommendations of the European Association of Urologists, drugs for the treatment of prostate adenoma are used if patients have moderate symptoms of the disease.
Currently, two groups of drugs are most commonly used: alpha-blockers and 5-alpha-reductase inhibitors. Phosphodiesterase inhibitors and anticholinergics and others are less commonly used.
Alpha blockers
Alpha-blockers relax the smooth muscle fibers that make up the prostate and the neck of the bladder, which results in reduced pressure on the walls of the urethra and expansion of its lumen. This facilitates the outflow of urine from the bladder. Alpha blockers are given to patients with moderate to severe BPH symptoms. It is worth noting that alpha-blockers alleviate the symptoms of the lower urinary tract, but theythey do not slow or stop further prostate growth.
Most men report alleviation of lower urinary tract symptoms, which is reflected in a decrease in the I-PSS index of prostate symptoms (international scaleevaluation of prostate symptoms) for 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 the muscles of the prostate cell, butand in other body structures, for example, in the heart, blood vessels, lungs. Previously, alpha-blockers, which act on all types of receptors, and alpha-1 and alpha-2-adrenergic receptors have been used to treat BPH. In this regard, the development of complications is often observed in men. Scientists have discovered that alpha-1a-adrenergic receptors are located in the prostate. After the development of drugs that selectively block alpha-1-adrenergic receptors (selective alpha-blockers), it was possible to reduce the number of side effects associated with the use of non-selective drugs (angina attack, arrhythmia, etc. ).
Short-acting alpha-1 blockers
Prazosin was the first selective alpha-1 blocker approved for the treatment of BPH. Deficiencies of prazosin, as well as other short-acting drugs, were the need for multiple doses during the day and severe arterial hypotension.
Selective long-acting alpha-1 blockers
The European Association of Urologists recommends the use of the following long-acting alpha blockers: tamsulosin, alfuzosin, terazosin and doxazosin. These drugs have approximately the same efficacy and a number 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, decreased pressure that occurs when moving from horizontal to 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 such a complication as retrograde ejaculation, when the sperm during ejaculation moves to the bladder, and not to the penis, is more common. However, it is harmless.
Feature associated with taking alpha-blockers
If you are taking erectile dysfunction medications such as Viagra, you must be aware that their combination with alpha-blockers can lead to a significant reduction in blood pressure, collapse and loss of consciousness. Remember that you can take the Viagra pill no earlier than four hours after taking the alpha blocker.
5-alpha reductase inhibitors
5-alpha reductase inhibitors are another group of drugs used to treat BPH and help alleviate the symptoms of lower urinary symptoms. 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 slowing of prostate growth and reduction of its size, which in turn leads to alleviation 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 the treatment of prostate adenoma.
Men whose prostate was significantly enlarged before treatment (more than 30 cc) have the greatest effect of treating prostate adenoma with 5-alpha-reductase inhibitors. Men taking 5-alpha-reductase inhibitors report a 3-point decrease in the I-PSS prostate symptom index. Patients with a small prostate before treatment (less than 30 cc) did not show a significant improvement in the I-PSS index of prostate symptoms.
The effect of treatment with 5-alpha-reductase inhibitors develops after 6-12 months from the start of medication. As we know, prostate size is not always correlated with 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 libido (6, 4%), impotence (8, 1%), ejaculation disorder (3, 7%), erection problems, rash in less than one percent of cases, increased size andmammary gland compaction.
A property associated with taking a 5-alpha reductase inhibitor
Taking finasteride changes the concentration of prostate-specific antigen in the blood towards its reduction. In patients taking 5-alpha reductase inhibitors, the concentration of prostate-specific antigen can be reduced by 50%. Prostate-specific antigen is a non-specific marker of prostate cancer. Increased levels of prostate-specific antigen in the blood may be the first sign that allows you to suspect an early-stage tumor and take steps to further diagnose and treat it. Underestimation of prostate-specific antigen levels in the blood can lead to false-negative prostate cancer screening results.
To get the right result of a prostate-specific antigen analysis in the blood of a patient taking finasteride or dutasteride, the doctor multiplies the resulting number by two.
It is also known that taking finasteride in men reduces the risk of developing non-aggressive prostate cancer, but increases the risk of developing a very aggressive prostate tumor.
Phosphodiesterase inhibitors
Previously, the substance tadalafil (phosphodiesterase inhibitor) was used to treat erectile dysfunction in men. In 2011, this drug was approved for the treatment of benign prostatic hyperplasia. One scientific study found that daily intake of tadalafil leads to a significant improvement in lower urinary tract symptoms in men with BPH.
Administration of tadalafil with nitrates (nitroglycerin), alpha-blockers and other antihypertensive drugs may cause a sudden drop in blood pressure. In addition, 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 - disorders of hearing and vision, muscle pain, etc.
Anticholinergic drugs
Anticholinergic drugs to treat prostate adenoma help relieve symptoms such as urinary incontinence, frequent urination, urgency, which cannot 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 a 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.
A combination of drugs to treat prostate adenoma
Frequent treatment of benign prostatic hyperplasia with drugs requires the appointment of a combination of drugs. Men who take the combination of dutasteride and tamsulosin experience more significant relief of BPH symptoms than patients who take these drugs alone.
Dosage forms are currently being developed that include both an alpha blocker and a 5-alpha reductase inhibitor. This dosage form is convenient, requiring a single dose.
As a rule, patients tolerate treatment with combination drugs well. The side effect profile includes a combination of side effects that are specific to the drugs separately. The most common adverse events in combination therapy are erectile dysfunction (7. 4%), retrograde ejaculation (4. 2%), decreased libido (3. 4%).
As a rule, long-term use of medications is required, and when they are discontinued, symptoms may return.
Many men refuse to take medication to treat prostate adenoma because they are terribly afraid of developing side effects, primarily those related to sexual function.
Patient's anamnesis:"The doctor advised me to start BPH treatment with one or more drugs. I can urinate, but my urine stream is weak and sometimes it hurts when I want to urinate in large quantities. I read on the internet about two main classes of BPH drugs: alpha-blockers and 5-alpha-reductase inhibitors. Some men describe a significant improvement in symptoms after taking one of the drugs, but most talk about the negative effects of the drugs.
As far as I understand, 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'm taking the medication my doctor prescribed and so far I haven't had any of the side effects described in the instructions. . . I've been taking them for about three years. There were times when the medication didn't seem to work, then I had to double the dose and everything went backplace. . . "
"I've been taking the medication my doctor has recommended for a long time and it helps me, but I can only experience a 'dry' orgasm that I don't really like. "
I took alpha-adrenergic blockers and they allowed me to urinate well. The side effects were a decrease in ejaculate volume and terrible dizziness with a sudden increase. When I stopped taking it, urination became frequent up to 13-15 times a day, sperm volumesignificantly increased. I am now 45 years old and my urologist has given me an alpha blocker. It occasionally makes me dizzy when I get up abruptly, my nose is always stuffy and oh, yes, a "dry" orgasm. The first time it happened, I kept thinking it was just a cramp and an orgasm along the way. I was wrong. But worst of all was priapism! (Priapism is a prolonged, persistent, sometimes painful erection that occurs without prior arousal). At first I was sure that surgical treatment was not for me, but now I am already thinking about this option. "
"Hello, I've been taking medication for prostate adenoma for a long time. . . From the side effects, I was periodically worried about dizziness and nasal congestion. My symptoms of prostate adenoma have significantly decreased and I'm glad I managed to avoid surgery! "
As you can see, not every man develops side effects, and different patients may have different side effects. No doctor can say with a 100% guarantee whether you will develop this or that side effect.
By making an appointment with a doctor, you can discuss the most appropriate therapy for you. At the consultation, you must inform the doctor without hiding about all the information about your health condition, accompanying diseases, medications you are taking. This will help your doctor decide which treatment plan is best for you.