Medications for the treatment of prostate adenoma help relieve lower urinary tract symptoms. According to the recommendations of the European Urological Association, drugs for the treatment of prostate adenoma are used if the patient has moderately severe symptoms of the disease.
Currently, two groups of drugs are most widely used: alpha blockers and 5-alpha-reductase inhibitors. Less commonly used are phosphodiesterase inhibitors and anticholinergic drugs and others.
Alpha blocker
Alpha blockers relax the smooth muscle fibers that make up the prostate and bladder neck, resulting in a reduction in pressure on the urethral wall and expansion of its lumen. This makes it easier for urine to flow out of the bladder. Alpha blockers are given to patients with moderate to severe BPH symptoms. Keep in mind that alpha blockers relieve lower urinary tract symptoms, but they aredo not slow or stop further prostate growth.
Most men report lower urinary tract symptom relief, as indicated by a decrease in the I-PSS Prostatic Symptom Index (international scaleassessment of prostate symptoms) as many as 4-6 units.
The effect of taking alpha-blockers develops after 2-3 weeks.
In the human body, several types (alpha-1 and alpha-2) and subtypes (alpha-1a, alpha-1b, alpha-1d, etc. ) are distinguished alpha-adrenergic receptors, which are located not only in muscles. prostate cells, but also in other structures of the body, for example, in the heart, blood vessels, lungs. Previously, alpha blockers were used to treat BPH, which acts on all types of receptors, both alpha-1 and alpha-2-adrenergic receptors. In this case, the development of complications is often observed in men. Scientists have found 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 is possible to reduce the number of side effects associated with the use of non-selective drugs (angina attacks, arrhythmias, etc. ).
Short-acting alpha-1 blockers
Prazosine is the first selective alpha-1 blocker approved for the treatment of BPH. The disadvantages of prazosin, as well as other short -acting drugs, are the need for double doses during the day and severe arterial hypotension.
Long-acting selective alpha-1 blockers
The European Urological Association recommends the use of the following long -acting alpha blockers: tamsulosin, alfuzosin, terazosin and doxazosin. These drugs have almost the same effectiveness and range of side effects. These drugs for the treatment of prostate adenoma require one dose during the day.
The most common side effects associated with alpha -blocker intake are: headache, dizziness, weakness, pressure drop that occurs when moving from a horizontal to vertical position (usually observed only at the beginning of treatment - the effect of the first dose), drowsiness, nasal congestion andretrograde ejaculation. Although alpha blockers do not cause erectile dysfunction or decreased libido, these side effects have been reported in some cases taking this drug. But complications such as retrograde ejaculation, when sperm during ejaculation move into the bladder, and not into the penis, are more common. However, it is not dangerous.
Features associated with taking alpha blockers
If you are taking erectile dysfunction medications such as Viagra, you should be aware that their combination with alpha blockers can cause a significant drop in blood pressure, resulting in collapse and loss of consciousness. Remember that you can take Viagra pills no earlier than four hours after taking an alpha blocker.
5-alpha reductase inhibitors
5-alpha reductase inhibitors are the second group of drugs used to treat BPH and help relieve 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 a slowdown in the growth of the prostate gland and a reduction in its size, which in turn leads to relief of symptoms of the lower urinary tract. Finasteride inhibits 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.
The greatest effect of treatment of prostate adenoma with 5-alpha-reductase inhibitors was experienced by men whose prostate glands were significantly enlarged before treatment (more than 30 cc). Men taking 5-alpha-reductase inhibitors reported a 3-point decrease in the I-PSS prostate symptom index. Patients with a small pre-treated prostate (less than 30 cc) did not show a significant increase in the I-PSS Prostatic Symptom Index.
The effect of treatment with 5-alpha-reductase inhibitors develops after 6-12 months from the start of taking the drug. As we know, prostate size is not always associated with the severity of prostate adenoma symptoms, so treatment with finasteride or dutasteride does not always give the expected results. 30–50% of patients experience clinical effects 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%), ejaculatory disorders (3. 7%), erectile problems, rash in less than one percent of cases, increasedsize and compaction. mammary glands.
Features associated with taking 5-alpha reductase inhibitors
Taking finasteride changes the concentration of prostate -specific antigen in the blood towards its decrease. In patients taking 5-alpha reductase inhibitors, prostate-specific antigen concentrations may be reduced by 50%. Prostate -specific antigens are non -specific markers of prostate cancer. Elevated levels of prostate -specific antigens in the blood may be the first sign that allows you to suspect a tumor at an early stage and take steps for further diagnosis and treatment. Underestimating the level of prostate -specific antigens in the blood can lead to false negative screening test results for prostate cancer.
To get the actual results of the analysis of prostate -specific antigens in the blood of patients taking finasteride or dutasteride, the doctor multiplies the resulting number by two.
It is also known that taking finasteride reduces the risk of men getting non -aggressive prostate cancer, but increases the risk of developing highly aggressive prostate tumors.
Phosphodiesterase inhibitors
Previously, the substance tadalafil (phosphodiesterase inhibitor) was used to treat erectile dysfunction in men. In 2011, the drug was approved for the treatment of benign prostatic hyperplasia. One scientific study found that taking tadalafil daily produced a significant increase in lower urinary tract symptoms in men with BPH.
The use of tadalafil with nitrates (nitroglycerin), alpha blockers and other antihypertensive drugs can cause a sharp drop in pressure. In addition, the use of tadalafil is limited to patients with impaired renal and hepatic function. Among the side effects, the most common are headaches and disorders of the gastrointestinal tract, less often - hearing and vision disorders, muscle aches, etc.
Anticholinergic drugs
Anticholinergic drugs for the treatment of prostate adenoma help relieve symptoms such as urinary incontinence, frequent urination, urgency, which cannot be equated with alpha blockers. Doctors sometimes prescribe anticholinergic medications in combination with alpha blockers to better control the symptoms of BPH. The use of anticholinergic drugs is associated with the 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.
Combination drugs for the treatment of prostate adenoma
Often, drug treatment of benign prostatic hyperplasia requires the appointment of a combination of drugs. Men taking a combination of dutasteride with tamsulosin experienced more significant relief of BPH symptoms than patients taking this drug alone.
Currently, dosage forms have been developed that include alpha blockers and 5-alpha reductase inhibitors. This dosage form is simple, requiring one dose.
As a rule, treatment with combination drugs is well received by patients. The side effect profile includes a combination of adverse reactions that are characteristic of drugs separately. The most common adverse effects of combination therapy were erectile dysfunction (7. 4%), retrograde ejaculation (4. 2%), decreased libido (3. 4%).
As a rule, long -term use of the drug is required, and when it is canceled, symptoms may return.
Many men are reluctant to take drugs for the treatment of prostate adenoma, because they are very afraid of the development of side effects, especially those related to sexual function.
Patient history:"The doctor advised me to start treatment for BPH with one or more medications. I can urinate, but my urine flow is weak and sometimes it hurts when I want to urinate in large quantities. On the Internet, I read about twothe main classes of drugs for the treatment of BPH: alpha blockers and 5-alpha-reductase inhibitors. Some men describe a significant increase in symptoms from taking one of the drugs, but most talk about the negative effects of the drug.
As I understand it, both groups of drugs affect sexual function to one degree or another. . . . I'm scared to think about it. "
The story of a man taking medication to treat BPH
"I took the medication prescribed by the doctor for me and so far I haven't had any of the side effects stated in the instructions. . . I've been taking it for about three years. There were times when I didn't seem to find the medication working, so I had to double down. dose and everything is back in place. . . ".
"I've been taking the medications recommended by my doctor for a long time and it helped me, but I can only have a" dry "orgasm, which I really don't like. . . "
"I took alpha-adrenergic blockers and they gave me good urination. The side effects were a decrease in ejaculatory volume and severe dizziness with a sudden increase. . . . When I stopped taking them, urination became more frequent up to 13-15 times a day, totalsperm increased significantly. I am now 45 years old and my urologist has put me on an alpha blocker. Periodically, I get dizzy when I wake up suddenly, my nose is always clogged, and oh yes, orgasm is "dry. " The first time it happened, I kept thinking it was just cramps and orgasm along the way. I was wrong. But the worst was priapism! (Priapism is a prolonged, persistent, sometimes painful erection that occurs without prior stimulation. ) At first I was convinced that the surgical treatment wasnot for me, but now I'm thinking about this option. "
"Hello, I have been taking medication for the treatment of prostate adenoma for a long time. . . Instead of side effects, I periodically worry about dizziness and stuffy nose. My prostate adenoma symptoms have decreased significantly, and I am happy about it, because I can avoid it. surgery! "
As you can see, not every man experiences side effects, and different patients may experience different adverse reactions. No doctor can say with one hundred percent guarantee whether you will experience this or that side effect.
By making an appointment with a doctor, you can discuss the therapy that is most suitable for you. During the consultation, you must inform the doctor without hiding all the information about the health condition, the corresponding disease, the medication you are taking. This will help your doctor decide on the best treatment plan for you.