Medications for prostate adenomas can help relieve lower urinary tract symptoms. According to the recommendations of the European Association of Urology, if the patient has moderately severe disease symptoms, drugs for the treatment of prostate adenomas are used.
Currently, the most widely used drugs fall into two categories: alpha-blockers and 5-alpha-reductase inhibitors. Less commonly used are phosphodiesterase inhibitors and anticholinergic drugs.
alpha blocker
Alpha-blockers relax the smooth muscle fibers that make up the prostate and bladder neck, thereby reducing pressure on the wall of the urethra and widening its lumen. This makes it easier for urine to flow out of the bladder. Alpha-blockers are administered to patients with moderate to severe symptoms of BPH. Notably, alpha-blockers relieve lower urinary tract symptoms, but theyDo not slow or stop further growth of the prostate.
Most men reported relief of lower urinary tract symptoms, which was reflected in a decrease in the I-PSS Prostate Symptom Index (international scaleAssess prostate symptoms) 4-6 units.
The effects of taking alpha blockers appear after 2-3 weeks.
In the human body, there are several types (α1 and α2) and subtypes (α1a, α1b, α1d, etc. ) of α-adrenergic receptors, which are not only located in the muscles of the prostate cells, but also in other structures of the body, For example in the heart, blood vessels, lungs. Previously used to treat BPH, alpha-blockers act on all types of receptors, including alpha-1 and alpha-2-adrenergic receptors. In this regard, men often experience complications. Scientists have discovered that alpha-1a-adrenoceptors are located in the prostate. The development of drugs that selectively block alpha-1-adrenergic receptors (selective alpha blockers) can reduce the risk of side effects associated with the use of nonselective drugs (angina attacks, arrhythmias, etc. )quantity.
short-acting alpha1-blockers
Prazosin was the first selective alpha1-blocker approved for the treatment of BPH. The disadvantages of prazosin, as well as other short-acting drugs, are the need for multiple dosing during the day and severe arterial hypotension.
Long-acting selective alpha1-blockers
The European Association of Urology recommends the following long-acting alpha-blockers: tamsulosin, alfuzosin, terazosin, and doxazosin. These drugs have roughly the same range of efficacy and side effects. These drugs used to treat prostate adenomas require a single dose during the day.
The most common side effects associated with taking alpha-blockers are: headache, dizziness, weakness, decreased pressure when moving from a horizontal to a vertical position (usually only observed 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 complications like retrograde ejaculation, where sperm during ejaculation enters the bladder rather than the penis, are more common. However, it is harmless.
Characteristics associated with taking alpha-blockers
If you're taking erectile dysfunction drugs like Viagra, you should be aware that their combination with alpha blockers can lead to a significant drop in blood pressure and even collapse and loss of consciousness. Remember that you can take the Viagra pill within four hours of taking an alpha blocker.
5-alpha reductase inhibitor
5-alpha reductase inhibitors are a second group of drugs used to treat BPH and help relieve lower urinary tract symptoms. Two drugs in this group are used to treat prostate adenomas: finasteride and dutasteride. These drugs block 5-alpha-reductase, the enzyme that converts testosterone into dihydrotestosterone, which plays an important role in the development of prostate adenomas. The result is that the growth of the prostate gland slows down and reduces its size, which in turn leads to relief of lower urinary tract symptoms. Finasteride blocks the conversion of 70% of testosterone to DHT, and 95% of dutasteride. However, finasteride and dutasteride are not clinically effective in the treatment of prostate adenomas.
The greatest effect of treatment of prostate adenomas with 5-alpha-reductase inhibitors is in men with significantly enlarged prostates (over 30 cc) prior to treatment. Men taking 5-alpha-reductase inhibitors reported a 3-point decrease in the I-PSS Prostate Symptom Index. Patients with smaller prostates (less than 30 cc) before treatment showed no significant improvement in the I-PSS Prostate Symptom Index.
The effects of 5-alpha-reductase inhibitor therapy appear 6-12 months after starting the drug. It is well known that prostate size does not always correlate with the severity of prostate adenoma symptoms, so treatment with finasteride or dutasteride does not always produce the expected results. 30-50% of patients experience clinical benefit with 5-alpha reductase inhibitor therapy.
The most common side effects of 5-alpha reductase inhibitors were decreased libido (6. 4%), impotence (8. 1%), ejaculation disturbance (3. 7%), erection problems, rash in less than 1% of cases, Volume enlargement and compaction of the mammary glands.
Characteristics associated with taking 5-alpha reductase inhibitors
Taking finasteride can decrease the concentration of prostate-specific antigen in the blood. In patients taking 5-alpha reductase inhibitors, prostate-specific antigen concentrations may be reduced by 50%. Prostate-specific antigen is a nonspecific marker for prostate cancer. Elevated levels of PSA in your blood may be the first sign that you suspect a tumor at an early stage and take further steps for diagnosis and treatment. Underestimating the level of prostate-specific antigen in the blood can lead to false-negative results in prostate cancer screening tests.
To get a true analysis of PSA in the blood of patients taking finasteride or dutasteride, doctors multiply the number by 2.
Taking finasteride is known to reduce the risk of non-invasive prostate cancer in men, but it increases the risk of highly aggressive prostate tumors.
Phosphodiesterase inhibitor
Previously, tadalafil, a phosphodiesterase inhibitor, was used to treat erectile dysfunction in men. In 2011, the drug was approved for the treatment of benign prostatic hyperplasia. A scientific study found that taking tadalafil daily significantly improved lower urinary tract symptoms in men with BPH.
Using tadalafil with nitrates (nitroglycerin), alpha-blockers, and other antihypertensive drugs can cause a sharp 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 gastrointestinal disorders, and less commonly - hearing and vision disturbances, muscle pain, etc.
anticholinergic drugs
Anticholinergic drugs used to treat prostate adenomas help relieve symptoms of urinary incontinence, frequent urination, and urgency that cannot be achieved with alpha-blockers. Doctors sometimes prescribe anticholinergic drugs and 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 infection.
Anticholinergic drugs for the treatment of prostate adenomas: tolteridone and oxybutynin.
Drug combination for prostate adenoma
Typically, drug treatment of benign prostatic hyperplasia requires a prescribed drug combination. Men who took the combination of dutasteride and tamsulosin experienced greater relief of BPH symptoms than patients who took these drugs alone.
Currently, dosage forms including alpha blockers and 5-alpha reductase inhibitors have been developed. The dosage form is convenient and requires a single administration.
In general, patients tolerated combination drug therapy well. The side effect profile includes a combination of adverse effects that are characteristic of the drug alone. The most common adverse events in combination therapy were erectile dysfunction (7. 4%), retrograde ejaculation (4. 2%), and decreased libido (3. 4%).
As a rule, long-term use of the drugs is required, and when they are withdrawn, symptoms may reappear.
Many men refuse to take drugs for prostate adenomas because they are very afraid of side effects, mainly those related to sexual function.
Medical history:"The doctor advised me to start treating BPH with one or more medications. I can urinate, but my urine flow is weak and sometimes it hurts when I want to urinate a lot. On the Internet, I learned about the two major treatments for BPH. Classes of drugs: Alpha-blockers and 5-alpha-reductase inhibitors. Some men described significant improvement in symptoms after taking one of these drugs, but most talked about the drug's negative effects.
From what I understand, both groups of drugs affect sexual function to some extent. . . I don't even think about it. "
Stories of men taking medication for BPH
"I took the medicine that the doctor prescribed for me, and so far I have not had any of the side effects described in the instructions. . . I have been taking it for about three years. For a while, I felt that the medicine did not work, and then I had to double the dose and everything went back to where it was. . . ".
"I've been taking the medicines my doctor recommended and they've helped me, but I can only experience 'dry' orgasms, which I really don't like. . . "
"I took alpha-adrenergic blockers and they gave me good urination. The side effects were a drop in ejaculation and a horrendous dizziness that went up dramatically. . . When I stopped, urination became more frequent, up to 13-15 times a day with a significant increase in sperm count. I am 45 years old and my urologist put me on alpha blockers. Sometimes when I suddenly wake up I get dizzy and my noseAlways stuffy, oh yes, "dry" orgasms. The first time it happened, I kept thinking it was just cramps and orgasms along the way. I was wrong. But the worst was priapism! (Priapism is a long, persistent, sometimes painful erection that occurs without prior arousal). At first I decided surgery wasn't right for me, but now I'm considering this option. "
"Hello, I have been taking drugs for prostate adenomas for a long time. . . Among the side effects, I often worry about dizziness and nasal congestion. My prostate adenoma symptoms have been significantly relieved, and I am very happy because I can avoid surgery! "
As you can see, not everyone experiences side effects, and different patients may experience different adverse effects. No doctor can guarantee 100% whether you will experience this or that side effect.
By making an appointment with your doctor, you can discuss which therapy is best for you. At the time of the consultation, you must tell the doctor all information about your medical condition, concomitant diseases, and the medicines you are taking without concealment. This will help your doctor determine the best treatment plan for you.