Health and Prostate

Treatment of benign prostatic hyperplasia (benign prostatic hyperplasia) is directed primarily toward managing symptoms and improving patients’ quality of life (QoL). The two dominating classes of pharmacological agents used to treat benign prostatic hyperplasia are alpha Mockers and 5-alpha-reductase inhibitors (5-ARIs). Both drug classes are effective in alleviating lower urinary tract symptoms (lower urinary tract symptoms ) associated with benign prostatic hyperplasia, thereby improving patients’ comfort level. Alpha blockers are most useful in alleviating symptoms related to dynamic benign prostatic hyperplasia; 5-ARIs are used for the treatment of static benign prostatic hyperplasia. The dynamic and static forms of benign prostatic hyperplasia are discussed in the “Etiology and Pathophysiology” section.

Alpha blockers work by relaxing prostatic muscle involved in dynamic benign prostatic hyperplasia; they cannot stop further growth of the prostate. 5-ARIs and gonadotropin modulators (used only in Japan) reduce the cellular growth seen in static benign prostatic hyperplasia. lower urinary tract symptoms  are caused by bladder outlet obstruction due to prostate hyperplasia. If patients exhibit symptoms and have enlarged prostates (observed through digital rectal exam), physicians assume that they are afflicted with both static and dynamic benign prostatic hyperplasia. Clinical trials have been conducted to investigate the effects of combination therapy with alpha blockers and 5-ARIs to relieve symptoms and reduce prostate volume.

TABLE: Select Marketed Agents Used to Treat Benign Prostatic Hyperplasia

Agent	Company/Brand	Daily Dose	Availability
Alpha blockers
Tamsulosin	Astellas/Boehringer Ingelheim/Abbott’s Harnal/Flomax/Omnic	400 µg qd, 200 µg qd in Japan	US, France, Germany, ltaly, Spain, UK, Japan
Alfuzosin	Sanofi-Aventis’s Xatral/Uroxatral, others	2.5 mg tid, 5mg bid, 10mg qd	US, France, Germany, ltaly, Spain, UK
Terazosin	Abbott’s Hytrin, generics	1-10mg qd or bid	US, France, Germany, ltaly, Spain, UK, Japan
Doxazosin	Pfizer’s Cardura/Cardura XL, generics	1 -8 mg qd	US, France, Germany, ltaly, Spain, UK, Japan
Naftopidil	Asahi Kasei’s Flivas, Kanebo’s Avishot	25-50 mg qd	Japan
Prazosin	Pfizer’s Minipress, generics	1 mg qd or bid	US, France, Germany, ltaly, Spain, UK, Japan
Indoramin	GlaxoSmithKline’s Doralese	20 mg bid	UK
5-alpha-reductase inhibitors
Finasteride	Merck’s Proscar	5mg qd	US, France, Germany, ltaly, Spain, UK
Dutasteride	GlaxoSmithKline/Astellas Avodart	‘ 0.5 mg qd	US, France, Germany, ltaly, Spain, UK
Gonadotropin modulators
Chlormidinone acetate	Teikoku’s Prostal/Prostal L	50 mg qd	Japan

bid = Twice daily;

mg = Milligrams;

qd = Once daily;

tid = Three times daily;

fxg = Micrograms.

Also available for benign prostatic hyperplasia treatment are phytopharmaceutical agents and herbal remedies; little is known of their true efficacy and long-term side effects, but available research suggests that they mimic the action of 5-ARIs. Phytopharmaceuticals are used, sometimes in combination with alpha-blocker therapy, in patients with milder disease who require a more benign side-effect profile. TABLE: Select Marketed Agents Used to Treat Benign Prostatic Hyperplasia summarizes the leading therapies available to treat benign prostatic hyperplasia; and FIGURE.Targets for drug intervention in symptomatic benign prostatic hyperplasia identifies symptomatic benign prostatic hyperplasia targets for drug intervention.

luteinizing hormone = Luteinizing hormone.

luteinizing hormone-releasing hormone  = Luleinizing hormone-releasing hormone.

Gonadotropin-releasing hormone = Gonadotmpin-releasing hormone.

follicle-stimulating hormone = Folicle-stimulating hormone.

CG = Chorionia gonadotropirv

dihydrotestosterone = Dihydrotsstosterone,

FIGURE.Targets for drug intervention in symptomatic benign prostatic hyperplasia

The three primary end points used in most clinical trials of agents that target benign prostatic hyperplasia are the post-treatment urinary symptom scores, post-treatment average peak urinary flow rate (Qmax), and the percentage of patients who experience a clinically meaningful improvement in these two measures. These patients (also identified as “clinical responders”) achieve at least a 25% reduction in either the International Prostate Symptom Scores (International Prostate Symptom Scores) or the American Urological Association’s Symptom Index (AUASI) and at least a 30% increase in Qmax. Clinical trials investigating the effects of 5-ARIs, gonadotropin modulators, and phytopharmaceuticals have the additional end point of reduced prostate volume because these drugs act by reducing hyperplasia.

Using questionnaires such as the AUASI or the International Prostate Symptom Scores is the most common method of assessing symptom severity. Patients and physicians rate symptoms on a scale of 1 to 5 for a maximum score of 35. The questionnaires differ in that the International Prostate Symptom Scores has one additional question that evaluates patient QoL. Patients rate their quality of life on a scale of 1 to 6, but the result is not added to the total symptom score. The two symptom scoring systems are considered equally adequate in evaluating lower urinary tract symptoms . Another tool that was sometimes used in earlier clinical trials is the Boyarsky symptom score, which allows 0 to 3 points for each of nine questions for a maximum of 27 points.

Tags: Alfuzosin, Avodart, Cardura, Doxazosin, Dutasteride, Finasteride, Flomax, Hytrin, Minipress, Prazosin, Proscar, Tamsulosin, Terazosin, Uroxatral
Posted in: Benign Prostatic Hyperplasia