Medications used to treat prostate adenoma help relieve lower urinary tract symptoms. According to the recommendations of the European Association of Urology, drugs are used to treat prostate adenoma when patients show moderate symptoms of the disease.
Currently, two groups of drugs are most commonly used: alpha-blockers and 5-alpha-reductase inhibitors. Less commonly used are phosphodiesterase inhibitors and anticholinergic drugs and others.
alpha blockers
Alpha blockers relax the smooth muscle fibers that make up the prostate and bladder neck, resulting in decreased pressure on the walls of the urethra and dilation of its lumen. This allows urine to drain more easily from the bladder. Alpha blockers are given to people with moderate to severe BPH symptoms. It's worth noting that alpha-blockers relieve lower urinary tract symptoms, but theyDo not slow or stop further growth of the prostate.
Most men report relief from lower urinary tract symptoms, which is reflected in a decrease in the I-PSS index for prostatic symptoms (international scaleAssessment of prostate symptoms) by 4-6 units.
The effect of taking alpha-blockers unfolds after 2-3 weeks.
In the human body, several types (alpha-1 and alpha-2) and subtypes (alpha-1a, alpha-1b, alpha-1d, etc. ) of alpha-adrenergic receptors are distinguished, which are not only found in the muscle cells of the prostate, but also in other structures of the body, for example in the heart, in the blood vessels, in the lungs. Alpha-blockers have historically been used to treat BPH, acting on all types of receptors, both alpha-1 and alpha-2 adrenergic receptors. In this regard, the development of complications was often noted 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 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. The disadvantages of prazosin, like other short-acting drugs, were the need for multiple doses throughout the day and severe arterial hypotension.
Long-acting selective alpha-1 blockers
The European Association of Urology recommends the use of the following long-acting alpha-blockers: tamsulosin, alfuzosin, terazosin and doxazosin. These drugs have about the same potency and range of side effects. These drugs used to treat prostate adenoma require a single dose throughout the day.
The most common side effects associated with taking alpha-blockers are: headache, dizziness, weakness, decreased pressure that occurs when moving from a horizontal to a vertical position (usually observed 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 decrease in libido, these side effects have been reported in some cases of taking these drugs. But such a complication as retrograde ejaculation, when sperm enters the bladder, and not the penis, during ejaculation, is more common. However, it is harmless.
Function related to taking alpha blockers
If you are taking drugs for erectile dysfunction such as Viagra, you should be aware that combining them with alpha-blockers can lead to a significant drop in blood pressure, leading to collapse and unconsciousness. Remember that the earliest you can take a Viagra pill is 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 relieve lower urinary tract 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 into dihydrotestosterone, which plays an important role in the development of prostate adenomas. The result is a slowing of the growth of the prostate and a reduction in its size, which in turn leads to a reduction in 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.
The greatest effect of treatment of prostate adenoma with 5-alpha reductase inhibitors is found in men whose prostate was significantly enlarged (more than 30 cc) before treatment. 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) show no significant improvement in the I-PSS index for prostatic symptoms.
The effect of treatment with 5-alpha-reductase inhibitors develops after 6-12 months from the start of taking the drugs. As we know, the size of the prostate does not always correlate with the severity of the symptoms of prostate adenoma, 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, height gain, andCondensation of the mammary glands.
Feature associated with taking 5-alpha reductase inhibitors
Taking finasteride changes the concentration of prostate-specific antigen in the blood in the direction of its decrease. In patients taking 5-alpha reductase inhibitors, levels of prostate-specific antigen may decrease by 50%. Prostate specific antigen is a non-specific marker for prostate cancer. An increase in prostate-specific antigen in the blood can be the first sign that allows you to suspect a tumor at an early stage and to initiate measures for further diagnosis and treatment. Underestimating the level of prostate-specific antigen in the blood can lead to false negative results of prostate cancer screening tests.
To get a true result of the analysis of prostate-specific antigen 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 reduces a man's risk of developing non-aggressive prostate cancer but increases his risk of developing highly aggressive prostate cancer.
Phosphodiesterase Inhibitors
The drug tadalafil (a phosphodiesterase inhibitor) used to be used to treat erectile dysfunction in men. In 2011, this drug was approved for the treatment of benign prostatic hyperplasia. A scientific study found that taking tadalafil daily resulted in a significant improvement 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 in patients with impaired kidney and liver function is restricted. Among the side effects, the most common are headaches and diseases of the gastrointestinal tract, less often - hearing and visual impairment, muscle pain, etc.
anticholinergics
Anticholinergic drugs used to treat prostate adenoma help relieve symptoms such as urinary incontinence, frequent urination, urinary urgency that alpha-blockers have not been able to counteract. 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 the risk of developing acute urinary retention. In addition, the following side effects can be observed: blurred vision, constipation, dizziness, dry eyes, dry mouth, headache, gastrointestinal disorders, abdominal pain, urinary tract infections.
Anticholinergic drugs used to treat prostate adenoma: tolteridone and oxybutynin.
Combination of drugs used to treat prostate adenoma
Often, drug treatment of benign prostatic hyperplasia requires the appointment of a combination of drugs. Men taking the combination of dutasteride with tamsulosin experience more significant relief from BPH symptoms than patients taking these drugs alone.
Dosage forms have been developed that contain both an alpha blocker and a 5-alpha reductase inhibitor. This dosage form is convenient and requires a single dose.
As a rule, treatment with combined drugs is well tolerated by patients. The side effect profile includes a combination of side effects that are separately characteristic of drugs. The most common side effects in combination therapy are erectile dysfunction (7. 4%), retrograde ejaculation (4. 2%), decreased libido (3. 4%).
Long-term use of medications is usually required, and when they are stopped, symptoms can return.
Many men refuse to take drugs to treat prostate adenoma, because they are terrified of developing side effects, primarily related to sexual function.
medical history:"The doctor advised me to start BPH treatment with one or more medications. I can urinate, but my urine stream is weak and sometimes it hurts when I try to urinate in large amounts. I've read on the internet about two main classes of drugs used to treat BPH: alpha-blockers and 5-alpha-reductase inhibitors. Some men describe a significant improvement in symptoms from taking one of the drugs, but most speak of the negative effects of the drugs.
As I understand it, both groups of drugs affect sexual function to some extent. . . . I'm afraid to even think about it. "
Stories of men taking medication to treat BPH
"I am taking the medicines that the doctor prescribed for me and I have not had any side effects as described in the instructions. . . I've been taking it for about three years. There was a time when it seemed like the drug wasn't working, then I had to double the dose and everything fell back into place. . . ".
"I've been on medications for a long time that my doctor recommended and they help me, but I can only experience a 'dry' orgasm, which I really don't like. . . "
"I took alpha-adrenergic blockers and they made me urinate well. Side effects were a decrease in the volume of ejaculate and terrible dizziness with a sharp rise. . . . When I stopped taking it, urination became more frequent up to 13-15 times a day, the volume of sperm increased significantly. I am now 45 years old and my urologist prescribed me an alpha blocker. I occasionally get dizzy when I suddenly stand up, my nose is always stuffy and oh yeah, a "dry" orgasm. When it first happened I always thought it was just a spasm and an orgasm on the way. I was wrong. But the worst part was the priapism! (Priapism is a persistent, persistent, sometimes painful erection that occurs without prior arousal. ) At first I was sure surgical treatment wasn't for me, but now I think soabout this option. "
"Hello, I have been taking medication to treat prostate adenoma for a long time. . . Of the side effects, I was regularly worried about dizziness and nasal congestion. My prostate adenoma symptoms have reduced significantly and I'm glad I avoided surgery! "
As you can see, not every man develops side effects, and different patients may experience different side effects. No doctor can say with 100% certainty whether you will develop this or that side effect.
At an appointment with a doctor you can discuss the most suitable therapy for you. During the consultation, you must provide the doctor with all information about your state of health, concomitant diseases, and the medication you are taking. This will help your doctor decide which treatment plan is best for you.