PROSTATIC ALPHA(1)-ADRENOCEPTORS AND UROSELECTIVITY

BACKGROUND. alpha(1)-adrenoceptor antagonists (blockers) are now commo nly used in the treatment of the symptoms of lower urinary tract obstr uction. Originally phenoxybenzamine, a non-selective antagonist at bot h alpha(1)- and alpha(2)-adrenoceptors, was used by Marco Caine. In an attempt to minimize side effects, selective alpha(1)-antagonists, e.g , prazosin, were subsequently developed. More recently, agents such as alfuzosin, doxazosin, terazosin, and tamsulosin have been introduced and claims of ''uroselectivity'' and ''prostate'' selectivity have eme rged. METHODS. This review attempts to put these claims into perspecti ve and represents a comprehensive analysis of all pre-clinical and cli nical data including several papers from the Japanese literature. An a ttempt is made to define what is meant by selectivity at various level s including the test tube, in the laboratory animal and, most importan tly, in the clinical context of the whole patient. CONCLUSIONS. The co nclusions are interpreted within the context of the subdivision of the alpha(1)-adrenoceptor into alpha(1A), alpha(1B), and alpha(1D) subtyp es. (C) 1997 Wiley-Liss, Inc.