CURRENT TREATMENT OF BPH

Benign prostatic hypertrophy (BPH) is one of the most common diseases of adult males which increases with Effective therapeutic agents are a n attractive option for patients for whom surgery is not a necessity, improving quality of life when compared with watchful waiting. Epidemi ological studies show that 88% of patients over 80 years of age presen t anatomical BPH. This prevalence is similar in male populations throu ghout the world. Surgical treatment (transurethral resection of the pr ostate: TURF) has been the gold standard for over 50 years in patients with an enlarged prostate and obstructive symptoms but 20% of patient s remain unsatisfied with surgery. Various medicinal preparations have been used since biblical times, in particular plant extracts which ar e still prescribed in Europe. Some claim to have an enzymatic inhibito ry effect, but currently have not demonstrated objective efficacy. Alp ha-blockers act on bladder and prostate smooth muscle, the contraction of which is mediated through alpha(1)-receptors. Treatment has shown increased uroflow, decreased residual volume and a decrease in symptom s of BPH. Alpha-blockers; however, have shown no effect on prostate vo lume nor a reduction in the need for surgery for these patients. Finas teride, currently the only Scc-reductase inhibitor approved for treatm ent of symptomatic BPH, has been widely investigated. The drug has bee n shown to decrease prostate volume, improve symptoms, uroflow and inv asive urodynamic parameters in the majority of patients. Dihydrotestos terone (DHT) is decreased but the level of serum testosterone is maint ained. Prostatic specific antigen is decreased by 50% as an effect of the drug on epithelial cells. Overall, the drug is well tolerated but some patients have shown decreased libido and/or impotency; however, t wo-thirds of these patients improved when the treatment was continued. Two effective medical therapies are currently available for treating symptomatic BPH: finasteride and alpha antagonists. Studies are now in progress to determine whether a combination of these therapies would be an effective alternative to surgery or watchful waiting.