MEDICAL-TREATMENT OF BENIGN PROSTATIC HYPERPLASIA - 5-ALPHA-REDUCTASEINHIBITORS AND ALPHA-ADRENERGIC ANTAGONISTS

Benign prostatic hyperplasia (BPH), a nonmalignant neoplasm of the pro static epithelial and stromal tissue, occurs commonly in elderly men. The ''gold standard'' of care for symptomatic BPH has been and remains transurethral resection of the prostate. This operation, however, lik e any surgical procedure, has associated morbidity and imposes an appr eciable expense on the health-care system; therefore, enthusiasm for t he development of medical therapies for the management of symptomatic BPH has been substantial. Currently, practicing physicians have two ty pes of medications for the treatment of symptomatic BPH: 5alpha-reduct ase inhibitors and alpha-adrenergic antagonists. The former drugs inhi bit the conversion of testosterone to the potent prostatic androgen di hydrotestosterone. As a result, the androgenic stimulation to the pros tate gland is suppressed, and the size of the prostate is decreased by approximately 25%. In some patients, this outcome decreases the mecha nical obstruction of the prostatic urethra and improves micturition. A lpha-Adrenergic antagonists decrease the smooth muscle tone of the bla dder neck, prostatic adenoma, and prostatic capsule. After these struc tures have been relaxed, resistance to urine flow through the prostati c urethra can be decreased, and obstructive voiding symptoms can be re solved. Although two distinctly different mechanisms are involved, bot h types of medications are effective for treating BPH. Thus, in 1993, transurethral resection of the prostate is no longer the only availabl e therapeutic option. With the advent of medical therapies, internists and primary-care physicians will have more involvement in the care of patients with BPH than previously. Therefore, urologists and nonurolo gists must work together to serve the needs of patients with prostatis m.