PHARMACOLOGICAL THERAPY FOR PROSTATISM

Although the general approach to management of a sufficient degree of benign prostatic hyperplasia in the past was surgical intervention (tr ansurethral resection of the prostate), the current availability of ef fective pharmacologic therapy has changed the initial management strat egy. At present, two types of drug are available for treatment of pros tatism: (1) selective alpha-adrenergic blocking agents (terazosin, dox azosin, and tamsulosin) and (2) an inhibitor of the 5 alpha-reductase enzyme (finasteride), Pharmacologic blockade of the alpha(1)-adrenocep tors is thought to result in relaxation of the smooth muscle in the pr ostate and bladder neck, which reduces urethral resistance, improves v oiding function, and minimizes the symptoms of prostatism. These effec ts may be noted by the patient within several weeks after initiation o f treatment. The mechanism of action of finasteride is a blocking of t he conversion of testosterone to dihydrotestosterone and an associated volume shrinkage of the prostate. On the average, a 25% reduction in prostate volume can be achieved, but a period of 12 months or longer o f finasteride therapy is needed for maximal shrinkage and maximal decr ease in symptoms of prostatism. The expanding population of middle-age d and elderly men with prostatism of moderate severity will undoubtedl y prompt the development of additional pharmacologic options for treat ment of prostatism and benign prostatic hyperplasia.