Medications to treat prostate adenoma help relieve the symptoms of the lower urinary tract. According to the recommendations of the European Union of Urology, drugs for the treatment of prostate adenoma are used if patients have moderate to severe symptoms of the disease.
Currently, two groups of drugs are widely used: alpha-blockers and 5-alpha-reductase inhibitors. Less commonly used are phosphodiesterase inhibitors and anticholinergic drugs and others.
Alpha inhibitors
Alpha-blockers relax the smooth muscle fibers that make up the prostate and the neck of the bladder, resulting in reduced pressure on the walls of the urethra and the expansion of its lumen. This facilitates the flow of urine from the bladder. Alpha inhibitors are used in patients with moderate to severe symptoms of CKD. It is worth noting that alpha-blockers relieve the symptoms of the lower urinary tract, but theydo not slow down or stop further prostate growth.
Most men report relief from lower urinary tract symptoms, as reflected by a decrease in I-PSS Prostatic Symptoms (international scaleevaluation of prostate symptoms) by 4-6 units.
The effect of taking alpha-blockers develops after 2-3 weeks.
There are various types (alpha-1 and alpha-2) and subtypes (alpha-1a, alpha-1b, alpha-1d, etc. ) of alpha-adrenergic receptors in the human body, which are found not only in muscle cells of the prostate, but also in other structures of the body, for example, in the heart, blood vessels, lungs. Previously, alpha-blockers were used to treat BPH, which act on all types of receptors, both alpha-1 and alpha-2-adrenergic receptors. In this regard, the development of complications was often observed in men. Scientists have discovered that alpha-1α-adrenergic receptors are located in the prostate. Following the development of drugs that selectively block alpha-1-adrenergic receptors (selective alpha-blockers), it has been possible to reduce the number of side effects associated with the use of non-selective drugs (aggressive angina, arrhythmia, etc. ).
Alpha-1-short-acting inhibitors
Prazosin was the first selective alpha-1 inhibitor approved for the treatment of CKD. The disadvantages of prazosin, as well as other short-acting drugs, were the need for multiple doses during the day and severe hypotension.
Selective long-acting alpha-1 inhibitors
The European Urology Association recommends the use of the following long-acting alpha-blockers: tamsulosin, alfuzosin, terazosin and doxazosin. These drugs have about the same effectiveness and range of side effects. These drugs for the treatment of prostate adenoma require a single dose during the day.
The most common side effects associated with taking alpha-blockers are: headache, dizziness, weakness, decreased pressure when moving from horizontal to vertical position (usually observed only at the beginning of treatment - the effect of the first dose). drowsiness, nasal congestion and recurrent ejaculation. Although alpha-blockers do not cause erectile dysfunction or decrease libido, these side effects have been reported in some cases of taking these drugs. But such a complication as retrograde ejaculation, when the sperm during ejaculation moves to the bladder and not to the penis, is more common. However, it is harmless.
Feature associated with taking alpha-blockers
If you are taking medicines for erectile dysfunction such as Viagra, be aware that their combination with alpha-blockers can lead to a significant reduction in blood pressure, up to collapse and loss of consciousness. Remember that you can take a Viagra pill no earlier than 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 help relieve the symptoms of lower urinary tract symptoms. Two drugs in this group are used to treat prostate adenoma: finasteride and dutasteride. These drugs block the enzyme 5-alpha-reductase, which converts testosterone to dihydrotestosterone, which plays an important role in the development of prostate adenoma. The result is a slowing down of prostate growth and a reduction in its size, which in turn leads to relief from the symptoms of the lower urinary tract. Finasteride inhibits the conversion of testosterone to dihydrotestosterone by 70%, and dutasteride by 95%. However, finasteride and dutasteride are not clinically effective in treating prostate adenoma.
Men whose prostate gland had enlarged significantly before treatment (above 30 cc) have the greatest effect of treating prostate adenoma with 5-alpha-reductase inhibitors. 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) do not show a significant improvement in the I-PSS Prostatic Symptoms Index.
The effect of treatment with 5-alpha-reductase inhibitors develops 6-12 months after the start of taking the drug. As we know, prostate size is not always associated with the severity of prostate adenoma symptoms, 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 inIn less than one percent of cases, the mammary glands are enlarged and compressed.
Feature associated with the administration of 5-alpha reductase inhibitors
Taking finasteride changes the concentration of prostate-specific antigen in the blood to reduce it. In patients receiving 5-alpha reductase inhibitors, the concentration of prostate-specific antigen may be reduced by 50%. Prostate-specific antigen is a non-specific marker of prostate cancer. An increase in the level of prostate-specific antigen in the blood may be the first sign that allows you to suspect a tumor at an early stage and take steps for further diagnosis and treatment. Underestimation of the level of prostate-specific antigen in the blood can lead to false-negative results in prostate cancer screening tests.
To get a real result of the analysis of the prostate-specific antigen in the blood of a patient receiving 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 the risk of developing an extremely aggressive prostate tumor.
Phosphodiesterase inhibitors
Previously, tadalafil (a phosphodiesterase inhibitor) was 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 daily intake of tadalafil 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 blood pressure. In addition, the use of tadalafil is limited in patients with impaired renal and hepatic function. Among the side effects, the most common are headaches and disorders of the gastrointestinal tract, less common - hearing and vision disorders, muscle pain, etc.
Anticholinergic drugs
Anticholinergic drugs for the treatment of prostate adenoma help relieve symptoms such as urinary incontinence, frequent urination, urgency, which could not be equated with alpha-blockers. Doctors sometimes prescribe anticholinergic drugs in combination with alpha blockers to better control the symptoms of CKD. The use of anticholinergic drugs is associated with the risk of acute urinary retention. In addition, the following side effects may occur: blurred vision, constipation, dizziness, dry mouth, dry mouth, headache, gastrointestinal disorders, abdominal pain, urinary tract infections.
Anticholinergic drugs for the treatment of prostate adenoma: tolteridone and oxybutynin.
Combination of drugs for the treatment of prostate adenoma
Often, drug treatment of benign prostatic hyperplasia requires the appointment of a combination of drugs. Men taking the combination of dutasteride and tamsulosin experience more significant relief from the symptoms of CKD than patients taking these drugs on their own.
Currently, dosage forms have been developed that include both an alpha inhibitor and a 5-alpha reductase inhibitor. This dosage form is convenient, requires only one dose.
As a rule, treatment with combination drugs is well tolerated by patients. The adverse reaction profile includes a combination of adverse reactions that are characteristic of the individual drugs. The most common side effects in combination therapy are erectile dysfunction (7. 4%), retrograde ejaculation (4. 2%), decreased libido (3. 4%).
As a rule, long-term use of medication is required and when canceled, the symptoms may return.
Many men refuse to take drugs to treat prostate adenoma, as they are terrified of developing side effects, especially those related to sexual function.
Patient history:"The doctor advised me to start the treatment for KYP with one or more drugs. I can urinate, but my urine flow is weak and sometimes it hurts when I want to urinate in large volumes. On the Internet, I read about two major classes of drugs used to treat CKD: alpha-blockers and 5-alpha-reductase inhibitors. Some men describe a significant improvement in symptoms from taking one of the medications, but most talk about the side effects of the medications.
As I understand it, both groups of drugs affect sexual function to one degree or another…. I'm afraid to think about it. "
Stories of men taking medication to treat BPH
"I am taking the medication prescribed by my doctor and so far I have no side effects described in the instructions. . . I take it for about three years. There was a time when it seemed to me that the medicine did not work, then I had to double the dose and everything returned to normal. . . ».
"I'm taking medication that my doctor recommended for a long time and they help me, but I can only experience a 'dry' orgasm, which I really do not like…"
"I took alpha-adrenergic blockers and they urinated well on me. The side effects were a decrease in the volume of ejaculation and a terrible dizziness with a sharp increase. . . . When I stopped taking it, urination became more frequent up to 13-15 times a day, sperm volume increased significantly. I am now 45 years old and my urologist put me on an alpha blocker. Periodically, I get dizzy when I get up abruptly, my nose is always stuffy and oh yes, a "dry" orgasm. The first time it happened, I kept thinking it was just a spasm and an orgasm along the way. I was wrong. But the worst of all was the priapism! (Priapism is a prolonged, persistent, sometimes painful erection that occurs without prior stimulation). "At first I was sure that surgery was not for me, but now I am already thinking about this option. "
"Hello, I've been taking medication to treat prostate adenoma for a long time. . . From the side effects, I periodically worried about dizziness and nasal congestion. My symptoms in prostate adenoma have been significantly reduced and I am happy about that, because I managed to avoid surgery! ».
As you can see, not every man has side effects and different patients may experience different side effects. No doctor can say with a hundred percent guarantee if you will experience this or that side effect.
By making an appointment with a doctor, you can discuss the most appropriate treatment for you. During the consultation, you should inform the doctor without hiding about all the information about the state of health, the coexisting diseases, the medicines you are taking. This will help your doctor decide which treatment plan is best for you.