Djavan Bob, Waldert Matthias, Ghawidel Clemens, Marberger Michael
Department of Urology, University of Vienna, Vienna, Austria.
Curr Opin Urol. 2004 Jan;14(1):45-50. doi: 10.1097/00042307-200401000-00010.
Management of men with benign prostatic hyperplasia should reduce the lifetime risk of acute urinary retention and the need for benign prostatic hyperplasia-related surgery. A number of recent studies demonstrate that 5alpha-reductase inhibitors are unique in providing a long-term combination of improvements in symptoms and flow, and reductions in the risks of acute urinary retention and surgical intervention.
The 5alpha-reductase inhibitor finasteride was shown to reduce the risk of retention and surgery in men with large prostate volumes and/or high PSA. Recent studies have examined the role of adding an alpha1-blocker to 5alpha-reductase inhibitor in short- or long-term combination. The Medical Therapy of Prostatic Symptoms study randomised 3,047 men with benign prostatic hyperplasia to treatment with a 5alpha-reductase inhibitor (finasteride), an alpha1 blocker (doxazosin), a combination of both, or placebo. Only treatment arms containing 5alpha-reductase inhibitor therapy were associated with longer-term significant reductions in the risk of acute urinary retention and invasive therapy for benign prostatic hyperplasia. Three randomised, two-year, placebo-controlled studies have assessed the clinical relevance of the >93% DHT suppression provided by dutasteride. Dutasteride was also associated with a reduction in the risk of acute urinary retention of 57%, and a reduction of 48% in the risk of surgical intervention compared with placebo after 2 years.
Short-term combination of 5alpha-reductase inhibitor and alpha-blockade are optimal in providing symptomatic improvement among patients who require symptom relief, while enabling the initiation of 5alpha-reductase inhibitor therapy to reduce the risk of subsequent acute urinary retention or benign prostatic hyperplasia-related surgery in men who are at greater risk of disease progression.
良性前列腺增生男性患者的管理应降低急性尿潴留的终生风险以及与良性前列腺增生相关手术的需求。近期的多项研究表明，5α-还原酶抑制剂在长期改善症状和尿流、降低急性尿潴留风险及手术干预方面具有独特作用。
5α-还原酶抑制剂非那雄胺可降低前列腺体积大及/或前列腺特异性抗原（PSA）水平高的男性患者的尿潴留和手术风险。近期研究探讨了短期或长期联合使用α1受体阻滞剂与5α-还原酶抑制剂的作用。前列腺症状医学治疗研究将3047例良性前列腺增生男性患者随机分为接受5α-还原酶抑制剂（非那雄胺）、α1受体阻滞剂（多沙唑嗪）、两者联合或安慰剂治疗。只有含5α-还原酶抑制剂治疗的组在长期随访中显著降低了急性尿潴留风险及良性前列腺增生的侵入性治疗需求。三项为期两年的随机、安慰剂对照研究评估了度他雄胺使双氢睾酮（DHT）抑制率>93%的临床意义。与安慰剂相比，度他雄胺在2年后还使急性尿潴留风险降低了57%，手术干预风险降低了48%。
对于需要缓解症状的患者，5α-还原酶抑制剂与α受体阻滞剂短期联合使用能最佳地改善症状，同时可启动5α-还原酶抑制剂治疗以降低疾病进展风险较高男性患者随后发生急性尿潴留或与良性前列腺增生相关手术的风险。
