Marberger Michael
Department of Urology at the University of Vienna, Vienna, Austria.
Nat Clin Pract Urol. 2006 Sep;3(9):495-503. doi: 10.1038/ncpuro0577.
Benign prostatic hyperplasia (BPH) is a common problem among older men, which is characterized by an enlarged prostate, lower urinary tract symptoms, and decreased flow of urine. It is a progressive disease that can lead to complications such as acute urinary retention (AUR) or a need for BPH-related surgery in some men. Dihydrotestosterone is the primary androgen involved in both normal and abnormal prostate growth and 5alpha-reductase inhibitors (5ARIs) inhibit the conversion of testosterone to dihydrotestosterone. There are two 5ARIs licensed for the treatment of BPH; dutasteride, which inhibits both type 1 and type 2 isoenzymes of 5alpha reductase, and finasteride, which inhibits the type 2 isoenzyme. Both 5ARIs have been shown to decrease prostate volume, improve urinary flow and lower urinary tract symptoms and reduce the risk of AUR and BPH-related surgery. The prevention of disease progression, by treating the underlying cause, and the alleviation of symptoms are important aims of BPH therapy. 5ARIs are the only currently available medical therapy that can reduce the risk of AUR and BPH-related surgery while providing long-term symptom control. This provides a mandate for their use in men with enlarged prostates (volume >or=30 ml), who are at increased risk of disease progression.
良性前列腺增生（BPH）是老年男性中的常见问题，其特征是前列腺增大、下尿路症状以及尿流减少。它是一种进行性疾病，在某些男性中可导致诸如急性尿潴留（AUR）或需要进行与BPH相关的手术等并发症。双氢睾酮是参与正常和异常前列腺生长的主要雄激素，5α-还原酶抑制剂（5ARIs）可抑制睾酮向双氢睾酮的转化。有两种5ARIs被批准用于治疗BPH；度他雄胺可抑制5α还原酶的1型和2型同工酶，非那雄胺则抑制2型同工酶。两种5ARIs均已显示可减小前列腺体积、改善尿流和下尿路症状，并降低AUR和与BPH相关手术的风险。通过治疗根本病因来预防疾病进展以及缓解症状是BPH治疗的重要目标。5ARIs是目前唯一可用的药物疗法，可降低AUR和与BPH相关手术的风险，同时提供长期症状控制。这为其在前列腺增大（体积≥30 ml）且疾病进展风险增加的男性中的使用提供了依据。
