Kojima Yoshiyuki, Kubota Yasue, Sasaki Shoichi, Hayashi Yutaro, Kohri Kenjiro
Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Curr Aging Sci. 2009 Dec;2(3):223-39. doi: 10.2174/1874609810902030223.
Benign prostatic hyperplasia (BPH) occurs in over 50% of men over 60 years of age, most of whom have lower urinary tract symptoms (LUTS). The incidence of BPH appears to be increasing due to the increased longevity of men. LUTS associated with BPH (LUTS/BPH) greatly affects the patient's quality of life. Physicians should be aware of other issues associated with advancing age, such as cardiovascular diseases, sexual dysfunction and cataract, that may complicate the treatment of aging men with LUTS/BPH; therefore, management of LUTS/BPH requires careful selection of the most appropriate treatment for each patient. Alpha1-adrenoceptor (alpha(1)-AR) stimulation plays an important role in the regulation of prostate smooth muscle contraction. Recent remarkable advances in molecular biology offer the possibility of new findings about the role of alpha(1)-AR subtypes and new therapeutic options for BPH; however, even though alpha(1)-AR antagonists are used as the first-line medical treatment for patients affected by LUTS/BPH, responses to alpha(1)-AR antagonists differ among patients. The risks of unexpected adverse events, acute urinary retention and the need for invasive therapy also differ among patients. Translational pharmacology is the collaboration between researchers and clinicians to discover more effective medical therapies and to identify new drugs for various diseases. This review summarizes the recent molecular and physiological findings of alpha(1)-AR subtypes and discusses potential new strategies for BPH medical treatment. In the future, the promise of genetic-based prescriptions and therapeutic plans as a useful strategy to improve clinical outcomes of BPH medical therapy may become credible and warrants further investigation.
良性前列腺增生（BPH）发生在超过50%的60岁以上男性中，其中大多数人有下尿路症状（LUTS）。由于男性寿命延长，BPH的发病率似乎在上升。与BPH相关的LUTS（LUTS/BPH）极大地影响患者的生活质量。医生应意识到与年龄增长相关的其他问题，如心血管疾病、性功能障碍和白内障，这些问题可能会使患有LUTS/BPH的老年男性的治疗复杂化；因此，LUTS/BPH的管理需要为每个患者仔细选择最合适的治疗方法。α1肾上腺素能受体（α(1)-AR）刺激在前列腺平滑肌收缩的调节中起重要作用。分子生物学最近的显著进展为α(1)-AR亚型的作用和BPH的新治疗选择提供了新发现的可能性；然而，尽管α(1)-AR拮抗剂被用作LUTS/BPH患者的一线药物治疗，但患者对α(1)-AR拮抗剂的反应各不相同。意外不良事件、急性尿潴留的风险以及侵入性治疗的必要性在患者中也有所不同。转化药理学是研究人员和临床医生之间的合作，旨在发现更有效的药物治疗方法并识别针对各种疾病的新药。本综述总结了α(1)-AR亚型最近的分子和生理学发现，并讨论了BPH药物治疗的潜在新策略。未来，基于基因的处方和治疗计划作为改善BPH药物治疗临床结果的有用策略的前景可能变得可信，值得进一步研究。
