Kim Eric H, Brockman John A, Andriole Gerald L
Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Asian J Urol. 2018 Jan;5(1):28-32. doi: 10.1016/j.ajur.2017.11.005. Epub 2017 Nov 26.
Benign prostatic hyperplasia (BPH) is characterized by an enlarged prostate, lower urinary tract symptoms (LUTS), and a decreased urinary flow rate. Common in older men, BPH is a progressive disease that can eventually lead to complications including acute urinary retention (AUR) and the need for BPH-related surgery. Both normal and abnormal prostate growth is driven by the androgen dihydrotestosterone (DHT), which is formed from testosterone under the influence of 5-alpha reductase. Thus, 5-alpha reductase inhibitors (5-ARIs) effectively reduce the serum and intraprostatic concentration of DHT, causing an involution of prostate tissue. Two 5-ARIs are currently available for the treatment of BPH-finasteride and dutasteride. Both have been demonstrated to decrease prostate volume, improve LUTS and urinary flow rates, which ultimately reduces the risk of AUR and BPH-related surgery. Therefore, either alone or in combination with other BPH medications, 5-ARIs are a mainstay of BPH management.
良性前列腺增生（BPH）的特征是前列腺增大、下尿路症状（LUTS）以及尿流率降低。BPH在老年男性中很常见，是一种渐进性疾病，最终可能导致包括急性尿潴留（AUR）和BPH相关手术需求在内的并发症。正常和异常的前列腺生长均由雄激素双氢睾酮（DHT）驱动，DHT是在5α还原酶的影响下由睾酮形成的。因此，5α还原酶抑制剂（5-ARIs）可有效降低血清和前列腺内DHT的浓度，导致前列腺组织 involution（此处involution可能有误，推测应为“退化”之类意思）。目前有两种5-ARIs可用于治疗BPH——非那雄胺和度他雄胺。两者均已被证明可减小前列腺体积、改善LUTS和尿流率，最终降低AUR和BPH相关手术的风险。因此，5-ARIs单独使用或与其他BPH药物联合使用，都是BPH治疗的主要手段。
