Current treatment of BPH.

Benign prostatic hypertrophy (BPH) is one of the most common diseases of adult males which increases with age. Effective therapeutic agents are an attractive option for patients for whom surgery is not a necessity, improving quality of life when compared with watchful waiting. Epidemiological studies show that 88% of patients over 80 years of age present anatomical BPH. This prevalence is similar in male populations throughout the world. Surgical treatment (transurethral resection of the prostate: TURP) has been the gold standard for over 50 years in patients with an enlarged prostate and obstructive symptoms but 20% of patients remain unsatisfied with surgery. Various medicinal preparations have been used since biblical times, in particular plant extracts which are still prescribed in Europe. Some claim to have an enzymatic inhibitory effect, but currently have not demonstrated objective efficacy. Alpha-blockers act on bladder and prostate smooth muscle, the contraction of which is mediated through alpha 1-receptors. Treatment has shown increased uroflow, decreased residual volume and a decrease in symptoms of BPH. Alpha-blockers; however, have shown no effect on prostate volume nor a reduction in the need for surgery for these patients. Finasteride, currently the only 5 alpha-reductase inhibitor approved for treatment of symptomatic BPH, has been widely investigated. The drug has been shown to decrease prostate volume, improve symptoms, uroflow and invasive urodynamic parameters in the majority of patients. Dihydrotestosterone (DHT) is decreased but the level of serum testosterone is maintained. Prostatic specific antigen is decreased by 50% as an effect of the drug on epithelial cells. Overall, the drug is well tolerated but some patients have shown decreased libido and/or impotency; however, two-thirds of these patients improved when the treatment was continued. Two effective medical therapies are currently available for treating symptomatic BPH: finasteride and alpha antagonists. Studies are now in progress to determine whether a combination of these therapies would be an effective alternative to surgery or watchful waiting.