Roylance P, Gibelin B, Espié J
Merck Research Laboratories, Whitehouse, NJ 08889, USA.
Biomed Pharmacother. 1995;49(7-8):332-8. doi: 10.1016/0753-3322(96)82660-6.
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.
良性前列腺增生（BPH）是成年男性最常见的疾病之一，其发病率随年龄增长而增加。对于那些不需要手术的患者而言，有效的治疗药物是一个有吸引力的选择，与观察等待相比，可提高生活质量。流行病学研究表明，80岁以上的患者中有88%存在解剖学上的BPH。这种患病率在世界各地的男性人群中相似。手术治疗（经尿道前列腺切除术：TURP）在前列腺肿大和有梗阻症状的患者中50多年来一直是金标准，但20%的患者对手术仍不满意。自圣经时代以来就已使用各种药物制剂，特别是植物提取物，在欧洲仍有处方。一些药物声称具有酶抑制作用，但目前尚未证明其客观疗效。α受体阻滞剂作用于膀胱和前列腺平滑肌，其收缩通过α1受体介导。治疗已显示尿流增加、残余尿量减少以及BPH症状减轻。然而，α受体阻滞剂对前列腺体积没有影响，也没有减少这些患者的手术需求。非那雄胺是目前唯一被批准用于治疗有症状BPH的5α还原酶抑制剂，已得到广泛研究。该药物已显示在大多数患者中可减小前列腺体积、改善症状、尿流和侵入性尿动力学参数。双氢睾酮（DHT）降低，但血清睾酮水平保持不变。由于该药物对上皮细胞的作用，前列腺特异性抗原降低50%。总体而言，该药物耐受性良好，但一些患者出现性欲减退和/或阳痿；然而，三分之二的患者在继续治疗时症状有所改善。目前有两种有效的药物疗法可用于治疗有症状的BPH：非那雄胺和α拮抗剂。目前正在进行研究，以确定这些疗法的联合使用是否会成为手术或观察等待的有效替代方案。
