Eri L M, Tveter K J
Department of Urology, Ullevaal University Hospital, Oslo, Norway.
Drugs Aging. 1997 Feb;10(2):107-18. doi: 10.2165/00002512-199710020-00004.
Men with moderate symptoms of benign prostatic hyperplasia (BPH) are the best candidates for medical treatment, while surgery is usually indicated for patients with severe symptoms. Men with mild symptoms do not usually need treatment, but they might be re-evaluated annually if desirable. Finasteride, which produces selective hormonal deprivation, is now established as a well tolerated drug for the long term medical therapy of BPH. Recent studies suggest that finasteride is most effective in men with large prostates (> 40 ml), and the drug should probably be reserved for these patients. alpha-Blockers work in men with small or large prostates, and their rapid onset of action facilitates the identification of responders. alpha-Blockers are more effective than finasteride during the first year of treatment, but only finasteride induces regression of the prostate and offers increased efficacy over time. Even if drug therapy reduces the need for prostate surgery, the total economic cost of BPH treatment is likely to rise because of the increasing application of medical treatment. The magnitude of this increase depends largely on what percentage of the male population embark on long term therapy, at what age treatment is started, and how successful it is. At present, the answers to these questions are largely unknown. The personal economic expenses for men who begin long term medical therapy will probably be an important factor in deciding how common drug treatment for BPH will become in the future. For many men, the main benefit of drug treatment will be the relief of urinary symptoms, but whether this improvement is substantial enough to improve their overall quality of life has not yet been clearly demonstrated in controlled studies.
患有中度良性前列腺增生（BPH）症状的男性是药物治疗的最佳人选，而手术通常适用于症状严重的患者。症状轻微的男性通常不需要治疗，但如果愿意，可每年重新评估。非那雄胺可产生选择性激素剥夺作用，现已成为一种耐受性良好的用于BPH长期药物治疗的药物。最近的研究表明，非那雄胺对前列腺较大（>40毫升）的男性最有效，该药物可能应保留给这些患者使用。α受体阻滞剂对前列腺大小不同的男性均有效，其起效迅速便于确定有反应者。在治疗的第一年，α受体阻滞剂比非那雄胺更有效，但只有非那雄胺能使前列腺缩小并随着时间推移提高疗效。即使药物治疗减少了前列腺手术的需求，但由于药物治疗应用的增加，BPH治疗的总经济成本可能会上升。这种增长幅度在很大程度上取决于男性人口中接受长期治疗的比例、开始治疗的年龄以及治疗的成功率。目前，这些问题的答案大多未知。开始长期药物治疗的男性的个人经济支出可能是决定未来BPH药物治疗普及程度的一个重要因素。对许多男性来说，药物治疗的主要益处将是缓解尿路症状，但在对照研究中，这种改善是否足以提高他们的整体生活质量尚未得到明确证实。
