Symptomatic benign prostatic hyperplasia (BPH) is a common condition in older men and has a significant effect on their daily lives. Medical treatment of BPH has undergone many changes in the last decade. For patients presenting with minimal bothersome symptoms watchful waiting is an acceptable first line strategy. Many placebo controlled double blind trials have confirmed the efficacy of alpha blockers and 5 alpha reductase inhibitors in the medical management of BPH. The therapeutic efficacy of all contemporary alpha- blockers appear similar both in terms of symptomatic relief and urodynamic improvements in urine flow rate. Alpha blockers have a rapid onset of action and are likely to produce a therapeutic result within weeks, regardless of prostatic volume. There is well documented evidence of reduction in LDL cholesterol and serum triglyceride levels. In addition some patients on alpha blockers experience improvement in sexual function and quality of their erectile response. There is a small risk of hypotension, asthenia and dizziness with alpha blockers therapy. Finesteride, a potent 5-alpha reductase inhibitor, must be given for 6 months before its effectiveness in a given patient can be assessed and for at least 12 months to achieve maximum prostate shrinkage and the full extent of its other beneficial effects. This may be considered as a disadvantage when compared with the rapid relief afforded by surgery or alpha blockers. The efficacy of finesteride is also dependant on the prostate size. Finesteride is more effective in patients with prostate size greater than 40 gram. However on the long term it may reverse the disease progression and reduce the risk of urinary retention or prostate surgery. Side effects associated with finesteride therapy include decrease libido, impotence and interference with PSA estimation. In selected patients combination therapy with alpha adrenergic blocker and finesteride can be offered to relieve urinary symptoms and prevent BPH progression. When medical treatment fails and in those patients presenting with complications surgical treatment should be considered.
PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com