Pharmaceutical treatment for prostatic hyperplasia

When is treatment justified?

Most patients with prostatic hyperplasia first receive pharmaceutical treatment to alleviate symptoms. Alpha blockers relax the prostate and bladder neck area, allowing urine to flow more easily, while prostate-reducing 5α-reductase inhibitors cause the prostate tissue mass to shrink.

Patients with mild to moderate symptoms often respond well to medication. Some patients with difficult symptoms find that medication brings help and relief to their symptoms as well even though compared to surgical treatment, pharmaceutical treatments are less effective.

These medications are not suitable for everyone, and pharmaceutical treatment does not alleviate the symptoms of all patients sufficiently. In that case, the primary treatment alternative is surgery. There are different kinds of surgeries, ranging from laser surgery to open prostatectomy.

Medication that should be used

There are two kinds of medications being used to alleviate prostatic hyperplasia symptoms:

Alpha blockers relax the prostate and bladder neck area, improve symptoms quickly, but do not affect the natural course of hyperplasia. 5α-reductase inhibitors (finasteride, dutasteride) gradually reduce prostate size. Treatment results improve when these medications are combined.

Treatment duration

Continuous medication is used for significant urinary abnormalities caused by prostatic hyperplasia. Alpha blockers begin to take effect quickly, already within a few days. The effectiveness of 5α-reductases can be evaluated reliably only after about six months. Nevertheless, only 5α-reductase inhibitors that are used long-term have been proven to reduce the need for surgical treatment.

Pros and cons

Pharmaceutical treatment alleviates symptoms, and it is a good therapy if the symptoms are mild.

The medications used to treat prostatic hyperplasia do also have side effects for some patients, however. Significant adverse effects of 5α-reductases include decrease in libido and erectile and ejaculatory dysfunctions. The prevalence of these adverse effects is 5–19%. The adverse effects of alpha blockers include vertigo, weakness and ejaculatory dysfunctions.

Medication should be ingested daily, and for example, the effect of 5α-reductase inhibitors appears only after 3–6 months after starting the treatment. Regular PSA monitoring every 6–12 months is necessary especially when using 5α-reductase inhibitors.