Benign prostatic hyperplasia: Difference between revisions

From Citizendium
Jump to navigation Jump to search
imported>Robert Badgett
imported>Robert Badgett
(→‎Medications: Started combination therapy and table)
Line 38: Line 38:
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=18822025 | doi=10.1111/j.1742-1241.2008.01880.x | pmc=PMC2658011 }} </ref> [[Drug toxicity]] may include headaches, dizziness, or feeling lightheaded or tired. Vascular [[drug toxicity]] may be less with [[tamsulosin]] due to more selectivity to α<sub>1</sub>-A and α<sub>1</sub>-D [[adrenergic receptor]]s according to a [[meta-analysis]] supported by [[Boehringer Ingelheim Pharmaceuticals]], the maker of tamsulosin.<ref name="pmid18822025">{{cite journal| author=Nickel JC, Sander S, Moon TD| title=A meta-analysis of the vascular-related safety profile and efficacy of alpha-adrenergic blockers for symptoms related to benign prostatic hyperplasia. | journal=Int J Clin Pract | year= 2008 | volume= 62 | issue= 10 | pages= 1547-59 | pmid=18822025  
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=18822025 | doi=10.1111/j.1742-1241.2008.01880.x | pmc=PMC2658011 }} </ref> [[Drug toxicity]] may include headaches, dizziness, or feeling lightheaded or tired. Vascular [[drug toxicity]] may be less with [[tamsulosin]] due to more selectivity to α<sub>1</sub>-A and α<sub>1</sub>-D [[adrenergic receptor]]s according to a [[meta-analysis]] supported by [[Boehringer Ingelheim Pharmaceuticals]], the maker of tamsulosin.<ref name="pmid18822025">{{cite journal| author=Nickel JC, Sander S, Moon TD| title=A meta-analysis of the vascular-related safety profile and efficacy of alpha-adrenergic blockers for symptoms related to benign prostatic hyperplasia. | journal=Int J Clin Pract | year= 2008 | volume= 62 | issue= 10 | pages= 1547-59 | pmid=18822025  
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=18822025 | doi=10.1111/j.1742-1241.2008.01880.x | pmc=PMC2658011 }} </ref>
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=18822025 | doi=10.1111/j.1742-1241.2008.01880.x | pmc=PMC2658011 }} </ref>
* [[Testosterone 5-alpha-reductase]] inhibitors such as [[finasteride]] (Proscar®) can lower the amount of the male hormone (testosterone) in the body. The result is that the prostate shrinks and urinary problems get better.[[Drug toxicity]] can include less interest in sex and problems with erection or ejaculation.
* [[Testosterone 5-alpha-reductase]] inhibitors such as [[finasteride]] (Proscar®) can lower the amount of the male hormone (testosterone) in the body. The result is that the prostate shrinks and urinary problems get better.<ref name="pmid1383816">{{cite journal| author=Gormley GJ, Stoner E,  Bruskewitz RC, Imperato-McGinley J, Walsh PC, McConnell JD et al.|  title=The effect of finasteride in men with benign prostatic  hyperplasia. The Finasteride Study Group. | journal=N Engl J Med | year=  1992 | volume= 327 | issue= 17 | pages= 1185-91 | pmid=1383816 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=1383816}} </ref> [[Drug toxicity]] can include less interest in sex and problems with erection or ejaculation.
* Saw palmetto plant extract (''Serenoa repens''). Despite initial positive reports<ref name="pmid9820264">{{cite journal |author=Wilt TJ, Ishani A, Stark G, MacDonald R, Lau J, Mulrow C |title=Saw palmetto extracts for treatment of benign prostatic hyperplasia: a systematic review |journal=JAMA |volume=280 |issue=18 |pages=1604–9 |year=1998 |pmid=9820264 |doi=}}</ref>, a more recent [[randomized controlled trial]] found no benefit.<ref name="pmid16467543">{{cite journal |author=Bent S, Kane C, Shinohara K, ''et al'' |title=Saw palmetto for benign prostatic hyperplasia |journal=N. Engl. J. Med. |volume=354 |issue=6 |pages=557–66 |year=2006 |pmid=16467543 |doi=10.1056/NEJMoa053085}}</ref>
* Saw palmetto plant extract (''Serenoa repens''). Despite initial positive reports<ref name="pmid9820264">{{cite journal |author=Wilt TJ, Ishani A, Stark G, MacDonald R, Lau J, Mulrow C |title=Saw palmetto extracts for treatment of benign prostatic hyperplasia: a systematic review |journal=JAMA |volume=280 |issue=18 |pages=1604–9 |year=1998 |pmid=9820264 |doi=}}</ref>, a more recent [[randomized controlled trial]] found no benefit.<ref name="pmid16467543">{{cite journal |author=Bent S, Kane C, Shinohara K, ''et al'' |title=Saw palmetto for benign prostatic hyperplasia |journal=N. Engl. J. Med. |volume=354 |issue=6 |pages=557–66 |year=2006 |pmid=16467543 |doi=10.1056/NEJMoa053085}}</ref>
* If symptoms of urge and [[overactive urinary bladder]] are present, an antimuscarinic [[cholinergic antagonist]] such as [[tolterodine]] can be combined with an [[alpha adrenergic blocker]] such as [[tamsulosin]].<ref name="pmid17105794">{{cite journal| author=Kaplan SA, Roehrborn CG, Rovner ES, Carlsson M, Bavendam T, Guan Z| title=Tolterodine and tamsulosin for treatment of men with lower urinary tract symptoms and overactive bladder: a randomized controlled trial. | journal=JAMA | year= 2006 | volume= 296 | issue= 19 | pages= 2319-28 | pmid=17105794  
* If symptoms of urge and [[overactive urinary bladder]] are present, an antimuscarinic [[cholinergic antagonist]] such as [[tolterodine]] can be combined with an [[alpha adrenergic blocker]] such as [[tamsulosin]].<ref name="pmid17105794">{{cite journal| author=Kaplan SA, Roehrborn CG, Rovner ES, Carlsson M, Bavendam T, Guan Z| title=Tolterodine and tamsulosin for treatment of men with lower urinary tract symptoms and overactive bladder: a randomized controlled trial. | journal=JAMA | year= 2006 | volume= 296 | issue= 19 | pages= 2319-28 | pmid=17105794  
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=17105794 | doi=10.1001/jama.296.19.2319 }} </ref>
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=17105794 | doi=10.1001/jama.296.19.2319 }} </ref>
===Combination therapy===
{| class="wikitable"
|+ [[Randomized controlled trial]]s of combination therapy for benign prostatic hypertrophy.<ref name="pmid19825505">{{cite journal| author=Roehrborn CG, Siami P, Barkin J, Damião R, Major-Walker K, Nandy I et al.| title=The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia: 4-year results from the CombAT study. | journal=Eur Urol | year= 2010 | volume= 57 | issue= 1 | pages= 123-31 | pmid=19825505
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=19825505 | doi=10.1016/j.eururo.2009.09.035 }} </ref><ref name="pmid14681504">{{cite journal| author=McConnell JD, Roehrborn CG, Bautista OM, Andriole GL, Dixon CM, Kusek JW et al.| title=The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. | journal=N Engl J Med | year= 2003 | volume= 349 | issue= 25 | pages= 2387-98 | pmid=14681504 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=14681504 | doi=10.1056/NEJMoa030656 }}  [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=15230568 Review in: ACP J Club. 2004 Jul-Aug;141(1):20] </ref><ref name="pmid8684407">{{cite journal| author=Lepor H, Williford WO, Barry MJ, Brawer MK, Dixon CM, Gormley G et al.| title=The efficacy of terazosin, finasteride, or both in benign prostatic hyperplasia. Veterans Affairs Cooperative Studies Benign Prostatic Hyperplasia Study Group. | journal=N Engl J Med | year= 1996 | volume= 335 | issue= 8 |
pages= 533-9 | pmid=8684407 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=8684407 }} </ref>
! rowspan="2"|Trial!!rowspan="2"| Patients!!rowspan="2"| Intervention!!rowspan="2"|Comparison !!rowspan="2"|Outcome!!colspan="2"|Results
|-<br/>
! Intervention!!Control
|-
| CombAT<ref  name="pmid19825505"/><br/>2009<br/>Uncontrolled factorial trial<br/>Industry sponsored|| &nbsp;|| tamsulosin 0.4 mg and/or dutasteride 0.5 daily||Placebo|| Composite at 4 years|| &nbsp;|| &nbsp;
|-
| Medical Therapy of Prostatic Symptoms (MTOPS) Research Group<ref name="pmid14681504"/><br/>2003|| &nbsp;|| doxazosin 8 mg and finasteride 5  mg daily ||Placebo|| Composite at 4.5 years|| &nbsp;|| &nbsp;
|-
| Veterans Affairs Cooperative Studies Benign Prostatic Hyperplasia Study Group<ref name="pmid8684407"/><br/>1996|| &nbsp;|| terazosin 10 mg and finasteride 5 mg daily||Placebo|| Various at one year|| &nbsp;|| &nbsp;
|}
[[Alpha adrenergic blocker]]s have been combined with [[testosterone  5-alpha-reductase]]  inhibitors in randomized controlled trials.<ref name="pmid14681504">{{cite journal| author=McConnell JD, Roehrborn CG, Bautista OM, Andriole GL, Dixon CM, Kusek JW et al.| title=The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. | journal=N Engl J Med | year= 2003 | volume= 349 | issue= 25 | pages= 2387-98 | pmid=14681504
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=14681504 | doi=10.1056/NEJMoa030656 }}  [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=15230568 Review in: ACP J Club. 2004 Jul-Aug;141(1):20] </ref><ref name="pmid8684407">{{cite journal| author=Lepor H, Williford WO, Barry MJ, Brawer MK, Dixon CM, Gormley G et al.| title=The efficacy of terazosin, finasteride, or both in benign prostatic hyperplasia. Veterans Affairs Cooperative Studies Benign Prostatic Hyperplasia Study Group. | journal=N Engl J Med | year= 1996 | volume= 335 | issue= 8 | pages= 533-9 | pmid=8684407
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=8684407 }} </ref>


===Surgery===
===Surgery===

Revision as of 12:54, 18 March 2010

This article is developing and not approved.
Main Article
Discussion
Related Articles  [?]
Bibliography  [?]
External Links  [?]
Citable Version  [?]
 
This editable Main Article is under development and subject to a disclaimer.

Benign prostatic hyperplasia, or BPH, is very common in older men. The prostate is enlarged, but it is not cancerous. Over time, an enlarged prostate may press against the urethra, making it hard to urinate.

Diagnosis

BPH may cause dribbling after urinating or a need to urinate often, especially at night. A doctor will do a rectal exam to check for BPH. And he may suggest having special x-rays or scans to check the urethra, prostate, and bladder.

The American Urological Association Urinary symptom score is a validated measure of severity of symptoms.[1]

American Urological Association Urinary symptom score: ASK THE FOLLOWING QUESTIONS: Over the past month:

  1. How often have you had a sensation of not emptying your bladder after you finish urinating?
  2. How often have you had to urinate again after you finish urinating?
  3. How often have you found you stopped and started again several times when you urinated?
  4. How often have you found it difficult to postpone urination?
  5. How often have you had a weak urinary stream?
  6. How often had you had to push or strain to begin urination?
  7. How many times did you most typically get up to urinate from the time you went to bed at night until the time you got up in the morning?
ANSWER THE QUESTIONS AS FOLLOWS, POINTS ARE BELOW:
Not at    < 1      < than 1/2     About 1/2      > than 1/2      Almost
all    time in 5     the time     the time        the time       always
0          1            2             3               4             5

Total Score:
0-7     mild
8-19    moderate
20-35   severe

Treatment

If the symptoms are not too bad, the doctor may suggest "watchful waiting" before starting any treatment. This includes regular checkups. Treatment can start later on if symptoms get worse.

Medications

Combination therapy

Randomized controlled trials of combination therapy for benign prostatic hypertrophy.[7][8][9]
Trial Patients Intervention Comparison Outcome Results
Intervention Control
CombAT[7]
2009
Uncontrolled factorial trial
Industry sponsored
  tamsulosin 0.4 mg and/or dutasteride 0.5 daily Placebo Composite at 4 years    
Medical Therapy of Prostatic Symptoms (MTOPS) Research Group[8]
2003
  doxazosin 8 mg and finasteride 5 mg daily Placebo Composite at 4.5 years    
Veterans Affairs Cooperative Studies Benign Prostatic Hyperplasia Study Group[9]
1996
  terazosin 10 mg and finasteride 5 mg daily Placebo Various at one year    

Alpha adrenergic blockers have been combined with testosterone 5-alpha-reductase inhibitors in randomized controlled trials.[8][9]

Surgery

An operation can improve the flow of urine but it can also cause other problems. Usually, men have surgery only if medicine hasn’t worked. This surgery does not protect against prostate cancer. Regular check-ups are important after BPH surgery. There are three kinds of surgery:

  • Transurethral resection of the prostate (TURP) is the most common type of surgery. The surgeon takes out part of the prostate through the urethra.
  • Transurethral incision of the prostate (TUIP) may be used when the prostate is not too large. The doctor makes a few small cuts in the prostate near the opening of the bladder.
  • Open surgery is used only when the prostate is very large. The doctor removes the prostate through a cut in the belly or behind the scrotum.

References

  1. Barry MJ, Fowler FJ, O'Leary MP, et al (November 1992). "The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association". J. Urol. 148 (5): 1549–57; discussion 1564. PMID 1279218[e]
  2. 2.0 2.1 Nickel JC, Sander S, Moon TD (2008). "A meta-analysis of the vascular-related safety profile and efficacy of alpha-adrenergic blockers for symptoms related to benign prostatic hyperplasia.". Int J Clin Pract 62 (10): 1547-59. DOI:10.1111/j.1742-1241.2008.01880.x. PMID 18822025. PMC PMC2658011. Research Blogging.
  3. Gormley GJ, Stoner E, Bruskewitz RC, Imperato-McGinley J, Walsh PC, McConnell JD et al. (1992). "The effect of finasteride in men with benign prostatic hyperplasia. The Finasteride Study Group.". N Engl J Med 327 (17): 1185-91. PMID 1383816.
  4. Wilt TJ, Ishani A, Stark G, MacDonald R, Lau J, Mulrow C (1998). "Saw palmetto extracts for treatment of benign prostatic hyperplasia: a systematic review". JAMA 280 (18): 1604–9. PMID 9820264[e]
  5. Bent S, Kane C, Shinohara K, et al (2006). "Saw palmetto for benign prostatic hyperplasia". N. Engl. J. Med. 354 (6): 557–66. DOI:10.1056/NEJMoa053085. PMID 16467543. Research Blogging.
  6. Kaplan SA, Roehrborn CG, Rovner ES, Carlsson M, Bavendam T, Guan Z (2006). "Tolterodine and tamsulosin for treatment of men with lower urinary tract symptoms and overactive bladder: a randomized controlled trial.". JAMA 296 (19): 2319-28. DOI:10.1001/jama.296.19.2319. PMID 17105794. Research Blogging.
  7. 7.0 7.1 Roehrborn CG, Siami P, Barkin J, Damião R, Major-Walker K, Nandy I et al. (2010). "The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia: 4-year results from the CombAT study.". Eur Urol 57 (1): 123-31. DOI:10.1016/j.eururo.2009.09.035. PMID 19825505. Research Blogging.
  8. 8.0 8.1 8.2 McConnell JD, Roehrborn CG, Bautista OM, Andriole GL, Dixon CM, Kusek JW et al. (2003). "The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia.". N Engl J Med 349 (25): 2387-98. DOI:10.1056/NEJMoa030656. PMID 14681504. Research Blogging. Review in: ACP J Club. 2004 Jul-Aug;141(1):20 Cite error: Invalid <ref> tag; name "pmid14681504" defined multiple times with different content
  9. 9.0 9.1 9.2 Lepor H, Williford WO, Barry MJ, Brawer MK, Dixon CM, Gormley G et al. (1996). "The efficacy of terazosin, finasteride, or both in benign prostatic hyperplasia. Veterans Affairs Cooperative Studies Benign Prostatic Hyperplasia Study Group.". N Engl J Med 335 (8): 533-9. PMID 8684407. Cite error: Invalid <ref> tag; name "pmid8684407" defined multiple times with different content