The Use of 5-alpha Reductase Inhibitors in the Treatment of Benign Prostatic Hyperplasia

Overview

Journal Asian J Urol

Specialty Urology

Date 2018 Jan 31

PMID 29379733

Citations 36

Authors

Eric H Kim

John A Brockman

Gerald L Andriole

Affiliations

Soon will be listed here.

Abstract

Benign prostatic hyperplasia (BPH) is characterized by an enlarged prostate, lower urinary tract symptoms (LUTS), and a decreased urinary flow rate. Common in older men, BPH is a progressive disease that can eventually lead to complications including acute urinary retention (AUR) and the need for BPH-related surgery. Both normal and abnormal prostate growth is driven by the androgen dihydrotestosterone (DHT), which is formed from testosterone under the influence of 5-alpha reductase. Thus, 5-alpha reductase inhibitors (5-ARIs) effectively reduce the serum and intraprostatic concentration of DHT, causing an involution of prostate tissue. Two 5-ARIs are currently available for the treatment of BPH-finasteride and dutasteride. Both have been demonstrated to decrease prostate volume, improve LUTS and urinary flow rates, which ultimately reduces the risk of AUR and BPH-related surgery. Therefore, either alone or in combination with other BPH medications, 5-ARIs are a mainstay of BPH management.

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References

Souverein P, van Riemsdijk M, de la Rosette J, Opdam P, Leufkens H . Treatment of benign prostatic hyperplasia and occurrence of prostatic surgery and acute urinary retention: a population-based cohort study in the Netherlands. Eur Urol. 2005; 47(4):505-10. DOI: 10.1016/j.eururo.2004.11.001. View

Lepor H . Alpha blockers for the treatment of benign prostatic hyperplasia. Rev Urol. 2008; 9(4):181-90. PMC: 2213889. View

Roehrborn C, McConnell J, Bonilla J, Rosenblatt S, Hudson P, Malek G . Serum prostate specific antigen is a strong predictor of future prostate growth in men with benign prostatic hyperplasia. PROSCAR long-term efficacy and safety study. J Urol. 1999; 163(1):13-20. View

Andriole G, Bostwick D, Brawley O, Gomella L, Marberger M, Montorsi F . Effect of dutasteride on the risk of prostate cancer. N Engl J Med. 2010; 362(13):1192-202. DOI: 10.1056/NEJMoa0908127. View

McVary K, Roehrborn C, Avins A, Barry M, Bruskewitz R, Donnell R . Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol. 2011; 185(5):1793-803. DOI: 10.1016/j.juro.2011.01.074. View

Crawford E, Wilson S, McConnell J, Slawin K, Lieber M, Smith J . Baseline factors as predictors of clinical progression of benign prostatic hyperplasia in men treated with placebo. J Urol. 2006; 175(4):1422-6. DOI: 10.1016/S0022-5347(05)00708-1. View

Sarma A, Jacobson D, McGree M, Roberts R, Lieber M, Jacobsen S . A population based study of incidence and treatment of benign prostatic hyperplasia among residents of Olmsted County, Minnesota: 1987 to 1997. J Urol. 2005; 173(6):2048-53. DOI: 10.1097/01.ju.0000158443.13918.d6. View

Guess H, Arrighi H, Metter E, Fozard J . Cumulative prevalence of prostatism matches the autopsy prevalence of benign prostatic hyperplasia. Prostate. 1990; 17(3):241-6. DOI: 10.1002/pros.2990170308. View

Stoner E . Three-year safety and efficacy data on the use of finasteride in the treatment of benign prostatic hyperplasia. Urology. 1994; 43(3):284-92; discussion 292-4. DOI: 10.1016/0090-4295(94)90068-x. View

10.

Jacobsen S, Jacobson D, Girman C, Roberts R, Rhodes T, Guess H . Natural history of prostatism: risk factors for acute urinary retention. J Urol. 1997; 158(2):481-7. DOI: 10.1016/s0022-5347(01)64508-7. View

11.

Wurzel R, Ray P, Major-Walker K, Shannon J, Rittmaster R . The effect of dutasteride on intraprostatic dihydrotestosterone concentrations in men with benign prostatic hyperplasia. Prostate Cancer Prostatic Dis. 2006; 10(2):149-54. DOI: 10.1038/sj.pcan.4500931. View

12.

Roehrborn C, McConnell J, Lieber M, Kaplan S, Geller J, Malek G . Serum prostate-specific antigen concentration is a powerful predictor of acute urinary retention and need for surgery in men with clinical benign prostatic hyperplasia. PLESS Study Group. Urology. 1999; 53(3):473-80. DOI: 10.1016/s0090-4295(98)00654-2. View

13.

Deslypere J, Young M, Wilson J, McPhaul M . Testosterone and 5 alpha-dihydrotestosterone interact differently with the androgen receptor to enhance transcription of the MMTV-CAT reporter gene. Mol Cell Endocrinol. 1992; 88(1-3):15-22. DOI: 10.1016/0303-7207(92)90004-p. View

14.

Anderson J, Roehrborn C, Schalken J, Emberton M . The progression of benign prostatic hyperplasia: examining the evidence and determining the risk. Eur Urol. 2001; 39(4):390-9. DOI: 10.1159/000052475. View

15.

Redman M, Tangen C, Goodman P, Lucia M, Coltman Jr C, Thompson I . Finasteride does not increase the risk of high-grade prostate cancer: a bias-adjusted modeling approach. Cancer Prev Res (Phila). 2009; 1(3):174-81. PMC: 2844801. DOI: 10.1158/1940-6207.CAPR-08-0092. View

16.

McConnell J, Bruskewitz R, Walsh P, Andriole G, Lieber M, HOLTGREWE H . The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. Finasteride Long-Term Efficacy and Safety Study Group. N Engl J Med. 1998; 338(9):557-63. DOI: 10.1056/NEJM199802263380901. View

17.

Norman R, Coakes K, Wright A, Rittmaster R . Androgen metabolism in men receiving finasteride before prostatectomy. J Urol. 1993; 150(5 Pt 2):1736-9. DOI: 10.1016/s0022-5347(17)35882-2. View

18.

Guess H, Gormley G, Stoner E, Oesterling J . The effect of finasteride on prostate specific antigen: review of available data. J Urol. 1996; 155(1):3-9. View

19.

Lepor H, Williford W, Barry M, Brawer M, DIXON C, Gormley G . The efficacy of terazosin, finasteride, or both in benign prostatic hyperplasia. Veterans Affairs Cooperative Studies Benign Prostatic Hyperplasia Study Group. N Engl J Med. 1996; 335(8):533-9. DOI: 10.1056/NEJM199608223350801. View

20.

Frye S, Bramson H, Hermann D, Lee F, Sinhababu A, Tian G . Discovery and development of GG745, a potent inhibitor of both isozymes of 5 alpha-reductase. Pharm Biotechnol. 1998; 11:393-422. DOI: 10.1007/0-306-47384-4_17. View