BPH - Treatment with medications
Dr. Kevin Zorn, MD, FRCSC, FACS, Urologist
Treatment with medication is the frontline therapy that primary care, emergency doctors, and urologists have been prescribing since their first discovery in the 1970s. Medications called alpha-blockers are typically used first and they are used to relax the prostate. Flomax, you have Zatrial and a newer one called Rapid Flow. They are easy-to-apply medications which are relatively safe and with a quick onset of around a week. These medications can help get men who were in acute retention and who had a catheter placed a week ago out of trouble.
There's a 70% - 80% chance that medication will get patients out of retention. Once men start on this medication, they do have to take it forever after that point. It's a life long medication and it’s sole function is to relax the prostate. If you have a large prostate it is not going to change the anatomy and it's not going to stop BPH. In other words, the prostate will continue to grow, at approximately 2% to 5% in volume per year. At some point in men’s 50’s or 60’s, and occasionally in the 40s, men's prostate start this secondary growth phase which we know is related to genetics, so some familial family history, hormones or testosterone derivatives inside the prostate, are triggering that growth.
Medications like alpha blockers don't actually treat BPH, they treat the symptoms by relaxing the muscle around the urethra, so thereby reducing some of the resistance.
Sometimes we will add in a second line medication in order to try and shrink the prostate. These medications are called the five alpha reductase inhibitors. So we have Proscar or Avodart These are medications which work by lowering the conversion of testosterone within the prostate. Over a period of 6 to 12 months, this can shrink the prostate by around 20%.
Taking five alpha reductase inhibitors may be a good option for patients looking to avoid surgical therapy. The downside is that it is again a lifelong therapy and it can have sexual impacts by lowering the libido. Some people have also experienced some breast tenderness and less ejaculatory volume with these medications.
Studies have shown that when an alpha blocker and a five alpha reductase inhibitor are used together, patients had the best improvements in their IPSS scores and had the greatest reduction in risk of having acute retention or needing surgery, four years after initiating dual therapy.
At this point, if you are not happy with medication therapy, then the next step would be surgical therapy. This would be a maximal tissue removing surgery where it’s minimally invasive and office based.
Presenter: Dr. Kevin Zorn, Urologist, Montreal, QC
Local Practitioners: Urologist
