Evidence‐based meta‐analysis of pharmacotherapy for benign prostatic hypertrophy

Abstract

Evidence-based diagnosis and treatment have been proposed recently in various medical fields. Evidence-based diagnostic and therapeutic guidelines for benign prostatic hypertrophy (BPH), one of the most common urological diseases, have been proposed in foreign countries. This paper examines common therapeutic drugs for BPH in Japan from the viewpoint of evidence-based medicine (EBM). The term 'BPH' and drugs indicated for BPH were used as key words to search related articles in the PubMed website. A total of 813 articles extracted as of October 2001 were examined. The articles were ranked in levels ranging from I-V, where Level I indicated a large randomized controlled trial and Level V indicated a non-controlled case accumulation study. Among the 813 articles extracted, 132 clinical articles were suitable for evaluation. There were many reliable articles on the effectiveness of a -blockers. However, it seemed necessary to examine further how to choose the optimum a -blocker for each clinical case and the combination of antiandrogen drugs with a -blockers. It was also considered necessary to evaluate the effectiveness of drugs, such as eviprostat and hachimi-jio-gan, that are available only in Japan.The present study evaluated the effectiveness of commonly available therapeutic drugs for BPH in Japan from a viewpoint of EBM.

Tadalafil for the Treatment of Lower Urinary Tract Symptoms in Japanese Men with Benign Prostatic Hyperplasia: Results from a 12‐week Placebo‐controlled Dose‐finding Study with a 42‐week Open‐label Extension

“…tamsulosin, prazosin, silodosin, naftopidil, and terazosin), antiandrogens (e.g. oxendolone, chlormadinone acetate, and allylestrenol), and the 5‐ α reductase inhibitor, dutasteride 8,9 . Although these treatments are effective in reducing symptoms caused by BPH, they have been associated with side‐effects such as dizziness and hypotension ( α ‐blockers), or sexual dysfunction (tamsulosin, silodosin, dutasteride, and antiandrogens), 3,8,10–15 which may impact treatment adherence 16 .…”

“…oxendolone, chlormadinone acetate, and allylestrenol), and the 5-α reductase inhibitor, dutasteride. 8,9 Although these treatments are effective in reducing symptoms caused by BPH, they have been associated with side-effects such as dizziness and hypotension (α-blockers), or sexual dysfunction (tamsulosin, silodosin, dutasteride, and antiandrogens), 3,8,10 -15 which may impact treatment adherence. 16 In a retrospective assessment of Japanese men treated with silodosin, a low 1-year continuation rate (12.0%) was attributed in part to the occurrence of adverse events (AEs; 28.7%).…”

Prostate cancer incidence among finasteride and alpha-blocker users in the Finnish Prostate Cancer Screening Trial

“…a1-Adrenoceptor antagonists (alpha-blockers) are used in the medical management of symptoms of benign prostatic hyperplasia. Alpha-blockers lower smooth muscle tension in the prostate and urinary tract, thereby improving urinary flow and decreasing LUTS (Ishizuka et al, 2002). Some experimental studies have reported increased prostate cancer cell apoptosis after treatment with quinazoline-derived alpha-blockers, terazosin and doxazosin (Kyprianou and Benning, 2000;Benning and Kyprianou, 2002).…”

Association between 5α-reductase inhibitors therapy and incidence, cancer-specific mortality, and progression of prostate cancer: evidence from a meta-analysis

“…5α-reductase inhibitors (5-ARI) are a class of therapeutic agent that can reduce prostate volume via a hormonal regulation mechanism, thus improving the symptoms of the lower urinary tract in patients suffering from benign prostatic hyperplasia (BPH). 1 Dihydrotestosterone (DHT) serves a crucial role regulating the cell proliferation of both normal prostatic epithelial and prostate cancer. 2 3 5-ARI are specific inhibitor of intracellular 5α-reductase, which is necessary for the process of testosterone metabolism into DHT.…”