Management of benign prostate hyperplasia (BPH) by combinatorial approach using alpha-1-adrenergic antagonists and 5-alpha-reductase inhibitors

Abstract

Currently, the main available treatments for benign prostate hyperplasia (BPH) are alpha-1 adrenergic receptor antagonists (ARAs), 5-alpha reductase inhibitors (5-αRI), anticholinergics, and Phosphodiesterase-5 inhibitors. Recent studies support the combined therapy approach using ARAs with 5-αRI for lower urinary tract symptoms (LUTS) in BPH patients at risk of clinical progression. We aimed to review BPH management in select group of randomized controlled trials by combination therapy with ARAs and 5-αRIs compared to monotherapy with either drug with respect to the safety and efficacy. A total of 6 randomized controlled trials (RCTs) involving comparison of combination therapy with monotherapy using ARAs and 5-αRIs were retrieved from PubMed Central and reviewed for international prostate symptom score (IPSS), quality of life (QoL), post-residual urinary flow rate (PUF), and clinical progression. The results significantly favour the treatment group that received the combination therapy in comparison with the groups receiving monotherapy. However, outcome with regard to prostate volume showed insignificant improvement when the combination therapy is compared with 5-αRIs alone, rather than ARAs. In conclusion, combination therapy using ARAs and 5-αRI is better than monotherapy in the patients of BPH. Fixed dose combination (FDC), a type of combination, is also cost-effective and its sideeffects profile resembles to that of monotherapy.

Comparative efficacy and safety of alpha-blockers as monotherapy for benign prostatic hyperplasia: a systematic review and network meta-analysis

“…Benign prostatic hyperplasia (BPH) is a ubiquitous urological disease that inevitably affects older men, occurring in up to 50% of men over 50 to 60 years, rising to 90% by age 80, and its predominance increases further with age 1 – 3 . BPH results from the noncancerous prostate gland enlargement induced by cellular hyperplasia of both glandular and stromal components 4 .…”

Prostate diseases: pathogenetic bases and therapeutic possibilities of entomotherapy

“…Арсенал медикаментозных средств для лечения заболеваний предстательной железы и симптомов со стороны нижних мочевых путей (СНМП) достаточно большой. Перечень используемых препаратов у больных ДГПЖ включает ингибиторы 5α-редуктазы, α-адреноблокаторы, антихолинергические препараты, ингибиторы фосфодиэстеразы 5-го типа [25][26][27]. Пациентам с бактериальным простатитом назначают антибактериальные препараты, а при наличии простатического болевого синдрома -нестероидные противовоспалительные средства [28].…”

Treatment of Benign Prostatic Hyperplasia by Natural Drugs

“…To prevent the disease progression, α1-blocker + 5α-reductase inhibitor combinational therapy may also have potential, especially if the patient accepts long-term medication ( Table 1 ). In cases when detrusor overactivity was demonstrated, co-administration of α1-blockers and muscarinic receptor antagonists showed synergic activity [ 10 , 23 , 24 ]. In patients with overactive bladder symptoms, β-3 adrenergic agonist (mirabegron) add-on therapy was also investigated as a promising alternative [ 15 ].…”