Use of 5α-reductase inhibitors to prevent benign prostatic hyperplasia disease

Abstract

A histologic change in the prostate, benign prostatic hyperplasia (BPH), is a normal part of aging. However, BPH disease, defined here as a life-altering urinary condition caused by BPH requiring prompt medical intervention, is a serious medical disorder associated with major complications, surgical intervention, and severe lifestyle interference. BPH disease is preventable. The rationale for BPH disease prevention rests on four pillars of evidence: (1) BPH disease generally is a progressive disorder; (2) complications and severe lifestyle interference from BPH disease are common and serious; (3) men at greatest risk of BPH disease can be identified using prostate-specific antigen (PSA) level higher than 1.5 ng/mL as a surrogate marker for an enlarged prostate; and (4) 5alpha-reductase inhibitors (5ARIs) reduce the primary androgen responsible for prostate growth (dihydrotestosterone), shrink the prostate, and arrest the disease process regardless of symptom status. Thus, we now can identify men with an enlarged prostate at risk for BPH disease who may be candidates for preventive therapy with 5ARIs, regardless of urinary symptoms or bother.

Androgen Deficiency and Defective Intracrine Processing of Dehydroepiandrosterone in Salivary Glands in Sjögren’s Syndrome

“…be treated by 5-α-reductase inhibition 17 . Also in SS it would seem to be more important to check the local tissue concentrations, conversions, and effects of DHEA rather than to assess their somewhat irrelevant systemic levels.…”

Canary in the Coal Mine? Male Infertility as a Marker of Overall Health

“…Five-α reductase (5AR) is the enzyme involved in steroid metabolism that is responsible for the conversion of testosterone to dihydrotestosterone (DHT). Individuals with 5AR deficiency therefore have a 46XY karyotype but anatomically have testes, internal Wolffian duct structures (ejaculatory ducts, epididymis, vas deferens, and seminal vesicles), and female external genitalia (99). These individuals are often raised as females until puberty, when phallic development occurs; they continue to have reduced facial hair, no acne, and limited recession of their hair line (99).…”

“…Individuals with 5AR deficiency therefore have a 46XY karyotype but anatomically have testes, internal Wolffian duct structures (ejaculatory ducts, epididymis, vas deferens, and seminal vesicles), and female external genitalia (99). These individuals are often raised as females until puberty, when phallic development occurs; they continue to have reduced facial hair, no acne, and limited recession of their hair line (99). These males have reduced phallic length and hypospadias, which may preclude natural conception, but also low volume and viscous ejaculates due to poor prostate growth from deficient dihydrotestosterone and an absence of serine proteases necessary for liquefaction (81).…”