Treatment of Benign Prostatic Hyperplasia
Benign prostatic hyperplasia (BPH) is one of the most frequent diseases of elderly men. 50% of men of 50 years old and 80-90% of men of 80 years old have this kind of benign tumors. More than 23 million men have BPH symptoms. On this basis, we can see medical and social problems of this kind of disease.
Age-related changes of balance of androgenic hormones develop BPH. Imbalance of androgenic hormones causes prostate tumor, which is a target-organ for sex hormones.
The pathogenesis of BPH is based on disorder of bladder functions.
The International Prostate Symptom Score (IPSS) is an eight-question approved by the International BPH Conferences (Paris, 1993, 1997, 2000; Monaco, 1995). According to the International Prostate Symptom Score (IPSS) and a step scale, it is possible to scale presence and evidence of the next seven symptoms: incomplete emptying, frequent urination, discrete urination, micturition urgency, weak urine stream, late start of stream, and night pollakiuria. These symptoms of the disease have a negative influence on life-style of a patient and make life of a patient worse.
A clinical presentation and state of disease mostly depend on degree of disorder of urination. It is necessary to remember that there are two reasons of development of infravesicular obstruction at BPH. They are static reason and dynamic reason. A static reason is hyperplasia of urethra tissue squeezing urethra mechanically; a dynamic reason is hyperactivity of adrenoreceptors of bladder neck, of prostatic urethra, and of prostate (constriction).
In this connection, despite complicate genesis of symptoms of BPH, there are two groups of symptoms of BPH. There are obstructive symptoms and irritative symptoms. Obstructive symptoms are urinary retention, weak urine stream, sense of incomplete emptying, abdominal muscles tension, and drop urinary. The reason of obstructive symptoms is progressive difficult urinary caused by hyperplasia. Irritative symptoms are day and night pollakiuria, micturition urgency, and urinary incontinence. Irritative symptoms are symptoms of irritation caused by the degree of a functional illness of neuromuscular system of bladder.
The main methods of physical examination are digital rectal investigation, bladder and prostate ultrasound, uroflowmetry, and analysis of prostate-specific antigen (PSA).
It is very important to determine a kidney function and to determine if there are inflammatory changes in kidneys and urinary tracts to choose a method of treatment.
Besides BPH, men of elderly and old age have various associated diseases increasing a risk of development of complications of surgical treatment of patients who have BPH. In this connection, a role of medical treatment of the disease increases.
Currently, to this purpose, the 5-α-Reductase inhibitors and the α-adrenoreceptors blockers are often used.
What is Proscar
The Proscar (Finasteride) medicine made by the “Merck Sharp and Dohme” Company is competitive 5-α-Reductase enzyme inhibitor acting in prostate cells. Proscar has pathogenetic action to hyperplasia tissues of the organ, reduces a size of the organ, and causes regressive symptoms of infravesicular obstruction.
Finasteride is the main active component of medicine. It is the 5-α-Reductase testosterone inhibitor (the second type). The substance is an intracellular enzyme converting testosterone to androgen dihydrotestosterone causing mainly this kind of prostatic hyperplasia. Activity of androgen dihydrotestosterone is the highest.
Effectiveness of Finasteride reducing a level of recycling and prostatic dihydrotestosterone is very high. The medicine keeps halving of acute retention after 4 years of treatment. During this period, risk of surgical intervention reduces by 50%.
Size of prostate reduces by 1/5 and speed of urination increases. Risks of the disease to keep progress reduce by 67%.
The USA research revealed that if regular taking of the medicine against benign prostatic hypertrophy, risk of pernicious prostate diseases increases by 25%.
Proscar Indications
The medicine is used for treatment and control of benign prostatic hyperplasia of patients whose prostates are increasing. The results of treatment with the medicine are:
- decrease (regression) of increasing prostate;
- increase urination speed;
- decrease amount of hyperplasia symptoms;
- decrease risk of acute urinary retention and decrease risk of surgical intervention such as transurethral resection of the prostate and prostatectomy.
Proscar Contraindications
Contraindication of the medicine is acute hypersensitivity (allergy) of a patient to one of the main ancillary components.
Taking Proscar with Pregnancy and Nursing
Pregnant women should not take the medicine for treatment.
If the medicine is necessary to take during nursing period, lactation should be inhibited during treatment.
Method of Application of Proscar and Doses of Proscar
The medicine is prescribed to take it regularly for a long time. Recommended dose is 5 mg (1 pill) once a day at the same time.
Taking of the medicine does not depend on meal.
The treatment course may take many months or many years. Diagnostic investigation helps to determine punctual duration of treatment depends on effectiveness of the medicine individually.
Effectiveness of the medicine is determined once per 6 months.
Increasing dose does not increase effectiveness.
Dose correction is not necessary for elder patients as well as for patients who have renal failure or hepatic failure.
Proscar Overdose
Registered cases of overdose (400 mg per once and 80 mg daily during 3 months) did not cause side effects.
There are no recommendations for overdose to neutralize.
Proscar Side Effects
Possible side effects are:
- erectile dysfunction and often decreased interest are usually over after treatment termination;
- allergic reactions are rash, pruritus, medicamentous urticaria, and angioneurotic edema;
- depression and tachycardia;
- increasing level of liver enzymes;
- impotence, ejaculation disorder, increasing beast, pain in beast, breast cancer, pain in testis, decreasing semen quality;
- decreasing ejaculate.
