New Pharmacologic Horizons in the Treatment of Benign Prostatic Hyperplasia

Yoshiyuki      Kojima; Masa      Hayase; Shoichi      Sasaki; Yutaro      Hayashi; Kenjiro      Kohri

Abstract

Benign prostatic hyperplasia (BPH) is a progressive disease that is commonly associated with bothersome lower urinary tract symptoms (LUTS) such as incomplete emptying, frequency, intermittency, urgency, weak stream, straining and nocturia. Surgical therapy, mainly transurethral resection of the prostate, used to be the major method of BPH therapy, but it is now being applied in more limited case, and medical therapy is usually applied first. Recent studies have shed new light on the medical therapy of this common problem in aging men. Alpha1-adrenoceptor (α1-AR) antagonists are often used as first line medical therapy for the patients affected by BPH. However, they are more effective in combination with 5α-reductase inhibitors depending on the prostate volume, or with anti-muscarinic agents if overactive bladder symptoms such as urgency, frequency, and/or urge incontinence predominate. Additionally, the combination of α1-AR antagonists and phosphodiesterase-5 inhibitors may have a positive impact on both LUTS and erectile dysfunction. Although the objectives of medical therapy for BPH include not only reduction of symptoms, but also improvement of quality of life, the choices of the medical therapeutic options should be personalized for the individual patient. Efforts to characterize the effect of genetic heterogeneity in response to each drug may add credence to the viability of the concept of pharmacogenomics and the realization of personalized medicine for the treatment of BPH. The purpose of this review is to summarize the recent concept of BPH medical therapy, and to discuss a potential new strategy based on the individual genetic information.

Keywords: Benign prostatic hyperplasia, lower urinary tract symptom, α1-adrenoceptor antagonists, 5α-reductase inhibitor, antimuscarinics, phosphodiesterase-5 inhibitors, combination therapy, pharmacogenomics, urinary tract symptoms, Alpha1-adrenoceptor, a1-AR antagonists, a1-adrenoceptor antagonists, 5a-reductase inhibitor, nocturia, urge incontinence predominate, catecholamines, prazosin, terazosin, doxazosin, Placebo-controlled, Alfuzosin, postural hypotension, adrenergic stimulation, Tamsulosin, naftopidil, silodosin, testosterone, dihydrotestosterone, isoenzymes, finasteride blocks, Medical Therapy of Prostatic Symptoms, detrusor muscle, antimuscarinic drugs, uroepithelium, oxybutynin, tolterodine, propiverine, trospium, darifenacin, solifenacin, Dutasteride, Finasteride, Sildenafil, Vardenafil, Tadalafil, polymorphism, haplotypes