Benign Prostatic Hyperplasia: Challenges and Opportunities in Modern Treatment
Urination disorders become more common with age. Usually, men are troubled by these urological symptoms: weakened urine stream, sudden difficult-to-control urge to urinate, frequent urination, nocturia. The older the man, the more frequent these symptoms become, among them weak urine stream symptom prevails in all age groups: its prevalence is about 30% under 50 years old, around 45% in 50–59 years old, almost 65% in 60–69 years old, about 70% in 70–79 years old, over 75% in 80–84 years old. From the age of 60, another symptom starts to increase rapidly – nocturia: in the age group of 70–84 years, its frequency reaches 60–65%.
Benign prostatic hyperplasia (BPH) manifests with so-called lower urinary tract symptoms, which are pathophysiologically divided into: urinary retention, voiding, and post-micturition symptoms.
• Urinary retention: nocturia, sudden urge to urinate, frequent urination, urinary incontinence.
• Voiding: dribbling at the end of urination, weak urine stream, straining to urinate, intermittent urine stream.
• Post-micturition symptoms: sensation of incomplete emptying after urination, post-micturition dribble.
In the 2004 European Association of Urology guidelines, it is stated that the main goals of BPH treatment are: to relieve lower urinary tract symptoms, improve patients' quality of life, protect against BPH-related complications such as urinary retention and upper urinary tract dilatation.
When treating BPH, like many chronic diseases, the aim is to effectively manage symptoms and prevent disease progression, significantly improving patients' quality of life. BPH treatment has a long history. As knowledge about this disease, its causes, and consequences has increased, treatment goals have evolved.
At the beginning of the 20th century, when treating patients with BPH, doctors had almost one task: to reduce acute and chronic urinary retention. Over time, the goals and tasks of treatment increased: to reduce the risk of BPH complications, treat lower urinary tract symptoms, delay the need for surgical treatment, halt disease progression, and one of the most important goals of modern medicine – preserve bladder function.
Currently, the following tactics are used to treat BPH:
• Watchful waiting;
• Drug therapy;
• Minimally invasive therapy;
• Surgical treatment.
If lower urinary tract symptoms are mild, a watchful waiting approach and herbal remedies may be sufficient. When the disease progresses, treatment with alpha-1 adrenergic blockers (AAB), 5-alpha reductase inhibitors (5-ARI), anticholinergic drugs is initiated.
If treatment with a single drug is not effective, drug combinations are prescribed:
• AAB and 5-ARI;
• AAB and anticholinergic drug;
• AAB and phosphodiesterase 5 (PDE-5) inhibitors.
New drugs are currently being tested in clinical trials for the treatment of BPH, including next-generation alpha-adrenergic blockers.
Minimally invasive procedures for BPH include:
• Thermal therapy (TUMT, TUNA, etc.);
• Laser therapy (KTP, Ho – Laser, ILC);
• Injection solutions (alcohol, botox);
• Stenting.
Surgical treatment: mono- or bipolar TURP, TUIP, open surgery.
Herbal treatment
For the treatment of benign prostatic hyperplasia with herbal remedies, one of the most commonly used herbal medicines is preparations of Serenoa repens (registered in Lithuania under the name Prostamol uno). Clinical trials of Prostamol have been conducted since 1990. Comparative studies involving over 1000 patients with BPH have shown that Prostamol uno significantly more effectively reduced the symptoms of the disease compared to placebo and was equally safe.
Prostamol uno effectively alleviated severe and moderate BPH symptoms over 12 months, as effectively as the alpha-1 adrenergic blocker tamsulosin.
After 26 weeks, Prostamol uno significantly improved the symptoms of Benign Prostatic Hyperplasia (BPH) and the quality of life of patients as effectively as 5-alpha reductase inhibitors, and even more effectively improved the strongest urinary flow than 5-alpha reductase inhibitors. Prostamol uno significantly improved the sexual function of patients suffering from BPH.
TRIUMPH comparative study analysis showed that all current drugs used to treat BPH (Serenoa repens, AAB, 5-ARI) are significantly more effective compared to careful observation.
Alpha-1 adrenergic blockers are among the most commonly chosen drugs for treating BPH because they effectively reduce the symptoms of the disease and improve the quality of life of patients. However, when taking AAB, unwanted effects on sexual function may occur - ejaculatory disorders, decreased libido. A study by Debruyne F. et al. showed that Serenoa repens preparations significantly surpass AAB in terms of safety for sexual function: only 0.6% of patients treated with Prostamol uno experienced ejaculatory disorders and only 0.3% of patients experienced decreased libido. In the group of patients treated with tamsulosin, these unwanted effects occurred in 4.2% and 1.1% of cases, respectively.
Prostamol uno is a herbal medicine made from spirit of Serenoa repens fruit extract, one of the most effective and well-researched herbal medicines used to treat BPH. The efficacy and safety of Prostamol uno in treating BPH have been proven in numerous clinical trials conducted in various countries:
• A 12-month study in Slovakia involving patients with symptomatic BPH.
• A study in Romania (FLUX, 24 months) involving patients with mild or moderate BPH.
• A 36-month study in Russia involving patients with initial BPH symptoms and a high risk of disease progression.
Summary
Studies have shown that Prostamol uno:
• is very well tolerated (similar to placebo); it may cause discomfort in the stomach only in rare cases;
• effectively reduces lower urinary tract and other BPH symptoms;
• does not worsen sexual function (does not affect ejaculation, does not decrease libido), with only very few cases of sexual dysfunction identified;
• helps improve erectile function disturbed by BPH;
• has no effect on prostate cancer screening markers (the effect on PSA level is insignificant);
• patients rate the treatment with Prostamol uno very favorably.
According to Prof. Frans M. J. Debruyne's lecture "Pharmacological Management of BPH" presented by Dr. J. Kastys at the Baltic Countries Congress of the European Association of Urology in Vilnius on May 23-25, 2014.
References
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11. source not provided