Management of Benign Prostatic Hyperplasia in 2024
DOI:
https://doi.org/10.58931/cpct.2024.2125Abstract
Benign prostatic hyperplasia (BPH) is a condition involving the proliferation of smooth muscle and epithelial cells within the transition zone of the prostate. The process by which this takes place is not precisely known. It does require that testosterone and 5-alpha reductase convert it to dihydrotestosterone (DHT) which is the active androgen within the prostate. The growth of the prostate results from an imbalance between cell growth and cell death. Obstruction occurs via compression of the urethra by the resulting hyperplastic nodules, as well as increased smooth muscle tone and resistance within the enlarged gland. It is an almost universal process in men beginning in their 40’s; it increases to a prevalence of 60% by age 60 and 80% by age 80.1 This results in progressive bladder outlet obstruction (BOO) and lower urinary tract symptoms (LUTs). Patients can range from being asymptomatic to severely symptomatic. In the most extreme cases, it can result in complete urinary retention and renal dysfunction. The annual economic impact of BPH has been estimated at nearly $4 billion in the Unites States.
References
Lerner LB, McVary KT, Barry MJ, et al. J Urol. Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA GUIDELINE PART 1-Initial Work-up and Medical Management. 206(10):806-17.
Saigal CS, Joyce G. Economic costs of BPH in the private sector. J Urol, 173(4):1309-13.
Elterman D, Aube-Peterkin M, Evans H, et al. UPDATE-Canadian Urologic Association guideline: Male lower urinary tract symptoms/benign prostatic hyperplasia. Can Urol Assoc J. 2022;16(8):245-56. DOI: https://doi.org/10.5489/cuaj.7906
Mason RJ, Marzouk K, Finelli A, et al. UPDATE-2022 Canadian Urologic Association recommendations on prostate cancer screening and early diagnosis: Endorsement of the 2021 Cancer Care Ontario guidelines on prostate multiparametric magnetic resonance imaging. Can Urol Assoc J. 2022;16(4).
US Preventive Services Task Force. Screening for prostate cancer: US Preventive Services Task Force recommendation statement. JAMA. 2018;319:1901-13. DOI: https://doi.org/10.1001/jama.2018.3710
Campbell RJ, El-Defrawy SR, Gill SS et al. Evolution in the risk of cataract surgical complications among patients exposed to tamsulosin: a population-based study. Ophthalmology. 2019;126:490. DOI: https://doi.org/10.1016/j.ophtha.2018.11.028
Michel MC, Vrydag W. Adrenoreceptors in the urinary bladder, urethra and prostate. Br J Pharmacol. 2006 Feb;147(Suppl 2).
Dahm P, Brasure M, MacDonald R et al. Comparative effectiveness of newer medications for lower urinary tract symptoms attributed to benign prostatic hyperplasia: a systematic review and meta-analysis. Eur Urol. 2017;71:570. DOI: https://doi.org/10.1016/j.eururo.2016.09.032
Boyle P, Gould AL, Roehrborn CG. Prostate volume predicts outcome of treatment of benign prostatic hyperplasia with finasteride: meta-analysis of randomized clinical trials. Urology. 1996;48:398. DOI: https://doi.org/10.1016/S0090-4295(96)00353-6
Nickel JC, Giling P, Tammela TL. Comparison of dutasteride and finasteride for treating benign prostatic hyperplasia: the Enlarged Prostate International Comparator Study (EPICS). BJU Int. 2011;108:388. DOI: https://doi.org/10.1111/j.1464-410X.2011.10195.x
Nguyen DD, Marchese M, Cane EB, et al. Investigation of suicidality and psychological adverse events in patients treated with finasteride. JAMA Dermatol. 2021;157:35-42. DOI: https://doi.org/10.1001/jamadermatol.2020.3385
Etzioni RD, Howlader N, Shaw PA, et al. Long-term effects of finasteride on prostate specific antigen levels: results from the Prostate Cancer Prevention trial. J Urol. 2005;174:877. DOI: https://doi.org/10.1097/01.ju.0000169255.64518.fb
McConnel JD, Roehrborn CG, Bautista OM, et al. The Medical Therapy of Prostatic Symptoms (MTOPS) Research Group. The long-term effects of doxazosin, finasteride and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med. 2003;349:2387-98. DOI: https://doi.org/10.1056/NEJMoa030656
Roehrborn CG, Siami P, Barkin J, et al. The effects of dutasteride, tamsulosin and combination therapy on lower urinary tract symptoms in men with benign prostatic hyperplasia and prostatic enlargement: 2-year results from the CombAT study. J Urol. 2008;179:616. DOI: https://doi.org/10.1016/j.juro.2007.09.084
Nickel JC, Barkin J, Kock C, et al. Finasteride monotherapy maintains stable lower urinary tract symptoms in men with BPH following cessation of alpha blockers. Can Urol Assoc J. 2008;2:16-21. DOI: https://doi.org/10.5489/cuaj.520
Oelke M, Giuliano F, Mirone V, et al. Monotherapy with tadalafil or tamsulosin similarly improved lower urinary tract symptoms suggestive of benign prostatic hyperplasia in an international, randomized, parallel, placebo-controlled clinical trial. Eur Urol. 2012;61:917-25. DOI: https://doi.org/10.1016/j.eururo.2012.01.013
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Canadian Primary Care Today
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
