The use of 5-alpha reductase inhibitors in the treatment of benign prostatic hyperplasia

doi:10.1016/j.ajur.2017.11.005

Asian Journal of Urology, 2018, 5 (1): 28-32 doi: 10.1016/j.ajur.2017.11.005

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The use of 5-alpha reductase inhibitors in the treatment of benign prostatic hyperplasia

H.Kim Eric,A.Brockman John,L.Andriole Gerald

Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO, USA

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Abstract

Benign prostatic hyperplasia (BPH) is characterized by an enlarged prostate, lower urinary tract symptoms (LUTS), and a decreased urinary flow rate. Common in older men, BPH is a progressive disease that can eventually lead to complications including acute urinary retention (AUR) and the need for BPH-related surgery. Both normal and abnormal prostate growth is driven by the androgen dihydrotestosterone (DHT), which is formed from testosterone under the influence of 5-alpha reductase. Thus, 5-alpha reductase inhibitors (5-ARIs) effectively reduce the serum and intraprostatic concentration of DHT, causing an involution of prostate tissue. Two 5-ARIs are currently available for the treatment of BPH—finasteride and dutasteride. Both have been demonstrated to decrease prostate volume, improve LUTS and urinary flow rates, which ultimately reduces the risk of AUR and BPH-related surgery. Therefore, either alone or in combination with other BPH medications, 5-ARIs are a mainstay of BPH management.

Key words： Benign prostatic hyperplasia 5-alpha reductase inhibitors Lower urinary tract symptoms

Published: 07 March 2018

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H.Kim Eric,A.Brockman John,L.Andriole Gerald. The use of 5-alpha reductase inhibitors in the treatment of benign prostatic hyperplasia[J]. Asian Journal of Urology, 2018, 5(1): 28-32.

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http://www.ajurology.com/EN/10.1016/j.ajur.2017.11.005 OR http://www.ajurology.com/EN/Y2018/V5/I1/28

[1]	Girman CJ . Population-based studies of the epidemiology of benign prostatic hyperplasia. Br J Urol , 1998;82(Suppl. 1): 34-43.
[2]	Guess HA, Arrighi HM, Metter EJ, Fozard JL . Cumulative prevalence of prostatism matches the autopsy prevalence of benign prostatic hyperplasia. Prostate, 1990;17: 241-6.
[3]	Emberton M , Andriole GL, de la Rosette J, Djavan B, Hoefner K, Vela Navarrete R, et al. Benign prostatic hyperplasia: a progressive disease of aging men. Urology, 2003;61: 267-73.
[4]	Anderson JB, Roehrborn CG, Schalken JA, Emberton M . The progression of benign prostatic hyperplasia: examining the evidence and determining the risk. Eur Urol , 2001;39: 390-9.
[5]	Jacobsen SJ, Jacobson DJ, Girman CJ, Roberts RO, Rhodes T, Guess HA , et al. Natural history of prostatism: risk factors for acute urinary retention. J Urol, 1997;158: 481-7.
[6]	Roehrborn CG , McConnell JD, Lieber M, Kaplan S, Geller J, Malek GH, et al. Serum prostate-specific antigen concentration is a powerful predictor of acute urinary retention and need for surgery in men with clinical benign prostatic hyperplasia. Urology, 1999;53: 473-80.
[7]	Roehrborn CG , McConnell J, Bonilla J, Rosenblatt S, Hudson PB, Malek GH, et al. Serum prostate specific antigen is a strong predictor of future prostate growth in men with benign prostatic hyperplasia. J Urol, 2000;163: 13-20.
[8]	Crawford ED, Wilson SS , McConnell JD, Slawin KM, Lieber MC, Smith JA, et al. Baseline factors as predictors of clinical progression of benign prostatic hyperplasia in men treated with placebo. J Urol, 2006;175: 1422-7.
[9]	Sarma AV, Jacobson DJ , McGree ME, Roberts RO, Lieber MM, Jacobsen SJ. A population based study of incidence and treatment of benign prostatic hyperplasia among residents of Olmsted County, Minnesota: 1987-1997. J Urol, 2005;173: 2048-53.
[10]	Vela-Navarrete R, Gonzalez-Enguita C, Garcia-Cardoso JV, Manzarbeitia F, Sarasa-Corral JL, Granizo JJ . The impact of medical therapy on surgery for benign prostatic hyperplasia: a study comparing changes in a decade (1992e2002). BJU Int, 2005;96: 1045-8.
[11]	Souverein PC, van Riemsdijk MM, de la Rosette JJMCH, Opdam PCE, Leufkens HGM . Treatment of benign prostatic hyperplasia and occurrence of prostatic surgery and acute urinary retention: a population-based cohort study in The Netherlands. Eur Urol, 2005; 47: 505-10.
[12]	Deslypere JP, Young M, Wilson JD, McPhaul MJ .Testosterone and 5 alpha-dihydrotestosterone interact differently with the androgen receptor to enhance transcription of the MMTV-CAT reporter gene. Mol Cell Endocrinol, 1992; 88: 15-22.
[13]	Span PN, Voller MCW, Smals AGH, Sweep FGJ, Schalken JA, Feneley MR , et al. Selectivity of finasteride as an in vivo inhibitor of 5 alpha-reductase isozyme enzymatic activity in the human prostate. J Urol, 1999;161: 332-7.
[14]	Bramson HN, Hermann D, Batchelor KW, Lee FW, James MK, Frye SV . Unique preclinical characteristics of GG745, a potent dual inhibitor of 5AR. J Pharmacol Exp Ther, 1997;282: 1496-502.
[15]	Frye SV, Bramson HN, Hermann DJ, Lee FW, Sinhababu AK, Tian G . Discovery and development of GG745, a potent inhibitor of both isozymes of 5 alpha-reductase. Pharm Biotechnol, 1998;11: 393-422.
[16]	Evans HC, Goa KL . Dutasteride. Drugs Aging, 2003;20: 905-18.
[17]	Marks LS, Partin AW, Dorey FJ, Gormley GJ, Epstein JI, Garris JB , et al. Long-term effects of finasteride of prostate tissue composition. Urology, 1999;53: 574-80.
[18]	Clark RV, Hermann DJ, Cunningham GR, Wilson TH, Morrill BB, Hobbs S . Marked suppression of dihydrotestosterone in men with benign prostatic hyperplasia by dutasteride, a dual 5 alpha-reductase inhibitor. J Clin Endocrinol Metab, 2004;89: 2179-84.
[19]	Norman RW, Coakes KE, Wright AS, Rittmaster RS . Androgen metabolism in men receiving finasteride before prostatectomy. J Urol, 1993;150(5 Pt 2): 1736-9.
[20]	Wurzel R, Ray P, Major-Walker K, Shannon J, Rittmaster R . The effect of dutasteride on intraprostatic dihydrotestosterone concentrations in men with benign prostatic hyperplasia. Prostate Cancer Prostatic Dis, 2007;10: 149-54.
[21]	Guess HA, Gromley GJ, Stoner E, Oesterling JE . The effect of finasteride on prostate specific antigen: review of available data. J Urol, 1996;155: 3-9.
[22]	Stoner E . Three-year safety and efficacy data on the use of finasteride in the treatment of benign prostatic hyperplasia. Urology, 1994;43: 284-94.
[23]	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: 398-405.
[24]	McConnell JD, Bruskewitz R, Walsh R, Andriole G, Lieber M, Holtgrewe HL , et al. The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. Finasteride long-term efficacy and safety study group. N Engl J Med, 1998; 338: 557-63.
[25]	Roehrborn CG, Boyle P, Nickel JC, Hoefner K, Andriole G , ARIA3001 ARIA3002 and ARIA3003 Study Investigators. Efficacy and safety of a dual inhibitor of 5-alpha-reductase types 1 and 2 (dutasteride) in men with benign prostatic hyperplasia. Urology, 2002;60: 434-41.
[26]	Debruyne F , Barkin J, van Erps P, Reis M, Tammela TLJ, Roehrborn C, et al. Efficacy and safety of long-term treatment with the dual 5 alpha-reductase inhibitor dutasteride in men with symptomatic benign prostatic hyperplasia. Eur Urol , 2004; 46: 488-95.
[27]	Thompson IM, Goodman PJ, Tangen CM, Lucia MS, Miller GJ, Ford LG , et al. The influence of finasteride on the development of prostate cancer. N Engl J Med, 2003;349: 215-24.
[28]	Andriole GL, Bostwick DG, Brawley OW, Gomella LG, Marberger M, Montorsi F , et al. Effect of dutasteride on the risk of prostate cancer. N Engl J Med 2010;362: 1192e202.
[29]	Lepor H . Alpha blockers for the treatment of benign prostatic hyperplasia. Rev Urol, 2007;9: 181-90.
[30]	Roehrborn CG . Alfuzosin 10 mg once daily prevents overall clinical progression of benign prostatic hyperplasia but not acute urinary retention: results of a 2-year placebo-controlled study. BJU Int , 2006;97: 734-41.
[31]	Roehrborn CG, Siami P, Barkin J, Damiao R, Major-Walker K, Nandy I , et al. The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia: 4-year results from the CombAT study. Eur Urol, 2010;57: 123-31.
[32]	Lepor H, Williford WO, Barry MJ, Brawer MK, Dixon CM, Gormley G , et al. The efficacy of terazosin, finasteride, or both in benign prostatic hyperplasia. Veterans affairs cooperative studies benign prostatic hyperplasia study group. N Engl J Med, 1996;335: 533-9.
[33]	Kirby RS, Roehrborn C, Boyle P, Bartsch G, Jardin A, Cary MM , et al. Efficacy and tolerability of doxazosin and finasteride, alone or in combination, in treatment of symptomatic benign prostatic hyperplasia: the Prospective European Doxazosin and Combination Therapy (PREDICT) trial. Urology, 2003;61: 119-26.
[34]	Oelke M, Bachmann A, Descazeaud A, Emberton M, Gravas S, Michel MC , et al. EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol, 2013;64: 118-40.
[35]	McVary KT, Roehrborn CG, Avins AL, Barry MJ, Bruskewitz RC, Donnell RF , et al. Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol, 2011;185: 1793-803.
[36]	Redman MW, Tangen CM, Goodman PJ, Parnes H, Ford PG, Lucia MS , et al. Finasteride does not increase the risk of highgrade prostate cancer: a bias-adjusted modeling approach. Cancer Prev Res, 2008;1: 174-81.
[37]	Lucia MS, Epstein JI, Goodman PJ, Darke AK, Reuter VE, Civantos F , et al. Finasteride and high-grade prostate cancer in the prostate cancer prevention trial. J Natl Cancer Inst, 2007;99: 1375-83.