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PubMed2005

[Therapeutic effect of harnal and proscar in treating benign prostatic hyperplasia].

OBJECTIVE: To evaluate the therapeutic effect of harnal and proscar in treating benign prostatic hyperplasia (BPH). METHODS: Two hundreds and twenty-two patients with BPH were randomly assigned into 2 groups:harnal (0.2 mg/d) group (n = 112) and proscar (5 mg/d) group (n = 108). American Urologic Association Symptom Index (AUA-SI) scores, the maximal urinary flow rate (Qmax) and prostatic volume were analyzed in the 2 groups. RESULTS: After 12 weeks of treatment, 54.5% of the harnal group improved in AUA-SI score; 54.6% of the proscar group improved in AUA-SI score; and there was no significant difference between the 2 groups (P > 0.05). After 24 weeks of treatment, the proscar group (79.6%) had a greater improvement in AUA-SI score than the harnal group (64.3%) (P < 0.05); Qmax in the 2 groups was significantly increased than that before the treatment, and it is proportional to the therapeutic time. The prostatic volume in 2 groups had no significant change. CONCLUSION: Harnal and proscar can significantly improve BPH symptoms and the urinary flow rate. The therapeutic effect of harnal and proscar has their own characteristics.

5-alpha Reductase Inhibitors↗
PubMed2006

The effectiveness of a treatment protocol for male lower urinary tract symptoms in general practice: a practical randomised controlled trial.

BACKGROUND: Randomised controlled trials have shown the efficacy of several treatment modalities for lower urinary tract symptoms (LUTS) in selected populations. The effectiveness in daily practice has hardly been investigated, especially in primary care and is dependent on choices between all possible treatment options and best investigated in a comprehensive study, including all treatment modalities (watchful waiting, alpha-blockers, 5-alpha-reductase inhibitors, and surgery). AIM: Assessment of the effectiveness of a comprehensive treatment protocol for LUTS in primary care. DESIGN OF STUDY: Randomised controlled trial. SETTING: Fourteen general practices in the Netherlands. METHOD INTERVENTION: treatment protocol based on a formalised expert opinion. Control condition: usual care. STUDY POPULATION: 208 subjects with moderate to severe LUTS (IPSS > or =8, median = 13). OUTCOME MEASURES: symptom severity (IPSS [International Prostate Symptom Score]), bother score (Dan-PSS [Danish Prostate Symptom Score]), and maximum urinary flow (Q(max)); incidence of acute urinary retention and urinary tract infections. RESULTS: In the intervention group markedly more subjects used an alpha-blocker at end of follow-up than in the usual care group (24% versus 6%). No significant differences were found between intervention and control group in IPSS, Q(max) or Dan-PSS. CONCLUSION: alpha-blockers and watchful waiting are the most frequent treatment modalities for LUTS in primary care. Our study showed no evidence that a protocol using well-defined indications for all possible treatment modalities based on a formalised expert opinion procedure has added value. Based on our results, we cannot recommend a broadening of the indication for alpha-blockers, which, however, seems to be the current trend.

Aged↗
PubMed1991

Role of 5 alpha-reductase inhibitors in the treatment of advanced prostatic carcinoma.

Everything we know about the biology of the prostate supports the concept that DHT is the obligate androgen responsible for normal and hyperplastic growth. Whether this selectivity is maintained during malignant transformation is unknown. The consistent emergence of androgen-insensitive disease highlights the spectrum of biologic evolution this cancer is capable of. If the tumor is dependent only on DHT for neoplastic growth, the unique characteristics of a 5 alpha-reductase inhibitor offer several potential actions that warrant a systematic evaluation.

5-alpha Reductase Inhibitors↗
PubMed1994

Pathogenesis and medical management of benign prostatic hyperplasia.

This is simultaneously an exciting and confusing time for those caring for patients with BPH. For years we thought we had the answer, TURP, but costs and complications have opened this area for further study in alternative methods for the management of BPH. The pathogenesis and the maintenance of BPH is poorly understood and the natural history of BPH has not been well characterized. The bothersome level of symptoms to individual patients varies widely as well as the expectations of patients to the outcome of treatment. Satisfaction and cure are not necessarily identical, especially in patients with BPH, in which there seems to be great variability in the clinical course. Perhaps, in the future, this will be able to be related to the equally variable histological picture of BPH. There are problems in designing appropriate clinical trials for the evaluation of new treatments for BPH to take into account these variabilities in patient cases and histology (Table 9). The proper evaluation of new approaches to the management of patients with BPH takes years to complete, and physicians must resist the temptation to rush into any new treatment without reasonable caution for proven safety and efficacy when compared with existing modalities of treatment.

Adrenergic alpha-Antagonists↗