https://orcid.org/0000-0002-7681-9771
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ABSTRACT
Introduction
Benign prostatic hyperplasia (BPH) represents the histological entity of prostate cell proliferation, which inflicts a gradually increasing obstruction of the bladder outlet and is accompanied by a progressing manifestation of lower urinary tract symptoms (LUTS). BPH management algorithm includes conservative measures, pharmaceutical agents, and surgical procedures.
Areas covered
A comprehensive literature review was performed using PubMed, Scopus, and Google Scholar databases to identify publications written in English, analyzing BPH pharmaceutical treatment. The search was conducted from January 2000 to January 2023. Six main drug classes can be administered, either as monotherapy or in combination. Furthermore, the authors provide current direction of research on future medications, which focuses on a more etiological interference to the BPH pathophysiological mechanism.
Expert opinion
The available medications represent an effective first-line step of BPH/LUTS therapy. Currently, the administration of BPH medications is tailored to patient/disease characteristics and entails long-time adherence to therapy. The emergence of new surgical modalities, which combine significantly lower morbidity compared to standard procedures and more durable effects than the available medications, seems to challenge the current treatment algorithm. More direct comparisons and the increasing experience with these surgical modalities will delineate the switch points between various therapy levels along the BPH management sequence.
Article highlights
Benign prostatic hyperplasia (BPH) represents a histologic diagnosis of not completely elucidated pathogenesis, which manifests as progressing voiding and storage symptoms.
Pharmacotherapy comprises the first-line active treatment and is based on six main drug classes, whose therapeutic effect is well-documented for application as monotherapy or in combination.
Research in future BPH medications is mainly focused on the neutralization of chronic prostatic inflammation, which seems to comprise the common link among factors associated with BPH pathogenesis.
BPH pharmacotherapy demonstrates a significant effect on symptom amelioration and delay of surgery, but it entails long-time adherence and inflicts an ‘’age-shift’’ for BPH operative management, which increases operative risk at the time of surgery.
New surgical modalities, which combine minimal operative risks and durable therapeutic effects, are challenging the current BPH management algorithm since they demonstrate clinical and financial benefits.
Abbreviations
| 5ARI | = | 5α-reductase inhibitors |
| AB | = | alpha 1 blockers |
| Ach | = | Acetylocholine |
| AdR | = | Adrenergic receptor |
| AE | = | Adverse event |
| AM | = | Antimuscarinic |
| AR | = | Androgen receptor |
| AUA | = | American Urological Association |
| AUR | = | Acute urinary retention |
| BOO | = | Bladder Outlet Obstruction |
| BPH | = | Benign Prostatic Hyperplasia |
| BPH-II | = | Benign Prostatic Hyperplasia Impact Index |
| cAMP | = | Cyclic adenosine monophosphate |
| cGMP | = | Cyclic guanosine monophosphate |
| DHT | = | Dihydrotestosterone |
| DO | = | Detrusor overactivity |
| EAU | = | European Association of Urology |
| ED | = | Erectile dysfunction |
| EjD | = | Ejaculation disorder |
| EMA | = | European Medicines Agency |
| FU | = | Folllow-up |
| HESr | = | Hexane extracted Serenoa repens |
| HMPC | = | Herbal Medicine Products Committee |
| IFIS | = | Intraoperative floppy iris syndrome |
| IIEF | = | International Index of Erectile Function |
| IL | = | Interleukin |
| IPSS | = | International Prostate Symptom Score |
| LUTS | = | Lower Urinary Tract Symptoms |
| MIST | = | Minimal Invasive Surgical Therapies |
| NO | = | Nitric oxide |
| OAB | = | Overactive bladder |
| OR | = | Odds ratio |
| PDE5I | = | Phosphodiesterase type 5 inhibitors |
| PFS | = | Post Finasteride Syndrome |
| PSA | = | Prostatic Specific Antigen |
| PVR | = | Post-void residual |
| Qmax | = | Maximum flow rate |
| QoL | = | Quality of Life |
| Sr | = | Serenoa repens |
| TGFβ | = | Τransforming growth factor beta |
| TNFa | = | Tumor necrosis factor alpha |
| TURP | = | TransUrethral Resection of Prostate |
| UTI | = | Urinary Tract Infection |
Declaration of interest
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
Reviewer disclosures
Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.