Treatment options for benign prostatic hyperplasia

医学 排尿 泌尿科 前列腺 下尿路症状 增生 药物治疗 前列腺尿道 经尿道前列腺电切术 夜尿症 内科学 泌尿系统 癌症
作者
Richard J. Thurlow
出处
期刊:Emerging drugs [Informa]
卷期号:3 (1): 225-246 被引量:7
标识
DOI:10.1517/14728214.3.1.225
摘要

Benign prostatic hyperplasia (BPH) is a disease of the prostate in which benign enlargement leads to partial constriction of the urethra and reduced urinary flow rates during micturition are observed. BPH is prevalent in men over 60 with about 50% of all males in this age group developing symptomatic BPH. Symptomatic BPH is characterised by symptoms that include increased frequency of urination, especially at night (nocturia), difficulty or delay in initiating urination (hesitancy), reduced force of the urinary stream and post-void dribbling. Current therapy options fall into two categories: surgery and pharmacotherapy. Significant morbidity is associated with surgery but this currently remains the gold-standard treatment option for many sufferers of the disease. Current pharmacotherapy is not curative and treatment with pharmaceuticals has mainly targeted the alleviation of the symptomatic manifestation of the disease. The most effective treatment option is the use of non-selective alpha-adrenergic antagonists. These block the smooth muscle contraction of the prostate that is associated with the obstructive symptoms described above. Other existing treatments have been targeted at the irritative, static or proliferative component of the disease. These agents, 5a-reductase (5aR) inhibitors, despite wide prescription initially, have yielded disappointing results in the clinic with limited symptomatic relief and reduction in prostate size mainly confined to those individuals with an exceptionally enlarged prostate. The proliferative (or static) component is observed in discrete regions of the prostate, predominantly in the stromal cell layer. Future drug therapies are being developed to treat both the dynamic and static components of BPH. Firstly, through pharmacological characterisation of the prostate, it is now possible to target a1-adrenoceptor antagonists that are selective for the prostate rather than acting in both the prostate and the cardiovascular system. It has been hypothesised that these agents will have fewer cardiovascular side-effects, and several of these are currently in early to late phase clinical trials. Secondly, companies are continuing to developing new generations of 5aR inhibitors that target both isoforms of this enzyme (5aR1 and 5aR2), despite poor clinical symptomatic relief observed with the first generation 5aR inhibitor, finasteride (Proscar, Merck), which is selective for the 5aR2 over the 5aR1 isoform. Through extensive research it has become evident that the proliferative component of BPH involves a complex relationship between androgens and growth factors. 5aR inhibitors lower dihydrotestosterone (DHT) levels, the main mediator of androgen action in theprostate, which in turn leads to modest inhibition of prostate growth and some symptom relief. It is now becoming evident that growth factors are important in the development of BPH and a new generation of BPH drug therapies now include diverse categories of drugs such as androgen receptor antagonists, luteinising hormone releasing hormone (LHRH) antagonists, aromatase inhibitors, proteinase inhibitors, tyrosine kinase inhibitors and cell control agents. The success of these compounds remains to be proved and initial clinical data demonstrate poor side-effect profiles and varying efficacy. However, innovation in drug development for the treatment of BPH continues to be high and novel mechanisms are being suggested in the current literature. This exciting and developing drug therapy area is growing rapidly and, as our understanding of the cell-cell interactions in the prostate increases, novel approaches for the treatment of BPH will be developed.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
CipherSage应助Rita采纳,获得10
4秒前
4秒前
共享精神应助gxmu6322采纳,获得10
5秒前
5秒前
rioo发布了新的文献求助10
6秒前
爆米花应助独特冰安采纳,获得10
7秒前
知其荣完成签到,获得积分10
8秒前
情怀应助zozo采纳,获得10
9秒前
yuiiuy发布了新的文献求助10
9秒前
科目三应助TANGchenran采纳,获得30
9秒前
九九发布了新的文献求助10
9秒前
啵啵龙完成签到,获得积分10
9秒前
科研小白董完成签到 ,获得积分10
14秒前
上官若男应助sjy采纳,获得10
14秒前
小果叮完成签到,获得积分10
15秒前
15秒前
结实机器猫完成签到,获得积分10
18秒前
默默函完成签到,获得积分10
18秒前
LiYaru完成签到,获得积分10
19秒前
20秒前
20秒前
文无第一完成签到,获得积分20
21秒前
量子星尘发布了新的文献求助10
21秒前
kk应助科研通管家采纳,获得10
21秒前
凡迪亚比应助科研通管家采纳,获得10
21秒前
Tina发布了新的文献求助30
21秒前
21秒前
21秒前
ding应助科研通管家采纳,获得20
21秒前
21秒前
香蕉觅云应助科研通管家采纳,获得30
21秒前
21秒前
传奇3应助科研通管家采纳,获得10
21秒前
21秒前
21秒前
深情安青应助科研通管家采纳,获得10
21秒前
Owen应助默默函采纳,获得10
22秒前
ww发布了新的文献求助10
23秒前
23秒前
独特冰安发布了新的文献求助10
24秒前
高分求助中
A new approach to the extrapolation of accelerated life test data 1000
ACSM’s Guidelines for Exercise Testing and Prescription, 12th edition 500
Picture Books with Same-sex Parented Families: Unintentional Censorship 500
Nucleophilic substitution in azasydnone-modified dinitroanisoles 500
不知道标题是什么 500
A Preliminary Study on Correlation Between Independent Components of Facial Thermal Images and Subjective Assessment of Chronic Stress 500
Phylogenetic study of the order Polydesmida (Myriapoda: Diplopoda) 370
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 3971655
求助须知:如何正确求助?哪些是违规求助? 3516320
关于积分的说明 11181963
捐赠科研通 3251445
什么是DOI,文献DOI怎么找? 1795889
邀请新用户注册赠送积分活动 876131
科研通“疑难数据库(出版商)”最低求助积分说明 805266