What are the symptoms of prostate problems?
What I need to know about Prostate Problems
Can alpha blocker drugs and 5 alpha reductase drugs be used together?
The short answer to this question is yes. For several years, many urologists used these drugs together with the rationale that because their mechanisms of action were different, their benefits might be additive; however, there was no objective proof that this really was so. A recent study, known as the MTOPS (The Medical Therapy of Prostate Symptoms) study, was published in the New England Journal of Medicine (2003;349). It looked at whether a combination of both kinds of drugs was better than either drug alone.
This study was a double-blind trial that involved over 3,000 men who were followed for an average of 4.5 years. The men were divided into four groups: placebo (control group), doxazosin (an alpha blocker) alone, finasteride alone, and doxazosin and finasteride together. These four groups of patients were then followed for signs of progression of BPH. Progression was defined as an increase of urinary symptoms, as measured by the American Urological Association symptom score, acute urinary retention, urinary incontinence, renal insufficiency, or recurrent urinary tract infections. The risk reduction of signs of progression of BPH was 39% with doxazosin, 34% with finasteride, and 66% with combination therapy.
This study proved that the two classes of drugs used together were superior as compared with either type of drug alone; however, the practical issue is cost. Obviously, two drugs cost more than one. Therefore, in most cases, the physician will start treatment with one class of drug or the other and add the second drug only if the response to the first drug alone is not satisfactory.
JN: Because we’re now learning that there have been thousands of long-term adverse reactions to drugs classified as COX-2 inhibitors, apart from the side effects of alpha blockers and 5 alpha reductase inhibitor drugs listed here, are there any serious (life-threatening) adverse reactions that have been recorded that patients have had from taking either or both of these drugs for a long period of time?
KL: No, these drugs are safe. There have been no life threatening reactions.
What is the effect of 5 alpha reductase drugs on prostate cancer?
The final answer to that question has not been resolved. A recent study in the New England Journal of Medicine reports on almost 20,000 men 55 years of age or older with a normal digital rectal examination and a PSA level of less than 3.0 ng/ml who were treated with either finasteride or placebo for 7 years. At the end of the study, prostate cancer was diagnosed in 18.4% of the men in the finasteride group and 24.4% of the men in the placebo group. This difference was statistically significant.
It was also found in this study, however, that aggressive cancers (those with Gleason scores 7, 8, 9, or 10) were more common in the finasteride group than the placebo group. Specifically, of those men in the finasteride group who developed prostate cancer, 37% had these more aggressive cancers, whereas in the placebo group of those men who developed cancer, only 22.2% had these more aggressive tumors.
There is no easy explanation for these findings, and further studies are needed. Currently, a study, known as the REDUCE (The Reduction by Dutasteride of Prostate Cancer Events) trial, is underway to examine whether dutasteride, which blocks both type 1 and type 2 five alpha reductase, will reduce the incidence of prostate cancer. This study also examines whether the cancers that occur in those patients on dutasteride are of the more aggressive kind.
Currently, most urologists recommend the patient use 5 alpha reductase inhibitors to reduce BPH symptoms and not as anticancer agents.
What is the role of herbal therapy in BPH treatment?
This question is difficult to answer. Herbs are considered as food additives and not drugs and, as such, are not regulated by the Food and Drug Administration (FDA).
The production and marketing of herbs are essentially unregulated. Therefore, few randomized studies evaluate the efficacy of herbal therapy in the treatment of BPH.
Can saw palmetto be used to treat BPH?
Phytotherapy, or what is more commonly known as herbal therapy, has become increasingly popular in the treatment of BPH. About 30 herbal compounds have been used to treat prostatic urinary symptoms. The most popular of these is known as saw palmetto, which is the extract of the dried ripe fruit from the American dwarf saw palmetto plant, Serenoa repens.
Until recently, the efficacy of saw palmetto was unknown. A recent study in the New England Journal of Medicine (2006;354:557–566), however, demonstrated that there was no significant difference between saw palmetto and placebo as measured by symptom scores or urinary flow rates. Unless subsequent reports refute this well-done study, it would seem that saw palmetto has no benefit in the treatment of BPH.
JN: However, because we do know that the substances that are part of saw palmetto, such as beta sitosterol, free fatty acids, and flavonoids, are also substances that have appeared in separate studies as possible prostate anticancer agents, have there been any studies to show whether any of these substances individually might be effective in working to inhibit growth of any prostate cells?
KL: Currently, no well-done studies show that herbal therapy reduces the risk of prostate cancer.
