Tuesday, December 13, 2016

Prostatic Diseases - Updated Current Medications of Benign Prostatic Hyperplasia (BPH


Prostatic diseases continue to affect and account for a substantial number of lives around the world. An estimated one in 11 men will develop a malignant neoplasm of the prostate and approximately 37,000 men will die each year from prostate cancer.

For European Community countries, more than 35,000 annual deaths are forecast due to prostate cancer. Prostate cancer mortality results from metastases to the bone and lymph nodes together with progression from androgen-dependent to androgen independent disease.

The high mortality associated with these tumors is due to the fact that more than 50% of newly diagnosed patients present with advanced, metastatic disease. Radical prostatectomy, androgen-ablation mono-therapy and radiotherapy are considered to be curative for localized disease, but there is no effective treatment for metastatic prostate cancer that increases patient survival.

In humans, the prostate lies immediately below the base of the bladder surrounding the proximal portion of the urethra and consists of canals and follicles lined with columnar epithelial cells and surrounded by a fibromuscular stroma consisting of connective tissue and smooth muscle. The prostate contributes to seminal fluid, where its secretions are important in optimizing conditions for fertilization by enhancing the viability of sperm in both male and female reproductive tracts.

In all mammals, the prostatic secretions are stored in the acini and released into the urethra, at ejaculation, by contraction of the prostatic (stromal) smooth muscle. BPH is a progressive disease that is commonly associated with bothersome lower urinary tract symptoms (LUTS) such as frequent urination, urgency, nocturia, decreased and intermittent force of stream, and the sensation of incomplete bladder emptying.

The term BPH actually refers to a histologic condition, namely the presence of stromal glandular hyperplasia within the prostate gland BPH is a common and progressive clinical disease of ageing men, which may be associated with enlargement of the prostate, bothersome LUTS and bladder outlet obstruction (BOO).

 In the large scale Multinational Survey of the Aging Male, = 34% of men in the USA and 29% of European men aged 50–80 years reported moderate to severe LUTS.

Sexual dysfunction is another common condition in ageing men; the results of the Multinational Survey of the Aging Male also showed that LUTS is an independent risk factor for sexual dysfunction in ageing men. Both of these age-dependent conditions have a measurable effect on overall quality of life (QOL). Thus, LUTS and sexual dysfunction are common and important health concerns of men aged ≥50 years.

At least 300,000 patients with LUTSs are treated annually by physicians in Japan, and this figure is expected to increase in the coming years.

BPH is defined as a disease that manifests as a lower urinary tract dysfunction due to benign hyperplasia of the prostate, usually associated with enlargement of the prostate and LUTS suggestive of lower urinary tract obstruction. Although BPH is generally not a life threatening condition, it can have a marked effect on a patient's QOL.

The cost of managing BPH is > $4 billion per year. In benign prostatic hyperplasia (BPH) there will be a sudden impact on overall quality of life of patient. This disease occurs normally at the age of 40 or above and also is associated with sexual dysfunction.

Thus, there is a need of update on current medications of this disease. The presented review provides information on medications available for BPH. Phytotherapies with some improvements in BPH are also included. Relevant articles were identified through a search of the English-language literature indexed on MEDLINE, PUBMED, Sciencedirect and the proceedings of scientific meetings. The search terms were BPH, medications for BPH, drugs for BPH, combination therapies for BPH, Phytotherapies for BPH, Ayurveda and BPH, BPH treatments in Ayurveda.

Medications including watchful waitings, Alpha one adrenoreceptor blockers, 5-alpha reductase inhibitors, combination therapies including tamsulosin-dutasteride, doxazosin-finasteride, terazosin-finasteride, tolterodine-tamsulosin and rofecoxib-finasteride were found. Herbal remedies such as Cernilton, Saxifraga stolonifera, Zi-Shen Pill (ZSP), Orbignya speciosa, Phellodendron amurense, Ganoderma lucidum, Serenoa Repens, pumpkin extract and Lepidium meyenii (Red Maca) have some improvements on BPH are included. Other than these discussions on Ayurvedic medications, TURP and minimally invasive therapies (MITs) are also included. Recent advancements in terms of newly synthesized molecules are also discussed.

Specific alpha one adrenoreceptor blockers such as tamsulosin and alfuzosin will remain preferred choice of urologists for symptom relief. Medications with combination therapies are still needs more investigation to establish as preference in initial stage for fast symptom relief reduced prostate growth and obviously reduce need for BPH-related surgery. Due to lack of proper evidence Phytotherapies are not gaining much advantage. MITs and TURP are expensive and are rarely supported by healthcare systems. Learn more updated current medications of benign prostatic hyperplasia (BPH

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