What Western medicine should I take for prostate hyperplasia?

Prostatic hyperplasia is a common disease in men. Many people think that prostatic hyperplasia is an embarrassing disease, so they would rather endure it themselves than go to the hospital for treatment. However, everyone should face the disease and go to the hospital for timely examination and treatment. Don't take medicine randomly when you are sick. You must know how to take the right medicine for the right symptoms. The following is an introduction to Western medicine for the treatment of prostatic hyperplasia.

Benign prostatic hyperplasia is a common and multiple disease in elderly men. BPH mainly occurs in the periurethral area or transitional area of ​​the prostate. The pathogenesis is not yet fully understood. Testosterone, dihydrotestosterone and estrogen may be involved in the formation of BPH. BPH is mainly manifested by hyperplasia of prostatic stroma and glandular components, prostate enlargement, lower urinary tract symptoms and bladder outlet obstruction. BPH is the most common benign disease that causes urination disorders in middle-aged and elderly men. It progresses slowly, and the progression of the disease is mainly manifested by the aggravation of lower urinary tract symptoms, acute urinary retention and renal function impairment. Currently, there are three main types of drugs for the treatment of benign prostatic hyperplasia: 5α-reductase inhibitors, such as finasteride; α-receptor blockers, such as terazosin hydrochloride and doxazosin mesylate controlled release; herbal preparations and traditional Chinese medicines, such as Prosperity.

Benign prostatic hyperplasia is mainly manifested by the proliferation of prostatic stroma and glandular components, prostate enlargement, lower urinary tract symptoms and bladder outlet obstruction. BPH is the most common benign disease causing urination problems in middle-aged and elderly men. BPH is a slowly progressive benign disease, and the progression of the disease is mainly manifested by the occurrence of complications such as aggravation of lower urinary tract symptoms, acute urinary retention and renal function impairment.

Patients with mild lower urinary tract symptoms and moderate symptoms whose quality of life has not been significantly affected can observe whether the disease progresses. If the condition worsens, surgical treatment will eventually be required. The short-term goal of BPH drug treatment is to relieve lower urinary tract symptoms, and the long-term goal is to delay disease progression and prevent the occurrence of complications. The overall goal is to reduce drug side effects while maintaining a high quality of life.

1. Drug Classification

There are three main types of drugs for the treatment of benign prostatic hyperplasia: 5α-reductase inhibitors, such as finasteride; α-receptor blockers, such as terazosin hydrochloride and doxazosin mesylate controlled release; plant preparations and traditional Chinese medicine, such as Pristai, etc. 5α-reductase inhibitors and α-receptor blockers are commonly used in clinical practice, either alone or in combination.

1.5α-reductase inhibitors

5α-reductase inhibitors can inhibit the 5α-reductase required for the conversion of testosterone into dihydrotestosterone, inhibiting the production of dihydrotestosterone, thereby reducing the content of dihydrotestosterone in the prostate, achieving the purpose of reducing the size of the prostate and improving dysuria. There are two types of 5α-reductase isoenzymes: type I is mainly distributed in tissues outside the prostate (such as skin and liver), and type II plays a major role in the prostate. 5α-reductase inhibitors can be divided into two major categories: competitive and non-competitive. Finasteride is a competitive type II 5α-reductase specific inhibitor, epasteride is a non-competitive type II reductase inhibitor, and dutasteride is a competitive dual inhibitor (inhibiting both type I and type II).

5α-reductase inhibitors are suitable for patients with moderate to severe BPH and high risk of progression who have enlarged prostates and/or elevated serum prostatic specific antigen (PSA) levels. Its advantage is that long-term use can reduce the risk of acute urinary retention and surgical treatment in BPH patients and delay disease progression. 5α-reductase inhibitors have a relatively slow onset of action and require continuous use for 6-12 months to achieve maximum therapeutic effect. Symptoms recur after discontinuation of the drug, and long-term medication is required to maintain efficacy. Common adverse reactions of 5α-reductase inhibitors include erectile dysfunction, abnormal ejaculation, and low libido. Other adverse reactions include male breast feminization, mastalgia, and rash. Current studies have shown that finasteride and dutasteride are similar in clinical efficacy, but the incidence of sexual function-related adverse reactions and breast pain caused by dutasteride is higher than that of finasteride.

2.M receptor antagonists

M receptor antagonists selectively act on the bladder, blocking the binding of acetylcholine to the M receptors that mediate detrusor contraction, inhibiting involuntary detrusor contraction, and thus improving bladder urine storage function. The human body is known to have 5 M receptor subtypes, of which M2 and M3 are expressed in the detrusor. M receptor antagonists are divided into non-selective and selective types. Commonly used in China are tolterodine (non-selective M receptor antagonist) and solifenacin (selective M3 receptor antagonist).

When BPH patients mainly present with urinary retention symptoms such as urgency and frequent urination, M receptor antagonists can be used alone. Due to the risk of acute urinary retention, changes in residual urine volume need to be closely monitored.

The main adverse reactions of M receptor antagonists include dry mouth, dizziness, constipation, dysuria and blurred vision, which often occur within 2 weeks of medication and in patients aged > 66 years. M receptor antagonists should be used with caution in patients at high risk of acute urinary retention; they are contraindicated when the detrusor muscle is weak in contraction. They are contraindicated in patients with urinary retention, gastric retention, narrow-angle glaucoma and allergy to M receptor antagonists.