Skip to main content
Log in

Conservative non-instrumental treatment of benign prostatic hyperplasia

  • Original Paper
  • Published:
Urological Research Aims and scope Submit manuscript

Abstract

This paper critically reviews the clinical effects in benign prostatic hyperplasia (BPH) patients that can be achieved with the presently available medical treatment options. The classes of drugs that are reviewed include: 5-α-reductase inhibitors,α-blockers, cholesterol-lowering agents and phytotherapeutic drugs. Only double-blind placebo-controlled studies with a duration of at least 3 months that have reported symptomatic changes and changes in flow rate in a quantitative fashion have been included. Studies that exclusively included selected groups of patients such as hypertensives or non-hypertensives have been excluded. The results of the clinical trials that are reviewed in this paper often show improvements in symptom score and maximum flow rate in the patients taking the active drug. These improvements are often statistically significantly better than the improvements seen in the placebo groups. However, taking into account that the symptomatic and the flow rate improvements achieved are below the level of perception in most of these trials, there seems to be no convincing evidence that medical treatment of BPH with the presently available drugs is also clinically more effective than placebo.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Abrams P, Schulman CC, Vaage S, and the European Tamsulosin study group (1995) Tamsulosin, a selective alpha-1A-adrenoceptor antagonist: a randomised, controlled trial in patients with benign prostatic obstruction (symptomatic BPH). Br J Urol 76:325

    Google Scholar 

  2. Andersen JT, Ekman P, Wolf H, Beisland HO, Johanson JE, Kontturi M, Lehtonen T, Tveter K and the Scandinavian BPH study group (1995) Can finasteride reverse the progress of benign prostatic hyperplasia? A two year placebo-controlled study. Urology 46:631

    Google Scholar 

  3. Barry MJ, Fowler FJ, O'Leary MP, Bruskewitz RC, Holtgrewe HL, Mebust WK (1992) and the measurement committee of the American Urological Association: Correlation of the American Urological Association symptom index with the self-administered versions of the Madsen-Iversen, Boyarsky and Maine Medical Assessment Program symptom indexes. J Urol 148:1558

    Google Scholar 

  4. Barry MJ, Girman CJ, O'Leary MP, Walker-Corkery ES, Binkowitz BS, Cockett AT et al (1995) Using repeated measures of symptom score, uroflowmetry, and prostate specific antigen in the clinical management of prostate disease. J Urol 153:99

    Google Scholar 

  5. Barry MJ, Williford WO, Chiang Y, Machi M, Jones KM, Walker-Corkery E, Lepor H (1995) Benign prostatic hyperplasia specific health status measures in clinical research: How much change in the American Urological Association symptom index and the benign prostatic hyperplasia impact index is perceptible to patients? J Urol 154:1770

    Google Scholar 

  6. Beisland HO, Binkowitz B, Brekkan E, Ekman P, Kontturi M, Lehtonen T, Lundmo P, Pappas F, Round E, Shapiro D, Stoner E, Swartz R, Varenhorst E (1992) Scandinavian clinical study of finasteride in the treatment of benign prostatic hyperplasia. Eur Urol 22:271

    Google Scholar 

  7. Berges RR, Windeler J, Trampisch HJ, Senge Th, and the ß-sitosterol study group (1995) Randomised, placebo-controlled, double-blind clinical trial of ß-sitosterol in patients with benign prostatic hyperplasia. Lancet 345:1529

    Google Scholar 

  8. Bosch R (1996) Urodynamic effects of various treatment modalities for benign prostatic hyperplasia: A meta-analysis. J Urol 155:395A

    Google Scholar 

  9. Brawer MK, Adams G, Epstein H, the Terazosin benign prostatic hyperplasia study group (1993) Terazosin in the treatment of benign prostatic hyperplasia. Arch Fam Med 2:929

    Google Scholar 

  10. Buck AC, Cox R, Rees RWM, Ebeling L, John A (1990) The treatment of outflow tract obstruction due to benign prostatic hyperplasia with the pollen extract, cernilton. A double-blind, placebo-controlled study. Br J Urol 66:398

    Google Scholar 

  11. Buzelin JM, Hebert M, Blondin P, and the PRAZALF group (1993) Alpha-blocking treatment with alfuzosin in symptomatic benign prostatic hyperplasia: comparative study with prazosin. Br J Urol 72:922

    Google Scholar 

  12. Carbin B-E, Larsson B, Lindahl O (1990) Treatment of benign prostatic hyperplasia with phytosterols. Br J Urol 66:639

    Google Scholar 

  13. Chapple CR, Christmas TJ, Milroy EJG (1990) A twelve-week placebo-controlled study of prazosin in the treatment of prostatic obstruction. Urol Int 45 (Suppl):47

    Google Scholar 

  14. Chapple CR, Carter P, Christmas TJ, Kirby RS, Bryan J, Milroy EJG, Abrams P, (1994) A three month double-blind study of doxazosin as treatment for benign prostatic outlet obstruction. Br J Urol 74:50

    Google Scholar 

  15. Chapple CR, Wyndale JJ, Nordling J, Boeminghaus F, Ypma AFGVM, Abrams P, and the European Tamsulosin study group (1996) Tamsulosin, the first prostate-selective alpha-1A-adrenoceptor antagonist. Eur Urol 29:155

    Google Scholar 

  16. Dreikorn K, Richter R, Schönhöfer PS (1990) Konservative, nicht-hormonelle Behandlung der benignen Prostatahyperplasie. Urologe [A] 29:8

    Google Scholar 

  17. Elhilali MM, Ramsey EW, Barkin J, Casey RW, Boake RC, Beland G, Fradet Y, Trachtenberg J, Orovan WL, Schick E, Klotz LH (1996) A multicenter, randomised, double-blind, placebo-controlled study to evaluate the safety and the efficacy of terazosin in the treatment of benign prostatic hyperplasia. Urology 47:335

    Google Scholar 

  18. Feneley MR, Dunsmuir WD, Pearce J, Kirby RS (1996) Reproducibility of uroflow measurement: experience during a double-blind, placebo-controlled study of doxazosin in benign prostatic hyperplasia. Urology 47:658

    Google Scholar 

  19. Finasteride study group (1993) Finasteride (MK-906) in the treatment of benign prostatic hyperplasia. Prostate 22:291

    Google Scholar 

  20. Fitzpatrick JM, Lynch TH (1995) Phytotherapeutic agents in the management of symptomatic benign prostatic hyperplasia. Urol Clin N Am 22:407

    Google Scholar 

  21. Furuya S, Kumamoto Y, Yokoyama E, Tsukamoto T, Izumi T, Abiko Y (1982) Alpha-adrenergic activity and urethral pressure in prostatic zone in benign prostatic hypertrophy. J Urol 128:836

    Google Scholar 

  22. Garraway WM, Collins GN, Lee RJ (1991) High prevalence of benign prostatic hypertrophy in the community. Lancet 338:469

    Google Scholar 

  23. Girman CJ, Panser LA, Chute CG, Oesterling JE, Barrett DM, Chen CC, Arrighi HM, Guess HA, Lieber MM (1993) Natural history of prostatism: urinary flow rates in a community-based study. J Urol 150:887

    Google Scholar 

  24. Gormley GJ, Stoner E, Bruskewitz RC, Imperato-McGinley J, Walsh PC, McConnell JD et al (1992) The effect of finasteride in men with benign prostatic hyperplasia. N Eng J Med 327:1185

    Google Scholar 

  25. Hald T (1989) Urodynamics in benign prostatic hyperplasia: a survey. Prostate (Suppl 2):69

  26. Hansen BJ, Nordling J, Mensink HJA, Walter S, Meyhoff H-H, and the Alfech Study Group (1994) Alfuzosin in the treatment of benign prostatic hyperplasia: effects on symptom scores, urinary flow rates and residual volume. A multicenter, doubleblind placebo-controlled trial. Scand J Urol Nephrol (Suppl)157:169

    Google Scholar 

  27. Isaacs JT (1990) Importance of the natural history of benign prostatic hyperplasia in the evaluation of pharmacologic intervention. Prostate (Suppl)3:1

    Google Scholar 

  28. Janknegt RA, Chapple CR for the doxazosin study groups (1993) Efficacy and safety of the alpha-1 blocker doxazosin in the treatment of benign prostatic hyperplasia. Eur Urol 24:319

    Google Scholar 

  29. Jardin A, Bensadoun H, Delauche-Cavallier MC, Attali P, and the BPH-ALF group (1991) Alfuzosin for treatment of benign prostatic hypertrophy. Lancet 337:1457

    Google Scholar 

  30. Jensen KM-E, Madsen PO (1983) Candicidin treatment of prostatism: a prospective double-blind placebo-controlled study. Urol Res 11:7

    Google Scholar 

  31. Lepor H (1996) Prostate selectivity of alpha-blockkes: From receptor biology to clinical medicine. Eur Urol 29 (Suppl):12

    Google Scholar 

  32. Lepor H, Meretyk S, Knapp-Maloney G (1992) The safety, efficacy and compliance of terazosin therapy for benign prostatic hyperplasia. J Urol 147:1554

    Google Scholar 

  33. Lepor H, Auerbach S, Puras-Baez A, Narayan P, Soloway M, Lowe F, Moon T, Leifer G, Madsen P (1992) A randomised, placebo-controlled multicenter study of the efficacy and safety of terazosin in the treatment of benign prostatic hyperplasia. J Urol 148:1467

    Google Scholar 

  34. Lepor H, Williford WO, Barry MJ, Brawer MK, Dixon CM, Gormley G, Haakenson C, Machi M, Narayan P, Padley RJ, for the Veteran Affairs Cooperative Studies Benign Prostatic Hyperplasia Study Group (1996) The efficacy of terazosin, finasteride, or both in benign prostatic hyperplasia. N Eng J Med 335:533

    Google Scholar 

  35. McConnell JD, Wilson J, George FW, Geller J, Pappas F, Stoner E (1992) Finasteride, an inhibitor of 5-alpha-reductase, suppresses prostatic dihydrotestosterone in men with benign prostatic hyperplasia. J Clin Endocrinol Metab 74:505

    Google Scholar 

  36. Perlberg S, Caine M (1982) Adrenergic response of bladder muscle in prostatic obstruction. Its relation to detrusor instability. Urology 20:524

    Google Scholar 

  37. Reece Smith H, Memon A, Smart CJ, Dewbury K (1986) The value of permixon in benign prostatic hypertrophy. Br J Urol 58:36

    Google Scholar 

  38. Reynard JM, Peters TJ, Lim C, Abrams P (1996) The value of multiple free flow studies in men with lower urinary tract symptoms. Br J Urol 77:813

    Google Scholar 

  39. Rhodes L, Primka RL, Berman C, Vergult G, Gabriel M, Pierre-Malice M, Gibelin B (1993) Comparison of finasteride (proscar), a 5-alpha-reductase inhibitor, and various commercial plant extracts in in vitro and in vivo 5 alpha-reductase inhibition. Prostate 22:43

    Google Scholar 

  40. Schröder FH (1994) 5-alpha-reductase inhibitors and prostatic disease. Clin Endocr 41:139

    Google Scholar 

  41. Shapiro E, Hartanto V, Lepor H (1992) The response to alpha blockade in benign prostatic hyperplasia is related to the percent area density of prostate smooth muscle. Prostate 21:297

    Google Scholar 

  42. Stoner E, and members of the finasteride study group (1994) Three-year safety and efficacy data on the use of finasteride in the treatment of benign prostatic hyperplasia. Urology 43:284

    Google Scholar 

  43. Tempany CM, Partin AW, Zerhouni EA, Zinreich SJ, Walsh PC (1993) The influence of finasteride on the volume of the peripheral and periurethral zones of the prostate in men with benign prostatic hyperplasia. Prostate 22:39

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bosch, J.L.H.R. Conservative non-instrumental treatment of benign prostatic hyperplasia. Urol. Res. 25 (Suppl 2), S107–S114 (1997). https://doi.org/10.1007/BF00941996

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00941996

Key words

Navigation