Benign Prostatic Hyperplasia

Question 1

What is the definition of benign prostatic hyperplasia (BPH)?

Answer 1

Noncancerous enlargement of the prostate gland

Question 2

What is the prevalence of BPH?

Answer 2

Ubiquitous in aging men:
> 50% = > 60 years
> 80% = > 80 years

Question 3

What are the lower urinary tract symptoms (LUTS) associated with BPH?

Answer 3

• Decrease in force or caliber of urinary stream
• Hesitancy, post-void dribbling
• Incomplete bladder emptying
• Incontinence
• Urinary retention
• Frequency, urgency, nocturia
• Painless hematuria
• Firm, smooth, symmetrically enlarged prostate

Question 4

Name the types of medications commonly given to treat BPH.

Answer 4

• Alpha blockers (alpha-adrenergic antagonists)
• Non-selective alpha blockers
• Uro-selective alpha blockers
• 5-alpha-reductase inhibitors
• PDE-5 inhibitors

Question 5

How do Alpha blockers (alpha-adrenergic antagonists) help treat BPH?

Answer 5

Decrease bladder outlet obstruction due to abundance of alpha receptors in:
- prostate
- base of bladder
- prostate capsule
- prostatic urethra

Question 6

Name non-selective alpha blockers commonly used to treat BPH and describe the associated required education/precautions.

Answer 6

• Doxazosin (Cardura)
• Prazosin (Minipress)
• Terazosin (Hytrin)

Education/precautions:
- risk of hypotension/orthostatic hypotension

Question 7

Name common uro-selective alpha blockers used to treat BPH and describe the associated precautions.

Answer 7

• Tamsulosin (Flomax):
  - precaution r/t sulfa allergy
• Alfuzosin (Uroxatral) and
• Silodosin (Rapaflo):
  - need renal and hepatic dose adjustments

Combo: Jalyn =
Tamsulosin/Flomax with
Dutasteride/Avodart (5-aplha-reductase inhibitor)

Question 8

What are the 5-alpha-reductase-inhibitors and PDE-5 inhibitors used to treat BPH?

Answer 8

5-alpha-reductase-inhibitors:
- Dutasteride (Avodart)
- Finasteride (Proscar)

- Reduce size of prostate
- 6 - 12 months of treatment needed to see 
  benefit

PDE-5 inhibitor:
- Tadalafil (Cialis)