August Health Tip

Enlarged Prostate (BPH): A “Growing” Problem in Elderly Men

Prepared by:
Duvall Hamilton, Dharmesh Ghelani, Pharm.D. Candidates
Preceptor: Nancy Borja, Pharm.D.

Benign prostatic hyperplasia (BPH) refers to an increase in size of the prostate gland in middle-age and elderly men. According to the American Urology Association, approximately 50% of men will have some degree of BPH by the time they are 60 years of age, and up to 90% will be affected by age 80. This is a topic of concern because as the volume of the prostate increases, it applies pressure to the urethra. Ultimately, this may lead to several complications: A slow-down in urine stream, hesitancy in urinating, a frequent and urgent need to urinate, and dribbling of urine at the end of the flow. Other potential consequences of BPH include development of urinary tract infections (UTI), kidney stones, and sexual dysfunction.

Medications used to treat BPH:

Alpha Blockers

Alpha blockers provide symptomatic relief at BPH symptoms. They work by relaxing smooth muscle in the prostate and bladder neck. Such relaxation helps decrease the degree of urine flow obstruction. These drugs improve obstructive symptoms, but do not keep the prostate from enlarging.

5 α–reductase Inhibitors

5 α-reductase inhibitors work by inhibiting the production of the hormone responsible for prostate enlargement (DHT). These drugs are capable of shrinking the prostate and may delay the need for surgery.

Notable side effects:

• Endocrine metabolic: Gynecomastia
• Reproductive: Disorder of ejaculation , impotence , reduced libido
• Dermatologic: Immune hypersensitivity reaction, including rash, pruritus, urticaria etc

Adverse reaction of Alpha Blockers:

• Cardiovascular: Chest pain
• Dermatologic: Rash
• Gastrointestinal: Abdominal discomfort, abnormal taste in mouth, bitter, diarrhea, and nausea
• Musculoskeletal: Joint pain, backache, muscle pain
• Neurologic: Asthenia, dizziness, headache, insomnia, and somnolence
• Reproductive: Abnormal ejaculation, reduced libido
• Respiratory: Cough, pharyngitis, rhinitis, and sinusitis

Important Facts to Know

• Women should not handle capsules of Proscar® and Avodart® when they are pregnant or potentially may become pregnant due to the possibility of absorption and subsequent potential harm to a male fetus
• Patient should not donate blood for at least 6 months after the last dose to prevent Avodart® or Proscar® exposure in a pregnant transfusion recipient
• This drug may cause impotence
• Annual prostate exam is recommended for all patients over the age of 50 years

Early detection is the key

Lookout for any of these symptoms:

• Frequent urge to urinate
• Getting up to urinate 2 or more times a night
• Difficulty emptying the bladder
• Urination starts and stops

Whether or not BPH is caused by hormonal changes in aging men, there is no known way of preventing it. Once it does develop and symptoms are present that interfere seriously with the patient's life, timely medical or surgical treatment will reliably prevent symptoms from getting worse. Also, if the condition is treated before the prostate has become grossly enlarged, the risk of complications is minimal.

References:

• Urological Science Research Foundation Web site available at http://www.usrf.org. Accessed 07/12/2007.
• American Urology Association Web site available at http://www.auanet.org. Accessed 07/12/2007.
• Thompson Micromedex Web site available at http://www.micromedex.com. Accessed 07/12/2007.