New Treatments for BPH

Investigational new treatments to relieve symptoms of enlarged prostate, BPH, include aspirin, Viagra, Botox, and a number of promising new drugs.

Current medical treatment for benign prostatic hyperplasia (BPH, or an enlarged prostate) relies on alpha-1-adrenergic blockers (alpha-blockers), which relax muscles in the prostate, or 5-alpha-reductase inhibitors, which lower androgen levels within the prostate.

When combined, these medications relieve symptoms in up to two thirds of men with an enlarged prostate who take them. Several other approaches to BPH are being studied. These range from investigational new drugs to the use of existing non- BPH medications to control prostate enlargement.

Experimental Drugs -- Some of the medications under investigation for BPH include:

• Cetrorelix. Cetrorelix (Cetrotide) is a luteinizing hormone– releasing hormone (LHRH) antagonist. It works on LHRH receptors in the pituitary gland to suppress production of testosterone (which fuels the growth of prostate tissue). In early clinical trials, Cetrotide has improved BPH symptoms, increased urine flow, and reduced prostate volume.

• Silodosin. An experimental alpha-blocker, silodosin appears to target prostate tissue more precisely than do other alpha-blockers. If so, it might be less likely than other alpha-blockers to cause side effects such as low blood pressure (hypotension). The drug is being investigated in an ongoing clinical trial.

• Naftopidil. Another experimental alpha-blocker, naftopidil binds to two subtypes of the alpha-1 receptor, making it active within the bladder as well as the prostate. Researchers theorize that naftopidil might be particularly beneficial in men who have both BPH and an overactive bladder. In early research, the drug reduced overall BPH symptom scores and improved bladder irritation and urinary urgency. Naftopidil also appears to reduce nighttime urination.

• NX-1207. Early clinical trials suggest that this investigational drug can shrink the prostate by about 25% within one month. In one trial, men treated with NX- 1207 experienced a 10-point improvement in BPH symptom scores, with minimal side effects in general and no sexual side effects. In a follow-up assessment 29–34 months after NX-1207 treatment ended, more than half of the men had required no additional treatment for BPH symptoms.

As urologists learn more about what contributes to the condition, they come up with new approaches based on trying known agents in different ways.

• Botox. It’s known as a wrinkle remedy, but the ability of Botox (botulinum toxin type A) to weaken or paralyze muscles can help in a variety of medical conditions. Injections of Botox into the prostate have improved BPH symptoms for up to a year in some men. In one study, 76% of men who received Botox injections experienced more than a 30% improvement in BPH symptoms and quality-of-life measures. Performed under ultrasound guidance (much like a prostate biopsy), the procedure is quick, safe, and has shown no significant side effects. It’s not clear how Botox works in the prostate, but it appears to alter the inner structure of the gland.
• Aspirin and ibuprofen. BPH has recently been added to the growing list of health conditions that are associated with inflammation. By some estimates, about half of prostate tissue obtained through biopsies or surgical specimens shows evidence of inflammation.

Inflammation in the prostate increases the likelihood that BPH will progress, according to an analysis of data from the large Medical Therapy of Prostatic Symptoms (MTOPS) study. It showed that men with evidence of inflammation in prostate tissue had larger prostates, higher prostate specific antigen (PSA) levels, a greater risk of developing urinary retention, and a higher rate of BPH progression. Consistent with this new information, a recent study found that taking medications that reduce inflammation may benefit the prostate and urinary tract. In the study, men who took an aspirin a day (or another type of nonsteroidal anti-inflammatory drug such as ibuprofen) had a 27% reduction in urinary symptoms, a 49% lower risk of developing an enlarged prostate, and a 48% lower risk of having an elevated PSA level.

• ED medications. Another surprising finding is that erectile dysfunction (ED) drugs like sildenafil (Viagra) and tadalafil (Cialis) can improve urinary symptoms associated with BPH. In one study of men with both ED and BPH, Viagra significantly improved both erectile function and BPH symptoms. Other research suggests that alpha-blockers and Viagra have a synergistic effect on the two conditions. In other words, BPH-related urinary symptoms respond better when Viagra is given along with an alpha-blocker, and erectile function improves more when an alpha-blocker is given with Viagra.

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Medical Disclaimer: This information is not intended to substitute for the advice of a physician. Click here for additional information: Johns Hopkins Health Alerts Disclaimer

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Posted in Prostate Disorders on November 1, 2007