Medicines for prostate cancer help relieve symptoms of the lower urinary tract. According to the recommendations of the European Urology Association, drugs to treat prostate cancer are used if the patient has moderate symptoms of the disease.
Currently, the two most widely used drug classes are alpha-blockers and 5-alpha-reductase inhibitors. Less commonly used are phosphodiesterase inhibitors and anticholinergics and others.
alpha blockers
Alpha-blockers relax the smooth muscle fibers that make up the prostate and bladder neck, resulting in a decrease in pressure on the urethral wall and widening of the lumen. This makes it easier for urine to flow out of the bladder. Alpha blockers are given to patients with moderate to severe symptoms of BPH. It is worth noting that alpha blockers relieve lower urinary tract symptoms, but theydoes not slow or stop further growth of the prostate.
Most men reported a decrease in lower urinary tract symptoms, as demonstrated by a decrease in the Prostate Symptom Index I-PSS (international scaleevaluate prostate symptoms) by 4-6 units.
The effect of taking alpha-blockers develops after 2-3 weeks.
In the human body, several types (alpha-1 and alpha-2) and subtypes (alpha-1a, alpha-1b, alpha-1d, etc. ) of alpha-adrenergic receptors are distinguished, they are not onlylocated in the muscle cells of the prostate gland, but also in other structures of the body, eg, in the heart, blood vessels, lungs. In the past, alpha blockers, used to treat BPH, act on all types of receptors, both alpha-1 and alpha-2-adrenergic receptors. In this regard, the development of complications is often noted in men. Scientists have discovered that alpha-1a-adrenergic receptors are located in the prostate gland. After the development of drugs that selectively block alpha-1-adrenergic receptors (selective alpha blockers), it is possible to reduce the number of side effects associated with the use of nonselective drugs (angina pectoris). , arrhythmia, etc. ).
Short-acting alpha-1 blockers
Prazosin was the first selective alpha-1 blocker approved to treat BPH. The disadvantages of prazosin, as with other short-acting agents, are the need for multiple daily doses and severe arterial hypotension.
Long-acting selective alpha-1 blocker
The European Society of Urology recommends the following long-acting alpha-blockers: tamsulosin, alfuzosin, terazosin and doxazosin. These drugs are effective and have approximately the same range of side effects. These drugs for the treatment of prostate cancer require a single daily dose.
The most common side effects associated with taking alpha-blockers are: headache, dizziness, weakness, and decreased pressure that occur when moving from a horizontal to an upright position (usually only observed)at the beginning of treatment - the effect of the first dose), drowsiness, nasal congestion and retrograde ejaculation. Although alpha blockers do not cause erectile dysfunction or decreased sex drive, these side effects have been reported in some cases of taking these drugs. But a complication like retrograde ejaculation, when sperm during ejaculation move into the bladder, and not into the penis, is more common. However, it is harmless.
Features related to taking alpha-blockers
If you are taking erectile dysfunction drugs like Viagra, you should know that their combination with alpha blockers can lead to a significant drop in blood pressure, leading to collapse and loss of consciousness. Remember that you can take a Viagra tablet no earlier than four hours after taking an alpha blocker.
5-alpha reductase inhibitors
5-alpha reductase inhibitors are the second class of drugs used to treat BPH and help relieve symptoms of lower urinary tract symptoms. Two drugs from this group are used to treat prostate tumors: Finasteride and dutasteride. These drugs block the enzyme 5-alpha-reductase, which converts testosterone to dihydrotestosterone, which plays an important role in prostate tumor growth. The result is slowing the growth of the prostate gland and reducing its size, thereby alleviating symptoms of the lower urinary tract. Finasteride blocks the conversion of testosterone to dihydrotestosterone 70% and dutasteride 95%. However, Finasteride and dutasteride are not clinically effective in the treatment of prostate cancer.
The greatest effect from treating prostate tumors with 5-alpha-reductase inhibitors was experienced by men with significantly enlarged prostates prior to treatment (more than 30 cc). Men taking 5-alpha-reductase inhibitors reported a 3-point reduction in the prostate symptom index I-PSS. Patients with pre-treatment small prostate (less than 30 cc) did not show significant improvement in the Prostate Symptom Index I-PSS.
The effectiveness of treatment with 5-alpha-reductase inhibitors develops 6-12 months after starting the drug. As we all know, prostate size does not always correlate with the severity of prostate cancer symptoms, so treatment with either finasteride or dutasteride is not always effective. results as expected. 30-50% of patients develop a clinical effect on treatment with 5-alpha reductase inhibitors.
The most common side effects of 5-alpha reductase inhibitors were decreased libido (6. 4%), impotence (8. 1%), ejaculation disorders (3. 7%), problemserection problems, rash in less than one percent of cases, increased size and tightness of the mammary glands.
Features associated with taking 5-alpha reductase inhibitors
Administration of Finasteride changes the blood levels of prostate-specific antigen in a downward direction. In patients receiving 5-alpha reductase inhibitors, prostate-specific antigen levels may be reduced by 50%. Prostate-specific antigen is a non-specific marker of prostate cancer. An increase in the level of prostate-specific antigen in the blood may be the first sign that allows you to suspect a tumor at an early stage and take further diagnostic and therapeutic measures. Underestimating the level of prostate-specific antigen in the blood can lead to false-negative results on prostate cancer screening tests.
To get the actual results of a prostate-specific antigen analysis in the blood of a patient taking Finasteride or dutasteride, doctors multiply the resulting number by two.
It is also known that taking Finasteride reduces a man's risk of developing noncancerous prostate cancer, but increases a man's risk of developing a very severe prostate tumor.
Phosphodiesterase inhibitors
In the past, tadalafil (a phosphodiesterase inhibitor) was used to treat erectile dysfunction in men. In 2011, this drug was approved for the treatment of benign prostatic hyperplasia. One scientific study found that taking tadalafil daily significantly improved lower urinary tract symptoms in men with BPH.
The use of tadalafil with nitrates (nitroglycerin), alpha blockers, and other antihypertensive drugs can cause a sharp drop in blood pressure. In addition, the use of tadalafil is restricted to patients with impaired liver and kidney function. Among the side effects, the most common are headaches and gastrointestinal disturbances, less often - hearing and vision disturbances, myalgias, etc. v.
Anticholinergic drugs
Anticholinergic drugs in the treatment of prostate cancer help relieve symptoms such as urinary incontinence, frequent urination, and urgency that cannot be leveled by alpha blockers. Doctors sometimes prescribe anticholinergics in combination with alpha blockers to better control the symptoms of BPH. The use of anticholinergics is associated with an increased risk of developing acute urinary retention. In addition, the following side effects may occur: blurred vision, constipation, dizziness, dry eyes, dry mouth, headache, digestive disorders, abdominal pain, urinary tract infection.
Anticholinergics for the treatment of prostate tumors: tolteridone and oxybutynin.
Combination of drugs to treat prostate cancer
Usually, the treatment of prostate cancer with drugs requires the appointment of many drugs. Men taking the combination of dutasteride and tamsulosin had significantly less symptoms of BPH compared with patients taking the drugs alone.
Currently, dosage forms have been developed that include both an alpha blocker and a 5-alpha reductase inhibitor. This dosage form is convenient, requiring only a single dose.
As a rule, combination drug therapy is well tolerated by patients. The adverse event profile includes combinations of adverse reactions that are characteristic of the individual drugs. The most common adverse events in combination therapy were erectile dysfunction (7. 4%), retrograde ejaculation (4. 2%), decreased libido (3. 4%).
As a rule, drugs must be used long-term, and when they are canceled, symptoms can return.
Many men refuse to take medication for prostate cancer because they fear the development of side effects, mainly those related to sexual function.
Patient history:"The doctor advised me to start treating BPH with one or more medications. I can urinate, but my urine stream is weak and sometimes painful when I want to urinate in large volumes. On the Internet, I read about the two main classes of drugs used to treat BPH: alpha blockers and 5-alpha-reductase inhibitors Some men describe significant improvement in symptoms with one of the medications, but most do. All talk about the negative effects of the drug.
It is my understanding that both classes of drugs affect sexual function to one degree or another…. I dread even thinking about it. "
The story of a man using medicine to treat brown planthoppers
"I take the medicines the doctor prescribed me and so far I have not experienced any of the side effects described in the instructions . . . I have been taking it for about three years. There was a time when I thought it was medicine. If it doesn't work, double the dose and everything goes back to its place. . . . "
"I've been taking the drugs the doctor recommended for a long time and they've worked for me, but I can only experience a 'dry' orgasm, which I really don't like . . . "
"I was on alpha-adrenergic blockers and they helped me urinate well. The side effects were a decrease in the volume of the ejaculate and terrible dizziness with a drastic increase. . . . . urinating up to 13-15 times/day, my sperm count has increased dramatically I am 45 years old now and my urologist has put me on an alpha blocker medication periodically I get dizzywhen I get up suddenly my nose is always stuffy and oh yeah, a "dry" orgasm. The first time it happened, I thought it was just a contraction and an orgasm along the way. I was wrong. . But the worst is privatism! (Long, persistent, sometimes painful erection occurs without prior stimulation. ) At first, I was certain that the treatment was surgical. not for me, but now I've been thinking about this option".
"Hello, I have been taking medicine to treat prostate cancer for a long time. . . and I'm glad for that, because I was able to avoid surgery! "
As you can see, not every man develops side effects, and different patients may experience different adverse reactions. No doctor can say with one hundred percent certainty whether you will develop this side effect.
By making an appointment with your doctor, you can discuss the best therapy for you. When examining a doctor, you must inform the doctor without hiding all information about your health condition, diseases, and medications you are taking. This will help your doctor decide which treatment plan is best for you.