Treatment Options for Benign Prostatic Hyperplasia (BPH) in Men
Jan 06, 2022
Source: Cainiu Health
Dr. Sun Shaolong
Introduction
Watchful waiting: For patients with mild symptoms and an IPSS score below 7, observation without active treatment is appropriate.
Pharmacotherapy: 5α-reductase inhibitors. Dihydrotestosterone (DHT) plays a role in benign prostatic hyperplasia (BPH); therefore, 5α-reductase inhibitors can help suppress prostate growth.
Benign prostatic hyperplasia (BPH) is a common urological condition, particularly prevalent among middle-aged and elderly men. Patients with BPH often experience symptoms such as urinary frequency, nocturia, dysuria, and urinary retention—symptoms that can significantly impair quality of life in later years. Therefore, timely and active treatment is essential; in some cases, surgical intervention may be required. Below, we outline the various treatment options for benign prostatic hyperplasia.
Treatment Options for Benign Prostatic Hyperplasia in Men
Watchful Waiting
For patients with mild symptoms (International Prostate Symptom Score [IPSS] < 7), watchful waiting without active intervention is appropriate.
Pharmacotherapy
5α-Reductase Inhibitors: Dihydrotestosterone (DHT) plays a key role in prostate growth; thus, 5α-reductase inhibitors help suppress prostate enlargement.
Alpha-Adrenergic Blockers: These agents improve dynamic urethral obstruction by reducing smooth muscle tone in the prostate and bladder neck, thereby alleviating lower urinary tract symptoms (LUTS). Commonly used drugs include tamsulosin.
Anti-Androgens: Progestins are the most widely used anti-androgen agents. Although short-term use can improve symptoms, increase peak urinary flow rate, reduce post-void residual urine volume, and shrink prostate volume, these benefits reverse upon discontinuation—prostate volume rebounds and symptoms recur. Moreover, recent evidence suggests these agents may increase blood viscosity and elevate the risk of cardiovascular and cerebrovascular thrombotic events. Gonadotropin-releasing hormone (GnRH) analogues act selectively on the pituitary gland to stimulate luteinizing hormone (LH) and follicle-stimulating hormone (FSH) release; prolonged administration ultimately depletes pituitary responsiveness, leading to markedly reduced or even absent testosterone production by the testes—a pharmacologic castration effect.
Other Pharmacologic Agents: Include muscarinic (M) receptor antagonists, phytotherapeutic agents, and traditional Chinese medicine. M-receptor antagonists alleviate overactivity of the detrusor muscle and reduce bladder hypersensitivity by blocking bladder M-receptors, thereby improving storage-phase symptoms in BPH patients. Phytotherapeutic agents such as Cernilton® are indicated for the management of BPH and associated lower urinary tract symptoms (LUTS).
Prior to initiating pharmacotherapy, clinicians should comprehensively assess disease severity and carefully consider potential drug-related adverse effects as well as the necessity for long-term medication. Treatment response must be monitored through long-term follow-up and periodic urodynamic evaluation to avoid delaying surgical intervention when indicated.
Surgical Treatment
Surgery remains a cornerstone in the management of symptomatic BPH.
We hope this information is helpful. Wishing you a healthy and joyful life!
