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04.02.2015

Treatment options for bph, chinese herbal chicken soup - Try Out

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The Johns Hopkins Hospital is the only hospital in history to have earned the number one ranking for 22 years—an unprecedented 21 years in a row from 1991 to 2011, and again in 2013. One study published last year suggests that finasteride may be best suited for men with relatively large prostate glands. Finasteride can lower PSA levels by about 50%, but is not thought to limit the utility of PSA as a screening test for prostate cancer. Symptomatic BPH is generally recognized as including the presence of lower urinary tract symptoms (LUTS). Despite the great prevalence of BPH in today’s society, many patients remain untreated. The use of drugs in the treatment of BPH is based upon disease severity as well as the underlying cause. The five alpha-antagonists currently available in the United States for the treatment of BPH are alfuzosin, doxazosin, silodosin, tamsulosin, and terazosin. The 5-alpha-reductase inhibitor class has been shown to improve LUTS in the presence of BPH.4 Two drugs currently available within this class are finasteride and dutasteride (TABLE 2).
Recently, clinical evidence has emerged for using tolterodine, an anticholinergic, in the treatment of overactive bladder and BPH if symptoms are not controlled with monotherapy with an alpha-antagonist.
Combination Therapy: Because of its efficacy in halting symptoms and progression of BPH with use of combination therapy, cost-effectiveness has also been demonstrated. The medication management of BPH should be focused on improving LUTS associated with the disease while limiting side effects of medications used to treat them. Innovations in Treatment of BPH and Enlarged Prostate: The emerging role of the new transprostatic implant using the Urolift System for treatment of BPH symptoms caused by enlarged prostate.
Symptoms, as well as objective measurements of urethral obstruction, can remain stable for many years and may even improve over time as many as one-third of men, according to some studies.


Despite the high prevalence of histologic diagnosis, symptoms of the disorder do not affect all men presenting with BPH. Acute urinary retention, nephropathy, infections, and bladder stones have all been reported outcomes of uncontrolled disease.2 In addition, much QOL research on BPH management has been done. In an analysis of 1,500 men with BPH surveyed in a 1999 study completed in the United Kingdom, only 11% were aware of treatment options that could treat or manage their disease.6 Due to the vital role pharmacists play on the health care team, involvement in the education of patients with BPH is essential in promotion of therapy to manage their disease appropriately.
Alpha-antagonists are a useful option in the management of moderate-to-severe LUTS secondary to BPH. All available alpha-antagonists have activity at all receptors, with only two being semiselective for the a1A subtype, tamsulosin and silodosin. When offered alpha-antagonist treatment, men should be asked if cataract surgery is planned, and therapy should be delayed until after the procedure is completed. Other factors considered include severity of symptoms, morbidities resulting from the disease, and patient QOL while on therapy.5 Appropriate patient selection for pharmacotherapy in treating BPH is essential when considering cost of the disease. TABLE 1 describes symptoms of BPH assessed by this tool, which are related to both storage and voiding dysfunction. For mild-to-moderate symptoms, a period of watchful waiting is sometimes recommended in which no pharmacotherapy is prescribed.
Alpha-antagonists are the most effective agents used to treat the moderate-to-severe and bothersome symptoms associated with bladder outlet obstruction (BOO) secondary to BPH.4 Symptoms related to urinary storage including frequency, nocturia, urgency, and incontinence are generally reported as the most bothersome with the largest impact on QOL. By inhibiting the formation of DHT, 5-alpha-reducatase inhibitors are able to mitigate the effects that androgens have on the prostate. Watchful waiting is recommended in patients with low symptom severity scores, whereas treatment is indicated in patients who have IPSS scores above 7 and are generally considered to have moderate-to-severe LUTS.5 Symptom severity at this level has demonstrated significantly higher costs, more utilization of health care resources, and decreased QOL of patients, indicating that cost of the disease would outweigh the cost of treatment. Identification, quantitation, and localization of mRNA for three distinct alpha 1 adrenergic receptor subtypes in human prostate.


Silodosin, a new alpha 1A-adrenoreceptor selective antagonist for treating benign prostatic hyperplasia: results of a phase III randomized, placebo-controlled, double-blind study in Japanese men.
Current status of 5-alpha reductase inhibitors in the treatment of benign hyperplasia of prostate. Dutasteride: a dual 5-alpha reductase inhibitor for the treatment of symptomatic benign prostatic hyperplasia. Efficacy and tolerability of doxazosin and finasteride, alone or in combination, in treatment of symptomatic benign prostatic hyperplasia: the Prospective European Doxazosin and Combination Therapy (PREDICT) trial. Anticholinergic therapy for lower urinary tract symptoms associated with benign prostatic hyperplasia. The cost-effectiveness of terazosin and placebo in the treatment of moderate to severe benign prostatic hyperplasia. Cost-effectiveness of tamsulosin, doxazosin, and terazosin in the treatment of benign prostatic hyperplasia.
An economic evaluation of doxazosin, finasteride and combination therapy in the treatment of benign prostatic hyperplasia. This may then become severe enough to negatively affect men’s quality of life (QOL) due to increased frequency of BPH-associated urinary symptoms. Other agents have shown possible benefit as well when used in combination with standard treatment, or as monotherapy if patients are unable to tolerate usual treatment.
Although nocturia (frequent nighttime urination) is one of the most annoying symptoms of BPH, it does not predict the need for future intervention.



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