The drugs for treating prostate hyperplasia fall into the following categories:
(1) Anti-androgen drugs: The most widely used drugs in this category are progestin drugs. After using anti-androgen drugs for a period of time, symptoms and urine flow rate can be improved, residual urine decreased, and the prostate reduced in size.
① Diethylstilbestrol: Take 2-3 mg orally per day for four weeks as one course of treatment. Long-term use will increase cardiovascular complications. Side effects include nausea, vomiting, gynecomastia, and impotence.
② Medroxyprogesterone acetate: Usage: 40 mg, three times daily. It inhibits the activity of 5-α reductase and can lower plasma testosterone levels.
③ Flutamide: Usage: 250 mg each time, three times daily, with one course lasting three months. It can reduce the volume of the patient's prostate and decrease residual urine. Side effects include gynecomastia, nausea, vomiting, and abnormal liver function.
(2) α-receptor blockers: The prostate is glandular tissue but contains a large amount of smooth muscle distributed throughout it, along with a large number of α-adrenergic receptors. When the patient’s sympathetic nervous system is excited, it can cause contraction of the prostate smooth muscle, leading to dynamic obstruction. α-receptor blockers can alleviate urinary tract obstruction symptoms in patients. For those with acute urinary retention, it helps remove the catheter early. The commonly used drugs in this category include:
① Phenoxybenzamine: Take 10 mg each time, two to three times daily, for two weeks. Side effects often include dizziness, vision impairment, and orthostatic hypotension.
② Phentolamine: Usage: Slow intravenous drip of 10 mg. It belongs to the same class of drugs as phenoxybenzamine, but due to its rapid onset and short duration of action, it is generally used for acute urinary retention. Side effects are similar to those of phenoxybenzamine.
③ Prazosin: Initial dose 0.5 mg, if no reaction, change to 1 mg, three times daily. It can cause orthostatic hypotension and has no effect on sexual function.
④ Terazosin (Hytrin): Usage: Initial dose 1 mg, then 2 mg, taken once before bedtime. As a selective α-receptor inhibitor, it is mainly used to relieve bladder neck obstruction and improve urination. This product has fewer side effects and generally does not cause dizziness or orthostatic hypotension.
(3) 5-α reductase inhibitors: By inhibiting 5-α reductase, it blocks the conversion of testosterone into dihydrotestosterone, thus preventing further enlargement of the prostate. Clinical observation confirms its efficacy. The commonly used drug is Finasteride (Proscar), 5 mg each time, once daily, with a course of treatment lasting at least six months. This product has basically no side effects, though a few patients may experience sexual dysfunction.
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