The Evolving Role of a-Blockers in Benign Prostatic Hyperplasia and Beyond
INTRODUCTION The Evolving Role of -Blockers in Benign Prostatic Hyperplasia and Beyond Steven A. Kaplan, MD Department of Urology, College of Physicians & Surgeons, Columbia University, New York, NY [Rev Urol. 2005;7(suppl 8):S1-S2] © 2005 MedReviews, LLC he paradigm for the medical management of benign prostatic hyperplasia (BPH) has undergone significant change over the past 15 years. Guided by new research, the approval of novel pharmaceutical and minimally invasive therapies, and the economics of health care financing, physicians have altered their approach to patient care in distinct ways. This evolution in thinking continues today. Indeed, as novel therapeutic modalities become available, as new connections between symptoms and sexual function become identified, and as we learn which baseline parameters best predict treatment response in particular patient populations, the therapeutic paradigm is likely to evolve and progress still further. -Blockers remain the most commonly prescribed medical therapy for BPH. A significant body of knowledge has evolved regarding the use of these agents to treat lower urinary tract symptoms (LUTS) as well as other urologic entities. The objective of this CME-certified supplement to Reviews in Urology is to provide an update for the urologist on new perspectives in the management of BPH and, specifically, the role of -blockade in the treatment of this condition. This supplement brings together many of the key thought leaders who conducted the pivotal studies that have extended our knowledge and understanding of -blockers for the treatment of BPH. Moreover, the potential role of these agents in the management of other urologic entities is explored. I am grateful to all of the authors for their scholarly contributions to this project. In this supplement, Kevin T. McVary, MD, discusses the increasingly recognized relationship among age, the presence of LUTS, and sexual dysfunction. -Blockers have been used to treat LUTS not related to BPH. Victor W. Nitti, MD, provides a scholarly review of the potential use of -blockers in younger men and in women T VOL. 7 SUPPL. 8 2005 REVIEWS IN UROLOGY S1 Introduction continued with primary bladder neck obstruction, as well as a rational approach to the clinical evaluation of men with LUTS and BPH. Chronic prostatitis is a condition that frustrates both patients and urologists. One of the leading investigators in the field, J. Curtis Nickel, MD, provides a comprehensive review of the pathophysiology of this ever increasingly recognized condition and describes new and exciting treatment paradigms for the disorder. In the past, patients presenting with urinary retention almost universally underwent surgical intervention with a prostatectomy. However, we have become increasingly aware that blockers may successfully treat this condition. Herbert Lepor, MD, reviews a refreshing approach to more conservative management of urinary retention, including his own experience, using medical therapy. Over the past decade, clinical studies have focused on examining the effectiveness of medical therapy to relieve S2 VOL. 7 SUPPL. 8 2005 LUTS and bladder outlet obstruction. Steven A. Kaplan, MD, reviews the currently available -blockers and describes the particular niches for each agent. The potential role of medical therapy to reduce the progression of BPH has been the focus of extensive research efforts. The Medical Therapy of Prostatic Symptoms (MTOPS) trial was the first, randomized, double-blind, placebo-controlled trial designed to determine the role of medical therapies in the progression of BPH. The results of the MTOPS trial, which were recently published in The New England Journal of Medicine, validate the role of monotherapy using -blockers or 5--reductase inhibitors, as well as combination therapy, for the treatment of LUTS and to delay the progression of BPH. Claus G. Roehrborn, MD, who was intimately involved in the design and interpretation of this study, reviews the MTOPS data and explores what they have taught us about the treatment of BPH. REVIEWS IN UROLOGY Proxies for BPH remain ill-defined. The use of baseline symptoms, prostate size, urodynamic parameters, and prostate-specific antigen (PSA) level has not been universally adopted. Kevin M. Slawin, MD, and colleagues introduce a novel compound, BPSA (benign PSA), which may be the best determinant of both severity, as well as potential progression, of BPH. There is a tremendous amount of new and important information in this supplement for the urologist to digest. Equipped with the supplement and enclosed CD-ROM, the urologist will be at the cutting edge of medical service as it relates to the use of -blockers for the treatment of LUTS associated with BPH and other urologic disorders. References 1. McConnell JD, Roehrborn CG, Bautista OM, et al, for the Medical Therapy of Prostatic Symptoms (MTOPS) Research Group. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med. 2003;349:23872398.