Depot medroxyprogesterone in the management of benign prostatic hyperplasia

The effects of depot medroxyprogesterone (DMPA), a 5 alpha-reductase, luteinizing-hormone release and human androgen receptor adhesion inhibitor, were assessed in 80 patients with benign prostatic hyperplasia (BPH) in a double-blind, placebo-controlled study. Patients were randomized to DMPA 150 mg single-dose intramuscular injection or placebo in a similar fashion. The following changes were seen with DMPA after 3 months (duration of DMPA effect): (1) serum testosterone reached castration levels within 3 days as compared to no changes in the placebo group; (2) the prostate volume was reduced by 25% compared to a 3% decrease with placebo (p < 0.001); (3) maximum urinary-flow rates increased by 3.7 ml/s compared to placebo (p < 0.001); (4) total urinary symptom scores decreased by 4.9 points compared to a nonsignificant decrease with placebo (p < 0.005). There was a 2.5-point decrease in irritative symptoms (urinary frequency, nocturia and urgency) as compared to a nonsignificant decrease with placebo (p < 0.005). After 3 months, the urinary symptoms and urodynamic changes were reversed but significantly greater than the baseline values (p < 0.001). The prostates showed regrowth to the initial sizes within 18-36 weeks. DMPA was better tolerated, except for a higher incidence of impotence, decreased libido and ejaculatory disorders, than in the placebo group. The quality of life is improved with DMPA since it did not produce hot flashes. It was concluded that single-dose DMPA 150 mg is a safe and effective treatment for prostatic obstruction where potency is a secondary consideration.