[Treatment of benign prostatic hyperplasia with alpha 1-adrenoreceptor antagonists]

The International Consensus Committee recommends alpha-adrenoceptor antagonists for medical therapy benign prostatic hyperplasia (BPH). This review evaluates 52 randomized, placebo-controlled, double-blind studies, including 10399 patients and, moreover, 40 clinical studies including 33600 patients undergoing treatment with alpha-adrenoceptor antagonists because of BPH. The therapeutic efficacy of all alpha-adrenoceptor antagonists is more or less the same. There is an average improvement of symptom scores of about 35% and a mean increase in maximum flow rate of between 1.8 and 2.5 ml/s. Studies investigating long-term efficacy and quality of life tend to show a long-term benefit. The introduction of selective alpha 1-adrenoceptor antagonists led to a significant reduction of side effects. These side effects are primarily caused by the vasodilatatory qualities of alpha-blockers. The development of so-called uroselective alpha 1A-adrenoceptor antagonists in the treatment of BPH possibly leads to further reduction of side effects related to vasodilatation. Medical therapy by alpha 1-adrenoceptor antagonists seems to be superior to phytotherapy or treatment with 5 alpha-reductase inhibitors, as shown in a few studies. So far, it is not clear whether there is any advantage of combination therapy. The application of alpha 1-adrenoceptor antagonists is indicated in all cases of symptomatic BPH, excluding patients who need TUR-P (e.g., middle lobe) or prostatectomy. If patients are either willing or eligible to have surgical treatment, therapy by alpha 1-adrenoceptor antagonists is a rational choice. Comparative clinical trials have to be conducted to provide additional information and to clarify which alpha-blocker may be recommended as the first choice. Until then, those alpha 1-adrenoceptor antagonists should be used for which safety and efficacy are well documented and which can be prescribed at reasonable costs.