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Enlarged Prostate Special Report

In the Pipeline: New Treatments for BPH

Current medical treatment for benign prostatic hyperplasia (BPH, or an enlarged prostate) relies on alpha-1-adrenergic blockers (alpha-blockers), which relax muscles in the prostate, or 5-alpha-reductase inhibitors, which lower androgen levels within the prostate. This Special Report reviews other promising BPH treatment currently in the pipeline.

Experimental Drugs: Some of the medications under investigation for BPH include:

  • Cetrorelix. Cetrorelix (Cetrotide) is a luteinizing hormone-releasing hormone (LHRH) antagonist. It works on LHRH receptors in the pituitary gland to suppress production of testosterone (which fuels the growth of prostate tissue). In early clinical trials, Cetrotide has improved BPH symptoms, increased urine flow, and reduced prostate volume. This drug is under investigation in on ongoing clinical trial.
  • Naftopidil. This experimental alpha-blocker binds to two subtypes of the alpha-1 receptor, making it active within the bladder as well as the prostate. Researchers theorize that naftopidil might be particularly beneficial in men who have both BPH and an overactive bladder. In early research, the drug reduced overall BPH symptom scores and improved bladder irritation and urinary urgency. Naftopidil also appears to reduce nighttime urination.
  • NX-1207. Early clinical trials suggest that this investigational drug can shrink the prostate by about 25% within one month. In one trial, men treated with NX-1207 experienced a 10-point improvement in BPH symptom scores, with minimal side effects in general and no sexual side effects. In a follow-up assessment 29–34 months after NX-1207 treatment ended, more than half of the men had required no additional treatment for BPH symptoms. NX-1207 is currently in phase 3 clinical trials.

As urologists learn more about what contributes to BPH, they come up with new approaches based on trying known agents in different ways. For example:

Botox. It's known as a wrinkle remedy, but the ability of Botox (botulinum toxin type A) to weaken or paralyze muscles can help in a variety of medical conditions. Injections of Botox into the prostate have improved BPH symptoms for up to a year in some men. Performed under ultrasound guidance (much like a prostate biopsy), the procedure is quick, safe, and has shown no significant side effects, although it is still considered investigational.

Aspirin and ibuprofen. BPH has recently been added to the growing list of health conditions that are associated with inflammation. By some estimates, about half of prostate tissue obtained through biopsies or surgical specimens shows evidence of inflammation. Inflammation in the prostate increases the likelihood that BPH will progress, according to an analysis of data from the large Medical Therapy of Prostatic Symptoms (MTOPS) study. Consistent with this new information, researchers have found that taking medications that reduce inflammation may benefit the prostate and urinary tract.

ED medications. Another surprising finding is that erectile dysfunction (ED) drugs like sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levita) can improve urinary symptoms associated with BPH. In three large randomized trials, men with BPH and ED who were treated with Viagra, Cialis, or Levitra also experienced improvements in their urinary symptoms.

Other research suggests that alpha-blockers and ED medications have a synergistic effect on the two conditions. In other words, BPH-related urinary symptoms respond better when an ED drug is given along with an alpha-blocker, and erectile function improves more when an alpha-blocker is given with an ED drug.

Posted in Enlarged Prostate on September 15, 2009

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