Treatment of prostate adenoma with finasteride

Finasteride for adenoma

Prostate adenoma is an overgrowth of the prostate gland of a benign nature. Such a condition is on the verge between physiological and pathological, since it manifests itself in almost all men of advanced age and is considered a kind of sign of aging of an organ. But at the same time, it causes a huge number of unpleasant symptoms, and therefore requires treatment.

To get rid of this pathology, two methods of treatment are used - conservative and surgical. If the prostate gland has grown slightly, and the disease is in the first stages, then they resort to medical, that is, conservative, therapy.

Finasteride proved to be an excellent drug for prostate adenoma. But you can’t drink it just like that, before use, you should carefully study the instructions for use and consult with your doctor. Since the drug is not suitable for everyone.

For what symptoms can Finasteride be prescribed

Before prescribing treatment, it is imperative to undergo examinations that will help find the disease. But the reason for contacting specialists should be the following subjective feelings:

• the duration of the act of urination has increased significantly;
• the pressure of urine is noticeably weakened, the stream is sluggish, sometimes it can be interrupted;
• after going to the toilet there is no feeling of emptying the bladder;
• at the very beginning of urination, there is a delay between muscle relaxation and the appearance of a jet;
• at the end of urination, urine may start to come out in droplets;
• at night you have to go to the toilet often;
• going to the toilet during the day also became more frequent;
• in some cases, you have to strain hard to urinate;
• Incontinence incidents are sometimes possible.

All these signs may indicate an adenoma of the prostate. In order not to start the process, treatment should be started at the first symptoms.

Composition of Finasteride

The main active ingredient has the same name as the commercial name of the drug - finasteride. Usually one tablet contains 5 mg.

But besides this component, auxiliary substances are also present:

• lactose monohydrates;
• cellulose and starch;
• titanium dioxide;
• magnesium stearate.

They all give a specific shape and appearance to the tablet, and also prevent it from dissolving too early. They help deliver Finasteride exactly where it needs to be absorbed and act.

The drug is prescribed to stop the growth of glandular tissue, as well as reduce prostatic hyperplasia. It helps to restore the patency of the urethra, improve the flow of urine through it, and also reduce the brightness of clinical manifestations. In addition, it significantly reduces the risk of developing acute urinary retention, which may require surgical intervention.

When not to drink the drug

Finasteride is strictly forbidden to be taken by women, and during the bearing of a child, in general, any contact with the drug is undesirable. This is due to the fact that the active substance of this drug negatively affects the fetus, especially the male. It interferes with the normal development of the reproductive organs in the embryo.

Also, you can not use the drug for people who have a history of allergic reactions to any components of Finasteride. There is no experience in using this medicine for the treatment of diseases in children, so they are also contraindicated.

How to drink the drug

Finasteride should be taken 1 tablet once a day. It is not recommended to exceed the daily dose - 5 mg, since the drug contains hormonal substances. And you should not abuse it.

The course of treatment is always very long. It can be 5-6 months or more. But all these criteria should be limited by the doctor. The drug should be taken under constant supervision by the attending physician with regular tests.

Side effects

Like any other, and especially hormonal drugs, Finasteride has not only a positive side - a therapeutic effect, but also a negative side - side reactions. They can occur from various organs and systems:

• immunity - allergies, angioedema on the lips and face;
• epidermis - various types of skin rashes, severe itching, sometimes urticaria;
• digestive organs - increased concentration of liver tests;
• cardiovascular disorders - palpitation, that is, flutter of the heart muscle, in rare cases, tachycardia;
• psyche - a sharp decrease in libido (craving for the opposite sex). Usually this unpleasant moment occurs at the beginning of therapy and completely disappears approximately by the end of the second week of treatment.In rare cases, low libido can be observed during the entire course, and also persist after drug withdrawal. Another mental disorder can be depression;
• genital organs - transient impotence, pain in the scrotum, impaired ejaculation (ejaculation), decreased concentration and motility of spermatozoa in semen;
• pain, swelling, sometimes a significant increase in the mammary glands in men.

If you experience such unpleasant symptoms, you should inform your doctor about it. Since it may be necessary to adjust the dose of Finasteride or select an analogue.

Reception features

In patients who take Finasteride, the risk of developing obstructive uropathy increases. This is a condition during which the patency of the urinary tract is disturbed in any department of the entire system. It is dangerous because it can lead to kidney pathologies and disruption of their functions.

Before you start taking Finasteride, you should make sure that the body does not have the following diseases that are easily confused with prostatic hyperplasia:

• oncological process in the prostate gland;
• bladder muscle weakness;
• prostatitis;
• stricture of the urethra;
• Violation of the innervation of the bladder.

Patient opinion

Reviews about Finasteride for Prostate adenoma in men are very different. Some write that taking the drug did not help them at all, and sometimes even worsened the condition, because it caused side effects. But still, most of the reviews are positive.

People say that the medicine helped them get rid of the problem, removed unpleasant symptoms and did not cause any negative changes in the body and well-being. Also, patients note that the pricing policy of Finasteride is very loyal, so even long-term use of the drug does not hit the budget much. Below are some testimonials.

Instructions for the use of Finasteride for adenoma

Hyperplasia (adenoma) of the prostate gland occurs in many men whose age has passed the mark of 45 years. The disease is to some extent considered age-related, occurs against the background of hormonal changes and natural aging of the body. It is necessary and important to treat the pathology in order to avoid serious complications and irreversible changes in the prostate. In the early stages, conservative therapy with medications, in particular Finasteride, shows high efficiency. Adenoma and Finasteride - let's figure out how the drug helps.

Brief description and action of "Finasteride"

"Finasteride" is a synthetic hormonal drug from the group of testosterone-5-alpha-reductase inhibitors. It is used in urological practice for the treatment of benign prostatic hyperplasia (prostate adenoma) and associated urinary disorders. It is prescribed exclusively for men in order to relieve the main symptoms of the disease and prevent complications.

The composition of the drug includes a special intracellular enzyme that stops the conversion of the male sex hormone testosterone into biologically active dihydrotestosterone. Its concentration in the blood and prostate tissues decreases, the stimulating effect on tumor growth decreases.

Finasteride proved to be an excellent drug for prostate adenoma

Result:

• the prostate decreases in volume;
• urine flow increases;
• obstruction of the urinary tract is eliminated;
• The functionality of the organ is gradually restored.

The active substance of the drug is the same name as finasteride. It is the only active ingredient that has a moderate androgenic effect. The content in one tablet is 5 mg.

Auxiliary ingredients are:

• lactose;
• corn starch;
• microcrystalline cellulose;
• magnesium stearate;
• macrogol;
• titanium dioxide;
• indigo carmine;
• Hypromellose

The drug is produced in tablet dosage form. Tablets are round, biconvex, blue, film-coated. Unpacked 10 pieces in a blister, 3 plates in a package with instructions. Storage conditions are standard, shelf life - no more than 3 years. Available in pharmacies only by prescription.

The main active ingredient has the same name as the commercial name of the drug - finasteride

Indications and contraindications for the drug

"Finasteride" is a highly specialized drug that is used exclusively in urology. It directly affects the functionality of the genitourinary system and the work of sex hormones. It has no other hormonal effect.

Only two pathological conditions are direct indications for prescribing the drug:

• benign prostatic hyperplasia (adenoma);
• androgenetic alopecia (baldness).

It is used in monotherapy of the mentioned diseases, as well as in combination with alpha-blockers. It is prescribed exclusively for male patients suffering from problems of the genitourinary system. "Finasteride" for prostatitis is indicated as an aid to normalize the outflow of urine.

The action of the drug is purposeful and systematic. Treatment involves several important effects that are achieved as a result of therapy:

Reducing the size of the prostate gland; removal of puffiness and hyperemia of the organ; improving the outflow of urine from the bladder; relief of the main uncomfortable symptoms of the disease; reducing the risk of developing acute urinary retention; prevention of complications and surgical intervention; stopping baldness in men. The drug is prescribed to stop the growth of glandular tissue, as well as reduce prostatic hyperplasia

The hormonal remedy has no strict contraindications. It is necessary to take into account the objective conditions in which it is not prescribed. These include:

• hypersensitivity to the composition;
• female (especially during pregnancy);
• Children under 18.

With great care, Finasteride is treated with renal failure, obstructive uropathy, and in old age. The expediency of prescribing and dosing is selected by the doctor according to individual indications.

How to use "Finasteride"

Pills are taken exclusively orally, that is, inside, as a whole. Chewing or grinding them is prohibited. You need to drink enough plain water. The time of admission is not of particular importance, food does not affect the absorption of the active substance. You can take the tablet with meals or after a meal. It is desirable to determine the time so that every day the reception takes place at approximately the same time.

According to the instructions, the daily dose is 5 mg of finasteride, that is, 1 tablet. It is not recommended to increase or decrease the dosage. If necessary, only the attending physician can change the scheme on an individual basis. The treatment course is long, on average it takes 6 months. The therapy can be extended for several months or repeated after a break.

The action of the tablets develops gradually, a lasting effect is achieved after about 3 months of regular use. A significant decrease in symptoms, improvement in the process of urination is observed at 6-7 months of treatment.

Finasteride should be taken 1 tablet once a day

Dose adjustment is not required in renal failure. In old age, a slight decrease in the rate of elimination of finasteride is recorded, which does not affect the general condition in any way - a special scheme is not selected.

Treatment with "Finasteride" should be carried out only after consultation with a urologist or andrologist, strictly according to the prescribed scheme. Unauthorized changes in the therapeutic course, and even more so self-treatment, are strictly prohibited. Violation of the doctor's recommendations will not only not bring the desired result, but will also lead to serious complications.

Possible side effects

Hormonal drugs often cause adverse reactions, especially with long-term use. Against the background of long therapy in men, a decrease in libido and potency is often recorded. Sexual function is usually restored after the end of the treatment course.

There are also complaints about:

• allergic skin reaction - itching, redness, rashes, swelling of the face;
• rapid heartbeat;
• impotence;
• ejaculation disorders (ejaculation);
• pain and enlargement of the mammary glands;
• pain in the testicles;
• a depressed state.

Most of the unpleasant symptoms occur at the beginning of treatment, disappear on their own as the body gets used to the drug. In some cases, an individual reaction of intolerance is noted, expressed in an acute allergic reaction (up to Quincke's edema). In this condition, an urgent cancellation of therapy is required, the selection of a suitable analogue.

Like any other, and especially hormonal drugs, Finasteride has not only a positive side - a therapeutic effect, but also a negative one - side reactions

No cases of overdose have been identified, there is no specific antidote.

Any adverse symptom should be reported to the attending physician, it may be necessary to make changes in dosing, treatment regimen and duration of the course. In no case should you stop taking Finasteride on your own.

Special Considerations

Finasteride is fairly well tolerated by patients, but precautions should not be neglected.

When prescribing and treating the drug, it is necessary to take into account all its features, follow some important instructions:

Before starting therapy, it is important to exclude such serious diseases as a malignant tumor of the prostate, infectious prostatitis, bladder hypotension, urethral stenosis - in the presence of pathologies, the drug is not used; a strong decrease in urine flow, and a large amount of residual urine requires constant medical monitoring due to the risk of developing obstructive uropathy; young (childbearing age) and pregnant women should avoid even small doses of "Finasteride" - it leads to pathological developmental disorders of the fetus (male); it is necessary to regularly monitor laboratory tests, check the condition of the kidneys, liver, bladder; should not be used in patients with lactose intolerance; drug interaction has not been identified, it can be used in a complex treatment regimen; about six months after the cessation of therapy, changes in the prostate gland are restored to some extent, therefore, in most cases, repeated courses are needed; does not have any negative effect on psychomotor reactions, during therapy it is allowed to control transport and complex mechanisms. Patients taking Finasteride have an increased risk of developing obstructive uropathy

Compliance with all the doctor's recommendations and constant monitoring of the condition is the key to good health and a speedy recovery.

"Finasteride" for prostate diseases - analogues

Individual intolerance, strong and prolonged side effects suggest drug withdrawal. In this case, the doctor must select an adequate analogue, similar in therapeutic effect and composition.

There are several medicines to choose from:

An analogue can only be prescribed by a doctor based on the patient's complaints and diagnosis. In no case should you change drugs on your own, especially in the middle of the course. Any changes are agreed with the attending urologist.

Finasteride in the treatment of patients with prostatic hyperplasia

Authors: Grigoryan V.A. Lokshin K.L. (Clinical hospital "Lapino", Moscow region), Shpot E.V. (GBOU VPO "First Moscow State Medical University named after I.M.

For citation: Grigoryan V.A., Lokshin K.L., Shpot E.V., Dymov A.M. Finasteride in the treatment of patients with prostatic hyperplasia // BC. 2008. 14. P. 977

Benign prostatic hyperplasia (BPH) continues to be one of the main problems of modern urology. First of all, this is due to the high prevalence of this disease. According to Novara et al. 10 who analyzed the recommendations for the diagnosis and treatment of BPH, which are offered by the American Urological Association, the Austrian National Council for Health and Medical Research, the British Urological Association, the Canadian Urological Association, the European Urological Association, as well as the MEDLINE database, where 134 literature sources were selected, prevalence BPH is 60% among men aged 60 years and 80% among patients 80 years and older.

The clinical manifestations of the disease are determined by the degree of violation of the outflow of urine. The symptom complex of the disease includes obstructive (difficult, sluggish urination, straining urination, feeling of incomplete emptying of the bladder) and irritative (increased urge to urinate during the day and night, imperative urge to urinate, which may be accompanied by urinary incontinence) symptoms that are combined into symptoms lower urinary tract (LUTS). Although symptoms of urinary outflow disorders (weak stream, intermittent urination) are much less common than irritative symptoms (frequent urination in small portions, nocturia, urgency, urinary incontinence), they are dominant among the symptoms that reduce the quality of life of patients 2. About 25% of men after 50 years of age have lower urinary tract symptoms (LUTS), the severity of which is usually determined by the sum of the scores of the International Prostate Symptoms Scale (IPSS), which was developed to objectify the clinical manifestations of BPH 6.7. Clinical studies show that LUTS are predominant and increase progressively with age (4,8). Today, the average life expectancy for a man in Europe and North America is 72 years and continues to grow 8. The dynamics of growth is such that from 1980 to 2050 the population over the age of 65 should double and reach 15% of the total human population. As a result, we can expect an increase in the number of potential patients suffering from prostatic hyperplasia. In this regard, the diagnosis and treatment of BPH is not only a serious medical, but also a major social problem, which emphasizes the importance of timely treatment of BPH 2. Currently, medical and surgical methods for the treatment of BPH are used, which are quite effective.As a result of the use of drug therapy, the number of surgical interventions for prostate hyperplasia has significantly decreased. So, for example, in the USA, the number of transurethral and open adenomectomy decreased from 250,000 in 1987 to 88,000 in 2000, and this despite the fact that the total number of patients suffering from BPH increased by 5 as a result of population aging. The main directions of conservative therapy for BPH are: - symptom reduction, - improvement in quality of life, - prevention of disease progression (in particular, prevention of such a severe complication as acute urinary retention and the need for surgical treatment) 9. Today, as is known, there are 3 groups of drugs used in the treatment of patients with prostatic hyperplasia: ?1-blockers, 5?-reductase inhibitors and plant extracts 2. One of the most widely used and studied drugs is finasteride (Prosteride and others) - a synthetic inhibitor of 5a-reductase. One of the central provisions of the theory of BPH pathogenesis concerns the role of the enzyme 5a-reductase and dihydrotestosterone (DHT). The basis for the development of this concept was the observation of cases of pseudohermaphroditism due to the congenital absence of 5a-reductase. With normal serum testosterone levels, these men had a significant decrease in DHT levels, accompanied by underdevelopment or almost no prostate. Subsequently, they did not experience the occurrence of adenoma and prostate cancer (PCa). According to the chemical structure, finasteride belongs to 4-azasteroids and is a powerful competitive inhibitor of 5a-reductase, mainly type 2. The drug blocks the conversion of testosterone into a more active androgen - 5a-DHT at the level of the prostate gland. During therapy with finasteride (Prosteride), the volume of the prostate gland decreases, the level of DHT in the blood serum decreases by 70-75%, and the PSA value by about 50%. The mechanism of action of finasteride on the pathogenesis of BPH through growth factors has been established: the specific effect of the drug on the TGFb signaling system, which has an inhibitory effect on the proliferation of prostate tissue, leads to glandular atrophy and stimulates the process of cell death (apoptosis), as well as a significant decrease in intraprostatic levels of DHT and EGF (mainly in the periurethral zone) and a decrease in the presence of bFGF in the prostate stroma of patients with BPH F. Sciarra et al., 1997; F. Torruba et al., 1997; C. Saez et al., 1999. A series of morphological studies demonstrated that in men, finasteride leads to atrophic processes in the glandular and stromal tissues of the prostate gland, and in the first case, changes are detected already after 3, and in the second - after 6 months of treatment M El-Demiry, E. Ishak, 1997. According to L. Marks et al. (1997) and M. Feneley et al. (1997), finasteride therapy reduces the proportion of epithelial tissue in the prostate gland and the epithelial-stromal ratio by about 50%, mainly in the transient zone. Finasteride has been used in clinical practice since the late 1980s and early 1990s. Clinic of Urology MMA named after I.M. Sechenova has experience in the long-term use of finasteride, first tested in a two-year, multicenter, placebo-controlled, double-blind study in 1992-1994. We analyzed our own experience of long-term treatment of patients with prostatic hyperplasia with finasteride in the urological clinic of the Moscow Medical Academy in the period from 1995 to 2004. The analyzed data were based on the results of 5-year treatment with finasteride in 56 patients with BPH. The mean age of the patients was 63.8 years (from 59 to 81 years). Patients took finasteride 5 mg once a day. Control examinations were carried out in patients after 2, 6, 12, 24 months, 3, 4 years and 5 years. We carried out a quantitative assessment of the complaints of patients with prostatic hyperplasia using the IPSS questionnaire. The baseline mean IPSS total score was 14.6. A statistically significant decrease in the mean IPSS score was observed after 6 months of treatment and amounted to 13%. An even more pronounced (22%) decrease in the mean IPSS value was registered after 12 months of therapy. In the next 4 years, the effect of treatment persisted: the mean IPSS score slowly decreased and by the end of the fifth year of treatment was 10.65 (-27% of baseline). The quality of life of patients was assessed based on the results of the response to the question about the degree of anxiety (BS) caused by the symptoms of impaired urination contained in the IPSS-BS questionnaire. Analysis of the values of the BS indicator showed its significant decrease after 6 months of treatment, which indicated an improvement in the quality of life of patients and, accordingly, the subjective effectiveness of treatment.The mean value of the BS quality of life index was initially 3.8 points - mostly unsatisfactory, and after 60 months of treatment - 1.9 - mostly satisfactory. Persistent improvement in the quality of life index during 5 years of treatment with finasteride was registered in 73.2% of patients. As criteria for an objective assessment of the effectiveness of drug treatment with finasteride, we used the change in the maximum volumetric urination rate (Qmax) according to uroflowmetry and the volume of the hyperplastic prostate according to transrectal ultrasonography before, during and after the end of therapy. The initial mean value of Qmax was 9.4 ml/s. Statistically significant mean Qmax increased after six months of finasteride therapy and amounted to 11.4 (+2) ml/s. The most significant increase in the indicator was noted by the end of 12 months of treatment (12.5 ml/s; +3.1 ml/s). By the end of the five-year period, the average Qmax increased slightly and amounted to 12.7 (+3.3 ml / s), which objectively indicated the continued effectiveness of finasteride with long-term use. According to transrectal ultrasonography, the average value of the initial volume of the hyperplastic volume of the prostate was 51.8 cm3. During the first 6 months of treatment with finasteride, there was a decrease in the enlarged prostate by an average of 9%, after 12 months of therapy, the most significant decrease in the average prostate volume to 40.7 cm3 (-23%) was noted, over the next four years of treatment there was a further decrease in volume hyperplastic prostate, resulting in a decrease in the average prostate volume to 37.9 cm3 (-26.7% of the original). The degree of reduction in the volume of the hyperplastic prostate was more pronounced in patients with an initial volume of more than 40 cm3, which is probably due to the predominance of the glandular component in large hyperplasia. Drug treatment with finasteride led to a significant decrease in the average volume of hyperplastic prostate gland, with the preservation of this trend throughout the 60 months of follow-up. Thus, treatment with finasteride for 5 years was effective both according to subjective assessment (IPSS-BS) and objective parameters (Qmax, prostate volume) 1. The safety of long-term treatment with finasteride was assessed based on the frequency and severity of adverse reactions and changes in blood and urine tests. Evaluation of changes in sexual function was recorded using a brief questionnaire to assess sexual (Brief Sexual Function Inventory) - BSFI. Of the 56 patients taking finasteride, 6 (10.7%) patients were diagnosed with 7 adverse events. Most of the adverse events were due to the effect of finasteride on sexual function - 8.9% of our patients had erectile dysfunction and / or decreased sexual desire. Within 60 months of finasteride treatment, 13 (23.2%) of 56 patients discontinued treatment. Due to side effects, 4 (7.1%) patients completed taking the drug: 3 patients developed sexual disorders, and one patient developed gynecomastia after 3 years of continuous use of finasteride. All three patients with sexual dysfunction who refused further treatment with finasteride were under 65 years of age, and it was important for them to maintain sexual activity. After discontinuation of finasteride, all 3 patients recovered sexual function. 8 (14.3%) of 56 patients refused further treatment due to the lack of effect. Only 1 (1.8%) patient experienced acute urinary retention during treatment, which required surgical treatment. During treatment with finasteride, there were no clinically significant changes in laboratory parameters. Our results indicate a relatively low incidence of adverse events and the safety of long-term use of finasteride in patients with prostatic hyperplasia 1. The efficacy and safety of long-term therapy with finasteride has also been established in several large studies, including placebo-controlled. Data from studies of the effectiveness of the drug are presented in Table 1. According to all the studies presented, in the process of continuous treatment for up to 4 years, finasteride made it possible to statistically significantly reduce the severity of urination disorders (reduce the total IPSS score) compared to placebo, improve the quality of life of patients (reduce the index BS) and reduce the volume of the prostate gland (according to transrectal ultrasound). Thus, studies indicate a long-term effect and the safety of long-term treatment of patients with BPH with finasteride. Interesting and important are the data on the effectiveness of finasteride as a means of chemoprevention of prostate cancer (PCa).The effect on testosterone metabolism in the prostate gland has long attracted the attention of specialists to finasteride as a potential cancer chemoprophylaxis agent I. Thompson et al. PCPT. It included 18,882 men over 50 years of age with no changes suspicious of PCa on per rectum examination, a PSA level of less than 3 ng/ml, and an IPSS score of less than 20 points. All patients underwent a prostate biopsy at the initial stage of the study, the results of which excluded cases of prostate cancer and high-grade dysplasia (prostatic intraepithelial neoplasia - PID). All participants in the study received placebo for 3 months, after which they were randomized into two approximately equal groups, one of which (n9423) received finasteride 5 mg / day, and the other (n9459) received placebo. Follow-up biopsies were performed during the "as indicated" program (if the PSA level exceeded 4 ng/ml) and in all patients after its completion. The study lasted 7 years. As a result, prostate cancer was diagnosed in 18.4% of patients taking finasteride, and in 24.4% of placebo, i.e. the relative risk of developing the disease decreased by 24.8% (p 26.06.2008 Experience with Prostamol Uno.

Introduction to Benign prostatic hyperplasia (BPH) and chronic prostate disease.

Introduction Modern tasks in relation to approaches to the problem of chronic prostatitis are possible.