Yan Kit Fong

Natural history and clinical predictors of clinical progression in benign prostatic hyperplasia

PURPOSE OF REVIEW Prevalence of benign prostatic hyperplasia (BPH) is increasing with the aging population worldwide. Knowledge of the natural history of BPH is crucial for primary, secondary and tertiary prevention of its progression. This review examines the evidence of the natural history of BPH, highlighting the group of patients with mild symptoms and the risk factors for progression. RECENT FINDINGS Several community and clinical studies have demonstrated the progressive nature of BPH. Different surrogate endpoints, which include symptom score, peak urinary flow rate, prostate volume, and the occurrence of acute urinary retention and need for surgery, have been described. Prostatic specific antigen and prostate volume are the two most common predictors of clinical progression and are helpful to the clinician for identifying high-risk patients. SUMMARY With further understanding of the natural history and the predictors of progression of BPH, management can be better tailored according to risk stratification and the results of clinical trials of effectiveness can be better interpreted.

Dutasteride: a novel dual inhibitor of 5α-reductase for benign prostatic hyperplasia

Dutasteride is a new dual 5α-reductase inhibitor for the treatment of benign prostatic hyperplasia. It differs from finasteride as it inhibits both isoenzymes of 5α-reductase and results in near-complete suppression of serum dihydro-testosterone. Similar to finasteride, it reduces serum prostatic specific antigen by ∼ 50% at 6months and total prostate volume by 25% in 2years. Randomised, placebo-controlled trials conducted over 2years have shown the efficacy of dutasteride in symptomatic relief, improvements in quality of life and peak urinary flow rate, and reduction of acute urinary retention events and the need for surgery. The main side effects are erectile dysfunction, decreased libido, gynaecomastia and ejaculation disorders. However, long-term usage for > 4years did not reveal increased new onset of sexual side effects. In addition, the combination of dutasteride and tamsulosin is well-tolerated and has the added advantage of rapid symptomatic relief. Finally, dutasteride has been shown to possess tumour regression properties invitro and its role in chemoprevention of prostate cancer will be confirmed in the ongoing Reduction by Dutasteride of Prostate Cancer Events (REDUCE) trial.

Role of phytotherapy in men with lower urinary tract symptoms.

Purpose of review Serenoa repens extract is a popular phytotherapeutic agent in men with lower urinary tract symptoms. Although the exact mechanism of action is unknown, the agent is generally well accepted for its easy availability and good tolerability. This paper reviews the evidence of its efficacy in comparison with placebo, 5-α reductase inhibitor and α-1 adrenoreceptor antagonist. Recent findings Serenoa repens extract is comparable with 5-α reductase (finasteride) and α-1 antagonist in the treatment of benign prostatic hyperplasia in terms of symptom score and peak urinary flow rate improvement, but has a lower incidence of associated sexual dysfunction. Furthermore, long-term usage (36 months) of Serenoa repens decreases the progression rate of the condition as compared with watchful waiting. In addition, the efficacies of Serenoa repens are proven in several placebo-controlled trials. Summary Serenoa repens has proven its role in the management of benign prostatic hyperplasia and will remain as a viable first-line treatment option.