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Treatments for BPH | Off the Cuff With Mark Moyad, MD, MPH & Steven Gange, MD

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PCRI’s resident moderator Mark Moyad, MD, MPH, sits down with urologist Steven Gange, MD, FACS, to discuss a category of medications called 5-Alpha-Reductase Inhibitors (e.g. Proscar and Avodart) for the treatment of enlarged prostates known as benign prostatic hyperplasia (BPH).

So the relaxers are okay they are very commonly used they’re gonna matter they throw them out like candy no i mean you watch i watched a movie with jack nicholson the other 90s that i’m on full max during the movie i don’t know if he’s really on it but so that’s the relaxers they’re simple it’s an easy script have a nice day and then you got the shrinker pills

Right so these are the 5 alpha reductase inhibitors this alphas 5 alpha reductase is an enzyme which converts testosterone to dihydrotestosterone within the prostate cell and so what does that do if you block if you block that conversion you don’t have as much of the active the die hydro impact in the prostate so and what happens then is the prostate cells

Don’t grow they recede in their in their growth and over time fewer cells actually are produced and and because these cells are the building blocks of these big prostates they themselves the prostates also received in size so the idea is that a smaller prostate is typically less bothersome prostate and and will often use these drugs in combination with the alpha

Blockers but there are some unique you know problems with these drugs yeah so it takes a while for these drugs to shrink the prostate research them on three to six months until you your urine flow is a little bit better mm-hmm and what are the side effects got a notorious class of drugs what are the side effects that you don’t like with the shrinkers so not only

Is there a problem with ejaculation in this case not related to the squeeze of the mechanism as is the alpha blockers but in this case related to the fact that these glands these glandular cells in the prostate or the cells were semen is produced and in essence the semen production just stops and so men on five off reductase inhibitors don’t have don’t have any

Forward ejaculation but it’s not because the mek paralyzed the factory has been shut down yeah and that’s a bother to some men but also in these in these drugs there’s a higher instance of erectile dysfunction a loss of libido or sexual drive and again we’re starting to begin to see other more serious potential side effects like changes in metabolism of glucose

And lipids and you know things that we need to be healthy so these ones may actually impact organs outside the prostate we have about the prostate cancer or prevention well we could talk about i mean the shrinker is there’s a theory that the shrinkers actually reduce the risk of prostate cancer so what they do without question is they reduce the psa production

We’ve known this and in fact a psa six months into the treatment with this kind of drug will typically be 50% of what it was before it’s a bit of a smoke and mirrors situation it doesn’t mean you have that necessarily that degree of improvement in a cancer diagnosis or or less likely to have cancer but that was tested in two major trials that the cancer prevention

Potential and in both trials with each of the two drugs in this class an asteroid and dete asteroid or proscar avodart there was some some evidence of cancer prevention the downside or the flip side is that in those patients who got prostate cancer in those trials they had a higher risk of a higher grade prostate cancer and all the package labeling talks about it

And you know we we have to appropriately counsel our patients that that’s a possibility even though many of us think it’s sort of an artifact of the studies but but i think in the end because of this sort of secondary finding these drugs aren’t in widespread use for prostate cancer prevention yeah yeah but then so yeah but you know we talked about your relaxers

In the shrinker and now you can even buy a pill that combines both yep right yep you can put a relaxer nurse shrinker in one pill and they please take the pill apart and many pills fall out of it that’s an expensive way to do it there’s also just generic options and most of us do it that way if you don’t seem very excited about these pills and i know you’re not

A big pill pusher i know you do some procedures but you don’t seem excited about them i think i’ve just done it long enough to know that we get what we get and it’s not always enough so and i think they almost low patience into this sense that everything is okay because yeah i don’t get up as many times at night or what have you even if we’re taking away the side

Effects the impact of these therapies is not a homerun and so some guys need a homerun some guys just need a single i’ll do fine but some guys really need more than what these pills can offer and when you say i’m not excited about it i write these all day long because patients want them yeah but then it’s interesting to me to see how many of them stop them yeah

Yeah and i’m worried about the guys who stop them say well that guy didn’t know he was doing and don’t come back and then on goes the bladder disease right and then the kidney problem and all the other bad that you talked about

Transcribed from video
Treatments for BPH | Off the Cuff With Mark Moyad, MD, MPH & Steven Gange, MD By Prostate Cancer Research Institute