The Long-Term Outcome of Medical Therapy for BPH
| Autor: | Peter Berger, Martin Marszalek, Stephan Madersbacher, Georg Schatzl, Jakob Lackner |
|---|---|
| Rok vydání: | 2007 |
| Předmět: |
Male
Nephrology medicine.medical_specialty Combination therapy Urology Prostatic Hyperplasia Placebo Risk Assessment law.invention Pharmacotherapy Randomized controlled trial law Internal medicine medicine Humans Intensive care medicine Adrenergic alpha-Antagonists Clinical Trials as Topic Plant Extracts Urinary retention business.industry Placebo Effect Surgery Natural history Treatment Outcome Disease Progression Drug Therapy Combination Hydroxymethylglutaryl-CoA Reductase Inhibitors medicine.symptom business Risk assessment |
| Zdroj: | European Urology. 51:1522-1533 |
| ISSN: | 0302-2838 |
| DOI: | 10.1016/j.eururo.2007.03.034 |
| Popis: | Objectives The lack of cure with medical therapy implies life-long treatment emphasising the need for a thorough understanding of the long-term outcome. We review the natural history, markers for progression, placebo effect, efficacy, pharmacoeconomic aspects, and preventive measures. Methods Literature review with particular reference to long-term controlled studies using plant extracts, α 1 -blockers, 5α-reductase inhibitors (5-ARIs), and combination therapy. Results There is a long-lasting (≥12 mo) placebo response of symptoms (20% decrease) and maximum flow rate (10% rise). The five long-term controlled trials of plant extracts are inconclusive and therefore their role in contemporary medical management is still controversial. The α 1 -blockers provide fast amelioration of symptoms yet have no relevant impact on the risk of acute urinary retention or surgery. Combination therapy should be reserved for moderately or severely symptomatic patients with a high risk of progression; in the majority of patients the α 1 -blocker can be safely stopped after 6–12 mo. The preventive use of 5-ARIs in men with no or mild symptoms at risk of progression is scientifically sound yet not generally accepted mainly for economic reasons. Conclusions A sharp contrast exists between the duration of the longest controlled trial (4.5 yr) and the situation in real life with treatment periods up to one or two decades of life. Real-life and registry data will be the only source of this important information in the future. |
| Databáze: | OpenAIRE |
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