Benign prostatic hyperplasia therapy agents

• Finasteride (Proscar) is a drug that inhibits the action of the male hormone testosterone. The prostate enlargement in BPH is directly dependent on DHT, the principal androgen hormone in the prostate. Finasteride (Proscar) blocks the enzyme needed to make DHT and so lowers blood and tissue DHT levels and helps to shrink the prostate. Side effects of finasteride include declining interest in sex, problems getting an erection, and problems with ejaculation. Again, because it is new, doctors do not know its long-term effects.
• Surgery is the treatment most likely to relieve BPH symptoms. However, it also has the most complications. Doctors use three kinds of surgery for BPH:
• Transurethral resection of the prostate (TURP) is the most common. After the patient is given anesthesia, the doctor inserts a special instrument into the urethra through the penis. With the instrument, the doctor then removes part of the prostate to lessen its obstruction.
• Transurethral incision of the prostate (TUIP) may be used when the prostate is not too enlarged. In this procedure, the doctor passes an instrument through the urethra to make one or two small cuts in the prostate.
• Open surgery is used when the prostate is very enlarged. In open surgery, the surgeon makes an incision in the abdomen or between the scrotum and the anus to remove prostate tissue.
Men should carefully weigh the risks and benefits of each of these options. Prostate surgery has traditionally been seen as offering the most benefits for BPH, but unfortunately carries the most risks.

PURPOSE:: Several studies document the impact of benign prostatic hyperplasia (BPH) in working, aged men. Direct medical costs related to BPH treatment are largely borne by employees through higher premiums. However, indirect costs related to lost work are primarily borne by the employer. In this study we used claims data and absentee records from large employers to estimate the costs associated with BPH in working age males. MATERIALS AND METHODS:: We used 2 data sources to examine direct and indirect costs associated with BPH in a privately insured, nonelderly population. Multivariate regression models were used to predict spending for persons with and without a medical claim for BPH, controlling for relevant covariates. Data on work loss were linked to medical claims to estimate work loss related to treatment for BPH. RESULTS:: Mean annual expenditures were $4,193 for men without a medical claim for BPH. In contrast, annual spending was $5,729 for men with a claim for BPH. Thus, the incremental cost associated with a diagnosis of BPH was $1,536 yearly. Overall the average employee with the condition missed 7.3 hours of work yearly related to BPH with approximately 10% reporting some work loss related to a health care encounter for BPH. CONCLUSIONS:: Treatment of men with BPH places a significant burden on employees and their employers through direct medical costs as well as through lost work time. Direct and indirect costs to the private sector related to BPH treatment are estimated to be $3.9 billion.

PURPOSE:: Benign prostatic hyperplasia (BPH), the most common benign neoplasm in American men, is a chronic condition that is associated with progressive lower urinary tract symptoms and affects almost 3 of 4 men during the seventh decade of life. Approximately 6.5 million of the 27 million white men who are 50 to 79 years old in the United States in 2000 were estimated to meet the criteria for discussing treatment. MATERIALS AND METHODS:: The analytical methods used to generate these results have been described previously. RESULTS:: In 2000 approximately 4.5 million visits were made to physician offices to for a primary diagnosis of BPH and almost 8 million visits were made with a primary or secondary diagnosis of BPH. In the same year approximately 87,400 prostatectomies for BPH were performed in inpatients in nonfederal hospitals in the United States. While the number of outpatient visits for BPH increased consistently during the 1990s, there was a dramatic decrease in the use of transurethral prostatectomy, inpatient hospitalization and length of hospital stay for this condition. These trends reflect the changing face of medical management for BPH, ie increasing use of pharmacological agents and minimally invasive therapies. In 2000 the direct cost of BPH treatment was estimated to be $1.1 billion exclusive of outpatient pharmaceuticals. CONCLUSIONS:: Given the impact that BPH has on quality of life and health care cost in millions of American men, additional research into risk factors, diagnostic and therapeutic resource use, and effectiveness and cost benefit of therapies are warranted.

J Altern Complement Med. 2002 Dec;8(6):813-21.
Flavonoid and botanical approaches to prostate health.
Katz AE.
Center for Holistic Urology, New York Presbyterian Hospital, and Columbia University School of Medicine, College of Physicians and Surgeons, New York, NY, USA.

Benign prostatic hyperplasia (BPH) is a common problem among aging men that produces significant morbidity and health care costs. Contention exists as to whether currently available surgical and pharmacologic options for BPH are appropriate for men in the watchful-waiting stage. Recently, the possible benefits of phytotherapies (plant-derived preparations) in treating BPH and prostate cancer are being considered. Several phytotherapies, including saw palmetto, Pygeum africanum, curbicin, and isoflavone-containing supplements (red clover [Trifoleum pratense] and soy), are widely used in patients with BPH. Evidence suggests that the consumption of isoflavones found in legumes is related to lower rates of BPH and prostate cancer among Asian men. When evaluating natural therapies, the physician should look for a product that relieves symptoms and is safe, contains a health-conferring ingredient with a defined mechanism of action, and is standardized for that ingredient. Phytotherapies, particularly isoflavone-containing supplements, are likely to have an important role in the management of patients in the watchful-waiting stage of BPH.