Issue: Vojnosanit Pregl 2017; Vol. 74 (No. 2)
Impact of pharmacologic therapy for benign prostatic hyperplasia on prostate volume and free testosterone and consequently on urinary parameters and sexual desire in men
Authors:
Nebojša Stojanović, Nebojša Djenić, Dragan Bogdanović, Konstansa Lazarević
Background/Aim. Pharmacologic therapy for benign prostatichyperplasia (BPH) relieves disease progression and affects
the androgen hormone status. A decrease in the level of
free testosterone (freeT) within total testosterone (totalT) leads
to symptoms of sexual dysfunction. The aim of this study
was to show the impact of pharmacological treatment for
BPH on prostate volume (PV) and levels of freeT and,
consequently, on urinary parameters and sexual desire in men
during 6 months of administration. Methods. This clinical
prospective study included 156 BPH patients with moderate
urinary symptoms – International Prostate Symptom Score
(IPSS) < 19, PV > 30 mL and prostate specific antigen (PSA)
value < 4 ng/mL. The average age of patients was 61.16 ±
2.97 years. The performed tests included determination of
tumor markers (PSA, free PSA), hormones (totalT, freeT,
freeT/totalT ratio), trans abdominal ultrasonography and
uroflowmetry. Urinary symptoms were measured by IPSS
and the Quality of Life (QoL) questionnaire while the changes
in sexual desire were measured using the International
Index of Erectile Function (IIEF) questionnaire. Four groups
were formed, 39 patients each. The group 1 received alpha1-
blocker (AB) tamsulosin, the group 2, 5 alpha-reductase inhibitor
(5-ARI) finasteride, the group 3, combined therapy of
both drugs (tamsulosin and finasteride), while the group 4
(control group) had no therapy. Follow-ups were performed
every three and six months during therapy administration.
Results. Prostate volume significantly decreased in the patients
on combined therapy (-6.95 ± 2.00; p < 0.001) and finasteride
(-6.67 ± 3.35). In the finasteride group, the levels of
freeT (-4.23 ± 5.2; p < 0.001) and freeT/totalT ratio (-0.12
0.08; p < 0.001) significantly decreased as did the freeT (-2.64
± 7.81) and freeT/totalT ratio (-0.09 ± 0.13) in the combined
therapy group. Uroflowmetry showed a significant improvement
in all parameters and all the therapy groups. Combined
therapy provided the greatest improvement in the maximum
flow rate (Qmax) (+4.06 ± 1.75; p < 0.001) and urinary
symptoms (-10.95 ± 3.19). A significant improvement of
sexual desire occurred in the patients on tamsulosin (+0.78 ±
1.00; p < 0.001), with a slight deterioration in the finasteride
group, but without statistical significance. Conclusion. Hormonal
component of pharmacologic therapy for BPH most
effectively reduces PV and freeT levels, improves urinary
symptoms with a slight decline of sexual desire in men on finasteride
monotherapy.
