Page 1 - Use of 5 ARI's in Clinical Practice: A Canadian Position

Urological Health
5ARIs in BPH treatment and
prostate cancer prevention
What is the prostate?
The prostate is a small gland about the size and shape
of a walnut. It is located just below the bladder and is
wrapped around the male urethra, the passageway
that carries urine from the bladder through the
penis during urination. The prostate secretes fluid,
which forms part of the semen in which sperm are
transported.
What is benign prostatic
hyperplasia (BPH)?
As men age, it is common for the prostate to
grow. This increase in size is called benign prostatic
hyperplasia (BPH). This growth may not cause any
problems, but about half of men who have it will have
symptoms. The most common symptoms caused
by BPH include problems with urination, a delayed
urination, a weak urine flow, an urge to urinate,
leaking, or sometimes dribbling in your underwear.
BPH is NOT cancer.
How do you know that you have BPH?
It is usually symptoms like the ones described above
that will cause you to see a doctor. The doctor will
need to do some tests to confirm your diagnosis of BPH.
Your doctor will ask you a number of questions to
determine how severe your symptoms are and if these
symptoms bother you. Your prostate will be examined
with a gloved, lubricated finger in the rectum. This is
called a digital rectal exam (DRE), which is done to
determine if the prostate is enlarged. You may be
asked to provide a urine sample to ensure that you
do not have any infection. A prostate specific antigen
(PSA) blood test will likely be suggested, which is
used to rule out cancer in some men. If the PSA is
elevated, it does not necessarily mean that you have
prostate cancer, as BPH can also cause the PSA to be
elevated.
5ARIs for the treatment of BPH
The treatment of BPH is determined by the severity
and how much you are bothered by your symptoms.
It is also determined by your general health and your
personal preferences. After consideration of various
factors, your urologist may recommend a 5-alpha
reductase inhibitor (5ARI) to control your symptoms.
5ARIs (e.g. Proscar , Avodart ) block the hormones
TM
TM
that stimulate the prostate to grow and actually shrink
the prostate. They are most effective in men with a
large prostate. It takes some time for a 5ARI to shrink
the prostate, so improvement in urination symptoms
may not be noticed for up to six months. Side effects
include a decrease in semen volume and less
frequently a loss of sexual desire (libido) and difficulties
with erections. 5ARIs can be taken together with an
alpha-blocker (e.g. Flomax , Xatral , RAPAFLO ) to
TM
TM
®
give you the best control of your symptoms. Alpha-
blockers relax the muscle in and around the prostate
gland and the bladder opening to relieve your
symptoms and make urination easier.
What monitoring is necessary when
you are taking a 5ARI for BPH?
If you have BPH, your doctor will monitor your PSA
levels before you start taking a 5ARI. Your PSA levels
will be measured again about six months later and at
least once a year afterwards. Your PSA usually drops
when you are on a 5ARI. If your PSA levels rise while on
a 5ARI, further testing may be done to make sure that
you do not have prostate cancer. An elevated level
of PSA while you are on a 5ARI does NOT necessarily
mean you have prostate cancer.
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