4.3.1 Sintesi e raccomandazioni - Biblioteca Medica

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α 1
-adrenoreceptor blockers produce a persistent increase in peak flow of about
2-3 ml/sec
Tamsulosin and alfuzosin (in the modified release formulation) are better
tolerated than terazosin and doxazosin
The incidence of symptomatic postural hypotension is similar to the incidence
with placebo in patients treated with tamsulosin, whereas it appears to be
significantly higher in patients on treatment with terazosin or doxazosin
5-α-reductase inhibitors reduce prostate volume by 15-25% after 12 months,
especially when it is particularly large; in any case they prevent further increases in
size
5-α-reductase inhibitors produce a significant improvement in symptoms and in
peak urinary flow, which is smaller than that achieved with a1-adrenergic blockers
5-α-reductase inhibitors reduce the risk of acute urinary retention
5-α-reductase inhibitors could reduce the risk of surgery related to LUTS/IPB
Short-term studies with a small sample size suggest that Serenoa repens and
Pygeum africanum may be effective in patients with LUTS/BPH, but their
mechanism of action has not been elucidated yet. Further randomized, placebocontrolled
trials of adequate duration and with large patient population are
necessary to confirm their efficacy
Short-term studies with a small sample size suggest that Mepartricin may be
effective in patients with LUTS/BPH; however, further randomized, placebocontrolled
studies of adequate duration and with a sufficiently large sample size
are required to confirm its efficacy
There are no acceptable studies on the use of antiandrogens and LH-RH
analogues in patients with LUTS/BPH
The combination of an α 1
-adrenoreceptor blocker and a 5- α reductase inhibitor
is the only kind of combination therapy that is supported by scientific evidence
The combination of an α 1
-adrenoreceptor blocker + finasteride is effective in the
prevention of progression of LUTS/BPH in the long-term follow up
Its clinical impact on the patient in terms of quality of life/well-being has not
been established
In patients with prostate >40mL or PSA >4ng/mL combined treatment reduces
the number of patients that need to be treated to avoid one unfavourable event
(progression or surgery)
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