Treatments for BPH | Off the Cuff With Mark Moyad, MD, MPH & Steven Gange, MD

PCRI’s resident moderator Mark Moyad, MD, MPH, sits down with urologist Steven Gange, MD, FACS, to discuss a category of medications called 5-Alpha-Reductase Inhibitors (e.g. Proscar and Avodart) for the treatment of enlarged prostates known as benign prostatic hyperplasia (BPH).

Dr. Steven Gange graduated from the UCLA School of Medicine in 1986. After his Urology residency training at the University of Kentucky in 1991, he entered the US Army as an academic urologist, teaching, and training residents. He joined Western Urological Clinic (now Summit Urology Group) in Salt Lake City, UT, in 1996. With over 25 years of clinical and research experience, he has developed an expertise in Men’s Health Urology, emphasizing minimally invasive procedures. He continues to be active as a Clinical Researcher and as such was the first Urologist in North America to perform the NeoTract UroLift for BPH, and the first in the world to perform UroLift under local anesthesia.

0:27 5 alpha-reductase inhibitors, “shrinkers,” are a class of medicines that shrink the prostate by blocking the conversion of testosterone into dihydrotestosterone. This prevents the growth of prostate cells and will eventually cause the entire gland to shrink in size. 5 alpha-reductase inhibitors are usually used in conjunction with alpha blockers (Flomax, Rapaflo, etc.).

1:22 Shrinkers take about 3-6 months to achieve a reduction in size and improvement of symptoms. There are also a number of possible side effects: Impeded semen production, erectile dysfunction, loss of libido, and changes in the metabolism of glucose and lipids.

2:39 There is a theory that shrinkers can help prevent prostate cancer. Two studies using Proscar and Avodart found a reduced risk of prostate in men who used these medications; however, it also found that those men had a higher risk of having a higher grade of prostate cancer. It is controversial whether these medications actually increase the risk of having a higher grade of prostate cancer or whether there were limitations to the studies. To another point, Shrinkers reduce PSA, but there is no evidence that this indicates an improvement in a cancer diagnosis.

4:03 Medicinal solutions for BPH (as opposed to surgical solutions) do not always produce desirable results for patients. Dr. Gange says that Relaxers and Shrinkers are unlikely to produce a dramatic change that some men need to alleviate symptoms and protect the health of their genitourinary system.

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