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Erschienen in: Der Urologe 2/2013

01.02.2013 | Leitthema

Stellenwert der α1-Adrenozeptorblocker und 5α-Reduktaseinhibitoren

Monotherapie bei der Behandlung des benignen Prostatasyndroms

verfasst von: Dr. F. Strittmatter, S. Madersbacher, C.G. Stief, C. Gratzke

Erschienen in: Die Urologie | Ausgabe 2/2013

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Zusammenfassung

Bei Patienten mit moderaten bis schweren Symptomen des unteren Harntraktes (LUTS) stellt die medikamentöse Therapie die primäre konservative Therapieoption dar. Die zur Verfügung stehenden α1-Blocker sind bei Patienten mit moderaten bis schweren LUTS indiziert und können wegen ihres schnellen Wirkeintritts bei Patienten mit geringem Progressionsrisiko als Monotherapie eingesetzt werden. Trotz der Symptomverbesserung kann eine Krankheitsprogression nicht vermieden werden. 5α-Reduktaseinhibitoren (5ARI) eignen sich wegen ihres verzögerten Wirkeintritts primär nicht zur initialen Monotherapie. Mittel bis langfristig führen 5ARI zu einer Verbesserung der Symptome und der maximalen Harnflussrate und haben darüber hinaus – als einzige Substanzgruppe – einen positiven Effekt auf die Krankheitsprogression. Der Einsatz von 5ARI im Sinne einer BPS-Prävention ist zwar wissenschaftlich gut belegt jedoch ist dieser Ansatz nicht leitlinienkonform.
Literatur
1.
Zurück zum Zitat Chapple CR, Roehrborn CG (2006) A shifted paradigm for the further understanding, evaluation, and treatment of lower urinary tract symptoms in men: focus on the bladder. Eur Urol 49(4):651–658PubMedCrossRef Chapple CR, Roehrborn CG (2006) A shifted paradigm for the further understanding, evaluation, and treatment of lower urinary tract symptoms in men: focus on the bladder. Eur Urol 49(4):651–658PubMedCrossRef
2.
Zurück zum Zitat Berges R (2008) Epidemiology of benign prostatic syndrome. Associated risks and management data in German men over age 50. Urologe A 47(2):141–148PubMedCrossRef Berges R (2008) Epidemiology of benign prostatic syndrome. Associated risks and management data in German men over age 50. Urologe A 47(2):141–148PubMedCrossRef
3.
Zurück zum Zitat McConnell JD, Roehrborn CG, Bautista O et al (2003) The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med 349(25):2387–2398PubMedCrossRef McConnell JD, Roehrborn CG, Bautista O et al (2003) The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med 349(25):2387–2398PubMedCrossRef
4.
Zurück zum Zitat Berges R, Pientka L, Hoefner K et al (2009) Therapy of benign prostate syndrome (BPS): guidelines of the German Urologists (DGU). Urologe A 48(12):1503–1516PubMedCrossRef Berges R, Pientka L, Hoefner K et al (2009) Therapy of benign prostate syndrome (BPS): guidelines of the German Urologists (DGU). Urologe A 48(12):1503–1516PubMedCrossRef
5.
Zurück zum Zitat Strittmatter F, Walther S, Gratzke C et al (2012) Inhibition of adrenergic human prostate smooth muscle contraction by the inhibitors of c-Jun N-terminal kinase, SP600125 and BI-78D3. Br J Pharmacol 166(6):1926–1935PubMedCrossRef Strittmatter F, Walther S, Gratzke C et al (2012) Inhibition of adrenergic human prostate smooth muscle contraction by the inhibitors of c-Jun N-terminal kinase, SP600125 and BI-78D3. Br J Pharmacol 166(6):1926–1935PubMedCrossRef
6.
Zurück zum Zitat Strittmatter F, Walther S, Gratzke C et al (2012) Activation of protein kinase B/Akt by alpha1-adrenoceptors in the human prostate. Life Sci 90(11–12):446–453 Strittmatter F, Walther S, Gratzke C et al (2012) Activation of protein kinase B/Akt by alpha1-adrenoceptors in the human prostate. Life Sci 90(11–12):446–453
7.
Zurück zum Zitat Strittmatter F, Gratzke C, Walther S et al (2011) Alpha1-adrenoceptor signaling in the human prostate involves regulation of p38 mitogen-activated protein kinase. Urology 78(4):969PubMedCrossRef Strittmatter F, Gratzke C, Walther S et al (2011) Alpha1-adrenoceptor signaling in the human prostate involves regulation of p38 mitogen-activated protein kinase. Urology 78(4):969PubMedCrossRef
8.
Zurück zum Zitat Bauer RM, Strittmatter F, Gratzke C et al (2011) Coupling of alpha(1)-Adrenoceptors to ERK1/2 in the human prostate. Urol Int 86(4):427–433PubMedCrossRef Bauer RM, Strittmatter F, Gratzke C et al (2011) Coupling of alpha(1)-Adrenoceptors to ERK1/2 in the human prostate. Urol Int 86(4):427–433PubMedCrossRef
9.
Zurück zum Zitat Kortmann BB, Floratos DL, Kiemeney LA et al (2003) Urodynamic effects of alpha-adrenoceptor blockers: a review of clinical trials. Urology 62(1):1–9PubMedCrossRef Kortmann BB, Floratos DL, Kiemeney LA et al (2003) Urodynamic effects of alpha-adrenoceptor blockers: a review of clinical trials. Urology 62(1):1–9PubMedCrossRef
10.
Zurück zum Zitat Murata S, Taniguchi T, Takahashi M et al (2000) Tissue selectivity of KMD-3213, an alpha(1)-adrenoreceptor antagonist, in human prostate and vasculature. J Urol 164(2):578–583PubMedCrossRef Murata S, Taniguchi T, Takahashi M et al (2000) Tissue selectivity of KMD-3213, an alpha(1)-adrenoreceptor antagonist, in human prostate and vasculature. J Urol 164(2):578–583PubMedCrossRef
11.
Zurück zum Zitat Barendrecht MM, Abrams P, Schumacher H et al (2008) Do alpha1-adrenoceptor antagonists improve lower urinary tract symptoms by reducing bladder outlet resistance? Neurourol Urodyn 27(3):226–230PubMedCrossRef Barendrecht MM, Abrams P, Schumacher H et al (2008) Do alpha1-adrenoceptor antagonists improve lower urinary tract symptoms by reducing bladder outlet resistance? Neurourol Urodyn 27(3):226–230PubMedCrossRef
12.
Zurück zum Zitat Andersson KE, Gratzke C (2007) Pharmacology of alpha1-adrenoceptor antagonists in the lower urinary tract and central nervous system. Nat Clin Pract Urol 4(7):368–378PubMedCrossRef Andersson KE, Gratzke C (2007) Pharmacology of alpha1-adrenoceptor antagonists in the lower urinary tract and central nervous system. Nat Clin Pract Urol 4(7):368–378PubMedCrossRef
13.
Zurück zum Zitat Strittmatter F, Hedlund P (2011) Silodosin:pharmacological and clinical features. Aging Health 7(1):45–57CrossRef Strittmatter F, Hedlund P (2011) Silodosin:pharmacological and clinical features. Aging Health 7(1):45–57CrossRef
14.
Zurück zum Zitat Djavan B, Chapple C, Milani S et al (2004) State of the art on the efficacy and tolerability of alpha1-adrenoceptor antagonists in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Urology 64(6):1081–1088PubMedCrossRef Djavan B, Chapple C, Milani S et al (2004) State of the art on the efficacy and tolerability of alpha1-adrenoceptor antagonists in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Urology 64(6):1081–1088PubMedCrossRef
15.
Zurück zum Zitat Kerrebroeck P van, Jardin A, Laval KU, van Cangh P (2000) Efficacy and safety of a new prolonged release formulation of alfuzosin 10 mg once daily versus alfuzosin 2.5 mg thrice daily and placebo in patients with symptomatic benign prostatic hyperplasia. ALFORTI Study Group. Eur Urol 37(3):306–313PubMedCrossRef Kerrebroeck P van, Jardin A, Laval KU, van Cangh P (2000) Efficacy and safety of a new prolonged release formulation of alfuzosin 10 mg once daily versus alfuzosin 2.5 mg thrice daily and placebo in patients with symptomatic benign prostatic hyperplasia. ALFORTI Study Group. Eur Urol 37(3):306–313PubMedCrossRef
16.
Zurück zum Zitat MacDonald R, Wilt TJ (2005) Alfuzosin for treatment of lower urinary tract symptoms compatible with benign prostatic hyperplasia: a systematic review of efficacy and adverse effects. Urology 66(4):780–788PubMedCrossRef MacDonald R, Wilt TJ (2005) Alfuzosin for treatment of lower urinary tract symptoms compatible with benign prostatic hyperplasia: a systematic review of efficacy and adverse effects. Urology 66(4):780–788PubMedCrossRef
17.
Zurück zum Zitat Wilt TJ, Howe RW, Rutks IR, MacDonald R (2002) Terazosin for benign prostatic hyperplasia. Cochrane Database Syst Rev 4:CD003851PubMed Wilt TJ, Howe RW, Rutks IR, MacDonald R (2002) Terazosin for benign prostatic hyperplasia. Cochrane Database Syst Rev 4:CD003851PubMed
18.
Zurück zum Zitat Wilt TJ, Mac Donald R, Rutks I (2003) Tamsulosin for benign prostatic hyperplasia. Cochrane Database Syst Rev 1:CD002081PubMed Wilt TJ, Mac Donald R, Rutks I (2003) Tamsulosin for benign prostatic hyperplasia. Cochrane Database Syst Rev 1:CD002081PubMed
19.
Zurück zum Zitat Michel MC, de la Rosette JJ (1998) Comparison of tamsulosin efficacy in subgroups of patients with lower urinary tract symptoms. Prostate Cancer Prostatic Dis 1(6):332–335PubMedCrossRef Michel MC, de la Rosette JJ (1998) Comparison of tamsulosin efficacy in subgroups of patients with lower urinary tract symptoms. Prostate Cancer Prostatic Dis 1(6):332–335PubMedCrossRef
20.
Zurück zum Zitat Nickel JC, Sander S, Moon TD (2008) A meta-analysis of the vascular-related safety profile and efficacy of alpha-adrenergic blockers for symptoms related to benign prostatic hyperplasia. Int J Clin Pract 62(10):1547–1559PubMedCrossRef Nickel JC, Sander S, Moon TD (2008) A meta-analysis of the vascular-related safety profile and efficacy of alpha-adrenergic blockers for symptoms related to benign prostatic hyperplasia. Int J Clin Pract 62(10):1547–1559PubMedCrossRef
21.
Zurück zum Zitat Barendrecht MM, Koopmans RP, de la Rosette JJ, Michel MC (2005) Treatment of lower urinary tract symptoms suggestive of benign prostatic hyperplasia: the cardiovascular system. BJU Int 95(Suppl 4):19–28PubMedCrossRef Barendrecht MM, Koopmans RP, de la Rosette JJ, Michel MC (2005) Treatment of lower urinary tract symptoms suggestive of benign prostatic hyperplasia: the cardiovascular system. BJU Int 95(Suppl 4):19–28PubMedCrossRef
22.
Zurück zum Zitat Chapple CR, Montorsi F, Tammela TL et al (2011) Silodosin therapy for lower urinary tract symptoms in men with suspected benign prostatic hyperplasia: results of an international, randomized, double-blind, placebo- and active-controlled clinical trial performed in Europe. Eur Urol 59(3):342–352PubMedCrossRef Chapple CR, Montorsi F, Tammela TL et al (2011) Silodosin therapy for lower urinary tract symptoms in men with suspected benign prostatic hyperplasia: results of an international, randomized, double-blind, placebo- and active-controlled clinical trial performed in Europe. Eur Urol 59(3):342–352PubMedCrossRef
23.
Zurück zum Zitat Chang DF, Campbell JR (2005) Intraoperative floppy iris syndrome associated with tamsulosin. J Cataract Refract Surg 31(4):664–673PubMedCrossRef Chang DF, Campbell JR (2005) Intraoperative floppy iris syndrome associated with tamsulosin. J Cataract Refract Surg 31(4):664–673PubMedCrossRef
24.
Zurück zum Zitat Andriole G, Bruchovsky N, Chung LW et al (2004) Dihydrotestosterone and the prostate: the scientific rationale for 5alpha-reductase inhibitors in the treatment of benign prostatic hyperplasia. J Urol 172(4 Pt 1):1399–1403PubMedCrossRef Andriole G, Bruchovsky N, Chung LW et al (2004) Dihydrotestosterone and the prostate: the scientific rationale for 5alpha-reductase inhibitors in the treatment of benign prostatic hyperplasia. J Urol 172(4 Pt 1):1399–1403PubMedCrossRef
25.
Zurück zum Zitat Naslund MJ, Miner M (2007) A review of the clinical efficacy and safety of 5alpha-reductase inhibitors for the enlarged prostate. Clin Ther 29(1):17–25PubMedCrossRef Naslund MJ, Miner M (2007) A review of the clinical efficacy and safety of 5alpha-reductase inhibitors for the enlarged prostate. Clin Ther 29(1):17–25PubMedCrossRef
26.
Zurück zum Zitat Nickel JC, Roehrborn C, Montorsi F et al (2011) Comparison of dutasteride and finasteride for treating benign prostatic hyperplasia: the Enlarged Prostate International Comparator Study (EPICS). BJU Int 108(3):388–394PubMedCrossRef Nickel JC, Roehrborn C, Montorsi F et al (2011) Comparison of dutasteride and finasteride for treating benign prostatic hyperplasia: the Enlarged Prostate International Comparator Study (EPICS). BJU Int 108(3):388–394PubMedCrossRef
27.
Zurück zum Zitat Lepor H, Williford WO, Barry MJ et al (1996) The efficacy of terazosin, finasteride, or both in benign prostatic hyperplasia. Veterans Affairs Cooperative Studies Benign Prostatic Hyperplasia Study Group. N Engl J Med 335(8):533–539PubMedCrossRef Lepor H, Williford WO, Barry MJ et al (1996) The efficacy of terazosin, finasteride, or both in benign prostatic hyperplasia. Veterans Affairs Cooperative Studies Benign Prostatic Hyperplasia Study Group. N Engl J Med 335(8):533–539PubMedCrossRef
28.
Zurück zum Zitat Kirby RS, Roehrborn C, Boyle P et al (2003) Efficacy and tolerability of doxazosin and finasteride, alone or in combination, in treatment of symptomatic benign prostatic hyperplasia: the Prospective European Doxazosin and Combination Therapy (PREDICT) trial. Urology 61(1):119–126PubMedCrossRef Kirby RS, Roehrborn C, Boyle P et al (2003) Efficacy and tolerability of doxazosin and finasteride, alone or in combination, in treatment of symptomatic benign prostatic hyperplasia: the Prospective European Doxazosin and Combination Therapy (PREDICT) trial. Urology 61(1):119–126PubMedCrossRef
29.
Zurück zum Zitat Roehrborn CG, Lukkarinen O, Mark S et al (2005) Long-term sustained improvement in symptoms of benign prostatic hyperplasia with the dual 5alpha-reductase inhibitor dutasteride: results of 4-year studies. BJU Int 96(4):572–577PubMedCrossRef Roehrborn CG, Lukkarinen O, Mark S et al (2005) Long-term sustained improvement in symptoms of benign prostatic hyperplasia with the dual 5alpha-reductase inhibitor dutasteride: results of 4-year studies. BJU Int 96(4):572–577PubMedCrossRef
30.
Zurück zum Zitat Roehrborn CG, Siami P, Barkin J et al (2010) The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia: 4-year results from the CombAT study. Eur Urol 57(1):123–131PubMedCrossRef Roehrborn CG, Siami P, Barkin J et al (2010) The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia: 4-year results from the CombAT study. Eur Urol 57(1):123–131PubMedCrossRef
31.
Zurück zum Zitat Roehrborn CG, Barkin J, Siami P et al (2011) Clinical outcomes after combined therapy with dutasteride plus tamsulosin or either monotherapy in men with benign prostatic hyperplasia (BPH) by baseline characteristics: 4-year results from the randomized, double-blind Combination of Avodart and Tamsulosin (CombAT) trial. BJU Int 107(6):946–954PubMedCrossRef Roehrborn CG, Barkin J, Siami P et al (2011) Clinical outcomes after combined therapy with dutasteride plus tamsulosin or either monotherapy in men with benign prostatic hyperplasia (BPH) by baseline characteristics: 4-year results from the randomized, double-blind Combination of Avodart and Tamsulosin (CombAT) trial. BJU Int 107(6):946–954PubMedCrossRef
32.
Zurück zum Zitat Roehrborn CG (2008) BPH progression: concept and key learning from MTOPS, ALTESS, COMBAT, and ALF-ONE. BJU Int 101(Suppl 3):17–21PubMedCrossRef Roehrborn CG (2008) BPH progression: concept and key learning from MTOPS, ALTESS, COMBAT, and ALF-ONE. BJU Int 101(Suppl 3):17–21PubMedCrossRef
33.
Zurück zum Zitat Barkin J, Guimarães M, Jacobi G et al (2003) Alpha-blocker therapy can be withdrawn in the majority of men following initial combination therapy with the dual 5alpha-reductase inhibitor dutasteride. Eur Urol 44(4):461–466PubMedCrossRef Barkin J, Guimarães M, Jacobi G et al (2003) Alpha-blocker therapy can be withdrawn in the majority of men following initial combination therapy with the dual 5alpha-reductase inhibitor dutasteride. Eur Urol 44(4):461–466PubMedCrossRef
34.
Zurück zum Zitat Nickel JC, Barkin J, Koch C et al (2008) Finasteride monotherapy maintains stable lower urinary tract symptoms in men with benign prostatic hyperplasia following cessation of alpha blockers. Can Urol Assoc J 2(1):16–21PubMed Nickel JC, Barkin J, Koch C et al (2008) Finasteride monotherapy maintains stable lower urinary tract symptoms in men with benign prostatic hyperplasia following cessation of alpha blockers. Can Urol Assoc J 2(1):16–21PubMed
35.
Zurück zum Zitat Thompson IM, Goodman PJ, Tangen CM et al (2003) The influence of finasteride on the development of prostate cancer. N Engl J Med 349(3):215–224PubMedCrossRef Thompson IM, Goodman PJ, Tangen CM et al (2003) The influence of finasteride on the development of prostate cancer. N Engl J Med 349(3):215–224PubMedCrossRef
36.
Zurück zum Zitat Parsons JK, Schenk JM, Arnold KB et al (2012) Finasteride reduces the risk of incident clinical benign prostatic hyperplasia. Eur Urol 62(2):234–241PubMedCrossRef Parsons JK, Schenk JM, Arnold KB et al (2012) Finasteride reduces the risk of incident clinical benign prostatic hyperplasia. Eur Urol 62(2):234–241PubMedCrossRef
37.
Zurück zum Zitat Andriole GL, Bostwick DG, Brawley OW et al (2010) Effect of dutasteride on the risk of prostate cancer. N Engl J Med 362(13):1192–1202PubMedCrossRef Andriole GL, Bostwick DG, Brawley OW et al (2010) Effect of dutasteride on the risk of prostate cancer. N Engl J Med 362(13):1192–1202PubMedCrossRef
Metadaten
Titel
Stellenwert der α1-Adrenozeptorblocker und 5α-Reduktaseinhibitoren
Monotherapie bei der Behandlung des benignen Prostatasyndroms
verfasst von
Dr. F. Strittmatter
S. Madersbacher
C.G. Stief
C. Gratzke
Publikationsdatum
01.02.2013
Verlag
Springer-Verlag
Erschienen in
Die Urologie / Ausgabe 2/2013
Print ISSN: 2731-7064
Elektronische ISSN: 2731-7072
DOI
https://doi.org/10.1007/s00120-012-3086-0

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