BPH Relief - Two New Approaches

Robert W. Griffith, MD

The American Urological Association meeting produced two reports of new approaches to the treatment of symptoms of benign prostate hypertrophy, or BPH, or prostatism. Both involve the use of drugs that are marketed with other indications, and which are not (yet) approved for use in BPH.

First, botulinum toxin. We've listed all the possible uses for Botox®, and here's another one. A small preliminary Taiwanese study of 37 men given a single Botox injection into their enlarged prostates showed that 27 of them had at least a 30% improvement in both their prostatism and quality-of-life scores. At 6 and 12 months the average prostate volume had dropped by at least 16%. Another study - also from Taiwan - investigated the use of Botox in men already on medication (an alpha-blocker and a 5-alpha reductase inhibitor). Addition of Botox improved symptoms and quality-of-life scores, PSA levels fell, and volume of the gland was reduced. Despite a little skepticism from observers at the meeting, this approach deserves further studies.

Second, 3 studies (two US, one German) reported the use of erectile dysfunction (ED) drugs in men with BPH and urinary symptoms, in two instances regardless of whether they had erectile dysfunction. In one of the studies, which was reported last year, prostate symptoms lessened (without a concomitant increase in urine flow rate), and there was marked improvement in patients with ED. The other two studies were also positive. This looks like "killing two birds with one stone", always a popular solution. Again, more studies may be needed before the treatment in placed on the BPH drug palette.

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