$Unique_ID{BRK02198}
$Pretitle{}
$Title{New Drug for Enlarged Prostate}
$Subject{Drug Enlarged Prostate Proscar shrink benign hypertrophy BPH
finasteride 5-alpha reductase inhibitors prostatism gland bladder semen sperm
enlarging urethra urinary urination testosterone DTH 5a-dihydrotestosterone}
$Volume{}
$Log{
Benign Hypertrophy of the Prostate*0007602.scf}

Copyright (c) 1993   Tribune Media Services, Inc.


New Drug for Enlarged Prostate


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QUESTION:  Please give me and your readers an update on "Proscar," the new
drug that is supposed to shrink the prostate.  I want to use it, but my doctor
says "let's wait, its too early to see what side effects it will cause," etc.
Also he says the expense is pretty steep for a senior citizen.  How expensive?
I need to start on this pill as soon as possible, so write this as soon as you
can.

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ANSWER:  This new drug for the treatment of benign prostate hypertrophy (BPH)
was approved by the Food and Drug Administration in 1992.  Manufactured and
distributed by Merck, Proscar (finasteride) is the first of a new class of
drugs known as 5-alpha reductase inhibitors.  It is approved for use in cases
of symptomatic BPH, and is probably most effective in mild to moderate cases.
     BPH (or "prostatism") can be seen in almost 100 percent of all men over
the age of 80, and changes can be discovered in about 50 percent of men by the
time they reach the age of 60.  But the course of the problem is very variable
and highly unpredictable.  Many men remain without symptoms, others show slow
progression, while others remain stable, some lucky ones even showing a
regression of the condition.  However, some 400,000 men a year have symptoms
severe enough to require surgery.
     The prostate gland is a small gland, shaped a bit like a chestnut, and is
located at the base of the bladder.  It surrounds the tube-like urethra, which
carries urine from the bladder out of the body.  Its function is to produce
the semen, which transports the sperm during ejaculation.  It reaches its
normal size during the years of puberty, and then remains stable until after
the age of 45, when the tissue begins to change, growing and causing the size
of the prostate to increase.  The enlarging prostate squeezes the urethra,
producing the symptoms that characterize BPH.  These include difficulty in
starting urination (hesitancy), a weak urinary stream, dribbling after
urination, and frequency or urgency during the sleep period.  Sometimes
urination may be painful.  These symptoms of obstruction of the urethra can
often become more severe if a urinary infection develops, one of the common
complications of BPH.
     Hypertrophy of the prostate tissue is related to the actions of the
active form of testosterone, called DTH (for 5a-dihydrotestosterone).  The new
drug interferes with the process that transforms testosterone into DHT, and
this leads to a reduction in the size of the gland.  The maximum effect of the
medication occurs after three months of oral therapy.  The daily recommended
dose is 5 mg a day, a single tablet.  A decrease in size averaging 12 percent
can be expected after 4 weeks of treatment, and the maximum decrease in volume
is about 28 percent.  These amounts are usually enough to reduce symptoms,
with up to 90 percent of patients showing significant improvement in their
urinary flow after 1 year.
     Side effects seem to be minimal, with most patients having no problems.
When reactions such as headache do occur, they seem to be mild and transient.
Though I inquired about long term reactions from the manufacturer, they were
not available at the time of this writing, but data concerning an experience
of three years with the medication will be reported at the May meeting of the
American Urological Association.
     As to expense, the average cost of 30 5 mg tablets (a one month's
supply) at four pharmacies I called in my local area was $60.00.  You would
have to price them in your locality, where the price might differ considerably
from mine.

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The material contained here is "FOR INFORMATION ONLY" and should not replace
the counsel and advice of your personal physician.  Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.