Drug Forecast

INTRODUCTION Benign prostatic hyperplasia (BPH) is the most common non-neoplastic disorder of aging American men.1 The prevalence of BPH increases from 8% in men between 31 and 40 years of age to 50% in men between 51 and 60 years of age to more than 80% in men older than 80 years of age.2,3 Although the exact etiologic mechanism of BPH is unknown, hormonal changes involving the accumulation of dihydrotestosterone (DHT) promote both prostate enlargement and growth.4 As the prostate increases in size, pressure is exerted on the lumen of the urethra, causing obstruction of urinary flow.2,5 Enlargement of the prostate gland also correlates with excessive alphaadrenergic tone, resulting in contraction of the prostate gland and narrowing of the urethral lumen.6 Symptoms associated with BPH include urinary hesitancy, a weak urine stream, increased urinary frequency or urgency, nocturia, incontinence, and painful urination. Untreated BPH is associated with lower urinary tract symptoms such as gross hematuria, repeated urinary tract infections, and obstructive uropathy.4 Standard treatments include watchful waiting in patients with mild symptomatic BPH, pharmacological treatment with alpha-adrenergic antagonists and 5-alpha reductase inhibitors in patients with moderate-to-severe symptomatic BPH, and surgery in patients with severe symptomatic BPH.1 Three generations of alpha-adrenergic antagonists have been used to treat BPH:1,6