This page is being served from the Urological Sciences Research Foundation web repository, and was originally posted between 1996-2008. In January 2009 USRF’s founder, Dr. Leonard S. Marks and his staff joined UCLA’s Department of Urology where they are continuing their research. Click for more information.
Prevention of BPH Disease
By Early Use of 5-Alpha Reductase Inhibitors
Leonard S. Marks, M.D.
Medical Director, USRF
Clinical Professor of Urology, UCLA
Key Reference: “Prevention of BPH Disease”
If the 20th century was the age of astonishing cures,
Fall, 2007---Prevention, the most advanced form of disease control, is the ultimate aim of medical science. However, benign prostatic hyperplasia (BPH), which is a progressive disease process, has throughout the 20th century been treated late in its course. Little has changed since the father of urology said:
In early cases, where the symptoms are not aggravated
For the past century, the classic teaching has been that when the pathology of BPH progressed to the stage of BPH disease, the unfortunate men who developed complications were treated after the fact with surgical remedies (‘astonishing cures’). Until recently, control of the BPH process was not possible, and prevention was unthinkable.
Now, in the 21st century, a safe, well-tolerated way to control the fundamental BPH process---5α-reductase inhibition (5ARI)---has become available. With selective, early 5ARI treatment, prevention of BPH disease appears feasible for many men, offering them the hope that the astonishing cures of the previous century have become, if not irrelevant, only a last resort. The discovery of 5ARI drugs, which came from study of a strange congenital anomaly, is described here.
BPH Disease vs BPH Histology
However, BPH disease is another matter altogether. When the prostate enlarges past a critical volume, approximately 30-40 cc, the process becomes more serious. The condition then threatens to become more than an “inevitable concomitant of aging.” Increasingly, at that point the BPH process carries with it the likelihood of becoming a disease, which can become clinically manifest by acute urinary retention, urinary bleeding, urinary infection, bladder stones, functional and anatomic decompensation of the bladder wall, and difficulty urinating that interferes with life so severely that treatment is no longer optional.
5 Alpha Reductase Inhibitors (5ARI)
Logic of BPH Prevention
Prostate cancer, PSA, and BPH Prevention
After cancer has been excluded---and that may require more than one set of biopsies or more sophisticated testing, e.g. PCA3 gene test---the patient is likely to ask, “What now, doctor?” At this point, assuming the serum PSA level exceeds 1.5 ng/ml, a discussion can be held with the patient regarding prophylactic use of a 5ARI drug. Other men with elevated PSA levels will also have to make decisions regarding prophylactic use of 5ARI (and biopsy), but those men returning for biopsy report appear to be the most highly motivated.
Reasons for Caution
1. Marks LS, Roehrborn CG, Andriole GL. Prevention of benign prostatic hyperplasia disease. J Urol. 2006 Oct;176(4 Pt 1):1299-306.
2. Marks LS. Use of 5alpha-reductase inhibitors to prevent benign prostatic hyperplasia disease. Curr Urol Rep. 2006 Jul;7(4):293-303.
3. Marks LS. Benign Prostatic Hyperplasia Disease: Is Prevention Feasible? Weill Medical College of Cornell University Reports on Men’s Urological Health Vol 1-4.
4. Marks LS: Treatment of men with minimally symptomatic benign prostatic hyperplasia—PRO: the argument in favor. Urology 2003;62:781-783.
This posting and overall website maintenance by Anthony Cancio