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Clinical Course of the Benign Prostate Hyplasia Patients during the Intermittent Use of 5-Alpha Reductase Inhibitors
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Kwibok Choi, Byounghoon Kim, In-Chang Cho, Seung Ki Min
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Urogenit Tract Infect 2019;14(3):93-98. Published online December 31, 2019
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DOI: https://doi.org/10.14777/uti.2019.14.3.93
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 Abstract
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- Purpose: 5-Alpha reductase inhibitors (5ARI), inhibit the conversion of testosterone to dihydrotestosterone, which is essential in prostate hyperplasia, and decreases the prostate volume directly. On the other hand, 5ARI have a range of side effects, such as sexual dysfunction. After the discontinuation of 5ARI, prostate regrowth occurs rapidly until it reaches the baseline size. This study examined the effects of 5ARI when used intermittently.
Materials and Methods: Between March 2009 and May 2017, patients who visited one physician’s outpatient clinic and were diagnosed with BPH underwent transrectal ultrasonography. The selected patients began to take 5ARI until the prostate size decreased at least 10% of the baseline (the first medication). After confirming adequate prostate shrinkage, the patients stopped medication until prostate regrowth reached 50% of the decreased size. After regrowth, they restarted medication for one year (second medication). The prostate size, serum prostate specific antigen (PSA) levels, international prostate symptom score (IPSS) scores, and maximum flow rate (Qmax) in uroflowmetry were collected after the first and second medication and compared using paired t-tests.
Results: Sixty patients with a mean age of 65.1 years were included in the study. The prostate size and serum PSA level increased after the second medication compared to the first, and the prostate reduction and Qmax in uroflowmetry decreased significantly. On the other hand, the symptoms felt by the patients surveyed by the IPSS scores showed no significant difference.
Conclusions: 5ARI appear to be less effective in reducing the prostate volume and improving uroflowmetry after discontinuation.
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Patient’s Factors Correlated with Prostate Volume Recovery after 5 Alpha Reductase Inhibitor Discontinuation
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Kwibok Choi, Byounghoon Kim, In-Chang Cho, Seung Ki Min
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Urogenit Tract Infect 2018;13(3):79-83. Published online December 31, 2018
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DOI: https://doi.org/10.14777/uti.2018.13.3.79
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Abstract
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- Purpose: The 5 alpha reductase inhibitor (5ARI) reduces the size of the prostate and alleviates lower urinary tract symptoms. After stopping 5ARI, the prostate quickly recovers to its pre-medication size. The purpose of this study was to investigate the factors affecting the restoration of prostate size after 5ARI discontinuation.
Materials and Methods: Between March 2009 and May 2017, patients who visited an outpatient clinic and were diagnosed with benign prostatic hyperplasia were selected and start 5ARI medication. After 6 months of medication, the patients stopped medication for 1 year. Meanwhile, we measured the prostate volumes of patients 3 times (before and after medication, after discontinuation) and divide the patients into 3 groups (maintained, intermediate, and restored) with recovered prostate volume ratio. After classification, we investigated the relationship between the variable factors (age, serum prostate-specific antigen, initial volume, reduced volume after medication) between groups.
Results: Among the 147 selected patients, the mean age and plasma PSA level were 61.6±7.9 and 0.8±0.6, respectively. The mean initial prostate volume was 32.3±4.2 ml, which reduced to 23.2±3.2 ml after medication. After one year of discontinuation, the mean volume was 31.4±6.4 ml, with restoration to 101.5% of the reduced size. We noticed a tendency that patients with faster prostate volume recovery were generally older than those with slower recovery; however, this was not statistically significant. Other factors showed no relationship with prostate recovery.
Conclusions: When using 5ARI in elderly patients, continuous treatment seems better than intermittent treatment. If discontinuation is needed, short term follow-up is recommended.
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