How To Relax The Prostate - BPH Pills with Stephen Gange, MD | Off The Cuff with Dr. Mark Moyad

PCRI's resident moderator Mark Moyad, MD, MPH, sits down with urologist Steven Gange, MD, FACS, to discuss "alpha blockers," a class of drugs typically used as a first-line medication for treating lower urinary tract symptoms (LUTS) caused by an enlarged prostate, also known as benign prostatic hyperplasia (BPH).

Dr. Steven Gange graduated from the UCLA School of Medicine in 1986. After his Urology residency training at the University of Kentucky in 1991, he entered the US Army as an academic urologist, teaching, and training residents. He joined Western Urological Clinic (now Summit Urology Group) in Salt Lake City, UT, in 1996. With over 25 years of clinical and research experience, he has developed an expertise in Men’s Health Urology, emphasizing minimally invasive procedures. He continues to be active as a Clinical Researcher and as such was the first Urologist in North America to perform the NeoTract UroLift for BPH, and the first in the world to perform UroLift under local anesthesia.

0:17 Prior to the medicinal solutions developed in the late 1980s, the only treatment available for BPH was the Transurethral Resection of the Prostate (also known as the TURP surgery).

1:16 In the late 1980s to early 1990s two classes of medicines were developed. Alpha-blockers (relaxers) and then 5-alpha reductase inhibitors (shrinkers). This is also the typical order in which they are prescribed—first, alpha-blockers and then 5-alpha reductase inhibitors. This video focuses on alpha blockers.

1:33 "Alpha" refers to a receptor that leads to a muscle contraction, and an "alpha-blocker" is meant to cause a failure of that contraction. Early iterations of relaxers include Prazosin, Hytrin, and Cardura. They have fallen out of use for BPH because of issues with low blood pressure, and are now actually used as blood pressure medications. The current most popular relaxers are Flomax, Uroxatral, and Rapaflo.

2:28 There is muscular and glandular tissue in the prostate. Some prostates are mostly muscular, some are mostly glandular, and some are a mix of the two. The relaxers only work on muscular tissue.

3:05 A lot of men start relaxers with enthusiasm that it will solve their problem, but many are eventually disappointed because of the medication's side effects, their lack of effectiveness, or the cost of the medications.

3:28 One benefit to the relaxers is that if they are going to work, then they will work within a couple of weeks. However, the symptom relief is usually relatively mild (about 3-4 points on a 35 point scale). About 70% of men who try relaxers will eventually stop them and move on to a different treatment.

4:15 Side effects of relaxers include dizziness (which can be extremely dangerous with elderly patients but possibly ameliorated by food), nasal congestion, floppy iris syndrome (which can affect future cataract surgery), and issues with ejaculation (either retrograde ejaculation, in which it goes the wrong direction or anejaculation, in which there is no ejaculation at all).

5:38 Dr. Gange argues that besides the relaxer's mild efficacy and their undesirable side effects, his main issue is that they do nothing to change the long-term course of BPH. They merely delay issues that will eventually have to be dealt with by other means.

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