PROSCAR
One of the drugs of the future for controlling BPH may be a product now in final testing by Merck & Co. called Proscar. This drug blocks an enzyme that stimulates prostate growth. The Merck researchers say that the male hormone testosterone undergoes changes in the prostate gland and this is believed to be the primary factor in unwanted prostate growth when a man gets into his 40’s and 50’s and later.
By blocking this enzyme and refusing to let it change the testosterone, it would also stop the growth of the prostate.
Researchers say they are still in testing on the drug but it is in human clinical trials, one of the last of the procedures.
Using 350 patients in one clinical test, the drug reduced the size of enlarged prostates an average of twenty-eight percent. One third of the test patients also had a “dramatic improvement” in their urine flow.
Dr. John McConnell, assistant professor of urology at the University of Texas Southwestern Medical Center in Dallas, said: “The drug is highly effective from a biochemical point of view. It does shrink the prostate.”
He went on to say since only about one-third of the patients had an improvement in urine flow, the drug is not applicable to all men or all BPH cases.
One advantage of the Proscar treatment is that it has resulted in no side effects, at least so far in the testing. Side effects have been the killer of most prostate drugs so far.
Proscar is in final testing and with success should win the Food and Drug Administration approval for sale in the “early 1990’s”. That could still mean that it’s three or four years away.
One drawback to Proscar has been determined so far. It takes “about three months” before the prostate shrinks enough to help in urinary flow problems.
Merck is excited about the new product from a breakthrough standpoint, but also because it could have a great financial future. The market for such a medication that works, is said to be in the hundreds of million of dollars a year. The quickly expanding male population in the “prostate years” adds to this sales potential. This is one product to watch closely.
Some drug industry spokesmen say Proscar and Merck may be facing a problem: getting urologists to prescribe a medication that could cut their income by reducing the 400,000 prostate surgeries a year. Most urologists discount this saying they welcome another tool to fight prostatic disease.

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CAN DRUGS BE USED INSTEAD OF SURGERY?
Over the years there have been many attempts made to find a drug that would shrink the prostate gland. The scientists worked on the belief that the enlargement of the prostate had something to do with the male hormone production.
This led to the use of female hormones that did shrink the prostate and help the BPH problem and reduced or eliminated the symptoms. The only trouble was that it also reduced and eliminated the male sex drive and often led to sterilization and impotence of the patient.
After that the lab men worked on drugs that would simply block the production of testosterone produced in the testicles. They came up with Leuprolide (lupron) which blocks ninety percent of the body’s total production.
Another companion drug used at the same time, Flutamide (eulexin), eliminates the other ten percent of testosterone made by the adrenal gland.
What these drugs do is effectively castrate the man by chemical action. This reduces the male libido, his sex drive, and sterilizes him and makes him impotent. These are mighty tough side effects even for a man in his seventies just to shrink the size of the prostate.
These drugs are most often chosen when a man has an extreme case of BPH or cancer of the prostate, and his sexual life is no longer a factor in his life whether he’s 65 or 80 years.
For most men the sexual side of life is always a vital part of their existence. It’s like watching a shiny new bus stop at your corner. It’s nice to know the bus service is always there, even though you seldom use it any more.
RELAXATION DRUGS
Some urologists find that the use of a drug such as Minipress (prazosin hydrochloride) will relax the smooth muscles surrounding the prostate. The purpose here is to get these muscles to relax or loosen to allow the prostate to expand slightly outward and thereby ease the internal pressure on the urethra.
A second drug used for the same purpose of relaxation of the muscles around the prostate is Terazosin. It relaxes the muscles and greatly reduces the spasms that these muscles frequently have which slow or prevent urination.
BPH is a highly subjective ailment. What bothers one patient may be little more than a minor and unnoticed irritant to another. Some patients who use one of these drugs may report relief from some of their symptoms, while others say they have no effect whatsoever on their life style.
Tests have shown some urologists that the use of Minipress and Dibenzyline drugs have made specific improvement in patient symptoms. Studies have been done to measure the voiding flow rate and residual urine before and after the use of these drugs, with an average of 60% improvement.

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WHAT CAUSES BPH?
No one knows what causes BPH. Just why the prostate starts to enlarge itself in the forty to fifty male years is not understood.
There are two significant factors in this mystery that have been tied down by medical research over the years. One is that a man who has been surgically or hormonally castrated, eliminating the male hormone from his body, never develops an enlarged prostate.
The other uncontested fact is that the onset of BPH is started only with the passage of time.
Castration at an early age to eliminate BPH is a totally unthinkable idea. The other alternative, death at an early age is equally ridiculous as a prevention of BPH.
Which leaves medical science still in kindergarten when it comes to determining the cause of BPH and the chances of scientifically developing a preventive drug or routine and this stops any work on a cure.
Many medical studies have been made in an effort to isolate some other common factor in BPH patients. So far all of these human factors have been ruled out: specific blood types, coronary heart disease, celibacy, hypertension, use of alcohol or tobacco, industrial and environmental conditions.
One constant has been determined: By the age of sixty years, fifty percent of all men will have, to some degree, an enlarged prostate whether or not it is bothering them. By the time American men reach their eightieth birthday, only five out of one hundred will not have BPH.
After broad studies involving Asian men, it was determined that as a group they had fewer cases of BPH and prostatic cancer. However Asian men who moved to the US for a period of time had a significantly increased rate of both BPH and prostatic cancer.
Since Asians typically have had a low cholesterol and low red meat diet, it is speculated that diet may have a larger impact on BPH and prostatic cancer than had been previously thought. With the current wave of anti-cholesterol and anti-fat foods including the campaign against red meat, American men could be experiencing a lower rate of BPH and prostatic cancer in the future.
Is a man’s sex life in any way connected with the cause of BPH or prostatic cancer? A man’s sexual life appears to have no bearing whatsoever on the development of BPH or cancer of the prostate. However, sudden surges in sexual activity, or sudden celibacy often does affect the prostate. These situations will be discussed in a later section.
SO WHAT HAPPENS TO ME NEXT?
Let’s say that you’re reading this book in the first place
because you had some questions about your general health,
or your urination, or your prostate, and after reading the
list of symptoms, bingo! you have three of the symptoms.
Let’s say that you have a hesitancy to start to urinate,
you have a noticeably reduced stream, and you’ve been getting up about three A.M. every night to urinate. What should you do next?
Pick up the phone and get an appointment with your family doctor or call a urologist. It’s time you found out just what’s going on and how serious your BPH really is.
Your next move is to have an examination by a medical professional or a specialist. Just how does a doctor examine you for possible BPH or other prostatic troubles?

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