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NONSURGICAL TREATMENTS FOR BPH: FLUTAMIDE (EUXELIN), CASODEX, AND ZENESS

Flutamide, sold under the name Euxelin, is receiving a lot of interest as a drug to control "bad testosterone." There are two categories of testosterone: "good" testosterone is manufactured in the testicles; "bad" testosterone, or dihydrotestosterone (DHT), is produced inside the prostate from the testosterone furnished by the testicles. DHT is necessary in order for the male to enjoy normal physical development at puberty. But as he grows older, it creates problems by causing excess tissue to grow in the prostate.

Flutamide is intended to inhibit the production of DHT inside the prostate without preventing the good testosterone from doing its job in other parts of the body. It appears to be working for many patients. There are side effects, but not usually severe ones: patients have experienced gastrointestinal problems and, very rarely, some problems associated with the liver.

In October 1995, the pharmaceutical company Zeneca, Inc. received FDA clearance to use Casodex, a new antiandrogen (a medication that reduces or eliminates the presence or activity of androgens) for the hormonal treatment of advancing prostate cancer. Its objective is to reduce the production of the male hormone testosterone and to block stimulation of prostate cancer cells by any remaining testosterone. It was tested as part of a treatment regimen called maximal androgen blockade (MAB) on 813 patients with advanced prostate cancer.

The most commonly reported adverse effects as reported in a study by Dr. Paul Schellhammer and colleagues were hot flashes (49 percent), general pain (27 percent), constipation (17 percent), back pain (15 percent), asthenia (13 percent), pelvic pain (13 percent), nausea (11 percent), diarrhea (10 percent), and infection (10 percent).

Recently, Casodex and a similar drug, Zeness, have come on the market. They are antiandrogens that work similarly to Flutamide by blocking a cell's ability to absorb hormones. A patient only has to take one pill a day, but in some patients it causes gastrointestinal difficulties.

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Nonsurgical treatments for bph: medications: dibenzyline
Drugs widely used to control high blood pressure and to remove urethral obstructions that reduce normal flows have been found helpful in treating the enlarged prostate. One example is Dibenzyline. This drug has been used for years to lower high blood pressure. As little as 10 milligrams of Dibenzyline a day doubled the urine flow in 46 percent of the patients studied over a ten-year period, and 80 percent were relieved of obstructive symptoms.
Some physicians are skeptical, however, and claim that Dibenzyline causes cancer in the digestive tract of rats. Nasal obstruction, delay or inhibition of orgasm, and a significant danger of lowering the patient's blood pressure are cited as other reasons to avoid its use. Further study is necessary, but if the problems related to its use can be ameliorated, then it could be another valuable tool to help the patient.

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