Medikamentöse Behandlung des benignen Prostatasyndroms: Was gibt’s Neues?

Zusammenfassung

Auch Jahrzehnte nach der Einführung der 5α-Reduktasehemmer und der α1-Adrenozeptor-Antagonisten ergeben sich praxisrelevante, neue Daten zu deren erwünschten und unerwünschten Wirkungen. Einige der neuen Befunde sind ihrer Natur nach ernst zu nehmen, aber bisher unzureichend abgesichert wie z.B. ein Zusammenhang mit Depressionen oder Demenz. Verschiedene Kombinationsbehandlungen wurden getestet. Dabei war die Kombination der Monotherapie häufig statistisch signifikant überlegen, aber der Unterschied bewegte sich meistens in der Größenordnung von 1 IPSS-Punkt, was Zweifel an der klinischen Relevanz der Beobachtungen im Gruppenmittel lässt. Die neuen Daten ermöglichen eine weiter individualisierte BPS-Behandlung, machen die individuelle Nutzen-Risiko-Abwägung aber komplizierter.

Abstract

Decades after the introduction of 5α-reductase inhibitors and α1-adrenoceptor antagonists, new data of practical relevance related to their desired and adverse effects continues to emerge. Some of these novel findings are to be taken seriously but are insufficiently established, for instance associations between drug use and depression or dementia. Multiple combination treatments have been tested. While combination treatment was often statistically superior to monotherapy, the difference was mostly in the range of 1 IPSS point, which raises doubts on the clinical relevance of the findings at the group level. The new evidence enables further personalisation of the treatment of male lower urinary tract dysfunction, but also makes individual risk-benefit considerations more complex.

Schlüsselwörter

Benignes Prostatasyndrom - 5α-Reduktasehemmer - α1-Adrenozeptor-Antagonisten - Depression - Demenz

Keywords

male lower urinary tract symptoms - 5α-reductase inhibitors - α1-adrenoceptor antagonists - depression - dementia

Publication History

Received: 28 November 2021

Accepted after revision: 14 January 2022

Article published online:
22 February 2022

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