Treatments for BPH | Off the Cuff With Mark Moyad, MD, MPH & Steven Gange, MD
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- เผยแพร่เมื่อ 6 ก.พ. 2025
- PCRI's resident moderator Mark Moyad, MD, MPH, sits down with urologist Steven Gange, MD, FACS, to discuss a category of medications called 5-Alpha-Reductase Inhibitors (e.g. Proscar and Avodart) for the treatment of enlarged prostates 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.
0:27 5 alpha-reductase inhibitors, "shrinkers," are a class of medicines that shrink the prostate by blocking the conversion of testosterone into dihydrotestosterone. This prevents the growth of prostate cells and will eventually cause the entire gland to shrink in size. 5 alpha-reductase inhibitors are usually used in conjunction with alpha blockers (Flomax, Rapaflo, etc.).
1:22 Shrinkers take about 3-6 months to achieve a reduction in size and improvement of symptoms. There are also a number of possible side effects: Impeded semen production, erectile dysfunction, loss of libido, and changes in the metabolism of glucose and lipids.
2:39 There is a theory that shrinkers can help prevent prostate cancer. Two studies using Proscar and Avodart found a reduced risk of prostate in men who used these medications; however, it also found that those men had a higher risk of having a higher grade of prostate cancer. It is controversial whether these medications actually increase the risk of having a higher grade of prostate cancer or whether there were limitations to the studies. To another point, Shrinkers reduce PSA, but there is no evidence that this indicates an improvement in a cancer diagnosis.
4:03 Medicinal solutions for BPH (as opposed to surgical solutions) do not always produce desirable results for patients. Dr. Gange says that Relaxers and Shrinkers are unlikely to produce a dramatic change that some men need to alleviate symptoms and protect the health of their genitourinary system.
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#BPH #MarkMoyadMD #StevenGangeMD
One of the most informative presentations on the topic I have seen. Thanks.
I tried a prostate artery embolization "PAE" nine weeks ago with zero results,. Prostate was at 120. Will be doing the Aquablation June 13th.
wow...i've been looking to pursue this. Did dr say why it was ineffectual?
Radiologist said I was his only case that was unsuccessful. Asked my Urologist , and he said my prostate after the embolization still had prostate wrapped around my urethra so to speak. Subsequently had the Aquablation and that proved to be a great success. @@DeathSentryCoH
What procedure do urologists as BPH patients choose to receive? Can they take what they dish out?
Thanks for your honesty comment !
Thanks for your honesty comment of knowledge. I was with flomax las 3 years side effects really bad but I stop las 4 months my body can clean that drug. Hope if did some damage is not permanent. Thanks you you two, for the info. 👍🙂
I’ve been taking flomax for the past six months without and side effects.
Can we take it for 3-6 months and slowly leave in another in 6 months also !
But I want to use it for maintenance after a hair transplant.
My doctor suggested me take for just one year .
Surgeons like to cut. That's their go to option for everything. 12 years ago my urologist was adamant that he wanted to remove my prostate immediately. When I asked for a couple of weeks to think about he insisted that we should do it right away. I got a new urologist and 12 years later we are still watching my slow acting cancer.
Way to go with very low risk Cancer and change your lifestyle.
Exactly... Most men will die with prostate cancer, not from it. It is usually very slow growing, and the risk of surgery is not worth it.
The worst side affect was the depression and the suicidal thoughts, I would sooner get up at night.
Riiiiight
What are your thoughts about prostate shrinkage with natural foods?
I'm 38 and my psa was fine but was still prescribe flomax and finastride, couldn't handle flomax side effects especially the eye sight probs, been on finastride 3 months not noticed much tbh. I've also been using 10mg ciallis. Still have the urge to pre 24/7
Do u guys have any sexual activity issue?
Another question i have is....if i stopped taking the combination drug ie combodart and just took flomax would my existing small low grade prostate cancer grow quicker? Many many thanks!
I will add that question (and your other one) to the list for future videos!
Thank you so much! !👍
Can you explain the bit where side effects are mentioned ie. changes in metabolism of glucose and lipids! As l have been taking the combination drug combodart! Superb video! Thank you
I been taking Dutasteride for 3 months I have a lot of the bad side effects I am going to stop taking this medication I have got to see my doctor in a month or so and I will tell him about the side effects. Penis shrinking, low sex drive, dry ejaculation , server fatigue, pain in my prostate.
Taking .5mg Dusty every other day. Because of its Half-Life and the fact it takes up to 6 months to get out of your system, it makes no sense to take it everyday! There are some studies that show, you only need to take it two to three times a week. With that said, my every other day dosage, I've noticed better flow. No sexual side effects. Just lower amounts of ejaculation. We'll see more in 6 months, when my blood work comes back.
If taking these pills, the PSA is a false reading???
I would like to learn more about side effects of proscar involving muscles like one of the commenters said. Ive been on it since 2017 5mg a day. No sperm production what so ever. What happens if I stop will the prostate enlarge?
If you would like to speak with a patient advocate about your case, feel free to contact us at: pcri.org/helpline
Ok , I was told, my breast would inlarge. I don't like the side effects mentioned, so I'll live with getting up at night .
Taking something like Silosidin will reduce the amount of times you get up without changing your hormone profile so you wont get breast tissue enlargement
Getting up at night until meds no longer work, then retention occurs, then you’ll need a catheter and surgery. Drugs are a bandaid.
Would be interesting to hear what Doctors like you guys honestly think about over the counter supplements..Saw Palmetto " so on to clear the myths
Find some reputable studies and read them for yourself! Plenty of info literally at your finger tips!
YES...Its ARTIFACT.
Avoid finasteride and dutaseride if you possibly can. Huge impact on energy cause muscle wasting and profound fatigue.
It does not cause muscle wasting there are several studies that have done tests on this and they all come to the conclusion it has no effect on muscle mass stop spreading bull shit
You have to remember folks he's a doctor with his opinion and you can talk to five other doctors and they'll have five other opinions I can tell you from personal experience I take flomax and I take finasteride and you would think I would have no sperm production that's not true so what he's saying is not true you still produce sperm I absolutely have retrograde ejaculation and no semen production at all that comes out of my penis but I had a huge epididymal cyst that got so big I had to get it removed and it kept getting bigger and bigger guess what it was filled with. ??? sperm if I wasn't producing sperm I wouldn't have had the cyst or it wouldn't have been as big.
He said semen not sperm There is a difference between two
3 things continue to grow. Nose Ears Prostate As soon as a drug makes my nose smaller , I will believe.
No such thing as a shrinker.. relaxers work .. The surgery methods result retrograde ejaculation
This medication gave me a runny nose
SO WHERE'S THE ANSWERR FOR MEN SUFFRERING ??????? 7-14-22. SO DEPRESSING.
quecertin bromelian 100mg a day
What brand do you recommend?
Where can you buy it
No it is not.