I. Proscar Fact File

Proscar was introduced by Merck Pharmaceuticals in 1998.

Merck & Co., Inc. is a well known global research-driven pharmaceutical company dedicated to putting patients first. Established in 1891, Merck discovers, develops, manufactures and markets vaccines and medicines in over 20 therapeutic categories.

II. Proscar Medication

As a men reach about age 50, the prostate may start causing problems. Urinary symptoms begin to trouble many men as they reach middle age. The most common source of symptoms is the prostate gland. More specifically, it is the growth of the prostate gland in some men that can cause urinary tract problems. Generic Proscar is a medication that helps shrink the prostate in many men.

Proscar medication has been shown to reduce the risk of a sudden inability to pass urine, referred to as acute urinary retention, and the need for surgery—potential long-term serious consequences of benign prostatic hyperplasia (BPH).

Proscar medication lowers levels of a key hormone called DHT (dihydrotestosterone), which is a major cause of prostate growth. Lowering DHT leads to shrinkage of the enlarged prostate gland in most men. This can lead to gradual improvement in urine flow and symptoms over the next several months.

Proscar medication will help reduce the risk of developing a sudden inability to pass urine and the need for surgery. However, since each case of BPH is different, you should know that:

• Even though the prostate shrinks, you may NOT notice an improvement in urine flow or symptoms.
• You may need to take Proscar medication for 6 months or more to see whether it improves your symptoms.
• Therapy with Generic Proscar may reduce your risk of developing a sudden inability to pass urine and the need for surgery.

Benign prostatic hyperplasia (BPH): Information

Benign Prostatic Hyperplasia (BPH), also colled as benign prostatic hypertrophy, is a non-cancerous enlargement of the prostate, a small gland that encircles the urethra in males and produces a fluid that makes up part of semen. As the volume of the prostate increases, it can put pressure on the urethra, causing a slowdown in the urine stream, hesitancy in urinating, a frequent and urgent need to urinate, and sometimes dribbling of urine at the end of the flow. It can also cause urine retention, which can weaken the bladder muscle and increase the risk of developing a urinary tract infection (UTI) or kidney stones. In severe cases of BPH, urine may back up into and damage the kidneys. Rarely, BPH may prevent a patient from urinating at all, a situation that requires immediate medical attention.

Benign Prostatic Hyperplasia BPH can also affect sexual functioning. It can lead to reduced sexual ability, painful orgasm, and impotence. The type and severity of symptoms experienced will vary from person to person and may vary over time. For many men, BPH never progresses beyond a minor to moderate annoyance; for others, it may represent a significant challenge to their quality of life. BPH becomes a very common condition in men as they age. According to the American Urology Association, about 50% of men will have some degree of BPH by the time they are 60 years old, and up to 90% will be affected by age 80. While BPH does not cause prostate cancer, both may be found together.

Diagram 1: Normal Prostate

Diagram 2: Enlarged Prostate

Causes of BPH

The cause of benign Prostatic Hyperplasia is not known. It is possible that the condition is associated with hormonal changes that occur as men age. The testes produce the hormone testosterone, which is converted to Dihydrotestosterone (DHT) and Estradiol (estrogen) in certain tissues. High levels of dihydrotestosterone, a testosterone derivative involved in prostate growth, may accumulate and cause hyperplasia. How and why levels of DHT increase remains a subject of research.

Signs and Symptoms of BPH

Common symptoms of Benign Prostatic Hyperplasia include the following:

• Blood in the urine (i.e., hematuria), caused by straining to void
• Dribbling after voiding
• Feeling that the bladder has not emptied completely after urination
• Frequent urination, particularly at night (i.e., nocturia)
• Hesitant, interrupted, or weak urine stream caused by decreased force
• Leakage of urine (i.e., overflow incontinence)
• Pushing or straining to begin urination
• Recurrent, sudden, urgent need to urinate

In some cases of BPH, another symptom, acute urinary retention (the inability to urinate), can result from holding urine for a long time, alcohol consumption, long period of inactivity, cold temperatures, allergy or cold medications containing decongestants or antihistamines, and some prescription drugs (e.g., ipratropium bromide, albuterol, epinephrine). Any of these factors can prevent the urinary sphincter from relaxing and allowing urine to flow out of the bladder. Acute urinary retention causes severe pain and discomfort. Catheterization may be necessary to drain urine from the bladder and obtain relief.

Treatment of BPH

There are some other treatment options for men with benign prostate hyperplasia, depending on the severity of symptoms. If symptoms do not threaten the man's health, he may choose not to be treated. If symptoms are severe enough to cause discomfort, interfere with daily activities, or threaten health, treatment is usually recommended.

• Watchful waiting : Most men with mild symptoms may choose to return for annual examinations. The physician will perform an examination that includes a DRE, PSA tests, and a urinary flow rate. The patient will be asked to describe symptoms in order to determine if the condition is worsening.

• Medication : 5-Alpha Reductase inhibitors such as finasteride (Proscar medication) and dutasteride (Avodart) prevent the conversion of testosterone to the hormone dihydrotestosterone (DHT). In many cases, a treatment period of 6-month is necessary to see if the therapy is going to work. These drugs are taken orally, once a day.
  
• Alpha blockers relax smooth muscle tissue in the bladder neck and prostate, which increases urinary flow. They typically are taken orally, once or twice a day.

Commonly prescribed alpha blockers include the following:

• alfuzosin (UroXatral), extended-release tablet taken once daily
• doxazosin (Cardura), tablet taken once daily
• prazosin (Minipress), capsule taken 2 or 3 times daily
• tamsulosin hydrochloride (Flomax), capsule taken once daily
• terazosin (Hytrin), capsule taken once daily

Patients taking an alpha blocker require follow-up during the first 3 or 4 weeks to evaluate the effect on symptoms and adjust the dosage, if necessary.

• Prostatic Stents

Even though a Prostatic stent is not a medical treatment, neither does it fall under the classification of a surgical procedure. Prostatic stents are used most often for patients with significant medical problems that prohibit medication or surgery. It is a tiny, springlike device inserted into the urethra. When expanded, it pushes back the surrounding tissue and widens the urethra. Prostatic stents have several advantages:

• They can be placed in less than 15 minutes under regional anesthesia.
• Bleeding during and after surgery is minimal.
• The patient can be discharged the same day or the next morning.

There are also several disadvantages:

• Prepositioning can be difficult.
• They may cause irritation and frequent urination.
• They may cause pain or incontinence.
• Removing them (necessary in one-third of cases) can be difficult.

Side effects of Proscar (BPH Medications)

• Side effects of Proscar & Avodart include reduced libido, impotence, breast tenderness and enlargement, and reduced sperm count. Long-term risks and benefits have not been studied.
• Women who may be pregnant must avoid handling dutasteride capsules and broken or crushed finasteride tablets because exposure to the Propecia drugs may cause serious side effects to the fetus. Intact tablets are coated to prevent absorption through the skin during normal handling. Patients should wait at least 6 months after dutasteride treatment to donate blood to prevent pregnant women from being exposed to the drug through blood transfusion.
• Side effects of Alpha blockers include headache, dizziness, low blood pressure, fatigue, weakness, and difficulty breathing. Long-term risks and benefits have not been studied.

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III. Useful links

http://www.cdc.gov/

http://www.fda.gov/

http://www.fda.gov/cder/ogd/

http://www.nih.gov/

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi

http://www.health.gov.on.ca/

National Library of Medicine

World Health Organization

http://www.mayoclinic.com/index.cfm

MedicineNet.com

Drugdigest.org

Healthsquare.com

http://www.propecia.com/finasteride/propecia/consumer/index.jsp

http://www.merck.com/product/

http://www.proscar.com/proscar_finasteride/proscar/consumer/index.jsp

http://www.proscar.com/proscar_finasteride/proscar/consumer/taking_proscar/index.jsp

http://www.labtestsonline.org/understanding/conditions/bph.html

http://www.urologychannel.com/prostate/bph/index.shtml

http://www.urologychannel.com/prostate/bph/treatment_med.shtml

Pharmacy sites

http://www.roche.com/home/company/com_hist.htm

http://www.healthdigest.org/Bactrim-DS(Oral)_2006_PRO.php

http://www.hsforum.com/stories/storyReader$1509

http://www.hsforum.com/stories/storyReader$1516

http://www.hsforum.com/stories/storyReader$1504

http://www.people.vcu.edu/~urdesai/atc.htm#Process%20of%20clotting

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