Uticaj farmakološke terapije benigne hiperplazije prostate na volumen prostate i slobodni testosteron i, posledično, na urinarne parametre i seksualnu želju muškaraca
Sažetak
Uvod/Cilj. Farmakološka terapija benigne hiperplazije prostate (BHP) ublažava progresiju bolesti i utiče na androgeni hormonski status. Opadanje nivoa slobodnog testosterona (slobodniT) unutar ukupnog testosterona (ukupniT) dovodi do simptoma seksualne disfunkcije. Cilj rada bio je da se prikažu rezultati uticaja farmakološke terapije BHP u toku 6 meseci korišćenja na volumen prostate (VP) i nivo slobodnogT kao i efekat na urianarne parametre i seksualnu želju muškaraca. Metode. Ova klinička prospektivna studija obuhvatila je 156 bolesnika sa BHP, sa umerenim simptomima poremećaja mokrenja – internacionalni prostata simptom skor (IPSS) < 19,VP > 30 mL i vrednošću prostata specifičnog antigena (PSA) < 4 ng/mL. Prosečna starost bolesnika bila je 61,16 ± 2,97 god. Rađene su analize krvi sa određivanjem tumorskih markera (PSA, slobodni PSA), hormona (ukupniT, slobodniT, odnos slobodniT/ukupniT), transabdominalna ultrasonografija i urofloumetrija. Simptomi poremećenog mokrenja mereni su upitnicima za IPSS i kvalitet života (Quality of Life – QoL), a promene seksualne želje upitnikom Internacionalni indeks erektilne funkcije (IIEF). Formirane su četiri grupe sa po 39 bolesnika. Prva grupa dobijala je alfa1-blokator (AB) tamsulosin, druga grupa inhibitor 5alfa-reduktaze (5-ARI) finasterid, treća grupa kombinovanu terapiju (tamsulosin i finasterid) i četvrta, kontrolna grupa, bila je bez terapije. Kontrole su rađene na tri i šest meseci tokom terapije. Rezultati. Značajno je smanjen VP kod bolesnika sa kombinovanom terapijom (-6,95 ± 2,00; p < 0,001) i finasteridom (-6,67 3,35). U grupi sa finasteridom značajno je smanjen slobodniT (-4,23 ± 5,20; p < 0,001) i odnos slobodniT/ukupniT (-0,12 ± 0,08; p < 0,001), kao i u grupi sa kombinovanom terapijom [slobodniT (-2,64 ± 7,81) i odnos slobodniT/ukupniT (-0,09 ± 0,13)]. Urofloumetrija je pokazala značajno poboljšanje svih urinarnih parametara u svim terapijskim grupama. Kombinovanom terapijom postignuto je najveće poboljšanje maksimalnog protoka (Qmax)(+4,06 1,75; p < 0,001) i simptoma poremećenog mokrenja (-10,95 ± 3,19). Seksualna želja kod bolesnika sa tamsulosinom bla je značajno poboljšana (+0,78 1,00; p < 0,001), dok je u grupi sa finasteridom registrovano blago pogoršanje, ali bez statističke značajnosti. Zaključak. Hormonska komponenta farmakološke terapije za BHP najefikasnije smanjuje VP i nivo slobodnogT, poboljšava simptome poremećenog mokrenja sa blagim pogoršanjem seksualne želje muškaraca lečenih samo finasteridom.
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