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Primär- und Sekundärprävention des benignen Prostatasyndroms

Aktueller Wissenstand und Auswirkungen auf die klinische Routine

Primary and secondary prevention of benign prostatic hyperplasia

Current knowledge and implications for clinical management

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Zusammenfassung

Die benigne Prostatahyperplasie (BPH) und das klinische Krankheitsbild des benignen Prostatasyndroms (BPS) kommen häufig vor, führen zur Lebensqualitätseinschränkung, sind progressiv und gehen potentiell mit Komplikationen im unteren oder oberen Harntrakt einher, weshalb Maßnahmen zur Prävention sinnvoll erscheinen. Aufgrund einer Literaturrecherche in PubMed/Medline von 1990–2011 summiert dieser Artikel die bekannten Maßnahmen zur Primär- und Sekundärprävention der BPH bzw. des BPS.

Primärpräventive Maßnahmen sollen die histologische BPH und das BPS verhindern, bevor diese klinisch evident werden. Gewichtsreduktion, regelmäßige körperliche Aktivität, der Verzehr von Gemüse, Aufnahme von Alkohol, die Einnahme von Dutasterid oder Finasterid sowie das Vermeiden von Übergewicht und fettreicher Nahrung können die BPH, Symptome des unteren Harntraktes (LUTS) oder BPS-assoziierte Komplikationen verhindern. Mit den Maßnahmen der Sekundärprävention sollen die Progression des BPS und BPS-assoziierte Komplikationen vermieden werden. Die regelmäßige und lang dauernde Einnahme eines α1-Blockers reduziert LUTS und verhindert die symptomatische Progression des BPS, kann aber BPS-assoziierte Komplikationen (z. B. Harnverhalt, Notwendigkeit einer Prostataoperation) nicht verhindern. 5α-Reduktaseinhibitoren können zwar die symptomatische Progression, den Harnverhalt und die Notwendigkeit einer Prostataoperation bei Patienten mit BPS reduzieren, die Medikamentenkombination bestehend aus α1-Blocker und 5α-Reduktaseinhibitor ist aber effektiver als die Einzelsubstanzen. Von der Sekundärprävention profitieren insbesondere ältere Männer mit größerer Prostata (>40 cm3) und mit höherer PSA-Konzentration im Serum (>1,6 µg/l).

Bei der Primärprävention ist die Datenqualität gering und die Therapie mit 5α-Reduktaseinhibitoren bisher noch nicht akzeptiert. Bei der Sekundärprävention sollten Männer mit Risikofaktoren für eine Krankheitsprogression eine Therapie mit 5α-Reduktaseinhibitoren erhalten. Trotz zahlreicher epidemiologischer und klinischer Untersuchungen zur Progressionshemmung existieren in Deutschland keine offiziellen Programme zur Prävention der BPH bzw. BPS.

Abstract

Histological benign prostatic hyperplasia (BPH) and the BPH disease are frequent, lead to a reduction of quality of life, are both progressive and potentially associated with complications in the lower and upper urinary tract. A PubMed/MEDLINE search was conducted for the years 1990 to 2011. This article summarizes known selective measures of primary and secondary disease prevention.

Measures of primary disease prevention aim to inhibit histological BPH and the development of clinically relevant BPH. Weight loss, regular physical activity, vegetable consumption, alcohol intake, 5α-reductase inhibitors, avoidance of overweight and reduction of fatty food can reduce the probability of histological and clinical BPH. Selective measures of secondary prevention aim to inhibit disease progression and BPH-associated complications. The regular and long-term use of α1-blockers reduces lower urinary tract symptoms (LUTS) and inhibits symptomatic disease progression but cannot prevent BPH-associated complications (e.g. urinary retention or need for prostate surgery). 5α-Reductase inhibitors can reduce the probability of symptomatic disease progression, urinary retention or need for surgery but the combination of α1-blocker and 5α-reductase inhibitor is more efficacious than either monotherapy. Especially older men with enlarged prostates (>40 cm3) and elevated serum PSA concentration (>1.6 µg/l) profit from measures of secondary disease prevention.

For primary disease prevention, data quality is low and early treatment with 5α-reductase inhibitors is not been approved. For secondary disease prevention, men with risk factors of disease progression should use a treatment containing 5α-reductase inhibitors. Despite several epidemiological and clinical investigations on BPH disease progression no official programme exists in Germany for disease prevention.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: M.O. ist Berater, Referent oder Teilnehmer an wissenschaftlichen Studien bei den folgenden Firmen: Astellas, GlaxoSmithKline und Merckle-Recordati. S.M. ist Berater, Referent oder Teilnehmer an wissenschaftlichen Studien bei den folgenden Firmen: Astellas und GlaxoSmithKline.

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  1. Klinik für Urologie und Urologische Onkologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland

    M. Oelke

  2. Abteilung für Urologie, Donauspital-SMZO, Wien, Österreich

    S. Madersbacher

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  1. M. Oelke
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  2. S. Madersbacher
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Correspondence to M. Oelke.

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Oelke, M., Madersbacher, S. Primär- und Sekundärprävention des benignen Prostatasyndroms. Urologe 50, 1257–1264 (2011). https://doi.org/10.1007/s00120-011-2618-3

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