Selective Estrogen Receptor Modulators for BPH

New Factors on the Ground

M Garg; D Dalela; D Dalela; A Goel; M Kumar; G Gupta; S N Sankhwar

Disclosures

Prostate Cancer Prostatic Dis. 2013;16(3):226-232. 

In This Article

Abstract and Introduction

Abstract

As the current management of BPH/lower urinary tract symptoms by traditionally involved pharmacological agents such as 5alpha-reductase inhibitors and α 1-adrenoceptor antagonists is suboptimal, there is definite need of new therapeutic strategies. There is ample evidence in literature that suggests the role of estrogens in BPH development and management through the different tissue and cell-specific receptors. This article reviews the beneficial actions of selective estrogen receptor modulator (SERM) and ERβ-selective ligands, which have been demonstrated through in vitro studies using human prostate cell lines and in vivo animal studies. SERMs have anti-proliferative, anti-inflammatory and pro-apoptotic mechanisms in BPH, and also act by inhibiting various growth factors, and thus represent a unique and novel approach in BPH management directed at estrogen receptors or estrogen metabolism.

Introduction

BPH is a common urological problem of aging males. It occurs in about 10% of men below the age of 40 and increases to about 80% by 80 years of age.[1]

Clinical BPH is a benign enlargement of the prostate, which results in voiding urinary difficulties that may, sometimes, significantly impair the quality of life in older patients.[2] Currently, the favored treatment option for lower urinary tract symptoms due to BPH/BPE is medical therapy with α-blockers that help in alleviating the symptoms by reducing the stromal tone, and androgen suppressors that counteract the static component. These two approaches give modest improvement in objective parameters such as peak flow rate and prostate volume regression but on discontinuation of these agents, both disease as well as symptoms tends to recur. As the present medical therapies are focused mostly on relief of lower urinary tract symptoms and have some impact on benign prostatic enlargement, there is a definite need to find novel therapies that affect the basic pathophysiology of BPH.

Estrogens and selective estrogen receptor modulators (SERMs) have been shown to affect the prostatic cellular and stromal proliferation.[3] The current review intends to examine the potential role of SERMs in management of BPH.

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