Emerging treatments
Fexapotide
Fexapotide is a pro-apoptotic protein that stimulates caspase, tumor necrosis, and B-cell lymphoma pathways in prostate glandular epithelial tissue, resulting in cell death. It is administered as a single transrectal injection into the transition zone of the prostate. It is a painless procedure that does not require anesthesia. Reviews have reported that treatment with fexapotide significantly improves symptoms of BPH, with decreased need for both further intervention and episodes of acute urinary retention when compared with placebo at 3 years.[103][104]
Naftopidil
Naftopidil is a long acting subtype (alpha-1D) selective alpha-blocker that has also been demonstrated to improve symptoms and objective measures of LUTS associated with BPH.[105][106][107]
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Phytotherapy
AUA guidelines suggest that positive recommendations on the use of supplements and nutraceuticals containing ingredients such as Serenoa repens (saw palmetto) are not warranted because the quality and results of studies have been variable.[17] The European Association of Urology recommends offering hexane-extracted Serenoa repens to men with LUTS who want to avoid any potential adverse events, especially those related to sexual function, informing them that the magnitude of efficacy may be modest.[18]
Desmopressin
Intranasal and sublingual formulations of desmopressin may be prescribed for persistent nocturia despite other medical therapy.[108] One systematic review found that adding desmopressin to alpha-blockers decreased the frequency of night voids.[109] Hyponatremia occurred in up to 6% of patients taking desmopressin. Electrolytes should be monitored at 1 week and 4 weeks after starting therapy.
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