Drug Prevention and Treatment of Benign Prostatic Diseases: from Clinical Original to Translational Research

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Background

Prostatitis is a major group of benign prostatic diseases that can be further categorized into chronic pelvic pain syndrome (CPPS), bacterial prostatitis (BP) and benign prostatic hyperplasia (BPH).

CPPS, or 'abacterial prostatitis', is characterized by pelvic or perineal pain in the absence of pathogenic bacterial infections in prostatic secretions. It is estimated that CPPS comprises up to 10% of all prostatitis diagnoses, and its incidence peaks in people aged 20 to 40 years or older than 70 years.

Bacterial prostatitis, which can be acute (ABP) or chronic (CBP), is characterized by recurrent urinary tract bacterial infections (UTIs) often resulting from urinary tract instrumentation in the prostate.

BPH, on the other hand, is one of the most frequent diseases in elderly men. BPH can result in a non-malignant prostate enlargement, which not only causes discomfort to the patients but also compromises their quality of life (QoL). Relevant research indicates that one third of men aged over 80 years needs treatment to relieve BPH-induced symptoms.

The morbidity and mortality of prostatitis have a major impact on adult men’s QoL, causing heavy social and economic burden to patients and their families.

Management of ABP currently depends on severity of symptoms, risk factors, and local antibiotic resistance patterns, with most patients being treated with outpatient antibiotics, which don’t necessarily involve hospitalization.

On the other hand, management of chronic prostatitis depends on the disease process and it usually aims to eliminate the bacterial infection with minimum adverse effects in the context of CBP, and to clinically and significantly alleviate the symptoms in the context of CPPS. However, the multidrug-resistance, including pan-drug resistance, remains a big challenge for treating both CBP and CPPS.

Pharmacological management of BPH includes α1-Adrenoceptor antagonists (α1-blockers), 5α-reductase inhibitors, muscarinic receptor antagonists, phosphodiesterase 5 inhibitors (PDE5Is), plant extracts, beta-3 agonists, and combination therapies. The use of most of these pharmacological tools was actually recommended by a study published in 2017 establishing 15 distinct clinical practice guidelines (CPGs) for the diagnosis and treatment of BPH worldwide.

However, each of these guidelines recommended some of the drugs with a certain limit and some of them were not discussed at all. Therefore, the selection of pharmacological therapies for the management of BPH needs to be scrutinized, especially in an era where all patients should be counselled about pharmacological treatment-related adverse events before being assigned an appropriate treatment.

Surgical treatment for BPH patients may also be considered and the selection of drugs for the treatment of post-surgery conditions, for example bleeding, UTIs, or erectile dysfunction, needs to be addressed as well.

The scope of this Research Topic is to discuss the current pharmacological interventions for prevention and/or treatment of benign prostatic diseases, as well as the risk factors that would influence the effect of pharmacologic prevention and treatment.

We will welcome research studies including observational studies, clinical trials, real world studies, systematic reviews and meta-analysis, clinical practice guidelines, modelling studies, pharmacoeconomic studies, drug resistance studies, bibliometric analysis, relevant research protocols and all the other article types that are generally accepted within the section Pharmaceutical Medicine and Outcome Research.

Keywords: Prostatitis, Benign prostatic hyperplasia, Lower urinary tract syndrome, Drug Prevention, Drug Control

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

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