Clinical symptoms of urinary dysfunction include urgency, hesitancy, weak urinary stream, intermittency, dribbling, and feeling of incomplete emptying, etc. Attributed to urinary symptoms, men with BPH may also have a higher level of botherness, and more interference in selected daily living activities caused by urinary dysfunction, together with embarrassment about urinary dysfunction, and worry or concern over prostate cancer.
The etiology of BPH is undoubtedly multifactorial. However, it is well recognized that the two pre- requisites for developing BPH are aging and a normal function hypothalamopituitary-testicular axis. Steroid hormones appear to play a significant role in the pathogenesis of BPH. Experimentally, estrogen is synergistic with androgens in the induction of BPH. Estrogen induces the androgen receptor complex and may also play a role in the reduction of the prostatic cell turnover. The role of androgens in BPH was related with the enzyme 5a-reductase which concerts testosterone into the biologically more potent androgen dihydrotestosterone (DHT) within the prostate gland. DHT appears to be essential for prostatic growth.
The standard treatment for BPH is surgery, usually transurethral resection of the prostate. However, recent study found there was a higher cardiovascular mortality rate associated with this treatment. On the other hand, traditional nonsurgical therapies such as flutamide and LH-RH analogs obtained reduction in prostate volume comparable to the reduction obtained following surgical castration. Unfortunately, significant side effects, such as impotence, decreased libido, lack of energy, gynecomastia, and the increased risk of osteoporosis, make these treatment unacceptable for BPH. In light of these findings, other promising treatments are desirable, and ATCA is one of them
According to a previous study, the death rate of newly diagnosed patients within 2 years was approximately 30%. About 50% of the rest had bone metastases and 30% had metastases to regional lymph nodes or extra prostatic invasion. Approximately 80% of men with metastatic symptomatic prostatic carcinoma respond to androgen ablation with an average life expectancy of 43 months; 20% of men fail to respond and survive an average of 7 to 9 months. Chemotherapy induces DNA damage, which proves lethal to tumor cells only if the DNA is not repaired by cellular mechanisms prior to cell division. Therefore, the unavailability of effective treatment for prostatic carcinoma demands other promising therapies to improve survival, and ATCA is one of them
