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Additional resources for 100 Questions & Answers About Prostate Disease
The enzymes 5 alpha reductase are present in two isoforms: type 1 and type 2. Type 1 is found predominantly in extra prostatic tissues such as the skin and liver, although it is also found in the prostate. Type 2 is found predominantly in the prostate. Two drugs have been developed that inhibit 5 alpha reductase. The first is finasteride or Proscar, which is a type 2 or selective 5 alpha reductase inhibitor. The second is dutasteride or Avodart, which is a type 1 and type 2 or nonselective 5 alpha reductase inhibitor.
37. What effects do 5 alpha reductase inhibitor drugs have on PSA levels? PSA is a valuable blood test that screens for prostate cancer, as discussed in Questions 5 to 11. However, 5 alpha reductase inhibitor drugs do affect PSA levels. As mentioned in Question 33, 5 alpha reductase inhibitor drugs block the conversion of testosterone to DHT, which results in shrinkage of the prostate or a decrease in prostate volume. Because prostate cells make PSA, it is reasonable to assume that as the prostate gets smaller, the PSA level will decline.
Recent studies report that blood transfusions are required in about 4% of the patients who undergo the procedure. Because the apex of the prostate is near the external urinary sphincter, incontinence is a potential complication. Fortunately, the risk of urinary incontinence after a TURP has been estimated to be about 1%. Erectile dysfunction or impotence can occur after a TURP. It is theorized that some of the electrical current from the resectoscope loupe scatters beyond the prostate capsule and injures the nerves.