Prostate disease and the pharmaceutical industry

In 1925 it was suggested that hormones regulated the growth of the prostate gland and in 1937 the first medicine for prostate cancer was synthesised. This compound, stilbestrol, remained in use for 40 years, but was troubled by a number of side effects. Work in the pharmaceutical industry over the next 30 years led to new medicines with improved properties, such as the antiandrogens and the hormonal therapies, cyproterone acetate and fosfesterol tetrasodium. A major breakthrough came in 1971, when the hormone LHRH was isolated and purified and its role in regulating sex hormones in men and women was revealed. This led to the development of medicines that mimic LHRH (agonists) and provided for the first time a really successful treatment for advanced prostate cancer. Parallel developments in surgery, medical instrumentation and radiation science also provided very successful treatments for both BPH and early prostate cancer.

During the mid-1970s a compound called phenoxybenzamine showed efficacy against BPH and led directly to the use of the alpha-blockers (e.g. indoramin and prazosin), already available for the control of high blood pressure. This led to the search for compounds with greater selectivity for the urinary tract or for alpha-receptor sub-types, such as alfuzosin and tamsulosin, while studies on the biochemistry of testosterone and related products led to the synthesis of the 5-alpha reductase inhibitor, finasteride.

These developments have greatly improved the prospects for men with prostate disorders but much remains to be done, especially to diagnose prostate cancer early enough for treatment to be effective, as well as to discover medicines for late stage metastatic prostate cancer, which still ends the lives of many men. The medicines currently available for prostate disorders and some new ones in development are described on the next page.