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Treatments for Benign Prostatic Hyperplasia. Part 2

Posted by admin on November 28th, 2009 No Comments

α-Adrenergic blockers It has been suggested that the dynamic component of obstruction, smooth muscle tone in bladder heck, prostate, urethra, and prostatic capsule, is responsible for the variation in symptoms. Prostatic smooth muscle tone is regulated by the autonomic nervous system. The contractile response of prostatic tissue to norepinephrine and its abolishment by pretreatment with OC-adrenergic antagonists was first demonstrated by Gaine and colleagues during the 1970s. α1 and α2-receptors have recently been identified in human prostate and bladder neck by radioligand receptor studies. Contractile response is predominantly mediated by α1-receptors. Well-controlled studies have been performed demonstrating the efficacy of phe-noxybenzamine (non-selective α-adrenergic antagonist), prazosin (α1-adrenergic antagonist), and terazosin (α1-adrenergic antagonist) in the treatment of Benign Prostatic Hyperplasia. Meaningful improvements in symptom score, global assessment, and urodynamic parameters (peak flow rate, mean flow rate) have been documented with these agents. Side Read more [...]

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Treatments for Benign Prostatic Hyperplasia. Part 1

Posted by admin on November 28th, 2009 No Comments

Benign Prostatic Hyperplasia (BPH) is the most common neoplasm affecting humans. More than 400 000 prostatectomies are performed annually in the United States, second only to cataract extractions in charges to Medicare. In an era of limited health care funds, the indications for and efficacy of traditional therapy must be reviewed. A variety of new therapies for BPH are being clinically evaluated. Any new treatment will need to show comparable efficacy, safety, and cost efficiency. Natural history Histologically detectable Benign Prostatic Hyperplasia has an increasing incidence with age, with virtually all men demonstrating hyperplasia by age 80. However, clinical enlargement is detected in only 50%. Of these, roughly half will develop symptoms sufficient to seek treatment. It is estimated that a 50-year-old man has a 10% to 20% chance of receiving surgery for relief of bladder outlet obstruction in his lifetime. The symptoms of bladder outlet obstruction vary significantly over time. It has been proposed that oudet obstruction has both a static and dynamic component. Read more [...]

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Moderate symptoms of benign prostatic hyperplasia. Part 2

Posted by admin on November 26th, 2009 No Comments

Questions and Answers 1. Have similar studies been done comparing drug treatment to surgery or watchful waiting? No. It's very unlikely that anyone could get funding for such a study. It's pretty clear that surgery is much more effective than medication. 2. Can watchful waiting really be considered a treatment that can succeed or fail? Yes, there's a huge amount of improvement that occurs in watchful waiting over time, particularly if they do the behavioural approaches you described - avoid medications that make it worse, stay away from caffeine and alcohol, don't drink fluids in the evening and empty the bladder before going to bed. These things seem to have a significant effect on a lot of men. Also, benign prostatic hyperplasia symptoms come and go naturally - you see that even with placebo, things just get better. If you're not really badly bothered, watchful waiting and drugs are reasonable alternatives, but if you're badly bothered, you're probably wasting your time with these options. 3. Does the age of the patient make watchful waiting more or less appropriate? Ironically, Read more [...]

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Moderate symptoms of benign prostatic hyperplasia. Part 1

Posted by admin on November 26th, 2009 No Comments

The urinary symptoms of benign prostatic hyperplasia (BPH) can range from very mild to severe enough to require prompt surgical treatment. Men with moderate symptoms of BPH do not face immediate health risks, but are typically bothered by symptoms such as frequent urination, dribbling and a hesitant urinary stream. These men are presented with the options of drug therapy, surgery to reduce the volume of the prostate, or watchful waiting, which monitors symptoms and employs behavioural measures, like learning to relax the muscles while urinating and eliminating caffeine and alcohol, to avoid or delay surgery. This study set out to compare the effectiveness of surgery and watchful waiting in managing moderate symptoms of BPH. Between 1986 and 1989, 556 men age 55 or older were recruited into the study at participating U.S. veterans' medical centres. All had moderate urinary symptoms of benign prostatic hyperplasia, making them appropriate candidates for either watchful waiting or surgery. After obtaining the consent of participants and conducting baseline exams, the researchers randomly assigned Read more [...]

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Don’t Forget Your PSA Test

Posted by admin on November 26th, 2009 No Comments

If you're a young man, you're probably not overly concerned about prostate cancer. If you are approaching the age of 50, you may be starting to wonder about it. If you're over 50, chances are that you have already been screened for this disease by your doctor. In fact, testing for prostate cancer has been the focus of a significant amount of research in recent years. One test in particular, the measurement of a man's PSA (prostate specific antigen), is revolutionizing the screening and treatment of this cancer. The prostate is a walnut-sized, male sex gland located below the bladder and directly in front of the rectum. During intercourse, it produces a thick fluid that helps force sperm through the urethra and out of the penis. The prostate also produces PSA, an enzyme that liquefies seminal fluid permitting sperm to swim more freely. In the case of a healthy prostate, some of this prostate specific antigen leaks out into the bloodstream where it is either bound to blood proteins, or it is left "free" and unbound. According to recent research at the National Institute of Aging (NIA) and Johns Read more [...]

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Casodex and Zolvadex improve advanced prostate cancer

Posted by admin on November 26th, 2009 No Comments

Casodex (bicalutamide / Zeneca) is a safe and effective treatment for advanced prostate cancer when used in combination with LHRH-A therapy (medical castration), a regimen known as CAB. Now two studies show that Casodex is effective when used as monotherapy. In one study, 288 patients with metastatic disease were randomized to treatment with Casodex alone or the CAB regimen. Of those treated only with Casodex, 70% had a favorable subjective response compared to 58% of patients on the CAB regimen. In the second study, treatment with Casodex led to a better quality of life.

A report on the use of Zolvadex (goserelin acetate implant / Zeneca) demonstrated that the drug improved five-year overall survival in those patients with locally advanced prostate cancer. The drug was given as adjuvant therapy, initiated simultaneously with radiotherapy and continued every four weeks for three years.

Posted in Prostate Cancer, Prostate Gland

Benign Prostatic Hyperplasia (BPH)

Posted by admin on November 26th, 2009 No Comments

The prostate gland is part of the male reproductive system. It is located just below the bladder and surrounds the urethra, the small tube through which urine travels out of the body. As men age, the prostate gland becomes larger. As it enlarges, it may press on the urethra and block the flow of urine out of the bladder. This condition is known as BPH, or benign prostatic hyperplasia. In men with Benign Prostatic Hyperplasia, the partial blockage of the urethra leads to irritation in the bladder, which eventually does not completely empty during voiding. The blockage and partial emptying of the bladder lead to a variety of problems, including a weak, interrupted or hesitant stream of urine, frequent urination (especially at night), a feeling of urgency to urinate, and leaking or dribbling of urine. For some men, these symptoms are simply annoying. Symptoms of prostate enlargement can also signal a more serious condition, such as prostate cancer. If BPH is not treated, it can cause serious problems over time, including urinary tract infections, incontinence (leaking urine), stone formation, and even Read more [...]

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The Prostate. Part 5

Posted by admin on November 26th, 2009 No Comments

Prostate Cancer: Medical or Surgical Castration? Some 30 to 40% of men over 50 years of age have prostate cancer. For advanced metastatic prostate cancer there is no cure, although therapy is available to control tumor growth, alleviate symptoms, and improve quality of life. Because androgens (primarily dihydrotestosterone) control the growth of the prostate gland, medical or surgical castration can cause regression of prostate cancer. Unfortunately, the response is often brief and prostate cancer continues to be a leading cause of death from cancer in men. Goserelin acetate (Zoladex/Zeneca) is a medical alternative to surgical castration, and appears to be even more effective than removal of the testes for prolonging survival. An analog of luteinizing hormone-releasing hormone, goserelin inhibits pituitary gonadotropin secretion, which reduces testosterone to castration levels. Goserelin is given in combination with an antiandrogen to block any remaining testosterone anywhere in the body, particularly the adrenals. Side effects include hot flashes in about half of patients, and often impotence Read more [...]

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The Prostate. Part 4

Posted by admin on November 26th, 2009 No Comments

Finasteride versus Terazosin for Benign Prostatic Hyperplasia Results from a large clinical trial comparing the 5-alpha-reductase inhibitor finasteride with the alpha1-blocker terazosin for benign prostatic hyperplasia suggest that terazosin is the more effective of the two drugs. Abbott and Merck co-sponsored the 1-year study, which involved 1229 men randomly assigned to either finasteride, terazosin, a combination of the two, or placebo. Herbert Lepor (Chief of Urology at New York University Medical Center) reported the results at a recent meeting of the American Urological Association in Orlando, FL. Lepor said that finasteride was no more effective for reducing symptoms than placebo, whereas terazosin was significantly more effective than either finasteride or placebo. Only patients with large prostate glands that are nonresponsive to alpha1-blockade should be treated with finasteride, according to Lepor. The report included an analysis of placebo-controlled trials as well as the comparison trial, comprising data on 2500 patients. Merck researchers responded that the size of the prostate Read more [...]

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The Prostate. Part 3

Posted by admin on November 26th, 2009 No Comments

Treating Benign Prostatic Hyperplasia with Finasteride The androgens testosterone and dihydrotestosterone (DHT) control the development and function of the prostate gland. Testosterone is converted to DHT - the active androgen in many tissues, including prostate and skin - by the enzyme 5-alpha-reductase. Inhibiting 5-alpha-reductase markedly reduces prostate dihydrotestosterone, which decreases the size of the prostate in men with benign prostatic hyperplasia and improves urine flow. There are several 5-alpha-reductase inhibitors in clinical trial, one of which - finasteride (Proscar/Merck) - is approved in the United States for benign prostatic hyperplasia. There are two types of 5-alpha-reductase, and they are produced from different genes on different chromosomes and have different structures (there is only a 50% homology in amino acid sequence). Type 1 is found in all skin; type 2 is found mainly in genital skin. Finasteride blocks primarily type 2. It does not bind the androgen receptor, does not block other steroid hormones, and has no other hormonal effects. With the recommended dosage Read more [...]

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