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Posts Tagged ‘Proscar’

Benign Prostatic Hyperplasia

Posted by admin on July 11th, 2011 No Comments

Definition Benign prostatic hyperplasia, a nearly ubiquitous condition, is the most common benign neoplasm of American men and occurs as a result of hormone-driven prostate growth. Pathophysiology The prostate gland comprises three types of tissue: epithelial or glandular, stromal or smooth muscle, and capsule. Both stromal tissue and capsule are embedded with О±1-adrenergic receptors. The precise pathophysiologic mechanisms that cause Benign prostatic hyperplasia are not clear. However, both intraprostatic dihydrotestosterone and type II 5 О±-reductase are thought to be involved. Benign prostatic hyperplasia commonly results from both static (gradual enlargement of the prostate) and dynamic (agents or situations that increase О±-adrenergic tone and constrict the gland's smooth muscle) factors. Examples of drugs that can exacerbate symptoms include testosterone, О±-adrenergic agonists (e.g., decongestants), anticholinergics (e.g., antihistamines, phenothiazines, tricyclic antidepressants, anticholinergic antispasmodics, Read more [...]

Posted in Benign Prostatic Hyperplasia

Prostatitis: Advanced Therapy

Posted by admin on June 21st, 2011 No Comments

Prostatitis is one of the most perplexing disease entities with which the practicing urologist must contend. Also, the treatment of this disease is the least gratifying in that the patients often are labeled as "crazy" and have a poor response. In many ways, there are some significant similarities with interstitial cystitis, and perhaps some of the patients with complaints of prostatitis actually have interstitial cystitis, as has been suggested. Indeed, many of the symptoms and physical findings are similar and are outlined in Table 71-1. As in the case of interstitial cystitis, prostatitis has also been difficult to study, being a disease that lacked a formal and specific definition. Therefore, the National Institute for Diabetes, Digestive, and Kidney Diseases (NIDDKD) convened a consensus group to define prostatitis, expressly for the purpose of describing the different prostatitis syndromes in such a way that they could be investigated, and ultimately treated, in a more efficacious fashion. These new definitions, while not being radically different from the old criteria, serve the purpose of Read more [...]

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Findings from Community Studies and Clinical Trials

Posted by admin on June 21st, 2011 No Comments

Symptoms It is well known that the prevalence of urinary symptoms increases with age. Based on cross-sectional community-based studies, age-related increases in the prevalence of lower urinary tract symptoms have been consistently found in numerous countries in studies using similar questionnaires, despite cross-cultural differences in the prevalence of moderate to severe symptoms. Few longitudinal studies have explored the progression of lower urinary tract symptoms by following untreated men over time. Recent longitudinal findings from the community-based Olmsted County Study of Urinary Symptoms and Health Status Among Men suggest a measurable progression in symptom severity, on average, over 3.5 to 4 years accompanied by high intraindividual variability The age-related changes found in this study were consistent with autopsy prevalence studies relating prostate volume to age. Another community study has also documented symptom progression over 3 years. Continued follow-up of such community-based cohorts of men should better characterize the rate of progression of urinary symptoms over longer Read more [...]

Posted in Benign Prostatic Hyperplasia

5-Alpha-Reductase Inhibitors

Posted by admin on May 10th, 2011 No Comments

Overview Because inhibition of the enzyme 5-alpha-reductase is known to reduce prostate size, patients with an enlarged prostate (greater than 40 g) are often prescribed a 5-alpha-reductase inhibitor (5-ARI). Along with alpha Mockers, 5-ARIs dominate the benign prostatic hyperplasia drug market. The agents currently available are finasteride (Merck's Proscar) and dutasteride (GlaxoSmithKline/Astellas's Avodart). These drugs are effective in preventing further prostatic growth and in reducing prostate size, but they have a slow onset of action and cause sexual side effects. Despite these disadvantages, new data on combination therapy with alpha blockers and 5-ARIs have increased 5-ARI use. Mechanism Of Action Research has substantiated the role of 5-alpha-reductase in the pathophysiology of benign prostatic hyperplasia. The fact that men who have undergone castration before puberty or have genetic androgen deficiency are not afflicted by the disease is evidence of the vital role that androgens play in normal male development and in the progression of static benign prostatic hyperplasia. 5-ARIs Read more [...]

Posted in Benign Prostatic Hyperplasia

Finasteride

Posted by admin on May 10th, 2011 No Comments

The search for specific inhibitors of 5-alpha-reductase led to the discovery of finasteride (Merck's Proscar), which has been marketed in the United States and Europe since 1992 and is now the leading agent of this class. Merck licensed finasteride to Yamanouchi and Banyu, a Merck subsidiary, in Japan, but no development has been reported since 1994. Finasteride inhibits dihydrotestosterone synthesis and thereby prevents enlargement of the prostate. It acts predominantly via suppression of the type 2 isoenzyme of 5-alpha-reductase, preventing conversion of testosterone to dihydrotestosterone and reducing serum and prostatic tissue dihydrotestosterone levels by 70% and 85%, respectively. Because 5-ARIs reduce prostate size, the subset of patients with static benign prostatic hyperplasia is most likely to benefit from this type of therapy. The clinical benefits and risks of finasteride treatment are best described by the Proscar Long-Term Efficacy and Safety Study (PLESS). In this four-year, double-blind, placebo-controlled trial, 3,040 men with moderate to severe symptoms of benign prostatic Read more [...]

Posted in Benign Prostatic Hyperplasia

Benign Prostatic Hyperplasia:Current Therapies

Posted by admin on May 10th, 2011 No Comments

Treatment of benign prostatic hyperplasia (benign prostatic hyperplasia) is directed primarily toward managing symptoms and improving patients' quality of life (QoL). The two dominating classes of pharmacological agents used to treat benign prostatic hyperplasia are alpha Mockers and 5-alpha-reductase inhibitors (5-ARIs). Both drug classes are effective in alleviating lower urinary tract symptoms (lower urinary tract symptoms ) associated with benign prostatic hyperplasia, thereby improving patients' comfort level. Alpha blockers are most useful in alleviating symptoms related to dynamic benign prostatic hyperplasia; 5-ARIs are used for the treatment of static benign prostatic hyperplasia. The dynamic and static forms of benign prostatic hyperplasia are discussed in the "Etiology and Pathophysiology" section. Alpha blockers work by relaxing prostatic muscle involved in dynamic benign prostatic hyperplasia; they cannot stop further growth of the prostate. 5-ARIs and gonadotropin modulators (used only in Japan) reduce the cellular growth seen in static benign prostatic hyperplasia. lower Read more [...]

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Benign Prostatic Hyperplasia: Anatomy

Posted by admin on May 10th, 2011 No Comments

Anatomy The prostate is approximately the size and shape of a walnut and is nestled under the bladder, anterior to the rectum. The primary function of the prostate is to secrete fluids that protect and sustain sperm while in the vagina after intercourse. Prostatic fluid is produced in the 30 to 50 secretory glands distributed throughout the prostate and is emptied directly into the urethra. The secretory glands are composed of prostatic ducts, which are lined with epithelial cells that may be secretory, basal, or neuroendocrine. Structural support for the prostrate is provided by the stroma, which consists of smooth-muscle cells, fibroblasts, and endothelial cells and is distributed throughout the prostate around secretory glands. FIGURE: Anatomic location of the prostate gland As shown in FIGURE: Anatomic location of the prostate gland, anatomic subsections of the prostate gland that contain the epithelial and stromal cell types include the transitional zone, the central zone, and the peripheral zone. The transitional zone surrounds the prostatic urethra; the proximal area is called the Read more [...]

Posted in Benign Prostatic Hyperplasia

Hormonal Therapies

Posted by admin on May 6th, 2011 No Comments

Overview. Several hormonal therapies are in development for CaP. Baxter Oncology's D-63153 and teverelix (Ardana's Antaralix) are decapeptide luteinizing hormone-releasing hormone (LHRH) antagonists in Phase II development. Lack of data precludes further discussion of them. Toremifene (GTx's Acapodene) is a nonsteroidal selective estrogen-receptor modulator (SERM) in Phase Ilb / III development. It is being tested for the prevention of CaP among patients with high-grade prostatic intraepithelial neoplasia and for the prevention and treatment of osteoporosis caused by adjuvant LHRH analogues. This agent falls outside the scope of this study. In late-stage development for CaP are finasteride. Mechanism Of Action. Finasteride is a steroid analogue of testosterone that treats benign prostatic conditions by blocking the activity of the enzyme 5-alpha reductase and obstructing the conversion of testosterone to dihydrotestosterone, a hormone that plays a role in benign prostatic growth and is believed to contribute to the development of CaP. Histrelin hydrogel implant is an LHRH antagonist. Unlike Read more [...]

Posted in Prostate Cancer

Emerging Therapies

Posted by admin on May 6th, 2011 No Comments

Prostate cancer (CaP) R&D is an extremely active field; several diverse agents will likely be launched by the end of 2006, and more than 90 agents are in Phase II trials. The fact that the majority of patients have historically received treatment only from urologists has presented a major hurdle for drug developers because urologists typically lack the facilities to administer chemotherapy. This hurdle is set to disappear for two reasons. First, the recent FDA approval of docetaxel for advanced CaP will ensure that more patients are referred to oncologists in the hopes of realizing a modest survival gain. Second, the advent of nonhormonal oral therapies is enabling increasing numbers of office-based urologists to enter patients into clinical trials. The availability of prostate-specific antigen (PSA) testing creates a development strategy dilemma for companies investigating agents to treat CaP. They may choose to test agents in late-stage disease where unmet need is greatest and regulatory requirements are less onerous. Alternatively, they may take advantage of the opportunity afforded by Read more [...]

Posted in Prostate Cancer

Finasteride

Posted by admin on June 11th, 2010 No Comments

Drug Approvals (British Approved Name, US Adopted Name, rINN) International Nonproprietary Names (INNs) in main languages (French, Latin, and Spanish): Finasterid; Finasterida; Finasteridas; Finasteride; Finasteridi; Finastendum; Finasztend; MK-906; MK-0906; YM-152. Pharmacopoeias. In Europe and US. European Pharmacopoeia, 6th ed. (Finasteride). A white or almost white crystalline powder. It exhibits polymorphism. Practically insoluble in water freely soluble in dehydrated alcohol and in dichloromethane. Protect from light. The United States Pharmacopeia 31, 2008 (Finasteride). A white to off-white crystalline solid. Very slightly soluble in water freely soluble in alcohol and in chloroform. Store in airtight containers. Adverse Effects The most commonly reported adverse effects of finasteride are decreased libido, erectile dysfunction, ejaculation disorders, and reduced volume of ejaculate. Breast tenderness and enlargement (gynaecomastia) may occur, and there have been reports of hypersensi-tivity reactions such as swelling of the lips and face, pruritus, urticaria, and rashes. Read more [...]

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