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Rastrelli G, Vignozzi L, Maggi M. Testosterone therapy: a friend or a foe for the aging men with benign prostatic hyperplasia? Asian J Androl 2021; 22:233-235. [PMID: 31424029 PMCID: PMC7275798 DOI: 10.4103/aja.aja_86_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Giulia Rastrelli
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini, Florence 6 I-50139, Italy
| | - Linda Vignozzi
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini, Florence 6 I-50139, Italy.,I.N.B.B., Biostructures and Biosystems National Institute, Viale delle Medaglie d'Oro, 305, Rome I-00136, Italy
| | - Mario Maggi
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini, Florence 6 I-50139, Italy.,I.N.B.B., Biostructures and Biosystems National Institute, Viale delle Medaglie d'Oro, 305, Rome I-00136, Italy.,Endocrinology Unit, Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini, Florence 6 I-50139, Italy
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2
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Urinary Biomarkers and Benign Prostatic Hyperplasia. CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00504-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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3
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Robert G, De La Taille A, Descazeaud A. Données épidémiologiques en rapport avec la prise en charge de l’HBP. Prog Urol 2018; 28:803-812. [DOI: 10.1016/j.purol.2018.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 08/08/2018] [Indexed: 10/28/2022]
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4
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Wen YC, Lu CF, Chen CY, Lee LM, Lin KH, Lin YW, Hsiao CH. Do 5α-reductase inhibitors prevent secondary benign prostate hyperplasia-related urinary retention? UROLOGICAL SCIENCE 2018. [DOI: 10.4103/uros.uros_6_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Dutasteride is associated with reduced risk of transrectal prostate biopsy-associated urinary tract infection and related hospitalizations. World J Urol 2017; 35:1525-1530. [PMID: 28396999 DOI: 10.1007/s00345-017-2036-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 04/06/2017] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES To evaluate whether the use of dutasteride is associated with a lower risk of transrectal prostate biopsy-associated urinary tract infection (TPBA-UTI) among men in the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) study. METHODS Retrospective analysis of 6045 men undergoing 2-year repeat prostate biopsy in REDUCE. Participants were randomized to receive dutasteride 0.5 mg or placebo daily. TPBA-UTI was defined as the presence of urinary symptoms and the prescription of antibiotics by the treating physician within 30 days after biopsy. Severe TPBA-UTI was defined as TPBA-UTI requiring hospitalization. Comparison of TPBA-UTI between treatment arms was done using Chi-square test and logistic regression adjusting for participant characteristics. RESULTS Of the subjects included in the study, 3067 (50.7%) were randomized to the placebo arm and 2978 (49.3%) to the dutasteride arm. A total 51 (0.8%) men had TPBA-UTI, including 38 (1.2%) in the placebo arm and 13 (0.4%) in the dutasteride arm (univariable relative risk [RR] = 0.35, P = 0.001; multivariable odds ratio [OR] = 0.34, P = 0.003). The number needed to treat (NNT) to prevent one TPBA-UTI was 125 subjects. Of these, 14 (28%) had severe TPBA-UTI, including 12 (0.4%) in the placebo arm and only 2 (0.07%) in the dutasteride arm (univariable RR = 0.17, P = 0.021; multivariable OR = 0.17, P = 0.031). The NNT to prevent one severe TPBA-UTI was 309 subjects. CONCLUSION Among men undergoing a 2-year repeat prostate biopsy, the use of dutasteride for 2 years was associated with a reduced the risk of overall and severe TBPA-UTI. CLINICALTRIALS. GOV IDENTIFIER NCT00056407.
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Abstract
The pharmacological treatment of benign prostatic hyperplasia (BPH) is indicated when men suffer from lower urinary tract symptoms (LUTS) but there are no absolute indications for prostate surgery or severe bladder outlet obstruction. Phytotherapy can be used in men with mild to moderate LUTS and alpha-blockers can quickly and effectively decrease the LUTS and symptomatic disease progression. Phosphodiesterase type 5 inhibitors (PDE5-I) are an alternative to alpha-blockers when men experience bothersome side effects from alpha-blockers or erectile dysfunction. If patients predominantly have bladder storage symptoms and a small prostate, muscarinic receptor antagonists are a viable treatment option. The combination of alpha-blocker plus muscarinic receptor antagonist is more efficacious in reducing LUTS than the single drugs alone. The 5 alpha-reductase inhibitors (5ARI) can significantly decrease LUTS and disease progression (e.g. acute urinary retention and need for prostate surgery) in men with larger prostates (> 30-40 ml). The combination of 5ARI plus alpha-blocker can reduce LUTS and disease progression more effectively than drug monotherapy. Combination therapy with PDE5-I (tadalafil) plus 5ARI (finasteride) reduces LUTS more substantially than 5ARI alone and, additionally, PDE5-Is reduce the sexual side effects during 5ARI treatment.
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Affiliation(s)
- M Oelke
- Klinik für Urologie und Urologische Onkologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - E Martinelli
- Klinik für Urologie und Urologische Onkologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
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7
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Olesovsky C, Kapoor A. Evidence for the efficacy and safety of tadalafil and finasteride in combination for the treatment of lower urinary tract symptoms and erectile dysfunction in men with benign prostatic hyperplasia. Ther Adv Urol 2016; 8:257-271. [PMID: 27928428 PMCID: PMC5131741 DOI: 10.1177/1756287216650132] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Benign prostatic hyperplasia (BPH) is an age-related phenomenon associated with prostatic enlargement and bladder outlet obstruction that can cause significant lower urinary tract symptoms (LUTS). These LUTS have a negative impact on an individual's quality of life, which is why treatment of symptomatic BPH has become a major priority. Although surgical interventions exist for treating BPH, pharmacological therapies are often preferred due to their minimal invasiveness and high degree of effectiveness. The three classes of drugs approved for treating BPH include α-blockers, 5-α-reductase inhibitors (5-ARIs) and phosphodiesterase 5 (PDE-5) inhibitors. Individually, each class of drug has been studied and shown to improve symptom relief through a variety of different mechanisms. A more recent focus has been on the development of combinatorial therapies that combine classes of drugs in order to provide maximal benefit. The mTOPS and CombAT studies were the first of their kind to examine whether the combination of 5-ARIs and α-blockers was more effective than monotherapy alone. Both studies found similar results in that the combinatorial therapy was superior to monotherapy. Over the last decade other combinatorial therapies have been at the forefront of investigation. One in particular is the combination of tadalafil, a PDE-5 inhibitor, with finasteride, a 5-ARI. Studies have shown that the combination of tadalafil and finasteride is a safe, effective, and well tolerated treatment for BPH. Evidence suggests that this combination may be particularly effective in reducing treatment-related sexual adverse events associated with 5-ARI treatments. The following review will explore in detail the current evidence surrounding treatment of BPH LUTS using tadalafil and finasteride.
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Affiliation(s)
| | - Anil Kapoor
- McMaster Institute of Urology, 50 Charlton Avenue, G344 Mary Grace Wing, Hamilton, ON, Canada L8N 4A6
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8
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Nickel JC, Roehrborn CG, Castro-Santamaria R, Freedland SJ, Moreira DM. Chronic Prostate Inflammation is Associated with Severity and Progression of Benign Prostatic Hyperplasia, Lower Urinary Tract Symptoms and Risk of Acute Urinary Retention. J Urol 2016; 196:1493-1498. [PMID: 27378134 DOI: 10.1016/j.juro.2016.06.090] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE We evaluated associations between histological prostate inflammation, and the development and progression of benign prostatic hyperplasia/lower urinary tract symptoms in men randomized to placebo in the REDUCE (Reduction by Dutasteride of Prostate Cancer Events) study in a 4-year period. MATERIALS AND METHODS The association of acute and chronic inflammation detected on baseline biopsies and benign prostatic hyperplasia related parameters, including I-PSS (International Prostate Symptom Score) and prostate volume, at multiple time points during 4 years in men randomized to placebo enrolled in the REDUCE prostate cancer prevention study was analyzed with the Student t-test. The association of inflammation with newly developed benign prostatic hyperplasia/lower urinary tract symptoms and benign prostatic hyperplasia progression in patients with existing benign prostatic hyperplasia/lower urinary tract symptoms was analyzed with univariable and multivariable Cox models. RESULTS Acute and chronic inflammation was seen in baseline negative biopsies of 641 (15.6%) and 3,216 (78.3%) of the 4,109 men in the study. Chronic but not acute inflammation was associated with slightly higher baseline I-PSS (0.6 difference, p = 0.001) and larger prostate volume (3.2 cc difference, p <0.001), a difference noted throughout the study interval. The presence of acute and chronic inflammation was not associated with the incidence of benign prostatic hyperplasia/lower urinary tract symptoms in men without those conditions at baseline or the progression of symptomatic benign prostatic hyperplasia in men with benign prostatic hyperplasia/lower urinary tract symptoms at baseline. However, an association was observed with more severe inflammation. Chronic inflammation at baseline was associated with an increased risk of acute urinary retention (HR 1.6-1.8, p = 0.001). CONCLUSIONS Our longitudinal evaluation of REDUCE patients randomized to placebo for 4 years confirmed that chronic inflammation is associated with severity and the progression of benign prostatic hyperplasia and benign prostatic hyperplasia/lower urinary tract symptom outcomes.
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Affiliation(s)
- J Curtis Nickel
- Department of Urology, Queen's University, Kingston, Ontario, Canada; Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Urology, Mayo Clinic, Rochester, Minnesota; Global R&D Unit, GlaxoSmithKline, Inc., King of Prussia, Pennsylvania; Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
| | - Claus G Roehrborn
- Department of Urology, Queen's University, Kingston, Ontario, Canada; Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Urology, Mayo Clinic, Rochester, Minnesota; Global R&D Unit, GlaxoSmithKline, Inc., King of Prussia, Pennsylvania; Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Ramiro Castro-Santamaria
- Department of Urology, Queen's University, Kingston, Ontario, Canada; Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Urology, Mayo Clinic, Rochester, Minnesota; Global R&D Unit, GlaxoSmithKline, Inc., King of Prussia, Pennsylvania; Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Stephen J Freedland
- Department of Urology, Queen's University, Kingston, Ontario, Canada; Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Urology, Mayo Clinic, Rochester, Minnesota; Global R&D Unit, GlaxoSmithKline, Inc., King of Prussia, Pennsylvania; Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Daniel M Moreira
- Department of Urology, Queen's University, Kingston, Ontario, Canada; Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Urology, Mayo Clinic, Rochester, Minnesota; Global R&D Unit, GlaxoSmithKline, Inc., King of Prussia, Pennsylvania; Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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9
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Zegelbone PM, Reljic T, Wilson D, Mhaskar R, Miladinovic B, Kumar A, Djulbegovic B. Chemoprevention agents for prostate cancer. Hippokratia 2016. [DOI: 10.1002/14651858.cd012228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Phillip M Zegelbone
- University of South Florida Morsani College of Medicine - Lehigh Valley Health Network SELECT Program; Evidence Based Medicine; 12901 Bruce B. Downs Blvd, MDC54 Tampa Florida USA 33647
| | - Tea Reljic
- University of South Florida; Center for Evidence Based Medicine and Health Outcomes Research; 12901 Bruce B. Downs Blvd., MDC27 Tampa Florida USA 33612
| | - Danyell Wilson
- Bowie State University; Natural Science; Baltimore Maryland USA 220715
| | - Rahul Mhaskar
- University of South Florida; Center for Evidence Based Medicine and Health Outcomes Research; 12901 Bruce B. Downs Blvd., MDC27 Tampa Florida USA 33612
| | - Branko Miladinovic
- University of South Florida; Center for Evidence Based Medicine and Health Outcomes Research; 12901 Bruce B. Downs Blvd., MDC27 Tampa Florida USA 33612
| | - Ambuj Kumar
- University of South Florida; Center for Evidence Based Medicine and Health Outcomes Research; 12901 Bruce B. Downs Blvd., MDC27 Tampa Florida USA 33612
| | - Benjamin Djulbegovic
- Moffitt Cancer Center, Division of Oncologic Sciences, University of South Florida; Department of Blood and Marrow Transplantation; Tampa Florida USA
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10
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Maeda T, Kikuchi E, Hasegawa M, Ando T, Matsushima M, Yuge K, Ito Y, Miyajima A, Oya M. A prospective longitudinal survey of erectile function status in symptomatic benign prostatic hyperplasia patients treated with dutasteride. Aging Male 2016; 19:111-6. [PMID: 26964647 DOI: 10.3109/13685538.2016.1156082] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
We prospectively evaluated erectile function (EF) using the Sexual Health Inventory for Men (SHIM) and the erectile hardness score (EHS) as well as urinary statuses using the International Prostate Symptom Score (IPSS) and Overactive Bladder Symptom Score (OABSS) before and 3, 6, and 12 months after a daily treatment with 0.5 mg dutasteride (DUT). Significant improvements were observed in IPSS and OABSS in 98 patients with the DUT treatment, and the effects were similar between 28 patients with potency with baseline SHIM of 8 or greater and 70 severe erectile dysfunction (ED) patients at baseline. In the 28 patients with potency, significant decreases were observed in SHIM and EHS after 3, 6, and 12 months of the DUT treatment, with the severity of ED according to SHIM deteriorating in half of these patients after 12 months of the DUT treatment. Eighteen out of 28 patients (64.3%) with potency at baseline had awareness of the occurrence of ED before the DUT treatment, were younger, and had higher SHIM and EHS just before the DUT treatment than their counterparts. Regular assessments of EF may be needed, especially in younger patients and those with higher levels of EF before the administration of DUT.
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Affiliation(s)
- Takahiro Maeda
- a Department of Urology , Keio University School of Medicine , Tokyo , Japan
| | - Eiji Kikuchi
- a Department of Urology , Keio University School of Medicine , Tokyo , Japan
| | - Masanori Hasegawa
- a Department of Urology , Keio University School of Medicine , Tokyo , Japan
| | - Toshiyuki Ando
- a Department of Urology , Keio University School of Medicine , Tokyo , Japan
| | - Masashi Matsushima
- a Department of Urology , Keio University School of Medicine , Tokyo , Japan
| | - Kazuyuki Yuge
- a Department of Urology , Keio University School of Medicine , Tokyo , Japan
| | - Yujiro Ito
- a Department of Urology , Keio University School of Medicine , Tokyo , Japan
| | - Akira Miyajima
- a Department of Urology , Keio University School of Medicine , Tokyo , Japan
| | - Mototsugu Oya
- a Department of Urology , Keio University School of Medicine , Tokyo , Japan
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11
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Liu TT, Grubisha MJ, Frahm KA, Wendell SG, Liu J, Ricke WA, Auchus RJ, DeFranco DB. Opposing Effects of Cyclooxygenase-2 (COX-2) on Estrogen Receptor β (ERβ) Response to 5α-Reductase Inhibition in Prostate Epithelial Cells. J Biol Chem 2016; 291:14747-60. [PMID: 27226548 DOI: 10.1074/jbc.m115.711515] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Indexed: 11/06/2022] Open
Abstract
Current pharmacotherapies for symptomatic benign prostatic hyperplasia (BPH), an androgen receptor-driven, inflammatory disorder affecting elderly men, include 5α-reductase (5AR) inhibitors (i.e. dutasteride and finasteride) to block the conversion of testosterone to the more potent androgen receptor ligand dihydrotestosterone. Because dihydrotestosterone is the precursor for estrogen receptor β (ERβ) ligands, 5AR inhibitors could potentially limit ERβ activation, which maintains prostate tissue homeostasis. We have uncovered signaling pathways in BPH-derived prostate epithelial cells (BPH-1) that are impacted by 5AR inhibition. The induction of apoptosis and repression of the cell adhesion protein E-cadherin by the 5AR inhibitor dutasteride requires both ERβ and TGFβ. Dutasteride also induces cyclooxygenase type 2 (COX-2), which functions in a negative feedback loop in TGFβ and ERβ signaling pathways as evidenced by the potentiation of apoptosis induced by dutasteride or finasteride upon pharmacological inhibition or shRNA-mediated ablation of COX-2. Concurrently, COX-2 positively impacts ERβ action through its effect on the expression of a number of steroidogenic enzymes in the ERβ ligand metabolic pathway. Therefore, effective combination pharmacotherapies, which have included non-steroidal anti-inflammatory drugs, must take into account biochemical pathways affected by 5AR inhibition and opposing effects of COX-2 on the tissue-protective action of ERβ.
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Affiliation(s)
- Teresa T Liu
- From the Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15260
| | - Melanie J Grubisha
- From the Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15260
| | - Krystle A Frahm
- From the Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15260
| | - Stacy G Wendell
- From the Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15260
| | - Jiayan Liu
- Division of Metabolism, Endocrinology, and Diabetes, Departments of Internal Medicine and Pharmacology, University of Michigan Medical School, Ann Arbor, Michigan 48109, and
| | - William A Ricke
- Department of Urology, University of Wisconsin, Madison, Wisconsin 53705
| | - Richard J Auchus
- Division of Metabolism, Endocrinology, and Diabetes, Departments of Internal Medicine and Pharmacology, University of Michigan Medical School, Ann Arbor, Michigan 48109, and
| | - Donald B DeFranco
- From the Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15260,
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12
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Sorokin I, Schatz A, Welliver C. Placebo Medication and Sham Surgery Responses in Benign Prostatic Hyperplasia Treatments: Implications for Clinical Trials. Curr Urol Rep 2016; 16:73. [PMID: 26303775 DOI: 10.1007/s11934-015-0544-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Placebo medications and sham surgeries have long been thought to be inert treatments. These groups served as a threshold to which an active treatment should be compared in a randomized trial to determine the true efficacy of the active treatment. However, surprising changes in subjective symptom scores and objective measures of voiding have been demonstrated in numerous placebo medication or sham surgery arms of trials. The exact mechanisms by which these inactive treatments augment patient outcomes are not clearly defined and multiple theories have been proposed to explain the often pronounced response. It appears that urologic outcomes are particularly prone to these effects and the astute physician should keep these responses in mind when interpreting any trial on a new therapy.
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Affiliation(s)
- Igor Sorokin
- Division of Urology, Albany Medical College, Albany, NY, USA
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13
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Koo KC, Lee DH, Kim KH, Lee SH, Hong CH, Hong SJ, Chung BH. Unrecognized kinetics of serum testosterone: impact on short-term androgen deprivation therapy for prostate cancer. Yonsei Med J 2014; 55:570-5. [PMID: 24719121 PMCID: PMC3990065 DOI: 10.3349/ymj.2014.55.3.570] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 09/10/2013] [Accepted: 10/25/2013] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To evaluate the kinetics of serum testosterone (T) recovery following short-term androgen deprivation therapy (ADT), as the understanding thereof is essential for the proper management of prostate cancer (PCa), especially intermittent ADT. MATERIALS AND METHODS This prospective analysis included male sex offenders who voluntarily received leuprolide acetate in order to alleviate sexual aberrance. Thirty-three and 25 patients who received 3 and 6 months of ADT were assigned to Group A and Group B, respectively. Serum T levels were obtained every week during the on-cycle period, then monthly during the off-cycle period for at least 12 months. RESULTS The kinetics of serum T during the on-cycle period were similar in both groups. After flare reaction at week 2, a nadir of 0.45±0.29 ng/mL was achieved. In Group A, an abrupt rebound-upsurge was observed during the first 2 month off-cycle period, which surpassed the baseline level and reached a plateau level of 8.74±2.11 ng/mL during the flare (p<0.001). This upsurge was followed by a gradual decline back to baseline over the following 10 months. In Group B, a gradual increase was observed, and a baseline level of 7.26±1.73 ng/mL was reached at 5 months. Thereafter, an ongoing upsurge that surpassed baseline levels was observed until 12 months (8.81±1.92 ng/mL; p=0.002). CONCLUSION The kinetics of serum T recovery during the off-cycle period varied according to the duration of ADT. Serum T should be monitored beyond normalization, as an excessive rebound may improve quality-of-life, but hamper the treatment efficacy of PCa.
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Affiliation(s)
- Kyo Chul Koo
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
- Sex Offender Treatment and Rehabilitation Center, National Forensic Hospital, Gongju, Korea
| | - Dong Hoon Lee
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kyu Hyun Kim
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Hwan Lee
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Hee Hong
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Joon Hong
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Ha Chung
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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14
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Cooper LA, Page ST. Androgens and prostate disease. Asian J Androl 2014; 16:248-55. [PMID: 24407178 PMCID: PMC3955334 DOI: 10.4103/1008-682x.122361] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 07/23/2013] [Accepted: 07/23/2013] [Indexed: 11/04/2022] Open
Abstract
A growing body of literature has established the anabolic benefi ts of testosterone (T) therapy in hypogonadal men. However, there remains a paucity of data regarding the risks of exogenous androgen use in older men and the potential for adverse effects on the prostate gland. Whether T therapy in older, hypogonadal men might worsen lower urinary tract symptoms or exacerbate, unmask, or even incite prostate cancer development has tempered enthusiasm for T therapy, while known prostatic disease has served as a relative contraindication to T therapy. Androgens are necessary for the development and maintenance of the prostate gland. However, epidemiologic studies do not consistently fi nd a positive relationship between endogenous serum androgen concentrations and the risk of prostate disease. Recent data demonstrate that 5α-reductase inhibitors decrease the risk of low-grade prostate cancer, suggesting that modifying androgen metabolism may have beneficial effects on prostate health, yet similar reductions in high-grade disease have not been observed, thereby questioning the true clinical benefits of these agents for chemoprevention. Knowing how to best investigate the relationship between androgens and the development of prostate disease given the lack of large, randomized trials is difficult. Accumulating data challenges the assumption that alterations in serum androgens have parallel effects within the prostate hormonal environment or change androgen-regulated processes within the gland. Long-term intervention studies are needed to truly ascertain the effects of androgen manipulation on prostate tissue and disease risk. However, available data do not support the notion that restoring serum androgens to normal physiologic ranges drives prostate disease.
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Affiliation(s)
- Lori A Cooper
- Department of Medicine, Division of Endocrinology and Metabolism, University of Washington, Seattle, USA
| | - Stephanie T Page
- Department of Medicine, Division of Endocrinology and Metabolism, University of Washington, Seattle, USA
- University of Washington and Harborview Medical Center, Seattle, Washington, USA
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15
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Shigehara K, Koh E, Sakamoto J, Yaegashi H, Izumi K, Ueno S, Kitagawa Y, Maeda Y, Kadono Y, Konaka H, Mizokami A, Nakashima T, Namiki M. Effects of dutasteride on lower urinary tract symptoms and general health in men with benign prostatic hypertroplasia and hypogonadism: a prospective study. Aging Male 2014; 17:51-6. [PMID: 24134649 DOI: 10.3109/13685538.2013.845744] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION We investigated the effects of the relative increase in testosterone by dutasteride administration in patients with benign prostatic hyperplasia and hypogonadism on urinary symptoms or androgen-responsive general health. METHODS Seventy-six patients were enrolled, and were taking 0.5 mg dutasteride daily for 52 weeks. Before and after treatment, all participants underwent blood test, and body mass index, prostate volume (PV), bone mineral density (BMD), post-voiding residual (PVR) volume, and muscle volume were measured. All patients responded to the questionnaires: International prostatic symptom score (IPSS), Overactive Bladder Symptom score (OABSS). Patients were divided into two groups according to the increase rate of total testosterone (TT): group A, ≥20% increase in TT level; group B, <20% increase or decrease. RESULTS Baseline TT and free testosterone (FT) levels were significantly lower in group A than group B. Both groups showed marked improvement in PV and PVR. Group A showed significant improvement in IPSS and OABSS with a significant increase of FT level, whereas group B showed no significant change. Dutasteride treatment contributed to a significant increase in BMD in group A. CONCLUSIONS Dutasteride treatment significantly improved urinary symptoms and BMD in patients with low baseline serum TT and FT levels.
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Affiliation(s)
- Kazuyoshi Shigehara
- Department of Urology, Ishikawa Prefectural Central Hospital , Kanazawa City , Japan and
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16
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Kacker R, Harisaran V, Given L, Miner M, Rittmaster R, Morgentaler A. Dutasteride in men receiving testosterone therapy: a randomised, double-blind study. Andrologia 2014; 47:148-52. [DOI: 10.1111/and.12237] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2013] [Indexed: 11/30/2022] Open
Affiliation(s)
- R. Kacker
- Men's Health Boston; Brookline MA USA
| | - V. Harisaran
- Departments of Family Medicine and Urology; Miriam Hospital; Providence RI USA
| | - L. Given
- Departments of Family Medicine and Urology; Miriam Hospital; Providence RI USA
| | - M. Miner
- Departments of Family Medicine and Urology; Miriam Hospital; Providence RI USA
| | - R. Rittmaster
- GlaxoSmithKline (retired); Research Triangle Park NC USA
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Wu XJ, Zhi Y, Zheng J, He P, Zhou XZ, Li WB, Zhou ZS. Dutasteride on benign prostatic hyperplasia: a meta-analysis on randomized clinical trials in 6460 patients. Urology 2013; 83:539-43. [PMID: 24246318 DOI: 10.1016/j.urology.2013.10.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Revised: 10/03/2013] [Accepted: 10/13/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the clinical effectiveness of dutasteride in the treatment of benign prostatic hyperplasia by meta-analysis. MATERIALS AND METHODS Several databases were searched from inception to June 2013 for prospective clinical studies comparing dutasteride vs placebo. The continuous outcomes of therapeutic efficacy included International Prostate Symptom Score/American Urological Association Symptom Index, maximum flow rate, total prostate volume, and acute urinary retention (AUR). The dichotomous outcomes included surgery risk and the rate of sexual dysfunction. The relative risk for dichotomous outcome and the weighted mean difference for continuous outcomes were estimated using fixed effects model. RESULTS Four studies met the inclusion criteria and were included, in which a total of 6460 patients received dutasteride and 6475 received placebo treatment. The average symptom score was improved by 1.98 with 95% confidence interval (CI) 1.77-2.19 (P <.00001); the average maximum flow rate was increased by 1.16 mL/s with 95% CI 0.63-1.70 (P <.0001); the total prostate volume was reduced by 13.86 mL (95% CI 12.76-14.96; P <.00001); the odds ratio for AUR was 0.35 (95% CI 0.27-0.47; P <.00001). The major side effect for dutasteride was the increased rate of sexual dysfunction compared with placebo, with odds ratio of 0.41 (95% CI 0.31-0.54; P <.00001). CONCLUSION Dutasteride is highly effective in mitigating benign prostatic hyperplasia symptoms and reducing the size of enlarged prostate and the risks of AUR and surgical intervention. However, dutasteride therapy is related to an increased rate of sexual dysfunction.
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Affiliation(s)
- Xiao-Jun Wu
- Institute of Urinary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Yi Zhi
- Institute of Urinary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Ji Zheng
- Institute of Urinary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Peng He
- Institute of Urinary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Xiao-zhou Zhou
- Institute of Urinary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Wei-bing Li
- Institute of Urinary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Zhan-song Zhou
- Institute of Urinary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China.
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18
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The effects of chlormadinone acetate on lower urinary tract symptoms and erectile functions of patients with benign prostatic hyperplasia: a prospective multicenter clinical study. Adv Urol 2013; 2013:584678. [PMID: 23762042 PMCID: PMC3671298 DOI: 10.1155/2013/584678] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 04/20/2013] [Indexed: 11/23/2022] Open
Abstract
Purpose. To evaluate the effects of chlormadinone acetate (CMA), progesterone-derived antiandrogen, on lower urinary tract symptoms (LUTS) and erectile functions of benign prostatic hyperplasia (BPH). Methods. A multicenter, single-cohort prospective study was conducted. A total of 114 patients received CMA for 16 weeks. The endpoints were changes in International Prostate Symptom Scores (IPSS), IPSS-QOL, International Index of Erectile Function-5, Qmax prostate volume, and residual urine volume. Results. Significant improvements were observed in IPSS from week 8 to week 48 (32 weeks after treatment). IPSS-QOL improvements were also significant from week 8 to week 48. Qmax increased to a maximum at Week 16 and remained elevated throughout the study. Moreover, a decrease of 25% in prostate volume was observed at Week 16. IPSS, QOL, and Qmax changes during the study were not different between the previously treated and untreated patients. IPSS storage subscore changes differed between the age groups. Few severe adverse reactions were observed, except for erectile dysfunction. Conclusions. CMA rapidly and significantly reduced prostate volume and improved voiding and storage symptoms and QOL. Our results suggest that CMA is safe and beneficial, especially for elderly patients with LUTS associated with BPH.
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19
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Editorial Comment. Urology 2013; 81:984; discussion 984-5. [DOI: 10.1016/j.urology.2012.10.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Toren P, Margel D, Kulkarni G, Finelli A, Zlotta A, Fleshner N. Effect of dutasteride on clinical progression of benign prostatic hyperplasia in asymptomatic men with enlarged prostate: a post hoc analysis of the REDUCE study. BMJ 2013; 346:f2109. [PMID: 23587564 PMCID: PMC3626257 DOI: 10.1136/bmj.f2109] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the role of dutasteride in preventing clinical progression of benign prostatic hyperplasia in asymptomatic men with larger prostates. DESIGN Post hoc analysis of four year, double blind Reduction by Dutasteride of Prostate Cancer Events (REDUCE) study PARTICIPANTS 1617 men randomised to dutasteride or placebo with a prostate size >40 mL and baseline International Prostate Symptom Score (IPSS) <8. Subjects who took medications for benign prostatic hyperplasia were excluded at study entry. INTERVENTIONS Placebo or dutasteride 0.5 mg daily. MAIN OUTCOME MEASURES Comparison of risk of clinical progression of benign prostatic hyperplasia at four years (defined as a ≥ 4 point worsening on IPSS, acute urinary retention, urinary tract infection, or surgery related to benign prostatic hyperplasia). RESULTS 825 participants took placebo, 792 took dutasteride. A total of 464 (29%) experienced clinical progression benign prostatic hyperplasia, 297(36%) taking placebo, 167 (21%) taking dutasteride (P<0.001). The relative risk reduction was 41% and the absolute risk reduction 15%, with a number needed to treat (NNT) of 7. Among men who had acute urinary retention and surgery related to benign prostatic hyperplasia, the absolute risk reduction for dutasteride was 6.0% and 3.8%, respectively. On multivariable regression analysis adjusting for covariates, dutasteride significantly reduced clinical progression of benign prostatic hyperplasia with an odds ratio of 0.47 (95% CI 0.37 to 0.59, P<0.001). Analysis of time to first event yielded a hazard ratio of 0.673 (P<0.001) for those taking dutasteride. Sexual adverse events were most common and similar to prior reports. LIMITATIONS Further prospective studies may be warranted to demonstrate generalisability of these results. CONCLUSIONS This study is the first to explore the benefit of treating asymptomatic or mildly symptomatic men with an enlarged prostate. Dutasteride significantly decreased the incidence of benign prostatic hyperplasia clinical progression.
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Affiliation(s)
- Paul Toren
- Division of Urology, Department of Surgery, University of Toronto, University Health Network, 610 University Avenue, 3-130, Toronto, Ontario, Canada M5G 2M9
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Sánchez P, Torres JM, Castro B, Olmo A, del Moral RG, Ortega E. Expression of steroid 5α-reductase isozymes in prostate of adult rats after environmental stress. FEBS J 2012; 280:93-101. [DOI: 10.1111/febs.12052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Revised: 09/13/2012] [Accepted: 10/15/2012] [Indexed: 12/01/2022]
Affiliation(s)
- Pilar Sánchez
- Department of Biochemistry and Molecular Biology, Faculty of Medicine; University of Granada; Spain
| | | | - Beatriz Castro
- Department of Biochemistry and Molecular Biology, Faculty of Medicine; University of Granada; Spain
| | - Asunción Olmo
- Department of Pathology; San Cecilio University Hospital and School of Medicine, University of Granada; Spain
| | - Raimundo G. del Moral
- Department of Pathology; San Cecilio University Hospital and School of Medicine, University of Granada; Spain
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Liang JA, Sun LM, Lin MC, Chang SN, Sung FC, Muo CH, Kao CH. A population-based nested case-control study in taiwan: use of 5α-reductase inhibitors did not decrease prostate cancer risk in patients with benign prostate hyperplasia. Oncologist 2012; 17:986-91. [PMID: 22723508 DOI: 10.1634/theoncologist.2011-0464] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND 5α-Reductase inhibitors (5ARIs) are commonly used to treat benign prostate hyperplasia (BPH) by blocking the conversion of testosterone into the more potent dihydrotestosterone. This study explored a possible association between the use of the 5ARIs finasteride and dutasteride and the subsequent risk of prostate cancer or other cancers. METHODS We analyzed data from the Taiwanese National Health Insurance system. In a BPH cohort, we identified 1,489 patients with cancer and included them in our study group. For the control group, 3 patients without cancer were frequency matched with each BPH case for age, BPH diagnosis year, index year, and month. Information regarding past 5ARI use was obtained from the Taiwanese National Health Insurance Research Database (NHIRD). Multivariate logistic regression analysis was conducted, and odds ratio (OR) and 95% confidence interval (CI) were estimated. RESULTS Finasteride use marginally increased the incidence of prostate and overall cancer at a level of statistical significance (prostate cancer: OR = 1.90; 95% CI: 1.00-3.59; overall cancer: OR = 1.51; 95% CI: 1.00-2.28). Dutasteride use significantly increased kidney cancer risk (OR = 9.68, 95% CI: 1.17-80.0). Dosage analysis showed that lower doses of finasteride were associated with higher overall and prostate cancer risks. The major limitation is the lack of important data in the NHIRD, such as prostate cancer histologic grades, smoking habits, alcohol consumption, body mass index, socioeconomic status, and family history of cancer. CONCLUSIONS This population-based nested case-control study suggested that finasteride use may increase prostate and overall cancer risks for patients with BPH. The effects were more prominent for patients using lower doses of finasteride.
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Affiliation(s)
- Ji-An Liang
- Institute of Clinical Medicine Science, China Medical University, Taichung, Taiwan
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[Primary and secondary prevention of benign prostatic hyperplasia: current knowledge and implications for clinical management]. Urologe A 2011; 50:1257-8, 1260-4. [PMID: 21901570 DOI: 10.1007/s00120-011-2618-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Histological benign prostatic hyperplasia (BPH) and the BPH disease are frequent, lead to a reduction of quality of life, are both progressive and potentially associated with complications in the lower and upper urinary tract. A PubMed/MEDLINE search was conducted for the years 1990 to 2011. This article summarizes known selective measures of primary and secondary disease prevention.Measures of primary disease prevention aim to inhibit histological BPH and the development of clinically relevant BPH. Weight loss, regular physical activity, vegetable consumption, alcohol intake, 5α-reductase inhibitors, avoidance of overweight and reduction of fatty food can reduce the probability of histological and clinical BPH. Selective measures of secondary prevention aim to inhibit disease progression and BPH-associated complications. The regular and long-term use of α1-blockers reduces lower urinary tract symptoms (LUTS) and inhibits symptomatic disease progression but cannot prevent BPH-associated complications (e.g. urinary retention or need for prostate surgery). 5α-Reductase inhibitors can reduce the probability of symptomatic disease progression, urinary retention or need for surgery but the combination of α1-blocker and 5α-reductase inhibitor is more efficacious than either monotherapy. Especially older men with enlarged prostates (>40 cm(3)) and elevated serum PSA concentration (>1.6 µg/l) profit from measures of secondary disease prevention.For primary disease prevention, data quality is low and early treatment with 5α-reductase inhibitors is not been approved. For secondary disease prevention, men with risk factors of disease progression should use a treatment containing 5α-reductase inhibitors. Despite several epidemiological and clinical investigations on BPH disease progression no official programme exists in Germany for disease prevention.
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