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Niazi T, Kaldany E, Tisseverasinghe S, Malagón T, Bahoric B, McPherson V, Rompre-Brodeur A, Anidjar M. Prophylactic A-Blockers for Radiotherapy-Induced Lower Urinary Tract Symptoms in Men with Prostate Cancer: A Phase III Randomized Trial. Cancers (Basel) 2023; 15:3444. [PMID: 37444553 DOI: 10.3390/cancers15133444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/15/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
PURPOSE The present phase III randomized trial assessed the efficacy of prophylactic versus therapeutic α-blockers at improving RI-LUTSs in prostate cancer patients receiving external beam radiotherapy (EBRT). METHODS A total of 148 prostate cancer patients were randomized 1:1 to receive either prophylactic silodosin on day one of EBRT or the occurrence of RI-LUTSs. LUTSs were quantified using the international prostate symptom score (IPSS) at regular intervals during the study. The primary endpoint was the change in the IPSS from baseline to the last day of radiotherapy (RT). Secondary endpoints included changes in IPSS from baseline to 4 weeks and 12 weeks after the start of RT. RESULTS Patient demographics, baseline IPSS, and prescribed radiation doses were balanced between arms. On the last day of RT, the mean IPSS was 14.8 (SD 7.6) in the experimental arm and 15.7 (SD 8.5) in the control arm (p = 0.40). There were no significant differences in IPSSs between the study arms in the intention-to-treat (ITT) analysis at baseline, the last day of RT, and 4 and 12 weeks post-RT. CONCLUSION Prophylactic α-blockers were not effective at significantly reducing RI-LUTSs in prostate cancer patients treated with EBRT. Treating patients with α-blockers at the onset of RI-LUTSs will avoid unnecessary drug exposure and toxicity.
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Affiliation(s)
- Tamim Niazi
- Division of Radiation Oncology, Department of Oncology, McGill University, Montreal, QC H3A 0G4, Canada
| | - Edmond Kaldany
- Division of Radiation Oncology, Department of Oncology, McGill University, Montreal, QC H3A 0G4, Canada
| | - Steven Tisseverasinghe
- Division of Radiation Oncology, Department of Oncology, McGill University, Gatineau, QC J8V 3R2, Canada
| | - Talía Malagón
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, QC H3A 0G4, Canada
| | - Boris Bahoric
- Division of Radiation Oncology, Department of Oncology, McGill University, Montreal, QC H3A 0G4, Canada
| | - Victor McPherson
- Division of Urology, Department of Surgery, McGill University, Montreal, QC H3A 0G4, Canada
| | - Alexis Rompre-Brodeur
- Division of Urology, Department of Surgery, McGill University, Montreal, QC H3A 0G4, Canada
| | - Maurice Anidjar
- Division of Urology, Department of Surgery, McGill University, Montreal, QC H3A 0G4, Canada
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Hashimoto M, Shimizu N, Fujimoto S, Kuwahara K, Nishimoto M, Adomi S, Banno E, Minami T, Fujita K, Yoshimura K, Hirayama A, Uemura H. The pressure flow study investigation of pathophysiology of post-micturition dribble in male patients. Int Urol Nephrol 2023; 55:69-74. [PMID: 36125621 DOI: 10.1007/s11255-022-03367-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/16/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE In this study, we aimed to elucidate the pathophysiology of post-micturition dribble (PMD) through analyzing several variables including pressure flow study (PFS) findings and symptoms questionnaire. METHODS We retrospectively analyzed male patients who visited our department between 2010 and 2020. We used modified international prostate symptom score (m-IPSS), which consists of eight sub-score related to lower urinary tract symptoms (Incomplete Emptying, Frequency, Intermittency, Urgency, Weak Stream, Straining, Nocturia, and PMD) and one question related to quality of life (QOL). Multivariate regression analysis was conducted to evaluate the relationship between PMD and the variables, including age, prostate volume (PV), body mass index, bladder outlet obstruction index (BOOI), bladder contractility index, and bladder voiding efficiency, which were obtained by PFS. RESULTS A total of 143 male patients were analyzed. The patients with PMD showed significantly larger PV and higher BOOI, and worse IPSS total and QOL score than those without PMD. Multivariate regression analysis showed that large PV and BOOI were significantly associated with PMD. In Spearman's correlation analysis, PMD and each m-IPSS sub-score except nocturia had significant positive correlation. Furthermore, Spearman's correlation analysis showed that PMD and QOL had significant strong positive correlation. CONCLUSION PMD was significantly associated with large PV and BOO evaluated by PFS. Furthermore, PMD significantly exacerbated QOL. The severity of PMD and the other m-IPSS sub-score except nocturia could have intercorrelation with each other.
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Affiliation(s)
- Mamoru Hashimoto
- Department of Urology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Nobutaka Shimizu
- Department of Pelvic Floor Center, Kochi Medical School, Kochi University, Nankoku, Kochi, 783-8505, Japan.
| | - Saizo Fujimoto
- Department of Urology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Ken Kuwahara
- Department of Urology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Mitsuhisa Nishimoto
- Department of Urology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Shogo Adomi
- Department of Urology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Eri Banno
- Department of Urology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Takafumi Minami
- Department of Urology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Kazutoshi Fujita
- Department of Urology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Kazuhiro Yoshimura
- Department of Urology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Akihide Hirayama
- Department of Urology, Nara Hospital Kindai University Faculty of Medicine, Ikoma, Nara, Japan
| | - Hirotsugu Uemura
- Department of Urology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
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Tanuma Y, Tanaka Y, Okamoto T. Cutoff level of prostate volume to predict the efficacy of α1-D/A adrenoceptor antagonist, naftopidil. Urol Ann 2021; 13:296-300. [PMID: 34421268 PMCID: PMC8343274 DOI: 10.4103/ua.ua_93_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/25/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction: In lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) patients, prostate volume (PV) at baseline affects the improvement of International Prostate Symptom Score voiding symptoms (IPSS-VS) by naftopidil (NAF), but not total IPSS (IPSS-TS). To predict the efficacy of NAF, the PV cutoff point was examined using IPSS-VS. Materials and Methods: Seventy-seven patients with LUTS/BPH were administrated with NAF 50 mg/day for 4 weeks. Age, PV, IPSS, IPSS quality-of-life (IPSS-QoL), and maximum flow rate (MFR) were evaluated at baseline, and IPSS, IPSS-QoL, and MFR were evaluated after the treatment (at 4 weeks). Responders and nonresponders were divided by IPSS-VS at 4 weeks, and the PV cutoff point was calculated. Results: At baseline, the mean age and PV were 70.7 ± 8.2 years (range, 54–88 years) and 43.3 ± 24.5 mL (range, 20.6–141.7 mL), respectively. After 4 weeks, area under the receiver operating characteristic curve was largest in the patients with <4 points of IPSS-VS. The best standard value to evaluate the efficacy IPSS-VS at 4 weeks was 4 points for the NAF treatment, and the best PV cutoff point was 37.3 mL (sensitivity 60.5%, specificity 71.9%). Conclusions: PV at baseline was one of the predictive factors which affected the efficacy of NAF for IPSS-VS, and LUTS/BPH patients who had PV more than 37.3 mL indicated poor improvement of IPSS-VS, even if IPSS-TS was improved.
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Affiliation(s)
- Yasushi Tanuma
- Department of Urology, Hokkaido Social Welfare Association Hakodate Hospital, Hokkaido, Japan
| | - Yoshinori Tanaka
- Department of Urology, Hokkaido Prefectural Esashi Hospital, Hokkaido, Japan
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Yu ZJ, Yan HL, Xu FH, Chao HC, Deng LH, Xu XD, Huang JB, Zeng T. Efficacy and Side Effects of Drugs Commonly Used for the Treatment of Lower Urinary Tract Symptoms Associated With Benign Prostatic Hyperplasia. Front Pharmacol 2020; 11:658. [PMID: 32457631 PMCID: PMC7225336 DOI: 10.3389/fphar.2020.00658] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/22/2020] [Indexed: 12/11/2022] Open
Abstract
Benign prostatic hyperplasia (BPH) is the most common benign disease of the prostate gland and is caused by benign hyperplasia of the smooth muscle cells and stromal cells in this important gland. BPH is also the most common disease underlying lower urinary tract symptoms (LUTS). The incidence of BPH increases with age and affects more than half of all men 50 years or older. BPH mainly exerts effects on urinary function and can seriously reduce a patient's quality of life. At present, treatment for BPH aims primarily to improve the quality of life and reduce the risk of BPH-related complications. Pharmacological therapy is recommended for moderate-to-severe cases of LUTS that are suggestive of BPH. A range of drugs is currently available to treat this condition, including α1-adrenoceptor antagonists, 5α-reductase inhibitors (5-ARIs), phosphodiesterase type 5 inhibitors (PDE5Is), muscarinic receptor antagonists (MRAs), β3-adrenoceptor agonists, and plant extracts. Of these, the most commonly used drugs in the clinic are α1-adrenoceptor antagonists, 5-ARIs, and combination therapy. However, these drugs exert their effects via various mechanisms and are associated with adverse reactions. The purpose of this review is to provide current comprehensive perspectives on the mechanisms of action, efficacy, and adverse reactions associated with the drugs most commonly used for the treatment of BPH.
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Affiliation(s)
- Zhao-Jun Yu
- Department of Urology, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Medical Department of Graduate School, Nanchang University, Nanchang, China
| | - Hai-Lan Yan
- Department of Clinical Medicine, Xi'an Jiao Tong University Health Science Center, Xi'an, China
| | - Fang-Hua Xu
- Department of Pathology, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Hai-Chao Chao
- Institute of Clinical Medicine, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Lei-Hong Deng
- Department of Ultrasound, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiang-Da Xu
- Medical Department of Graduate School, Nanchang University, Nanchang, China
| | - Jian-Biao Huang
- Medical Department of Graduate School, Nanchang University, Nanchang, China
| | - Tao Zeng
- Department of Urology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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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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