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Asanad K, Sholklapper T, Samplaski MK, Cacciamani GE. Global online interest in finasteride sexual side effects. Int J Impot Res 2024; 36:408-413. [PMID: 36100687 DOI: 10.1038/s41443-022-00612-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/22/2022] [Accepted: 08/26/2022] [Indexed: 11/09/2022]
Abstract
Prior literature has suggested that finasteride may negatively impact men's sexual health. In 2011, the Food and Drug Administration (FDA) provided a warning on finasteride drug labels to incorporate sexual side effects such as reduced libido and erectile dysfunction. We aimed to evaluate global online interest in finasteride sexual side effects, their penetrance and variation, and how they compared overtime. We also aimed to evaluate the influence of the FDA label warnings on web-based searches for finasteride side effects. We utilized Google search engine from January 2004 to December 2020 to include separate trends from web searches of "Propecia," "Propecia side effects," "finasteride", "finasteride side effects", and "post-finasteride syndrome" compared amongst the United States, United Kingdom, and Australia. We performed join-point regression analysis. We compared the annual relative search volume (ARSV) and annual percentage change (APC) to evaluate for loss or gain of interest in the respective key terms. We determined that the average ARSV for "finasteride" was 14.8% in 2004 and increased significantly to 57.3% in 2020 (APC: +9.25%, 95% CI 8 to 10.5, p < 0.001). Likewise, there was significant increased interest in "finasteride side effects" (APC: +20.7, p < 0.001) and "post-finasteride syndrome" (APC: +29.2; p < 0.001) in the United States overtime. Finally, when we compared trends before and after the FDA warnings, the average ASRV of "finasteride", "finasteride side effects", and "post-finasteride syndrome" all increased significantly (p = 0.001, p = 0.014, p < 0.001), respectively. Thus, it is evident that there is a global web-based interest in finasteride and its sexual health side effects, particularly after the FDA warning in 2011. There is boosted public awareness, and thus providers should have more detailed and careful conversations with patients prior to starting a 5α-reductase inhibitor such as finasteride.
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Affiliation(s)
- Kian Asanad
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Tamir Sholklapper
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mary K Samplaski
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Giovanni E Cacciamani
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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Yoosuf BT, Panda AK, Kt MF, Bharti SK, Devana SK, Bansal D. Comparative efficacy and safety of alpha-blockers as monotherapy for benign prostatic hyperplasia: a systematic review and network meta-analysis. Sci Rep 2024; 14:11116. [PMID: 38750153 PMCID: PMC11096304 DOI: 10.1038/s41598-024-61977-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/13/2024] [Indexed: 05/18/2024] Open
Abstract
Despite the availability of various drugs for benign prostatic hyperplasia (BPH), alpha(α)-blockers are the preferred first-line treatment. However, there remains a scarcity of direct comparisons among various α-blockers. Therefore, this network meta-analysis (NMA) of randomized controlled trials (RCTs) aimed to evaluate the efficacy and safety of α-blockers in the management of BPH. A comprehensive electronic search covered PubMed, Embase, Ovid MEDLINE, and Cochrane Library until August 2023. The primary endpoints comprised international prostate symptom score (IPSS), maximum flow rate (Qmax), quality of life (QoL), and post-void residual volume (PVR), while treatment-emergent adverse events (TEAEs) were considered as secondary endpoints. This NMA synthesized evidence from 22 studies covering 3371 patients with six kinds of α-blockers with 12 dose categories. IPSS has been considerably improved by tamsulosin 0.4 mg, naftopidil 50 mg and silodosin 8 mg as compared to the placebo. Based on the p-score, tamsulosin 0.4 mg had the highest probability of ranking for IPSS, PVR, and Qmax, whereas doxazosin 8 mg had the highest probability of improving QoL. A total of 297 adverse events were reported among all the α-blockers, silodosin has reported a notable number of TEAEs. Current evidence supports α-blockers are effective in IPSS reduction and are considered safer. Larger sample size with long-term studies are needed to refine estimates of IPSS, QoL, PVR, and Qmax outcomes in α-blocker users.
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Affiliation(s)
- Beema T Yoosuf
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), S.A.S. Nagar, Mohali, Punjab, India
| | - Abhilash Kumar Panda
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), S.A.S. Nagar, Mohali, Punjab, India
| | - Muhammed Favas Kt
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), S.A.S. Nagar, Mohali, Punjab, India
| | - Saroj Kundan Bharti
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), S.A.S. Nagar, Mohali, Punjab, India
| | - Sudheer Kumar Devana
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Dipika Bansal
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), S.A.S. Nagar, Mohali, Punjab, India.
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Buț MG, Jîtcă G, Imre S, Vari CE, Ősz BE, Jîtcă CM, Tero-Vescan A. The Lack of Standardization and Pharmacological Effect Limits the Potential Clinical Usefulness of Phytosterols in Benign Prostatic Hyperplasia. PLANTS (BASEL, SWITZERLAND) 2023; 12:1722. [PMID: 37111945 PMCID: PMC10142909 DOI: 10.3390/plants12081722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 06/19/2023]
Abstract
The prevalence of benign prostatic hyperplasia (BPH) markedly increases with age. Phytotherapeutic approaches have been developed over time owing to the adverse side effects of conventional medications such as 5-reductase inhibitors and α1-adrenergic receptor antagonists. Therefore, dietary supplements (DS) containing active compounds that benefit BPH are widely available. Phytosterols (PSs) are well recognized for their role in maintaining blood cholesterol levels; however, their potential in BPH treatment remains unexplored. This review aims to provide a general overview of the available data regarding the clinical evidence and a good understanding of the detailed pharmacological roles of PSs-induced activities at a molecular level in BPH. Furthermore, we will explore the authenticity of PSs content in DS used by patients with BPH compared to the current legislation and appropriate analytical methods for tracking DS containing PSs. The results showed that PSs might be a useful pharmacological treatment option for men with mild to moderate BPH, but the lack of standardized extracts linked with the regulation of DS containing PSs and experimental evidence to elucidate the mechanisms of action limit the use of PSs in BPH. Moreover, the results suggest multiple research directions in this field.
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Affiliation(s)
- Mădălina-Georgiana Buț
- Doctoral School of Medicine and Pharmacy, I.O.S.U.D, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mures, 540139 Târgu Mures, Romania; (M.-G.B.); (C.-M.J.)
- Department of Biochemistry, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mures, 540139 Târgu Mures, Romania;
| | - George Jîtcă
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mures, 540139 Târgu Mures, Romania; (C.E.V.); (B.E.Ő.)
| | - Silvia Imre
- Department of Analytical Chemistry and Drug Analysis, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mures, 540139 Târgu Mures, Romania;
| | - Camil Eugen Vari
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mures, 540139 Târgu Mures, Romania; (C.E.V.); (B.E.Ő.)
| | - Bianca Eugenia Ősz
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mures, 540139 Târgu Mures, Romania; (C.E.V.); (B.E.Ő.)
| | - Carmen-Maria Jîtcă
- Doctoral School of Medicine and Pharmacy, I.O.S.U.D, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mures, 540139 Târgu Mures, Romania; (M.-G.B.); (C.-M.J.)
| | - Amelia Tero-Vescan
- Department of Biochemistry, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mures, 540139 Târgu Mures, Romania;
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Laanani M, Weill A, Jollant F, Zureik M, Dray-Spira R. Suicidal risk associated with finasteride versus dutasteride among men treated for benign prostatic hyperplasia: nationwide cohort study. Sci Rep 2023; 13:5308. [PMID: 37002313 PMCID: PMC10066399 DOI: 10.1038/s41598-023-32356-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 03/26/2023] [Indexed: 04/03/2023] Open
Abstract
Finasteride, a 5α-reductase inhibitor used in benign prostatic hyperplasia and androgenetic alopecia, has been associated with an increased suicidal risk, whereas it is unclear whether such risk is similar to that for another 5α-reductase inhibitor, dutasteride. We aimed to assess the risk of suicidal behaviours with finasteride relative to dutasteride. A nationwide cohort study was conducted using the French National Health Data System (SNDS). Men aged 50 years or older initiating finasteride 5 mg or dutasteride 0.5 mg in France between 01-01-2012 and 30-06-2016 were included and followed until outcome (suicide death identified from death certificate or self-harm hospitalisation), treatment discontinuation or switch, death, or 31-12-2016. Self-harm by violent means or resulting in admission to an intensive care unit were also examined. Cox proportional hazards models controlled for age and psychiatric and non-psychiatric conditions by inverse probability of treatment weighting (IPTW). Analyses were stratified according to psychiatric history. The study compared 69,786 finasteride new users to 217,577 dutasteride new users (median age: 72.0 years [Q1-Q3 = 64.5-80.2] vs. 71.1 [Q1-Q3 = 65.0-79.2]). During follow-up, 18 suicide deaths (0.57/1000 person-years) and 34 self-harm hospitalisations (1.08/1000) occurred among finasteride users versus 47 deaths (0.43/1000) and 87 hospitalisations (0.79/1000) among dutasteride users. Overall, finasteride was not associated with an increased risk of any suicidal outcome (IPTW-adjusted Hazard Ratio = 1.21 [95% Confidence Interval .87-1.67]), suicide death or self-harm hospitalisation. However, among individuals with a history of mood disorders, finasteride was associated with an increased risk of any suicidal outcome (25 versus 46 events; HR = 1.64 [95% CI 1.00-2.68]), suicide death (8 versus 10 events; HR = 2.71 [95% CI 1.07-6.91]), self-harm by violent means (6 versus 6 events; HR = 3.11 [95% CI 1.01-9.61]), and self-harm with admission to an intensive care unit (7 versus 5 events; HR = 3.97 [95% CI 1.26-12.5]). None of these risks was significantly increased among individuals without a psychiatric history. These findings do not support an increased risk of suicide with finasteride used in the treatment of benign prostatic hyperplasia. However, an increased risk cannot be excluded among men with a history of mood disorder, but this result based on a limited number of events should be interpreted with caution.
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Affiliation(s)
- Moussa Laanani
- Epiphare (French National Medicines Agency ANSM and French National Health Insurance CNAM), Saint-Denis, France.
- French National Health Insurance (CNAM), Paris, France.
| | - Alain Weill
- Epiphare (French National Medicines Agency ANSM and French National Health Insurance CNAM), Saint-Denis, France
| | - Fabrice Jollant
- Université Paris-Saclay & CHU Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
- Nîmes University Hospital (CHU), Nîmes, France
- Department of psychiatry, McGill Group for Suicide Studies, McGill University, Montréal, Canada
- Moods Team, INSERM UMR-1018, CESP, Le Kremlin-Bicêtre, France
| | - Mahmoud Zureik
- Epiphare (French National Medicines Agency ANSM and French National Health Insurance CNAM), Saint-Denis, France
| | - Rosemary Dray-Spira
- Epiphare (French National Medicines Agency ANSM and French National Health Insurance CNAM), Saint-Denis, France
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Pandolfo SD, Crauso F, Aveta A, Cilio S, Barone B, Napolitano L, Scarpato A, Mirto BF, Serino F, Del Giudice F, Chung BI, Crocerossa F, Di Zazzo E, Trama F, Vaglio R, Wu Z, Verze P, Imbimbo C, Crocetto F. A Novel Low-Cost Uroflowmetry for Patient Telemonitoring. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3287. [PMID: 36833979 PMCID: PMC9960409 DOI: 10.3390/ijerph20043287] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/12/2023] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
Uroflowmetry (UF) is a crucial guideline-recommended tool for men with benign prostatic obstruction (BPO). Moreover, UF is a helpful decision-making tool for the management of patients with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH). In the last few years, telemedicine and telehealth have increased exponentially as cost-effective treatment options for both patients and physicians. Telemedicine and telehealth have been well positioned during the COVID-19 pandemic to prevent healthcare system overload and to ensure adequate management of patients through screening, diagnosis, and follow-up at home. In the present manuscript, the main characteristics and performance of a novel and low-cost device for home-based UF have been analyzed. The simple weight-transducer method has been applied to perform UF. An inexpensive load cell connected to a 24 bit analogic digital converter (ADC) sends data to a cloud server via SIM card or home Wi-Fi. Data are processed and shown in graphics with both volume and flow rate as a function of time, allowing for measurement of average flow rate, maximum flow rate, voided volume, and voiding time. A numerical algorithm allows for filtering of the dynamic effect due to the urine gravity acceleration and for removing the funnel to simplify the home measurement procedure. Through an online platform, the physician can see and compare each UF data. The device's reliability has been validated in a first laboratory setting and showed excellent performance. This approach based on domiciliary tests and an online platform can revolutionize the urologic clinic landscape by offering a constant patient cost-effective follow-up, eliminating the time wasted waiting in the office setting.
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Affiliation(s)
- Savio Domenico Pandolfo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
- Division of Urology, Virginia Commonwealth University (VCU) Health, Richmond, VA 23298, USA
| | - Federica Crauso
- Department of Public Health, University of Naples “Federico II”, 80125 Naples, Italy
| | - Achille Aveta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Simone Cilio
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Biagio Barone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Luigi Napolitano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Antonio Scarpato
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Benito Fabio Mirto
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | | | - Francesco Del Giudice
- Department of Maternal-Infant and Urologic Sciences, “Sapienza” University of Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy
- Department of Urology, Stanford Medical Center, Stanford, CA 94305, USA
| | - Benjamin I. Chung
- Department of Urology, Stanford Medical Center, Stanford, CA 94305, USA
| | - Fabio Crocerossa
- Urology Unit, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Erika Di Zazzo
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Francesco Trama
- Andrological and Urogynecological Clinic, Santa Maria Terni Hospital, University of Perugia, 05100 Terni, Italy
| | - Ruggero Vaglio
- Department of Physics, University of Naples “Federico II”, and CNR SPIN, 80125 Naples, Italy
| | - Zhenjie Wu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Paolo Verze
- Department of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, 84081 Fisciano, Italy
| | - Ciro Imbimbo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Felice Crocetto
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
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Binmahfouz LS, Almukadi H, Alamoudi AJ, El-Halawany AM, Abdallah HM, Algandaby MM, Mohamed GA, Ibrahim SRM, Alghamdi FA, Al-Shaeri M, Abdel-Naim AB. 6-Paradol Alleviates Testosterone-Induced Benign Prostatic Hyperplasia in Rats by Inhibiting AKT/mTOR Axis. PLANTS (BASEL, SWITZERLAND) 2022; 11:2602. [PMID: 36235468 PMCID: PMC9571361 DOI: 10.3390/plants11192602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Benign prostatic hyperplasia (BPH) is a common disease among elderly men. Its pharmacological treatment is still unsatisfactory. 6-Paradol (6-PD) is an active metabolite found in many members of the Zingiberaceae family. It was reported to possess anti-proliferative, antioxidant, and anti-inflammatory activities. The present study aimed at exploring the potential of 6-PD to inhibit testosterone-induced BPH in rats as well as the probable underlying mechanism. METHODS Male Wistar rats were divided into 6 groups and treated as follows: Group 1 (control group) received vehicles only, Group 2 testosterone only, Groups 3 and 4 received 6-PD (2.5 and 5.0 mg/kg; respectively) and testosterone, and Group 6 received finasteride and testosterone. RESULTS Daily treatment of animals with 6-PD at the two dose levels of 2.5 and 5 mg/kg significantly ameliorated a testosterone-induced rise in prostate index and weight. This was confirmed by histological examinations of prostatic tissues that indicated a reduction in the pathological changes as well as inhibition of the rise in glandular epithelial height in 6-PD treated rats. Immunohistochemical investigations showed that 6-PD prevented the up-regulation of cyclin D1 induced by testosterone injections. Further, 6-PD significantly modulated mRNA expression of both Bcl2 and Bax in prostate tissues of testosterone-treated rats in favor of anti-proliferation. It also showed antioxidant activities as evidenced by inhibition of accumulation of malondialdehyde (MDA) and exhaustion of catalase (CAT) activity. In addition, 6-PD displayed significant anti-inflammatory activities as it prevented up-regulation of interleukin-6 (IL-6) and nuclear factor kappa B (NF-κB). Immunoblotting analysis revealed that 6-PD significantly inhibited testosterone-induced activation of AKT and mTOR in prostate tissues. CONCLUSIONS 6-PD protects against testosterone-induced BPH in rats. This can be attributed, at least partly, to its antiproliferative, antioxidant, and anti-inflammatory properties as well as its ability to inhibit activation of the AKT/mTOR axis.
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Affiliation(s)
- Lenah S. Binmahfouz
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Haifa Almukadi
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Abdulmohsin J. Alamoudi
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Ali M. El-Halawany
- Department of Pharmacognosy, Faculty of Pharmacy, Cairo University, Cairo 11562, Egypt
| | - Hossam M. Abdallah
- Department of Natural Products and Alternative Medicine, Faculty of Pharmacy, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Mardi M. Algandaby
- Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Gamal A. Mohamed
- Department of Natural Products and Alternative Medicine, Faculty of Pharmacy, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Sabrin R. M. Ibrahim
- Preparatory Year Program, Department of Chemistry, Batterjee Medical College, Jeddah 21442, Saudi Arabia
- Department of Pharmacognosy, Faculty of Pharmacy, Assiut University, Assiut 71526, Egypt
| | - Faraj A. Alghamdi
- Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Majed Al-Shaeri
- Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Ashraf B. Abdel-Naim
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, King Abdulaziz University, Jeddah 21589, Saudi Arabia
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A comprehensive review of medical therapy on benign prostatic hyperplasia. SEXOLOGIES 2022. [DOI: 10.1016/j.sexol.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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8
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Prognostic value of prostate volume in non-muscle invasive bladder cancer. Sci Rep 2021; 11:18784. [PMID: 34552102 PMCID: PMC8458356 DOI: 10.1038/s41598-021-98045-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/31/2021] [Indexed: 12/09/2022] Open
Abstract
There is evidence that a history of benign prostatic hyperplasia increases the incidence of bladder cancer, and treatment with 5-alpha reductase inhibitor or androgen deprivation therapy reduces recurrence of non-muscle invasive bladder cancer. We aimed to evaluate whether prostate volume affects its prognosis. We reviewed medical records of men who underwent transurethral resection of bladder tumor due to non-muscle invasive bladder cancer from January 2012 to December 2017. Patients were divided into two groups based on prostate volume measured by computed tomography (group 1: 264 patients with ≤ 30 mL, group 2: 124 patients with > 30 mL). Propensity score matching analysis was used for adjust selection bias, and then assessed recurrence-free survival and progression-free survival. With a median follow up duration of 52 months, group 1 showed higher 5-year recurrence-free and progression-free survival (69.3% vs 47.0%, p = 0.001; 96.7% vs 87.7%, p = 0.002). Further, cox-regression analysis showed that tumor size (HR = 1.292 p < 0.001), multifocal tumor (HR = 1.993, p < 0.001), adjuvant intravesical therapy (chemotherapy: HR = 0.580, p = 0.037 and bacillus Calmette-Guérin: HR = 0.542, p = 0.004) and prostate volume (HR = 2.326, p < 0.001) were significant predictors of recurrence-free survival. Prostate volume (HR = 2.886, p = 0.014) was also associated with PFS with age (HR = 1.043, p = 0.044) and tumor grade (HR = 3.822, p = 0.013). We conclude higher prostate volume is associated with worse recurrence and progression-free survival in non-muscle invasive bladder cancer.
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Miernik A, Gratzke C. Current Treatment for Benign Prostatic Hyperplasia. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 117:843-854. [PMID: 33593479 DOI: 10.3238/arztebl.2020.0843] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 02/28/2020] [Accepted: 07/28/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Benign prostatic hyperplasia (BPH) is characterized by the occurrence of.disorders of urine storage and bladder emptying. Most men over the age of 60 years are affected to some degree. METHODS A selective literature search with additional scrutiny of guidelines and meta-analyses. RESULTS The management of patients with BPH is complex. Emptying and retention disorders can be treated by various pharmacological and surgical means. Transurethral resection of the prostate (TURP) has long been considered the gold standard for operative treatment. Transurethral enucleation procedures show a better risk profile in some uses, however, and have, above all, largely displaced suprapubic prostatectomy. Numerous innovative treatment options have been developed in recent years, but their long-term effects remain to be determined. These treatment techniques can nevertheless be used in individual cases after thorough discussion with the patient. CONCLUSION The care of patients with BPH should be interdisciplinary. The efficacy and safety of many new developments in the area of pharmacological and minimally invasive treatment remain to be demonstrated in randomized trials.
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Malde S, Lam W, Adwin Z, Hashim H. Pharmacological and interventional treatment of benign prostatic obstruction: An evidence‐based comparative review. BJUI COMPASS 2021; 2:238-259. [PMID: 35475299 PMCID: PMC8988658 DOI: 10.1002/bco2.74] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/18/2021] [Accepted: 01/18/2021] [Indexed: 11/08/2022] Open
Abstract
Introduction The recommended treatment for bothersome lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO) after the failure of behavioral therapy and fluid modification includes pharmacological, minimally invasive interventional, and surgical approaches. Each option has different risk and benefit profiles, and the urologist must be aware of the unique characteristics of each option in order to be able to accurately counsel the patients based on their individual values and preferences. We provide a comparative review of the commonest pharmacological and most widely performed interventional/surgical treatments for BPO, discussing the evidence for the treatment characteristics that are most useful for the practicing urologist. Methods A search of the PubMed database was performed for articles reporting on the following treatments for LUTS due to BPO: α‐blockers, 5α‐reductase inhibitors, phosphpdiesterase‐5 inhibitors, prostatic urethral lift (Urolift), convective radiofrequency water vapor thermal therapy (Rezum), Temporary implantable Nitinol Device (iTIND), prostate artery embolization (PAE), transurethral resection of the prostate (TURP), photoselective vaporization of the prostate (PVP), Aquablation, and anatomical endoscopic enucleation of the prostate (AEEP). We performed a narrative review focussing on the following outcomes: efficacy, safety, durability, duration of catheterization, length of stay, re‐treatment rate, efficacy in special situations (enlarged median lobe, prostate size, urinary retention, and anticoagulant use), and sexual adverse events. Results AEEP offers the greatest long‐term improvement in maximum flow rate, IPSS, and prostate volume reduction, with lowest re‐treatment rate, followed by PVP, TURP, and Aquablation. Urolift, Rezum, and PAE have similar efficacy for prostate volume up to 80cc, and all are more effective than the pharmacological treatment. Urolift offers the lowest rate of sexual dysfunction, followed by Rezum, and both can be performed as a day case under local anesthesia. Conclusion Several treatment options exist to treat voiding LUTS due to BPO. Newer minimally invasive treatments reduce the hospital stay and postoperative complications, whereas AEEP provides the greatest long‐term symptom improvement at the expense of higher morbidity and sexual dysfunction. Men should be counseled regarding all suitable treatment options as some may favor reduced efficacy in association with reduced side effects.
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Affiliation(s)
- Sachin Malde
- Department of Urology Guy’s and St Thomas’ NHS Foundation Trust London UK
| | - Wayne Lam
- Division of Urology Department of Surgery LKS Faculty of Medicine Queen Mary Hospital The University of Hong Kong Hong Kong Hong Kong SAR
| | - Zainal Adwin
- Department of Surgery Faculty of Medicine Universiti Teknologi MARA Selangor Malaysia
| | - Hashim Hashim
- Bristol Urological Institute Southmead Hospital North Bristol NHS Trust Bristol UK
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11
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Eid BG, Abdel-Naim AB. Piceatannol Attenuates Testosterone-Induced Benign Prostatic Hyperplasia in Rats by Modulation of Nrf2/HO-1/NFκB Axis. Front Pharmacol 2020; 11:614897. [PMID: 33519479 PMCID: PMC7845651 DOI: 10.3389/fphar.2020.614897] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 11/30/2020] [Indexed: 12/13/2022] Open
Abstract
Benign prostatic hyperplasia (BPH) is a serious illness affecting middle-aged and elderly male patients. It is a complication of several diseases including metabolic syndrome. BPH has been associated with inflammation and increased oxidative stress in prostatic tissues. Piceatannol (PIC) is an active natural polyhydroxylated stilbene found in many plants. It has profound anti-inflammatory as well as antioxidant activities. However, it suffers relatively poor pharmacokinetic properties. Nanoformulation is an acknowledged approach to improve PIC bioavailability. The goal was to evaluate the ability of PIC in preventing testosterone-induced benign prostatic hyperplasia in rats. PIC was prepared in a self-nanoemulsifying drug delivery system (SNEDDS). Animals were placed into seven groups: 1) control (vehicle), 2) PIC SNEDDS (20 mg/kg), 3) testosterone (3 mg/kg), 4) testosterone + PIC SNEDDS (5 mg/kg), 5) testosterone + PIC (10 mg/kg), 6) testosterone + PIC SNEDDS (20 mg/kg) and 7) testosterone + finasteride (5 mg/kg). Testosterone was injected SC while PIC SNEDDS and finasteride were given orally. All treatments were given once daily, 5 days/week for four consecutive weeks. PIC administration ameliorated increased prostate weights and indices in addition to histopathological alterations. Further it inhibited accumulation of lipid peroxidation, depletion of glutathione (GSH) and exhaustion of catalase (CAT). PIC SNEDDS exhibited anti-proliferative activities as demonstrated by the inhibition of cyclin D1 protein expression and Bcl2 mRNA expression in addition to enhancement of Bax mRNA expression and caspase-3 content. Immunohistochemically, PIC SNEDDS protected against the testosterone-induced increased expression of tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), cyclooxygenase-2 (COX-2), inducible nitric oxide synthase (iNOS), nuclear factor kappa B (NFκB) and also offered protection against the decline in Nrf2 expression. Further, a significant enhancement of Nfe212 and Homx1 mRNA expression was detected in PIC SNEDDS-treated animals in comparison to the testosterone group. Conclusively, PIC prepared in SNEDDS protects against experimentally induced BPH via modulation of, at least partly, Nrf2/HO-1/NFκB axis.
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Affiliation(s)
- Basma G Eid
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ashraf B Abdel-Naim
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
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12
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Sebastianelli A, Spatafora P, Morselli S, Vignozzi L, Serni S, McVary KT, Kaplan S, Gravas S, Chapple C, Gacci M. Tadalafil Alone or in Combination with Tamsulosin for the Management for LUTS/BPH and ED. Curr Urol Rep 2020; 21:56. [PMID: 33108544 PMCID: PMC7591403 DOI: 10.1007/s11934-020-01009-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 12/18/2022]
Abstract
Purpose of Review Aim of our systematic review is to evaluate and summarize the efficacy and safety of tadalafil alone or in combination with tamsulosin for the management of lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH) and erectile dysfunction (ED). Recent Findings Daily tadalafil, in particular 5 mg, according to retrieved studies, appears to be both safe and effective in treating LUTS/BPH and ED, compared with placebo or tamsulosin. The combination of daily tadalafil 5 mg and tamsulosin 0.4 mg allows a better improvement of LUTS compared with both the monotherapies, even if with an increased, but acceptable and tolerated, adverse events rate. After discontinuation of tamsulosin or tadalafil in patients previously treated with their combination, the improvement of LUTS retains significance compared with baseline. Summary Tadalafil 5 mg should be considered a primary treatment option for patients with LUTS/BPH and ED. Evidence highlight an excellent tolerability, safety, and effectiveness profile, both alone or in combination with tamsulosin 0.4 mg. A better efficacy on LUTS relief has been observed for combination therapy, preserving also sexual function. The further switch to monotherapy allows to preserve LUTS relief, but tadalafil only is able to retain ED improvement. Our results support the evidence for a more and more tailored and modular LUTS treatment.
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Affiliation(s)
- A Sebastianelli
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
- Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy
| | - P Spatafora
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
- Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy
| | - S Morselli
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
- Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy
| | - L Vignozzi
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio," Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi Hospital, University of Florence, Florence, Italy
| | - S Serni
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
- Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy
| | - K T McVary
- Department of Urology, Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - S Kaplan
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - S Gravas
- Department of Urology, University of Thessaly, Larissa, Greece
| | - C Chapple
- Department of Urology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Mauro Gacci
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.
- Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy.
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13
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The Medical Management of Gender Dysphoric, Gender Fluid, Gender Nonconforming, Gender Queer, Nonbinary, and Transgender Patients: One Clinic’s Approach. CURRENT SEXUAL HEALTH REPORTS 2019. [DOI: 10.1007/s11930-019-00221-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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14
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Kim EY, Jin BR, Chung TW, Bae SJ, Park H, Ryu D, Jin L, An HJ, Ha KT. 6-sialyllactose ameliorates dihydrotestosterone-induced benign prostatic hyperplasia through suppressing VEGF-mediated angiogenesis. BMB Rep 2019. [PMID: 31383249 PMCID: PMC6774418 DOI: 10.5483/bmbrep.2019.52.9.113] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Benign prostatic hyperplasia (BPH), a common disease in elderly males, is accompanied by non-malignant growth of prostate tissues, subsequently causing hypoxia and angiogenesis. Although VEGF-related angiogenesis is one of the therapeutic targets of prostate cancer, there is no previous study targeting angiogenesis for treatment of BPH. Dihydrotestosterone (DHT)-induced expressions of vascular endothelial growth factor (VEGF) in prostate epithelial RWPE-1 cells and human umbilical vascular endothelial cells (HUVECs). Conditioned media (CM) from DHT-treated RWPE-1 cells were transferred to HUVECs. Then, 6SL inhibited proliferation, VEGFR-2 activation, and tube formation of HUVECs transferred with CM from DHT-treated RWPE-1 cells. In the rat BPH model, 6SL reduced prostate weight, size, and thickness of the prostate tissue. Formation of vessels in prostatic tissues were also reduced with 6SL treatment. We found that 6SL has an ameliorative effect on in vitro and in vivo the BPH model via inhibition of VEGFR-2 activation and subsequent angiogenesis. These results suggest that 6SL might be a candidate for development of novel BPH drugs.
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Affiliation(s)
- Eun-Yeong Kim
- Department of Korean Medical Science, School of Korean Medicine, Yangsan 50612, Korea
- Korean Medical Research Center for Healthy Aging, Pusan National University, Yangsan 50612, Korea
| | - Bo-Ram Jin
- Department of Pharmacology, College of Korean Medicine, Sangji University, Wonju 26339, Korea
| | - Tae-Wook Chung
- Korean Medical Research Center for Healthy Aging, Pusan National University, Yangsan 50612, Korea
| | - Sung-Jin Bae
- Korean Medical Research Center for Healthy Aging, Pusan National University, Yangsan 50612, Korea
| | - Hyerin Park
- Department of Korean Medical Science, School of Korean Medicine, Yangsan 50612, Korea
- Korean Medical Research Center for Healthy Aging, Pusan National University, Yangsan 50612, Korea
| | - Dongryeol Ryu
- Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon 16419, Korea
| | - Ling Jin
- Department of Korean Medical Science, School of Korean Medicine, Yangsan 50612, Korea
- Korean Medical Research Center for Healthy Aging, Pusan National University, Yangsan 50612, Korea
| | - Hyo-Jin An
- Department of Pharmacology, College of Korean Medicine, Sangji University, Wonju 26339, Korea
| | - Ki-Tae Ha
- Department of Korean Medical Science, School of Korean Medicine, Yangsan 50612, Korea
- Korean Medical Research Center for Healthy Aging, Pusan National University, Yangsan 50612, Korea
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15
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Bortnick EM, Simma-Chiang V, Kaplan SA. Long-term Consequences of Medical Therapy for Benign Prostatic Hyperplasia. Rev Urol 2019; 21:154-157. [PMID: 32071563 PMCID: PMC7020283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Benign prostatic hyperplasia (BPH) is a common disease in men. Although transurethral resection of the prostate (TURP) is the gold standard therapy for treatment of BPH and associated lower urinary tract symptoms (LUTS), many patients choose to avoid surgery and instead choose medical therapy. Until recently, medical therapy for BPH has been thought to be both safe and effective. However, new studies have shown that some of these medications can have significant neurocognitive, psychiatric, and sexual side effects, including dementia and depression. As most patients taking these medications will continue them for the long term, it is vital for physicians to explain these potential risks to the patient prior to prescribing them for a quality-of-life condition.
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Affiliation(s)
- Eric M Bortnick
- Department of Urology, Mount Sinai Hospital, Icahn School of Medicine New York, NY
| | - Vannita Simma-Chiang
- Department of Urology, Mount Sinai Hospital, Icahn School of Medicine New York, NY
| | - Steven A Kaplan
- Department of Urology, Mount Sinai Hospital, Icahn School of Medicine New York, NY
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