First analysis of the safety and efficacy of UGN-101 in the treatment of ureteral tumors

OBJECTIVE

UGN-101 has been approved for the chemoablation of low-grade upper tract urothelial cancer (UTUC) involving the renal pelvis and calyces. Herein is the first reported cohort of patients with ureteral tumors treated with UGN-101.

PATIENTS AND METHODS

We performed a retrospective review of patients treated with UGN-101 for UTUC at 15 high-volume academic and community centers focusing on outcomes of patients treated for ureteral disease. Patients received UGN-101 with either adjuvant or chemo-ablative intent. Response rates are reported for patients receiving chemo-ablative intent. Adverse outcomes were characterized with a focus on the rate of ureteral stenosis.

RESULTS

In a cohort of 132 patients and 136 renal units, 47 cases had tumor involvement of the ureter, with 12 cases of ureteral tumor only (8.8%) and 35 cases of ureteral plus renal pelvic tumors (25.7%). Of the 23 patients with ureteral involvement who received UGN-101 induction with chemo-ablative intent, the complete response was 47.8%, which did not differ significantly from outcomes in patients without ureteral involvement. Fourteen patients (37.8%) with ureteral tumors had significant ureteral stenosis at first post-treatment evaluation, however, when excluding those with pre-existing hydronephrosis or ureteral stenosis, only 5.4% of patients developed new clinically significant stenosis.

CONCLUSIONS

UGN-101 appears to be safe and may have similar efficacy in treating low-grade urothelial carcinoma of the ureter as compared to renal pelvic tumors.

Route of Administration for UGN-101 and Impact on Oncological and Safety Outcomes

BACKGROUND

UGN-101 can be used for chemoablation of low-grade upper tract urothelial carcinoma (UTUC). The gel can be administered via a retrograde route through a ureteral catheter or an antegrade route via a nephrostomy tube.

OBJECTIVE

To report outcomes of UGN-101 by route of administration.

DESIGN, SETTING, AND PARTICIPANTS

We performed a retrospective review of 132 patients from 15 institutions who were treated with UGN-101 for low-grade UTUC via retrograde versus antegrade administration.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Survival outcomes are reported per patient. Treatment, complications, and recurrence outcomes are reported per renal unit. Statistical analysis was performed for primary endpoints of oncological response and ureteral stricture occurrence.

RESULTS AND LIMITATIONS

A total of 136 renal units were evaluated, comprising 78 retrograde and 58 antegrade instillations. Median follow-up was 7.4 mo. There were 120 cases (91%) of biopsy-proven low-grade UTUC. Tumors were in the renal pelvis alone in 89 cases (65%), in the ureter alone in 12 cases (9%), and in both in 35 cases (26%). Seventy-six patients (56%) had residual disease before UGN-101 treatment. Chemoablation with UGN-101 was used in 50/78 (64%) retrograde cases and 26/58 (45%) antegrade cases. A complete response according to inspection and cytology was achieved in 31 (48%) retrograde and 30 (60%) antegrade renal units (p = 0.1). Clavien grade 3 ureteral stricture occurred in 21 retrograde cases (32%) and only six (12%) antegrade cases (p < 0.01). Limitations include treatment bias, as patients in the antegrade group were more likely to undergo endoscopic mechanical ablation before UGN-101 instillation.

CONCLUSIONS

These preliminary results show a significantly lower rate of stricture occurrence with antegrade administration of UGN-101, with no apparent impact on oncological efficacy.

PATIENT SUMMARY

We compared results for two different delivery routes for the drug UGN-101 for treatment of cancer in the upper urinary tract. For the antegrade route, a tube is inserted through the skin into the kidney. For the retrograde route, a catheter is inserted past the bladder into the upper urinary tract. Our results show a lower rate of narrowing of the ureter (the tube draining urine from the kidney into the bladder) using the antegrade route, with no difference in cancer control.

The ablative effect of mitomycin reverse thermal gel: Expanding the role for nephron preservation therapy in low grade upper tract urothelial carcinoma

PURPOSE

Assess the real-world ablative effect of mitomycin reverse thermal gel for low-grade upper tract urothelial carcinoma (UTUC) in patients who undergo biopsy only or partial ablation and evaluate utility of complete ablation prior to UGN-101.

MATERIAL AND METHODS

We retrospectively reviewed low-grade UTUC patients treated with UGN-101 from 15 high-volume centers. Patients were categorized based on initial endoscopic ablation (biopsy only, partial ablation, or complete ablation) and by size of remaining tumor (complete ablation, <1cm, 1-3cm, or >3cm) prior to UGN-101. The primary outcome was rendered disease free (RDF) rate at first post-UGN-101 ureteroscopy (URS), defined as complete response or partial response with minimal mechanical ablation to endoscopically clear the upper tract of visible disease.

RESULTS

One hundred and sixteen patients were included for analysis after excluding those with high-grade disease. At first post-UGN-101 URS, there were no differences in RDF rates between those who at initial URS (pre-UGN-101) had complete ablation (RDF 77.0%), partial ablation (RDF 55.9%) or biopsy only (RDF 66.7%) (P = 0.14). Similarly, a complimentary analysis focusing on tumor size (completely ablated, <1cm, 1-3cm or >3cm) prior to UGN-101 induction did not demonstrate significant differences in RDF rates (P = 0.17).

CONCLUSION

The results of the early real-world experience suggest that UGN-101 may play a role in initial chemo-ablative cytoreduction of larger volume low-grade tumors that may not initially appear to be amenable to renal preservation. Further studies will help to better quantify the chemo-ablative effect and to identify clinical factors for patient selection.

Efficacy and Safety of Mitomycin Gel (UGN-101) as an Adjuvant Therapy After Complete Endoscopic Management of Upper Tract Urothelial Carcinoma

PURPOSE

We describe a novel application of the reverse thermal polymer gel of mitomycin C (UGN-101) as adjuvant therapy after complete endoscopic ablation of upper tract urothelial carcinoma.

MATERIALS AND METHODS

We retrospectively reviewed patients treated with UGN-101 from 15 high-volume centers. Adjuvant therapy was defined as treatment administered following visually complete endoscopic ablation. Response at primary endoscopic evaluation was defined as no visual tumor or negative biopsy. Ipsilateral disease-free and progression-free survival were estimated by the Kaplan-Meier method. Ureteral stenosis and other adverse events were abstracted from the medical records. Ureteral stenosis was defined as a condition requiring ureteral stent or nephrostomy, or that would typically warrant stent or nephrostomy.

RESULTS

Adjuvant UGN-101 after complete endoscopic ablation was used in 52 of 115 (45%) renal units in the oncologic analysis. At first endoscopic evaluation, 36/52 (69%) were without visible disease. At 6.8 months' median follow-up, the ipsilateral disease-free rate was 63%. Recurrence after adjuvant UGN-101 therapy was more likely in multifocal tumors compared to unifocal (HR 3.3, 95% CI 1.07-9.91). Compared with UGN-101 treatment for chemoablation of measurable disease, there were significantly fewer disease detections with adjuvant therapy (P < .001). Ureteral stenosis after UGN-101 was diagnosed in 10 patients (19%) undergoing adjuvant therapy compared to 17 (29%) undergoing chemoablative therapy (P = .28).

CONCLUSIONS

In patients being considered for UGN-101, maximal endoscopic ablation prior to UGN-101 treatment may result in fewer patients with disease at first endoscopy and possibly fewer adverse events than primary chemoablative therapy. Longer follow-up is needed to determine if UGN-101 after complete endoscopic ablation will lead to durable disease-free interval.

Early experience with UGN-101 for the treatment of upper tract urothelial cancer - A multicenter evaluation of practice patterns and outcomes

BACKGROUND

UGN-101 is a novel delivery system for intracavitary treatment of upper tract urothelial cancer (UTUC). UGN-101 was approved based on a pivotal trial for small volume residual low-grade UTUC. Our aim was to report our experience with UGN-101 in a more heterogenous and real-world setting.

METHODS

We performed a retrospective review of all UGN-101 cases from 15 institutions with a focus on practice patterns, efficacy, and adverse effects. We include UGN-101 utilization in both the chemoablative and adjuvant setting.

RESULTS

There were a total 136 renal units treated from 132 patients. The majority of cases were biopsy proven low-grade UTUC. Practice patterns varied considerably - the most common administration technique was antegrade instillation via a percutaneous nephrostomy. When utilized in the adjuvant setting, 69% of patients were disease free at the time of their first endoscopic evaluation, while in the chemoablative setting, 37% were endoscopically clear on the first evaluation (P < 0.001). Complete response was higher in patients with smaller tumor size prior to UGN-101 induction; low volume (<1 cm) residual disease was associated with a 70% complete response, similar to disease free rate at first endoscopic evaluation when UGN-101 was used in the adjuvant setting. The use of maintenance doses of UGN-101 was reported in 27% of cases. The overall incidence of new onset, clinically significant ureteral stenosis was 23%.

CONCLUSIONS

This study represents the largest review of patients treated with UGN-101 and can serve as a basis of ongoing hypotheses regarding treatment with UGN-101 for UTUC.

A random-matrix theory of the number sense

Number sense, a spontaneous ability to process approximate numbers, has been documented in human adults, infants and newborns, and many other animals. Species as distant as monkeys and crows exhibit very similar neurons tuned to specific numerosities. How number sense can emerge in the absence of learning or fine tuning is currently unknown. We introduce a random-matrix theory of self-organized neural states where numbers are coded by vectors of activation across multiple units, and where the vector codes for successive integers are obtained through multiplication by a fixed but random matrix. This cortical implementation of the 'von Mises' algorithm explains many otherwise disconnected observations ranging from neural tuning curves in monkeys to looking times in neonates and cortical numerotopy in adults. The theory clarifies the origin of Weber-Fechner's Law and yields a novel and empirically validated prediction of multi-peak number neurons. Random matrices constitute a novel mechanism for the emergence of brain states coding for quantity.This article is part of a discussion meeting issue 'The origins of numerical abilities'.

Delayed local recurrence following radiation therapy for muscle-invasive bladder cancer emphasizing the need for lifelong surveillance: a case report

We report a case of 68 years old gentleman who developed a delayed local recurrence, 30 years following curative radiation treatment for muscle invasive bladder cancer. This case emphasizes the importance of lifelong post treatment surveillance for bladder cancer.

Induction of anoikis by doxazosin in prostate cancer cells is associated with activation of caspase-3 and a reduction of focal adhesion kinase

The quinazoline family of alpha1-blockers (prazosin, doxazosin, and terazosin) induce apoptosis of prostate cells through an alpha1-adrenoceptor-independent mechanism. The objective of this study was to gain insight into the non-adrenergic, apoptotic mechanism of action of doxazosin in the prostate and the induction of anoikis by doxazosin. Primary cultures of benign prostate stromal and epithelial cells and the LNCaP (androgen sensitive) and PC-3 (androgen insensitive) prostate carcinoma cell lines were treated with doxazosin (0-50 microM). The effects of doxazosin on cell morphology, caspase-3 activity, and the expression levels of focal adhesion kinase (FAK) and integrin-linked kinase (ILK) were examined. Doxazosin induced changes in morphology consistent with anoikis in both benign and cancerous prostatic cells and increased caspase-3 activity. The effects were similar comparing benign cells (which express alpha1-adrenoceptors) and cancer cells (which do not express alpha1-adrenoceptors), but were more robust in benign cells. Norepinephrine had no effect on doxazosin-induced cell morphology or caspase-3 activity. Treatment of PC-3 cells with doxazosin significantly reduced the protein levels of FAK but did not significantly affect the levels of ILK. These findings suggest that doxazosin induces apoptosis and anoikis of prostate cancer cells by a mechanism of action that is alpha1-adrenoceptor independent. The apoptosis of cancer cells induced by doxazosin counteracts cell proliferation and may have the potential of retarding or reversing prostate cancer cell growth.

Seeing more than meets the eye: processing of illusory contours in animals

This review article illustrates that mammals, birds and insects are able to perceive illusory contours. Illusory contours lack a physical counterpart, but monkeys, cats, owls and bees perceive them as if they were real borders. In all of these species, a neural correlate for such perceptual completion phenomena has been described. The robustness of neuronal responses and the abundance of cells argue that such neurons might indeed represent a neural correlate for illusory contour perception. The internal state of an animal subject (i.e., alert and behaving) seems to be an important factor when correlating neural activity with perceptual phenomena. The fact that the neural network necessary for illusory contour perception has been found in relatively early visual brain areas in all tested animals suggests that bottom-up processing is largely sufficient to explain such perceptual abilities. However, recent findings in monkeys indicate that feedback loops within the visual system may provide additional modulation. The detection of illusory contours by independently evolved visual systems argues that processing of edges in the absence of contrast gradients reflects fundamental visual constraints and not just an artifact of visual processing.

Release from masking in fluctuating background noise in a songbird's auditory forebrain

Fluctuations in the ubiquitous masking background noise can be exploited by the vertebrate auditory system to considerably improve signal detection. Here we demonstrate neuronal masking release in amplitude-modulated background noise on the level of the European starling's auditory forebrain, an area that is the analogue of the mammalian primary auditory cortex. Tone-evoked responses in the presence of modulated and unmodulated maskers were recorded in unrestrained birds via radiotelemetry. Based on a rate code, the average amount of neuronal masking release was similar to that observed in a psychoacoustic study on the starling with stimuli confined to a single auditory filter. The results suggest that the neurons exploited predominantly temporal features of the acoustic background to improve signal detection.

Encoding of both vertical and horizontal disparity in random-dot stereograms by Wulst neurons of awake barn owls

In binocular vision, the lateral displacement of the eyes gives rise to both horizontal and vertical disparities between the images projected onto the left and right retinae. While it is well known that horizontal disparity is exploited by the binocular visual system of birds and mammals to enable depth perception, the role of vertical disparity is still largely unclear. In this study, neuronal activity in the visual forebrain (visual Wulst) of behaving barn owls to vertical disparity was investigated. Single-unit responses to global random-dot stereograms (RDS) were recorded with chronically implanted electrodes and transmitted via radiotelemetry. Nearly half of the cells investigated (44%, 16/36) varied the discharge as a function of vertical disparity. Like horizontal-disparity tuning profiles, vertical-disparity tuning curves typically exhibited periodic modulation with side peaks flanking a prominent main peak, and thus, could be fitted well with a Gabor function. This indicates that tuning to vertical disparity was not caused by disrupting horizontal-disparity tuning via vertical stimulus offset, but by classical disparity detectors whose orientation tuning was tilted. When tested with horizontal in addition to vertical disparity, almost all cells investigated (92%, 12/13) were tuned to both kinds of disparity. The emergence of disparity detectors sensitive in two dimensions (horizontal and vertical) is discussed within the framework of the disparity energy model.

Hierarchical processing of horizontal disparity information in the visual forebrain of behaving owls

According to their restricted receptive fields and input-filter characteristics, disparity-sensitive neurons at early processing levels of the visual system perform rather ambiguous computations; they respond vigorously to disparity in false-matched images and show multiple response peaks in their disparity-tuning profiles. On the other hand, the perception of depth from binocular disparity is reliable, thus raising the question as to where and how in the brain additional processing is accomplished leading toward behaviorally relevant disparity detection. To address this issue, tuning data during stimulation with correlated and anticorrelated random-dot stereograms (a-RDS) were obtained from 52 disparity-sensitive visual Wulst neurons in three behaving owls. From the disparity-tuning curves, several quantitative measures were derived that allowed to determine the response ambiguity of a cell. A systematic decline of response ambiguities with increasing response latencies was observed. An increase in response latencies of neurons was correlated with a decrease of the strength of responses to a-RDS. Declining responses to a-RDS are expected for global detectors, because an owl was not able to discriminate depth in psychophysical tests with a-RDS. In addition, suppression of response side peaks was increased and disparity tuning was enhanced with growing response latencies. These results suggest a functional hierarchy of disparity processing in the owl's forebrain, leading from spatial filters to more global disparity detectors that may be able to solve the correspondence problem. Nonlinear threshold operations and inhibition are proposed as candidate mechanisms to resolve coding ambiguities.

Signal detection in amplitude-modulated maskers. II. Processing in the songbird's auditory forebrain

In the natural environment, acoustic signals have to be detected in ubiquitous background noise. Temporal fluctuations of background noise can be exploited by the auditory system to enhance signal detection, especially if spectral masking components are coherently amplitude modulated across several auditory channels (a phenomenon called 'comodulation masking release'). In this study of neuronal mechanisms of masking release in the primary auditory forebrain (field L) of awake European starlings (Sturnus vulgaris), we determined and compared neural detection thresholds for 20-ms probe tones presented in a background of sinusoidally amplitude modulated (10-Hz) noise maskers. Responses of a total of 34 multiunit clusters were recorded via radiotelemetry with chronically implanted microelectrodes from unrestrained birds. For maskers consisting of a single noise band centred around the recording site's characteristic frequency, a substantial reduction in detection threshold (21 dB on average) was found when probe tones were presented during envelope dips rather than during envelope peaks. Such effects could also explain results obtained for masking protocols where the on-frequency noise band was presented together with excitatory or inhibitory flanking bands that were either coherently modulated (in-phase) or incoherently modulated (phase-shifted). Generally, masking release for probe tones in maskers with flanking bands extending beyond the frequency range of a cell cluster's excitatory tuning curve was not substantially improved. Only some of the neurophysiological results are in agreement with behavioural data from the same species if only the average population response is considered. A subsample of individual neurons, however, could account for behavioural thresholds.

Miniature stereo radio transmitter for simultaneous recording of multiple single-neuron signals from behaving owls

Wireless radiotelemetric transmission of neuronal activity is an elegant technique to study brain-behavior interaction in unrestrained animals. In the current study, a miniature FM-stereo radio transmitter is described that permitted simultaneous recordings from two microelectrodes in behaving barn owls. Input from two independent channels is multiplexed to form a stereo composite signal that modulates a radio frequency carrier. The high quality of broadcasted extracellular signals enabled separation of single units based on differences in spike waveforms. Recording several single cells from different electrodes allows the possibility of investigating correlations between small, distributed neuronal ensembles. Multi-channel radiotelemetry that meets the demands of modern electrophysiology might open a new perspective for combined behavioral/neurophysiological approaches in freely-behaving animals.

Horizontal-disparity tuning of neurons in the visual forebrain of the behaving barn owl

Stereovision plays a major role in depth perception of animals having frontally-oriented eyes, most notably primates, cats, and owls. Neuronal mechanisms of disparity sensitivity have only been investigated in anesthetized owls so far. In the current study, responses of 160 visual Wulst neurons to static random-dot stereograms (RDS) were recorded via radiotelemetry in awake, fixating barn owls. The majority of neurons (76%) discharged significantly as a function of horizontal disparity in RDS. The distribution of preferred disparities mirrored the behaviorally relevant range of horizontal disparities that owls can exploit for depth vision. Most tuning profiles displayed periodic modulation and could well be fitted with a Gabor function as expected if disparity detectors were implemented according to the disparity energy model. Corresponding to this observation, a continuum of tuning profiles was observed rather than discrete categories. To assess a possible clustering of neurons with similar disparity-tuning properties, single units, and multi-unit activity recorded at individual recording sites were compared. Only a minority of neurons were clustered according to their disparity-tuning properties, suggesting that neurons in the visual Wulst are not organized into columns by preferred disparity. To assess whether variable vergence eye movements influenced tuning data, we correlated tuning peak positions on a trial-by-trial basis for units that were recorded simultaneously. The general lack of significant correlation between single-trial peak positions of simultaneously recorded units indicated that vergence, if at all, had only a minor influence on the data. Our study emphasizes the significance of visual Wulst neurons in analyzing stereoscopic depth information and introduces the barn owl as a second model system to study stereopsis in awake, behaving animals.

Perception and neuronal coding of subjective contours in the owl

Robust form perception and underlying neuronal mechanisms require generalized representation of object boundaries, independent of how they are defined. One visual ability essential for form perception is reconstruction of contours absent from the retinal image. Here we show that barn owls perceive subjective contours defined by grating gaps and phase-shifted abutting gratings. Moreover, single-neuron recordings from visual forebrain (visual Wulst) of awake, behaving birds revealed a high proportion of neurons signaling such subjective contours, independent of local stimulus attributes. These data suggest that the visual Wulst is important in contour-based form perception and exhibits a functional complexity analogous to mammalian extrastriate cortex.

Time course of simultaneous masking in the starling's auditory forebrain

Simultaneous masking of pure tones was studied in the primary auditory forebrain of a songbird species, the European starling (Sturnus vulgaris). The responses of 32 multi-unit clusters in the input layer of the auditory neostriatum (field L2a) were recorded via radiotelemetry from freely moving birds. The probe was a 10-ms tone burst at the units' characteristic-frequency (CF) presented 20 dB above the threshold. The masker was an 80-ms tone burst presented either at the units' CF (excitatory masker) or at a frequency located in inhibitory side-bands (inhibitory masker) of the units' tuning curves. The probe was presented either 3 ms or 63 ms after masker onset. Probes presented at a 3-ms delay were influenced at significantly lower levels of an excitatory masker than probes presented at a 63-ms delay. The mean difference in masker level at the detection thresholds for both probe delays was 8 dB. No difference in masker level was observed for inhibitory-frequency maskers. The observed neural masking effects may be explained by at least four mechanisms: (1) swamping of the probe response by the response to the masker, (2) a reduction of the probe response during neural adaptation of the response to the masker, (3) a reduction of the probe response during side-band inhibition in the central nervous system, and (4) suppression originating in the cochlea.

Adjustable frequency selectivity of auditory forebrain neurons recorded in a freely moving songbird via radiotelemetry

One of the hearing system's basic properties that determines the detection of signals is its frequency selectivity. In the natural environment, a songbird may achieve an improved detection ability if the neuronal filters of its auditory system could be sharpened to adapt to the spectrum of the background noise. To address this issue, we studied 35 multi-unit clusters in the input layer of the primary auditory forebrain of nine European starlings (Sturnus vulgaris). Microelectrodes were chronically implanted in this songbird's cortex analogue and the neuronal activity was transmitted from unrestrained birds via a miniature FM transmitter. Frequency tuning curves (FTCs) and inhibitory sidebands were determined by presenting a matrix of frequency-level combinations of pure tones. From each FTC, the characteristic frequency (CF) and several parameters describing the neurons' filter characteristics were derived and compared to the same recording site's filter function while simultaneously stimulating with a continuous CF tone 20 dB above the response threshold. Our results show a significant improvement of frequency selectivity during two-tone stimulation, indicating that spectral filtering in the starling's auditory forebrain depends on the acoustic background in which a signal is presented. Moreover, frequency selectivity was found to be a function of the time over which the stimulus persisted, since FTCs were much sharper and inhibitory sidebands were largely expanded several milliseconds after response onset. Neuronal filter bandwidths during two-tone stimulation in the auditory forebrain are in good agreement with psychoacoustically measured critical bandwidths in the same species. Radiotelemetry proved to be a powerful tool in studying neuronal activity in freely behaving birds.

A sensorineural progressive autosomal recessive form of isolated deafness, DFNB13, maps to chromosome 7q34-q36

Deafness is the most frequent sensorineural defect in children. The vast majority of the prelingual forms of isolated deafness are highly genetically heterogeneous with an autosomal recessive mode of inheritance. Using linkage analysis, we have mapped the gene responsible for a severe progressive sensorineural hearing loss, DFNB13, segregating in a large consanguineous family living in an isolated region in northern Lebanon. A maximum lod score of 4.5 was detected for markers D7S661-D7S498. Recombination events and homozygosity mapping by descent define a 17 cM gene interval in the chromosome region 7q34-q36, between the markers D7S2468/D7S2505, on the proximal side, and D7S2439, on the distal side.

Total prostate and transition zone volumes, and transition zone index are poorly correlated with objective measures of clinical benign prostatic hyperplasia

PURPOSE

We determined if total prostate volume, transition zone volume or transition zone index is correlated with the severity of clinical benign prostatic hyperplasia (BPH).

MATERIALS AND METHODS

A total of 93 men 52 to 85 years old, who were referred to a urology outpatient facility for treatment of clinical BPH, elevated serum prostate specific antigen or abnormal digital rectal examination, underwent measurement of total prostate and transition zone volume at transrectal ultrasonography. All men were requested to undergo uroflowmetry and complete the American Urological Association (AUA) symptom score.

RESULTS

The pairwise correlations between AUA symptom score, versus total prostate and transition zone volumes and transition zone index were not statistically or clinically significant. A weak pairwise relationship was observed between peak flow rate versus total prostate volume (r2 = 0.160), transition zone volume (r2 = 0.156) and transition zone index (r2 = 0.147). The pairwise relationships between AUA symptom scores versus all prostate volumes were not statistically significant for subjects with mild (score 8 or less) or moderate to severe (score more than 8) symptoms.

CONCLUSIONS

Total prostate and transition zone volumes, and transition zone index are not directly related to AUA symptom score and only weakly related to peak flow rate. These findings provide further evidence that the total prostate, total BPH and relative BPH volumes are not useful determinants of the severity of clinical BPH.

Effect of terazosin on prostatism in men with normal and abnormal peak urinary flow rates

OBJECTIVES

To determine if men with normal peak urinary flow rates (PFR) and prostatism respond to terazosin.

METHODS

Forty-one men over the age of 50 years with an American Urological Association (AUA) symptom score greater than 8, postvoid residual urine volume (PVR) less than 300 mL, and no clinical or biochemical evidence of prostate cancer were treated with terazosin independent of the baseline PFR. The effect of terazosin on the AUA symptom score and PFR were compared for subjects with a PFR of 15 mL/s or less (group I) and those with a PFR greater than 15 mL/s (group II).

RESULTS

The baseline age, AUA symptom score, prostate volume, and PVR were not significantly different between the two groups. The mean changes in AUA symptom score were -45.0% and -49.5% for groups I and II, respectively. The mean changes in PFR were 7.0% and -26.6% for groups I and II, respectively.

CONCLUSIONS

The effect of terazosin on AUA symptom score is independent of baseline PFR, indicating that the mechanism of action of terazosin is not exclusively mediated by reduction of bladder outlet obstruction. Randomized controlled studies are required to confirm this provocative observation.