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Krishnamoorthi R, Ganapathy A A, Hari Priya VM, Kumaran A. Future aspects of plant derived bioactive metabolites as therapeutics to combat benign prostatic hyperplasia. J Ethnopharmacol 2024; 330:118207. [PMID: 38636573 DOI: 10.1016/j.jep.2024.118207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/12/2024] [Accepted: 04/14/2024] [Indexed: 04/20/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Benign prostatic hyperplasia (BPH), characterized by prostate enlargement due to cell proliferation, is a common urinary disorder in men over 50, manifesting as lower urinary tract symptoms (LUTS). Currently, several therapeutic options are accessible for treating BPH, including medication therapy, surgery and watchful waiting. Conventional drugs such as finasteride and dutasteride are used as 5α-reductase inhibitors for the treatment of BPH. However long-term use of these drugs is restricted due to their unpleasant side effects. Despite the range of available medical therapies, the effective treatment against BPH is still inadequate. Certain therapeutic plants and their phytochemicals have the aforementioned goals and work by regulating this enzyme. AIM OF THE STUDY This review aims to provide a comprehensive insight to advancements in diagnosis of BPH, modern treatment methods and the significance of ethnobotanically relevant medicinal plants as alternative therapeutics for managing BPH. MATERIAL AND METHODS A thorough and systematic literature search was performed using electronic databases and search engines such as PubMed, Web of Science, NCBI and SciFinder till October 2023. Specific keywords such as "benign prostatic hyperplasia", "medicinal plants", "phytochemicals", "pharmacology", "synergy", "ethnobotany", "5-alpha reductase", "alpha blocker" and "toxicology". By include these keywords, a thorough investigation of pertinent papers was assured, and important data about the many facets of BPH could be retrieved. RESULTS After conducting the above investigation, 104 herbal remedies were found to inhibit Phosphodiesterase-5 (PDE-5) inhibition, alpha-blockers, or 5α -reductase inhibition effects which are supported by in vitro, in vivo and clinical trial studies evidence. Of these, 89 plants have ethnobotanical significance as alpha-blockers, alpha-reductase inhibition, or PDE-5 inhibition, and the other fifteen plants were chosen based on their ability to reduce BPH risk factors. Several phytocompounds, including, rutaecarpine, vaccarin, rutin, kaempferol, β-sitosterol, quercetin, dicaffeoylquinic acid, rutaevin, and phytosterol-F have been reported to be useful for the management of BPH. The use of combination therapy offers a strong approach to treating long-term conditions compare to single plant extract drugs. Furthermore, several botanical combinations such as lycopene and curcumin, pumpkin seed oil and saw palmetto oil, combinations of extracts from Funtumia africana (Benth.) Stapf and Abutilon mauritianum (Jacq.) Medik., and Hypselodelphys poggeana (K.Schum.) Milne-Redh. and Spermacoce radiata (DC.) Sieber ex Hiern are also supported through in vitro and in vivo studies for managing BPH through recuperation in patients with chronic long-term illnesses, as measured by the International Prostate Symptom Score. CONCLUSION The review proposes and endorses careful utilization of conventional medications that may be investigated further to discover possible PDE-5, 5 alpha-reductase, an alpha-blocker inhibitor for managing BPH. Even though most conventional formulations, such as 5 alpha-reductase, are readily available, systemic assessment of the effectiveness and mechanism of action of the herbal constituents is still necessary to identify novel chemical moieties that can be further developed for maximum efficacy. However, there exist abundant botanicals and medicinal plants across several regions of Africa, Asia, and the Americas, which can be further studied and developed for utilization as a potential phytotherapeutic for the management of BPH.
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Affiliation(s)
- Raman Krishnamoorthi
- Chemical Sciences and Technology Division, CSIR-National Institute for Interdisciplinary Science and Technology (NIIST), Thiruvananthapuram, 695 019, Kerala, India
| | - Anand Ganapathy A
- Chemical Sciences and Technology Division, CSIR-National Institute for Interdisciplinary Science and Technology (NIIST), Thiruvananthapuram, 695 019, Kerala, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - V M Hari Priya
- Chemical Sciences and Technology Division, CSIR-National Institute for Interdisciplinary Science and Technology (NIIST), Thiruvananthapuram, 695 019, Kerala, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Alaganandam Kumaran
- Chemical Sciences and Technology Division, CSIR-National Institute for Interdisciplinary Science and Technology (NIIST), Thiruvananthapuram, 695 019, Kerala, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India.
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Matsukawa A, Yanagisawa T, Bekku K, Parizi MK, Laukhtina E, Klemm J, Chiujdea S, Mori K, Kimura S, Miki J, Pradere B, Rivas JG, Gandaglia G, Kimura T, Kasivisvanathan V, Ploussard G, Cornford P, Shariat SF, Rajwa P. Nonsurgical Interventions to Prevent Disease Progression in Prostate Cancer Patients on Active Surveillance: A Systematic Review and Meta-analysis. Eur Urol Oncol 2024; 7:376-400. [PMID: 38277189 DOI: 10.1016/j.euo.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/17/2023] [Accepted: 10/10/2023] [Indexed: 01/27/2024]
Abstract
CONTEXT Active surveillance (AS) is a standard of care for patients with low-risk and selected intermediate-risk prostate cancer (PCa). Nevertheless, there is a lack of summary evidence on how to impact disease trajectory during AS. OBJECTIVE To assess which interventions prevent PCa progression effectively during AS. EVIDENCE ACQUISITION We queried PubMed, Scopus, and Web of Science databases to identify studies examining the impact of interventions aimed at slowing disease progression during AS. The primary endpoint was PCa progression, the definition of which must have included pathological upgrading. The secondary endpoint included treatment toxicities. EVIDENCE SYNTHESIS We identified 22 studies, six randomized controlled trials and 16 observational studies, which analyzed the association between different interventions and PCa progression during AS. The interventions considered in the studies included 5-alpha reductase inhibitors (5-ARIs), statins, diet, exercise, chlormadinone, fexapotide triflutate (FT), enzalutamide, coffee, vitamin D3, and PROSTVAC. We found that administration of 5-ARIs was associated with improved progression-free survival (PFS; hazard ratio: 0.59; 95% confidence interval 0.48-0.72), with no increased toxicity signals. Therapies such as vitamin D3, chlormadinone, FT, and enzalutamide have shown some efficacy. However, these anticancer drugs have been associated with treatment-related adverse events in up to 88% of patients. CONCLUSIONS The use of 5-ARIs in PCa patients on AS is associated with longer PFS. However, for the other interventions, it is difficult to draw clear conclusions based on the weak available evidence. PATIENT SUMMARY Patients with prostate cancer managed with active surveillance (AS) who are treated with 5-alpha reductase inhibitors have a lower risk of disease progression, with minimal adverse events. Other interventions require more studies to determine their efficacy and safety profile in men on AS.
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Affiliation(s)
- Akihiro Matsukawa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takafumi Yanagisawa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kensuke Bekku
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Mehdi Kardoust Parizi
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Shariati Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Jakob Klemm
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sever Chiujdea
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Spitalul Clinic Judetean Murures, University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Mures, Romania
| | - Keiichiro Mori
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shoji Kimura
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Jun Miki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, La Croix Du Sud Hospital, Quint Fonsegrives, France
| | - Juan Gomez Rivas
- Department of Urology, Clinico San Carlos Hospital, Madrid, Spain
| | | | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Veeru Kasivisvanathan
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK
| | | | - Philip Cornford
- Department of Urology, Liverpool University Hospitals, Liverpool, UK
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.
| | - Pawel Rajwa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Medical University of Silesia, Zabrze, Poland
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Choi S, Kwon SH, Sim WY, Lew BL. Long-term efficacy and safety of dutasteride 0.5 mg in Korean men with androgenetic alopecia: 5-year data demonstrating clinical improvement with sustained efficacy. J Dermatol 2024; 51:684-690. [PMID: 38321615 DOI: 10.1111/1346-8138.17138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/15/2024] [Accepted: 01/20/2024] [Indexed: 02/08/2024]
Abstract
Dutasteride 0.5 mg is a dual inhibitor of 5α-reductase type I and II and was approved in Korea in 2009 for treating androgenetic alopecia (AGA) in men. We investigated the 5-year efficacy and safety of dutasteride 0.5 mg in Korean men with AGA using the basic and specific (BASP) classification. This retrospective analysis included 99 male AGA patients aged ≥18 years who were treated with dutasteride 0.5 mg for at least 5 years from October 2009 to December 2016 at Kyung Hee University Hospital in Gangdong. Patient photographs were scored using the BASP classification, and the Investigator Global Assessment (IGA) was performed using a seven-point scale. Patient improvement (IGA score ≥1) and prevention of disease progression (IGA score ≥0) were 89.9% (89/99) and 93.9% (93/99), respectively. According to the BASP classification, 52.5% (52/99) of the basic type, 75% (15/20) of the specific F type, and 82.2% (60/73) of the specific V type showed clinical improvement after 5 years of treatment. Dutasteride demonstrated long-term safety and efficacy in Korean male patients with AGA over a period of at least 5 years, with results comparable to those of other long-term efficacy studies of finasteride 1 mg in male patients with AGA.
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Affiliation(s)
- Sangmin Choi
- Department of Dermatology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Soon-Hyo Kwon
- Department of Dermatology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Woo-Young Sim
- Department of Dermatology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Bark-Lynn Lew
- Department of Dermatology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
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Kim KH, Kwon SH, Sim WY, Lew BL. Therapeutic maintenance effect of finasteride 1 mg every other month regimen in androgenetic alopecia and study on the difference in response to finasteride treatment: A prospective cohort study. J Dermatol 2024; 51:552-557. [PMID: 38293734 DOI: 10.1111/1346-8138.17120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 12/08/2023] [Accepted: 01/02/2024] [Indexed: 02/01/2024]
Abstract
Finasteride is commonly used for androgenetic alopecia (AGA) treatment. The aim of this study was to assess the therapeutic maintenance effect of a finasteride every other month (EOM) regimen and analyze clinical and laboratory differences in patients with AGA according to their treatment response. One hundred males with AGA who received finasteride 1 mg daily treatment for a year were enrolled in the study. At 1 year follow-up, treatment responses of patients who completed the visit schedule were assessed using five scales. The patients were assigned to good or bad response groups according to their assessment. Further, they were randomly divided into two groups (daily vs. EOM) and treated with finasteride (1 mg) for 1 more year. At 2 years follow-up, treatment efficacy was assessed. At 1-year follow-up, 36 patients completed the schedule, including eight and three patients in the good and bad response groups, respectively. At the 2-year follow-up, 23 patients completed the schedule, with nine in the daily group and 14 in the EOM group. Changes in global photographic assessment in the second year were 1.33 and 1.29 for the daily and EOM groups, respectively. The daily group showed an elevated hair density and lower concentration of dihydrotestosterone (DHT) and the DHT to testosterone ratio (DHT/T). However, the EOM group showed decreased hair density and elevated DHT and DHT/T. Following treatment response assessment after 1 year of treatment, the good response group showed early onset which was associated with maternal AGA. Analysis of serum androgen hormone magnitude of DHT reduction was much greater (54.4% vs. 44.4%). DHT/T was higher in the bad response group (1.98 vs. 2.33). We concluded that the finasteride EOM regimen showed similar maintenance effects to the daily regimen.
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Affiliation(s)
- Ki-Hun Kim
- Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Soon-Hyo Kwon
- Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Woo-Young Sim
- Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Bark-Lynn Lew
- Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, Korea
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Jin R, Forbes CM, Miller NL, Lafin J, Strand DW, Case T, Cates JM, Liu Q, Ramirez-Solano M, Mohler JL, Matusik RJ. Transcriptomic analysis of benign prostatic hyperplasia identifies critical pathways in prostatic overgrowth and 5-alpha reductase inhibitor resistance. Prostate 2024; 84:441-459. [PMID: 38168866 DOI: 10.1002/pros.24661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 11/06/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND The medical therapy of prostatic symptoms (MTOPS) trial randomized men with symptoms of benign prostatic hyperplasia (BPH) and followed response of treatment with a 5α-reductase inhibitor (5ARI), an alpha-adrenergic receptor antagonist (α-blocker), the combination of 5ARI and α-blocker or no medical therapy (none). Medical therapy reduced risk of clinical progression by 66% but the reasons for nonresponse or loss of therapeutic response in some patients remains unresolved. Our previous work showed that prostatic glucocorticoid levels are increased in 5ARI-treated patients and that glucocorticoids can increased branching of prostate epithelia in vitro. To understand the transcriptomic changes associated with 5ARI treatment, we performed bulk RNA sequencing of BPH and control samples from patients who received 5ARI versus those that did not. Deconvolution analysis was performed to estimate cellular composition. Bulk RNA sequencing was also performed on control versus glucocorticoid-treated prostate epithelia in 3D culture to determine underlying transcriptomic changes associated with branching morphogenesis. METHOD Surgical BPH (S-BPH) tissue was defined as benign prostatic tissue collected from the transition zone (TZ) of patients who failed medical therapy while control tissue termed Incidental BPH (I-BPH) was obtained from the TZ of men undergoing radical prostatectomy for low-volume/grade prostatic adenocarcinoma confined to the peripheral zone. S-BPH patients were divided into four subgroups: men on no medical therapy (none: n = 7), α-blocker alone (n = 10), 5ARI alone (n = 6) or combination therapy (α-blocker and 5ARI: n = 7). Control I-BPH tissue was from men on no medical therapy (none: n = 8) or on α-blocker (n = 6). A human prostatic cell line in 3D culture that buds and branches was used to identify genes involved in early prostatic growth. Snap-frozen prostatic tissue taken at the time of surgery and 3D organoids were used for RNA-seq analysis. Bulk RNAseq data were deconvoluted using CIBERSORTx. Differentially expressed genes (DEG) that were statistically significant among S-BPH, I-BPH, and during budding and branching of organoids were used for pathway analysis. RESULTS Transcriptomic analysis between S-BPH (n = 30) and I-BPH (n = 14) using a twofold cutoff (p < 0.05) identified 377 DEG (termed BPH377) and a cutoff < 0.05 identified 3377 DEG (termed BPH3377). Within the S-BPH, the subgroups none and α-blocker were compared to patients on 5ARI to reveal 361 DEG (termed 5ARI361) that were significantly changed. Deconvolution analysis of bulk RNA seq data with a human prostate single cell data set demonstrated increased levels of mast cells, NK cells, interstitial fibroblasts, and prostate luminal cells in S-BPH versus I-BPH. Glucocorticoid (GC)-induced budding and branching of benign prostatic cells in 3D culture was compared to control organoids to identify early events in prostatic morphogenesis. GC induced 369 DEG (termed GC359) in 3D culture. STRING analysis divided the large datasets into 20-80 genes centered around a hub. In general, biological processes induced in BPH supported growth and differentiation such as chromatin modification and DNA repair, transcription, cytoskeleton, mitochondrial electron transport, ubiquitination, protein folding, and cholesterol synthesis. Identified signaling pathways were pooled to create a list of DEG that fell into seven hubs/clusters. The hub gene centrality was used to name the network including AP-1, interleukin (IL)-6, NOTCH1 and NOTCH3, NEO1, IL-13, and HDAC/KDM. All hubs showed connections to inflammation, chromatin structure, and development. The same approach was applied to 5ARI361 giving multiple networks, but the EGF and sonic hedgehog (SHH) hub was of particular interest as a developmental pathway. The BPH3377, 5ARI363, and GC359 lists were compared and 67 significantly changed DEG were identified. Common genes to the 3D culture included an IL-6 hub that connected to genes identified in BPH hubs that defined AP1, IL-6, NOTCH, NEO1, IL-13, and HDAC/KDM. CONCLUSIONS Reduction analysis of BPH and 3D organoid culture uncovered networks previously identified in prostatic development as being reinitiated in BPH. Identification of these pathways provides insight into the failure of medical therapy for BPH and new therapeutic targets for BPH/LUTS.
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Affiliation(s)
- Renjie Jin
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Connor M Forbes
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Urology Department, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicole L Miller
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - John Lafin
- Department of Urology, University of Texas, Southwestern, Dallas, Texas, USA
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Douglas W Strand
- Department of Urology, University of Texas, Southwestern, Dallas, Texas, USA
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Thomas Case
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Justin M Cates
- Department of Pathology Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Qi Liu
- Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Marisol Ramirez-Solano
- Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James L Mohler
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Robert J Matusik
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Lee KS, Yoo JW, Kim DH, Jeon S, Yang J, Chung BH, Koo KC. A prospective, randomized, open-label, parallel trial comparing the efficacy of α-blocker or 5α-reductase inhibitor withdrawal to continued combination therapy on the maintenance of lower urinary tract symptoms in men with benign prostatic hyperplasia. Prostate 2024; 84:403-413. [PMID: 38149792 DOI: 10.1002/pros.24663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/01/2023] [Accepted: 12/12/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND It is uncertain how long combination therapy should be continued in patients with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS). We investigated the withdrawal effects of α1-adrenergic receptor blocker (AB) or 5α-reductase inhibitor (5ARI) following successful combination therapy. METHODS This prospective, randomized, open-label, parallel trial enrolled 222 patients with BPH/LUTS who showed at least a seven-point improvement in International Prostate Symptom Score-total (IPSS-T) and a ≥ 20% reduction in prostate volume (PV) following the initiation of combination therapy. Patients were randomized in a 1:1:1 ratio into continued-combination, AB-withdrawal, and 5ARI-withdrawal groups. IPSS, overactive bladder symptom score, EuroQol-five-dimensional questionnaire (EQ-5D-5L), EuroQol-visual analog scale (EQ-VAS), prostate volume (PV), maximal flow rate, postvoid residual urine (PVR), and prostate-specific antigen level were assessed every 6 months for 24 months. The predictors of IPSS-T deterioration were evaluated. RESULTS At Month 24, IPSS-T deterioration (≥2 point) was observed in 20/72 (27.8%) and 19/72 (26.4%) patients in the AB- and 5ARI-withdrawal groups, respectively. Among them, 4/72 (5.6%) and 4/70 (5.7%) patients required readdition of the withdrawn drug (p = 0.868). In the continued combination group, EQ-VAS improved at Month 24 compared to baseline (p = 0.028). At Month 24, the AB-withdrawal group showed improvements in EQ-5D-5L, EQ-VAS, and PVR (all p < 0.005), while the 5ARI-withdrawal group showed improvement in IPSS-S (p = 0.011). Diabetes mellitus was associated with IPSS-T deterioration at Month 24 (p = 0.020). CONCLUSIONS In patients with BPH/LUTS who are reluctant to continue combination therapy, AB or 5ARI withdrawal may be offered in men with improvement in IPSS-T by at least seven points and reduction in PV by at least 20%.
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Affiliation(s)
- Kwang Suk Lee
- Department of Urology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeong Woo Yoo
- Department of Urology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dae Ho Kim
- Department of Urology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Soyoung Jeon
- Biostatistics Collaboration Unit, Medical Research Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Juyeon Yang
- Biostatistics Collaboration Unit, Medical Research Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byung Ha Chung
- Department of Urology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyo Chul Koo
- Department of Urology, Yonsei University College of Medicine, Seoul, Republic of Korea
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Haile ES, Sotimehin AE, Gill BC. Medical management of benign prostatic hyperplasia. Cleve Clin J Med 2024; 91:163-170. [PMID: 38429006 DOI: 10.3949/ccjm.91a.23027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
Medical management of benign prostatic hyperplasia (BPH) has progressed gradually in recent years and remains the starting point for most symptomatic patients seeking treatment. Beyond well-known alpha-blockers and 5-alpha reductase inhibitors, there is growing evidence for the use of phosphodiesterase-5 inhibitors and beta-3 agonists in managing the condition, which may afford additional relief of "bothersome" symptoms in some patients. This review details contemporary medical management of BPH with an emphasis on the indications for certain classes of pharmacotherapy and their relative benefits and side effects. Surgical and procedural treatment of BPH is covered in a separate review.
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Affiliation(s)
- Eiftu S Haile
- Department of Urology, Cleveland Clinic, Cleveland, OH
| | | | - Bradley C Gill
- Department of Urology, Cleveland Clinic, Cleveland, OH; Associate Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
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Tawfik A, Abo-Elenen M, Gaber M, El-Abd A, Zoeir A, Saad S, Sultan I, Ghoneim A. Tadalafil versus tamsulosin as combination therapy with 5-alpha reductase inhibitors in benign prostatic hyperplasia, urinary and sexual outcomes. World J Urol 2024; 42:70. [PMID: 38308714 DOI: 10.1007/s00345-023-04735-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/10/2023] [Indexed: 02/05/2024] Open
Abstract
PURPOSE To compare the urological and sexual outcomes of using either tamsulosin/finateride or tadalafil/finasteride as combination therapies in patients with large prostate. PATIENTS AND METHODS Selection criteria included prostate volume > 40 ml and IPSS > 7. Patients with severe erectile dysfunction (IIEF-erectile functions ≤ 10) were excluded. Patients were randomized into group I (tamsulosin/finasteride) and group II (tadalafil/finasteride). The primary endpoint was to define urinary and sexual function changes (IPSS, IPSS-quality of life, urinary flow rates and IIEF domains) within each group. The secondary endpoint was to compare the treatment induced changes between both groups. RESULTS At 4th and 12th weeks, 131 and 127 patients were available in both groups, respectively. Both groups showed significant LUTS improvement (IPSS changes: - 4.9 ± 2.7 and - 4.3 ± 2.9 at 4th week and - 6.1 ± 3 and - 5.4 ± 2.8 points by the 12th week in both groups, respectively). Group I had better average flow rates at both follow-up visits. Meanwhile, maximum flow rates were comparable in both groups at 12th week (13.5 ± 3.9vs. 12.6 ± 3.7, p > 0.05). In group I, all IIEF domains were significantly lowered at both visits (p < 0.05). Group II showed significant increase in IIEF-erectile function scores (1.3 ± 1.1 and 1.8 ± 1.2 at the 4th and 12th weeks) with a transient significant reduction of IIEF-orgasm and sexual desire noted only by the 4th week (- 0.8 ± 0.4 and - 0.6 ± 0.4, respectively). CONCLUSION Within three months, both combinations are comparably effective in improving BPH related LUTS. Tamsulosin/finasteride provided significantly better Qmax only at 4th week. Tadalafil/finasteride had the advantage of improving sexual performance over the other combination.
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Affiliation(s)
- Ahmed Tawfik
- Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Mohammed Gaber
- Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ahmed El-Abd
- Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ahmed Zoeir
- Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Sayed Saad
- Urology Department, Al-Azhar University, Cairo, Egypt
- Urology department, Ibn Sina National College for Medical Studies, Jeddah, Kingdom of Saudi Arabia
| | - Intessar Sultan
- Internal Medicine Department, Ibn Sina National College for Medical Studies, Jeddah, Kingdom of Saudi Arabia
| | - Ayman Ghoneim
- Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
- Urology department, Ibn Sina National College for Medical Studies, Jeddah, Kingdom of Saudi Arabia.
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Zheng RR, Ouyang QX, Liu ZY, Li LN, Yang L, Wang ZT. [Natural 5α-reductase inhibitors in treatment of benign prostatic hyperplasia]. Zhongguo Zhong Yao Za Zhi 2024; 49:858-867. [PMID: 38621893 DOI: 10.19540/j.cnki.cjcmm.20231113.601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Benign prostatic hyperplasia(BPH) is a common disease of the male urinary system, and its incidence rate in China is increasing. However, the mechanism underlying the pathogenesis of BPH remains unclear. Some studies demonstrated that the incidence of BPH was related to the change in the levels of steroid hormones. Too high content of dihydrotestosterone(DHT) in the body may cause BPH and other related diseases. Testosterone(T) is converted to DHT by 5α-reductase(SRD5A). By inhibiting the activity of this enzyme, the production of DHT can be reduced, and then the incidence of BPH can be lowered. Therefore, it has drawn great attention to screen and discover safer and more effective 5α-reductase inhibitors from natural medicines to treat prostatic hyperplasia without affecting the physiological function of men. This review summarizes the characteristics and tissue distribution of 5α-reductase, the discovery of 5α-reductase inhibitors in traditional Chinese medicine and natural medicines, 5α-reductase inhibitors commonly used in clinical practice and their side effects, as well as the animal models of prostatic hyperplasia and common detection indicators, aiming to provide a reference for more in-depth understanding and research about BPH and development of drugs.
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Affiliation(s)
- Rui-Rong Zheng
- Shanghai Key Laboratory of Compound Chinese Medicines, MOE Key Laboratory of Standardization of Chinese Medicines, SATCM Key Laboratory of New Resources and Quality Evaluation of Chinese Medicines, Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine Shanghai 201203, China School of Pharmacy and Pharmaceutical Sciences, Xiamen Medical College Xiamen 361023, China
| | - Qian-Xi Ouyang
- Shanghai Key Laboratory of Compound Chinese Medicines, MOE Key Laboratory of Standardization of Chinese Medicines, SATCM Key Laboratory of New Resources and Quality Evaluation of Chinese Medicines, Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine Shanghai 201203, China
| | - Zi-Yao Liu
- Shanghai Key Laboratory of Compound Chinese Medicines, MOE Key Laboratory of Standardization of Chinese Medicines, SATCM Key Laboratory of New Resources and Quality Evaluation of Chinese Medicines, Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine Shanghai 201203, China
| | - Lin-Nan Li
- Shanghai Key Laboratory of Compound Chinese Medicines, MOE Key Laboratory of Standardization of Chinese Medicines, SATCM Key Laboratory of New Resources and Quality Evaluation of Chinese Medicines, Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine Shanghai 201203, China
| | - Li Yang
- Shanghai Key Laboratory of Compound Chinese Medicines, MOE Key Laboratory of Standardization of Chinese Medicines, SATCM Key Laboratory of New Resources and Quality Evaluation of Chinese Medicines, Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine Shanghai 201203, China
| | - Zheng-Tao Wang
- Shanghai Key Laboratory of Compound Chinese Medicines, MOE Key Laboratory of Standardization of Chinese Medicines, SATCM Key Laboratory of New Resources and Quality Evaluation of Chinese Medicines, Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine Shanghai 201203, China
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10
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Gupta AK, Wang T, Bamimore MA, Talukder M. The relative effect of monotherapy with 5-alpha reductase inhibitors and minoxidil for female pattern hair loss: A network meta-analysis study. J Cosmet Dermatol 2024; 23:154-160. [PMID: 37386777 DOI: 10.1111/jocd.15910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/23/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Minoxidil and the 5-alpha reductase inhibitors (5-ARIs), specifically, dutasteride and finasteride, are usually used to treat pattern hair loss (PHL), but evidence on the relative effectiveness of these drugs is far less for women than men. AIMS We performed an age-adjusted network meta-analysis (NMA) to determine the comparative efficacy of monotherapy with the three agents-in any dosage and administrative route-on PHL in adult women. METHODS The peer-reviewed literature was systematically reviewed to obtain data for our NMA. The outcome measure for our NMA was "change in total hair density." We referred to "regimen" as an "agent and its dosage;" our Bayesian NMA estimated regimens' surface under the cumulative ranking curve (SUCRA) values and pairwise relative effects. RESULTS Our NMA used data from 13 trials-across which the following 10 regimens were identified (in decreasing order of SUCRA): 5 mg/day finasteride for 24 weeks (SUCRA = 95.7%), 5% topical minoxidil solution twice daily for 24 weeks (SUCRA = 89.5%), 1 mg/day minoxidil for 24 weeks (SUCRA = 78.1%), 5% topical minoxidil foam 1 half capful/day for 24 weeks (SUCRA = 66.5%), 3% topical minoxidil solution 1 mL twice daily for 24 weeks (SUCRA = 45.1%), 2% topical minoxidil solution 1 mL twice daily for 24 weeks (SUCRA = 44.6%), 5% topical minoxidil solution 1 mL/day for 24 weeks (SUCRA = 41.7%), 0.25 mg/day minoxidil for 24 weeks (SUCRA = 35.5%), 1.25 mg/day finasteride for 24 weeks (SUCRA = 24.8%) and 1 mg/day finasteride for 24 weeks (SUCRA = 4.3%). CONCLUSION Our findings can improve clinical guidelines and help dermatologists manage female PHL more optimally with the available options.
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Affiliation(s)
- Aditya K Gupta
- Mediprobe Research Inc., London, Ontario, Canada
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tong Wang
- Mediprobe Research Inc., London, Ontario, Canada
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11
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Lin Z, Liu Z, Niu Y. Exploring the Enigma of 5-ARIs Resistance in Benign Prostatic Hyperplasia: Paving the Path for Personalized Medicine. Curr Urol Rep 2023; 24:579-589. [PMID: 37987980 DOI: 10.1007/s11934-023-01188-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE OF REVIEW Despite the widespread utilization of 5-alpha reductase inhibitors (5-ARIs) for managing benign prostatic hyperplasia (BPH), certain BPH patients exhibit unresponsiveness to 5-ARIs therapy. This paper provides a comprehensive overview of the current perspectives on the mechanisms of 5-ARIs resistance in BPH patients and integrates potential biomarkers and underlying therapeutic options for 5-ARIs resistance. These findings may facilitate the development of novel or optimize more effective treatment options, and promote personalized medicine for BPH. RECENT FINDINGS The pathways contributing to resistance against 5-ARIs in certain BPH patients encompass epigenetic modifications, shifts in hormone levels, autophagic processes, and variations in androgen receptor structures, and these pathways may ultimately be attributed to inflammation. Promisingly, novel biomarkers, including intravesical prostatic protrusion, inflammatory factors, and single nucleotide polymorphisms, may offer predictive insights into the responsiveness to 5-ARIs therapy, empowering physicians to fine-tune treatment strategies. Additionally, on the horizon, GV1001 and mTOR inhibitors have emerged as potential alternative therapeutic modalities for addressing BPH in the future. After extensive investigation into BPH's pathological processes and molecular landscape, it is now recognized that diverse pathophysiological mechanisms may contribute to different BPH subtypes among individuals. This insight necessitates the adoption of personalized treatment strategies, moving beyond the prevailing one-size-fits-all paradigm centered around 5-ARIs. The imperative for early identification of individuals prone to treatment resistance will drive physicians to proactively stratify risk and adapt treatment tactics in future practice. This personalized medicine approach marks a progression from the current standard treatment model, emerging as the future trajectory in BPH management.
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Affiliation(s)
- Zhemin Lin
- Department of Urology, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Zhanliang Liu
- Department of Urology, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Yinong Niu
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
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12
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Mandour AA, Elkaeed EB, Hagras M, Refaat HM, Ismail NS. Virtual screening approach for the discovery of selective 5α-reductase type II inhibitors for benign prostatic hyperplasia treatment. Future Med Chem 2023; 15:2149-2163. [PMID: 37955117 DOI: 10.4155/fmc-2023-0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 10/24/2023] [Indexed: 11/14/2023] Open
Abstract
Background: 5α-Reductase type II (5αR2) inhibition is a promising strategy for benign prostatic hyperplasia treatment. A computational approach including virtual screening, ligand-based 3D pharmacophore modeling, 2D quantitative structure-activity relationship and molecular docking simulations were adopted to develop novel inhibitors. Results: Hits were first filtered via the validated pharmacophore and 2D quantitative structure-activity relationship models. Docking on the recently determined cocrystallized structure of 5αR2 showed three promising hits. Visual inspection results were compared with finasteride ligand and dihydrotestosterone as reference, to explain the role of binding to Glu57 and Tyr91 for 5αR2 selective inhibition. Conclusion: Alignment between Hit 2 and finasteride in the binding pocket showed similar binding modes. The biological activity prediction showed antitumor and androgen targeting activity of the new hits.
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Affiliation(s)
- Asmaa A Mandour
- Pharmaceutical Chemistry Department, Faculty of Pharmacy, Future University in Egypt (FUE), Cairo, 11835, Egypt
| | - Eslam B Elkaeed
- Department of Pharmaceutical Sciences, College of Pharmacy, AlMaarefa University, Riyadh, 13713, Saudi Arabia
| | - Mohamed Hagras
- Pharmaceutical Organic Chemistry Department, Faculty of Pharmacy (Boys), Al-Azhar University, Cairo, Egypt
| | - Hanan M Refaat
- Pharmaceutical Chemistry Department, Faculty of Pharmacy, Future University in Egypt (FUE), Cairo, 11835, Egypt
| | - Nasser Sm Ismail
- Pharmaceutical Chemistry Department, Faculty of Pharmacy, Future University in Egypt (FUE), Cairo, 11835, Egypt
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13
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Falagario UG, Lantz A, Jambor I, Busetto GM, Bettocchi C, Finati M, Ricapito A, Luzzago S, Ferro M, Musi G, Totaro A, Racioppi M, Carbonara U, Checcucci E, Manfredi M, D'Aietti D, Porcaro AB, Nordström T, Björnebo L, Oderda M, Soria F, Taimen P, Aronen HJ, Perez IM, Ettala O, Marchioni M, Simone G, Ferriero M, Brassetti A, Napolitano L, Carmignani L, Signorini C, Conti A, Ludovico G, Scarcia M, Trombetta C, Claps F, Traunero F, Montanari E, Boeri L, Maggi M, Del Giudice F, Bove P, Forte V, Ficarra V, Rossanese M, Mucciardi G, Pagliarulo V, Tafuri A, Mirone V, Schips L, Antonelli A, Gontero P, Cormio L, Sciarra A, Porpiglia F, Bassi P, Ditonno P, Boström PJ, Messina E, Panebianco V, De Cobelli O, Carrieri G. Diagnosis of prostate cancer with magnetic resonance imaging in men treated with 5-alpha-reductase inhibitors. World J Urol 2023; 41:2967-2974. [PMID: 37787941 PMCID: PMC10632288 DOI: 10.1007/s00345-023-04634-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/14/2023] [Indexed: 10/04/2023] Open
Abstract
PURPOSE The primary aim of this study was to evaluate if exposure to 5-alpha-reductase inhibitors (5-ARIs) modifies the effect of MRI for the diagnosis of clinically significant Prostate Cancer (csPCa) (ISUP Gleason grade ≥ 2). METHODS This study is a multicenter cohort study including patients undergoing prostate biopsy and MRI at 24 institutions between 2013 and 2022. Multivariable analysis predicting csPCa with an interaction term between 5-ARIs and PIRADS score was performed. Sensitivity, specificity, and negative (NPV) and positive (PPV) predictive values of MRI were compared in treated and untreated patients. RESULTS 705 patients (9%) were treated with 5-ARIs [median age 69 years, Interquartile range (IQR): 65, 73; median PSA 6.3 ng/ml, IQR 4.0, 9.0; median prostate volume 53 ml, IQR 40, 72] and 6913 were 5-ARIs naïve (age 66 years, IQR 60, 71; PSA 6.5 ng/ml, IQR 4.8, 9.0; prostate volume 50 ml, IQR 37, 65). MRI showed PIRADS 1-2, 3, 4, and 5 lesions in 141 (20%), 158 (22%), 258 (37%), and 148 (21%) patients treated with 5-ARIs, and 878 (13%), 1764 (25%), 2948 (43%), and 1323 (19%) of untreated patients (p < 0.0001). No difference was found in csPCa detection rates, but diagnosis of high-grade PCa (ISUP GG ≥ 3) was higher in treated patients (23% vs 19%, p = 0.013). We did not find any evidence of interaction between PIRADS score and 5-ARIs exposure in predicting csPCa. Sensitivity, specificity, PPV, and NPV of PIRADS ≥ 3 were 94%, 29%, 46%, and 88% in treated patients and 96%, 18%, 43%, and 88% in untreated patients, respectively. CONCLUSIONS Exposure to 5-ARIs does not affect the association of PIRADS score with csPCa. Higher rates of high-grade PCa were detected in treated patients, but most were clearly visible on MRI as PIRADS 4 and 5 lesions. TRIAL REGISTRATION The present study was registered at ClinicalTrials.gov number: NCT05078359.
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Affiliation(s)
- Ugo G Falagario
- Unit of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy.
| | - Anna Lantz
- Unit of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ivan Jambor
- Department of Radiology, University of Turku, Turku, Finland
- Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Gian Maria Busetto
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Carlo Bettocchi
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Marco Finati
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Anna Ricapito
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Stefano Luzzago
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, Università Degli Studi Di Milano, Milan, Italy
| | - Matteo Ferro
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Gennaro Musi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, Università Degli Studi Di Milano, Milan, Italy
| | - Angelo Totaro
- Department of Urology, Catholic University Medical School "A. Gemelli" Hospital, Rome, Italy
| | - Marco Racioppi
- Department of Urology, Catholic University Medical School "A. Gemelli" Hospital, Rome, Italy
| | - Umberto Carbonara
- Department of Urology, Andrology and Kidney Transplantation, University of Bari, Bari, Italy
| | - Enrico Checcucci
- Department of Urology, Azienda Ospedaliera Universitaria "San Luigi Gonzaga", University of Turin, Turin, Italy
| | - Matteo Manfredi
- Department of Urology, Azienda Ospedaliera Universitaria "San Luigi Gonzaga", University of Turin, Turin, Italy
| | - Damiano D'Aietti
- UOC Urologia, Azienda Ospedaliera Universitaria Integrata Di Verona, Verona, Italy
| | | | - Tobias Nordström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lars Björnebo
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Marco Oderda
- Department of Surgical Sciences, Città Della Salute E Della Scienza Di Torino, Molinette Hospital, Turin, Italy
| | - Francesco Soria
- Department of Surgical Sciences, Città Della Salute E Della Scienza Di Torino, Molinette Hospital, Turin, Italy
| | - Pekka Taimen
- Institute of Biomedicine, University of Turku, Turku, Finland
- Department of Pathology, Turku University Hospital, Turku, Finland
| | - Hannu J Aronen
- Department of Radiology, University of Turku, Turku, Finland
- Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Ileana Montoya Perez
- Department of Radiology, University of Turku, Turku, Finland
- Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Otto Ettala
- Department of Urology, University of Turku, Turku, Finland
- Turku University Hospital, Turku, Finland
| | - Michele Marchioni
- Department of Urology, Università "G.d'Annunzio", Chieti-Pescara, Italy
| | - Giuseppe Simone
- Department of Oncologic Urology, IRCCS "Regina Elena" National Cancer Institute of Rome, Rome, Italy
| | - Mariaconsiglia Ferriero
- Department of Oncologic Urology, IRCCS "Regina Elena" National Cancer Institute of Rome, Rome, Italy
| | - Aldo Brassetti
- Department of Oncologic Urology, IRCCS "Regina Elena" National Cancer Institute of Rome, Rome, Italy
| | - Luigi Napolitano
- Department of Urology, University of Naples Federico II, Naples, Italy
| | | | | | | | - Giuseppe Ludovico
- Department of Urology, Ente Ecclesiastico Miulli, Acquaviva Delle Fonti, Italy
| | - Marcello Scarcia
- Department of Urology, Ente Ecclesiastico Miulli, Acquaviva Delle Fonti, Italy
| | | | | | | | - Emanuele Montanari
- Department of Urology, IRCCS Foundation Ca' Granda-Maggiore Policlinico Hospital, Milan, Italy
| | - Luca Boeri
- Department of Urology, IRCCS Foundation Ca' Granda-Maggiore Policlinico Hospital, Milan, Italy
| | - Martina Maggi
- Department of Maternal Infant and Urological Sciences, Sapienza Rome University, Rome, Italy
| | - Francesco Del Giudice
- Department of Maternal Infant and Urological Sciences, Sapienza Rome University, Rome, Italy
| | - Pierluigi Bove
- Department of Urology, San Carlo Di Nancy Hospital, Rome, Italy
| | - Valerio Forte
- Department of Urology, San Carlo Di Nancy Hospital, Rome, Italy
| | | | - Marta Rossanese
- Department of Urology, University of Messina, Messina, Italy
| | | | | | | | - Vincenzo Mirone
- Department of Urology, University of Naples Federico II, Naples, Italy
| | - Luigi Schips
- Department of Urology, Università "G.d'Annunzio", Chieti-Pescara, Italy
| | - Alessandro Antonelli
- UOC Urologia, Azienda Ospedaliera Universitaria Integrata Di Verona, Verona, Italy
| | - Paolo Gontero
- Department of Surgical Sciences, Città Della Salute E Della Scienza Di Torino, Molinette Hospital, Turin, Italy
| | - Luigi Cormio
- Unit of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Urology, Ospedale L. Bonomo, Andria, Italy
| | - Alessandro Sciarra
- Department of Maternal Infant and Urological Sciences, Sapienza Rome University, Rome, Italy
| | - Francesco Porpiglia
- Department of Urology, Azienda Ospedaliera Universitaria "San Luigi Gonzaga", University of Turin, Turin, Italy
| | - PierFrancesco Bassi
- Department of Urology, Catholic University Medical School "A. Gemelli" Hospital, Rome, Italy
| | - Pasquale Ditonno
- Department of Urology, Andrology and Kidney Transplantation, University of Bari, Bari, Italy
| | - Peter J Boström
- Department of Urology, University of Turku, Turku, Finland
- Turku University Hospital, Turku, Finland
| | - Emanuele Messina
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Rome, Italy
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Rome, Italy
| | - Ottavio De Cobelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, Università Degli Studi Di Milano, Milan, Italy
| | - Giuseppe Carrieri
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
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Song Y, Xu T. Letter to the editor for the article "5-alpha reductase inhibitors (5-ARi) with or without alpha-blockers (α-B) for Benign Prostatic Hyperplasia do NOT lower the risk of incident Bladder Cancer: United States insurance claims data". World J Urol 2023; 41:3379-3380. [PMID: 37698635 DOI: 10.1007/s00345-023-04607-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 08/28/2023] [Indexed: 09/13/2023] Open
Affiliation(s)
- Yuxuan Song
- Department of Urology, Peking University People's Hospital, Beijing, 100044, China.
| | - Tao Xu
- Department of Urology, Peking University People's Hospital, Beijing, 100044, China.
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15
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Bilhim T. Do We Still Need 5α-Reductase Inhibitors for Patients with Benign Prostatic Hyperplasia After the PARTEM Study? Cardiovasc Intervent Radiol 2023; 46:1428-1429. [PMID: 37553447 DOI: 10.1007/s00270-023-03526-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 07/22/2023] [Indexed: 08/10/2023]
Affiliation(s)
- Tiago Bilhim
- Consultant Interventional Radiologist, Interventional Radiology Unit, Centro Hospitalar Universitário de Lisboa Central (CHULC), Lisbon, Portugal.
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16
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Del Giudice F, Belladelli F, Glover F, Basran S, Li S, Mulloy E, Pradere B, Soria F, Krajewski W, Nair R, Muncey W, Seranio N, Eisenberg ML. 5-alpha reductase inhibitors (5-ARi) with or without alpha-blockers (α-B) for Benign Prostatic Hyperplasia do NOT lower the risk of incident Bladder Cancer: United States insurance claims data. World J Urol 2023; 41:2783-2791. [PMID: 37548746 PMCID: PMC10582125 DOI: 10.1007/s00345-023-04551-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/21/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Chemoprotective effect of 5-alpha reductase inhibitors (5-ARi) on bladder cancer (BCa) risk in men with Benign Prostatic Hyperplasia (BPH) has been explored with conflicting results. We sought to examine the effect of 5-ARi on new BCa diagnoses in a large US database. METHODS Men ≥ 50 y/o with a prescription for 5-ARi after BPH diagnosis were identified in the IBM® Marketscan® Research de-identified Databases between 2007 and 2016 and matched with paired controls. Incident BCa diagnoses were identified after BPH diagnosis and/or pharmacologic treatment. Multivariable regression modeling adjusting for relevant factors was implemented. Sub-group analyses by exposure risk were performed to explore the association between 5-ARi and BCa over time. Administration of alpha-blockers (α-B) w/o 5-ARi was also examined. RESULTS In total, n = 24,036 men on 5-ARi, n = 107,086 on 5-ARi plus alpha-blockers, and n = 894,275 without medical therapy for BPH were identified. The percentage of men diagnosed with BCa was 0.8% for the 5-ARi, 1.4% for the 5-ARi + α-B, and 0.6% for the untreated BPH group of incident BCa (adjusted hazard ratio [aHR], 0.90, 95% confidence interval [CI] 0.56 - 1.47), and 1.08, 95%CI 0.89 - 1.30, respectively). This was also true at both shorter (≤ 2 yr) and longer-term (> 2 yr) follow up. In addition, α-B alone had no change in BCa risk (HR 1.06, 0.86-1.30). CONCLUSIONS We did not find any diminished risk of new BCa in men treated with 5-ARi (i.e., chemoprotective effect). The current report suggests that 5-ARi do not change a man's bladder cancer risk.
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Affiliation(s)
- Francesco Del Giudice
- Department of Maternal Infant and Urologic Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy.
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.
| | - Federico Belladelli
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
- University Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Frank Glover
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Satvir Basran
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Shufeng Li
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Evan Mulloy
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1030, Vienna, Austria
- Department of Urology, La Croix du Sud Hospital, 31130, Quint-Fonsegrives, France
| | - Francesco Soria
- Urology Division, Department of Surgical Sciences, University of Studies of Torino, 10124, Turin, Italy
| | - Wojciech Krajewski
- Department of Minimally Invasive and Robotic Urology, Wrocław Medical University, 50-367, Wrocław, Poland
| | - Rajesh Nair
- Department of Urology, Guys and St, Thomas' NHS Foundation Trust, London, England
| | - Wade Muncey
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Nicolas Seranio
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael L Eisenberg
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
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17
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Arnold MJ, Gaillardetz A, Ohiokpehai J. Benign Prostatic Hyperplasia: Rapid Evidence Review. Am Fam Physician 2023; 107:613-622. [PMID: 37327163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Lower urinary tract symptoms from benign prostatic hyperplasia affect 25% of U.S. men, nearly one-half of whom have at least moderate symptoms. Sedentary lifestyle, hypertension, and diabetes mellitus increase risk of symptoms. Evaluation is focused on determining severity of symptoms and therapy to improve symptoms. Rectal examination has limited accuracy in evaluating prostate size. Transrectal ultrasonography is preferred to verify size when starting 5-alpha reductase therapy or considering surgery. Serum prostate-specific antigen testing is not recommended in routine evaluation of lower urinary tract symptoms, and shared decision-making should be used for cancer screening decisions. The International Prostate Symptom Score is the best way to track symptoms. Self-management methods, including limiting evening fluid intake, reducing caffeine and alcohol intake, toilet and bladder training, pelvic floor exercises, and mindfulness techniques, can improve symptoms. Although saw palmetto is not effective, the herbal treatments Pygeum africanum and beta-sitosterol may be effective. Primary medical treatment involves alpha blockers or phosphodiesterase-5 inhibitors. Alpha blockers offer rapid benefit and can be used for acute urinary retention. Combining alpha blockers and phosphodiesterase-5 inhibitors is not beneficial. For uncontrolled symptoms, 5-alpha reductase inhibitors should be started if the prostate volume is 30 mL or greater by ultrasonography. 5-Alpha reductase inhibitors take up to one year to be fully beneficial and are more effective when taken with alpha blockers. Only 1% of patients with lower urinary tract symptoms require surgery. Although transurethral resection of the prostate improves symptoms, many less invasive options with varying effectiveness can be considered.
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Affiliation(s)
- Michael J Arnold
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Andrew Gaillardetz
- Southwestern Illinois/Scott Air Force Base Family Medicine Residency, O'Fallon, Illinois
| | - Jafar Ohiokpehai
- Southwestern Illinois/Scott Air Force Base Family Medicine Residency, O'Fallon, Illinois
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Taniguchi H, Inoue T, Kawa G, Murota T, Tsukino H, Yoshimura K, Kamoto T, Ogawa O, Matsuda T, Kinoshita H. Evaluation of sexual function after dutasteride treatment in patients with once-negative prostate biopsy and benign prostate hyperplasia. Urologia 2023; 90:295-300. [PMID: 36992564 DOI: 10.1177/03915603231163201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
INTRODUCTION Patients with benign prostatic hyperplasia are usually treated with 5α-reduced inhibitors (5ARIs) such as finasteride and dutasteride. However, studies on the influence of 5ARIs on sexual function have been controversial. In this study, we evaluated the impact of dutasteride treatment for erectile function in patients with once-negative prostate biopsy and benign prostate hyperplasia. PATIENTS AND METHODS 81 patients with benign prostate hyperplasia were enrolled in a one-armed prospective study. They were administrated 0.5 mg/day of dutasteride for 12 months. Patient characteristics and changes of International Prostate Symptom Score (IPSS) and International Index of Erectile Function (IIEF)-15 scores at baseline and 12 months after dutasteride administration were examined. RESULTS The mean ± standard deviation (SD) age of the patients was 69.4 ± 4.9 years and the prostate volume was 56.6 ± 21.3 mL, respectively. The mean ± SD prostate volume and PSA levels were decreased 25.0 and 50.9%, respectively, after 12 months of dutasteride administration. IPSS total, voiding subscore, storage subscore, and quality of life score significantly improved after 12 months of dutasteride administration. No statistically significant change in IIEF-total score from 16.3 ± 13.5 to 18.8 ± 16.0 (p = 0.14), IIEF-EF score from 5.1 ± 6.9 to 6.4 ± 8.3 (p = 0.13) were observed. There was no decrease in erectile function severity. CONCLUSION Twelve months administration of dutasteride for patients with BPH improved urinary function and did not increase the risk of sexual dysfunction.
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Affiliation(s)
- Hisanori Taniguchi
- Department of Urology and Andrology, Kansai Medical University, Hirakata, Japan
| | - Takaaki Inoue
- Department of Urology and Andrology, Kansai Medical University, Hirakata, Japan
- Department of Urology, Hara Hospital, Kobe, Japan
| | - Gen Kawa
- Department of Urology and Andrology, Kansai Medical University, Hirakata, Japan
| | - Takashi Murota
- Department of Urology and Andrology, Kansai Medical University, Hirakata, Japan
| | - Hiromasa Tsukino
- Department of Urology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
- Department of Urology, Junwakai Memorial Hospital, Miyazaki, Japan
| | - Koji Yoshimura
- Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Shizuoka General Hospital Urology, Shizuoka, Japan
| | - Toshiyuki Kamoto
- Department of Urology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Osamu Ogawa
- Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tadashi Matsuda
- Department of Urology and Andrology, Kansai Medical University, Hirakata, Japan
| | - Hidefumi Kinoshita
- Department of Urology and Andrology, Kansai Medical University, Hirakata, Japan
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Rodríguez-Cuadrado FJ, Pinto-Pulido EL, Fernández-Parrado M. Mesotherapy with dutasteride for androgenetic alopecia: a concise review of the literature. Eur J Dermatol 2023; 33:72. [PMID: 37178048 DOI: 10.1684/ejd.2023.4443] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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Daryanto B, Purnomo AF, Patriawan YS, Purnomo BB. The Effect of Long-Term Tamsulosin Monotherapy and Tamsulosin - Dutasteride Combination Therapy on PKC-α Enzyme Expression in Prostate Stromal Tissue. Med Arch 2023; 77:446-450. [PMID: 38313112 PMCID: PMC10834045 DOI: 10.5455/medarh.2023.77.446-450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 11/18/2023] [Indexed: 02/06/2024] Open
Abstract
Background The α-adrenergic receptor antagonist is the most effective medical therapy to reduce the dynamic component in patients with BPH. However, long-term administration of receptor antagonists can cause upregulation of mRNA receptor expression, resulting in tolerance of drug effectiveness. PKC-α is involved in the process of prostate smooth muscle contraction through activation of the voltage-gated Ca2+ conducted canal, influenced by androgen hormones, especially testosterone, and has an isoform with Twist1, a transcription factor that plays a role in up-regulation of androgen receptors. Objective The aim of the study was to compare the effect of long-term tamsulosin monotherapy and tamsulosin - dutasteride combination therapy in PKC-α enzyme expression in prostate stromal tissue of Rattus norvegicus rats of Wistar strain. Methods Out of 80 samples of Rattus norvegicus rats were divided into 8 groups with different interventions: negative control group, positive control group, tamsulosin monotherapy administration for 1 day, 3 day, and 6 day groups, and tamsulosin - dutasteride combination therapy for 1 day, 3 day, and 6 day groups. BPH was induced with 3 mg/kg of testosterone proprionate for 3 weeks, continued with drugs administration according to intervention grouping. Prostate stromal tissue was taken and prepared for PKC-α enzyme measurement with ELISA method. Results There was a significant difference (p<0.05) in the effect of tamsulosin monotherapy and tamsulosin-dutasteride combination therapy on the PKC-α expression. There was a strong positive relationship between the duration of tamsulosin-dutasteride combination therapy on the PKC-α expression, which means the longer the duration of the combination of tamsulosin-dutasteride combination the higher the PKC-α expression. Conclusion Administration of long-term tamsulosin - dutasteride combination therapy causes upregulation PKC-α expression more than tamsulosin only.
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Affiliation(s)
- Besut Daryanto
- Department of Urology, Faculty of Medicine Universitas Brawijaya, Saiful Anwar General Hospital, Malang Indonesia
| | - Athaya Febriantyo Purnomo
- Department of Urology, Faculty of Medicine Universitas Brawijaya, Saiful Anwar General Hospital, Malang Indonesia
| | - Yulian Salis Patriawan
- Department of Urology, Faculty of Medicine Universitas Brawijaya, Saiful Anwar General Hospital, Malang Indonesia
| | - Basuki Bambang Purnomo
- Department of Urology, Faculty of Medicine Universitas Brawijaya, Saiful Anwar General Hospital, Malang Indonesia
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Obinata D, Nakahara K, Yoshizawa T, Mochida J, Yamaguchi K, Takahashi S. Characteristics of prostate biopsy in patients under the dutasteride treatment. Medicine (Baltimore) 2022; 101:e31658. [PMID: 36343082 PMCID: PMC9646501 DOI: 10.1097/md.0000000000031658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We performed a retrospective study to clarify the characteristics of prostate biopsies in patients treated with dutasteride, a benign prostate hyperplasia treatment drug that inhibits 5α-reductase. We studied the digital clinical data of 677 patients, including 96 cases treated with dutasteride, with suspected localized prostate cancer. All patients underwent transrectal ultrasonography-guided prostate biopsy between 2014 and 2017 in our department. A propensity score matching analysis was performed based on prostate-specific antigen (PSA) (calculated as double the PSA value for the dutasteride group) and age. Ninety-six patients in each of the dutasteride and control groups were assessed and their characteristics were compared. The characteristics of the patients in the dutasteride and control groups were well balanced by matching. There were fewer prostate cancer-positive patients in the dutasteride group. When comparing only the prostate cancer-positive patients in each group, there were significantly more cases of high-grade cancers and abnormal magnetic resonance imaging (MRI) findings in the dutasteride group. In the dutasteride group, abnormal MRI findings and advanced age were significant predictors of high grade cancer. This study shows the characteristics of prostate biopsies in patients treated with dutasteride and indicates that patients on dutasteride with advanced age and abnormal MRI findings should undergo prostate biopsy.
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Affiliation(s)
- Daisuke Obinata
- Department of Urology, Nihon University School of Medicine, Tokyo, Japan
| | - Ken Nakahara
- Department of Urology, Nihon University School of Medicine, Tokyo, Japan
| | - Tsuyoshi Yoshizawa
- Department of Urology, Nihon University School of Medicine, Tokyo, Japan
| | - Junichi Mochida
- Department of Urology, Nihon University School of Medicine, Tokyo, Japan
| | - Kenya Yamaguchi
- Department of Urology, Nihon University School of Medicine, Tokyo, Japan
- * Correspondence: Kenya Yamaguchi, Department of Urology, Nihon University School of Medicine, 30-1, Oyaguchikamicho, Itabashi-ku, Tokyo 173-8610, Japan (e-mail: )
| | - Satoru Takahashi
- Department of Urology, Nihon University School of Medicine, Tokyo, Japan
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Jia L, Strand DW, Goueli RS, Gahan JC, Roehrborn CG, Mauck RJ. PSA density is associated with BPH cellular composition. Prostate 2022; 82:1162-1169. [PMID: 35652548 PMCID: PMC9329225 DOI: 10.1002/pros.24367] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/23/2022] [Accepted: 04/20/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Current AUA guidelines recommend 5 alpha reductase inhibitor (5ARI) treatment for patients with obstructive benign prostatic hyperplasia (BPH) that display prostate volume ≥30 cc and total prostate specific antigen (PSA) ≥1.5 ng/ml. However, BPH is highly pleomorphic and response to 5ARIs is highly variable. An understanding of cellular composition based on a noninvasive PSA density test could lead to improved clinical decision making. METHODS The histological composition of 307 BPH specimens was scored by a pathologist for stromo-glandular content and associated with total PSA, prostate volume, PSA density and other clinical variables using univariate and multivariate linear regression. RESULTS The percentage of glandular composition in prostates of 5ARI-naïve men was positively and independently associated with PSA and PSA density. It was determined through statistical modeling that a PSA density ≤0.05 ng/ml2 associated with a glandular composition of ≤30% with 76% sensitivity. CONCLUSIONS PSA density could provide a decisive variable for estimating BPH cellular content and may eventually improve selection of patients for 5ARI treatment. Further work is needed to demonstrate that patients with higher glandular content are more responsive to 5ARI treatment.
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Affiliation(s)
- Liwei Jia
- Department of Pathology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Douglas W Strand
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Ramy S Goueli
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Jeffrey C Gahan
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Claus G Roehrborn
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Ryan J Mauck
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas, USA
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23
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Hamilton RJ. 5-Alpha Reductase Inhibitor Use and Prostate Cancer Prevention: A Victim of the Times? Cancer Epidemiol Biomarkers Prev 2022; 31:1259-1260. [PMID: 35775229 DOI: 10.1158/1055-9965.epi-22-0338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/13/2022] [Accepted: 04/27/2022] [Indexed: 11/16/2022] Open
Abstract
Vaselkiv and colleagues present strong evidence of the long-term safety of 5-alpha reductase inhibitor (5-ARI) use. They demonstrated no association with developing advanced prostate cancer, nor dying of prostate cancer. This commentary covers the strengths and weaknesses of the article, and highlights the long and vacillating journey 5-ARIs and prostate cancer prevention have traveled. As 5-ARIs preferentially prevent low-grade prostate cancer, a fact confirmed in the study by Vaselkiv and colleagues, this commentary highlights how 5-ARI chemoprevention may be irrelevant now. With increasing use of active surveillance for low-grade prostate cancers found, and prebiopsy MRI and biomarkers shifting focus to only find those clinically significant cancers, it maybe that 5-ARIs are a victim of the times in their chemoprevention role. See related article by Vaselkiv et al., p. 1460.
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Papadopoulos KI, Papadopoulou A, Sutheesophon W, Aw TC. Anti-SARS-CoV-2 Action of 5α-Reductase Inhibitors May Be Mediated by Dehydroepiandrosterone. Letter. J Urol 2022; 207:1163-1164. [PMID: 35119308 DOI: 10.1097/ju.0000000000002469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
| | | | | | - Tar-Choon Aw
- Department of Laboratory Medicine, Changi General Hospital, Singapore, Singapore
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25
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Uemura H. [Chemoprevention for Prostate Cancer-The Potential of Angiotensin Ⅱ Receptor Blocker]. Gan To Kagaku Ryoho 2021; 48:1435-1439. [PMID: 34911906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In Japan, the incidence of prostate cancer(Pca)has been increasing mainly due to the early detection system by PSA screening. Considering pharmacoepidemiology, the statins and metformin have been recognized to lower the risk of incidence of Pca. Excessive intake of calcium, multivitamin and vitamin E increased the Pca risk. The 5-alpha-reductase inhibitors( 5ARIs)are widely used in the treatment of benign prostatic hyperplasia(BPH)by biological function of inhibiting the conversion from testosterone to dihydrotestosterone. A systematic review and meta-analysis identified that 5ARIs had no impact on overall mortality and Pca-related mortality, nor on high-grade Pca diagnosis. The use of anti-hypertensive drugs was reportedly associated with an increasing risk of Pca. However, as an effect of post diagnostic use of anti-hypertensive drugs, angiotensin Ⅱ receptor blockers(ARBs)was associated with improved overall survival and cause specific survival, which means the second chemoprevention potential for Pca. Our previous investigation demonstrated ARBs can suppress the expression of androgen receptor and affect the proliferative signal transduction system in Pca cells. Based on additional data of our experiment, we confirmed the anti-tumor effect of ARBs for Pca, and further clinical trials to make sure the chemoprevention for pre-diagnostic Pca is needed in future.
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Affiliation(s)
- Hiroji Uemura
- Dept. of Urology and Renal Transplantation, Yokohama City University Medical Center
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26
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Park JJ, Lee HY, Shim SR, Lee SW, Kim KT, Kim JH. Prostate cancer specific mortality after 5α-reductase inhibitors medication in benign prostatic hyperplasia patients: systematic review and meta-analysis. Aging Male 2021; 24:80-91. [PMID: 34889709 DOI: 10.1080/13685538.2021.1948993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Our study was conducted to investigate the effect of 5-ARI on the death rate from prostate cancer by means of an updated meta-analysis using related data. METHODS We did comprehensive literature searches using the PubMed, Embase, and Cochrane databases through July 2019. We evaluated the risk of bias in such studies using the ROBINS-I tool and analyzed deaths from cancer and deaths from all causes using HR. RESULTS The meta-analysis included 11 studies. The pooled overall HRs for cancer-specific deaths between 5-ARI treatment versus non-exposed groups were 0.937 (95% CI: 0.730, 1.201). In the subgroup moderator analysis, the number of patients and additional medication variables were significantly associated with deaths from all causes (p = 0.022 and p = 0.005, respectively). For detecting the publication bias or small-study effect in the included studies, we performed Begg and Mazumdar's correlation test (0.851 and 0.573) and Egger's regression coefficient test (0.035 and 0.245) and suggested that there was no evidence of publication bias or small-study effect in this meta-analysis. CONCLUSIONS Our study indicated that exposure to 5-ARI had no close association between the overall death rate or cancer-specific deaths. To confirm these results, well-designed prospective studies with large samples are required.
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Affiliation(s)
- Jae Joon Park
- Department of Urology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hyun Young Lee
- Department of Urology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Sung Ryul Shim
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sang Wook Lee
- Department of Urology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Kwang Taek Kim
- Department of Urology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jae Heon Kim
- Department of Urology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
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Minh TD, Thanh Ha TN, Duy TN, Hoang NN, PhamTien D, Thai HP, Thi HN, Thi Lan PD, Quoc BP, Ivkin DY, Povydysh MN, Cong BN, Krasnova MV. Linh Phu Khang Tue Tinh inhibited prostate proliferation in rats induced benign prostatic hyperplasia by testosterone propionate. J Ethnopharmacol 2021; 279:114388. [PMID: 34224813 DOI: 10.1016/j.jep.2021.114388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/16/2021] [Accepted: 06/30/2021] [Indexed: 06/13/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Benign prostatic hyperplasia (BPH) is the hyperproliferation of the stromal and the epithelial cells within the prostatic transition zone. In recent years, phytotherapy have been studied with the concern for increasing quality of life, improving lower urinary tract symptoms (LUTS) as well as reducing prostate volume and the frequency of adverse events was similar to that of placebo. Linh Phu Khang Tue Tinh (LPKTT) capsules are formulated from 4 herbs widely used in traditional Vietnamese medicine - Panax notoginseng (Burkill) F.H.Chen - Tam thất (radix), Crinum asiaticum L. - Náng hoa trắng or giant crinum lily, Polygonum cuspidatum Willd. ex Spreng. (= Reynoutria japonica Houtt) - Cốt củ khí or Japanese knotweed (radix), Oldenlandia herbacea (L.) Roxb. (formerly known as Hedyotis diffusa Spreng.) - Bạch hoa xà thiẹ^t thảo or slender oldenlandia (herb). The preparation has been used in traditional Vietnamese medicine to treat nocturia, weak urine stream, urinary tract infection. According to modern studies, these herbs have anti-inflammation, antitumor, and antioxidant activities. AIMS OF THE STUDY Evaluating the effects of LPKTT capsules on the development of BPH using a rat model of BPH induced by testosterone propionate (TP). MATERIALS AND METHODS 60 male Wistar rats, 10-12 weeks of age, weight 200-250 g were separated into six groups: (G1) a normal control group that was taken orally phosphate-buffered saline (p.o.; PBS.) with corn oil (subcutaneous injection- Sc); (G2) a BPH model group that received PBS (p.o) with TP (Sc); (G3) a positive control group that received dutasteride (25 μg/kg BW/24 h, p.o.) with TP (Sc); (G4) a positive control group that received alfuzosin HCl (1.8 mg/kg BW/24 h, p.o.) with TP (s.c.) and (G5 and G6) LPKTT groups that received LPKTT at 289.8 or 869.4 mg/kg(p.o.) respectively, with TP (s.c.). BPH model was induced by Sc of TP, 3 mg/kg for 4 weeks. After that, rats were received NaCl/Dutasteride/Alfuzosin/LPKTT for the next 28 days. On the 56th day, assessed the results were through the indicators: micturition frequency, voided volume, total voided volume, the prostate and body weights, the ratio of prostate weight to body weight, prostate histology. RESULTS LPKTT reduced micturition frequency and increased the voided volume when compared to the control group (p < 0.01). The results were equivalent to those of the alfuzosin ones (G4). LPKTT lowered prostate weight and the ratio of prostate weight to body weight when compared to the control group (p < 0.01). These reductions were the same in the dutasteride ones. Histomorphology in G5 and G6 also showed that LPKTT inhibited TP induced prostatic hyperplasia. The results were similar to that in the dutasteride group. Microscopic images of prostate in G5 and G6 were almost similar to that of G1. CONCLUSION LPKTT capsules work to inhibit prostate proliferation in rats induced BPH by TP.
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Affiliation(s)
- Thuy Doan Minh
- Vietnam University of Traditional Medicine, 2 Tranphu Street, Hadong district, Hanoi, 100000, Viet Nam; General Surgery Department, Viet Nam.
| | - Tuan Nguyen Thanh Ha
- Hospital 103, Viet Nam; Vietnam Military Medical University, 160 Phunghung, Hadong district, Hanoi, 100000, Viet Nam
| | - Thuan Nguyen Duy
- Vietnam University of Traditional Medicine, 2 Tranphu Street, Hadong district, Hanoi, 100000, Viet Nam; Department of Pharmacology, Viet Nam
| | - Ngan Nguyen Hoang
- Vietnam Military Medical University, 160 Phunghung, Hadong district, Hanoi, 100000, Viet Nam; Department of Pharmacology, Viet Nam
| | - Dung PhamTien
- Department of Traditional Medicine, Haiphong University of Medicine and Pharmacy, 72A Nguyen Binh Khiem, Ngo Quyen, Hai Phong, 180000, Viet Nam
| | - Hung Pham Thai
- Vietnam University of Traditional Medicine, 2 Tranphu Street, Hadong district, Hanoi, 100000, Viet Nam; General Surgery Department, Viet Nam
| | - Hoa Nguyen Thi
- Vietnam University of Traditional Medicine, 2 Tranphu Street, Hadong district, Hanoi, 100000, Viet Nam; General Surgery Department, Viet Nam
| | - Phuong Dang Thi Lan
- Vietnam University of Traditional Medicine, 2 Tranphu Street, Hadong district, Hanoi, 100000, Viet Nam; General Surgery Department, Viet Nam
| | - Binh Pham Quoc
- Vietnam University of Traditional Medicine, 2 Tranphu Street, Hadong district, Hanoi, 100000, Viet Nam; Department of Theoretical Traditional Medicine, Viet Nam
| | - D Y Ivkin
- Department of Pharmacology and Clinical Pharmacology, Saint Petersburg State Chemical Pharmaceutical University, Saint Petersburg, Russia
| | - M N Povydysh
- Department of Pharmacology and Clinical Pharmacology, Saint Petersburg State Chemical Pharmaceutical University, Saint Petersburg, Russia.
| | - Bang Nguyen Cong
- Vietnam Military Medical University, 160 Phunghung, Hadong district, Hanoi, 100000, Viet Nam
| | - M V Krasnova
- Department of Pharmacology and Clinical Pharmacology, Saint Petersburg State Chemical Pharmaceutical University, Saint Petersburg, Russia
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Jin R, Strand DW, Forbes CM, Case T, Cates JM, Liu Q, Ramirez-Solano M, Milne GL, Sanchez S, Wang ZY, Bjorling DE, Miller NL, Matusik RJ. The prostaglandin pathway is activated in patients who fail medical therapy for benign prostatic hyperplasia with lower urinary tract symptoms. Prostate 2021; 81:944-955. [PMID: 34288015 PMCID: PMC8750893 DOI: 10.1002/pros.24190] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/16/2021] [Accepted: 06/29/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Little is known about how benign prostatic hyperplasia (BPH) develops and why patients respond differently to medical therapy designed to reduce lower urinary tract symptoms (LUTS). The Medical Therapy of Prostatic Symptoms (MTOPS) trial randomized men with symptoms of BPH and followed response to medical therapy for up to 6 years. Treatment with a 5α-reductase inhibitor (5ARI) or an alpha-adrenergic receptor antagonist (α-blocker) reduced the risk of clinical progression, while men treated with combination therapy showed a 66% decrease in risk of progressive disease. However, medical therapies for BPH/LUTS are not effective in many patients. The reasons for nonresponse or loss of therapeutic response in the remaining patients over time are unknown. A better understanding of why patients fail to respond to medical therapy may have a major impact on developing new approaches for the medical treatment of BPH/LUTS. Prostaglandins (PG) act on G-protein-coupled receptors (GPCRs), where PGE2 and PGF2 elicit smooth muscle contraction. Therefore, we measured PG levels in the prostate tissue of BPH/LUTS patients to assess the possibility that this signaling pathway might explain the failure of medical therapy in BPH/LUTS patients. METHOD Surgical BPH (S-BPH) was defined as benign prostatic tissue collected from the transition zone (TZ) of patients who failed medical therapy and underwent surgical intervention to relieve LUTS. Control tissue was termed Incidental BPH (I-BPH). I-BPH was TZ obtained from men undergoing radical prostatectomy for low-volume, low-grade prostatic adenocarcinoma (PCa, Gleason score ≤ 7) confined to the peripheral zone. All TZ tissue was confirmed to be cancer-free. S-BPH patients divided into four subgroups: patients on α-blockers alone, 5ARI alone, combination therapy (α-blockers plus 5ARI), or no medical therapy (none) before surgical resection. I-BPH tissue was subgrouped by prior therapy (either on α-blockers or without prior medical therapy before prostatectomy). We measured prostatic tissue levels of prostaglandins (PGF2α , PGI2 , PGE2 , PGD2 , and TxA2 ), quantitative polymerase chain reaction levels of mRNAs encoding enzymes within the PG synthesis pathway, cellular distribution of COX1 (PTGS1) and COX2 (PTGS2), and tested the ability of PGs to contract bladder smooth muscle in an in vitro assay. RESULTS All PGs were significantly elevated in TZ tissues from S-BPH patients (n = 36) compared to I-BPH patients (n = 15), regardless of the treatment subgroups. In S-BPH versus I-BPH, mRNA for PG synthetic enzymes COX1 and COX2 were significantly elevated. In addition, mRNA for enzymes that convert the precursor PGH2 to metabolite PGs were variable: PTGIS (which generates PGI2 ) and PTGDS (PGD2 ) were significantly elevated; nonsignificant increases were observed for PTGES (PGE2 ), AKR1C3 (PGF2α ), and TBxAS1 (TxA2 ). Within the I-BPH group, men responding to α-blockers for symptoms of BPH but requiring prostatectomy for PCa did not show elevated levels of COX1, COX2, or PGs. By immunohistochemistry, COX1 was predominantly observed in the prostatic stroma while COX2 was present in scattered luminal cells of isolated prostatic glands in S-BPH. PGE2 and PGF2α induced contraction of bladder smooth muscle in an in vitro assay. Furthermore, using the smooth muscle assay, we demonstrated that α-blockers that inhibit alpha-adrenergic receptors do not appear to inhibit PG stimulation of GPCRs in bladder muscle. Only patients who required surgery to relieve BPH/LUTS symptoms showed significantly increased tissue levels of PGs and the PG synthetic enzymes. CONCLUSIONS Treatment of BPH/LUTS by inhibition of alpha-adrenergic receptors with pharmaceutical α-blockers or inhibiting androgenesis with 5ARI may fail because of elevated paracrine signaling by prostatic PGs that can cause smooth muscle contraction. In contrast to patients who fail medical therapy for BPH/LUTS, control I-BPH patients do not show the same evidence of elevated PG pathway signaling. Elevation of the PG pathway may explain, in part, why the risk of clinical progression in the MTOPS study was only reduced by 34% with α-blocker treatment.
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Affiliation(s)
- Renjie Jin
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Connor M. Forbes
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Thomas Case
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Justin M.M. Cates
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Qi Liu
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Marisol Ramirez-Solano
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ginger L. Milne
- Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stephanie Sanchez
- Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Zunyi Y. Wang
- School of Veterinary Medicine, University of Wisconsin, Madison, WI
| | - Dale E. Bjorling
- School of Veterinary Medicine, University of Wisconsin, Madison, WI
| | - Nicole L. Miller
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert J. Matusik
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
- Corresponding author Robert J. Matusik, Ph.D., Department of Urology, A1302 MCN, Vanderbilt University Medical Center, Nashville, TN 37232,
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Spivak L, Morozov A, Shpikina A, Enikeev D, Rapoport L. Postoperative medical treatment of lower urinary tract symptoms after benign prostatic hyperplasia surgery. Are we underestimating the problem? Curr Opin Urol 2021; 31:451-455. [PMID: 34175875 DOI: 10.1097/mou.0000000000000912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The aim of this study was to determine whether well timed start of medical and surgical treatment of benign prostatic obstruction (BPO) influences the treatment's effectiveness and thus the patients' overall functional outcomes and quality of life. RECENT FINDINGS Pharmacological therapy even in high-volume (>80 cm3) BPH typically begins with α-blockers sole and only subsequently are 5ARI added. Several studies showed that acute urinary retention (AUR) developed more frequently in men who suffered severe lower urinary tract symptoms (LUTS) and who did not start combination therapy immediately. Moreover, there are no strict criteria which determine the right time for performing surgery in patients with mild and moderate LUTS, especially when pharmacological therapy fails. However, sometimes, the surgery does not eliminate all the symptoms, as it deals effectively with BPO, but does not treat an overactive bladder. Also, data show that surgery should be performed as soon as possible and be more radical after the first episode of AUR. SUMMARY A combination of α-blockers and 5ARI makes for a good starting point where the treatment of high volume BPH is concerned. Ideally, surgery should be performed immediately or as soon as possible in patients with the first episode of AUR and 'anatomic' BPH tissue removal is preferable (dissection of tissue along the prostate capsule to remove its maximum volume).
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Affiliation(s)
| | | | - Anastasia Shpikina
- International School 'Medicine of the Future', Sechenov University, Moscow, Russia
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Soares Júnior JM, Guimarães DZ, Simões RDS, Veiga ECDA, Roa CL, Sorpreso ICE, Baracat MC, Baracat EC. Systematic review of finasteride effect in women with hirsutism. Rev Assoc Med Bras (1992) 2021; 67:1043-1049. [PMID: 34817521 DOI: 10.1590/1806-9282.20210248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 05/23/2021] [Indexed: 11/22/2022]
Affiliation(s)
- José Maria Soares Júnior
- Universidade de São Paulo, School of Medicine, Clinic's Hospital, Department of Gynecology - São Paulo (SP), Brazil
| | - Daniela Zaros Guimarães
- Universidade de São Paulo, School of Medicine, Clinic's Hospital, Department of Gynecology - São Paulo (SP), Brazil
| | - Ricardo Dos Santos Simões
- Universidade de São Paulo, School of Medicine, Clinic's Hospital, Department of Gynecology - São Paulo (SP), Brazil
| | | | - Cristiane Lima Roa
- Universidade de São Paulo, School of Medicine, Clinic's Hospital, Department of Gynecology - São Paulo (SP), Brazil
| | | | - Maria Cândida Baracat
- Universidade de São Paulo, School of Medicine, Clinic's Hospital, Department of Gynecology - São Paulo (SP), Brazil
| | - Edmund Chada Baracat
- Universidade de São Paulo, School of Medicine, Clinic's Hospital, Department of Gynecology - São Paulo (SP), Brazil
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Kuzmenko AV, Kuzmenko VV, Gyaurgiev TA. [Comparative analysis of the effectiveness of early and delayed initiation of combined DRUG therapy for bph]. Urologiia 2021:27-30. [PMID: 33960153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Currently, -blockers (-AB) and 5-alpha-reductase inhibitors (I-5-AR) are recommended as the drugs of choice for the treatment of patients with benign prostatic hyperplasia (BPH). However, despite the clear advantages of combination therapy, at the initial stages of treatment, I-5-AR is either not prescribed at all, or added to therapy after a few months. The aim of our study is to study the effectiveness of early and various options for delayed combined drug therapy of patients with BPH using -AB and I-5-AR. MATERIALS AND METHODS The study included 90 patients with BPH, who were divided into three groups of 30 people. In group 1, monotherapy with drugs from the -AB group was performed for 6 months, after which they were transferred to treatment with a combined drug. In group 2, monotherapy was performed for three months, after which they were also transferred to treatment with a combined drug. And in group 3, patients were prescribed combination therapy from day 1. RESULTS Early combination therapy with dutasteride was more effective than delayed Therapy for 6 months. There were no significant differences in the main parameters studied between patients who simultaneously started combination therapy and switched to it after 3 months, by the end of the 12th month of treatment. However, early therapy is a combined drug made it possible to achieve a more rapid effect in relation to LUTS. CONCLUSION Thus, the data obtained confirm the clinical recommendations regarding the expediency of early initiation of combined therapy with an -adrenoblocker and a 5-reductase inhibitor in patients with moderate and severe LUTS caused by BPH and the risk of disease progression. Postponing the transition to combination therapy for 6 months or more may lead to a decrease in the effectiveness of treatment of patients in this category.
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Affiliation(s)
- A V Kuzmenko
- Voronezh State Medical University n.a. N.N. Burdenko, Voronezh, Russia
| | - V V Kuzmenko
- Voronezh State Medical University n.a. N.N. Burdenko, Voronezh, Russia
| | - T A Gyaurgiev
- Voronezh State Medical University n.a. N.N. Burdenko, Voronezh, Russia
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Loughlin KR. The clinical applications of five-alpha reductase inhibitors. Can J Urol 2021; 28:10584-10588. [PMID: 33872554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
UNLABELLED INTRODUCTION Five-alpha reductase (5-AR) deficiency was first identified by Imperato-McGinley and Walsh as the cause of pseudohermaphroditism in two separate studies. The discoveries led to the development of finasteride (inhibitor of type 2 isoenzyme of 5-AR) and dutasteride (inhibitor of type 1 and type 2 isoenzymes of 5-AR. Both drugs have been proven effective for the treatment of benign prostatic hyperplasia and improve voiding symptoms, reduce the risk of urinary retention and the need for prostate surgery. Five-alpha reductase inhibitors 5-ARIs have been demonstrated to be chemopreventive agents and reduce the risk of prostate cancer, although the risk of selecting out or mediating higher grade prostate cancer remains uncertain. A lower dose of finasteride has been shown to be effective in the treatment of male pattern baldness. MATERIALS AND METHODS A Medline search was performed using mesh terms, benign prostatic hypertrophy, prostate cancer, male pattern baldness, female and 5-AR. RESULTS The Prostate Long Term Efficacy and Safety Study (PLESS) was a randomized double-blind study that established that finasteride resulted in a 22% increase in maximum flow rate and a 19% decrease in prostate volume. Further studies demonstrated that finasteride caused a significant reduction in the risk of the need for surgery and urinary retention in a 4 year period. Additional studies showed similar beneficial results with dutasteride. The potential benefits of 5-ARIs as chemopreventive agents were examined in the Prostate Cancer Prevention Trial (PCPT) and the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) studies. In the 7 year PCPT trial, 18.4% of the finasteride group developed prostate cancer compared to 24.4% in the placebo group. In the 4 year REDUCE trial, there was a 22.8% reduction of prostate cancer at the conclusion of the study. Despite the reduction of prostate cancer in both the PCPT and REDUCE trials, each study showed an increased risk of prostate cancer in the treatment arms. The explanation for these observations remains an area of investigation. Low dose finasteride has also been used successfully for the treatment of male pattern baldness. CONCLUSIONS The use of 5-ARIs has been a major advance in urologic clinical practice. Urologists should be familiar with the underlying pharmacology of 5-ARIs as well as the clinical indications for their use.
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Affiliation(s)
- Kevin R Loughlin
- Harvard Medical School, Vascular Biology Laboratory, Boston Children's Hospital, Boston, Massachusetts, USA
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Nikolaou N, Hodson L, Tomlinson JW. The role of 5-reduction in physiology and metabolic disease: evidence from cellular, pre-clinical and human studies. J Steroid Biochem Mol Biol 2021; 207:105808. [PMID: 33418075 DOI: 10.1016/j.jsbmb.2021.105808] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 12/31/2020] [Accepted: 01/03/2021] [Indexed: 01/01/2023]
Abstract
The 5-reductases (5α-reductase types 1, 2 and 3 [5αR1-3], 5β-reductase [5βR]) are steroid hormone metabolising enzymes that hold fundamental roles in human physiology and pathology. They possess broad substrate specificity converting many steroid hormones to their 5α- and 5β-reduced metabolites, as well as catalysing crucial steps in bile acid synthesis. 5αRs are fundamentally important in urogenital development by converting testosterone to the more potent androgen 5α-dihydrotestosterone (5αDHT); inactivating mutations in 5αR2 lead to disorders of sexual development. Due to the ability of the 5αRs to generate 5αDHT, they are an established drug target, and 5αR inhibitors are widely used for the treatment of androgen-dependent benign or malignant prostatic diseases. There is an emerging body of evidence to suggest that the 5-reductases can impact upon aspects of health and disease (other than urogenital development); alterations in their expression and activity have been associated with metabolic disease, polycystic ovarian syndrome, inflammation and bone metabolism. This review will outline the evidence base for the extra-urogenital role of 5-reductases from in vitro cell systems, pre-clinical models and human studies, and highlight the potential adverse effects of 5αR inhibition in human health and disease.
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Affiliation(s)
- Nikolaos Nikolaou
- Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford, OX3 7LE, UK
| | - Leanne Hodson
- Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford, OX3 7LE, UK
| | - Jeremy W Tomlinson
- Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford, OX3 7LE, UK.
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Rundle CW, Price KN, Hogeling M, Hsiao JL, Shi VY. Recent advances in hidradenitis suppurativa in pediatrics. Dermatol Online J 2020; 26:13030/qt5gt6m9n3. [PMID: 33423411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 12/29/2020] [Indexed: 06/12/2023] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that can cause significant physical, mental, and socioeconomic burden. There remains a paucity of literature on HS in the pediatric population. This systematic review highlights recent advances in pediatric HS in epidemiology, presentation, comorbidities, and management. PubMed, Embase, Google Scholar, and Clinicaltrials.gov databases were used to identify trials and articles published on HS in pediatric patients between January 2015 and October 2019. A total of 39 articles were included. Current evidence suggests that pediatric onset HS may be associated with genetic factors along with endocrine and metabolic abnormalities. Delayed diagnosis in children with HS contributes to poor outcomes. Overall, children and adults with HS share similar lesion types and involved areas. Pediatric HS is associated with a number of comorbid conditions including acne, obesity, inflammatory joint disease, Down syndrome, inflammatory bowel disease, and diabetes. There are currently no pediatric treatment guidelines. Adalimumab is approved for the treatment of moderate-to-severe HS in children 12 and older. Other targeted immunomodulators and hormonal modulators are under investigation. Although the number of studies concerning HS are increasing, further investigation is warranted to better characterize HS, facilitate early diagnosis, and determine the best management for children.
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Affiliation(s)
| | | | | | | | - V Y Shi
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, AR.
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35
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Mizoguchi S, Mori K, Shin T, Wang Z, DeFranco DB, Yoshimura N, Mimata H. Effects of dutasteride in a rat model of chemically induced prostatic inflammation-Potential role of estrogen receptor β. Prostate 2020; 80:1413-1420. [PMID: 32941694 PMCID: PMC7685523 DOI: 10.1002/pros.24071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 08/25/2020] [Accepted: 08/31/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND Dutasteride administration reportedly improves lower urinary tract symptoms in patient with chronic, histologically-identified prostatic inflammation, potentially through estrogen receptor β (ERβ), activation of which has anti-inflammatory effects in the prostate tissue. Therefore, we investigated the effect of dutasteride on intraprostatic inflammatory responses and bladder activity using a rat model of chemically induced prostatic inflammation. METHODS Male Sprague-Dawley rats at 10 weeks old were used. Prostatic inflammation was induced by 5% formalin injection into ventral lobes of the prostate and saline was injected in the control group (control, n = 5). Rats with prostatic inflammation were divided into dutasteride therapy (dutasteride, n = 5) and placebo groups (placebo, n = 5). Dutasteride was administrated at a dose of 0.5 mg/kg daily from 2 days before induction of prostatic inflammation whereas placebo rats received vehicle only. Twenty-eight days later, cystometry was performed in a conscious condition to measure non-voiding contractions (NVCs), intercontraction intervals (ICI) and postvoid residual volume (RV). After cystometry, the prostate was excised for analysis of messenger RNA (mRNA) expression levels of ERα, ERβ, interleukin-1β (IL-1β), and IL-18 by quantitative polymerase chain reaction. RESULTS The mean number of NVCs was significantly greater in placebo group than that of control group without prostatic inflammation (p < .05), and ICI were significantly decreased in placebo group compared with control group (p < .05). On the contrary, there was no significant change in NVCs or ICI between control and dutasteride groups. RV was not significantly different among three groups. Gene expression levels of ERα, IL-1β, and IL-18 was significantly increased in placebo rats compared with control rats (p < .05), but not significantly different between control and dutasteride rats. On the other hand, the mRNA expression level of ERβ was significantly decreased in placebo rats (p < .05), but not in dutasteride rats, compared with control rats. CONCLUSION Dutasteride treatment improved not only prostatic inflammation evident as increased gene expression levels in IL-1β and IL-18, but also bladder overactivity shown by increased NVCs during bladder filling. These therapeutic effects were associated with the restored expression of anti-inflammatory ERβ. Therefore, dutasteride might be effective via ERβ modulation for the treatment of prostatic inflammation in addition to its previously known, anti-androgenic effects on benign prostatic hyperplasia.
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Affiliation(s)
- Shinsuke Mizoguchi
- Department of Urology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Urology, Oita University Graduate School of Medicine, Yufu, Japan
| | - Kenichi Mori
- Department of Urology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Urology, Oita University Graduate School of Medicine, Yufu, Japan
| | - Toshitaka Shin
- Department of Urology, Oita University Graduate School of Medicine, Yufu, Japan
| | - Zhou Wang
- Department of Urology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Pharmacology & Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Donald B. DeFranco
- Department of Pharmacology & Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Naoki Yoshimura
- Department of Urology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Pharmacology & Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Hiromitsu Mimata
- Department of Urology, Oita University Graduate School of Medicine, Yufu, Japan
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Stoddard MD, Cho A, Te AE, Chughtai B. A Systematic Review on the Timing of Surgical Intervention for Benign Prostatic Enlargement (BPE). Curr Urol Rep 2020; 21:64. [PMID: 33230722 DOI: 10.1007/s11934-020-01016-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW Surgical intervention for benign prostatic enlargement (BPE) is typically reserved for those who fail medical therapy (i.e., α-blocker or 5-α reductase inhibitor treatment). We conducted a systematic review to determine whether timing of surgical intervention for BPE affects patient outcomes. RECENT FINDINGS The studies we reviewed suggested that patients who undergo surgical intervention for BPE after failing medical therapy may have worse outcomes. Increased age, worsened bladder function, and worse overall health may contribute to worsened outcomes. To date, there are few high-quality studies on the timing of surgical intervention for BPE in the literature. Further prospective trials are needed to determine ideal timing for intervention.
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Affiliation(s)
| | - Ahra Cho
- Weill Cornell Medicine, New York, NY, 10065, USA
| | - Alexis E Te
- Weill Cornell Medicine, New York, NY, 10065, USA
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Hashizume A, Fischbeck KH, Pennuto M, Fratta P, Katsuno M. Disease mechanism, biomarker and therapeutics for spinal and bulbar muscular atrophy (SBMA). J Neurol Neurosurg Psychiatry 2020; 91:1085-1091. [PMID: 32934110 DOI: 10.1136/jnnp-2020-322949] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/10/2020] [Accepted: 07/27/2020] [Indexed: 12/13/2022]
Abstract
Spinal and bulbar muscular atrophy (SBMA) is a hereditary neuromuscular disorder caused by CAG trinucleotide expansion in the gene encoding the androgen receptor (AR). In the central nervous system, lower motor neurons are selectively affected, whereas pathology of patients and animal models also indicates involvement of skeletal muscle including loss of fast-twitch type 2 fibres and increased slow-twitch type 1 fibres, together with a glycolytic-to-oxidative metabolic switch. Evaluation of muscle and fat using MRI, in addition to biochemical indices such as serum creatinine level, are promising biomarkers to track the disease progression. The serum level of creatinine starts to decrease before the onset of muscle weakness, followed by the emergence of hand tremor, a prodromal sign of the disease. Androgen-dependent nuclear accumulation of the polyglutamine-expanded AR is an essential step in the pathogenesis, providing therapeutic opportunities via hormonal manipulation and gene silencing with antisense oligonucleotides. Animal studies also suggest that hyperactivation of Src, alteration of autophagy and a mitochondrial deficit underlie the neuromuscular degeneration in SBMA and provide alternative therapeutic targets.
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MESH Headings
- 5-alpha Reductase Inhibitors/therapeutic use
- Adipose Tissue/diagnostic imaging
- Adrenergic beta-Agonists/therapeutic use
- Autophagy
- Biomarkers
- Bulbo-Spinal Atrophy, X-Linked/diagnostic imaging
- Bulbo-Spinal Atrophy, X-Linked/metabolism
- Bulbo-Spinal Atrophy, X-Linked/physiopathology
- Bulbo-Spinal Atrophy, X-Linked/therapy
- Clenbuterol/therapeutic use
- Creatinine/metabolism
- Dutasteride/therapeutic use
- Glycolysis
- Humans
- Insulin-Like Growth Factor I/analogs & derivatives
- Leuprolide/therapeutic use
- Magnetic Resonance Imaging
- Mitochondria/metabolism
- Muscle Fibers, Fast-Twitch/metabolism
- Muscle Fibers, Fast-Twitch/pathology
- Muscle Fibers, Slow-Twitch/metabolism
- Muscle Fibers, Slow-Twitch/pathology
- Muscle, Skeletal/diagnostic imaging
- Muscle, Skeletal/metabolism
- Muscle, Skeletal/pathology
- Oligonucleotides, Antisense/therapeutic use
- Oxidation-Reduction
- RNAi Therapeutics
- Receptors, Androgen/genetics
- Receptors, Androgen/metabolism
- Trinucleotide Repeat Expansion
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Affiliation(s)
- Atsushi Hashizume
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kenneth H Fischbeck
- Neurogenetics Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Maria Pennuto
- Department of Biomedical Sciences (DBS), University of Padova, Padova, Italy
- Veneto Institute of Molecular Medicine (VIMM), Padova, Italy
| | - Pietro Fratta
- Depatment of Neuromuscular Diseases, University College London Institute of Neurology, London, UK
- MRC Centre for Neuromuscular Diseases, University College London Institute of Neurology, London, UK
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Lee SG, Park PJ, Lee SR, Koo BH, Byun GY, Kim MJ, Kang HJ, Kim S, Oh BS, Lee YH. Influence of Postoperative Finasteride Therapy on Recurrence of Gynecomastia After Mastectomy in Men Taking Finasteride for Alopecia. Am J Mens Health 2020; 13:1557988319871423. [PMID: 31552775 PMCID: PMC6764051 DOI: 10.1177/1557988319871423] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Finasteride is commonly used for treatment of alopecia. Because finasteride is a
cause of gynecomastia, there is concern regarding the continuation of
finasteride therapy after mastectomy. No studies have been performed to
determine whether finasteride should be continued after mastectomy when
gynecomastia occurs in patients taking finasteride for the treatment of
alopecia. The researchers studied the effects of finasteride on gynecomastia
recurrence after mastectomy in men with gynecomastia taking finasteride for
alopecia. The researchers retrospectively evaluated 1,673 patients with
gynecomastia who underwent subcutaneous mastectomy with liposuction at Damsoyu
Hospital from January 2014 to December 2016. In total, 52 of the patients were
taking finasteride for alopecia before surgery and continued to use it in the
same manner after mastectomy. Ultrasonography was performed 1 year after
mastectomy. The patients’ median age was 26.5 (24.75–30) years. All 52 patients
had bilateral gynecomastia. The median duration of finasteride therapy before
and after surgery was 12 (5–25.75) and 33 (27.5–40.5) months, respectively.
There were no statistically significant differences between the groups with and
without the use of finasteride in relation to postoperative complications and
recurrence rates. Taking finasteride seems to have little effect on recurrence
in patients with alopecia who have undergone surgical treatment of gynecomastia.
Surgeons may recommend continuous finasteride therapy in patients with alopecia
who wish to take finasteride after mastectomy.
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Affiliation(s)
- Seung Geun Lee
- Department of Surgery, Damsoyu Hospital,
Gangnam-gu, Seoul, Republic of Korea
| | - Pyoung Jae Park
- Department of Surgery, Korea University
Guro Hospital, Korea University College of Medicine, Guro-gu, Seoul, Republic of
Korea
| | - Sung Ryul Lee
- Department of Surgery, Damsoyu Hospital,
Gangnam-gu, Seoul, Republic of Korea
- Sung Ryul Lee, MD, PhD, Department of
Surgery, Damsoyu Hospital, 234 Hakdong-ro, Gangnam-gu, Seoul, 06104, Republic of
Korea.
| | - Bum Hwan Koo
- Department of Surgery, Damsoyu Hospital,
Gangnam-gu, Seoul, Republic of Korea
| | - Geon Young Byun
- Department of Surgery, Damsoyu Hospital,
Gangnam-gu, Seoul, Republic of Korea
| | - Myoung Jin Kim
- Department of Surgery, Damsoyu Hospital,
Gangnam-gu, Seoul, Republic of Korea
| | - Hyok Jo Kang
- Department of Surgery, Damsoyu Hospital,
Gangnam-gu, Seoul, Republic of Korea
| | - Sarang Kim
- Department of Surgery, Damsoyu Hospital,
Gangnam-gu, Seoul, Republic of Korea
- Research Centre, Damsoyu Hospital,
Gangnam-gu, Seoul, Republic of Korea
| | - Beom Seok Oh
- Department of Surgery, Damsoyu Hospital,
Gangnam-gu, Seoul, Republic of Korea
- Research Centre, Damsoyu Hospital,
Gangnam-gu, Seoul, Republic of Korea
| | - Young Hyun Lee
- Department of Surgery, Damsoyu Hospital,
Gangnam-gu, Seoul, Republic of Korea
- Research Centre, Damsoyu Hospital,
Gangnam-gu, Seoul, Republic of Korea
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Dobrek Ł, Nalik-Iwaniak K, Arent Z. Effect of α-1-adrenolytic agent and 5-α-reductase inhibitor on renal function in an experimental model of hyperprolactinemia-induced benign prostatic hyperplasia. Pol Merkur Lekarski 2020; 48:188-194. [PMID: 32564045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
UNLABELLED The standard pharmacotherapy of benign prostatic hyperplasia (BPH) may also alleviate potential kidney dysfunction resulting from the development of obstructive uropathy in the course of BPH. AIM The aim of study was to evaluate the effect of treatment with α-1- adrenolytic agent (tamsulosin) and 5-α-reductase inhibitor (finasteride) on renal function in rats. MATERIALS AND METHODS Four groups of rats were studied: 1 - controls, 2 - rats with metoclopramide-induced hyperprolactinemia BPH model, 3 - rats with BPH treated with tamsulosin, 4 - rats with BPH treated with finasteride. BPH presence was verified by histopathological examination. The renal function was assessed by histopathological examination, and the laboratory assessment of the classic nitrogen parameters and new kidney function markers (cystatin C; CysC, kidney injury molecule-1; KIM-1). RESULTS In group 2, BPH development was confirmed by histopathological examination, without simultaneous significant kidney disturbances. Compared to the controls, BPH animals exhibited significant proteinuria, and increased concentration and daily urinary excretion of CysC and KIM- 1. Treatment with tamsulosin significantly improved the histopathological image of the prostate without affecting renal structure and led to reduced blood urea and proteinuria. Treatment with finasteride also significantly reduced the histopathological signs of BPH without changing the image of the kidneys, and reduced CysC concentration and daily CysC excretion with urine compared to group 2 individuals. CONCLUSIONS In the course of experimental hyperprolactinemiainduced BPH, kidney tubulopathy developed, which was indicated by KIM-1 and CysC disturbances in urine. The administration of finasteride reduced renal dysfunction to a higher degree, bringing the concentration and daily excretion of CysC back to normal.
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Affiliation(s)
- Łukasz Dobrek
- Department of Clinical Pharmacology, Wroclaw Medical University, Poland
| | - Klaudia Nalik-Iwaniak
- Experimental and Innovative Medicine Centre, University Centre of Veterinary Medicine, University of Agriculture in Krakow, Poland
| | - Zbigniew Arent
- Experimental and Innovative Medicine Centre, University Centre of Veterinary Medicine, University of Agriculture in Krakow, Poland
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40
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Wang Z, Deng T, Long X, Lin X, Wu S, Wang H, Ge R, Zhang Z, Wu CL, Taplin ME, Olumi AF. Methylation of SRD5A2 promoter predicts a better outcome for castration-resistant prostate cancer patients undergoing androgen deprivation therapy. PLoS One 2020; 15:e0229754. [PMID: 32134978 PMCID: PMC7058338 DOI: 10.1371/journal.pone.0229754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 02/06/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To determine whether SRD5A2 promoter methylation is associated with cancer progression during androgen deprivation therapy (ADT) in CRPC. PATIENTS AND METHODS In a Local CRPC cohort, 42 prostatic specimens were collected from patients who were diagnosed as CRPC and underwent transurethral resection of the prostate (TURP) at Massachusetts General Hospital (MGH). In a metastatic CRPC (Met CRPC) cohort, 12 metastatic biopsies were collected from CRPC patients who would be treated with abiraterone plus dutasteride (Clinical Trial NCT01393730). As controls, 36 benign prostatic specimens were collected from patients undergoing prostate reduction surgery for symptoms of bladder outlet obstruction secondary to benign prostatic hyperplasia (BPH). The methylation status of cytosine-phosphate-guanine (CpG) site(s) at SRD5A2 promoter regions was tested. RESULTS Compared with benign prostatic tissue, CRPC samples demonstrated higher SRD5A2 methylation in the whole promoter region (Local CRPC cohort: P < 0.001; Met CRPC cohort: P <0.05). In Local CRPC cohort, a higher ratio of methylation was correlated with better OS (R2 = 0.33, P = 0.013). Hypermethylation of specific regions (nucleotides -434 to -4 [CpG# -39 to CpG# -2]) was associated with a better OS (11.3±5.8 vs 6.4±4.4 years, P = 0.001) and PFS (8.4±5.4 vs 4.5±3.9 years, P = 0.003) with cutoff value of 37.9%. Multivariate analysis showed that SRD5A2 methylation was associated with OS independently (whole promoter region: P = 0.035; specific region: P = 0.02). CONCLUSION Our study demonstrate that SRD5A2 methylation in promoter regions, specifically at CpG# -39 to -2, is significantly associated with better survival for CRPC patients treated with ADT. Recognition of epigenetic modifications of SRD5A2 may affect the choices and sequence of available therapies for management of CRPC.
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Affiliation(s)
- Zongwei Wang
- Department of Surgery, Division of Urology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
- Department of Pathology and Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Tuo Deng
- Department of Surgery, Division of Urology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
- Department of Urology, Minimally Invasive Surgery center, The First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangzhou Institute of Urology, Guangzhou, Guangdong, China
| | - Xingbo Long
- Department of Urology, Union Medical College, Beijing, China
| | - Xueming Lin
- Department of Pathology and Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Shulin Wu
- Department of Pathology and Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Hongbo Wang
- Department of Pathology and Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Rongbin Ge
- Department of Pathology, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Zhenwei Zhang
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States of America
| | - Chin-Lee Wu
- Department of Pathology and Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Mary-Ellen Taplin
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States of America
| | - Aria F. Olumi
- Department of Surgery, Division of Urology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
- * E-mail:
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41
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Busby J, Karasneh R, Murchie P, McMenamin Ú, Gadalla SM, Camargo MC, Iversen L, Lee AJ, Spence AD, Cardwell CR. The role of 5α-reductase inhibitors in gastro-oesophageal cancer risk: A nested case-control study. Pharmacoepidemiol Drug Saf 2020; 29:48-56. [PMID: 31713940 PMCID: PMC8520491 DOI: 10.1002/pds.4909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 08/08/2019] [Accepted: 09/17/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE The strong male predominance of gastro-oesophageal cancer suggests that sex hormones play an important role. 5α-Reductase (5AR) inhibitors have antiandrogen effects and have been shown to decrease cancer cell proliferation and metastasis. We conducted the first epidemiologic investigation into the association between 5AR inhibitor use and gastro-oesophageal cancer risk. METHODS We conducted a nested case-control study within the Scottish Primary Care Clinical Information Unit Research database. Male cases diagnosed with oesophageal or gastric cancer between 1999 and 2011 were matched to up to five male controls based on birth year, diagnosis year, and general practice. We used electronic prescribing records to ascertain medication use. We used conditional logistic regression to calculate odds ratios (ORs) for the association between 5AR inhibitor use and cancer risk, after adjusting for comorbidities and aspirin, statin, or proton pump inhibitor use. RESULTS The study included 2003 gastro-oesophageal cancer cases and 9650 controls. There was some evidence of reduced gastro-oesophageal cancer risk among 5AR inhibitor users (adjusted OR = 0.75; 95% CI, 0.56-1.02), particularly for finasteride (adjusted OR = 0.68; 95% CI, 0.50-0.94). These decreases were more marked among those who received at least 3 years of 5AR inhibitors (adjusted OR = 0.54; 95% CI, 0.27-1.05; P value = .071) or finasteride (adjusted OR = 0.49; 95% CI, 0.24-0.99; P value = .046). CONCLUSIONS We found evidence of reduced gastro-oesophageal cancer risk among users of 5AR inhibitors, particularly finasteride. However, larger epidemiological studies are required before randomised controlled trials are considered.
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Affiliation(s)
- John Busby
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
| | - Reema Karasneh
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
| | - Peter Murchie
- Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Úna McMenamin
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
| | - Shahinaz M. Gadalla
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, USA
| | - M Constanza Camargo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, USA
| | - Lisa Iversen
- Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Amanda J Lee
- Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Andrew D. Spence
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
| | - Chris R Cardwell
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
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Startsev VY, Dudarev VA, Sevryukov FA, Zabrodina NB. [Economic aspects of treatment for lower urinary tract symptoms associated with benign prostatic hyperplasia]. Urologiia 2019:115-119. [PMID: 32003180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A review of the literature dedicated to the economic aspects of drug and surgical treatment of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) is presented in the article. Currently, symptomatic therapy, which usually leads to an increase in the financial costs associated with the complications and surgical treatment, is most commonly used. The pathogenetic treatment of BPH (5-alpha reductase inhibitors), including combination therapy, requires an increase in costs, but it is also considered the most cost-effective approach. Despite the continuous growing of therapeutic armamentarium, the surgical treatment is still relevant and holds an important place. A lot of studies have shown that open procedures are inferior to endoscopic and minimally invasive interventions by both clinical and cost-effective results. At the same time, transurethral interventions on the prostate does not exclude economic losses due to the necessity of expensive laser technologies and the development of complications in the early postoperative period. Thus, currently, the best treatment option should be chosen not only on individual basis, but also depending on economic aspects based on a balanced medical and economic analysis of each treatment method.
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Affiliation(s)
- V Yu Startsev
- Department of Oncology, Pediatric Oncology and Radiation Therapy FGBOU VO Saint-Petersburg State Pediatric Medical University, Saint-Petersburg, Russia
- FGBNU Institute of Experimental Medicine of Russian Academy of Science, Saint-Petersburg, Russia
- Department of Faculty Surgery with the course of Urology FGBOU VO Chita State Medical University, Chita, Russia
- Department of Urology named after E.V. Shakhov of Privolzhsky Research Medical University of the Ministry of Health of the Russia, Nizhny Novgorod
- Clinical Hospital at Nizhny Novgorod Railway Station of JSC RZD, Nizhny Novgorod, Russia
- Department of endoscopic urology of FGBOU DPO RMANPO, Moscow, Russia
| | - V A Dudarev
- Department of Oncology, Pediatric Oncology and Radiation Therapy FGBOU VO Saint-Petersburg State Pediatric Medical University, Saint-Petersburg, Russia
- FGBNU Institute of Experimental Medicine of Russian Academy of Science, Saint-Petersburg, Russia
- Department of Faculty Surgery with the course of Urology FGBOU VO Chita State Medical University, Chita, Russia
- Department of Urology named after E.V. Shakhov of Privolzhsky Research Medical University of the Ministry of Health of the Russia, Nizhny Novgorod
- Clinical Hospital at Nizhny Novgorod Railway Station of JSC RZD, Nizhny Novgorod, Russia
- Department of endoscopic urology of FGBOU DPO RMANPO, Moscow, Russia
| | - F A Sevryukov
- Department of Oncology, Pediatric Oncology and Radiation Therapy FGBOU VO Saint-Petersburg State Pediatric Medical University, Saint-Petersburg, Russia
- FGBNU Institute of Experimental Medicine of Russian Academy of Science, Saint-Petersburg, Russia
- Department of Faculty Surgery with the course of Urology FGBOU VO Chita State Medical University, Chita, Russia
- Department of Urology named after E.V. Shakhov of Privolzhsky Research Medical University of the Ministry of Health of the Russia, Nizhny Novgorod
- Clinical Hospital at Nizhny Novgorod Railway Station of JSC RZD, Nizhny Novgorod, Russia
- Department of endoscopic urology of FGBOU DPO RMANPO, Moscow, Russia
| | - N B Zabrodina
- Department of Oncology, Pediatric Oncology and Radiation Therapy FGBOU VO Saint-Petersburg State Pediatric Medical University, Saint-Petersburg, Russia
- FGBNU Institute of Experimental Medicine of Russian Academy of Science, Saint-Petersburg, Russia
- Department of Faculty Surgery with the course of Urology FGBOU VO Chita State Medical University, Chita, Russia
- Department of Urology named after E.V. Shakhov of Privolzhsky Research Medical University of the Ministry of Health of the Russia, Nizhny Novgorod
- Clinical Hospital at Nizhny Novgorod Railway Station of JSC RZD, Nizhny Novgorod, Russia
- Department of endoscopic urology of FGBOU DPO RMANPO, Moscow, Russia
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Na R, Labbate C, Yu H, Shi Z, Fantus RJ, Wang CH, Andriole GL, Isaacs WB, Zheng SL, Helfand BT, Xu J. Single-Nucleotide Polymorphism-Based Genetic Risk Score and Patient Age at Prostate Cancer Diagnosis. JAMA Netw Open 2019; 2:e1918145. [PMID: 31880795 PMCID: PMC6991229 DOI: 10.1001/jamanetworkopen.2019.18145] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
IMPORTANCE Few studies have evaluated the association between a single-nucleotide polymorphism-based genetic risk score (GRS) and patient age at prostate cancer (PCa) diagnosis. OBJECTIVES To test the association between a GRS and patient age at PCa diagnosis and to compare the performance of a GRS with that of family history (FH) in PCa risk stratification. DESIGN, SETTING, AND PARTICIPANTS A cohort study of 3225 white men was conducted as a secondary analysis of the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) chemoprevention trial, a 4-year, randomized, double-blind, placebo-controlled multicenter study conducted from March 2003 to April 2009 to evaluate the safety and efficacy of dutasteride in reducing PCa events. Participants were confirmed to be cancer free by prostate biopsy (6-12 cores) within 6 months prior to the study and underwent 10 core biopsies every 2 years per protocol. The dates for performing data analysis were from July 2016 to October 2019. INTERVENTIONS A well-established, population-standardized GRS was calculated for each participant based on 110 known PCa risk-associated single-nucleotide polymorphisms, which is a relative risk compared with the general population. Men were classified into 3 GRS risk groups based on predetermined cutoff values: low (<0.50), average (0.50-1.49), and high (≥1.50). MAIN OUTCOMES AND MEASURES Prostate cancer diagnosis-free survival among men of different risk groups. RESULTS Among 3225 men (median age, 63 years [interquartile range, 58-67 years]) in the study, 683 (21%) were classified as low risk, 1937 (60%) as average risk, and 605 (19%) as high risk based on GRS alone. In comparison, 2789 (86%) were classified as low or average risk and 436 (14%) as high risk based on FH alone. Men in higher GRS risk groups had a PCa diagnosis-free survival rate that was worse than that of those in the lower GRS risk group (χ2 = 53.3; P < .001 for trend) and in participants with a negative FH of PCa (χ2 = 45.5; P < .001 for trend). Combining GRS and FH further stratified overall genetic risk, indicating that 957 men (30%) were at high genetic risk (either high GRS or positive FH), 1667 men (52%) were at average genetic risk (average GRS and negative FH), and 601 men (19%) were at low genetic risk (low GRS and negative FH). The median PCa diagnosis-free survival was 74 years (95% CI, 73-75 years) for men at high genetic risk, 77 years (95% CI, 75 to >80 years) for men at average genetic risk, and more than 80 years (95% CI, >80 to >80 years) for men at low genetic risk. In contrast, the median PCa diagnosis-free survival was 73 years (95% CI, 71-76 years) for men with a positive FH and 77 years (95% CI, 76-79 years) for men with a negative FH. CONCLUSIONS AND RELEVANCE This study suggests that a GRS is significantly associated with patient age at PCa diagnosis. Combining FH and GRS may better stratify inherited risk than FH alone for developing personalized PCa screening strategies.
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Affiliation(s)
- Rong Na
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, Illinois
- Huashan Hospital, Fudan Institute of Urology, Fudan University, Shanghai, China
- Ruijin Hospital, Department of Urology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Craig Labbate
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, Illinois
- Section of Urology, University of Chicago Medicine, Chicago, Illinois
| | - Hongjie Yu
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, Illinois
| | - Zhuqing Shi
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, Illinois
| | - Richard J. Fantus
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, Illinois
- Section of Urology, University of Chicago Medicine, Chicago, Illinois
| | - Chi-Hsiung Wang
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, Illinois
| | - Gerald L. Andriole
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - William B. Isaacs
- James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - S. Lilly Zheng
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, Illinois
| | - Brian T. Helfand
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, Illinois
| | - Jianfeng Xu
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, Illinois
- Huashan Hospital, Fudan Institute of Urology, Fudan University, Shanghai, China
- Section of Urology, University of Chicago Medicine, Chicago, Illinois
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Macoska JA, Uchtmann KS, Leverson GE, McVary KT, Ricke WA. Prostate Transition Zone Fibrosis is Associated with Clinical Progression in the MTOPS Study. J Urol 2019; 202:1240-1247. [PMID: 31188728 PMCID: PMC7339116 DOI: 10.1097/ju.0000000000000385] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Medications targeting androgen receptor activity (eg finasteride) or smooth muscle contractility (eg doxazosin) do not resolve lower urinary tract symptoms indicative of lower urinary tract dysfunction in an important subgroup of men. Recently fibrosis has been implicated as another pathobiology contributing to male lower urinary tract symptoms but to our knowledge no systematic studies have been done to assess fibrosis in the context of medical treatment. We determine whether fibrotic changes in the prostate transition zone are associated with an increased risk of clinical progression in participants treated with doxazosin, finasteride or finasteride plus doxazosin in the MTOPS (Medical Therapy of Prostatic Symptoms) study. MATERIALS AND METHODS Transition zone biopsy tissues from men who did or did not experience clinical progression on placebo, doxazosin, finasteride or combination therapy were assessed for collagen content and architectural changes using picrosirius red birefringence and CT-FIRE (Curvelet Transform-Fiber Extraction) analysis. Correlations were made with annotated demographic and clinical data. Statistical analyses were done with the Pearson correlation coefficient, ANOVA and the t-test. RESULTS High levels of wavy, aligned prostate transition zone collagen significantly correlated with an increased risk of clinical progression among MTOPS trial participants treated with doxazosin plus finasteride, particularly those with a high body mass index. CONCLUSIONS Fibrotic changes in the prostate transition zone are associated with an increased risk of clinical progression in men treated with doxazosin plus finasteride. Antifibrotic therapeutics might provide a new treatment approach in men with lower urinary tract dysfunction who do not respond to current medical treatment approaches.
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Affiliation(s)
- Jill A. Macoska
- Center for Personalized Cancer Therapy, University of Massachusetts, Boston, MA, USA
- George M. O’Brien Center for Benign Urologic Research, University of Wisconsin, Madison, WI, USA
| | - Kristen S. Uchtmann
- George M. O’Brien Center for Benign Urologic Research, University of Wisconsin, Madison, WI, USA
- Department of Urology, The University of Wisconsin, Madison, WI, USA
| | - Glen E. Leverson
- Department of Urology, The University of Wisconsin, Madison, WI, USA
| | - Kevin T. McVary
- Department of Urology, Loyola University Medical Center, Maywood, IL, USA
| | - William A. Ricke
- George M. O’Brien Center for Benign Urologic Research, University of Wisconsin, Madison, WI, USA
- Department of Urology, The University of Wisconsin, Madison, WI, USA
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45
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Nizov AN. [Efficacy of 5-reductase inhibitors in the treatment of lower urinary tract symptoms in patients with benign prostatic hyperplasia]. Urologiia 2019:156-160. [PMID: 31808653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In the treatment of lower urinary tract in combination with benign prostatic hyperplasia, alpha-blockers are most often prescribed, but in certain cases, the appointment of 5-reductase inhibitors is justified. This article analyzes relevant studies of recent years regarding the validity of the use of dutasteride (Gardium) 0.5 mg per day. Dutasteride can effectively reduce the total score of IPSS to 30%. It increases a volumetric urine flow rate 2-3 ml/sec, significantly reduces the chance of acute urinary retention in 70-88% in various studies, and reduces the frequency of hospitalization by 66%. Dutasteride also increases the likelihood of timely diagnosis of prostate cancer by 23%. Erectile dysfunction is a common side effect, serving as a reason for refusal of therapy is erectile dysfunction, which occurs in 16% of cases, and the probability of which is the highest in the first months during conservative therapy.
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Affiliation(s)
- A N Nizov
- Roswell Park Comprehensive Medical Center, Buffalo, NY, USA
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46
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Kumar A, Nalawade V, Riviere P, Sarkar RR, Parsons JK, Murphy JD, Rose BS. Association of Treatment With 5α-Reductase Inhibitors and Prostate Cancer Mortality Among Older Adults. JAMA Netw Open 2019; 2:e1913612. [PMID: 31626312 PMCID: PMC6813580 DOI: 10.1001/jamanetworkopen.2019.13612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
This cohort study examines the association between use of 5α-reductase inhibitors and prostate cancer mortality among US Medicare beneficiaries.
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Affiliation(s)
- Abhishek Kumar
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla
| | - Vinit Nalawade
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla
| | - Paul Riviere
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla
| | - Reith R. Sarkar
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla
| | - J. Kellog Parsons
- Department of Urology, University of California, San Diego, La Jolla
| | - James D. Murphy
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla
| | - Brent S. Rose
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla
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47
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Rhie A, Son HY, Kwak SJ, Lee S, Kim DY, Lew BL, Sim WY, Seo JS, Kwon O, Kim JI, Jo SJ. Genetic variations associated with response to dutasteride in the treatment of male subjects with androgenetic alopecia. PLoS One 2019; 14:e0222533. [PMID: 31525235 PMCID: PMC6746394 DOI: 10.1371/journal.pone.0222533] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 08/31/2019] [Indexed: 12/30/2022] Open
Abstract
Dutasteride, a dual inhibitor of both type I and II 5α-reductases, is used to treat male pattern hair loss (MPHL). However, patient response to dutasteride varies in each individual, the cause of which is yet to be identified. To identify genetic variants associated with response to dutasteride treatment for MPHL, a total of 42 men with moderate MPHL who had been treated with dutasteride for 6 months were genotyped and analysed by quantitative linear regression, case-control association tests, and Fisher’s exact test. The synonymous single nucleotide polymorphism (SNP) rs72623193 in DHRS9 was most significantly associated with response to dutasteride, followed by the non-synonymous SNP rs2241057 in CYP26B1. Additionally, variants in ESR1, SRD5A1, CYP19A1, and RXRG are suggested to be associated with response to dutasteride. Cumulative effect and interaction among these SNPs were presented in both additive and non-additive models.
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Affiliation(s)
- Arang Rhie
- Genomic Medicine Institute (GMI), Medical Research Center, Seoul National University, Seoul, Korea
- Genome Informatics Section, Computational and Statistical Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Ho-Young Son
- Genomic Medicine Institute (GMI), Medical Research Center, Seoul National University, Seoul, Korea
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
- Department of Biochemistry and Molecular Biology, Seoul National University College of Medicine, Seoul, Korea
| | - Soo Jung Kwak
- Genomic Medicine Institute (GMI), Medical Research Center, Seoul National University, Seoul, Korea
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
- Department of Biochemistry and Molecular Biology, Seoul National University College of Medicine, Seoul, Korea
| | - Seungbok Lee
- Genomic Medicine Institute (GMI), Medical Research Center, Seoul National University, Seoul, Korea
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
- Department of Biochemistry and Molecular Biology, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Young Kim
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
- Laboratory of Cutaneous Aging and Hair Research, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
- Institute of Human-Environmental Interface Biology, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Bark-Lynn Lew
- Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Woo-Young Sim
- Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jeong-Sun Seo
- Genomic Medicine Institute (GMI), Medical Research Center, Seoul National University, Seoul, Korea
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
- Department of Biochemistry and Molecular Biology, Seoul National University College of Medicine, Seoul, Korea
| | - Ohsang Kwon
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
- Laboratory of Cutaneous Aging and Hair Research, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
- Institute of Human-Environmental Interface Biology, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jong-Il Kim
- Genomic Medicine Institute (GMI), Medical Research Center, Seoul National University, Seoul, Korea
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
- Department of Biochemistry and Molecular Biology, Seoul National University College of Medicine, Seoul, Korea
| | - Seong Jin Jo
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
- Laboratory of Cutaneous Aging and Hair Research, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
- Institute of Human-Environmental Interface Biology, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
- * E-mail:
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48
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Spivak LG, Platonova DV, Yagudaev DD. [Medical treatment of patients with benign prostatic hyperplasia with 5-reductase inhibitors]. Urologiia 2019:175-179. [PMID: 31535827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The results of studies comparing the therapy of benign prostatic hyperplasia with 5-reductase inhibitors and 1-blockers are presented in the article. Benign prostatic hyperplasia is a common disease in older men. Pathogenetic treatment allows to block a progression of prostatic hyperplasia and is of greatest interest in the treatment of this disease. The obtained data reliably demonstrate the advantage and safety of long-term pathogenetic therapy with dutasteride compared with symptomatic tamsulosin monotherapy with regard to quality of life and subjective symptoms. In addition, pathogenetic therapy provides better results in preventing the progression of benign prostatic hyperplasia.
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Affiliation(s)
- L G Spivak
- FGAOU VO I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia, Moscow, Russia
- FGBUZ CH 85 FMBA of Russia, Moscow, Russia
| | - D V Platonova
- FGAOU VO I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia, Moscow, Russia
- FGBUZ CH 85 FMBA of Russia, Moscow, Russia
| | - D D Yagudaev
- FGAOU VO I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia, Moscow, Russia
- FGBUZ CH 85 FMBA of Russia, Moscow, Russia
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49
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Carmina E, Azziz R, Bergfeld W, Escobar-Morreale HF, Futterweit W, Huddleston H, Lobo R, Olsen E. Female Pattern Hair Loss and Androgen Excess: A Report From the Multidisciplinary Androgen Excess and PCOS Committee. J Clin Endocrinol Metab 2019; 104:2875-2891. [PMID: 30785992 DOI: 10.1210/jc.2018-02548] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 02/15/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To determine the current state of knowledge and provide evidence-based recommendations that could be valid for all specialists taking care of female pattern hair loss (FPHL), a common form of hair loss in women that is characterized by the reduction of hair density in the central area of the scalp, whereas the frontal hairline is generally well conserved. PARTICIPANTS An expert task force appointed by the Androgen Excess and PCOS Society, which included specialists from dermatology, endocrinology, and reproductive endocrinology. DESIGN Levels of evidence were assessed and graded from A to D. Peer-reviewed studies evaluating FPHL published through December 2017 were reviewed. Criteria for inclusion/exclusion of the published papers were agreed on by at least two reviewers in each area and arbitrated by a third when necessary. CONCLUSIONS (i) The term "female pattern hair loss" should be used, avoiding the previous terms of alopecia or androgenetic alopecia. (ii) The two typical patterns of hair loss in FPHL are centrifugal expansion in the mid scalp, and a frontal accentuation or Christmas tree pattern. (iii) Isolated FPHL should not be considered a sign of hyperandrogenism when androgen levels are normal. (iv) The assessment of patients with FPHL is primarily clinical. (v) In all patients with FPHL, assessment of a possible androgen excess is mandatory. Measurement of vitamin D, iron, zinc, thyroid hormones, and prolactin are optional but recommended. (vi) Treatment of FPHL should start with minoxidil (5%), adding 5α-reductase inhibitors or antiandrogens when there is severe hair loss or hyperandrogenism.
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Affiliation(s)
- Enrico Carmina
- Department of Health Sciences and Mother and Child Care, University of Palermo, Palermo, Italy
| | - Ricardo Azziz
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, State University of New York, Albany, New York
| | - Wilma Bergfeld
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Héctor F Escobar-Morreale
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain
- Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas, Madrid Spain
- Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | | | - Heather Huddleston
- Department of Obstetrics and Gynecology, University of California at San Francisco, San Francisco, California
| | - Rogerio Lobo
- Department of Obstetrics and Gynecology, Columbia University, New York, New York
| | - Elise Olsen
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
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50
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D'Agate S, Wilson T, Adalig B, Manyak M, Palacios-Moreno JM, Chavan C, Oelke M, Roehrborn C, Della Pasqua O. Impact of disease progression on individual IPSS trajectories and consequences of immediate versus delayed start of treatment in patients with moderate or severe LUTS associated with BPH. World J Urol 2019; 38:463-472. [PMID: 31079189 PMCID: PMC6994451 DOI: 10.1007/s00345-019-02783-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 04/23/2019] [Indexed: 01/07/2023] Open
Abstract
Purpose Despite superiority of tamsulosin–dutasteride combination therapy versus monotherapy for lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH), patients at risk of disease progression are often initiated on α-blockers. This study evaluated the impact of initiating tamsulosin monotherapy prior to switching to tamsulosin–dutasteride combination therapy versus immediate combination therapy using a longitudinal model describing International Prostate Symptom Score (IPSS) trajectories in moderate/severe LUTS/BPH patients at risk of disease progression. Methods Clinical trial simulations (CTS) were performed using data from 10,238 patients from Phase III/IV dutasteride trials. The effect of varying disease progression rates was explored by comparing profiles on- and off-treatment. CTS scenarios were investigated, including a reference (immediate combination therapy) and six alternative virtual treatment arms (delayed combination therapy of 1–24 months). Clinical response (≥ 25% IPSS reduction relative to baseline) was analysed using log-rank test. Differences in IPSS relative to baseline at various on-treatment time points were assessed by t tests. Results Delayed combination therapy initiation led to significant (p < 0.01) decreases in clinical response. At month 48, clinical response rate was 79.7% versus 74.1%, 70.3% and 71.0% and IPSS was 6.3 versus 7.6, 8.1 and 8.0 (switchers from tamsulosin monotherapy after 6, 12 and 24 months, respectively) with immediate combination therapy. More patients transitioned from severe/moderate to mild severity scores by month 48. Conclusions CTS allows systematic evaluation of immediate versus delayed combination therapy. Immediate response to α-blockers is not predictive of long-term symptom improvement. Observed IPSS differences between immediate and delayed combination therapy (6–24 months) are statistically significant. Electronic supplementary material The online version of this article (10.1007/s00345-019-02783-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Salvatore D'Agate
- Clinical Pharmacology and Therapeutics Group, University College London, London, UK
| | | | - Burkay Adalig
- Classic and Established Products, GSK, Istanbul, Turkey
| | - Michael Manyak
- Classic and Established Products, GSK, Washington, DC, USA
| | | | | | - Matthias Oelke
- Department of Urology, St. Antonius Hospital, Gronau, Germany
| | - Claus Roehrborn
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Oscar Della Pasqua
- Clinical Pharmacology and Therapeutics Group, University College London, London, UK.
- Clinical Pharmacology Modelling and Simulation, GSK, Stockley Park, 1-3 Ironbridge Road, Uxbridge, Middlesex, UB11 1BT, UK.
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