Drug Therapy

Atlanta-PSA doubling time (PSADT) appears to have limitations as a predictor of treatment outcome, according to results of a phase II, placebo-controlled trial of atrasentan (Xinlay) in patients with early-stage, hormone-naive prostate cancer. Researchers found that both placebo and drug recipients showed an extended PSADT of similar length.

Atlanta-Results from the Prostate Cancer Prevention Trial (PCPT) showing treatment with the type 2-specific 5-alpha-reductase inhibitor finasteride (Proscar) reduced the incidence of prostate cancer, but was associated with increased detection of high-grade cancers has prompted additional research on the association among prostate cancer detection, cancer grade, and prostate volume.

Research has begun to examine a range of novel treatment modalities, some with quite promising results.

Atlanta-Are nanobacteria involved in prostate disease? That question hasn't been settled, but evidence of these controversial organisms has been found in the prostates and serum of men with prostatic inflammation.

Within the past year, enormous strides have been made in the treatment of renal cell carcinoma, particularly in the pharmacotherapeutic arena. To date, two new drugs have received FDA approval, and other promising agents are in development. As research provides new insights into the nature of RCC and its treatment, the role of the urologist in patient management is evolving quickly.

Atlanta-At a tertiary referral center in the Netherlands, long-term results of sacral neuromodulation for interstitial cystitis were disappointing, despite initial success. The study, presented here at the AUA annual meeting, adds to similar results presented last year by researchers at the Cleveland Clinic and, for some IC specialists, confirms their own experience.

Atlanta-Although the etiology of interstitial cystitis is unknown, one of the most popular theories is that patients have especially permeable bladders that allow noxious substances through, eliciting pain and other symptoms. But a study of bladder permeability in IC patients presented at the AUA annual meeting here cast doubt on what has become almost common wisdom.

Horsham, PA-Biocoat, Inc. has received FDA approval of the PICSI sperm selection device to facilitate assisted reproduction.

Atlanta-With the number of bariatric surgery procedures being performed each year rising exponentially, urologists are wondering what is their risk for causing stone disease. Two studies presented at the AUA annual meeting here explored this issue, with somewhat conflicting results.

Atlanta-Unselected calcium oxalate stone formers have neither elevated urinary uric acid excretion nor an increased prevalence of hyperuricosuria compared with age-matched controls when the two groups are evaluated under conditions of strict dietary control, according to the results of a study undertaken at Wake Forest University, Winston-Salem, NC.

Atlanta-Five new compounds-none an antimuscarinic and all in different classes-are showing potential for overactive bladder. They may also have applications in BPH, chronic prostatitis/chronic pelvic pain syndrome, and painful bladder syndrome/interstitial cystitis (PBS/IC).

In men with BPH, drugs indicated for other urologic conditions may play a role in the treatment of their lower urinary tract symptoms, suggest data from a number of studies presented at the 2006 AUA annual meeting. These studies were among those on BPH and LUTS highlighted by Claus G. Roehrborn, MD, professor and chairman of the department of urology at the University of Texas Southwestern Medical Center, Dallas.

As lifestyle choices influence the incidence of stone disease, shockwave lithotripsy appears to be losing ground as a treatment option for patients with stones of certain compositions and stones located in hard-to-reach places.

An intravesical formulation of the chemotherapy agent docetaxel (Taxotere) appears to be safe for further investigation in patients with superficial bladder cancer that has recurred following standard therapies, according to findings from a phase I trial published in the Journal of Clinical Oncology (2006; 24:3075-80).

Atlanta-Patients with metastatic hormone-refractory prostate cancer who were treated with triple therapy using docetaxel (Taxotere), thalidomide (Thalomid), and estramustine phosphate sodium (Emcyt) demonstrated a 90% response rate, defined as a decline in PSA levels of at least 50%, reported researchers from the National Cancer Institute, Bethesda, MD.

Malvern, PA and Woodstock, GA-The new LithoGold spark gap shockwave lilthotripsy unit from Siemens Medical Solutions, USA, and Shockwave Technical Service, a division of Tissue Regeneration Technologies, LLC, is built into the housing of the Siemens Modularis system, ensuring compatibility with Siemens' C-arms and the Modularis table. The unit incorporates the STS SmartTrode intelligent electrode, which automatically adjusts to the specified energy level. FDA 510(k) review is pending.

Patients today are demanding more of our time, and, as a result, we have less time to spend with pharmaceutical representatives.

Atlanta-An investigational vaccine directed against prostate cancer cells has been found to be well tolerated with minimal toxicity in patients with hormone-refractory prostate cancer. In patients receiving the agent, median survival appeared to be enhanced when compared with accepted nomograms, reported researchers from Virginia Mason Medical Center, Seattle. These results were from two phase II trials of the vaccine, known as GVAX, presented at the AUA annual meeting here.

Atlanta-Combining the endothelin A (ETA) receptor antagonist atrasentan (Xinlay) with taxane chemotherapy has a significant additive effect against prostate cancer, results of a preclinical investigation presented at the AUA annual meeting here have demonstrated.

Atlanta-Phosphodiesterase-5 inhibitor therapy, which is commonly used to treat erectile dysfunction, may have a paradoxical benefit as a treatment for priapism in patients with sickle cell anemia, according to research presented at the AUA annual meeting here and at the American Society of Andrology annual meeting in Chicago.

When we replace testosterone, we bring the serum testosterone levels in hormone-deficient men to that of their eugonadal peers.

An oral drug under development for the treatment of multiple side effects of androgen deprivation therapy appears to lower total cholesterol levels, according to an interim analysis of phase III clinical trial results.

The second of two phase III trials has shown that once-daily trospium chloride (Sanctura XR) reduces frequency of urination and the number of urge incontinence episodes in individuals with a once-daily formulation for the treatment of overactive bladder.

Teva Pharmaceutical Industries Ltd. has received final FDA approval to market a generic formulation of finasteride tablets, 5 mg.

Administration of sipuleucel-T (Provenge) in men with advanced androgen-independent prostate cancer shows a significant survival benefit and "a very favorable toxicity and safety profile," according to the authors of a double-blind, placebo-controlled, multicenter phase III study published recently in the Journal of Clinical Oncology (2006; 24:3089-94).

Somerville, NJ-A new mid-urethral sling device from the Women's Heath & Urology division of Ethicon, Inc., has received 510(k) approval from the FDA for use beginning in autumn 2006. The Gynecare TVT SECUR System is a polypropylene mesh tape that is inserted through the vagina and positioned under the urethra to form a supportive scaffold. It prevents urine loss by maintaining the seal in the bladder neck during movement. No incisions are required, and the procedure can be conducted under local anesthesia, minimizing post-surgical pain and complications. The device is contraindicated for women who are or who intend to become pregnant and those who are on anticoagulant therapy.

Atlanta-Combining an alpha-blocker with a phosphodiesterase-5 (PDE-5) inhibitor appears to produce a greater therapeutic benefit in men with lower urinary tract symptoms than either drug alone, according to a study from Weill Cornell Medical College, New York.

Chicago-A widely studied protein can help urologists find sperm to be used for in vitro fertilization and may even indicate another future pharmaceutical application of the substance, according to research presented here at the American Society of Andrology annual meeting here.

Among the more than 1,700 scientific papers presented at the 2006 AUA annual meeting, the focus was less on new medical or procedural innovations than on the benefits and risks of current tests and therapies.

Sunitinib malate (Sutent) appears to be a promising treatment for metastatic renal cell carcinoma, according to a preliminary study published last week in JAMA (2006; 295:2516-24).