Drug Therapy

From surgical techniques to genetic manipulation, researchers continue to find new and novel ways to deal with the age-old problem of stone disease. Urologists are now better equipped to deal with the condition than they have ever been, said Glenn M. Preminger, MD, professor of urology and director of the Comprehensive Kidney Stone Center at Duke University Medical Center, Durham, NC.

No single study on the topic of sexual dysfunction leapt from the podium as a breakthrough at this year's AUA annual meeting, but a number of studies offered valuable observations about various aspects of sexual function/dysfunction. Among these were studies showing that the degree of personal involvement in restoring sexual function after radical prostatectomy correlates with the degree of success, said John Mulcahy, MD, PhD, professor of urology, Indiana University Medical Center, Indianapolis. Also, research showed that erectile dysfunction can be associated with metabolic disorders and heart disease, and when prescriptions with level 1 interactions overlap, they are often for sildenafil citrate (Viagra) and nitrates.

In patients with prostate cancer, measures of PSA kinetics are proving to be accurate predictors of outcomes as well as treatment efficacy in those patients who are receiving systemic therapy. This, along with reports about the use of traditional and nontraditional agents for slowing the progression of PSA rise and the effects of androgen deprivation on bone, headed the key take-home messages in advanced prostate cancer presented at this year's AUA annual meeting.

One by one, drug-resistant microbes have weakened or destroyed the efficacy of established antimicrobials. The appearance of a strain of urinary tract infection-associated Escherichia coli that is resistant to ciprofloxacin (Cipro, Proquin) is not necessarily a surprise, but it is a significant concern, according to Anthony J. Schaeffer, MD, chairman of the department of urology, Northwestern School of Medicine, Chicago.

San Antonio--The tricyclic antidepressant amitriptyline (Elavil) has long been used for interstitial cystitis, but now, long-term data confirm its usefulness, even when patients don't fit the strict research definition of IC provided by the National Institute of Diabetes and Digestive and Kidney Diseases. Key to long-term success is allowing patients to titrate the dose themselves.

The 2005 AUA annual meeting in San Antonio proved to be fertile ground for research on both epidemiologic trends and clinical aspects of benign prostatic hyperplasia and lower urinary tract symptoms—medical therapy, minimally invasive treatments, and phytotherapy. Data from several key studies appeared to clarify the role of various treatment modalities in selected patient populations. Not all the news was positive, however, as one study showed no significant effect with saw palmetto, a commonly used herbal therapy.

An investigational laboratory test known as BPH-A may help identify BPH, researchers reported at a joint meeting of the International Federation of Clinical Chemistry and Laboratory Medicine and American Association for Clinical Chemistry in Orlando, FL.

Urologists should recommend that their patients with stones maintain a normal intake of calcium.

Barr Laboratories, Inc. has received FDA approval to market a generic version of desmopressin acetate tablets in 0.1- and 0.2-mg strengths. The agent is indicated for the treatment of primary nocturnal enuresis.

Orlando, FL--An investigational agent that inhibits both Raf kinase and vascular endothelial growth factor receptor significantly prolongs progression-free survival in pa-tients with advanced renal cell carcinoma, according to results of a phase III clinical trial presented at the American Society for Clinical Oncology annual meeting here.

The interim final rules for the Competitive Acquisition Program (CAP), which goes into effect Jan. 1, 2006, have been published, although the final rules may not be published for 2 to 3 years.

San Antonio--People who receive a high-calcium diet in the setting of liberal oxalate intake may be at increased risk for calcium oxalate stone formation, according to the results of a small metabolic study reported at the 2005 AUA annual meeting here.

Rockville, MD--After discussion with the FDA, manufacturers of three drugs used to treat erectile dysfunction have agreed to revise drug labels and physician and patient information to include stronger warnings about possible vision loss. The new labeling became effective immediately on its approval on July 8, 2005.

San Antonio--Using their established ex vivo model for measuring ureteral contractility, urologists at the University of Wisconsin, Madison have demonstrated that the nonselective alpha-1 receptor antagonist doxazosin (Cardura) relaxes ureteral smooth muscle and reverses the contractile effects induced by phenylephrine and epinephrine.

QThe definition of premature ejaculation seems very subjective. Criteria stated in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) are

San Antonio--Results of a prospective, randomized, controlled study undertaken by Italian urologists indicate that expulsive medical therapy is a useful adjunct to extracorporeal shockwave lithotripsy in the treatment of ureteral stones.

Urologists should recommend that their patients with stones maintain a normal intake of calcium.

Bayer Pharmaceuticals Corp. and Onyx Pharmaceuticals, Inc., have submitted a new drug application with the FDA for sorafenib for patients with advanced renal cell carcinoma. Submission is based on an ongoing phase III trial suggesting that the drug doubled progression-free survival compared with patients receiving placebo.

A study published in the Journal of the National Cancer Institute (2005; 97:975-80) suggests that regular nonsteroidal anti-inflammatory drug use over a long duration is associated with a modestly reduced risk of prostate cancer.

Patients receiving tamsulosin hydrochloride (Flomax) experienced significantly greater improvement in symptoms associated with BPH than patients who received terazosin hydrochloride (Hytrin) after 4 days of treatment, according to a study appearing in The Journal of Applied Research in Clinical and Experimental Therapeutics (2005; 5:231-45).

Abbott Laboratories has been granted permission by the FDA to initiate an expanded access program for the investigational agent astrasentan (Xinlay) for men with late-stage, hormone refractory prostate cancer.

Barr Laboratories, Inc., has received final FDA approval to market a generic version of desmopressin acetate tablets, 0.1 mg and 0.2 mg, for the management of primary nocturnal enuresis.

Up to 84% of doses with the investigational oral phosphodiesterase type-5 inhibitor avanafil resulted in erections sufficient for vaginal penetration compared with placebo (p

Anaheim, CA--Laboratory data from German investigators point to the use of the CD70 protein as a biomarker for clear-cell renal cell carcinoma and suggest that the marker could be useful in differential diagnosis in cases of uncertain histologic classification. This, in turn, could be very important clinically if found to be present in serum or urine.

Software promotes accurate prostate staging

Three routes have been used with some success and are favored one over the other on the basis of perceived risk to surrounding structures.

Anaheim, CA--Data from a very large, prospective cohort study suggest that men taking statin drugs may reduce their risk of advanced prostate cancer by more than half and reduce their risk of metastatic or fatal disease by more than two-thirds.

Orlando, FL--Men with localized prostate cancer who are treated with primary androgen deprivation therapy tend to be older and to have more comorbidities and lower incomes than men treated by other primary therapies, according to a study presented at the 2005 American Society of Clinical Oncology meeting.

The most important factor in predicting a successful prostatectomy appears to be the overall experience of the surgeon, not the frequency of using a specific approach.

Botulinum toxin type A (Botox) produces a rapid and sustained reduction in the number of daily incontinence episodes and markedly improves patients' quality of life, according to a European phase II clinical trial presented at the AUA annual meeting.