Drug Therapy

Knowledge about the efficacy and safety of testosterone therapy in men remains inadequate, despite its frequent use in clinical practice. Clinical research into the benefits of testosterone therapy is also lacking, according to Alvaro Morales, MD.

A 6-month course of androgen suppression therapy following radiation treatment for clinically localized prostate cancer confers survival benefits similar to those seen with longer courses of androgen blockade (>3 years), according to a recent study from Brigham and Women's Hospital and the Dana Farber Cancer Institute, Boston. The study also suggests that only partial blockade with a luteinizing hormone-releasing hormone (LHRH) agonist may be sufficient.

New Orleans--Four-year results of a phase III clinical trial suggest that a single dose of the chemotherapeutic agent carboplatin (Paraplatin) is as safe and effective as adjuvant 3-week-long radiation therapy following orchiectomy of seminomatous testis cancer. More surprising was the observation that there were fewer germ cell cancers in the other testis, British oncologists reported at the American Society of Clinical Oncology annual meeting.

A higher intake of dietary calcium appears to decrease the risk of kidney stone formation in women, according to findings from the Nurses' Health Study II.

A free, centralized online database with the results of all controlled clinical drug trials (mainly phase III and IV studies) will be available next month to the public at www.clinicalstudyresults.org.

Even though men age 56 years and older continue to receive the majority of sildenafil citrate (Viagra) prescriptions, use in men ages 18 to 46 years increased 312% from 1998 to 2002, according to a study in the International Journal of Impotence Research (2004 16:313-8.)

A new study has been launched to compare long-term benefits and risks of three treatments for BPH-transurethral needle ablation, transurethral microwave thermotherapy, and a combination drug regimen of alfuzosin (Uroxatral) and finasteride (Proscar), the National Institute of Diabetes and Digestive and Kidney Diseases announced.

CMS estimates that Medicare payments to urologists will decrease 13% in 2005.

New Orleans--Treatment with the endothelin receptor antagonist atrasentan (Xinlay) significantly delays time to progression in patients with metastatic, hormone-refractory prostate cancer, according to a meta-analysis of pooled data from two large trials.

San Francisco--An investigational selective alpha-1 adrenoreceptor blocker improves both the obstructive symptoms associated with BPH and symptoms associated with overactive bladder, according to a Japanese study presented at the AUA annual meeting here.

San Francisco--Interim results from two multi-national European studies show that once-daily treatment with a uroselective alpha-blocker reduces lower urinary tract symptoms and may benefit sexual function. The drug, alfuzosin (Uroxatral), appears to be efficacious in men with co-morbidities such as hypertension, heart disease, and diabetes, and does not seem to significantly interact with medications for those conditions, according to two separate studies presented at the AUA annual meeting here.

San Francisco--Phytotherapy with the saw palmetto extract Serenoa repens (Permixon) appears to be more effective than an alpha-blocker in relieving severe BPH, European researchers report. Their finding is based on a study of nearly 700 patients with symptomatic BPH who received either the saw palmetto extract or the alpha-blocker tamsulosin (Flomax).

San Francisco--Androgens, estrogens, and the development of BPH appear to be related, according to a study presented at the AUA annual meeting this year, but the nature of those relationships and the underlying mechanisms remain unknown.

New York--New disease registries aimed at collecting real-world data on the management of two common urologic conditions in men-BPH and rising PSA following initial treatment for prostate cancer-are currently in the patient recruitment phase. The registries will help to quantify the wide range of practice patterns and outcomes that have not been previously examined, say urologists involved in the initiatives.

New Orleans--The amount and velocity of change in PSA during the first few months of chemotherapy can independently predict patients who will survive, according to data from the Southwest Oncology Group (SWOG) and Cancer and Leukemia Group B. The results are among many recent findings begging FDA consideration in the debate about how PSA measurements can be used to more quickly approve prostate cancer drugs.

The procedure should be of a durationand complexity that will permit the patient to recover and be discharged.

New Orleans--Data from a randomized clinical trial show that long-term treatment with the bisphosphonate agent zoledronic acid (Zometa) halved the rate of skeletal events in patients with advanced prostate cancer and bone metastases.

San Francisco--Elevated PSA levels in men who have chronic bacterial prostatitis return to normal after antimicrobial treatment with either levofloxacin (Levaquin) or ciprofloxacin (Cipro), according to researchers from Northwestern University and Ortho-McNeil Pharmaceutical.

San Francisco--Because of its longer half-life, dutasteride (Avodart) may confer an advantage not seen with finasteride (Proscar), according to UCLA researchers. Missed doses of dutasteride, a newer 5-alpha-reductase inhibitor, are not likely to impact drug-induced suppression of dihydrotestosterone (DHT), and clinically that difference may be important because BPH patients often miss doses of prescribed medicines.

San Francisco--Baseline PSA and transrectal ultrasound volumes may predict the best medical therapy for BPH, according to investigators involved in the Medical Therapy of Prostatic Symptoms (MTOPS) trial. Similar to the initial findings of MTOPS, this secondary analysis suggests a role for different drug regimens based on patients' level of risk.

Men with erectile dysfunction who do not respond to treatment with a phosphodiesterase type-5 inhibitor may benefit from the addition of a testosterone gel, according to researchers from New York-Presbyterian Hospital/Columbia University Medical Center.

Progress was made in understanding the mechanism of urinary tract infection during several presentations made at the AUA annual meeting. At the same time, certain assumptions about drug therapy for chronic prostatitis and imaging for UTIs were disproven.

At the 2004 AUA annual meeting, researchers reported that daily administration of a phosphodiesterase type-5 inhibitor improves chances of recovery from post-prostatectomy erectile dysfunction-good news about a difficult-to-treat patient population. The bad news was a finding that herbal ED treatments purchased over the Internet are often ineffective, potentially dangerous, and occasionally tainted with active, unlabeled PDE-5 inhibitors.

New research on the potential of antibiotic-eluting stents and alpha-blockers that may speed or ease the passage of stones may lead to significant changes in urologic practices, according to Glenn M. Preminger, MD.

San Francisco--Just because it looks like interstitial cystitis doesn't mean it is interstitial cystitis. Some irritative voiding symptoms that look like IC may be symptoms of bladder cancer, even in patients who do not have the usual bladder cancer risk factors.

The 2004 AUA annual meeting brought news of the most dramatic advance in the field of interstitial cystitis/painful bladder syndrome over the last 20 years. Researchers reported the complete molecular structure of antiproliferative factor (APF), the peptide produced by bladder epithelial cells only in IC patients.

I believe the evidence is accumulating in favor of earlier [androgen deprivation] therapy to provide a survival benefit.

Arlington Heights, IL-Presutti Laboratories has received FDA approval to market tinidazole (Tindamax) for the treatment of trichomoniasis, as well as giardiases, intestinal amebiases, and amebic liver abscess.

The goal of endoscopic intervention for vesicoureteral reflux should be the same as it is for open surgery-a 95% to 98% cure rate after one treatment with the option of excluding a postoperative voiding cystogram.

San Francisco--The tricyclic antidepressant amitriptyline (Elavil) is a safe and effective treatment for interstitial cystitis with significant benefits for reducing overall symptoms along with pain and urgency, according to the results of a German study.