Drug Therapy

Male orgasmic quality can be adversely affected by prostate cancer surgery.However, early treatment with PDE-5 inhibitors may not only improve erectilefunction but orgasmic function as well, according to research from New YorkUniversity.

Some "herbal" products marketed as having efficacy similarto PDE-5 inhibitors without the side effects and the need for medical monitoringactually contain pharmacologic concentrations of PDE-5 inhibitors, accordingto the results of a Canadian study presented here. Separately, Britishresearchers confirmed what many urologists already know-that informationabout herbal ED therapies sold on the Internet is unreliable and misleading.

Celsion Corp. has received FDA approval to market the Prolieve Thermodilatationsystem for the treatment of BPH symptoms. Boston Scientific will distributeand co-market the treatment.

Today, many patients with apparent interstitial cystitis receive diagnosesbased on the minimally invasive (but not very specific) potassium sensitivitytest and the pelvic pain urgency/frequency (PUF) questionnaire-not throughcystoscopy and hydrodistension under anesthesia, which has been the goldstandard. That means that when the irritative voiding symptoms are in factcaused by transitional cell carcinoma of the bladder, they can be misdiagnosedas IC.

After 1 year of follow-up, women with stress urinary incontinence treatedwith an investigational bulking agent containing ethylene vinyl alcoholdissolved in a dimethyl sulfoxide carrier (EVOH/DMSO, Uryx) are demonstratingdry and improved outcomes more often than controls receiving injectablecollagen (Contigen), investigators from a multicenter study reported yesterday.

Over the next 5 days, urologists can expect to hear a great deal aboutprostate cancer treatment outcomes, robotic and minimally invasive surgicaltechniques, pelvic pain in both men and women, the obesity epidemic andits connection to prostate cancer, and advances in erectile dysfunctiontherapy. These are among the key areas of scientific research grabbing headlinesat this year's AUA annual meeting, said J. Brantley Thrasher, MD, chairof AUA's Public Media Committee.Dr. Thrasher briefed a small group of journalists yesterday on theseand other significant topics that make up part of the nearly 2,000 researchpapers being presented here.

The FDA has approved changes to the prescribing information for finasteride(Proscar) based on results of the landmark Medical Therapy of ProstaticSymptoms (MTOPS) study. Under the new approval, finasteride administeredin combination with doxazosin (Cardura) is indicated to reduce the riskof symptoms of BPH from progressing over time (a confirmed rise of fouror more points in AUA symptom score). MTOPS showed that the two-drug combinationsignificantly reduced the risk of BPH symptoms progressing versus placeboand versus either finasteride or doxazosin alone.

Today, standard practice for treating chronic prostatitis/chronicpelvic pain syndrome (CP/CPPS) is to try one treatment and, if that fails,move on to the next. It may be time to change this practice, said J. CurtisNickel, MD.

A commonly prescribed antibiotic and alpha-blockerappear to be ineffective in the treatment of men with moderate to severechronic prostatitis/chronic pelvic pain syndrome of long duration. Bothciprofloxacin and tamsulosin-used primarily in the treatment of UTI andBPH, respectively-offered no significant benefit in the treatment of chronicprostatitis in patients who were heavily pretreated and had long-standingsymptoms, a multicenter study shows.

Reduced reimbursement for chemo will cause urologists to make drasticchanges, AUA says

The use of hormone therapy in most patients with advanced prostate cancerproduces a dramatic positive response followed by a disappointing progression.In many cases, this occurs because treatment is withheld until late in thedisease. Can the grim prognosis of advanced prostate cancer be altered throughthe use of novel agents? Or can outcomes be improved by delivering hormonaltherapy earlier in the disease? The answers are likely yes, as two articlesin this issue of Urology Times suggest (see pages 13 and 24). But the solutionsare not imminent.

Here's some important advice for urologists while we await final detailson new payment system

Urinary pH has a strong inverse association with body weight, researchshows

All three agents found highly efficacious at maximum- and half-dose regimens

Hollywood, FL--The National Comprehensive Cancer Network (NCCN) has issuednew prostate cancer screening guidelines with several significant changes.The new guidelines suggest, but do not unequivocally mandate, screeningall men aged 50 years and older who have a greater than 10-year life expectancyand initiating biopsies if PSA exceeds 2.5 ng/mL.

Hysterectomy is one of the most commonly performed abdominal operations in the United States.

Before beginning any discussion of advanced prostate cancer, it is importantto point out that early detection of the disease has dramatically reducedthe cohort of men who present with locally advanced or metastatic disease.A review of the Eastern Virginia Medical School database indicates that,of the 320 new diagnoses of prostate cancer in 2003, only 5% presented withstage T3 disease, and 7% presented with stage M+ disease.

Tissue engineering and regeneration will one day offer cure for incontinence

Dallas--The two most significant developments in the management of benignprostatic hyperplasia in the past year were the release of the AUA updateof clinical guidelines for the condition and analysis of data from the MedicalTherapy of Prostatic Symptoms (MTOPS) trial, said Claus G. Roehrborn, MD,professor and chairman of the department of urology, University of TexasSouthwestern Medical Center, Dallas.

Antiproliferative factor may pinpoint etiology of IC and help boost futureresearch

But open discussions of sexual dysfunction have led to 'hucksterism'and false claims

It is becoming increasingly clear that immunology plays a large role in urinary tract infections and potentially in their cure. One new theory is that bacteria can influence the host's immune response by down-regulating it, suppressing the immune system and preventing the host from responding in a normal way.

Robotic-assisted prostatectomy and pharmacologic approaches continueto evolve

Brothers of diagnosed prostate cancer patients are aware of the increased risk of possibly developing prostate cancer and have taken complementary or alternative medicine associated with prostate health as a result, according to a study by the University of Michigan Health System published in Cancer (2004;100:1537-44).

The FDA has added BAY 43-9006, an investigational treatment for metastatic renal cell carcinoma, to its fast track program.

Current lack of support may stem from misinterpretation of OIG guidelines

Florence, Italy--The anticholinergic drug trospium chloride seemsto reduce urgency severity among patients with overactive bladder, accordingto the results of a prospective investigation by researchers from NorthwesternUniversity, Feinberg School of Medicine, Evanston, IL.

Sydney, Australia--Duloxetine, a selective serotonin and norepinephrinereuptake inhibitor, yields significant improvements in incontinent episodesand quality of life among women with stress urinary incontinence, and ispoised to become the first effective oral agent for the condition, an Australianurologist says.

Inappropriate wetting and voiding habits are common in children, constituting 20% to 25% of new patients seen in the pediatric urology office setting.

Alexandria, VA--The search for a sensitive and specific screening tool for interstitial cystitis has been nothing short of elusive.