New drug class, herbal therapies making news in BPH

Natural compounds, a novel new drug class, and the growing popularity of a minimally invasive laser are poised to make news in the treatment of benign prostate hyperplasia, Claus G. Roehrborn, MD, told Urology Times.

"The NIH and the National Center for Complementary and Alternative Medicine are planning a large study of saw palmetto, Pygeum africanum, and placebo in men with these conditions. This will probably be the definitive study of these compounds. The question everyone wants answered is, do these natural compounds have a role in these diseases or are their effects largely placebo," he said.

"The answer to that question would obviously be of great interest to men over 50," said Dr. Roehborn, professor and chairman of the department of urology, University of Texas Southwestern Medical Center, Dallas.

"My prediction is that during the next 5 years, this will be one of the hottest topics in clinical BPH management," he said.

Urologists and their patients may not have to wait 5 years for the initial response to this question. Dr. Roehrborn hopes to present initial findings on the issue at the upcoming AUA annual meeting. He is working with data from 1,095 patients who were part of the Medical Therapy of Prostatic Symptoms (MTOPS) study who had baseline biopsies at entry into the study.

"We never had information sufficient to answer this sort of question. We didn't have a large number of patients with baseline data and baseline biopsy information. The MTOPS trial has provided a lot of data. The data that I've analyzed suggests that men who have chronic inflammatory infiltrates in the prostate are perhaps at twice the risk of disease progression leading to surgery," he said.

(See Urology Times, May 1, 2005, for more on this finding.)

Metabolic inhibitorsDr. Roehrborn called attention to a scheduled phase II trial of what may be the first of a new class of drugs tentatively called targeted metabolic inhibitors. The drug in the trial is known as TH-070.

"The drug takes advantage of unique metabolism in the prostate. The prostate relies on glycolysis for energy rather than the Krebs cycle. In the prostate, the Krebs cycle is inefficient because it is inhibited by high levels of zinc in the organ. The drug inhibits glycolysis, and in animals and initial trials, has a significant impact on the prostate. It appears to reduce symptoms, increase flow rates, reduce prostate size, and lower PSA readings as early as a month after the therapy is started," said Dr. Roehrborn.

"This and similar compounds are going to be exciting compounds to follow during the next couple of years."

Laser treatment In the arena of minimally invasive treatment, Dr. Roehrborn noted that the high-power KTP laser (GreenLight PVP, Laserscope, San Jose, CA) is earning significant attention from urologists.

"In this era of minimally invasive treatments, the GreenLight laser is enjoying tremendous popularity," he said.