New intraprostatic injectables and prostatic urethral lift for male LUTS

Abstract

Treatment modalities for male lower urinary tract symptoms (LUTS) comprise a broad spectrum of medical and surgical options. Interest is growing in minimally invasive treatment options, which should ideally be performed in an outpatient setting and have a short recovery time, durable efficacy and a good safety profile. The preservation of all aspects of sexual function, including antegrade ejaculation, seems to be increasingly important for patients. Initial experimental data on new minimally invasive procedures-such as the intraprostatic injection of novel agents including botulinum neurotoxin A (BoNT-A), NX-1207 and PRX302-were promising, but clinical trials have not confirmed the findings. Trials of the mechanical prostatic urethral lift device-Urolift(®) (Neotract, Inc., USA)-have been positive, but further long-term results are needed to confirm its beneficial effects.

24‐month durability after crossover to the prostatic urethral lift from randomised, blinded sham

“…The present results highlight the ability of PUL to sustainably de-obstruct the urethra and achieve long-term therapeutic results, an achievement that minimally invasive injectable therapies have struggled to achieve [27].…”

“…Considered further, when individual aspects of the IPSS are evaluated, each symptom is significantly better after PUL compared to sham by 3 months, as the effect of dilatation and placebo are severely diminished by that time. The present results highlight the ability of PUL to sustainably de‐obstruct the urethra and achieve long‐term therapeutic results, an achievement that minimally invasive injectable therapies have struggled to achieve .…”

Expected Next-Generation Drugs Under Development in Relation to Voiding Symptoms

“…PRX-302 (topsalysin) is another injectable modified recombinant peptide which might be selectively activated by prostate-specific antigen (PSA), which induces prostatic cell apoptosis without damaging the surrounding tissue and nerves [10]. After activation with PSA, PRX-302 is combined with other PRX-302, which induces cell apoptosis through the formation of transmembrane pores.…”

Apoptotic Pathways Linked to Endocrine System as Potential Therapeutic Targets for Benign Prostatic Hyperplasia

“…NX-1207 is a novel cysteine-containing linear protein [128] and is also the first drug in phase III trials suitable for BPH patients [129]. It is administered to BPH patients through a transrectal intraprostatic inoculation under ultrasound guidance [130].…”

“…PRX-302, known also as topsalysin, is a modified recombinant protein able to be selectively activated by prostate specific antigen (PSA), causing localized cell death and tissue disruption without any damage of the neighboring tissues [128]. PRX-302 binds to glycosylphosphatidyl inositol (GPI) receptors placed on the cell surface of prostate cells.…”