The Effect of Finasteride on the Risk of Acute Urinary Retention and the Need for Surgical Treatment among Men with Benign Prostatic Hyperplasia

McConnell, John D.; Bruskewitz, Reginald C.; Walsh, Patrick C.; Andriole, Gerald L.; Lieber, Michael M.; Holtgrewe, H. Logan; Albertsen, Peter C.; Roehrborn, Claus G.; Nickel, J. Curtis; Wang, D Z; Taylor, Allison J.; Waldstreicher, Joanne

doi:10.1056/nejm199802263380901

Cited by 1,028 publications

(314 citation statements)

References 24 publications

Supporting

Mentioning

297

Contrasting

Unclassified

Order By: Relevance

“…27 The clinical, chemical, and volumetric observations made in the present group of long-term finasteride responders are consistent with previous reports. [1][2][3][4][5] After 6 months of treatment, prostate volume decreases by approximately 18% to 20%; serum levels of DHT and PSA decrease by approximately 70% and 50%, respectively; voiding symptoms and flow rates are improved; and the new levels are maintained for years thereafter. Thus, the present group of patients, although highly selected (see Material and Methods, Patients), appears to be representative of the thousands of men studied in other clinical trials.…”

Section: Huggins and Stevensmentioning

confidence: 99%

“…1 Moreover, the treated men also experienced a 55% reduction in risk of surgical intervention and a 57% reduction in risk of acute urinary retention compared with the untreated men. 1 However, prostatic tissue changes, which may explain the clinical effects of finasteride, have only been systematically evaluated for up to 6 months of treatment. 6,7 Long-term tissue effects might have important implications regarding the mechanism of action of the drug.…”

mentioning

confidence: 97%

“…[1][2][3][4][5] For example, in the Proscar Long-Term Efficacy and Safety (PLES) study, men treated with finasteride for 4 years exhibited a sustained decrease in voiding symptoms, prostate volume, and serum prostate-specific antigen (PSA) levels and a sustained increase in urinary flow rate compared with placebo-treated control subjects. 1 Moreover, the treated men also experienced a 55% reduction in risk of surgical intervention and a 57% reduction in risk of acute urinary retention compared with the untreated men. 1 However, prostatic tissue changes, which may explain the clinical effects of finasteride, have only been systematically evaluated for up to 6 months of treatment.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Long-term effects of finasteride on prostate tissue composition

Marks

Partin

Dorey

et al. 1999

Urology

101

View full text Add to dashboard Cite

Objectives. To determine the long-term effects of finasteride treatment on prostate tissue composition; to relate these effects to clinical outcomes; and to test the hypothesis that finasteride exerts a selective or preferential action on the transition zone. Methods. Nineteen men with symptomatic benign prostatic hyperplasia (BPH) who completed a 6-month double-blind trial of finasteride were enrolled in a 24-month open-label extension study of drug responders. Magnetic resonance imaging and prostate biopsy for morphometric analysis were performed together 70 times: at baseline (n ϭ 19), after treatment periods of intermediate duration (6 to 18 months, n ϭ 32), and after long-term drug treatment (24 to 30 months, n ϭ 19). At baseline, prostate volume averaged 51 cc, of which 57% was transition zone. Results. Decreases in symptom score, dihydrotestosterone and prostate-specific antigen levels, and prostate volume occurred at 6 months (P Ͻ0.01), stabilized, and were maintained without further long-term decreases. Prostate epithelium contracted progressively from baseline (19.2% tissue composition; 6.0-cc volume; 3.2 stroma/epithelial ratio) to intermediate (12.5%, 3.3 cc, and 5.6, respectively) to long-term treatment (6.4%, 2.0 cc, and 17.4, respectively, P Ͻ0.01 for all). Percent epithelial contraction was similar in the peripheral and transition zones (P ϭ NS). The transition zone remained a relatively constant proportion (53% to 58%) of whole-prostate volume from baseline to long-term observation. Conclusions. Long-term finasteride treatment (24 to 30 months) results in a marked involution of the prostate epithelium, which continues to progress for many months after clinical effects stabilize. The effect on the epithelium is similar in the peripheral and transition zones for both morphometric and volumetric changes. Progressive contraction of the prostate epithelium appears to constitute the underlying mechanism for sustained action of finasteride. UROLOGY 53: 574-580, 1999.

show abstract

Section: Huggins and Stevensmentioning

confidence: 99%

mentioning

confidence: 97%

mentioning

confidence: 99%

See 1 more Smart Citation

Long-term effects of finasteride on prostate tissue composition

Marks

Partin

Dorey

et al. 1999

Urology

101

View full text Add to dashboard Cite

show abstract

“…The results of the USA PLESS study, 30 the largest and longest BPH study ever completed, was ®rst reported by Dr J McConnell at the SIU meeting in Montreal in September 1997. This landmark study con®rmed the hypothesis generated by the Endpoint Analysis.…”

Section: Does Medical Therapy Change the Incidence Of Bph Complications?mentioning

confidence: 99%

Medical therapy for BPH: expanding our treatment paradigm?

Nickel

1999

Prostate Cancer Prostatic Dis

View full text Add to dashboard Cite

Medical therapy for relief of symptoms of benign prostatic hyperplasia (BPH) is now a clinical reality. The challenge for urologists treating BPH with medical therapy is how to rationally employ the two proven classes of medications, the alpha blockers and ®nasteride, in their practice. To accomplish this, we must critically examine the results of multiple important clinical BPH trials published over the last decade and examine the short and long term effect of the various available medical therapies on symptoms, objective progression and consequences of the disease process and whether evidence based indicators will allow us to choose appropriate therapies. It appears that we can rationalize our medical therapy decisions, taking into consideration severity of disease, prostate size (and perhaps PSA) and most importantly, the patients' longterm expectations for treatment outcome. But ®rst physicians must decide for themselves whether to expand their treatment paradigm beyond short term symptom relief to encompass long term durability and even prevention of the consequences of the long term progression of BPH.Keywords: benign prostatic hyperplasia; prostate; ®nasteride; alpha blockers The challengeDuring the last decade medical therapy for benign prostatic hyperplasia (BPH) has become a clinical reality. 1 Two classes of medication have emerged with consistently proven results in randomized controlled trials as better than placebo: the alpha-blockers and the 5-alphareductase inhibitors. Well designed studies have proven that these medications are both safe and effective over the short term (1 y).The challenge for urologists treating BPH with medical therapy is how to rationally employ these medications in their practice. To tackle this task we must ask a number of fundamental questions: Is BPH a long term progressive disease? Should the solution for this disease with medical therapy be viewed not in terms of weeks, months or even a year, but rather be considered a life time treatment for the patient? As surgeons we have always been most interested in short term symptom relief. But now, should we be convinced that that therapy is safe over the long term, has long term ef®cacy compared to placebo, is durable over years and even decades, hopefully has the ability to halt the progression of the disease and prevent complications such as acute urinary retention or the requirement for surgery? The ultimate challenge is whether we as a urological community are ready to expand beyond short term symptom relief to long term symptom control and perhaps even prevention of disease progression with its associated complications. The problemIt appears, that in many (but certainly not all) patients with lower urinary tract symptoms, BPH can indeed be considered a slowly progressive disease. The prostate gland increases in size at an average rate of 0.6 ml/y with some age variation. 2 The average decrease in¯ow rate over time, which is an indirect measure of obstruction, is about 2 ml/sec/decade. 3,4 The frequency and severity of sy...

show abstract

“…4 Recently, a number of studies reported that early administration of a 5-alpha reductase inhibitor (Proscar) to BPH patients is able to reduce the chance of prostate surgery by around 50%. 5 However, owing to the lack of reliable biomarkers for early detection, majority of BPH patients are presented at late stage, which may not be reverted even after TURP. 6 Therefore, early detection as well as prevention of the progression of this disease is essential for the successful treatment of BPH.…”

Section: Introductionmentioning

confidence: 99%

Evidence of a novel biomarker, αs1-Casein, a milk protein, in benign prostate hyperplasia

Wang

et al. 2006

Prostate Cancer Prostatic Dis

View full text Add to dashboard Cite

Benign prostate hyperplasia (BPH) is a common disease in elderly men. Although it is a nonmalignant disease, it has a significant detrimental impact on the quality of life in patients with latestage disease. Owing to the lack of specific markers, diagnosis of early-stage BPH has been proven unsuccessful. Recently, using two-dimensional electrophoresis, we identified a group of prostatic secretory proteins that are specifically produced by BPH cells (Xu et al., Electrophoresis 2003; 24: 1311). In this study, we investigated the potential diagnostic value of one of the secretory proteins, as1-Casein, in BPH by inmmunohistological staining of normal, BPH and prostate cancer tissues. We found that 90% (20 out of 22) of BPH tissues showed moderate to strong as1-Casein protein expression whereas none of the normal tissues (0 out of 10) and less than 10% of the prostate cancer tissues (3 out of 30) showed similar staining intensity. Our results suggest that as1-Casein may be a potential biomarker for early identification of BPH patients.

show abstract

The Effect of Finasteride on the Risk of Acute Urinary Retention and the Need for Surgical Treatment among Men with Benign Prostatic Hyperplasia

Abstract: Among men with symptoms of urinary obstruction and prostatic enlargement, treatment with finasteride for four years reduces symptoms and prostate volume, increases the urinary flow rate, and reduces the risk of surgery and acute urinary retention.

Cited by 1,028 publications

References 24 publications

Long-term effects of finasteride on prostate tissue composition

Long-term effects of finasteride on prostate tissue composition

Medical therapy for BPH: expanding our treatment paradigm?

Evidence of a novel biomarker, αs1-Casein, a milk protein, in benign prostate hyperplasia

Contact Info

Product

Resources

About