The Role of Dutasteride in Acute Prostatic Haematuria

Abstract

Background: Dutasteride has been found to reduce chronic prostatic bleeding and when taken 2 -6 weeks preoperatively reduces bleeding during transurethral prostate resection. The aim of this study is to determine if the drug will be effective in the control of acute gross prostatic haematuria. Patients and Method: 87 Consecutive patients with gross haematuria were enrolled. Clotting Profile, Cystoscopy and Intravenous Urography were done to exclude haematuria from medical, renal and bladder causes. Patients suspected to have prostatic haematuria were further evaluated using serum Prostate specific antigen (PSA) and Prostate scan. Those with elevated PSA ≥ 10 ng/ml and abnormal digital rectal examination (DRE) finding had prostate biopsy. The patients were randomly divided into 2 treatment groups. The control group had Normal saline irrigation and broad spectrum antibiotics while the second group received 0.5 mg oral dutasteride in addition. The time taken and volume of irrigation fluid used before haematuria stopped were noted. Statistical analysis was done using SPSS version 20.0. Result: 75 patients had haematuria of prostatic origin. 49 (65.3%) of these had benign prostatic hyperplasia (BPH) and 26 (34.7%) had cancer of prostate. 25(51%) of the 49 patients with BPH had Normal saline irrigation and antibiotics while 24 (49%) had oral dutasteride in addition. 14 (53.8%) of the prostate cancer patients had Normal saline irrigation and antibiotics while 12 (46.2%) had dutasteride in addition. Haematuria resolved in significantly shorter length of time using lesser volume of irrigation fluid in those treated with dutasteride than in those on control arm. Conclusion: Addition of 0.5 mg oral dutasteride daily leads to early resolution of acute prostatic haematuria.

Prevalence of prostate cancer in men with haematuria: a systematic review and meta‐analysis

“…In total, 65 studies were included in this review [20–84] (Table S1), and divided in two categories; (A) studies describing clearly how many of men referred to hospital or private practice for evaluation of haematuria aetiology had prostate cancer ( n = 42) [20–61], and (B) studies clearly describing haematuria as a presenting symptom leading to a prostate cancer diagnosis ( n = 23) [62–84]. The 42 studies describing evaluation of haematuria were included in a meta‐analysis [20–61]. All of the 42 studies […”

“…The 42 studies describing evaluation of haematuria were included in a meta‐analysis [20–61]. All of the 42 studies [20–61] were cohort studies, enabling direct comparison. Prostate cancer prevalence's are given in Table 1.…”

“…For the 42 studies [20–61], quality was ‘good’ in eight [20,21,24–26,36,53,57], ‘fair’ in 22 [23,27,29,31–33,37,38,40,41,43,47,49,51,52,54–56,58–61] and ‘poor’ in 12 studies [22,28,30,34,35,39,42,44–46,48,50]. As studies rated of ‘good’ quality were deemed to have low bias, we wanted to investigate the prostate cancer prevalence specifically for these studies [20,21,24–26,36,53,57].…”

“…From the 42 studies included in the meta‐analysis [20–61], the pooled prevalence (95% CI) of prostate cancer was 3.0% (2.0–4.1%; Fig. 2).…”

“…Histopathology was provided for 50 of the 505 identified prostate cancers, and all were adenocarcinomas [26,27,39,51]. The PSA level was described for 61 of the 505 identified prostate cancers, and all had elevated PSA [23,40,46,57]. No study described tumour burden or cancer size.…”