Drug Therapy

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Indianapolis--For urologists who are less than happy with the current options for performing intracorporeal lithotripsy, researchers from one of the country's highest-volume stone centers have some good news. A novel, dual-probe lithotriptor appears to offer the best features of both pneumatic and ultrasonic devices, and provides a significantly shorter penetration time than a combination pneumatic-ultrasonic device, in vitro research data show.

New York--Preliminary results from the first two U.S. patients to undergo surgery to create a somatic-autonomic reflex pathway for micturition suggest the procedure may be an effective, safe treatment for neurogenic bladder secondary to spinal cord injury, report urologists from New York University.

Z?rich Switzerland--Botulinum toxin A (Botox) may be an effective, safe alternative treatment option in patients experiencing overactive bladder refractory to more standard treatments, according to a study performed at the Universit?tsspital Z?rich and Kantonsspital Luzern, Switzerland.

Scottsdale, AZ--Injecting botulinum toxin A (Botox) into the prostate gland shows potential for providing a quick, easy, and safe treatment option for men with lower urinary tract symptoms related to BPH, but two small studies—one from the United States and Chile, and one from Italy—provided equivocal results regarding the efficacy of this investigational approach. While the Italian data showed significant decreases in International Prostate Symptom Score and prostate size with botulinum toxin, U.S. researchers were unable to duplicate these results. Both studies were presented at the AUA annual meeting in San Antonio.

A combination of samarium SM-153 lexidronam injection (Quadramet) and docetaxel (Taxotere) appears to reduce PSA levels in patients with progressive hormone-refractory prostate cancer, according to a phase II study involving 29 patients.

Washington--Months of intensive lobbying and hard work have paid off for urologists, who now have an outside shot at a net Medicare fee schedule increase for their services, compared with the overall 4.3% reduction for 2006 announced in March.

Mountain View, CA--Apparently avoiding problems with a potentially common drug combination, the investigational premature ejaculation therapy dapoxetine does not interact with phosphodiesterase type-5 inhibitors, according to results of a clinical pharmacokinetics study.

Hamburg, Germany--Serious male cycling enthusiasts might want to consider taking a phosphodiesterase type-5 inhibitor prior to a long ride to prevent pressure-induced hypo-oxygenation of the penis, according to German researchers.

Initial findings from a continuing phase II multicenter study of docetaxel (Taxotere) as adjuvant therapy in radical prostatectomy patients at high risk of recurrence have shown that the drug is well tolerated, with reversible side effects.

Two newer-generation antimuscarinic agents &#8212 solifenacin succinate (Vesicare) and tolterodine tartrate extended-release (Detrol LA) &#8212 improve symptoms of overactive bladder, but solifenacin appears to provide superior outcomes, partly because it offers a flexible dosing regimen, researchers say.

Washington--Urologists and other physicians now have some breathing room as they seek to decide whether to participate in the new Competitive Acquisition Program (CAP) established by the Centers for Medicare & Medicaid Services for drugs administered in the office.

Orlando, FL--A small clinical trial presented at the American Society of Clinical Oncology annual meeting has demonstrated the feasibility of a vaccine strategy for the treatment of men with prostate cancer who had completed neoadjuvant chemotherapy or hormone therapy at least 6 months prior to enrollment. The multi-institutional phase II study evaluated the role of vaccination in men with rising PSA after local treatment for prostate cancer using a prime/boost approach with vaccinia virus and fowl pox virus expressing PSA.

Orlando, FL--The addition of the nonsteroidal antiandrogen bicalutamide (Casodex) to a luteinizing hormone-releasing hormone agonist (LHRHa) confers significant benefits over LHRH monotherapy as first-line treatment for advanced prostate cancer, according to a study presented by Japanese researchers at the American Society of Clinical Oncology annual meeting here.

Orlando, FL--Treatment with a novel form of immunotherapy known as APC8015 (Provenge) offers a substantial survival advantage in asymptomatic prostate cancer patients with metastatic disease who have failed to respond to hormone treatment, according to findings from a placebo-controlled phase III trial. At 36 months, 34% of the treated patients were alive versus 11% of those on placebo.

San Antonio—Researchers continue to probe the effects of docetaxel (Taxotere) on prostate cancer in efforts to devise the most efficacious application of the compound. Combining the agent with thalidomide (Thalomid) appears to enhance survival in androgen-independent disease, according to a phase II National Cancer Institute study whose initial data appeared earlier this year.

San Antonio--The foundation for a wider application of docetaxel (Taxotere) in prostate cancer is being laid, but it is far from complete. Two major studies appearing last year allowed the drug to replace mitoxantrone (Novantrone) as a first-line treatment in hormone-resistant metastatic prostate cancer. Data from a continuing phase II study of the agent as adjuvant therapy in radical prostatectomy patients at high risk of recurrence were presented here at the AUA annual meeting. Initial findings have shown that the drug is well tolerated, with reversible side effects.

Results of a U.S. phase II trial investigating the safety, tolerability, and efficacy of the nonselective muscarinic antagonist fesoterodine fumarate in patients with detrusor overactivity offer hope for the 10% of men and women over age 40 years who have the syndrome, researchers say.

No single study on the topic of sexual dysfunction leapt from the podium as a breakthrough at this year's AUA annual meeting, but a number of studies offered valuable observations about various aspects of sexual function/dysfunction. Among these were studies showing that the degree of personal involvement in restoring sexual function after radical prostatectomy correlates with the degree of success, said John Mulcahy, MD, PhD, professor of urology, Indiana University Medical Center, Indianapolis. Also, research showed that erectile dysfunction can be associated with metabolic disorders and heart disease, and when prescriptions with level 1 interactions overlap, they are often for sildenafil citrate (Viagra) and nitrates.