5-ARI shows efficacy in chronic prostatitis symptoms

September 1, 2010

Five-alpha-reductase inhibitors may do more than treat BPH and reduce prostate cancer risk; they may ease chronic prostatitis/chronic pelvic pain syndrome symptoms.

In fact, the drugs have been used off-label in some men with the condition, but there hasn't been good scientific support for this use. But an analysis of data from the REDUCE (Reduction by Dutasteride of Prostate Cancer Events) trial has inched closer to an indication. The findings from this large trial, which included more than 8,000 men, bolster the results of small, underpowered studies showing 5-ARIs may be useful in CP/CPPS.

It's not time to take out the prescription pad with confidence yet for men with CP/CPPS and no other indications for 5-ARIs, however. It's going to take another randomized, controlled trial with appropriately selected patients with the condition.

Significant reduction in pain observed

Among the 647 men with prostatitis-like pain, the reduction in total CPSI score at the end of the trial was significantly greater for the 323 men taking dutasteride (Avodart): a mean of 5.2 points compared with 2.7 among placebo recipients.

The difference was also significant for the men with prostatitis-like syndrome, with a reduction in 4.2 points for the men taking dutasteride versus 2.8 for those taking placebo. Pain, urinary, and quality of life subscores also showed significant differences.

In addition, there were significantly more 4- and 6-point responders in the dutasteride group than the placebo group. Among the men with prostatitis-like pain who took dutasteride, 63% had a 4-point reduction and 49% had a 6-point reduction in their total CPSI scores compared with 59% and 37%, respectively, among men taking placebo. Among the men with prostatitis-like syndrome who took dutasteride, 58% had a 4-point reduction and 46% a 6-point reduction in their total scores, compared with 47% and 35% of those taking placebo.

Is CP/CPPS a prostate condition?

These results seem to belie the new mindset that CP/CPPS and interstitial cystitis are not end-organ diseases. So is CP/CPPS really a prostate condition?

"In some patients, it is," Dr. Nickel told Urology Times.

About 50% of men with CP/CPPS have pain and inflammation localized to the prostate. Those are the men that need to be studied in a randomized placebo-controlled trial that he and his colleagues want to do, said Dr. Nickel, who presented the current study at the AUA annual meeting in San Francisco.

Today, he does prescribe 5-ARIs for patients who have an indication-BPH or prostate cancer prevention-for one of these medications.

"If they have prostatitis, along with one of these other prostate conditions, I can predict there's a very good chance they're going to get better on long-term dutasteride therapy," said Dr. Nickel, "but, what we need to do is test this."

Dr. Nickel disclosed that he is a member of the GlaxoSmithKline Canadian advisory board.