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Bruce R. Kava, MD, presents the take home messages on BPH/LUTS from the AUA annual meeting in San Diego.
Presented by Bruce R. Kava, MD
University of Miami Miller School of Medicine, Miami
• BPH treatment with finasteride (Proscar)/tadalafil (Cialis) combination therapy led to a significant reduction in International Prostate Symptom Score. The treatment also provides early improvement in lower urinary tract symptoms in men with moderate-sized prostate volumes compared to finasteride alone; longer follow-up is needed to determine whether this attenuation of effects continues out further.
• A randomized clinical trial of alfuzosin (Urotraxal)/propiverine combination therapy versus alfuzosin alone for patients with symptomatic bladder outlet obstruction and overactive bladder yielded a dose-dependent reduction in the OAB symptom score for the combination therapy group, as well as a drop in IPSS score. Storage and voiding symptoms also improved in the combination therapy group.
• Imidafenacin and tamsulosin (Flomax) in patients with BPH/OAB refractory to alpha-blockers is a safe, effective, and durable combination therapy.
• In two studies of acute urinary retention following antimuscarinic use in men with BPH, incidence of retention appeared to be higher than reported in most clinical trials. Retention occurs within the first 3 months 80% of the time. In addition, the incidence of acute urinary retention increases markedly in elderly patients.
• In 40 BPH/OAB patients, treatment with mirabegron (Myrbetriq) led to a significant decrease in IPSS score, a slight improvement in Qmax, and a slight increase in post-void residual.
• Long-term testosterone replacement therapy does not appear to affect LUTS in the majority of patients.
• Men with BPH and a PSA >4.0 ng/mL who exercised vigorously for an hour raised their PSA level by an average of 25%. Over the next 2 days, they sustained the increase in PSA level, which subsequently declined. Men should abstain from physical exercise at least 24 hours before PSA screening.
• Polymorphisms of cytochrome P450-17, glutathione S-transferase-M1, interleukin 4, steroid 5-alpha-reductase, and the vitamin D receptor appear to be associated with BPH/LUTS.
• The antioxidants vitamin C, lutein/zeaxanthin, and β-cryptoxanthin may prevent LUTS in elderly men.
• Two single-nucleotide polymorphisms were associated with exacerbation of LUTS in African-American men.
• In the future, tyrosine kinase inhibitors or antiangiogenesis medications may be useful for patients with BPH.
• Bipolar plasma vaporization of the prostate outperformed bipolar transurethral resection in saline and monopolar transurethral resection of the prostate in operative time, intraoperative bleeding, hospital stay, catheterization time, and transfusion requirements.
• Photoselective vaporization of the prostate with the GreenLight XPS 180W laser (American Medical Systems) showed comparable efficacy to TURP with fewer serious side effects, decreased catheterization times, and shorter length of stay.UT