Pre-Androgen Ablation Prostate Cancer Patients Who Bleed Do Well with 5 Alpha Reductase Inhibitors
- 1 Urology Division, Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
- 2 Department of Anatomical Pathology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
Abstract
Background: Patients with gross haematuria are sometimes found to have prostate cancer after clinical evaluation. The treatment of such haematuria could be very challenging. Use of a 5 alpha reductase inhibitor like dutasteride has been found helpful in bleeding prostate cancer patients if they have not undergone hormonal manipulation before they developed haematuria. Patients and Method: 26 patients with gross haematuria of prostatic origin who had histologic confirmation of adenocarcinoma of the prostate but who have not had chemical or surgical castration were randomized to receive daily dutasteride in addition to vigorous saline irrigation and antibiotics on one arm and vigorous saline irrigation and antibiotics only as control on the other arm. The time taken before haematuria resolved and the amount of irrigation fluid used were noted. Statistical analysis was done using SPSS. Student’s t-test and Kaplan Meier survival analysis were used to test various variables at 0.5 significant levels. Results: Of the 26 patients 12(46.2%) received 0.5 mg oral dutasteride in addition to saline irrigation while 14 (53.8%) received saline irrigation only. Haematuria stopped in all of 12 (100%) patients on dutasteride arm but on 12 (85.7%) of the 14 patients on the control arm. It took significantly shorter time and lesser volume of irrigation fluid before haematuria resolved in those treated with dutasteride than in those on the control arm. Conclusion: Dutasteride is effective in the control of acute haematuria in pre-androgen ablation prostate cancer patients.
- Mbonu, O.O., Amene, P.C. and Nwofor, A.M. (1991) Gross Haematuria in a Negro Population: An Analysis of 100 Adult Patients. International Urology and Nephrology, 23, 261-263. https://doi.org/10.1007/BF02550422
- Gofrit, O.N., Katz, R., Pizov, G., Zarn, K.C., Duvdevani, M., Landau, E.H., et al. (2013) Gross Haematuria in Patients with Prostatic Cancer: Etiology and Management. ISRN Surgery, 2013, Article ID: 685327. https://doi.org/10.1155/2013/685327
- Del Regato, J.A., Trailins, A.H. and Pittman, D.D. (1993) Twenty Years Follow up of Patients with Inoperable Cancer of Prostate (Stage C) Treated by Radiotherapy: Report of a National Co-Operative Study. International Journal of Radiation Oncology • Biology • Physics, 26, 197-201. https://doi.org/10.1016/0360-3016(93)90197-4
- Devisetty, K., Zorm, K.C., Katz, M.H., Jani, A.B. and Liauw, S.L. (2010) External Beam Radiation Therapy after Transurethral Resection of the Prostate: A Report on Acute and Late Genitourinary Toxicity. International Journal of Radiation Oncology • Biology • Physics, 77, 1060-1065. https://doi.org/10.1016/j.ijrobp.2009.06.078
- Andriole, G.L., Humphrey, P., Ray, P., et al. (2004) Effect of the Dual 5 Alpha Reductase Inhibitor Dutasteride on Markers of Tumor Regression in Prostate Cancer. Journal of Urology, 72, 915-919. https://doi.org/10.1097/01.ju.0000136430.37245.b9
- Crain, D.S., Amling, C.L. and Kane, C.J. (2004) Palliative Transurethral Prostate Resection for Bladder Outlet Obstruction in Patients with Locally Advanced Prostate Cancer. Journal of Urology, 171, 668-671. https://doi.org/10.1097/01.ju.0000104845.24632.92
- Rodriquez-Patron, R.R., Sanz-Mayoyo, E., Gomer, G.I., Blazquez, S.J., Sandez, C.J., Briones, M.G., et al. (2003) Hypogastric Artery Embolization as a Palliative Treatment for Bleeding Secondary to Intractable Bladder or Prostate Diseases. Archivos Españoles de Urología, 56, 111-118.
- Djavan, B. and Mirone, V. (2006) The Benefits of Dual Inhibitors of 5α Reductase. European Urology Supplements, 5, 1013-1017.
- Branson, H.N., Hermann, D., Bachelor, K.W., Lee, F.W., James, M.K. and Frye, S.V. (1997) Unique Preclinical Characteristics of GG745, a Potent Dual Inhibitor of 5 Alpha Reductase. Journal of Pharmacology and Experimental Therapeutics, 282, 1496-1502.
- Buccon-Gibod, L., Valton, M., Ibrahim, H. and Commenducci, A. (2007) Effect of Dutasteride on the Reduction of Intraoperative Bleeding Related to Transurethral Resection of the Prostate after Pre-Treatment with Dutasteride. BJU International, 99, 587-594.