RESUMEN
OBJECTIVE: A post hoc analysis of Asian men in the REDUCE study was conducted to investigate whether the outcomes were in line with those of the overall population. METHODS: REDUCE was a 4-year international, multicenter, randomized, double-blind, placebo-controlled, parallel-group study. Inclusion criteria were men between 50 and 75 years of age, a serum prostate-specific antigen level of 2.5-10.0 ng/ml (50-60 years) or 3.0-10.0 ng/ml (>60 years), and a single, negative prostate biopsy (6-12 cores) within 6 months before enrollment. The primary endpoint was biopsy-detectable prostate cancer. This post hoc analysis included subjects who were recorded as Asian. RESULTS: A total of 134 Asians, including 57 Japanese, were randomized to the study treatment. During the study period, the incidence of prostate cancer in the placebo and dutasteride groups was 19.6% (11/56) and 9.3% (5/54), respectively (relative risk reduction, 54%; 95% confidence intervals, -27 to 83%, P = 0.12), in the Asian subpopulation. Fewer tumors with the Gleason scores of 7-10 and 8-10 were detected among dutasteride-treated men. Although the incidences of drug-related sexual adverse events were higher in the dutasteride group, only in rare occasions did they lead to drug discontinuation. CONCLUSIONS: The incidence of prostate cancer in the dutasteride group was lower than that in the placebo group, although the difference was not significant. These results paralleled those for the overall population and support the value of dutasteride for prostate cancer risk reduction in Asian men with an increased risk of prostate cancer.
Asunto(s)
Inhibidores de 5-alfa-Reductasa/uso terapéutico , Azaesteroides/uso terapéutico , Neoplasia Intraepitelial Prostática/tratamiento farmacológico , Neoplasias de la Próstata/tratamiento farmacológico , Anciano , Pueblo Asiatico , Método Doble Ciego , Dutasterida , Humanos , Agencias Internacionales , Masculino , Dosis Máxima Tolerada , Persona de Mediana Edad , Placebos , Neoplasia Intraepitelial Prostática/patología , Neoplasias de la Próstata/patología , Conducta de Reducción del Riesgo , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
Although Knudson's two-hit hypothesis with functional loss of a tumor suppressor gene has been widely accepted, accumulating evidence suggests that several genes are regulated by the quantity of their product in a dose-dependent manner (gene dosage effect). The study was designed to identify the influence of gene dosage effect of 8p22 on patient prognosis. With a median age of 71 years, 40 patients with prostate cancer (11 organ-confined, 13 capsular penetrating, and 16 nodal and/or distant metastatic) were followed for a median of 68.5 months. A fluorescence in situ hybridization (FISH) technique was applied using a region-specific cosmid probe combined with centromeric probe. Allelic losses of 8p22, 8p21.3, 8p21.1 approximately 2, and 8p12 were found in 23, 22, 14, and 9 patients, respectively. A Cox proportional hazard model revealed that decreased fraction (i.e., the fraction of nuclei with a lesser number of cosmid signals than of centromeric probe signals) of 8p22 proved to be the sole independent prognostic factor predicting cancer-specific death, as well as disease progression--but allelic loss of 8p22 was not predictive. Cytogenetic estimation of 8p22 by FISH can yield quantitative evaluation of relevant gene dosage, which may become a useful biomolecular marker predicting poor patient prognosis.
Asunto(s)
Cromosomas Humanos Par 8/genética , Dosificación de Gen/genética , Neoplasias de la Próstata/genética , Anciano , Anciano de 80 o más Años , Genoma Humano/genética , Haploidia , Humanos , Hibridación Fluorescente in Situ , Estimación de Kaplan-Meier , Pérdida de Heterocigocidad/genética , Masculino , Metafase , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , Modelos de Riesgos Proporcionales , Próstata/patología , Neoplasias de la Próstata/patología , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
A 63-year-old male with symptomatic benign prostatic enlargement (220 ml as estimated by transrectal ultrasonography) was underwent transurethral holmium laser enucleation. Total operative time was 211 minutes and actual weight of tissue enucleated was 156 grams. There was no perioperative hyponatremia and a blood transfusion. The duration of catheterization was 3 days and the hospital stay was 5 days. Three months after treatment, the international prostate symptom score (IPSS) decreased from 19 preoperatively to 1. The quality of life (QOL) index decreased from 6 preoperatively to 1, whilst the maximum flow rate (Qmax) increased from 7 ml/sec preoperatively to 58 ml/sec.
Asunto(s)
Terapia por Láser , Hiperplasia Prostática/cirugía , Resección Transuretral de la Próstata , Holmio , Humanos , Masculino , Persona de Mediana Edad , Próstata/diagnóstico por imagen , Próstata/patología , Hiperplasia Prostática/diagnóstico por imagen , Hiperplasia Prostática/patología , UltrasonografíaRESUMEN
PURPOSE: We elucidate the learning curve, efficacy and safety of holmium laser enucleation of prostatic adenomas. MATERIALS AND METHODS: We retrospectively reviewed data on 70 patients who had undergone holmium laser enucleation for prostatic adenoma. All patients were assessed preoperatively and at an interval of 6 months postoperatively based on the International Prostate Symptom Score, quality of life index, peak urinary flow rate and post-void residual urine measurement. All complications were noted. The relationship between the number of procedures performed and treatment efficacy was analyzed. The learning curve with regard to efficiency for tissue enucleation and morcellation was assessed. RESULTS: Holmium laser enucleation of the prostate resulted in a significant improvement in subjective symptoms and urodynamic parameters. The ratio of improvement in the preoperative-to-postoperative peak urinary flow rate, post-void residual urine, International Prostate Symptom Score and quality of life index did not change significantly as experience increased. However, the efficiency of enucleation increased significantly as experience increased. Complications included short-term stress urinary incontinence in 8 cases and postoperative urethral stricture in 5. Bladder injury during morcellation was observed in 2 cases. CONCLUSIONS: Holmium laser enucleation of the prostate is an effective treatment option for benign prostatic adenoma, providing good treatment efficacy and minimal bleeding even if the surgeon has minimal experience. It requires more time to perform than traditional surgery but there is a learning curve for the enucleation technique as experience increases. Technical improvement in tissue morcellation may be necessary if the prevalence of this treatment is to increase dramatically.