Alfuzosin for treatment of benign prostatic hypertrophy

Objectives: To investigate (a) the magnitude and durability of symptom score reduction and HRQL score improvement (including sexual drive); (b) adverse outcomes; and (c) progression to acute urinary retention and prostate surgery up to three years of treatment with alfuzosin.Methods: Three thousand two hundred and twenty-eight BPH-patients out of 812 centers were included in a prospective three-year open-labelled study and treated with alfuzosin (immediate release formulation) at the recommended dosage. A symptom score (Boyarsky modi®ed) and a 20-item BPH speci®c HRQL score including three questions of sexuality (Urolife TM BPH QoL 20) were selfadministered at baseline, 3,6,12,18,24,30, and 36 months.Results: Two thousand ®ve hundred and seventy-nine patients (79.9%) completed the study at the end of three years. Symptom score was signi®cantly reduced by 54% at 3 months and this reduction was maintained up to 36 months (748.4%); HRQL score was signi®cantly improved by 45.4% at 12 months and this improvement was maintained up to 36 months ( 43.4%). Alfuzosin was well tolerated: the quantitative and qualitative distribution of adverse events was similar to that previously observed in placebo-controlled studies (vertigo/dizziness: 2.1%). Adverse events accounted for 4.2% of the drop-outs. 120 patients (3.7%) were operated on for BPH and nine patients (0.3%) experienced acute urinary retention.Conclusion: This medical outcomes study con®rms the long-term safety pro®le of alfuzosin in the naturalistic conditions of general practice and highlights the need to measure HRQL in the context of patient's preferences.

Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Three-year prospective study of 3228 clinical BPH patients treated with alfuzosin in General Practice

Lukacs

Grange

Comet

et al. 1998

“…Terazosin also reduces detrusor sphincter dyssynergia in patients with bladder neck contracture, possibly via a central effect. 74 63 Buzelin et al (1997) 64 Lepor et al (1996) 67 Brawer et al (1993) 66 …”

Section: Comparative Ef®cacy Of the Current Agentsmentioning

confidence: 99%

α1-Adrenoceptor selectivity and the treatment of benign prostatic hyperplasia and lower urinary tract symptoms

Kirby

Lepor

et al. 2000

The storage (irritative) and voiding (obstructive) symptoms associated with benign prostatic hyperplasia are generally attributed to prostate enlargement and increased prostatic smooth muscle tone mediated by the prevailing a 1 -adrenoceptors in the bladder neck and prostate. This results in obstruction and subsequent secondary changes to the bladder. However, there is growing evidence that many of these symptoms may be due to changes in extraprostatic a 1 -adrenoceptors, possibly a 1D -adrenoceptors. Findings from the VA cooperative trial challenge the current theory that the common side effects associated with these agents are due to vascular action of a 1 -adrenoceptor blockers. Prostate Cancer and Prostatic Diseases (2000) 3, 76±83.

“…At this point, most studies have not demonstrated that alpha-blockers reduce similar long term endpoints. In one study comparing alfuzasin to placebo, 31 there was an indication that this particular alpha blocker may have an effect on these outcomes in the short term. However in the one-year terazosin outcomes study in 2084 men, the 1-year incidence of AUR was 1.3% in both the placebo and terazosin treated groups.…”

Section: Does Medical Therapy Change the Incidence Of Bph Complications?mentioning

confidence: 99%

Medical therapy for BPH: expanding our treatment paradigm?

Nickel

1999

Medical therapy for relief of symptoms of benign prostatic hyperplasia (BPH) is now a clinical reality. The challenge for urologists treating BPH with medical therapy is how to rationally employ the two proven classes of medications, the alpha blockers and ®nasteride, in their practice. To accomplish this, we must critically examine the results of multiple important clinical BPH trials published over the last decade and examine the short and long term effect of the various available medical therapies on symptoms, objective progression and consequences of the disease process and whether evidence based indicators will allow us to choose appropriate therapies. It appears that we can rationalize our medical therapy decisions, taking into consideration severity of disease, prostate size (and perhaps PSA) and most importantly, the patients' longterm expectations for treatment outcome. But ®rst physicians must decide for themselves whether to expand their treatment paradigm beyond short term symptom relief to encompass long term durability and even prevention of the consequences of the long term progression of BPH.Keywords: benign prostatic hyperplasia; prostate; ®nasteride; alpha blockers The challengeDuring the last decade medical therapy for benign prostatic hyperplasia (BPH) has become a clinical reality. 1 Two classes of medication have emerged with consistently proven results in randomized controlled trials as better than placebo: the alpha-blockers and the 5-alphareductase inhibitors. Well designed studies have proven that these medications are both safe and effective over the short term (1 y).The challenge for urologists treating BPH with medical therapy is how to rationally employ these medications in their practice. To tackle this task we must ask a number of fundamental questions: Is BPH a long term progressive disease? Should the solution for this disease with medical therapy be viewed not in terms of weeks, months or even a year, but rather be considered a life time treatment for the patient? As surgeons we have always been most interested in short term symptom relief. But now, should we be convinced that that therapy is safe over the long term, has long term ef®cacy compared to placebo, is durable over years and even decades, hopefully has the ability to halt the progression of the disease and prevent complications such as acute urinary retention or the requirement for surgery? The ultimate challenge is whether we as a urological community are ready to expand beyond short term symptom relief to long term symptom control and perhaps even prevention of disease progression with its associated complications. The problemIt appears, that in many (but certainly not all) patients with lower urinary tract symptoms, BPH can indeed be considered a slowly progressive disease. The prostate gland increases in size at an average rate of 0.6 ml/y with some age variation. 2 The average decrease in¯ow rate over time, which is an indirect measure of obstruction, is about 2 ml/sec/decade. 3,4 The frequency and severity of sy...