Observations on the influence of cyproterone acetate on the sonographic image of the benign prostate in patients treated with local hyperthermia

Abstract

A total of 114 patients suffering from prostatic symptoms due to benign hyperplasia (BPH) and scheduled for surgery elected to participate in a clinical trial of local hyperthermia therapy to the prostate. One group was given cyproterone acetate (CPA) as well. Transrectal ultrasound (TRUS) was performed before and following such treatment. Interesting changes in the volume and the configuration of the gland were observed. Prostatic volume measured 1 month following chemotherapy showed a 20°70 reduction in patients receiving CPA, whereas no significant change was evident in those not given the medication. Significant changes were particularly noted in patients above the age of 68 years whose prostates measured > 85 cm 3. Marked relief of obstructive symptoms was noted in the majority of cases, although this did not correlate with the observed changes in prostatic volume.The etiology of benign prostatic hyperplasia (BPH) remains unclear. Through the years, much research has been aimed at attempting to treat this condition conservatively and, thus, to avoid the need for surgery. In 1965 Geller et al. [2] reported encouraging results in the treatment of BPH using hydroxyprogesterone caproate, a moderately strong progestational agent. In 1969 Scott and Wade [4] reported their results on the long-term use of cyproterone acetate (CPA) in BPH. Objective data regarding the size and volume of the gland were obtained by digital palpation, and variations in bladder base elevation were evaluated on cystourethrograms. Further data on the influence of CPA on BPH have been reported by Bartsch et al. [1]. Transrectal ultrasound (TRUS) has become a popular investigative tool in urological practice [7]. Local hyperthermia has been used experimentally for the treatment of diseases of the prostate, including benign enlargement [3,5,6]. In the present study, the prostates of 114 patients with BPH were evaluated by TRUS to determine alterations in prostatic volume and shape * Offprint requests to: C. Servadio both before and 1 month following hyperthermia treatment (a modality under investigation for treatment of BPH) given with or without the administration of CPA. Patients and methodsThe prostates of 114 patients considered to be candidates for hyperthermia treatment were evaluated by TRUS as part of our routine eligibility studies. A model 1849 Bruel and Kjaer transrectal device was used. The length of the gland was defined as the diameter from the bladder neck to the apex; the width, as the transverse diameter from left to right; and the height, as the postero-anterior diameter. All measurements were expressed in centimeters. We defined the volume of the prostate to be the product of the multiplication of the maximal values for these three dimension. The obliquity factor, or shape of the prostate, was defined as the maximal height divided by the maximal width.The ultrasound evaluation was performed by a physician who was not involved in the study and was carried out prior to the hyperthermia treatment. After the patient had compl...

Transrectal ultrasound in local hyperthermia to the benign prostate

“…However, in the present study no correlation was noted between the changes observed on echography and the clinical outcome at 1 month of follow-up [2]. A longer follow-up period may well alter this finding.…”