Paul Perrin

Comparison of phytotherapy (Permixon®) with finasteride in the treatment of benign prostate hyperplasia: A randomized international study of 1,098 patients

Controversy regarding the relative efficacy of treatments for the relief of the symptoms of benign prostatic hyperplasia (BPH).

Comparison of a Phytotherapeutic Agent (Permixon) with an α-Blocker (Tamsulosin) in the Treatment of Benign Prostatic Hyperplasia: A 1-Year Randomized International Study

OBJECTIVE While the lipidosterolic extract (LSESr) of Serenoa repens--Permixon--has been shown to have an equivalent efficacy to finasteride in patients with benign prostatic hyperplasia (BPH), to date, there has been no valid comparison of phytotherapy with alpha-blockers. The aim of this study was to assess the equivalent efficacy of Permixon and tamsulosin. METHODS Eight hundred and eleven men with symptomatic BPH (international prostdate symptom score, I-PSS > or = 10) were recruited in 11 European countries for a 12-month, double-blind randomized trial. After a 4-week run-in period, 704 patients were randomly assigned to either tamsulosin 0.4 mg per day (N = 354) or Permixon 320 mg per day (N = 350). I-PSS, QoL and maximum urinary flow rate (Qmax) were evaluated at baseline and periodically for 1 year. Prostate volume and serum prostate-specific antigen (PSA) were measured at selection and at endpoint. The endpoint analysis was performed on the per-protocol (PP) population of 542 patients (tamsulosin: N = 273; Permixon: N = 269). RESULTS At 12 months, I-PSS decreased by 4.4 in each group and no differences were observed in either irritative or obstructive symptom improvements. The increase in Qmax was similar in both treatment groups (1.8 ml/s Permixon, 1.9 ml/s tamsulosin). PSA remained stable while prostate volume decreased slightly in the Permixon-treated patients. The two compounds were well tolerated, however, ejaculation disorders occurred more frequently in the tamsulosin group. CONCLUSION This study demonstrated that Permiwon and tamsulosin are equivalent in the medical treatment of lower urinary tract symptoms in men with BPH, during and up to 12 months of therapy.

Guidelines for the diagnosis and treatment of benign prostatic hyperplasia: a comparative, international overview

G within the healthcare system aim to rationalize the diagnosis, treatment, and monitoring of a particular disease and can be applicable on an international scale or may be country-specific. This information is directed at either the specialist or the general practitioner (GP). Guidelines have been produced by governmental agencies or professional organizations on various diseases in the urologic field, such as urolithiasis, erectile dysfunction, penile cancer, bladder cancer, prostate cancer, and benign prostatic hyperplasia (BPH). BPH is an increasingly common condition in the aging male. By the age of 60 years, more than 50% of men will have microscopic evidence of the disease,1 and more than 40% of men beyond this age will have lower urinary tract symptoms.2 This factor, together with the geographic variations in patterns of practice, high cost of treatment, and increasing number of treatment options, make BPH a suitable candidate for practice guidelines. In general, guideline development involves the participation of specialists who determine the clinical evidence for individual practices. Subsequently, a series of recommendations are proposed, the strength of which depends on the available evidence. This can be a lengthy procedure, as evidenced by the 3 years it took for the development of the U.S. guidelines on BPH by the Agency for Health Care Policy and Research (AHCPR) published in 1994.3 The process involved the review of the world literature on BPH diagnosis and treatment, and the draft guidelines were extensively reviewed by experts and practitioners in the fields of urology, internal medicine, and family practice before a final report was published. Another body, the International Consultation (IC), patronized by the World Health Organization, is an international group of experts in prostatic diseases who meet as individual committees to develop recommendations on the diagnosis and treatment of BPH using a “consensus approach,” again based on a detailed review of the published data. This review aims to compare and contrast the current guidelines available both internationally and within individual countries. The goals are to determine whether patients might receive similar care in different countries and whether guidelines are sufficiently up-to-date to keep up with the new developments in the targeted disease area.

Thermoregulation during transurethral microwave thermotherapy : experimental and clinical fundamentals

Transurethral microwave thermotherapy of 340 patients treated at our center for benign prostatic hypertrophy shows the importance of the role played by two thermoregulation processes during the procedure. The first one is artificial and automatically driven by the machine (the power output and cooling rate are adjusted to the urethral and rectal temperature safety thresholds). The second one is natural thermoregulation; the latter is species specific, organ specific, zone specific and even cell specific. Thermoregulation variability is linked to the geometry of the gland, vessel distribution, histology and tissue conductivity. This variability has been demonstrated by interstitial thermometry and histological study. Interstitial thermometry was performed during treatment in 30 dogs and 35 patients; a histological study of prostate specimens was performed 1-12 weeks after treatment in 30 dogs and 15 patients. The human prostate is more resistant to heat than the dog prostate of a comparable volume and treated with the same thermal dose. The prostate of a young patient requires a higher thermal dose than that of an old patient with the same prostate volume in order to achieve a comparable intraprostatic temperature, probably due to a more viable blood supply. The transition zone is more sensitive to heat than the peripheral zone, as demonstrated by temperatures recorded at the same distance from the antenna of up to 60 versus 42 degrees C, respectively. Acinar cells seem to be more resistant to heat than smooth muscle cells when exposed to the same temperature level, as demonstrated by microscopic examination at the periphery of the treated area.(ABSTRACT TRUNCATED AT 250 WORDS)

The epidemiology of trauma of the genitourinary system after traffic accidents: analysis of a register of over 43,000 victims

To analyse the frequency and type of injury to the genitourinary system, by user category, after traffic accidents.

Comparative Evaluation of Urinary PCA3 and TMPRSS2: ERG Scores and Serum PHI in Predicting Prostate Cancer Aggressiveness

It has been suggested that urinary PCA3 and TMPRSS2:ERG fusion tests and serum PHI correlate to cancer aggressiveness-related pathological criteria at prostatectomy. To evaluate and compare their ability in predicting prostate cancer aggressiveness, PHI and urinary PCA3 and TMPRSS2:ERG (T2) scores were assessed in 154 patients who underwent radical prostatectomy for biopsy-proven prostate cancer. Univariate and multivariate analyses using logistic regression and decision curve analyses were performed. All three markers were predictors of a tumor volume ≥0.5 mL. Only PHI predicted Gleason score ≥7. T2 score and PHI were both independent predictors of extracapsular extension (≥pT3), while multifocality was only predicted by PCA3 score. Moreover, when compared to a base model (age, digital rectal examination, serum PSA, and Gleason sum at biopsy), the addition of both PCA3 score and PHI to the base model induced a significant increase (+12%) when predicting tumor volume >0.5 mL. PHI and urinary PCA3 and T2 scores can be considered as complementary predictors of cancer aggressiveness at prostatectomy.

PCA3 and PCA3-Based Nomograms Improve Diagnostic Accuracy in Patients Undergoing First Prostate Biopsy

While now recognized as an aid to predict repeat prostate biopsy outcome, the urinary PCA3 (prostate cancer gene 3) test has also been recently advocated to predict initial biopsy results. The objective is to evaluate the performance of the PCA3 test in predicting results of initial prostate biopsies and to determine whether its incorporation into specific nomograms reinforces its diagnostic value. A prospective study included 601 consecutive patients addressed for initial prostate biopsy. The PCA3 test was performed before ≥12-core initial prostate biopsy, along with standard risk factor assessment. Diagnostic performance of the PCA3 test was evaluated. The three available nomograms (Hansen’s and Chun’s nomograms, as well as the updated Prostate Cancer Prevention Trial risk calculator; PCPT) were applied to the cohort, and their predictive accuracies were assessed in terms of biopsy outcome: the presence of any prostate cancer (PCa) and high-grade prostate cancer (HGPCa). The PCA3 score provided significant predictive accuracy. While the PCPT risk calculator appeared less accurate; both Chun’s and Hansen’s nomograms provided good calibration and high net benefit on decision curve analyses. When applying nomogram-derived PCa probability thresholds ≤30%, ≤6% of HGPCa would have been missed, while avoiding up to 48% of unnecessary biopsies. The urinary PCA3 test and PCA3-incorporating nomograms can be considered as reliable tools to aid in the initial biopsy decision.

SUCCESSFUL USE OF SAMARIUM 153 FOR EMERGENCY TREATMENT OF DISSEMINATED INTRAVASCULAR COAGULATION DUE TO METASTATIC HORMONE REFRACTORY PROSTATE CANCER

Chronic disseminated intravascular coagulation is present in 13% to 30% of prostate cancer cases. In contrast, overt disseminated intravascular coagulation is rare (0.4% to 1.65%) but pejorative, arising in metastatic cases. We report the successful use of samarium 153 in a patient with metastatic hormone refractory disease.

Endogenous and exogenous testosterone and the risk of prostate cancer and increased prostate-specific antigen (PSA) level: a meta-analysis

To review and quantify the association between endogenous and exogenous testosterone and prostate‐specific antigen (PSA) and prostate cancer.

Critical role of prostate biopsy mortality in the number of years of life gained and lost within a prostate cancer screening programme

Study Type – Therapy (data synthesis)