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Short-term pretreatment with a dual 5α-reductase inhibitor before bipolar transurethral resection of the prostate (B-TURP): evaluation of prostate vascularity and decreased surgical blood loss in large prostates.
- Source :
-
BJU international [BJU Int] 2015 Jul; Vol. 116 (1), pp. 117-23. Date of Electronic Publication: 2015 Jan 21. - Publication Year :
- 2015
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Abstract
- Objective: To investigate if short-term treatment with dutasteride (8 weeks) before bipolar transurethral resection of the prostate (B-TURP) can reduce intraoperative bleeding, as dutasteride a dual 5α-reductase inhibitor (5-ARI) blocks the conversion of testosterone into its active form dihydrotestosterone (DHT), and reduces prostate volume and prostate-specific antigen (PSA) levels, while increasing urinary flow rate.<br />Patients and Methods: In all, 259 patients were enrolled and randomised to two groups: Group A, receiving placebo and Group B, receiving dutasteride (0.5 mg daily for 8 weeks). Blood samples were taken before and after B-TURP for serum chemistry evaluation. In particular we evaluated blood parameters associated with blood loss [haemoglobin (Hb) and haematocrit (Ht)] and prostate vascularity [vascular endothelial growth factor (VEGF) immunoreactivity and microvessel density (MVD) using cluster of differentiation 34 (CD34) immunoreactivity].<br />Results: Total testosterone, DHT, PSA level and prostate volume were evaluated and with the exception of DHT and PSA level there was no statistically significant differences between the groups. When comparing changes in Hb and Ht between Group A and Group B before and after B-TURP, there was a statistically significant difference only in patients with large prostates of ≥50 mL (ΔHb 3.86 vs 2.05 g/dL and ΔHt 4.98 vs 2.64%, in Groups A and B, respectively). There was no significant difference in MVD and VEGF index in prostates of <50 mL, conversely in large prostates the difference become statistically significant.<br />Conclusions: Dutasteride was able to reduce operative and perioperative bleeding only in patients with large prostates (≥50 mL) that underwent B-TURP. Our findings are confirmed by Hb and Ht values reported before and after the B-TURP and reductions in the molecular markers for VEGF and CD34 in the dutasteride-treated specimens.<br /> (© 2014 The Authors BJU International © 2014 BJU International Published by John Wiley & Sons Ltd.)
- Subjects :
- Aged
Aged, 80 and over
Biomarkers blood
Dihydrotestosterone metabolism
Dutasteride
Humans
Male
Middle Aged
Postoperative Complications prevention & control
Prostate surgery
Prostate-Specific Antigen metabolism
Testosterone metabolism
Treatment Outcome
5-alpha Reductase Inhibitors administration & dosage
Azasteroids administration & dosage
Blood Loss, Surgical prevention & control
Prostate pathology
Transurethral Resection of Prostate methods
Subjects
Details
- Language :
- English
- ISSN :
- 1464-410X
- Volume :
- 116
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- BJU international
- Publication Type :
- Academic Journal
- Accession number :
- 25291499
- Full Text :
- https://doi.org/10.1111/bju.12917