PURPOSE: The purpose of the study is to investigate the efficacy of an alpha-1 adrenergic receptor antagonist (silodosin) for the treatment of lower urinary tract symptoms (LUTS) associated with interstitial 125I implantation for prostate cancer.
| To our knowledge, this is the first prospective, randomized, controlled study investigating voiding functions following brachytherapy (PI) using pressure flow study. We found that the selective alpha antagonist, silodosin, did not improve post-PI BOO index, but may improve urinary storage functions. A high proportion of patients experience ongoing urgency for 3 years following PI, and persistent overactive bladder after PI is potentially underestimated. An alpha-1 AR antagonist is typically used to treat LUTS following PI, but additional agents, such as anticholinergics ,β3-adrenoceptor agonists, and PDE5 inhibitor, may also help improve voiding symptoms in patients. Nobutaka Shimizu, MD, PhD, Department of Urology Kinki University Faculty of Medicine |
METHODS: This randomized single-center study involved 105 patients (53 with and 52 without silodosin). Silodosin was postoperatively administered, daily, for 6 months (8 mg/day). Urinary symptoms and pressure flow were evaluated preoperatively and postoperatively at 1, 3, 6, and 12 months.
RESULTS: At 12 months, interstitial 125I implantation had induced a significant decrease in prostate volume (28.3 ± 11.1-20.5 ± 8.1 g in the silodosin group and 26.1 ± 9.7-17.7 ± 4.9 g in the controls) and the prostate-specific antigen level (7.1 ± 3.6-1.4 ± 1.7 ng/mL in the silodosin group and 8.1 ± 4.3-1.3 ± 1.2 ng/mL in the controls). Significant improvements in the international prostate symptom voiding subscores at 6 months and quality of life at 3 months were observed in those receiving silodosin. The pressure flow studies demonstrated that silodosin had significantly enlarged the bladder capacity when the first non-voiding contraction was seen at 3 and 12 months (3M: 127.1 ± 74.8 vs. 118.2 ± 83.9 mL, p = 0.001; 12M: 123.7 ± 79.3 vs. 100.3 ± 73.4 mL, p = 0.01); however, there were no improvements in the bladder outlet obstruction index (BOOI) or urinary flow.
CONCLUSIONS: Silodosin temporarily improved LUTS, but did not improve the BOOI after 125I implantation in the prostate.
Written by:
Shimizu N, Minami T, Sugimoto K, Saito Y, Yamamoto Y, Hayashi T, Tsuji H, Nozawa M, Yoshimura K, Ishii T, Uemura H, Nakamatsu K. Are you the author?
Department of Urology, Faculty of Medicine, Kinki University, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan.
Reference: World J Urol. 2014 Jan 17. Epub ahead of print.
doi: 10.1007/s00345-014-1239-z
PubMed Abstract
PMID: 24435207
UroToday.com Prostate Cancer Section
