UF Researchers Compare Drugs In Study Of Enlarged Prostate Disease
GAINESVILLE—A drug commonly prescribed to treat prostate disease is not as effective as its less expensive counterpart for men with a certain form of the disorder, report University of Florida and Veterans Affairs researchers in a recent issue of the New England Journal of Medicine.
Researchers also determined that the two used in combination were no better than either drug taken individually.
The landmark study helps refine physicians’ understanding of benign prostatic hyperplasia (BPH), which is marked by an increase in the size of the inner core of the prostate gland. The prostate gland, about the size of a walnut, is found just below the bladder and usually begins to enlarge when men are in their 40s. The enlarged prostate presses on the urethra, the tube that carries urine out of the body, causing discomfort and a heightened risk of infection.
One in four men older than 50 will seek treatment for an enlarged prostate by the time they reach age 80, says Dr. Perinchery Narayan, professor and chief of urology at UF’s College of Medicine and the Veterans Affairs Medical Center in Gainesville.
When the only available treatment for the disorder was surgery, the plan was straightforward: The diagnosis was based on symptoms and a physical examination, and surgery usually was successful because it removed tissue causing the obstruction, says Dr. Patrick C. Walsh, a urologist at Johns Hopkins Hospital.
With the advent of drug therapy, it is now necessary to know more about what causes the disorder before doctors can predict a patient’s likely response to treatment. With a better understanding of how the disease varies among patients, researchers have come to realize that no single type of drug therapy is effective in all men, Walsh says.
The study has yielded insight into a condition characterized by the same irritating symptoms, despite the fact that these men have relatively small prostate glands.
“BPH was once thought to be a disorder in which the prostate gland was enlarged and sometimes caused symptoms,” said Narayan, who practices at Shands at UF and is a member of the Veterans Affairs Cooperative Studies Benign Prostatic Hyperplasia Study Group, which spearheaded the study. “There is, however, another condition in which men with small prostate glands have the same symptoms. This study has helped clarify the difference.”
UF researchers compared the safety and effectiveness of the drugs terazosin and finasteride, also known as Proscar — and the combination — with placebo in 1,229 men ages 45 to 80 who were diagnosed with benign prostatic hyperplasia, with the aim of relieving bothersome urinary symptoms. The study concluded that terazosin was effective therapy, whereas finasteride, more commonly prescribed and more expensive, was not. Also, the two taken together were no more effective than terazosin alone.
Researchers concluded that because the drugs have different mechanisms of action, each may have its advantages depending on the size of the inner core of the prostate. Because several previous studies have shown finasteride to be effective, physicians theorize that it may work better in men with larger prostate glands where the obstruction is related to an overgrowth of cells.
In the VA study, average prostate size was comparatively smaller, yet the inner core was considerably large.
Founded in 1958, Shands at UF is a 576-bed not-for-profit tertiary- and quaternary-care facility that serves as one of the Southeast’s leading treatment and referral centers. Shands offers a full complement of medical, surgical, pediatric, obstetrical and psychiatric services.
Shands was recognized among the top hospitals in the United States and Canada in the most recent edition of “The Best Hospitals in America.” The Aug. 12th issue of US News & World Report listed Shands as one of “America’s Best Hospitals,” specifically in the areas of orthopedics, gastroenterology, neurology, endocrinology and cancer. Forty-nine UF physicians at Shands are featured in the 1994-95 edition of “The Best Doctors in America.”
- Melanie Fridl Ross