Alfuzosin is an alpha blocker, used in Europe but not yet approved in Canada. It is clinically uroselective and is given without dose titration. A European study compared a-once-a-day, controlled, release preparation 10 mg versus the standard 2.5 mg t.i.d. versus placebo in 447 patients (Abst 973). At three months there was significant benefit for alfuzosin as compared to placebo. Overall symptoms improvement seemed less than with other alpha blockers which could be due to the drug being less effective or perhaps under dosed. There appeared to be better improvement in peak flow rates with the t.i.d. dosing. Marks from Los Angeles compared finasteride, saw-palmetto and placebo after six months of treatment (Abst 976). Changes in symptom score and peak flow rates were of the order of 20-30% with no obvious difference among groups. However, the number of patients was small and the main information from his study was the effect on serum DHT. The expected decrease was seen with finasteride but no change was seen with saw-palmetto. Roehrborn reported on the effect of finasteride 1 mg (Propecia) versus placebo on PSA levels in men aged 40-60 undergoing treatment for androgenic allopecia and no known prostatic disorder (Abstr 977). The mean percentage decrease in PSA was 42%, so when interpreting PSA levels in these men, one can apply the same principle as for men being treated for BPH, i.e. multiply PSA values by 2.

Previous reports have shown that finasteride inhibits the growth of small vessels within the prostate and decreases hematuria occurring from BPH. Kearney from New York reported on 53 patients treated with finasteride 5 mg daily for bleeding from the prostate (Abstr 1364). Fifty of 53 patients (94%) had improvement of their hematuria after treatment with finasteride and 41 of 53 (77%) experienced no further bleeding while taking finasteride. This included patients on coumadin and aspirin. Several papers suggested that prior treatment with finasteride for approximately three months can reduce the bleeding at TUR for patients with moderate sized prostates (Abstr 971, 1370).

Seitz reported on an 18 month follow-up study which had compared transurethral microwave thermotherapy (TUMT) versus alpha blockade with terazosin for BPH (Abstr 1481). By 18 months, 21 patients had failed terazosin therapy, 13 for ineffectiveness and 8 because of adverse events while 3 patients failed TUMT and proceeded to surgery. At 18 months, AUASI had dropped from 19 to 11 for terazosin and from 19 to 7 for TUMT. Qmax increased from 9 to 11 ml/s for terazosin and from 8 to 14 ml/s for TUMT. Quality of life score decreased from 4 to 2 for terazosin and from 4 to 1 for TUMT. Conclusions were that patients undergoing TUMT with second generation devices, in this case the Targis system, achieved significantly greater long term improvement in symptoms, flow rates and quality of life than patients on terazosin and at 18 months, the failure was markedly lower for patients treated with TUMT as compared to terazosin.

Williams reported on a multi-centre experience with interstitial laser coagulation using the Indigo system (Abstr 1202). Mean AUASI was 22 (n=312) and at 12 months was 10 (n=252) and at 24 months was 7 (n=75). Qmax prior to treatment was 8.6 ml/s and at 12 months was 14 ml/s and at 24 months 15.6 ml/s. Bladder catheter duration was 4.8 days on average. Complaints of postoperative dysuria occurred more frequently than previously reported but decreased as experience with the system increased. Bergamaschi from Milan reported on a 5 year experience using transurethral needle ablation (TUNA) in 204 patients with BPH (Abstr 1480). AUASI decreased from 20 to 6 at 12 months with some rise for patients followed out to 5 years, the symptom score being 11 for the 31 patients followed out to 5 years. Qmax rose from 8 ml/s to 15 ml/s at 12 months with some decrease for those patients followed out to 5 years, the Qmax being 12 ml/s for the 31 patients followed for 5 years. In this study, urodynamic studies were performed and it was found that 73% of patients were still obstructed at 2 years of follow-up. Muschter reported on a 2 year follow-up of a multi-centre study using water-induced thermotherapy (WIT) for BPH (Abstr 1195). AUASI decreased from 24 to 12 at 1 year and 2 years. Qmax increased from 8.7 ml/s to 16 ml/s at 1 year and 2 years. They concluded that the benefits of this treatment appeared to be sustained for at least a period of 2 years.