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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 李偉嘉 | 5α還原脢抑制劑對於男性前列腺肥大患者之前列腺容量與症狀表現在停藥後的效應：一個前瞻性的研究 | 2009/3/29 下午 03:07:41 | 1 |
| 原 文 | 題 目 | 5α還原脢抑制劑對於男性前列腺肥大患者之前列腺容量與症狀表現在停藥後的效應：一個前瞻性的研究 |
| 作 者 | Jeong YB, Kwon KS, Kim SD and Kim HJ. | |
| 出 處 | Urology | |
| 出版日期 | 2009， Feb 2 [Epub ahead of print] | |
| 評 論 |
這篇論文解答了我們長久以來的一個問題，5ARIs在前列腺肥大的治療上，究竟扮演什麼角色。5ARIs被設計出來治療前列腺肥大此一疾病時，泌尿科醫師在學理上的認同度應是相當高的，5ARIs可以明顯的抑制前列腺生長，使得前列腺容量降低，進而推論患者們的前列腺肥大得以控制與治療。然而在近幾年的報告中，我們知道在短期使用中，相對於α1blocker，5ARIs並非治療前列腺症狀與改善尿流速的主要藥物。但若使用5ARIs超過3年以上，則有降低急性尿滯留的風險。 5ARIs在臨床上屬於相對昂貴的藥物，但使用療效確莫衷一是，因此這種藥物的使用對於臨床醫師與健保費用控管單位都造成相當的困擾。期間也有研究想證明複合使用後，改採單一治療的試驗，但設計都較不理想。這個研究我認為結果上告訴我們兩個訊息，第一、5ARIs停藥後，會造成前列腺反彈增生，同時惡化臨床症狀，因此5ARIs的使用應有別於一般安慰劑，而確實有療效。第二、以臨床症狀IPSS的改變而言，α1blocker的使用仍是治療前列腺肥大症狀的主流藥物，不宜輕易停藥而改採用5ARIs進行單一治療。 另外，結論中建議應終身服用5ARIs來治療前列腺肥大，這點我們應該有所保留。無論如何，當患者的膀胱出現代償失敗或pressure-flow study 的阻塞標準時，TUR-P仍是治療前列腺肥大患者排尿障礙最具備直接效益與經濟效益的黃金標準。 |
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| abstract |
OBJECTIVES: To investigate the change in prostate volume and symptoms after discontinuation of 5alpha-reductase inhibitors (5ARIs) in men with moderate to severe symptoms due to benign prostatic hyperplasia (BPH). METHODS: A total of 120 patients with BPH were enrolled from December 2004 to May 2008. The patients were randomized into 2 groups: group 1 received finasteride 5 mg plus alfuzocin 10 mg or tamsulosin 0.2 mg daily, and group 2 received dutasteride 0.5 mg plus alfuzocin 10 mg or tamsulosin 0.2 mg daily. All the patients received combination therapy for 1 year, followed by 1 year of alpha-blocker monotherapy. The prostate volume, International Prostate Symptom Score, and serum prostate-specific antigen level were determined at baseline and at 12 and 24 months after treatment. RESULTS: At 1 year after treatment, the prostate volume was reduced by 24.5% +/- 10.01% (P < .001) in group 1 and by 26.1% +/- 5.06% (P < .001) in group 2. One year after withdrawal of the 5ARIs, the prostate volume had increased by 20.7% +/- 14.1% (P < .001) and 18.6% +/- 7.4% (P < .001) in groups 1 and 2, respectively, compared with at the end of 1 year of treatment. Furthermore, the International Prostate Symptom Score had significantly deteriorated at 1 year after cessation of the 5ARIs in both groups compared with the values at the end of 1 year of combination therapy. CONCLUSIONS: Our data demonstrate that the discontinuation of 5ARIs during combination therapy induces prostate regrowth, as well as aggravation of symptoms in men with BPH. This result, therefore, suggests that the life-long use of 5ARIs should be considered for the prevention of BPH progression. |
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| 王炯珵 |
I am very happy to welcome Dr. Lee Wei-Chia great contribution to this academic blog. Thanks a lot! | 2009/4/22 上午 09:36:33 |