Reduced intraoperative bleeding during transurethral resection of the prostate: Evaluation of finasteride, vascular endothelial growth factor, and CD34

Current Prostate Reports 08/2008; 6(3):123-127. DOI: 10.1007/s11918-008-0019-x

ABSTRACT Finasteride is an antiandrogen that inhibits 5-α-reductase, an enzyme that converts testosterone to dihydrotestosterone. Finasteride
significantly reduces intraoperative bleeding when 10 mg/d is administered for 60 days before transurethral resection of the
prostate. Our double-blind, randomized, placebo-controlled study evaluated 200 patients with benign prostatic hyperplasia
who underwent transurethral resection of the prostate. We compared a placebo group (n = 100) with a group (n = 100) administered 5 mg of finasteride twice a day for 8 weeks. We intended to demonstrate the mechanisms and effects of
finasteride compared with those of vascular endothelial growth factor, and to evaluate CD34, an immunohistochemical marker
of blood vessel density in the prostate. Our results indicated a lower average microvascular density and vascular endothelial
growth factor index for hypertrophic prostate in the finasteride group than in the placebo group.

  • [Show abstract] [Hide abstract]
    ABSTRACT: 5α-reductase inhibitors (5α-RIs), including finasteride and dutasteride, are commonly used medical therapies for benign prostatic hyperplasia (BPH). Many studies reported that preoperative 5α-RI had impact on intraoperative haemorrhage during surgery for BPH, but it was still in controversial. So, we conducted a systematic review of the effects and mechanisms of 5α-RIs on intraoperative bleeding for BPH. MEDLINE, EMBASE, the Cochrane Controlled Trail Register of Controlled Trials and the reference lists of retrieved studies were searched in the analysis. Sixteen publications involving 15 different randomized controlled trials (RCTs) and a total of 1156 patients were used in the analysis, including 10 RCTs for finasteride and five RCTs for dutasteride. We found that preoperative finasteride treatment decreases microvessel density (MVD) in resected prostate specimens. Total blood loss, blood loss per gram of resected prostate tissue and decreases in haemoglobin were all greatly reduced in the finasteride group as compared to controls. Dutasteride appeared to have no effect on bleeding. This meta-analysis shows that preoperative finasteride treatment could decrease intraoperative haemorrhage during surgery for BPH. Preoperative dutasteride had no effect on intraoperative haemorrhage, but further high-quality prospective studies are still needed to confirm this observation.
    Asian Journal of Andrology 09/2011; 13(6):812-8. DOI:10.1038/aja.2011.86 · 2.53 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Introductiondual 5α-reductase inhibitor (5-ARI), dutasteride, blocks the convertion of testosterone into its active form dihydrotestosterone (DHT), and reduces prostate volume, PSA, while increasing urinary flow rate. Bipolar transurethral resection of the prostate (B-TURP) represents an improvement of the traditional TURP with almost the same efficacy and outcomes while the incidence of side-effects is lower.Assuming that dutasteride has an action on prostatic vascularisation and assuming B-TURP as a standard procedure for patients affected by BPH, we hypothesized that a short-term pretreatment with dutasteride (0.5 mg daily for 8 weeks) can reduce intraoperative bleeding.Materials & MethodsA total of 259 patients have been enrolled and randomized in Group A receiving placebo and Group B receiving dutasteride. In particular we evaluated blood parameters (haemoglobin and hematocrit) and prostate vascularity with vascular endothelial growth factor (VEGF) and microvascular density (MVD) using CD34.Statistical analysis was carried out using two-sided tests, with p values < 0.05 denoting statistical significance. Continuous variables are reported as mean ± standard deviation and compared between groups using Student's t test. Analysis of Covariance was applied to assess the significance of variation in hemoglobin and hematocrit levels.Resultstotal testosterone, DHT, PSA and prostate volume were evaluated and with the exception of DHT and PSA there was no statistically significant difference between the two groups. When comparing changes in hemoglobin and haematocrit between the Group A and Group B, before and after the B-TURP, there is a statistically significant difference only when in the case of a large prostate ≥ 50 mL (ΔHb 3.86 vs. 2.05 and ΔHt 4.98 vs. 2.64 respectively). Evaluating MVD and VEGF index in prostates < 50 mL there is no significant difference while in large prostate the difference become statistically significant.Conclusionsdutasteride is able to reduce operative and peri-operative bleeding in patients submitted to B-TURP only if a large prostate (≥ 50 mL) is being treated. Our findings are confirmed by hemoglobin and hematocrit values reported before and after the surgery and by the count of VEGF and CD34.
    BJU International 10/2014; 14(2). DOI:10.1111/bju.12917 · 3.13 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The ability of 5α-reductase inhibitors (5ARIs) to decrease blood loss during transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH) remains controversial. We aimed to conduct a meta-analysis of all randomized controlled trials (RCTs) to establish the role of 5ARI use prior to TURP. We searched studies from the electronic databases PubMed, Embase, Scopus, and Cochrane Library from inception to March 25, 2014. Meta-analysis was performed using the statistical software Review Manager version 5.1. Seventeen RCTs including 1489 patients were examined. We observed that preoperative treatment with finasteride can decrease total blood loss, blood loss per gram of resected prostate tissue, hemoglobin level alteration, microvessel density (MVD), and vascular endothelial growth factor level. Neither finasteride nor dutasteride reduced operative time, prostate volume, or the weight of gland resected. In contrast, pretreatment with dutasteride before TURP did not decrease the total blood loss or MVD. Pretreatment with finasteride does seem to reduce perioperative blood loss related to TURP for BPH patients. However, the effect of preoperative dutasteride was inconclusive. Further studies are required to strengthen future recommendations regarding the use of 5ARI as a standard pre-TURP treatment and its optimal regimen.
    BMC Urology 06/2015; 15(1). DOI:10.1186/s12894-015-0043-4 · 1.94 Impact Factor