Article

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

Current Prostate Reports 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.

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    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.
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