Sexual satisfaction among patients after coronary bypass surgery or percutaneous transluminal angioplasty: eight-year follow-up.

BACKGROUND: Cardiovascular diseases are currently the leading cause of death worldwide. In addition to risk factor prevention, the treatment interventions of coronary artery disease (CAD) include medication, percutaneous transluminal coronary angioplasty (PTCA) with stenting, and coronary artery bypass grafting (CABG). Patients with CAD have a more than twofold risk of sexual dysfunctions compared with age-matched healthy persons. The physiologic changes in sexual satisfaction, such as erectile dysfunctions in men and impaired sexual arousal in women, correlate with the severity of CAD. OBJECTIVES: The purpose of this study was to describe the long-term effects of treatment interventions on the sexual satisfaction of patients with CAD. METHODS: The original study series consisted of 280 patients with CAD who were followed up for 8 years. There were 189 men and 91 women. At the baseline of the study, 100 patients underwent CABG, 100 patients underwent PTCA, and 80 patients were prescribed medication. Eight years later, we were able to reach 63 patients who underwent CABG, 50 patients who underwent PTCA, and 34 patients who were prescribed medication. Descriptive statistics, the chi-square test for testing group differences, and McNemar's test for dependent sample were used to analyze the data. RESULTS: Sixty percent of the patients were satisfied with their sexual functions before the treatment interventions, and 63% were satisfied 8 years after the interventions; 52% of men and 77% of women were sexually satisfied before the interventions. Eight years later, 59% of men and 70% of women were satisfied with their sex life. In the CABG group, 57% of the patients were satisfied with their sexual functions preoperatively, whereas 62% were satisfied 8 years later. The corresponding results were 56% and 64% in the PTCA group and 73% and 62% in the medication group, respectively. Women were more satisfied with their sex life than men (P = .002) before the interventions. However, the satisfaction of women declined during the 8-year follow-up period, whereas that of men increased, but the change was not statistically significant. CONCLUSION: The findings provide new knowledge about the long-term impacts of treatment interventions on the sexual satisfaction of patients with CAD.

The effects of transdermal dihydrotestosterone in the aging male: a prospective, randomized, double blind study.

The objective of the study was to investigate the effects of dihydrotestosterone (DHT) gel on general well-being, sexual function, and the prostate in aging men. A total of 120 men participated in this randomized, placebo-controlled study (60 DHT and 60 placebo). All subjects had nocturnal penile tumescence once per week or less, andropause symptoms, and a serum T level of 15 nmol/liter or less and/or a serum SHBG level greater than 30 nmol/liter. The mean age was 58 yr (range, 50-70 yr). Of these subjects, 114 men completed the study. DHT was administered transdermally for 6 months, and the dose varied from 125-250 mg/d. General well-being symptoms and sexual function were evaluated using a questionnaire, and prostate symptoms were evaluated using the International Prostate Symptoms Score, transrectal ultrasonography, and assay of serum prostate-specific antigen. Early morning erections improved transiently in the DHT group at 3 months of treatment (P < 0.003), and the ability to maintain erection improved in the DHT group compared with the placebo group (P < 0.04). No significant changes were observed in general well-being between the placebo and the DHT group. Serum concentrations of LH, FSH, E2, T, and SHBG decreased significantly during DHT treatment. Treatment with DHT did not affect liver function or the lipid profile. Hemoglobin concentrations increased from 146.0 +/- 8.2 to 154.8 +/- 11.4 g/liter, and hematocrit from 43.5 +/- 2.5% to 45.8 +/- 3.4% (P < 0.001). Prostate weight and prostate-specific antigen levels did not change during the treatment. No major adverse events were observed. Transdermal administration of DHT improves sexual function and may be a useful alternative for androgen replacement. As estrogens are thought to play a role in the pathogenesis of prostate hyperplasia, DHT may be beneficial, compared with aromatizing androgens, in the treatment of aging men.

Long-term sustained improvement in symptoms of benign prostatic hyperplasia with the dual 5alpha-reductase inhibitor dutasteride: results of 4-year studies.

OBJECTIVE: To report additional analyses of efficacy over the initial 2 years and during a 2-year open-label extension of the three pivotal phase 3 studies in which dutasteride, a dual inhibitor of type 1 and 2 5alpha-reductase, was shown to be effective and well tolerated. PATIENTS AND METHODS: All patients in the placebo and active groups were eligible for entry into the 2-year open-label extension, with all receiving dutasteride 0.5 mg daily. Mean changes from baseline were calculated for the American Urologic Association Symptom Index (AUA-SI) score at each scheduled time in the double-blind and open-label phase. The additional analyses included a breakdown of the AUA-SI score, including stratifying patients by symptom severity, assessment by baseline age and prostate volume, and the evaluation of symptoms responders. RESULTS: There was a clinically meaningful improvement in AUA-SI in patients on dutasteride in the double-blind phase, but not in those on placebo. At 48 months, patients on dutasteride in both study phases had greater improvements in AUA-SI score and individual question scores than those on dutasteride in the open-label phase only. The proportion of patients with severe symptoms declined in both study groups, although these changes were more profound in those receiving dutasteride for the 4-year duration of the study. CONCLUSION: In men with symptomatic benign prostatic hyperplasia, long-term (4-year) treatment with the dual isozyme 5alpha-reductase inhibitor dutasteride resulted in sustained and continued improvements in symptoms and flow rate. For 4 vs 2 years, longer dutasteride therapy resulted in greater symptom improvement.

Transurethral needle ablation for the treatment of chronic pelvic pain syndrome (category III prostatitis): a randomized, sham-controlled study.

OBJECTIVES: To investigate the effectiveness and durability of transurethral needle ablation (TUNA) in the treatment of symptoms of chronic pelvic pain syndrome (CPPS) in a randomized, single-blind, sham-controlled study. METHODS: Thirty-three patients with moderate-to-severe symptoms of CPPS were randomized to either TUNA (n = 25) or urethrocystoscopy as a sham treatment (n = 8). The response to therapy was evaluated 3, 6, and 12 months after treatment using the Prostatitis Symptom Severity Index (PSSI), the International Prostate Symptom Score (IPSS), a visual analogue scale, and prostate volume, prostate-specific antigen, urinary flow, and residual urine volume measurements. RESULTS: The PSSI decreased in both groups (TUNA group, P <0.001; sham group, P not significant), but no statistically significant difference was detected between them. Similarly, the IPSS decreased in the two groups (TUNA group, P = 0.002; sham group, P = 0.05), but no difference was found between those treated with TUNA and those who underwent sham treatment. Also the quality of life (IPSS-8) was significantly better at 12 months in both groups, but no difference was detected between them. Changes in pain score (visual analogue scale) were not statistically significant. Peak urinary flow rate, residual urine volume, prostate-specific antigen, and prostate volume were not altered in either group. CONCLUSIONS: The efficacy of TUNA in CPPS is comparable to sham treatment, and so cannot be recommended as routine treatment of CPPS.

The chronic prostatitis-chronic pelvic pain syndrome can be characterized by prostatic tissue pressure measurements.

PURPOSE: We performed a prospective study to confirm early results implying that intraprostatic tissue pressure is elevated in men with the chronic prostatitis-chronic pelvic pain syndrome. We planned to determine further whether this technique would detect a significant difference in inflammatory and noninflammatory categories IIIA and IIIB. MATERIALS AND METHODS: A total of 48 patients with the chronic prostatitis-chronic pelvic pain syndrome, including 18 with inflammatory category IIIA and 30 with noninflammatory category IIIB disease, and 12 asymptomatic controls completed a Finnish version of the National Institutes of Health-Chronic Prostatitis Symptom Index. In addition, culture and microscopy of lower urinary tract segmented specimens, serum prostate specific antigen determination, transrectal ultrasound, uroflowmetry and ultrasound post-void residual urine measurement were done. All patients and controls also underwent independent intraprostatic right and left lobe tissue pressure measurement using a standard intracompartmental tissue pressure monitor system. Pressure was measured via an intraprostatic needle placed percutaneously in the perineum at baseline, and 10, 60 and 120 seconds after standard saline injection. RESULTS: All patients with the chronic prostatitis-chronic pelvic pain syndrome had significantly higher pressure at all measurement points compared with controls (p <0.001). Mean intraprostatic tissue pressure was significantly higher (p <0.01) in category IIIA with greater than 10 leukocytes per high power field in prostate specific specimens compared with category IIIB with less than 10. CONCLUSIONS: Our study supports the suggestion that patients with the chronic prostatitis-chronic pelvic pain syndrome have significantly higher prostate tissue pressure than controls. Findings also validated the previous clinical assumption that there is a rationale for differentiating chronic prostatitis-chronic pelvic pain syndrome cases into inflammatory and noninflammatory categories.

Bicalutamide (150 mg) versus placebo as immediate therapy alone or as adjuvant to therapy with curative intent for early nonmetastatic prostate cancer: 5.3-year median followup from the Scandinavian Prostate Cancer Group Study Number 6.

PURPOSE: We evaluated the benefits of adding 150 mg bicalutamide to standard care, that is radical prostatectomy, radiotherapy or watchful waiting (WW), in patients with localized or locally advanced prostate cancer. MATERIALS AND METHODS: A total of 1,218 men with T1-4, M0, any N prostate cancer were recruited from 62 Scandinavian centers and randomized 1:1 to 150 mg bicalutamide or placebo plus standard care. Primary end points were progression-free survival (PFS) and overall survival. RESULTS: At a median 5.3-year followup patients with locally advanced disease had improved survival with bicalutamide (HR 0.68, 95% CI 0.50 to 0.92), while those with localized disease had decreased survival with bicalutamide (HR 1.47, 95% CI 1.06 to 2.03). Bicalutamide significantly improved PFS, decreasing the risk of disease progression by 43% compared with placebo (HR 0.57, 95% CI 0.48 to 0.68, p<0.0001). The rate of events was 35.4% for bicalutamide and 46.2% for placebo. Patients with locally advanced disease gained the greatest PFS benefits with bicalutamide (HR 0.40, 95% CI 0.31 to 0.52). Since 81% of the trial population were untreated before entry and would otherwise have undergone WW, the findings essentially reflect the results of immediate hormone therapy vs WW. CONCLUSIONS: Bicalutamide (150 mg) provides significant benefit in patients with locally advanced disease. In previously untreated patients there may be a tumor burden below which endocrine therapy provides no benefit or may even decrease survival.

Bicalutamide as immediate therapy either alone or as adjuvant to standard care of patients with localized or locally advanced prostate cancer: first analysis of the early prostate cancer program.

PURPOSE: We determine the efficacy and tolerability of bicalutamide as immediate therapy, either alone or as adjuvant to treatment of curative intent, in patients with clinically localized or locally advanced prostate cancer. MATERIALS AND METHODS: This international program consists of 3 ongoing, randomized, double-blind, placebo controlled clinical trials (trials 23, 24, and 25). Men with localized or locally advanced (T1-T4, Nx/N0, M0) prostate cancer were randomized to receive 150 mg. bicalutamide daily or placebo, in addition to standard care with radical prostatectomy, radiotherapy or watchful waiting. Primary end points are time to objective progression and overall survival. In this first analysis data from the trials were combined in a single overview analysis according to protocol. RESULTS: Data are available for 8,113 patients (4,052 randomized to bicalutamide, 4,061 to standard care alone) at a median followup of 3.0 years. Treatment with bicalutamide provided a highly significant reduction of 42% in the risk of objective progression compared with standard care alone (9.0% versus 13.8%, hazards ratio 0.58; 95% confidence interval 0.51, 0.66; p <<0.0001). The overall result was reflected in 2 of the 3 trials (trials 24 and 25) with trial 3 (trial 23) showing a nonsignificant difference at this time. Reductions in the risk of disease progression were seen across the entire patient population, irrespective of primary treatment or disease stage. Overall survival data are currently immature and longer followup will determine if there is also a survival benefit with bicalutamide. The most frequently reported side effects of bicalutamide were gynecomastia and breast pain. CONCLUSIONS: Immediate treatment with 150 mg. bicalutamide daily, either alone or as adjuvant to treatment of curative intent, significantly reduces the risk of disease progression in patients with localized or locally advanced prostate cancer. This benefit must be balanced with the morbidity associated with long-term hormonal therapy. Followup is ongoing to determine potential survival benefits of this treatment approach.