686 Is there an effect of antimuscarinics on the prostate? Preliminary results from a randomized study in patients with benign prostate enlargement (BPE) and overactive bladder (OAB)

Title

686

Is there an effect of antimuscarinics on the prostate? Preliminary results from a randomized study in patients with benign prostate enlargement (BPE) and overactive bladder (OAB) Eur Urol Suppl 2015;14/2;e686          

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Sakalis V. 1 , Sfiggas V. 1 , Vouros I.1 , Salpiggidis G.1 , Papathanasiou A. 1 , Apostolidis A. 2 1 Ippokration

Hospital, Dept. of Urology, Thessaloniki, Greece, 2 Aristotle University of Thessaloniki, 2nd Dept. of Urology, Thessaloniki,

Greece INTRODUCTION & OBJECTIVES: Approximately 50% of patients with BPE present with OAB symptoms and demonstrable detrusor overactivity urodynamically, and a third of them will have persistent OAB symptoms post-prostatectomy. Co-administration of a-blockers with antimuscarinics is now a recommended treatment option. All five muscarinic receptors subtypes have been detected in the prostate, but their role in BPE-OAB is yet unclear. Initial studies suggest an effect on secretion and growth of the prostate. This study aims to identify potential influence of antimuscarinics on morphometric and functional parameters of the prostate in patients with BPE-OAB. MATERIAL & METHODS: We recruited non-neurological patients with prostate volume >30ml, predominately storage LUTS, a score of ≥ 3 in the urgency question of IPSS, at least 3 urgency episodes per 24h in a 3-day bladder diary, maximum flow rate (Qmax) >10ml/s, postvoid residual (PVR) <100ml, PSA <4ng/ml and a negative history of urinary tract malignancy. Patients were randomized into two treatment groups. Group I received Tamsulosin 0.4mg and Group II received Tamsulosin + Solifenacin 5mg, which could be titrated to 10mg OD after one month. Recruited patients had pressure-flow study, transrectal and transabdominal ultrasonography and biochemistry done at induction and at 6 months. At 4 and 12 weeks they had a free-flow and transabdominal ultrasound. The paired t-test and Mann-Whitney test were used for intra- and intergroup variability of examined parameters. RESULTS: At baseline, both groups were comparable for age (mean 69.8±8.8 vs. 68.7±9.6 years), body mass index (28.2±2.8 vs. 28.7±2.9), total IPSS (21.2±4.6 vs. 20.4±4.5), micturition frequency (9.9±2.8 vs. 9.6±2.5), prostate volume (41.8±11.9 vs. 60.1±11.6), Qmax (12.2±4.3 vs. 13.9±6.2) and PVR. At end of treatment, both groups improved in total IPSS (p=0.001). Group I showed a greater improvement in voiding subscore (p=0.005) while Group II in storage score (p=0.004). Cystometric capacity improved in combination treatment only (p=0.002). Decreases in bladder outlet obstruction index were comparable between the 2 groups (p=0.036 vs p=0.018). PVR was increased in group II (+33.48%) as opposed to a decrease in group I (-24.83%) (p=0.003). Prostate volume increased by a mean 12.16% in monotherapy group as opposed to a 8.99% decrease in group II (comparative p=0.0001). Such changes were also reflected in adenoma volume (Group I: +10.81% vs Group II: -15.02%, p=0.001) and in detected vessel surface size (Group I: +40.39% vs. Group II: -10.1%, p=0.0001). PSA values dropped in Group II by contrast to an increase in Group I, but differences did not reach significance. CONCLUSIONS: Results of this pilot study suggest an effect of antimuscarinics on morphometric properties of the prostate with a decrease in prostatic volume and vascularity. Further studies should clarify whether this is via an effect on prostate muscarinic and other receptors and biochemistry, and how this might relate to the expected bladder effect of antimuscarinics.

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