[ Online CME for this issue ]

Editorial

E. David Crawford, MD

This issue of Grand Rounds in Urology features two outstanding reviews of interest to the practicing urologist. Both involve combination therapies for two common urologic diseases: advanced prostate cancer and benign prostatic hyperplasia (BPH). Dr. Gerald Chodak discusses the current state of hormonal therapy and maximal androgen suppression. He provides an interesting historical review of the development of hormonal therapy culminating in clinical trials in the 1980s that began to examine the concept of maximal androgen ablation. The results of these studies were the genesis of heated debates in urological oncology. Several meta-analyses failed to show a clinically significant benefit for maximal ablation. Dr. Chodak distills his concerns about these metaanalyses down into five areas: role of antiandrogen withdrawal; yielding similar results; sample size; extent of disease; and failure to include all studies. He concludes that although more side effects are present with the complete block, patients and physicians should ultimately decide the benefit based on three large, well-designed clinical trials. I agree with him, and furthermore there is level one evidence supporting the use of combined androgen blockade.

Another trial providing us level one evidence regarding patient care is culled from the results of the Medical Therapy of Prostatic Symptoms study (MTOPS). Drs. Harris E. Foster and David J. Rosenberg review the current role of the combination of alpha blockers and 5-alpha reductase inhibitors in the management of BPH. The evolution of BPH therapy in the past two decades has dramatically changed our approach to management. Alpha blockers remain the cornerstone of therapy. However, data from MTOPS suggest that many men will benefi t from combination therapy with both the alpha blocker and 5-alpha reductase agent. They review our recent publication (Crawford ED, Wilson SS, McConnell JD, et al. Baseline factors as predictors of clinical progression of benign prostatic hyperplasia in men treated with placebo. J Urol. 2006;175:1422-1427) that links the risk of progression to prostate volume > 31 grams, PSA > 1.6 ng/mL, baseline Qmax < 10.6 mL/sec, and baseline age > 62 years. Again, we have strong clinical parameters that help in treatment decisions.

Sincerely,

E. David Crawford, MD
Medical Editor
Grand Rounds in Urology

CONTENTS

• Continuing Medical Education
  [ Online CME for this issue ]
 

• A Critical Analysis of Maximum Androgen Blockade
  Gerald W. Chodak, MD

•The Current Role of the Combination of Alpha Blockers and 5 Alpha Reductase Inhibitors in the Management of Benign Prostatic Hyperplasia
  Harris E. Foster, Jr., MD

• Post-Test

• Application for CME Credit

• Directory of Meetings

 Download a PDF of the full issue (1.62 Mb)

[ Online CME for this issue ]