losartan-potassium and Prostatic-Hyperplasia

This article reviews complementary and alternative therapies for advanced prostate cancer. This is not a comprehensive survey of nontraditional therapies for prostate cancer. Rather, this review focuses on alternative and complementary therapies with published studies to evaluate efficacy and safety. Three areas are addressed: alternative forms of hormonal therapy, management of side effects of hormonal therapy, and management of skeletal complications.

Topics: Acupuncture; Adenocarcinoma; Androgen Antagonists; Androgens; Anemia; Anticarcinogenic Agents; Antineoplastic Agents; Antineoplastic Agents, Hormonal; Breast Neoplasms; Clinical Trials, Phase II as Topic; Complementary Therapies; Depression; Diphosphonates; Drugs, Chinese Herbal; Erythropoietin; Female; Flushing; Humans; Hypericum; Male; Multicenter Studies as Topic; Neoplasms, Hormone-Dependent; Osteoporosis; Phytotherapy; Pilot Projects; Plant Extracts; Prospective Studies; Prostatic Hyperplasia; Prostatic Neoplasms; Randomized Controlled Trials as Topic; Serenoa

The impact of chronic administration of the luteinizing hormone-releasing hormone agonist leuprolide depot on cardiovascular risk factors was investigated in a controlled double-blind study comprising 50 evaluable patients with benign prostatic hyperplasia. In the 26 patients receiving leuprolide the mean total cholesterol level increased by 10.6%, high density lipoprotein cholesterol by 8.2% and triglycerides by 26.9% (p = 0.003, 0.052 and 0.050, respectively). Low density lipoprotein cholesterol levels were unchanged. Apolipoprotein A1 increased by 13.2% (p = 0.001), while apolipoprotein B, fibrinogen, thrombocytes and plasminogen activator inhibitor were unchanged. Hemoglobin decreased by 1.2 gm./100 ml. without a concomitant decrease in serum erythropoietin concentration. These changes act in different directions with regard to cardiovascular risk and the overall effect is difficult to assess.

Topics: Aged; Apolipoprotein A-I; Apolipoproteins B; Blood Platelets; Cholesterol, HDL; Cholesterol, LDL; Double-Blind Method; Erythropoietin; Estradiol; Fibrinogen; Hemoglobins; Humans; Leuprolide; Lipoproteins; Male; Placebos; Plasminogen Activator Inhibitor 1; Prostatic Hyperplasia; Testosterone; Triglycerides

Recently, autologous blood transfusion has been widely endorsed, because of the adverse effects attributed to homologous blood transfusion. We found that the administration of recombinant human erythropoietin (rH-EPO) permitted the preoperative collection of an adequate volume of autologous blood in a short period of time. This reduced or eliminated the need for homologous blood transfusion.. To determine optimal dosage of rH-EPO, I conducted a randomized, controlled trial in 86 patients with benign prostatic hypertrophy (BPH) scheduled for transurethral resection of the prostate (TUR-P). The patients from whom approximately 10% of their total blood volume was removed, received six different doses of rH-EPO either intravenously or subctaneously. All patients received iron sulfate 100 mg orally once a day during the study.. I found that 9,000 IU of rH-EPO given intravenously daily or 10,500 IU of rH-EPO injected subcutaneously every third day for a week were optimal dosages. These schedules ennabled us to withdraw approximately 400 ml of blood prior to operation without adverse effects.. I conclude that the efficacy of rH-EPO is greater when administered subcutaneously rather than intravenously. It is clear that rH-EPO increases the ability of patients about to undergo selective surgery to donate greater amounts of blood for future autologous transfusion.

Topics: Aged; Blood Transfusion, Autologous; Erythropoietin; Humans; Injections, Intravenous; Injections, Subcutaneous; Male; Middle Aged; Preoperative Care; Prostatectomy; Prostatic Hyperplasia; Recombinant Proteins

We investigated the collection and transfusion of autologous blood after treatment with EPO in 68 BPH patients (including 10 controls) who were scheduled to undergo TUR-P. All patients received oral and/or intravenous iron supplements. Assessments were made based on the preoperative increase in blood hemoglobin levels including autologous blood predonation (deltaHb). The deltaHb in patients undergoing collection of 600 ml of blood were as follows: control group: -0.36 +/- 0.57 g/dl; EPO group, 9 x 3000 units intravenously: 1.15 +/- 0.83 g/dl; EPO group, 6 x 6000 units intravenously: 0.79 +/- 0.80 g/dl; EPO group, 3 x 12,000 units subcutaneously: 1.47 +/- 0.62 g/dl. In patients undergoing collection of 800 ml of blood, the results were as follows: EPO group, 3 x 12,000 units subcutaneously: 1.80 +/- 0.69 g/dl; EPO group, 3 x 24,000 units subcutaneously: 2.03 +/- 0.77 g/dl. All EPO-treated patients successfully underwent surgery using their own blood, and none of them required homologous transfusion. The increase of Hb was greater in the patients treated with EPO than in controls, allowing safe preoperative blood collection even in elderly patients. In patients with relatively severe BPH, homologous transfusion could be avoided and surgery was performed safely.

Topics: Aged; Blood Transfusion, Autologous; Case-Control Studies; Erythropoietin; Hemoglobins; Humans; Male; Prostatectomy; Prostatic Hyperplasia; Recombinant Proteins

In order to reduce the rate of homologous blood transfusion, predeposit autologous blood transfusion has been introduced in 134 out of 266 patients undergoing transurethral resection of the prostate since February 1988. Nine (6.7%) out of 134 patients who deposited their own blood were also transfused with homologous blood. In contrast, the rate of homologous blood transfusion was 22.7% in 132 patients who did not deposit autologous blood. Overall homologous blood transfusion rate (14.7%) in the past 4.5 years has been much lower than in the previous 4 years (22.2% in 203 patients). In 6 patients in whom blood donation was performed concurrently with administration of recombinant human erythropoietin, decrease of haemoglobin level was significantly less than in those without rHuEPO. Predeposit autologous blood transfusion can reduce homologous blood transfusion rate. It is safe and easily performed, and more effective when combined with rHuEPO administration even in elderly patients undergoing TURP.

Topics: Aged; Aged, 80 and over; Blood Banks; Blood Transfusion; Blood Transfusion, Autologous; Erythropoietin; Hemoglobins; Humans; Intraoperative Care; Male; Middle Aged; Preoperative Care; Prostatic Hyperplasia; Prostatic Neoplasms; Recombinant Proteins; Retrospective Studies; Surgical Procedures, Operative; Urethra

To examine the role of testosterone in the maintenance of hemoglobin levels, we studied the effect of reversible androgen deprivation on hemoglobin, serum immunoreactive erythropoietin, and serum testosterone in seven men treated with a luteinizing hormone-releasing factor (LHRH) agonist for 6 months and then followed for an additional 6 months. The mean serum testosterone level was 4.35 +/- 1.05 ng/ml initially and it decreased to castrate levels in all patients by 6 months. After stopping therapy, there was a rapid increase in serum testosterone such that by 12 months the mean concentration was normal. The pretreatment hemoglobin was 15.2 +/- 0.9 g/dl (mean +/- SD); after 6 months of androgen deprivation it had fallen to 14.1 +/- 0.4 g/dl (P less than 0.05). Six months after stopping therapy, the hemoglobin rose to pre-treatment levels. Before treatment, serum immunoreactive erythropoietin was 9.5 +/- 4.6 mu/ml (mean +/- SD) and did not change significantly during or after the 6 month period of androgen deprivation. No significant inhibition of burst-forming unit-erythroid (BFU-E) or colony-forming unit-granulocyte macrophage (CFU-GM) was observed at the serum level of nafarelin acetate obtainable in vivo. These data suggest that, within the normal range of hemoglobin in men, androgens are a determinant of the red cell mass.

Topics: Aged; Androgens; Erythropoietin; Gonadotropin-Releasing Hormone; Hemoglobins; Humans; Injections, Subcutaneous; Male; Middle Aged; Nafarelin; Prostate; Prostatic Hyperplasia; Radioimmunoassay; Testosterone; Time Factors

Erythropoietin (EPO) with an established clinical efficacy in renal anemia has in recent years become applied as an aid to autologous blood transfusion in surgical patients. This report describes our experience with autotransfusion along with the use of EPO in transurethral resection of the prostate (TUR-P), indicating its usefulness. Ten patients with benign prostatic hypertrophy aged 60 to 74 years received 3000 units of EPO, with an iron preparation, nine times beginning 3 weeks prior to operation. Autologous blood of 300 ml was collected from the patient each at 2 and 1 week before operation and was used at TUR-P. Five other patients who underwent TUR-P with the same volume of autotransfusion accompanied by preparative medication with the iron alone served as controls. In the EPO treated group (mean age, 68.3 years) the mean value for hemoglobin concentration (Hb) was 14.0 +/- 1.6 g/dl on the day of operation, which showed a recovery rate of 94.9 +/- 5.4% (Hb recovery rate) as against the pre-EPO treatment value (mean: 14.8 +/- 1.3 g/dl). This Hb recovery rate was significantly greater (p less than 0.001) when compared to 82.2 +/- 2.5% in the control group (mean age, 68.2 years). Of the EPO treated patients, those in their sixties (n = 6; mean age, 66.3 years) exhibited a significantly higher Hb recovery rate (98.3 +/- 3.5%) than the rate (89.9 +/- 3.0%) for patients in their seventies (N = 4; mean age, 71.3 years) (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Blood Transfusion, Autologous; Erythropoietin; Evaluation Studies as Topic; Humans; Male; Middle Aged; Prostatectomy; Prostatic Hyperplasia; Recombinant Proteins