Study Suggests α-Blocker or 5ARI Withdrawal May Be a Viable Option for Men with BPH/LUTS

A recent randomized trial has found that men with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) may successfully withdraw from α-blocker (AB) or 5α-reductase inhibitor (5ARI) therapy after achieving symptom improvement.

The study, which included 222 men who showed significant improvements in their International Prostate Symptom Score (IPSS) and reduced prostate volume (PV) following combination therapy, compared the effects of continued combined treatment versus withdrawal of either AB or 5ARI.

At the 24-month follow-up, 27.8% of patients in the AB-withdrawal group and 26.4% in the 5ARI-withdrawal group reported slight symptom deterioration (IPSS-T increase of ≥2 points).

Despite this, very few patients (5.6% in the AB group and 5.7% in the 5ARI group) required readdition of the withdrawn drug. Notably, both withdrawal groups showed improvements in quality-of-life measures, including the EuroQol-visual analog scale (EQ-VAS), and reduced post-void residual urine.

The results indicate that, for men unwilling to maintain long-term combination therapy, withdrawal of either AB or 5ARI may be possible, provided they have showed considerable improvement in symptoms and prostate size. However, careful monitoring is essential, particularly for those with diabetes, which was associated with symptom deterioration.

Sodium bicarbonate is an effective alternative to classic heparin as a lock solution for non-tunneled dialysis catheters

According to a recent study, sodium bicarbonate has comparable efficacy to classic unfractionated heparin in the prevention of catheter lumen thrombosis. Additionally, it serves as a cost-effective alternative that can be utilized in cases where heparin is not recommended. This study’s findings were published in the journal, International urology and nephrology.

In the prospective trial, 426 patients were assigned to four groups. : femoral bicarbonate (n = 100), femoral heparin (n = 113), jugular bicarbonate (n = 113), and jugular heparin (n = 113), Patients were allocated to receive either 8.4% sodium bicarbonate or heparin (5000 IU/ml) in a consecutive manner. Information on basic characteristics, catheters, dialysis sessions, and complications was collected.

The mean time to the last effective dialysis treatment for those on heparin was 10.7 ± 12.1 days compared to 11.5 ± 10.8 days for the bicarbonate group. Among the 25 (5.9%) patients who faced blood flow issues, 13 were in the heparin group and 12 were in the bicarbonate group. Out of these 25 cases, only 12 individuals (7 in the heparin group and 5 in the bicarbonate group) experienced catheter dysfunction.

The above study showed that sodium bicarbonate is as effective as classic unfractionated heparin in the prevention of catheter lumen thrombosis. It also provides a cost-effective alternative for cases where heparin is not suitable.

Safety and efficacy of either mirabegron, silodosin, or both in the expulsion of distal ureteric stones

A recent study demonstrated that lower ureteric stones can be effectively treated with both silodosin and mirabegron. Furthermore, when these medications are used together, they have been found to increase the rate of stone expulsion and reduce the duration of expulsion. This study’s findings were published in the journal, International Urology and Nephrology. 

This study included 105 patients, aged 20 to 56 years, who were diagnosed with a single radiopaque distal ureteral stone measuring ≤ 10 mm. The individuals were randomly allocated into three groups, each group containing 35 participants. Group A received an 8 mg daily dose of silodosin, group B was given 50 mg of mirabegron once daily, and group C received a combination of both medications. Treatment was given until the stone passed or for a maximum of four weeks. The stone-free rate was assessed by analyzing KUB films with or without ultrasonography.

Stone expulsion rate was higher in group C in comparison to groups A and B. The mean (standard deviation) time for expulsion of the stone in group A, group B, and group C was 14 ± 2.3 days, 11 ± 3.1 days, and 7 ± 2.2 days, respectively. Group C exhibited a significantly shorter stone expulsion time when compared to groups A and B. The incidence of renal colic in group C was significantly lower than that in groups A and B, leading to a decreased need for analgesics. Anejaculation was significantly more frequent in the silodosin group (73.9%) and combination group (84%) than in the mirabegron group.

Thus, it can be concluded that both silodosin and mirabegron are effective treatments for lower ureteric stones. Additionally, when these medications are utilized in combination, they have been shown to increase the rate of stone expulsion and decrease the duration of expulsion.

Patients with metastatic castration-resistant prostate cancer benefit from niraparib plus abiraterone acetate and prednisone

A recent study suggests that patients with metastatic castration-resistant prostate cancer (mCRPC) and BRCA alterations showed clinically relevant outcomes when treated with niraparib plus abiraterone acetate and prednisone (AAP). This study’s results were published in the Annals of Oncology.

The phase 3, MAGNITUDE trial included 212 HRR+ patients with/without BRCA1/2 alterations. They were randomized in a 1:1 ratio to receive 200mg of niraparib orally plus AAP (1000 mg/10 mg orally) or placebo plus AAP. At the second prespecified interim analysis (IA2), the secondary endpoints assessed were time to symptomatic progression, time to initiation of cytotoxic chemotherapy and overall survival (OS).

It was found that at IA2 with 24.8 months of median follow-up, niraparib plus AAP showed significantly prolonged radiographic progression-free survival (rPFS) (19.5 versus 10.9 months; hazard ratio (HR) = 0.55 [95% confidence interval (CI) 0.39-0.78] consistent with the first prespecified interim analysis. Similarly, in the total HRR+ population, rPFS was also prolonged. In the niraparib plus AAP group, time to symptomatic progression and time to initiation of cytotoxic chemotherapy showed improvements. Even the analysis of OS with niraparib plus AAP in the BRCA1/2 subgroup demonstrated a lower hazard ratio.

From the above results, it is clear that niraparib plus AAP in patients with BRCA1/2-altered mCRPC, may demonstrate an improved rPFS and other clinically relevant outcomes.