ABSTRACT
Background: Finasteride and dutasteride are inhibitors of the enzyme 5-alpha-reductase which inhibits the conversion of testosterone to dihydrotestosterone. Dutasteride inhibits both type I and type II 5-alpha-reductase while fi nasteride inhibits only the type II enzyme. As both isoenzymes are present in hair follicles, it is likely that dutasteride is more effective than fi nasteride. Aims: To compare the effi cacy, safety and tolerability of dutasteride and fi nasteride in men with androgenetic alopecia. Methods: Men with androgenetic alopecia between 18 and 40 years of age were randomized to receive 0.5 mg dutasteride or 1 mg fi nasteride daily for 24 weeks. The primary effi cacy variables were hair counts (thick and thin) in the target area from modifi ed phototrichograms and global photography evaluation by blinded and non-blinded investigators. The secondary effi cacy variable was subjective assessment using a preset questionnaire. Patients were assessed monthly for side effects. Results: Ninety men with androgenetic alopecia were recruited. The increase in total hair count per cm2 representing new growth was signifi cantly higher in dutasteride group (baseline- 223 hair; at 24 weeks- 246 hair) compared to fi nasteride group (baseline- 227 hair; at 24 weeks- 231 hair). The decrease in thin hair count per cm2 suggestive of reversal of miniaturization was signifi cantly higher in dutasteride group (baseline- 65 hair; at 24 weeks- 57 hair) compared to fi nasteride group (baseline- 67 hair; at 24 weeks- 66 hair). Both the groups showed a similar side effect profi le with sexual dysfunction being the most common and reversible side effect. Limitations: Limitations include the short duration of the study (6 months), the small sample size and the fact that it was an open-label study. Conclusions: Dutasteride was shown to be more effi cacious than fi nasteride and the side-effect profi les were comparable.
ABSTRACT
Prostate-specific membrane antigen (PSMA) is an attractive target for both diagnosis and therapy because of its high expression in the vast majority of prostate cancers. Development of small molecules for targeting PSMA is important for molecular imaging and radionuclide therapy of prostate cancer. Recent evidence implies that androgendeprivation therapy increase PSMA-ligand uptake in some cases. The reported upregulations in PSMA-ligand uptake after exposure to second-generation antiandrogens such as enzalutamide and abiraterone might disturb PSMA-targeted imaging for staging and response monitoring of patients undergoing treatment with antiandrogen-based drugs. On the other hand, second-generation antiandrogens are emerging as potential endoradio-/chemosensitizers. Therefore, the enhancement of the therapeutic efficiency of PSMA-targeted theranostic methods can be listed as a new capability of antiandrogens. In this manuscript, we will present what is currently known about the mechanism of increasing PSMA uptake following exposure to antiandrogens. In addition, we will discuss whether these above-mentioned antiandrogens could play the role of endoradio-/chemosensitizers in combination with the well-established PSMA-targeted methods for pre-targeting of prostate cancer.
Subject(s)
Humans , Androgen Antagonists , Diagnosis , Hand , Membranes , Molecular Imaging , Positron-Emission Tomography , Prostatic Neoplasms , Theranostic NanomedicineABSTRACT
O hirsutismo é definido como a presença de pelos terminais na mulher, em áreas anatômicas características de distribuição masculina. Pode se manifestar como queixa isolada ou ser acompanhada de outros sinais de hiperandrogenismo, virilização, distúrbios menstruais e/ou infertilidade, e está associado aos níveis circulantes de androgênios e à sensibilidade cutânea a estes hormônios. As causas mais prevalentes do hirsutismo são a síndrome dos ovários policísticos e o hirsutismo isolado, na presença de ciclos ovulatórios. Menos frequentes são as hiperplasias adrenais congênitas forma não-clássica por deficiência da 21-hidroxilase, bem como o hirsutismo secundário ao uso de medicamentos. Outras causas mais raras são a síndrome de Cushing e os tumores virilizantes. A avaliação diagnóstica deve focar na identificação da etiologia e do risco para comorbidades eventualmente associadas. Os objetivos do tratamento são: suprimir o excesso de androgênios, quando houver; bloquear a ação dos androgênios no folículo pilo-sebáceo; identificar pacientes com risco para distúrbios metabólicos e/ou de neoplasias do trato reprodutivo e proceder à sua prevenção primária e secundária.
Hirsutism may be defined as the presence of terminal hair in the women, with a male pattern of distribution. The clinical presentation is variable, from isolated hirsutism to the presence of other signs of hyperandrogenism, menstrual irregularities and/or infertility. Hirsutism is related to serum androgens and to the cutaneous sensitivity to these hormones. The most prevalent causes of hirsutism are polycystic ovary syndrome and isolated hirsutism, in the presence of ovulatory cycles. Non-classical congenital adrenal hyperplasia (21-hydroxylase deficiency) and drug-induced hirsutism are less frequent causes. Androgen-secreting neoplasms and Cushing syndrome are rare etiologies related to hirsutism. Diagnostic evaluation should address on identifying the etiology and potential risk for associated comorbidities. The aims of the treatment are: to suppress androgen overproduction, if present; to block androgen action on hair follicles; to identify and treat patients at risk for metabolic disturbances or reproductive neoplasias.