Recovery of serum prostate specific antigen value after interruption of antiandrogen therapy with allylestrenol for benign prostatic hyperplasia.

Decrease in serum prostate specific antigen (PSA) concentration is inevitably associated with antiandrogen therapy for benign prostatic hyperplasia (BPH), and might mask the presence of prostate cancer or delay its diagnosis. To determine the appropriate timepoint for determination of correct PSA value, we sequentially measured serum PSA and testosterone levels after discontinuation of antiandrogen therapy for BPH. With informed consent, 12 patients (72.8 +/- 12.2* years old) with BPH were treated with allylestrenol 50 mg/day for 4 months. Serum testosterone and PSA concentrations were determined before and just after treatment, as well as every month after treatment up to 3 months. After treatment with allylestrenol for 4 months, mean serum testosterone and PSA levels were significantly decreased from 408 +/- 136* to 87.9 +/- 76.2* ng/dl, and from 2.81 +/- 0.87* to 2.04 +/- 0.82* ng/ml, respectively. The mean serum PSA level recovered to the pretreatment level within 2 months and mean serum testosterone concentration within one month after discontinuation of administration. In conclusion, during treatment of BPH with antiandrogen allylestrenol, a two-month washout is adequate for determination of correct PSA value (*: M +/- SD).

[Clinical effects of allylestrenol on patients with benign prostatic hyperplasia (BPH) evaluated with criteria for treatment efficacy in BPH].

One hundred and twenty-nine patients with benign prostatic hypertrophy (BPH) were registered and treated with allylestrenol. Allylestrenol was administered at a dose of 50 mg/day given twice a day for 16 weeks. Out of 129 patients with a mean age of 67.8 years old, 92 cases completed the study and 48 cases with moderate symptoms were objectively evaluated with "Criteria for Treatment Efficacy in BPH" proposed by The Japanese Urological Association in 1997. Prostate volume was significantly decreased from 32.7 +/- 11.9 to 27.4 +/- 11.2 ml (mean +/- SD), and maximum flow rate was significantly increased from 8.4 +/- 3.4 to 10.8 +/- 5.0 ml/sec. Residual urine volume was significantly decreased from 62.4 +/- 57.4 to 37.0 +/- 38.7 ml. IPSS was significantly decreased from 15.3 +/- 4.9 to 9.9 +/- 4.0, and QOL index was significantly decreased from 4.4 +/- 0.8 to 2.7 +/- 1.2. The efficacy of allylestrenol was shown by its effects on prostate volume (anatomy), maximum urinary flow rate (function), and symptom scores (symptom) at the end of 16 weeks of treatment. The rates of improvement for symptoms, QOL, function, and anatomy are 68.7% (N = 48), 79.2% (N = 48), 50.0% (N = 48), and 61.0% (N = 41), respectively. Overall efficacy (Good and Fair) was 70.9% (N = 48). During this study, 5 patients (3.9%) complained of loss of libido and 2 patients dropped out. In conclusion, allylestrenol was demonstrated to be a quite effective and safe medical treatment for patients with symptomatic BPH based on the criteria for treatment efficacy in BPH.

Clinical significance of interruption of therapy with allylestrenol in patients with benign prostatic hypertrophy.

BACKGROUND: A multicenter, clinical trial investigated the effects of an interruption of antiandrogen therapy on subjective and objective clinical parameters in patients with benign prostatic hypertrophy (BPH). METHODS: Patients were given antiandrogen therapy with allylestrenol (50 mg/day) for 16 weeks. The medication was then withheld and the patients were carefully monitored for an additional 16 weeks. There were 34 BPH patients ranging in age from 55 to 82 years (mean, 66.1 years). The efficacy of allylestrenol was evaluated by its effects on prostate volume, maximum urinary flow rate (MFR), and symptom scores at the end of 16 weeks of treatment and then again at 32 weeks (16 weeks after cessation of therapy). RESULTS: Allylestrenol was effective in the treatment of BPH, and was still effective 16 weeks after the cessation of medication. The prostate volume did not change after treatment cessation nor did the total symptom score, but the MFR reversed to the pretreatment level. Serum testosterone (1.95 ng/mL), dihydrotestosterone, and gonadotropin levels decreased on therapy, but were completely reversed by the end of this study. A prostate needle biopsy revealed that after 16 weeks without therapy, some glands showed regressive glandular changes, while some glands showed slight hyperplastic changes of the secretory epithelium. Eight per cent of patients complained of loss of libido during this study. CONCLUSIONS: Allylestrenol is an effective and safe medical treatment for patients with symptomatic BPH. Hormonal and histopathologic findings suggest that the prostate gland may regrow after discontinuation of medication.

Transition zone ratio and prostate-specific antigen density as predictors of the response of benign prostatic hypertrophy to alpha blocker and anti-androgen therapy.

OBJECTIVE: To determine whether transrectal ultrasonography (TRUS) can predict the clinical response of patients with benign prostatic hypertrophy (BPH) to alpha 1-blocker and anti-androgen therapy. PATIENTS AND METHODS: From April 1994 to July 1995, 128 patients with BPH were randomized to treatment for 6 months with either tamsulosin (a long-acting selective alpha 1-blocker) or allylestrenol (an anti-androgen), with 64 patients receiving tamsulosin (0.2 mg/day) and 64 receiving allylestrenol (50 mg/day). The results of TRUS, uroflowmetry and the American Urologic Association (AUA) symptom score were compared before and after treatment. TRUS was used to calculate the transition zone (TZ) volume, transition zone ratio (TZ ratio = TZ volume/total prostate volume), total prostate volume and prostate-specific antigen density (PSAD). RESULTS: Both groups showed a statistically significant improvement in the AUA symptom score, quality-of-life (QOL) score and peak urinary flow rate (Qmax) at 6 months (P < 0.001). In the tamsulosin group, there was a significant negative correlation between the pretreatment PSAD and the percentage change in Qmax (r = -0.640, P < 0.001), while there was a positive correlation between PSAD and the percentage change in the AUA symptom score (r = 0.589, P < 0.001). On the other hand, the allylestrenol group showed a significant positive correlation between PSAD and the percentage change in Qmax (r = 0.397, P < 0.01) and a negative correlation between PSAD and the AUA symptom score (r = -0.313, P < 0.01). CONCLUSION: Patients with a high pretreatment PSAD responded well to anti-androgen therapy, while those with a low PSAD responded better to alpha 1-blocker therapy.

The effect of gestanone and ethynyl estradiol on benign breast disease.

The evidence related to the effects of Ocs on the breast benign diseases and their secondary relation to malignancy is studied. Our data are in concordance with other epidemiological studies, that showed no influence on breast mitosis and apoptosis and that there was a reduced incidence of benign breast disease; we also believe that it has a beneficial effect and that this method of contraception is the best.

Transurethral microwave thermotherapy for benign prostatic hyperplasia: patient characteristics in good and poor responders.

Transurethral microwave thermotherapy (TUMT) has been shown to produce a clinical benefit in patients with symptomatic benign prostatic hyperplasia. In order to identify the features of the ideal candidate, a retrospective analysis was conducted in 32 patients who were followed for 2 mo or more. Good responders (GR) were defined as having their Siroky peak flow rate (PFR) standard deviation (SD) increase by < 0.5 or a decrease in the International Prostatic Symptom Score (I-PSS) of > 10 (22 patients). Poor responders (PR) were defined as having their PFR SD increase by < or = 0.5 and their I-PSS decrease by < or = 10 (10 patients). The prostate volume, pre-TUMT I-PSS and intravesical opening pressure were significantly greater in the GR group, while there were no significant differences between the 2 groups for the other baseline patient characteristics: age, prostate length, PFR, PFR SD, post-voiding residual volume and quality of life. Concerning the operational parameters, significantly more total energy was delivered to the prostate in the GR group (mean 131 kJ) than in the PR group (mean 101 kJ). Moreover, the 7 patients with anti-androgen therapy pre-TUMT received less total energy and 5 of the 7 were poor responders. These results suggest that patients with apparent obstructive symptoms and with moderate enlargement of prostate could benefit more from this less invasive therapy. Clinical response seems to be dose-dependent and patients with a history of recent anti-androgen treatment may have a less favorable response.(ABSTRACT TRUNCATED AT 250 WORDS)

[Influence of anti-androgen therapy for prostatic hypertrophy on lipid metabolism].

Antiandrogen therapy has an important role in the treatment of patients with benign prostatic hypertrophy who lack indication for surgery. Herein, the effects on lipid metabolism of administration of antiandrogen agents for benign prostatic hypertrophy are reported. Eighty patients with benign prostatic hypertrophy were each treated with the antiandrogen agents, chlormadinone acetate, allylestrenol, gestonolone caproate and oxendolone for 12 months. The levels of total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL), low density lipoprotein (LDL), alpha-lipoprotein, apoprotein, and maronediardehyde (MDA) were measured every 4 weeks after initiation of antiandrogen treatment. In the chlormadinone acetate group, the TG level was significantly decreased between 3 and 6 months after treatment (p < 0.05). In the oxendolone group, the alpha-lipoprotein level was also elevated between 3 and 6 months and between 6 to 12 months after treatment (p < 0.05). The MDA level was also significantly elevated 6 and 12 months after treatment. However, the levels of the other lipids were within the normal range. In conclusion, the changes in the levels of plasma lipoprotein, apoprotein and MDA resulting from antiandrogen therapy were unlikely to be a cause of ischemic coronary disease.

[Clinical study of allylestrenol (Perselin) on patients with prostatic hypertrophy].

The efficacy and safety of allylestrenol were studied in 22 patients with benign prostatic hypertrophy. A 25 mg allylestrenol tablet (Perselin tablet) was administered twice a day. A significant decrease in frequency of nocturnal urination was observed and improvement rates of subjective symptoms, such as sensation of residual urine, delay in start of urination, straining during urination and strength of urinary stream, were 59.1-68.2%. The rate of decrease of maximum area of transverse plane of prostate estimated by transrectal sonography was 13.2% and presumed circle area ratio (PCAR) improved significantly. The incidence of total side effects was 22.7%, whereas a decrease in sexual potency was observed in only 4.5% of the cases. The final global improvement rating of allylestrenol was 72.2% and the rate of usefulness was estimated in 63.6% of the patients. The present findings confirmed that allylestrenol is a useful and safe drug for the treatment of benign prostatic hypertrophy.

[Lynestrenol and allylestrenol in the therapy of postmenopausal hot flushes]. / Lynestrenol a allylestrenol v lécbe postmenopauzálních návalu horka.

In a parallel randomized placebo controlled clinical trial the authors tested two synthetic gestagens--allylestrenol and lynestrenol--in the treatment of postmenopausal flushes. Both preparations were administered during a six-week period in rapidly declining doses. Allylestrenol was administered in initial doses of 30 mg/d, after five days the doses were reduced so that after 15 days a daily dose of 5 mg was reached. The initial dose of lynestrenol was 10 mg/d with a similar gradual decline to 1.25 mg per day. The trial comprised 42 women with menopausal flushes after a natural or artificial menopause (castration). Both preparations improved the subjective condition of the patients and reduced the gonadotropic production significantly better than placebo (p < 0.05). Subjective relief after lynestrenol was recorded after the second week of therapy, in allylestrenol only after the sixth week when the effects of the two preparations were equal and significantly better than after placebo. Suppression of gonadotropin production was similar after both preparation but with a more rapid onset after lynestrenol and a more prolonged effect after allylestrenol even after significant reduction of the doses. No serious undesirable effects were recorded, no changes in indicators of liver functions or serum lipids incl. the HDL/LDL ratio. Endometrial bleeding after administration of hormones was not more frequent than after placebo. In the discussion the authors analyze some aspect of treatment of the climacteric syndrome by means of these hormones. Allylestrenol in particular is an interesting gestagen due to its inherent oestrogenic effect in the absence of an androgenic effect.

[Antiandrogen therapy of benign prostatic hypertrophy: clinical effects of allylestrenol evaluated by transrectal ultrasonographic measurement].

A multicenter trial was carried out on 100 patients with benign prostatic hypertrophy to elucidate the efficacy of anti-androgen therapy with allylestrenol (AE). AE was administered at a daily dose of 50 mg for 16 weeks to the patients and its efficacy was evaluated with subjective symptom scores, residual urine volume and uroflow rates. The effects of AE on prostatic volume and morphology were evaluated using transrectal ultrasound. Of these patients 65 completed the protocol, and only three patients withdrew from the study owing to side effects. Very modest adverse effects on sexual performance were seen in one patient. In this study, significant beneficial effects of AE on symptom scores, residual urine, maximum flow rate, and prostate size were demonstrated. However, volumetric reduction was not associated with urodynamic improvement. Prostatic shape was not changed throughout the study. These findings suggest that allylestrenol can be used as an alternative to prostatectomy in patients who are at high risk for surgery.

[Antiandrogen therapy of benign prostatic hyperplasia--review of the agents evaluation of the clinical results].

Various non-surgical therapeutic modalities such as balloon dilation of the prostatic urethra, hyperthermia of the prostate and medication with antiandrogens and/or adrenergic blockade have been attempted for the patients with benign prostatic hyperplasia (BPH) especially in an early stage or in a poor operative risk. The observation that androgen deprivation induces shrinkage of the hyperplastic prostate represents the basis for the treatment of BPH with antiandrogen. Although several antiandrogens are now in clinical use in our country, there still remain problems to be solved. We reviewed the mechanism of action and the clinical results of antiandrogens in the treatment of BPH. The improvement following antiandrogen therapy occurred among the patients with symptomatic BPH, in 50-80% subjectively and in 40-50% objectively. The therapy appeared to be more effective in an early stage of the disease. However, the limitation of the duration of the effects and unfavorable side effects should also be noticed. The progestational agents such as gestonorone caproate, chlormadinone acetate and allylestrenol suppress more or less sexual function by interference of the pituitary-gonadal axis. Besides, coincidental prostate cancer must be excluded since antiandrogen therapy might hinder the natural course of the cancer.

[Clinical results and problems of anti-androgen therapy of benign prostatic hypertrophy].

We evaluated the effect of anti-androgen therapy for benign prostatic hypertrophy. Patients showed a significant reduction in the prostatic weight measured by means of transrectal ultrasonography after 3 to 4 months of treatment. However, there were no patients who showed any symptomatic improvement despite a reduction in the prostatic weight. They had prostatic stones more frequently than the group who showed symptomatic improvement properly. We summarized some problems of anti-androgen therapy for benign prostatic hypertrophy.

[Effects of drugs used in high-risk pregnancy on child development]. / Wplyw leków stosowanych u kobiet w ciazy ryzyka na dalszy rozwój dzieci.

The study involved 60 children delivered by the mothers of risk group who were given gestagens and beta-adrenomimetics during pregnancy. Physical, motoric development and morbidity in this group of children with particular relation to respiratory diseases were subject to our study. Thirty eight children delivered by healthy mothers were used as a control group. It was found that there was no developmental abnormalities in children from pregnancies maintained with gestagens and beta-adrenomimetics. Morbidity rate was the same in the tested and control groups.

[Effects of anti-androgens on sexual function. Double-blind comparative studies on allylestrenol and chlormadinone acetate Part I: Nocturnal penile tumescence monitoring].

Allylestrenol (ALE) and chlormadinone acetate (CMA) were administered to patients with prostatomegaly by the double-blind method, and the effects of these antiandrogens on their sexual function were objectively compared. Each agent was orally administered to 58 patients in a dosage of 50 mg/day for 12 consecutive weeks. For the objective evaluation of the sexual function, nocturnal penil tumescence (NPT) was measured using an erectometer. For the subjective evaluation the conventional interview method was employed. The levels of hormones relating to sexual function were also determined. A decrease in NPT was noted in both the ALE and CMA groups, but the degree of the decrease was significantly smaller in the ALE group than in the CMA group (p less than 0.001). The results of the interview, revealed a large between the two drug groups; in the CMA group, marked worsening for all items. In the determination of hormones, levels of luteinizing hormone, follicle stimulating hormone, testosterone and estradiol were decreased in both drug groups, while the prolactin level was increased in both groups. The changes in the testosterone, estradiol and prolactin levels in the CMA group were significantly dominant compared with those in the ALE group. In addition, drop-out cases due to a decrease in the sexual function numbered 7 (12.1%) in the CMA group, while there were no such drop-out cases in the ALE group; the difference in the drop-out rate was thus significant. In conclusion, ALE's effects on the sexual function were concluded to be smaller than those of CMA.

[Effects of anti-androgens on sexual function. Double-blind comparative studies on allylestrenol and chlormadinone acetate. Part II: Self-assessment questionnaire method].

Allylestrenol (ALE) and chlormadinone acetate (CMA) were administered to patients with prostatomegaly by the double-blind method, and a self-assessment questionnaire method developed by the authors was used to study the influence of these two antiandrogens on their sexual function. Each test drug was orally administered to 58 patients, in a daily dosage of 50 mg for 12 consecutive weeks. The questionnaires consisted of 6 categories each consisting of 5 questions, or 30 questions in total. The 6 categories were "sexual desire," "erectile capacity" and "ejaculation," which relate to the sexual function, and "living environment (including the frequency of sex)," "dysuria" and "dummy (personality)." Each question was graded into 0-10 points, and each patient was requested to circle the number which best described his status. The scores were compiled and statistically analyzed. Many patients were senile. Evaluable answers were obtained for 99 (85.3%) of the 116 patients. Factor analysis based on the preadministration scores confirmed the contents of the questionnaires to be appropriate for the objectives of the present study. Multiple regression analysis revealed a high correlation between the self-assessment scores and objective data (nocturnal penile tumescence values; NPT values) when dropout cases due to a decrease in the sexual function and non-replying cases were excluded. The self-assessment questionnaire method was concluded to be as useful an objective test method as the NPT measurement for examining the sexual function. Aggravation of the "frequency of urination during night" was conspicuous in the CMA group, and there was a significant difference (p less than 0.05) in this parameter between the two groups. Except for this parameter, dysuria was improved in both administration groups, and there was no significant difference in the efficacy of the two drugs. Both drugs tended to suppress overall sexual function, but the suppression was less severe in the ALE group. Especially the suppression was significantly (p less than 0.05) lower in the ALE group regarding the 3 parameters of "contact sexual arousal," "contact erection" and "morning erection", which are included in the category of "sexual desire" or "erectile capacity." Also, suppression of "frequency of sex" and "intensity of sexual desire" tended to be lower in the ALE group at a level of significance of p less than 0.1. Regarding questions in the category of "ejaculation," the incidence of non-replies was high in both groups, but its rate was higher in the CMA group.

The effect of estradiol valerate and allylestrenol on endometrial transformation in hypergonadotropic hypogonadic women.

The effect of estradiol valerate and allylestrenol on the endometrial transformation of five hypergonadotropic hypogonadic women was evaluated. Estradiol valerate was administered throughout the whole induced cycle (28 days), while allylestrenol was added during the second half of the cycle. Endometrial biopsies were performed during allylestrenol treatment and were evaluated histologically. Samples of endometrium were also subjected to one-dimensional SDS electrophoresis. Of ten biopsies performed, only one was interpreted to be in-phase, while the others were dated proliferative (4 biopsies) or showed abortive or out-of-phase secretory transformation. The highest mean serum progesterone level, detected under allylestrenol treatment, was 1.5 ng/ml. Protein electrophoresis demonstrated relative sequential changes in the protein patterns of the 115 kDa and 150 kDa protein bands. It is concluded that allylestrenol, although having gestagen properties, may not be efficient for the induction of an adequate secretory transformation of human endometrium in the absence of ovaries.

[Prenatal diagnosis and treatment of intrauterine growth retardation].

A diagnosis of intrauterine growth retardation (IUGR) was made in 150 pregnancies on the basis that the estimated fetal body weight was less than -1.5 SD of the intrauterine growth curve for the Japanese population in two consecutive measurements. The estimation of fetal body weight was made from the biparietal diameter and abdominal circumference using the formula of Shepard et al. Maternal plasma estriol, urinary estriol and plasma hPL were determined, and routine instructions to take daytime bedrest and a high protein diet were made. 75 optionally selected cases were given oral allylestrenol 30 mg/day until the time of delivery (the medicated group), and the other 75 cases (control group) were given no medication. Ultrasonic and biochemical measurements were repeated every two weeks thereafter. The estimated fetal weight calculated from Shepard's formula was of sufficient accuracy to make it possible to predict the fetal weight before delivery. In the control group, the estimated fetal weight averaged 1,281 grams at the initial measurements at an average of 32.7 weeks' gestation when the diagnosis of IUGR was made, and 2,498 grams at the final measurements at an average of 38.7 weeks gestation immediately before delivery. In the medicated group, the estimated fetal weight averaged 1,242 grams at the initial measurements at 32.8 weeks' gestation, and 2,826 grams at the final measurements at 39.0 weeks' gestation. Statistically significant increases in the fetal body weight were noted in the medicated group. Maternal plasma estriol, urinary estriol and plasma hPL concentrations rose significantly in the medicated group when compared with the control group.(ABSTRACT TRUNCATED AT 250 WORDS)