Adding Cyclooxygenase-2 inhibitor to alpha blocker for patients with benign prostate hyperplasia and elevated serum prostate specific antigen could not improve prostate biopsy detection rate but improve lower urinary tract symptoms.
OBJECTIVE
To investigate the impact of cyclooxygenase-2 (COX-2) inhibitor with α-adrenoceptor blocker (α-blocker) for men with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) for detecting prostate cancer in men with elevated prostate specific antigen (PSA).


METHODS
Male patients with clinical BPH, elevated serum PSA (> 4 ng/ml), and significant LUTS (International Prostate Symptom Score [IPSS] ≥ 8) were randomly assigned to receive doxazosin 4 mg daily plus celecoxib 200 mg daily (study group) or doxazosin 4 mg daily alone (control group) for 3 months. Patients were investigated for the changes in IPSS, maximum flow rate (Qmax), voided volume, postvoid residual (PVR) volume and serum PSA from baseline to 3 months after treatment. After the 3-month therapy, prostate biopsy was performed in the patients whose PSA were still higher than 4 ng/ml.


RESULTS
A total of 82 patients completed the study. The improvement in IPSS-voiding was significantly greater in the study group than control group (p = 0.034). In the study group, patients with prostatic hyperplasia or inflammation on the prostate biopsy had a significantly better result than in patients with prostatic adenocarcinoma, typically in the changes of Qmax and voided volume (p = 0.012 and p = 0.005, respectively). The PSA level in the study group showed significant improvement after treatment (p < 0.01). However, prostate cancer detection rate failed to show any significant difference between the patients whose PSA levels decreased or not (6/21 = 29% vs. 5/24 = 20%, respectively, p = 0.447).


CONCLUSIONS
Treatment with COX-2 inhibitor and α-blocker for 3 months could not improve prostatic cancer detection rate. But it could increase therapeutic effectiveness of LUTS in men with BPH and elevated PSA levels. The changes in Qmax and voided volume after combination treatment were significantly greater in patients with prostatic hyperplasia or inflammation than adenocarcinoma.
Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.
J-F
JF
Jhang
Y-H
YH
Jiang
H-C
HC
Kuo
D058668:Adrenergic alpha-1 Receptor Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D001706:Biopsy; D000068579:Celecoxib; D052246:Cyclooxygenase 2 Inhibitors / Q000627:therapeutic use*; D017292:Doxazosin / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000378:metabolism; D011470:Prostatic Hyperplasia / Q000188:drug therapy* / Q000473:pathology; D011720:Pyrazoles / Q000627:therapeutic use*; D013449:Sulfonamides / Q000627:therapeutic use*; D016896:Treatment Outcome; D014554:Urination / Q000187:drug effects
D058668:Adrenergic alpha-1 Receptor Antagonists; D052246:Cyclooxygenase 2 Inhibitors; D011720:Pyrazoles; D013449:Sulfonamides; D017430:Prostate-Specific Antigen; D000068579:Celecoxib; D017292:Doxazosin