title: Short-term pretreatment with a dual 5α-reductase inhibitor before bipolar transurethral resection of the prostate (B-TURP): evaluation of prostate vascularity and decreased surgical blood loss in large prostates.
abstract: OBJECTIVE
  To investigate if short-term treatment with dutasteride (8 weeks) before bipolar transurethral resection of the prostate (B-TURP) can reduce intraoperative bleeding, as dutasteride a dual 5α-reductase inhibitor (5-ARI) blocks the conversion of testosterone into its active form dihydrotestosterone (DHT), and reduces prostate volume and prostate-specific antigen (PSA) levels, while increasing urinary flow rate.
  
  
  METHODS
  In all, 259 patients were enrolled and randomised to two groups: Group A, receiving placebo and Group B, receiving dutasteride (0.5 mg daily for 8 weeks). Blood samples were taken before and after B-TURP for serum chemistry evaluation. In particular we evaluated blood parameters associated with blood loss [haemoglobin (Hb) and haematocrit (Ht)] and prostate vascularity [vascular endothelial growth factor (VEGF) immunoreactivity and microvessel density (MVD) using cluster of differentiation 34 (CD34) immunoreactivity].
  
  
  RESULTS
  Total testosterone, DHT, PSA level and prostate volume were evaluated and with the exception of DHT and PSA level there was no statistically significant differences between the groups. When comparing changes in Hb and Ht between Group A and Group B before and after B-TURP, there was a statistically significant difference only in patients with large prostates of ≥50 mL (ΔHb 3.86 vs 2.05 g/dL and ΔHt 4.98 vs 2.64%, in Groups A and B, respectively). There was no significant difference in MVD and VEGF index in prostates of <50 mL, conversely in large prostates the difference become statistically significant.
  
  
  CONCLUSIONS
  Dutasteride was able to reduce operative and perioperative bleeding only in patients with large prostates (≥50 mL) that underwent B-TURP. Our findings are confirmed by Hb and Ht values reported before and after the B-TURP and reductions in the molecular markers for VEGF and CD34 in the dutasteride-treated specimens.
authors.affiliation: Department of Gynecological-Obstetrics Sciences and Urological Sciences, Policlinico Umberto I Sapienza Rome University, Rome, Italy.
authors.forename: Gian Maria
authors.initials: GM
authors.lastname: Busetto
authors.affiliation: Department of Gynecological-Obstetrics Sciences and Urological Sciences, Policlinico Umberto I Sapienza Rome University, Rome, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Giovannone
authors.affiliation: Department of Gynecological-Obstetrics Sciences and Urological Sciences, Policlinico Umberto I Sapienza Rome University, Rome, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Antonini
authors.affiliation: Department of Pathology, Tor Vergata University, Rome, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Rossi
authors.affiliation: Department of Gynecological-Obstetrics Sciences and Urological Sciences, Policlinico Umberto I Sapienza Rome University, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Del Giudice
authors.affiliation: Department of Gynecological-Obstetrics Sciences and Urological Sciences, Policlinico Umberto I Sapienza Rome University, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Tricarico
authors.affiliation: Department of Gynecological-Obstetrics Sciences and Urological Sciences, Policlinico Umberto I Sapienza Rome University, Rome, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Ragonesi
authors.affiliation: Department of Gynecological-Obstetrics Sciences and Urological Sciences, Policlinico Umberto I Sapienza Rome University, Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Gentile
authors.affiliation: Department of Gynecological-Obstetrics Sciences and Urological Sciences, Policlinico Umberto I Sapienza Rome University, Rome, Italy.
authors.forename: Ettore
authors.initials: E
authors.lastname: De Berardinis
mesh_terms: D058891:5-alpha Reductase Inhibitors / Q000008:administration & dosage*; D000368:Aged; D000369:Aged, 80 and over; D001378:Azasteroids / Q000008:administration & dosage*; D015415:Biomarkers / Q000097:blood; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D013196:Dihydrotestosterone / Q000378:metabolism; D000068538:Dutasteride; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D011467:Prostate / Q000473:pathology* / Q000601:surgery; D017430:Prostate-Specific Antigen / Q000378:metabolism; D013739:Testosterone / Q000378:metabolism; D020728:Transurethral Resection of Prostate / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D058891:5-alpha Reductase Inhibitors; D001378:Azasteroids; D015415:Biomarkers; D013196:Dihydrotestosterone; D013739:Testosterone; D017430:Prostate-Specific Antigen; D000068538:Dutasteride
keywords: B-TURP; bleeding; dutasteride