Study of terazosin in the treatment of chronic prostatitis
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Date
2002
Authors
Phaik Yeong, Cheah
Journal Title
Journal ISSN
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Abstract
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is the most common form
of prostatitis but yet the least understood. There is at present, no evidence based
thl!rapeutic plan for the management of these patients. Hence, the present study aimed to
C\'aluate the efficacy terazosin, an Ill-blocker for treatment of CP/CPPS.
Prior to the above study, the National Institutes of Health - Chronic Prostatitis
Symptom Index (NIH-CPSl), a prostatitis specific index, recommended by the US
National Institutes of Health for research trials, was evaluated in the local population.
The NIH-CPSI was demonstrated to have satisfactory reliability and validity as an
outcome measure and hence found to be suitable for patient asse~sment in the terazosin
treatment study. The urodynamics equipment, Urodesk 300, on the other hand, was
validated for its within- and between-day precision and accuracy with respect to the
urinary flow rate and volume, together with pressure within the bladder, abdomen and
urethra. The urodynamics equipment was also demonstrated to give reliable outcome
measures.
In the next part of the study, the prevalence of CP/CPPS in Penang, Malaysia was
determined. Of the 3147 subjects surveyed, 8.7% were found to have CP/CPPS. In
'addition, thorough clinical evaluation of those found to have CP/CPPS confirmed that
75% of subjects who met the survey criteria also met clinical criteria for CP/CPPS. The
clinical evaluation, which included physical examination, ultrasound and urinalysis
found that 25% of the patients who met the survey criteria could be excluded due to
other urological conditions such as urinary stones and varicocele. The survey also
demonstrated that the prevalence of lower urinary tract symptoms was 8.0% in the
population studied.
To achieve a better understanding of this condition, the urodynamic profile ofCP/CPPS
patients was evaluated. A high proportion (41.2%) of CP/CPPS patients had various
bladder abnormalities, one each had bladder outlet obstruction and detrusor sphincter
pseudodyssynergia. Additionally, peak urinary flow rate was significantly lower while
post void residual urine volume was significantly higher than those of the control group.
An assay method for determining plasma terazosin levels was also developed and
subsequently a pharmacokinetic study of terazosin was conducted in the local
population.
In the final part of the study, a randomized double-blind placebo-controlled study was
conducted. A total of 100 CP/CPPS patients aged 20 to 50 years, were randomized to
receive either terazosin or placebo for 14 weeks. Treatment efficacy was assessed
primarily by the NIH-CPSI. Terazosin was found to reduce the NIH-CPSI total score
(57% reduction) significantly greater (p=O.Ol) than placebo (37% reduction). Ter~osin
was also effective in reducing the scores of the individual NIH-CPSI domains of pain,
urinary and quality of life impact as well as the IPSS score when compared to placebo.
Thus, the present study found that terazosin was more effective than placebo in the
treatment of patients with CP/CPPS.
Description
Keywords
Terazosin , Chronic prostatitis