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

Abstract

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). Male patients with clinical BPH, elevated serum PSA (> 4ng/ml), and significant LUTS (International Prostate Symptom Score [IPSS]≥8) were randomly assigned to receive doxazosin 4mg daily plus celecoxib 200mg daily (study group) or doxazosin 4mg daily alone (control group) for 3months. Patients were investigated for the changes in IPSS, maximum flow rate (Qmax), voided volume, postvoid residual (PVR) volume and serum PSA from baseline to 3months after treatment. After the 3-month therapy, prostate biopsy was performed in the patients whose PSA were still higher than 4ng/ml. 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). Treatment with COX-2 inhibitor and α-blocker for 3months 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.