Optimization of pharmacotherapy of patients with prostate adenoma with hormonal and metabolic disordes: correction of vitamin D deficiency with “Aquadetrim”

Oleg I Bratchikov,Igor A Tyuzikov,Sergey O Artishchev

doi:10.3897/rrpharmacology.5.49414

Oleg I Bratchikov, Igor A Tyuzikov + Show 1 more

Open Access

https://doi.org/10.3897/rrpharmacology.5.49414

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Abstract

Introduction: Modern studies demonstrate an epidemiological and pathogenetic role of systemic hormonal and metabolic disorders in men with prostate adenoma (PA), so it is obvious that a pharmacotherapeutic correction of these disorders can increase the efficacy of the traditional therapy of the disease. Aim of study: To investigate the frequency, relationships among themselves and with PA local parameters of key systemic hormonal and metabolic disorders (obesity, insulin resistance, testosterone deficiency, vitamin D deficiency) and to develop practical algorithms for optimizing diagnosis and management based on an integrative approach. Material and Methods: The results of a comprehensive examination of 160 patients with PA (main group; average age 62.3 ± 4.2 years) and 30 healthy men without PA of the same age (control group), including: collection of anamnesis and complaints; questionnaires; physical, hormonal and sonographic studies, – are presented. Pharmacotherapeutic correction methods were tested in some patients of the main group. The data was processed using descriptive and comparative statistics. Results and Discussion: In the patients with PA, a significantly higher frequency of concomitant systemic hormonal and metabolic disorders formed at a younger age was established, compared to the men without PA, and significantly worse local characteristics of PA compared to the patients with PA without such (p < 0.05). Reliable connections of some studied systemic hormonal and metabolic disorders with one another and with local parameters of PA (p < 0.05) were revealed. A more severe vitamin D deficiency in the patients with PA compared to the control group was revealed, and the safety and a significant positive effect of its drug compensation on the parameters of hormonal and metabolic status and PA in D-deficient men with PA were shown (p < 0.05). Conclusion: The results of the study confirm an important role of the studied systemic hormonal and metabolic disorders in the pathogenesis of PA and the need for their diagnosis and pharmacotherapeutic correction in all patients with PA on the basis of an integrative approach, according to the proposed algorithms.

Highlights

Modern studies demonstrate an epidemiological and pathogenetic role of systemic hormonal and metabolic disorders in men with prostate adenoma (PA), so it is obvious that a pharmacotherapeutic correction of these disorders can increase the efficacy of the traditional therapy of the disease
In the patients with PA, a significantly higher frequency of concomitant systemic hormonal and metabolic disorders formed at a younger age was established, compared to the men without PA, and significantly worse local characteristics of PA compared to the patients with PA without such (p < 0.05)
Despite the fact that in the main and control groups there were no significant differences between the absolute values of plasma glucose level, 30.0% of patients of the main group had a significantly higher average blood insulin level compared to that in the control group (p < 0.05), which allowed detecting the laboratory symptom of hyper-insulinemia in them, the most common in obesity (Fig. 1.) The frequency of clinical and laboratory signs of testosterone deficiency in patients with PA was 2 times significantly higher than that of men in the control group without PA (26.2% vs. 13.3%; p < 0.05) (Fig. 1.)

Summary

Introduction

Modern studies demonstrate an epidemiological and pathogenetic role of systemic hormonal and metabolic disorders in men with prostate adenoma (PA), so it is obvious that a pharmacotherapeutic correction of these disorders can increase the efficacy of the traditional therapy of the disease. The current standard pharmacotherapy of PA is often not effective enough for a number of patients, especially those with systemic hormonal and metabolic disorders (obesity, insulin resistance, testosterone deficiency, vitamin D deficiency), which tends to increase in frequency in the male population and significantly reliably correlate with one another, as well as with the frequency and severity of PA (Park et al 2008; Gorbachinsky et al 2010; Vignozzi et al 2012; Espinosa 2013; Tyuzikov and Kalinichenko 2016; Udensi and Tchounwou 2016; Wang et al 2016; Zou et al 2016; Ngai et al 2017) In this regard, new concepts of PA etiopathogenesis are being formed today from the standpoint of an integrative approach, which implies the most important role of the above-mentioned systemic disorders in the pathogenesis of hormonal and metabolic imbalance in the prostate gland, leading to PA and its further independent progression (the theory of cholesterol imbalance, the theory of subclinical chronic inflammation, the theory of oxidative stress, etc.), which reflects the modern evolution of classical theories of PA etiopathogenesis, many of which are hormonal by nature (the theory of androgen-estrogen imbalance, dihydrotestosterone theory, the theory of stromal-epithelial relationships) (Ruan et al 2011; Gacci et al 2015; Russo et al 2015; Tyuzikov et al 2015; Fu et al 2016; Zhao et al 2016a, b). In the Russian scientific literature, there is a clear shortage of scientific publications on this topic, which makes the relevance of this study obvious

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