Disorder In Elderly Men Research Articles

The impact of nine sweeps on preventing prostate cancer and benign prostate hyperplasia

AbstractBenign prostatic hyperplasia (BPH), often known as prostate gland enlargement, is a common disorder in elderly men. The nine sweeps or Istibra, a traditional Islamic habit, has been hypothesized to decrease the risk of prostate diseases. This study aims to investigate the potential preventive effects of Istibra on prostate cancer and BPH among individuals with a positive family history. It is a retrospective cohort study conducted among 215 high‐risk people for prostate cancer with positive family history who have been on regular habits of using the nine sweeps (Istibra) for 20 years or more. The data was collected retrospectively and full history was taken from each of the patients. Odds ratios were calculated to evaluate the relationship between Istibra usage and prostate pathologies. The majority of participants had no chronic diseases or exposure to known carcinogens. Most individuals performed Istibra 5–10 times per day for 20 years or more. Despite positive family histories, 82% and 85% of participants were not diagnosed with BPH or prostate cancer, respectively. Istibra may be effective in preventing BPH and prostate cancer among individuals with positive family histories. Further studies with larger samples are warranted to confirm these findings and elucidate the mechanism of action.

Mosaic loss of the Y chromosome and men's health.

BackgroundAlthough Y chromosomal genes are involved in male sex development, spermatogenesis, and height growth, these genes play no role in the survival or mitosis of somatic cells. Therefore, somatic cells lacking the Y chromosome can stay and proliferate in the body.MethodsSeveral molecular technologies, including next‐generation sequencing and multiplex PCR‐based assays, are used to detect mosaic loss of the Y chromosome (mLOY) in the blood of men.Main findingsAccumulating evidence suggests that mLOY represents the most common acquired chromosomal alteration in humans, affecting >40% of men over 70 years of age. Advanced age, tobacco smoking, and some SNPs in cell cycle genes are known to increase the frequency of mLOY. The developmental process of mLOY in elderly men remains to be clarified, but it possibly reflects recurrent mitotic elimination of Y chromosomes or clonal expansion of 45,X cell lineages. In rare cases, mLOY also occurs in young men and fetuses. MLOY has been associated with early death, cancers, and other disorders in elderly men, infertility in reproductive‐aged men, and developmental defects in children.ConclusionY chromosomes in men can be lost at every life stage and Y chromosomal loss is associated with various health problems.

The modulatory effects of cinnamaldehyde on uric acid level and IL-6/JAK1/STAT3 signaling as a promising therapeutic strategy against benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) is a widespread disorder in elderly men. Cinnamaldehyde, which is a major constituent in the essential oil of cinnamon, has been previously reported to reduce xanthine oxidase activity, in addition to its anti-inflammatory, anti-oxidant, and anti-proliferative activities. Our study was designed to investigate the potential modulatory effects of cinnamaldehyde on testosterone model of BPH in rats through reduction of uric acid level, and suppression of IL-6/JAK1/STAT3 signaling pathway. Cinnamaldehyde (40 and 75 mg/kg) was orally administered to male Wistar rats for 3 weeks, and concurrently with testosterone (3 mg/kg, s.c.) from the second week. Cinnamaldehyde ameliorated the elevation in prostatic weight and index compared to rats treated with testosterone only, that was also confirmed by alleviation of histopathological changes in prostate architecture. The protective mechanisms of cinnamaldehyde were elucidated through inhibition of xanthine oxidase activity and reduced uric acid level. That was accompanied by reduction of the pro-inflammatory cytokines; interleukin-6 (IL-6), IL-1β, tumor necrosis factor-alpha (TNF-α), and the nuclear translocation of the transcription factor NF-κB p65, that could be attributed also to the enhanced anti-oxidant defense by cinnamaldehyde. The protein expression of JAK1, which is IL-6 receptor linked protein, was reduced with subsequently reduced activation of STAT3 protein. That eventually suppressed the formation of the proliferation protein cyclin D1, while elevated Bax/Bcl2 ratio. It can be concluded that reducing uric acid level through xanthine oxidase inhibition and suppression of the inflammatory signaling cascade; IL-6/JAK1/STAT3; by cinnamaldehyde could be a novel and promising therapeutic approach against BPH.

The application of High-Speed camera (HS), acoustic analysis and Voice Handicap Index (VHI) questionnaire in diagnosis of voice disorders in elderly men.

The process of ageing begins after 60 years of age and is referred to as presbyphonia (Vox senium). The causes include functional or organic voice disorders, often coexisting with dry upper respiratory tract infection. The aim of the study is the use of high-speed camera and acoustic voice analysis in diagnostics of the clinical form of presbyphonia. M aterials and methods: The study included a group of 50 men, non-smokers, age from 51 to 72, who do not use their voice professionally. High-Speed Digital Imaging and HS camera have been used, allowing evaluation of real vibrations of vocal folds, along with acoustic voice analysis using a software by DiagNova Technologies. VHI questionnaire has been used for self-assessment of voice disability. Visualizations of the larynx enabled recognition of hypofunctional dysphonia or atrophy of vocal folds that cause voice disorders. This was confirmed by parameters of voice acoustic evaluation: F0, NHR, narrowband spectrography. The pathological value of NHR and the presence of nonharmonic components in the range of high frequency levels indicated glottal insufficiency, recorded with the visualization technique of the larynx by HS camera. A significant shortening of maximum phonation time in relation to the control group has also been recorded. The objective examination of voice pathology is crucial in diagnosis and rehabilitation, however, subjective assessment of the patient is important in the scope of the procedure used. The patient's subjective self-rating assessment (VHI) confirmed the sense of voice disorders in elderly men, indicating the need for rapid and accurate clinical diagnosis.

Drug adherence and drug-related problems in pharmacotherapy for lower urinary tract symptoms related to benign prostatic hyperplasia.

Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) is one of the most common urinary disorders in elderly men. In recent years, pharmacotherapy of BPH has increased the efficacy, including combination treatment mostly with two drug classes, namely, 5-α-reductase inhibitors and α-1-adrenolytics (alpha blockers) with a different pharmacological activity. Although pharmacological treatment of BPH is a success story in urology, daily practice suggests that several medical needs remain unmet. We aimed to evaluate drug adherence in patients receiving pharmacological therapy to treat LUTS/BPH, and to analyze drug adherence among monotherapy and combination therapy. The sample population consisted of 758 men aged > 40 years who had been prescribed medications for LUTS/BPH during the index period between June 2015 and August 2016. Only alpha blockers and 5-α-reductase inhibitors (5ARIs) were considered in the analysis. Among ABs there were doxazosin, tamsulosin, alfuzosin, terazosin and among 5-α-reductase inhibitors it was only finasteride. Drug adherence was assessed in patients who were treated for a minimum of 6 months. Two levels of exposure were evaluated, follow-ups: ≥ 6 months, and ≥ 12 months. In patients who were treated for at least 6 months, the drug adherence rate was 32% and the 12-month drug adherence rate was 23%. We observed an inverse relationship between drug adherence rates and the duration of treatment - longer the duration of pharmacological therapy, lower was the drug adherence rate noted. Our study shows a low rate of overall drug adherence in patients diagnosed with BPH. It was observed that a low adherence rate is closely related to drug-related problems (DRP). Furthermore, this is a correlation between the degree of LUTS/BPH and adherence rate - the higher degree of LUTS/BPH, the higher adherence rate. Further studies are warranted focusing on assessing adherence to pharmacological therapy.

Musulju improves benign prostatic hyperplasia by regulating inflammatory and apoptotic proteins.

Alternative medicine is a widely accepted therapeutic approach for the management of various diseases. The Korean medicine, musulju (MSJ), has been traditionally used to improve vital energy in men with reduced physical strength and a weakened urinary system. The present study determined the mechanisms underlying the protective effect of MSJ against benign prostatic hyperplasia (BPH), a common disorder in elderly men that involves inflammation-mediated imbalance between cell proliferation and death. MSJ treatment was demonstrated to decrease prostate weight, cell proliferation, and the protein expression of proliferating cell nuclear antigen in a rat model of BPH. In addition, MSJ markedly reduced serum testosterone levels, 5α-reductase2 mRNA expression and BPH-associated upregulation of inflammatory proteins, inducible nitric oxide synthase and cyclooxygenase 2. Furthermore, MSJ induced apoptosis by regulating B-cell lymphoma (Bcl)-2 protein expression and the Bcl-2:Bax ratio, leading to caspase 3 activation. Taken together, MSJ demonstrated antiproliferative effects in BPH model rats by regulating the expression levels of proteins involved in inflammation and apoptosis. The effects of MSJ may be attributed to its alternative therapeutic properties.

Rice Hull Extract Suppresses Benign Prostate Hyperplasia by Decreasing Inflammation and Regulating Cell Proliferation in Rats.

Even though rice hull has various physiological functions with high antioxidant potential, the molecular mechanism(s) underlying the effects of rice hull on benign prostatic hyperplasia (BPH) have not been evaluated. The aim of this study was to determine the protective effect of rice hull water extract (RHE) against BPH, which is a common disorder in elderly men and involves inflammation that induces an imbalance between cell proliferation and cell death. In this study, RHE-treated mice exhibited lower prostate weights and ratios of prostate weight to body weight compared to those for the BPH-induced group. In addition, RHE-treated mice had lower serum levels of dihydrotestosterone, mRNA expression of 5α-reductase2, and protein expressions of proliferating cell nuclear antigen (PCNA). Furthermore, RHE treatment significantly decreased cell proliferation by regulating the expression levels of inflammatory-related proteins (iNOS and COX-2) and apoptosis-associated proteins (Fas, FADD, procaspase-8, -3, and Bcl-2 family proteins). These results suggest that RHE could protect against the development of BPH through its anti-inflammatory and apoptotic properties and has good potential as a treatment for BPH.

Antiproliferative and Antioxidant Effects of Withania coagulans Extract on Benign Prostatic Hyperplasia in Rats

Background:Benign prostate hyperplasia (BPH) is a common urological disorder in elderly men. Phytotherapy is frequently used to alleviate the symptoms of this condition.Objectives:The present study investigated the effect of Withania coagulans extract (WCE), which is known to have antioxidant, anti-inflammatory, antihyperglycemic, and anti-cancer properties, on testosterone-induced BPH in rats.Materials and Methods:Forty Wistar rats were divided into five groups (each n = 8): the control group, the untreated BPH group, and three WCE-treated groups (WCE250, 500, and 1000). BPH was induced with 3 mg/kg subcutaneous injections of testosterone propionate for four weeks. WCE was concomitantly administrated by oral gavage. At the end of the induction schedule, the animals were sacrificed and their prostate glands were dissected, weighed, and fixed for histological examination (H&E and proliferating cell nuclear antigen [PCNA] staining). Half of each sample was prepared for measurement of malondialdehyde (MDA) and total antioxidant capacity (TAC) levels in the prostate.Results:The present study revealed that BPH caused elevation of MDA levels, suppression of TAC levels, and increased PCNA expression in the prostate gland. Interestingly, in a dose-dependent manner, WCE caused decreased MDA levels and increased TAC levels in the prostate gland, compared to the untreated BPH group. Histopathological examinations showed a reduction in PCNA expression in the prostate epithelium of the WCE animals.Conclusions:W. coagulans inhibits the development of BPH can be useful for the treatment of this condition.

Evaluation of the clinical indications, adverse drug reactions, and finasteride use in patients with benign prostatic hyperplasia in Poland

BackgroundBenign prostatic hyperplasia (LUTS/BPH) is one of the most common urinary disorders in elderly men. The symptoms of the disease include prostate gland enlargement, bladder outlet obstruction, and lower urinary tract symptoms (LUTSs). BPH predisposes patients to bladder infections and bladder stone formation and increases their risk of urinary retention, which in turn causes renal failure. Hence, the disease requires surgical treatment. However, over the recent years, the number of surgical interventions performed in pharmacotherapy has significantly reduced because of the increased efficacy of conservative therapy, including combination treatment mostly with 2 groups of drugs, namely, alpha-1-adrenolitics and other 5-alpha-reductase blockers, with a different pharmacological activity [5].The aim of this study was to evaluate the clinical indications, adverse drug reactions, and finasteride use in patients with diagnosed BPH in Poland. Materials and methodsWe conducted a clinical trial from November 2009 to November 2010 that included 5751 patients who were enrolled in 46 urological centres in Poland. The researchers who conducted the clinical trial were urologists from different regions of Poland. The clinical trial involved 6 follow-up visits. The mean age of the patients was 67 years (range, 45–93 years; median, 67.00; SD, 8.507). The inclusion criteria were as follows: LUTSs, finasteride therapy for at least 2 weeks, age>40 years, and BPH. ResultsPatients self-reported data on LUTSs, the symptom frequency, concurrent diseases, and intensification of urinary system symptoms. In addition, additional examinations were performed, including prostate-specific antigen test, urinary tract ultrasonography with evaluation of residual urine and prostate, and uroflowmetry. The study did not exclude data on the combined treatment with finasteride and alpha-1-adrenolitics. ConclusionFinasteride was demonstrated to be effective, as evidenced by the significant decrease in TPV by 40% even after 12 months. It was also found to contribute to the attenuation of LUTSs, improvement in maximum flow rate, decrease in nocturia, and improvement in QoL.

Prevalence and Burden of Gait Disorders in Elderly Men and Women Aged 60–97 Years: A Population-Based Study

BackgroundAlthough gait disorders are common in the elderly, the prevalence and overall burden of these disorders in the general community is not well defined.MethodsIn a cross-sectional investigation of the population-based Bruneck Study cohort, 488 community-residing elderly aged 60–97 years underwent a thorough neurological assessment including a standardized gait evaluation. Gait disorders were classified according to an accepted scheme and their associations to falls, neuropsychological measures, and quality of life were explored.ResultsOverall, 32.2% (95% confidence interval [CI] 28.2%–36.4%) of participants presented with impaired gait. Prevalence increased with age (p<0.001), but 38.3% (95%CI 30.1%–47.3%) of the subjects aged 80 years or older still had a normally preserved gait. A total of 24.0% (95%CI 20.4%–28.0%) manifested neurological gait disorders, 17.4% (14.3%–21.0%) non-neurological gait problems, and 9.2% (6.9%–12.1%) a combination of both. While there was no association of neurological gait disorders with gender, non-neurological gait disorders were more frequent in women (p = 0.012). Within the group of neurological gait disorders 69.2% (95%CI 60.3%–76.9%) had a single distinct entity and 30.8% (23.1%–39.7%) had multiple neurological causes for gait impairment. Gait disorders had a significant negative impact on quantitative gait measures, but only neurological gait disorders were associated with recurrent falls (odds ratio 3.3; 95%CI 1.4–7.5; p = 0.005 for single and 7.1; 2.7–18.7; p<0.001 for multiple neurological gait disorders). Finally, we detected a significant association of gait disorders, in particular neurological gait disorders, with depressed mood, cognitive dysfunction, and compromised quality of life.ConclusionsGait disorders are common in the general elderly population and are associated with reduced mobility. Neurological gait disorders in particular are associated with recurrent falls, lower cognitive function, depressed mood, and diminished quality of life.

Finasterid in der Behandlung der benignen Prostatahyperplasie

Benign prostatic hyperplasia (BPH) is one of the most common urinary disorders in elderly men. The symptoms of this disease are increased prostate size, bladder outlet obstruction and lower urinary tract disorders. It influences bladder infections, bladder stone formation and increases the risk of urinary retention which can cause renal failure. It is necessary for the disease to be treated operatively. The number of conducted surgical interventions for pharmacotherapy has been significantly reduced in recent years due to increased efficacy in conservative therapy including combined treatment mostly with two groups of drugs: finasteride and alpha-blockers with different pharmacological activities. The aim of the study was to evaluate finasteride efficacy in the treatment of benign prostatic hyperplasia. The clinical trial was conducted from October 2008 to November 2009. According to the urologist's recommendation the patients took finasteride at a dose of 5 mg daily. A total of 4,315 patients participated in the clinical trial and were enrolled in 50 urological centres in Poland. The average age of the patients was 66.5 years, the youngest patient was 46 and the oldest was 91 (median 67.00 years, standard deviation SD±8.101). The use of finasteride at least for 2 weeks was the criterion for the patient to be included in the study. The medical trial lasted 12 months and consisted of 6 visits at which data relating to IPSS, QoL, intensification of urinary system symptoms, the results of the additional studies, PSA serum concentrations, the urinary tract USG with evaluation of residual urine and prostate, urine analysis with evaluation of crystalline, uroflowmetry, transrectal ultrasonography (TRUS) and biopsy were recorded. The study did not exclude the combined treatment with finasteride and alpha-adrenergic blocking drugs. Prostatocystitis was diagnosed in 30 men among the patients treated at the first visit after the digital rectal examination (DRE) trial and they qualified for antibiotic therapy. Suspicion of a tumor was diagnosed in 69 (1.59 %) patients of the study group at the first visit after the DRE trial and they qualified for biopsy of the prostate after the PSA trial and TRUS at the second visit. Therefore, 4,216 patients took part in the clinical trial. In the course of 12 months 392 patients were excuded from the study for different reasons: cardiac infarct, apoplexy, resignation without reason and change of address. According to the IPSS scale (International Prostate Symptom Score) a small intensification of symptoms was diagnosed in 676 patients (16%), in 2,830 patients (67%) moderate and in 718 patients (17 %) considerable. Prostate cancer was confirmed histopathologically in 50 (1.15%) out of 69 patients who qualified for biopsy of the prostate. In 2,677 (70%) patients taking both alpha-blocker and finasteride, the progression of disease reduced, the micturation improved considerably and the mass of adenoma of the prostate diminished by 40%. However, in 956 (25%) patients taking only finasteride or finasteride + phytotherapy the mass of adenoma of the prostate diminished by 40%, too. When the medical trial was finished, 212 patients (5.02 %) of the study group who showed intensive symptoms of BPH and the finasteride and alfa-blocker treatment proved not to be effective enough qualified for surgical therapy. A total of 3,824 out of 4,216 (90.7%) patients finished the medical trial and 3,612 (85.6 %) were willing to continue the further therapy.

Metabolic assessment of elderly men with urolithiasis

OBJECTIVE:To assess the presence of metabolic disorders in elderly men with urolithiasis.METHODS:We performed a case-control study. The inclusion criteria were as follows: (1) men older than 60 years of age and either (2) antecedent renal colic or an incidental diagnosis of urinary lithiasis after age 60 (case arm) or (3) no antecedent renal colic or incidental diagnosis of urolithiasis (control arm). Each individual underwent an interview, and those who were selected underwent all clinical protocol examinations: serum levels of total and ionized calcium, uric acid, phosphorus, glucose, urea, creatinine and parathyroid hormone, urine culture, and analysis of 24-hour urine samples (levels of calcium, citrate, creatinine, uric acid and sodium, pH and urine volume). Each case arm patient underwent two complete metabolic urinary investigations, whereas each control arm individual underwent one examination. ClinicalTrials.gov: NCT01246531.RESULTS:A total of 51 subjects completed the clinical investigation: 25 in the case arm and 26 in the control arm. In total, 56% of the case arm patients had hypocitraturia (vs. 15.4% in the control arm; p = 0.002). Hypernatriuria was detected in 64% of the case arm patients and in 30.8% of the controls (p = 0.017).CONCLUSION:Hypocitraturia and hypernatriuria are the main metabolic disorders in elderly men with urolithiasis.

Comparison of Murraya koenigii– and Tribulus terrestris–Based Oral Formulation Versus Tamsulosin in the Treatment of Benign Prostatic Hyperplasia in Men Aged >50 Years: A Double-Blind, Double-Dummy, Randomized Controlled Trial

Background Drug treatment can defer surgical intervention in benign prostatic hyperplasia (BPH), a common disorder in elderly men, and is widely practiced. Various herbal formulations have been used for the treatment of BPH, but few have been compared with established modern medicines in head-to-head clinical trials. Objective We compared the effectiveness and tolerability of an oral formulation, comprising standardized extracts of Murraya koenigii and Tribulus terrestris leaves being marketed in India under Ayurvedic license, versus tamsulosin in the treatment of symptomatic BPH. Methods A double-blind, double-dummy, parallel-group, randomized controlled trial was conducted with treatment-naive ambulatory patients with BPH aged >50 years. Patients received either the plant drug in a dose of 2 capsules BID or tamsulosin 400 μg once daily for 12 weeks with 2 interim follow-up visits at the end of 4 and 8 weeks. The double-dummy technique was used to ensure double-blinding. The primary effectiveness measure was reduction in the International Prostate Symptom Score (IPSS). Proportion of patients becoming completely or relatively symptom free (IPSS <8), change in prostate volume (assessed by using ultrasonography conducted by a radiologist blinded to the nature or duration of treatment), and peak urinary flow rate (assessed by using uroflowmetry) were secondary measures. Treatment-emergent adverse events, changes in weight, vital signs, and routine laboratory safety parameters were recorded. Results Forty-six patients were randomized (23 per group); 19 completed all study visits in the plant drug group and 21 in the tamsulosin group. However, applying modified intention-to-treat criterion, 23 and 21 patients, respectively, were considered for effectiveness analysis. Mean (SD) age and baseline weight were 58.5 (14.0) years and 57.5 (10.5) kg in the plant drug arm, and 62.9 (6.3) years and 59.8 (9.9) kg in the tamsulosin arm, respectively. Median (interquartile range) symptom duration was 12.0 (12.0–24.0) months and 15.0 (12.0–24.0) months, respectively, in the 2 arms. These differences were not statistically significant. IPSS (median [interquartile range]) declined from 17.0 (12.0–19.0) to 9.0 (5.0–13.0) with the plant drug and from 14.0 (11.0–18.0) to 8.0 (6.0–13.0) with tamsulosin after 12 weeks of treatment. The decline was individually significant in both groups (both, P < 0.001), but intergroup values showed no statistically significant difference at any point of time. IPSS <8 at study end was achieved by 10 and 7 patients, respectively, in the 2 arms ( P = 0.548). The plant drug reduced prostate volume from 33.5 (26.2–45.9) mL to 31.6 (26.1–37.5) mL ( P = 0.040). The corresponding reduction with tamsulosin, from 41.3 (29.4–51.3) mL to 39.9 (32.6–52.3) mL, was not statistically significant. Peak urinary flow rate did not change appreciably. Mild joint pain was the most common adverse event in both arms. No serious events were encountered. Compliance was satisfactory. Conclusions These findings suggest that the M koenigii– and T terrestris–based formulation significantly lowered IPSS scores in the initial treatment of symptomatic BPH. Further trials are needed to determine if the beneficial effect is sustained beyond the 12-week observation period of this trial.

Altered mode of allelic replication accompanied by aneuploidy in peripheral blood lymphocytes of prostate cancer patients.

Replication timing of the genetic material is a highly programmed process correlated with expression, stability and methylation capacity. An important aspect of that timing is the temporal order of allelic replication: a synchronous mode for biallelically expressed genes and an asynchronous for monoallelically expressed genes. Previous studies showed that malignancy is associated with changes in the inherent mode of allelic replication, and even normal cells of cancer patients display alterations in the replication of various genes. Using fluorescence in situ hybridization (FISH), we checked whether allelic-replication mode differentiates cancer patients from healthy individuals. We focused on prostate cancer (CAP), the most common diagnosed cancer and the second leading cause of cancer death in men over 50 years old. Five nonrelated genes and a nontranscribed DNA sequence associated with chromosomal segregation were used in our study. All 6 tested loci displayed in peripheral blood lymphocytes stimulated with phytohemagglutinin (PHA) of CAP patients loss of their inherent temporal order of allelic replication, coupled with aneuploidy, the outcome of chromosome malsegregation. The replication-timing modification is a reversible epigenetic alteration, evidenced by our ability to resurrect the normal pattern in all 6 tested loci by introducing an inhibitor of methyl transferase. On the other hand, the methylation-blocking agent failed to obliterate aneuploidy. The replication alteration accompanied by aneuploidy, detected in peripheral blood cells, distinguishes between CAP patients and individuals with benign prostate hyperplasia (BPH; a common disorder in elderly men) better than the routinely used blood marker, the prostate-specific antigen (PSA).

Alcohol dependence and misuse in elderly suicides.

To assess suicide risk associated with alcohol use disorder in elderly men and women, and to examine the role of social stressors in elderly suicides with and without alcohol use disorders. This retrospective case-control study included 85 suicide cases aged 65 years and above (46 men, 39 women) and 153 randomly selected population controls (84 men, 69 women). Interviews were carried out with control persons and with informants for the suicide cases. Mental disorders were diagnosed in accordance to DSM-IV. A history of alcohol dependence or misuse was observed in 35% of the elderly men who died by suicide and in 18% of the women. This disorder was uncommon among persons in the control group (2% of the men and 1% of the women). Alcohol use disorder remained an independent predictor of suicide risk in the regression models for both sexes. Among suicide cases, those with alcohol use disorders were younger and less likely to be suffering from severe physical illness (35 vs 63%) than those without this disorder. Alcohol use disorder is associated with suicide in elderly men and women. Prevention programmes need to target this important subgroup.

Terazosin. A pharmacoeconomic evaluation of its use in benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) is a common disorder in elderly men which carries a substantial economic burden. Urinary symptoms associated with moderate to severe disease can significantly interfere with daily activities and reduce quality of life. Obstruction of urine flow in men with BPH can result from nonmalignant enlargement of the prostate gland (static component of BPH) and from alpha 1 receptor-mediated increased smooth muscle tone of the bladder neck and prostate (dynamic component of BPH). Transurethral resection of the prostate (TURP) is generally very effective and has traditionally been the standard treatment for men with moderate to severe BPH. However, response to therapy with TURP is not universal and the procedure is associated with a number of potential complications. Moreover, many men prefer to avoid or are not suitable candidates for this invasive procedure. Thus, there is an increasing role for less invasive treatment, including drug therapy, in men with moderate to severe BPH. Terazosin is an alpha 1 receptor antagonist which has been shown in placebo-controlled trials to significantly improve American Urology Association (AUA) symptom and quality-of-life scores and symptom problem index ('bother' score), as well as increase peak urinary flow rate, in men with BPH. In a recent large randomised US trial, treatment for 1 year with terazosin titrated to 10 mg/day improved mean AUA symptom score and peak urinary flow rate to a significantly greater extent than finasteride 5 mg/day in men with moderate to severe BPH. The most frequently reported adverse events associated with terazosin include dizziness, asthenia, postural hypotension, somnolence, headache, peripheral oedema, nasal congestion/rhinitis and syncope. Approximately 5% of men with BPH discontinue terazosin because of adverse events. Results of an economic evaluation of terazosin, in which both clinical and economic data were collected prospectively in a randomised placebo-controlled study design, showed similar total direct treatment costs per 1000 patients associated with 1 year of therapy with terazosin ($US3.57 million) and placebo ($US3.78 million) in men with moderate to severe BPH (1992 dollars). The analysis, which was conducted from the perspective of a managed care organisation in the US, demonstrated that the lower medication costs in the placebo group relative to the terazosin group were offset by increased inpatient care costs. Thus, terazosin (titrated to response up to a maximum of 10 mg/day) was significantly more effective than placebo in improving disease-specific symptoms and quality of life, but at a similar overall cost to placebo. Another economic analysis, also conducted from a third-party payer perspective in the US, modelled direct treatment costs associated with terazosin, finasteride and TURP during the first 2 years after initiating therapy in men with moderate to severe BPH. Results of the study favoured terazosin; the private insurance cost per patient undergoing primary treatment with TURP was $US6411, compared with $US2860 with finasteride (45% of the cost of TURP) and $US2422 with terazosin (38% of the cost of TURP). Medicare costs were lower for all 3 treatment groups but the relative comparisons were similar; corresponding costs per patient were $US3874, $US2161 and $US1820 (1992 dollars). A companion break-even cost analysis used a hypothetical cohort of men with BPH starting treatment at age 67 years. Private insurance costs associated with terazosin remained lower then those associated with TURP for approximately 15 years (the corresponding break-even point was 10 years for finasteride vs TRUP). Medicare costs associated with terazosin would not exceed those of TURP for approximately 7 years (5.5 years for finasteride vs TURP). In conclusion, a limited number of detailed pharmacoeconomic analysis of terazosin have been conducted to date, although it has not been compared with other a1 receptor antagonists.