Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan.
Int J Urol. 2013 Apr;20(4):421-8. doi: 10.1111/j.1442-2042.2012.03165.x. Epub 2012 Sep 19.
To comprehensively analyze the 5-year outcomes of tamsulosin treatment for patients with benign prostatic hyperplasia.
Tamsulosin (0.2 mg/day) was given to 112 patients who had International Prostate Symptom Scores ≥8. They were prospectively followed for 5 years with periodic evaluation. If tamsulosin had to be discontinued, the reason was determined. Treatment failure was considered in the case of disease progression (postvoid residual urine volume ≥200 mL, acute urinary retention, febrile urinary tract infection or hydronephrosis as a result of bladder outlet obstruction), conversion to other α1-blockers or need for surgery. An intention-to-treat analysis was carried out.
A total of 34 patients (30.4%) continued the same medication for the overall study period, whereas 78 patients (69.6%) discontinued the medication. International Prostate Symptom Scores, Benign Prostatic Hyperplasia Problem Index and Quality of Life Index were significantly improved over the 5-year period. Treatment failure was observed in 21 patients (18.8%). Baseline prostate volume and postvoid residual urine volume were independent factors to predicting treatment failure. A total of 21 patients (18.8%) discontinued tamsulosin because of an improvement of symptoms. They were younger and had lower prostate-specific antigen levels than the remaining 91 patients. Their symptoms were stable even 1 year after termination of therapy.
Long-term efficacy of tamsulosin was observed, although only a small portion of patients continued the treatment. α1-blocker monotherapy might be not appropriate for achieving a good long-term outcome in patients with a large prostate volume and a large amount of postvoid residual urine volume. Persistent improvement of symptoms, even after termination of tamsulosin, was observed in young patients with low prostate-specific antigen levels.
全面分析坦索罗辛治疗良性前列腺增生患者的 5 年疗效。
112 例国际前列腺症状评分≥8 分的患者接受坦索罗辛（0.2mg/天）治疗。前瞻性随访 5 年，定期评估。如果需要停用坦索罗辛，确定原因。如果出现疾病进展（残余尿量≥200ml、急性尿潴留、发热性尿路感染或膀胱出口梗阻导致肾积水）、转为其他α1 受体阻滞剂或需要手术，则认为治疗失败。采用意向治疗分析。
共有 34 例（30.4%）患者在整个研究期间继续使用相同的药物，78 例（69.6%）患者停止用药。5 年内国际前列腺症状评分、良性前列腺增生问题指数和生活质量指数均显著改善。21 例（18.8%）患者出现治疗失败。基线前列腺体积和残余尿量是预测治疗失败的独立因素。共有 21 例（18.8%）患者因症状改善而停止使用坦索罗辛。他们比其余 91 例患者更年轻，前列腺特异性抗原水平更低。停药 1 年后，他们的症状仍然稳定。
尽管只有一小部分患者继续治疗，但仍观察到坦索罗辛的长期疗效。α1 受体阻滞剂单药治疗可能不适合治疗前列腺体积大、残余尿量多的患者，获得良好的长期疗效。对于前列腺特异性抗原水平低、症状持续改善的年轻患者，即使停药后也可观察到症状改善。
