Urology
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Long-term effects of finasteride in patients with benign prostatic hyperplasia: a double-blind, placebo-controlled, multicenter study. PROWESS Study Group.
To compare the long-term effects of finasteride (5 mg/day) and placebo in patients with moderate symptoms of benign prostatic hyperplasia (BPH). ⋯ Finasteride causes long-term symptomatic improvement and reduces the risk of acute urinary retention or surgery. Men with enlarged prostates benefit most from finasteride treatment.
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Kaiser Permanente in Northern California is a group model health maintenance organization (HMO) that contracts with The Permanente Medical Group, Inc. (TPMG) to provide care for health plan members. TPMG is the largest (for-profit) private group practice in the world, with 3600 physicians in Northern California, including 62 urologists, providing care to 2.5 million health plan members. Recent changes in health care financing and delivery mandate an HMO-physician relationship which addresses issues of cost, quality of care, and the needs of physicians.
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To reveal the possible relationship of urodynamic tests and transrectal sonography (TRS) of the prostate with bladder hypertrophy as evaluated by ultrasound-estimated bladder weight (UEBW) in men with lower urinary tract symptoms. ⋯ Postvoid residual urine and PCAR were useful parameters for the evaluation of the severity of BPH in terms of bladder hypertrophy probably due to infravesical obstruction.
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Comparative Study Clinical Trial
Stage T3 prostate cancer: a nonrandomized comparison between definitive irradiation and induction hormonal manipulation plus prostatectomy.
At our institution, a Phase II trial using androgen suppression followed by surgery was completed for men with Stage T3 disease and negative laparoscopic nodal dissection. We recently reported the unfavorable biochemical outcome of that experience. Because that analysis did not include a control group of irradiated patients, the current project was undertaken to compare that Phase II experience with clinical Stage T3 patients treated at our institution with definitive irradiation during an overlapping period of time. ⋯ The combination of induction hormonal treatment followed by radical prostatectomy offered no advantage over irradiation alone in this single institutional experience. Notwithstanding, the majority of men treated by definitive radiotherapy manifested biochemical failure. More innovative strategies such as conformal irradiation (either alone or combined with androgen ablation) and radiation dose escalation should be pursued to optimize outcome for this unfavorable group of patients.