Prostate

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This site is extensive and patient orientated - set up by someone with cancer I think. You'll hear from doctors and patients. Bundles of articles and links. Great place to start. To get to site click on image above.

A pile of guidelines from NZGG

NZGG


Population Screening for Colorectal Cancer


Prostate Cancer Screening in New Zealand


A Guideline for the Management of Heart Failure: health professionals guide


Assessment and Management of Cardiovascular Risk


New Zealand Cardiovascular Guidelines Handbook: Developed for Primary Care Practitioners


The Management of People with Atrial Fibrillation and Flutter


Management of Type 2 Diabetes



Guidelines for the Management of Heavy Menstrual Bleeding


Management of Dyspepsia and Heartburn


Depression: information for health practitioners


Guidelines for Medical Practitioners Using Sections 110 and 110A of the Mental Health (Compulsory Assessment and Treatment) Act 1992


Guidelines for the Use of Acetylcholinesterase Inhibitor Drugs in the Treatment of People with Alzheimer's Disease


Diagnosis and Management of Soft Tissue Knee Injuries: Internal Derangements


Diagnosis and Management of Soft Tissue Shoulder Injuries and Related Disorders


New Zealand Acute Low Back Pain Guide, incorporating the Guide to Assessing Psychosocial Yellow Flags in Acute Low Back Pain

Analysis of Chronic Fatigue Syndrome Guidelines

Traumatic Brain Injury: Diagnosis, Acute Management and Rehabilitation

Diagnosis and Treatment of Adult Asthma

Management of Asthma in Children aged 1-15 years

The COPD-X Plan: Australian and New Zealand Guidelines for the management of Chronic Obstructive Pulmonary Disease 2006

Guidelines for the Management of Genital Herpes in New Zealand

Hormone Replacement Therapy

How come these have come out black

clozapine

Clozapine and myocarditis

Clozapine, marketed in Australia since 1993, is an effective antipsychotic for the management of treatment-resistant schizophrenia. All patients taking clozapine are enrolled in a registry and monitored regularly, primarily to detect the development of neutropenia and agranulocytosis.

A range of cardiac disorders has been associated with the use of clozapine, the most serious being myocarditis and cardiomyopathy. A boxed warning alerting prescribers to these reactions is included in the Product Information for clozapine.

Viagra

Sildenafil (Viagra®)

Pharmacology: Sildenafil facilitates erections associated with sexual stimulation. It will not act if the man is not sufficiently mentally aroused or his peripheral autonomic nerves are absent (e.g. radical prostatectomy). It acts by inhibiting phosphodiesterase isoenzyme 5 (PDE5), thus prolonging cyclic guanosine monophosphate (cGMP) activity in erectile tissue, and enhancing the vasodilating actions of nitric oxide, which is released in response to sexual stimulation.⁵ Sildenafil is rapidly absorbed from the gut peaking 30-120 min. after an oral dose. At peak effect it lowers mean systolic supine blood pressure (8 mmHg) in healthy volunteers. The drug is eliminated by liver metabolism (CYP3A4) with a half-life of 3-5 hours. Half-life is prolonged in patients > 65 years and in patients with renal or hepatic impairment.

Effectiveness: Six randomized, double-blind, clinical trials comparing sildenafil versus placebo were published prior to June, 1999.^6-10 Each trial enrolled between 12 and 532 patients over a duration of 2 to 24 weeks. In the best designed trial of 329 patients over 12 weeks, intercourse was reported successful in 59% of patients taking sildenafil as compared to 15% of patients taking placebo (absolute benefit increase 44%, NNT = 2 to achieve one success).⁶

Adverse effects: The most common adverse effects, as absolute risk increase over placebo, were headache 14%, flushing 17%, dyspepsia 4%, rhinitis 4% and visual disturbance 1%.⁷ None of the studies assessed the effects of long-term sildenafil use. Such studies are needed, particularly in patients with a history of retinal and cardiovascular disorders.

Serious rare side effects include priapism, severe hypotension, heart attack, stroke and death.

Contraindications: Patients taking or at risk of requiring nitrates in any form. Patients in whom sexual activity is inadvisable because of their cardiovascular status (e.g. MI or CVA within 6 months, heart failure, unstable angina, hypotension, uncontrolled hypertension, aortic stenosis, etc.). Patients with retinitis pigmentosa, anatomical deformities of the penis, conditions predisposing to priapism (e.g. sickle cell anemia, multiple myeloma), or receiving multiple antihypertensive drugs.

Precautions: There is no safety information on patients excluded from the trials (e.g. patients with alcoholism, active peptic ulcer, proliferative diabetic retinopathy, etc.). Inhibitors of CYP3A4 such as erythromycin, ketoconazole, grapefruit juice and others would be expected to increase the magnitude and duration of response to sildenafil.

Dosage and cost: The drug should be taken on an empty stomach 1 hour before intended sexual activity and no more than once daily. Dose range 25-100 mg. As with most drugs start with the lowest dose, 25 mg, and increase only if necessary. Since the cost of each tablet is similar ($10 - $12), prescribing the higher dose tablets and dividing them can substantially reduce the cost.

overactive bladder

Treatments for

• Oxybutynin and tolterodine (all forms) have not been tested in randomized controlled trials (RCTs) beyond 12 weeks nor in elderly patients or those with serious co-morbidities.

• Oral anticholinergic formulations and regimens are equivalent in benefit; evidence for transdermal oxybutynin is less clear.

• Symptomatic benefit occurs in 60% of people with OAB treated with an anticholinergic drug versus 45% of people treated with placebo, ARR 15%, NNT 6 to 7.

• Anticholinergic side effects, particularly dry mouth, are frequent: ARI 22%, NNH 4 to 5.

• The benefit of anticholinergic drugs (0.6 less leakage episodes per day) must be weighed against the harm (3% of patients treated for 12 weeks experienced a serious adverse event).

Prostate enlarged

Benign Prostatic htpertrophy

• Alpha blockers improve symptoms on average by 2-3 points more than placebo (35 point AUAscale), a difference patients perceive as 'slight benefit'. Alpha blockers do not reduce complications, but increase dizziness, postural hypotension and asthenia (ARI 3-8%, NNH 13-33).

• 5-a-reductase inhibitors reduce acute urinary retention (ARR 2%, NNT 50), and BPH surgery (ARR 2-3%, NNT 33-50), but impair sexual function (ARI 3%, NNH 33).

• There is insufficient evidence that combining the two drug classes provides additional benefit.

• Most BPH trials do not report total serious adverse events and mortality. This prevents an assessment of the overall clinical impact of drug treatment.

Benign Prostatic Hypertrophy

Conclusion

Alpha blockers improve symptoms on average by 2-3 points more than placebo - a difference patients perceive as 'slight benefit'. Alpha blockers increase dizziness, postural hypotension and asthenia.)

5-a-reductase inhibitors reduce acute urinary retention (ARR 2%, NNT 50), and BPH surgery (ARR 2-3%, NNT 33-50), but impair sexual function (ARI 3%, NNH 33).

There is insufficient evidence that combining the two drug classes provides additional benefit.

Most BPH trials do not report total serious adverse events and mortality.

Saw palmetto

A new 1-year RCT comparing standardized doses (160 mg BID) with placebo showed no differences in symptom scores, urinary flow rates, quality of life measures, adverse effects or SAEs.35