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Other Medical
Options
1) Dutasteride
2) GraftCyte
3) Cloning Hair
1) Dutasteride
Dutasteride (Avodart®),
a second-generation
5 alpha-reductase
inhibitor, is the
first and only
medicine to inhibit
both the type 1 and
type 2 enzymes
responsible for the
conversion of
testosterone to DHT
(dihydrotestosterone)the
primary cause of
prostate growth.
Dutasteride's dual
inhibition decreases
levels of DHT by 90
percent at two weeks
and 93 percent at
two years.
By reducing DHT
levels, dutasteride
reduces the size of
an enlarged
prostate. This
reduction in
prostate volume was
seen as early as one
month with
reductions
continuing through
treatment. Shrinking
the enlarged
prostate relieves
urinary obstruction
and improves urinary
flow. Dutasteride
also improves
urinary symptoms and
reduces the risk of
AUR (the sudden
complete inability
to urinate) and BPH-related
surgery, two
potential long-term
serious consequences
of BPH. The pivotal
phase III study data
were published in
this month's edition
of the journal
Urology.1
"With dutasteride,
we now have a
medicine that
reduces the
production of DHT by
more than 90
percent, helping to
shrink the
prostate," said
Claus Roehrborn, MD,
a principal trial
investigator and
professor and
chairman of the
Department of
Urology at the
University of Texas
Southwestern Medical
Center in Dallas,
Texas. "By taking
dutasteride,
patients can improve
urinary symptoms and
reduce their risk of
suffering from acute
urinary retention -
where you suddenly
can't urinate at all
- or needing BPH-related
prostate surgery."
Dutasteride was
approved by the
Swedish regulatory
authority (MPA) on
July 24th 2002. It
will be marketed in
Sweden by the trade
name Avolve. The MPA
agreed to act as the
Reference Member
State for the Mutual
Recognition
procedure within
Europe and GSK plan
to market the drug
in all major
European markets
once approvals are
finalized during
2003. The European
trade name (Avolve)
is to be confirmed.
Background on BPH
BPH is one of the
most common health
problems in older
men.2 BPH often
begins after age 50
and can progress and
worsen as men age.
More than half of
men over age 60
experience BPH,3 and
by age 80, nearly 80
percent of men have
the disease.3,4 In
the United States
alone, 375,000
hospital stays each
year involve a
diagnosis of BPH.5
BPH is a progressive
disease in which the
prostate gland
surrounding the
urethra enlarges.6
As it grows, the
prostate obstructs
the urethra, the
tube through which
urine flows, causing
urinary
difficulties. BPH
symptoms interfere
with normal
activities and
reduce the sense of
well being.7
Symptoms of BPH
vary, but the most
common involve
urinary problems,
such as a hesitant,
interrupted weak
stream; urgency and
leaking or
dribbling; and more
frequent urination,
especially at
night.5 In severe
cases, the bladder
and the kidney may
become damaged.5
An enlarged prostate
can continue to
increase in size and
may in severe cases
lead to AUR and the
need for BPH-related
surgery.6 A
60-year-old man with
a 20-year life
expectancy has a 23
percent risk of
developing acute
urinary retention.8
Among men 60 years
or older, with
prostatic
enlargement and
obstructive
symptoms, the
20-year probability
of needing BPH-related
surgery is 39
percent.9
To diagnose BPH, a
physician will
discuss urinary
symptoms with a
patient and conduct
a digital rectal
exam. A physician
may also use a
simple blood test
that measures a
protein called
"prostate-specific
antigen," or PSA.
PSA is produced by
the prostate, and an
increase in levels
is associated with
prostate growth.6
While PSA is
primarily used as a
screening tool for
prostate cancer, it
can also be used to
determine prostate
enlargement.
Clinical Trial
Results
Dutasteride was
investigated in
three large,
well-controlled
multi-center studies
involving 4,325 men
aged 50 and above
with a serum PSA
level 1.5 ng/mL and
10 ng/mL, and BPH
diagnosed by medical
history and physical
examination,
including enlarged
prostate (greater
than or equal to 30
cc) and BPH symptoms
that were moderate
to severe according
to the American
Urological
Association Symptom
Index.
Data from these
two-year clinical
trials demonstrated
that treatment with
dutasteride (0.5 mg
once daily) reduced
the risk of both AUR
and BPH-related
surgical
intervention
relative to placebo,
improved BPH-related
symptoms, decreased
prostate volume, and
increased maximum
urinary flow rates.
Dutasteride should
not be used in women
and children. Women
who are pregnant or
may become pregnant
should not handle
dutasteride because
of possibility of
absorption of
dutasteride and
subsequent potential
risk to a male
fetus.
Men treated with
dutasteride should
not donate blood
until at least six
months after their
final dose to
prevent giving
dutasteride to a
pregnant woman
through a blood
transfusion. Men
with an allergic
reaction to
dutasteride or its
ingredients should
not take it. Men
with liver disease
should talk to their
doctor before taking
dutasteride.
Clinical trials of
dutasteride showed
that it was
generally well
tolerated. Most side
effects were mild or
moderate and
generally went away
while on treatment
in both the
dutasteride and
placebo groups.
Drug-related side
effects during the
first six months
were as follows:
impotence (4.7
percent vs. 1.7
percent for
placebo), decreased
libido (3 percent
vs. 1.4 percent),
breast tenderness
and breast
enlargement (gynecomastia;
0.5 percent vs. 0.2
percent) and
ejaculation
disorders (1.4
percent vs. 0.5
percent).
The incidence of
most drug-related
sexual adverse
events decreased
with duration of
treatment. The
incidence of
drug-related breast
tenderness and
breast enlargement
remained constant
over the treatment
period. Ejaculate
volume may be
decreased in some
patients with
continued treatment.
This decrease did
not appear to
interfere with
normal sexual
function.
Dutasteride will
reduce the amount of
PSA measured in the
blood. A physician
will be aware of
this effect and can
still use PSA to
detect prostate
cancer.
Although improvement
in urinary symptoms
was seen in some
patients by three
months, a
therapeutic trial of
at least six months
is usually necessary
to assess whether a
beneficial response
in symptom relief is
achieved with
dutasteride.
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2) GraftCyte
GraftCyte is a new
product containing
copper-peptide
manufactured by
ProCyte Corporation,
that has been shown
to facilitate wound
healing in well
controlled
scientific studies.
Our clinical
experience with
these products has
been the same.
We supply GraftCyte
shampoo to our
patients as part of
their routine
post-operative care.
In addition, our
patients have the
option of using a
more intensive 7-day
course with a
variety of products
containing
copper-peptide. We
do not routinely use
the 7-day course of
GraftCyte in our
practice since we
have found that
GraftCyte has not
offered any
significant benefit
in Follicular Unit
Transplantation
where the very small
wounds already
permit extremely
rapid healing.
There has been
speculation that
copper-peptide
solutions may also
hasten the growth of
newly transplanted
hair. This later
claim has not yet
been proven and, at
this point in time,
we do not prescribe
GraftCyte for this
purpose. We do,
however, strongly
recommend its use
for wound healing.
The following
copper-peptide
products are
recommended for
post-op care:
GraftCyte Moist
Dressing Packets,
GraftCyte
Post-surgical
Shampoo, GraftCyte
Post-surgical
Conditioner,
GraftCyte
Concentrated Spray,
and GraftCyte Iamin-hydrating
Gel.
The protocol that we
use at our clinic is
as follows:
Moist Dressings -7
foiled packages of
three sheets each
The first dressings
(three sheets) will
be applied after
your procedure
before you leave the
office. The
dressings should be
placed to cover the
entire grafted area
using occasional
gentle pressure to
keep the area
saturated. Apply all
three sheets to the
transplanted area.
For best results
leave the dressings
in place 30 to 60
minutes. Apply
dressings twice per
day, AM and PM for
the following three
days, until all
packets are used up.
Concentrated Spray -
1 bottle
Beginning the day
after surgery, spray
the transplanted
area liberally every
hour or two in order
to keep the
transplanted area
moist. This should
be continued even
after the dressings
are stopped. Use a
minimum of 15 spays
per application and
5-10 applications
per day. Use until
the bottle is
finished.
Post-surgical
Shampoo and
Conditioner - 1
bottle each
Use the GraftCyte
shampoo and
conditioner in place
of other shampoos.
Use shampoo and
conditioner every
day until the
shampoo and
conditioner are
completely used up.
When GraftCyte
shampoo and
conditioner are used
up, resume your
regular shampoo.
Iamin-hydrating Gel
- 1 tube
Apply a continuous
layer to the entire
suture line 3 times
a day (AM, after
work, PM). Use this
in place of the
other ointments for
the suture line, as
discussed in your
post-operative
instructions. When
you shower, shampoo
out any existing gel
from previous
applications.
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3) Cloning Hair
The thought of being
able to culture hair
follicles and have
an unlimited donor
supply has been a
long-time dream of
patients with hair
loss and hair
restoration surgeons
alike. The
obstacles, however,
have seemed enormous
since the hair
follicle is a very
complex structure of
skin cells, blood
vessels, nerves,
muscles, and glands.
(As an analogy,
culturing a hair
follicle would be
more like culturing
an entire eyeball
rather than just the
cells of the
cornea.) Now there
is hope that not
only is cloning
possible, but that
this hair may not
even need to be your
own.
Dr. Colin Jahoda, a
British scientist
recently reported
that he took dermal
sheath cells (cells
from the lowest part
of the hair
follicle) from his
own scalp and
transplanted them
into his wife's
forearm. These
implanted cells then
stimulated his
wife's skin to grow
new hair. The hair
was analyzed by Dr.
Angela Christiano at
Columbia University
in New York and was
show to be composed
of cells with Dr.
Jahoda's XY
chromosomes at the
bottom and his
wife's XX
chromosomes at the
top.
This clever
experiment shows
that the hair
follicle's dermal
sheaths cells are
one of the bodies
"immune privileged"
organs, enabling
them to be
transplanted from
one person to
another without
rejection. More
importantly, this
study suggests that
all one might need
to do is to
transplant these
"inducer" cells to
stimulate new hair
growth, rather than
having to transplant
the entire follicle
itself. The great
significance, for
those that are
balding, is that
these cells may some
day be cultured in
the lab, to produce
a potentially
unlimited supply of
hair.
Although, this was
just one preliminary
study, the work
provides a clear
direction for
further cloning
research and gives
considerable hope
that the technology
may be available in
the not too distant
future. Stay tuned!
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