Efficacy of selective alpha-1 blocker therapy in the treatment of acute urinary symptoms during radiotherapy for localized prostate cancer

Purpose: To determine the efficacy of an alpha-1 adrenoreceptor blocking ag ent for acute urinary symptoms in patients treated with radiotherapy fdr lo calized prostate cancer. Methods and Materials: Between 1987 and 1995, 743 patients with clinically localized prostate cancer were treated with 3D-CRT. A total of 275 (37%) pa tients developed Grade 2 acute urinary symptoms as defined by the RTOG morb idity scoring system. Terazosin hydrochloride (THC), a selective alpha-1 ad renoceptor blocking agent, was given to 119 (43%) patients for treatment of their urinary symptoms, whereas nonsteroidal antiinflammatory medications (NSAID) were administered to 71 patients (26%). Thirty-one patients (11%) w ere treated with other medications, and 54 (20%) did not seek pharmacologic intervention for their urinary symptoms. Patients were monitored weekly to assess changes in urinary urgency, frequency, and nocturia. Results: Treatment with THC resulted in a significant resolution of urinary symptoms in 79 of 119 patients (66%), while 26 (22%) had moderate improvem ent, and 14 (12%) had minimal to no response to this drug. In contrast, onl y 11 of 71 (16%) of the patients treated with NSAIDs experienced significan t symptom relief, 20 (28%) had moderate improvement, and 40 (56%) had minim al to no response. The difference in the significant symptomatic improvemen t between THC and NSAID therapy (66% vs. 16%) was highly significant (p < 0 .001). For patients treated with THC, a higher likelihood of significant sy mptom relief was observed in patients who did not receive neoadjuvant andro gen ablation (p = 0.04) and in those who were younger than 65 years of age (p = 0.02). Conclusion: Alpha-1 selective adrenoceptor blocking agents are effective in ameliorating the acute urinary symptoms in patients receiving radiotherapy for localized prostate cancer. Although this was not a randomized prospect ive study, the data suggest that NSAIDs were less effective in relieving ra diation-induced urinary symptoms. (C) 1999 Elsevier Science Inc.