Can Inj LEUPROLIDE be used prior to TURP for a large prostate to shrink the gland ?
A single dose, 4 weeks prior to resection on large prostate, > 75 grams can reduce blood loss on table.
Is there any study or just a over the counter use
The point raised by Nitesh and the reply given by Anil with reference are indeed valuable.
I, like many others, have been using 5ARIs preoperatively in large prostate requiring TURP. The literature has considerable materials addressing the pros and cons of such usage of 5ARIs. 5ARIs, such as finasteride and dutasteride, reduce prostate volume by suppressing dihydrotestosterone synthesis. The prostate size is reduced by about 30% within a year with 5ARIs usage. But some have questioned this.
There are many who administer 5ARIs, two to three wks preoperatively and claim that the bleeding perioperatively is considerably reduced. Hagerty et al (2000) first reported that pretreatment with finasteride seemed to be useful in reducing the incidence of perioperative bleeding. LV Kavanagh et al reported that 5ARIs has been proven to reduce 77–100% of the amount of haematuria related to prostatic bleeding. SJ Foley et al (2000) found that haematuria completely resolved in about 86% of patients on finasteride compared to only 37% in the control group. Ankur Bhansal and Aditi Arora (2017) mentioned that short-term pretreatment with finasteride and dutasteride has similar efficacy and significantly reduces perioperative bleeding during TURP. AI Ali et al (2018) mention that pretreatment substantially reduces perioperative bleeding. All have attributed this effect is due to significantly lower the microvessel density (MVD) and vascular endothelial growth factor (VEGF).
There are others who have refuted this and claim that pretreatment with 5ARIs have no real benefit. RG Hahn et al (2010) found no significance in 5AHIs use to reduce blood loss. McVary et al (2011) mentioned in AUA Guideline on BPH that there is insufficient evidence to recommend perioperative 5ARI treatment to decrease bleeding. Ti-Yuan Yang, Ming-Chung Ko* et al (2018) from Taiwan did not show that significant associations exist between 5-alpha reductase inhibitor use before transurethral resection of the prostate and the risks of blood transfusion and blood clot evacuation or emergency visits for haematuria.
Many patients on Medical Therapy on 5ARIs may need Prostatic surgery due to progress while on medication. TURP in such patients have to be performed with caution. The resection planes so essential for a well performed resection may not be available in patients on 5ARIs. Though bleeding may be less, it should be remembered that missing these essential planes can cause unwanted problems. The effect of 5ARI is on Glandular component and very little on the stromal component. This is the main reason for this problem.
Goserelin as suggested (3.6mg) may be useful for preventing Perioperative bleeding. The cost of Goserelin in India varies between Rs6200 to 8900. This could be out of means for many Indians due to financial reasons. Affluent Urologists working in Affluent Centres on affluent patients may be able to use it.
With warm regards,