From Our 2007 Archives

Botox Could Treat Enlarged Prostate

By Alan Mozes
HealthDay Reporter

WEDNESDAY, May 23 (HealthDay News) -- Apparently, Botox is not just for wrinkles anymore. New research suggests that it may boost the quality of life of men with enlarged prostate when injected directly into the gland.

The small study revealed that about 75 percent of men suffering from benign prostatic hyperplasia (BPH) experienced partial symptom relief following the treatment.

"Many men have enlarged prostate," noted study senior author Dr. Michael B. Chancellor, a professor of urology at the University of Pittsburgh Medical Center. "They take pills, but sometimes they don't work, or sometimes they have side effects, and they're afraid of surgery. So now, Botox has been shown to be safe and effective, and a single office injection, which takes about 5 minutes, can achieve success for one entire year. So, it's a new and very exciting alternative that is something between standard drugs and surgery."

Chancellor was slated to present the findings this week in Anaheim, Calif., at the annual meeting of the American Urological Association. He conducted his work alongside colleagues at the Chang Gung University Medical College in Taiwan.

"This is not surprising, but it's very interesting," added Dr. Peter T. Scardino, chairman of the department of urology and head of the Prostate Cancer Program at Memorial Sloan-Kettering Cancer Center in New York City. "Essentially, what you're doing with Botox is not so much changing the prostate size as relaxing the nerves and muscle tone in the prostate and making urinary flow easier. It certainly makes sense."

Scardino was not involved in the study, which was funded by the pharmaceutical company Allergan Inc, the maker of Botox.

According to the National Kidney and Urologic Diseases Information Clearinghouse, BPH usually occurs among men over the age of 50. More than half of all men over the age of 60 develop BPH, the authors noted -- a figure that rises to 80 percent by the age of 80.

Between 40 percent and 50 percent of BPH patients develop a loss of bladder control as the growing prostate squeezes against the urethra, the passage through which urine flows.

Accompanying symptoms include a frequent need to urinate (often at night), trouble urinating (even when feeling the urge), blood in the urine, and urinary tract infections. In severe cases, bladder and kidney damage can result.

Physicians diagnose BPH by means of digital rectal exams, blood tests, X-rays, sonograms, or cystoscopy -- the insertion of a lighted tube into the bladder.

Once identified, patients with mild BPH may choose to forego treatment. However, those with more serious symptoms are often prescribed medications to shrink or relax the gland to relieve bladder blockage.

Doctors use a number of drugs, often in combination, to treat BPH. When that fails, the prostate can be reduced or removed via laser or microwave techniques, or invasive surgery.

In this study, Chancellor and his colleagues honed in on Botox as a possible treatment alternative.

The researchers focused on 37 men, averaging 67 years of age, who had not responded to standard treatments for BPH.

Using an ultrasound guide, the patients were injected once with between 100 and 200 units of Botox, depending on the size of the prostate.

The team found that nearly three-quarters of the patients experienced a 30 percent improvement in their symptoms for up to a year following the injection. None of the patients experienced significant side effects, such as erectile dysfunction or urinary incontinence.

Follow-up exams conducted six months and 12 months following treatment also showed an up to 15 percent reduction in prostate size among some, but not all, patients. According to the researchers, this suggests Botox instigated a controlled form of prostate cell death that shrank the gland.

However, these reductions in prostate size did not seem to explain symptom improvement, they said. Rather, symptom relief was probably associated with a change in prostate gland muscle tone and sensory function following Botox injections.

"In fact, the effect of the Botox is similar to what the alpha-blockers [drugs] do and have done for many years," noted Scardino. "But, I can imagine this being useful as an alternate to a more invasive procedure for people who all of a sudden can't urinate and face an emergency situation."

"The question is how practical is it?" Scardino cautioned. "It's worth exploring, but this is extremely preliminary in terms of its clinical benefit. Much more research is needed."

Chancellor agreed on the need for more research and said a new worldwide study is already under way to explore Botox's potential against BPH.

Dr. Robert E. Weiss is a urologic oncologist at The Cancer Institute of New Jersey and an associate professor of urology at the Robert Wood Johnson Medical School in New Brunswick, N.J. He said that patients who have failed standard medical therapies have the most to gain from this alternative approach.

"We have a significant number of patients nowadays who begin medical therapy, and either it initially doesn't work, or, with time their symptoms get worse," he noted. "And the next step would be a more invasive treatment. So, this would probably be a little better option, because it's presumably minimally invasive. It's certainly a novel idea."

SOURCES: Michael B. Chancellor, M.D., professor, urology, University of Pittsburgh Medical Center; Peter T. Scardino, M.D., chairman, department of urology and head of Prostate Cancer Program, Memorial Sloan-Kettering Cancer Center, New York, N.Y.; Robert E. Weiss, M.D., urologic oncologist, Cancer Institute of New Jersey. and associate professor, urology, Robert Wood Johnson Medical School, New Brunswick, N.J.; May 19-24, 2007, American Urological Association annual meeting, Anaheim, Calif.

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