Investigation of prostatic hypoxia-inducible factor-1 alfa ve vascular endothelial growth factor expression in patients recieving dutasteride

Objective: Benign prostatic hyperplasia (BPH) is a significant health problem for men over the age of 50. BPH is a progressive disease which can lead to serious complications such as, renal failure, urinary tract infections and hematuria. In recent years medical agents play an important role in the management of BPH. Alpha receptor blockers, 5-alpha reductase inhibitors, phytotherapy and combinations of these are used for the medical treatment of BPH. 5-alpha reductase inhibitors inhibit the enzyme that converts testosterone to dihydrotestosterone (DHT). Thus, it prevents the progression of BPH by reducing DHT which binds to nuclear receptors in prostate cells causing increased DNA synthesis and cell growth. Current 5-alpha reductase inhibitors are finasteride and dutasteride. It was shown that 5-alpha reductase inhibitors reduce the amount of bleeding during transurethral resection of the prostate (TUR-P) by suppressing anjiogenesis in prostate tissue. The current trial was planned to investigate three common parameters of anjiogenesis, namely hypoxia-inducible factor-1 alfa (HIF 1-alfa), vascular endothelial growth factor (VEGF) and microvessel density (MVD) in patients receiving dutasteride. Materials and Methods: The patients who underwent TUR-P routinely received dutasteride for a month prior to surgery during the last year at our clinic. These subsequent patients were than retrospectively compared with the previous consecutive TUR-P patients without dutasteride. Any additional disease such as urinary infections, bladder stones, bladder tumor, prostate cancer, urethral catheterization, pelvic radiotherapy constitutes the exclusion criteria. The histopathological spacemens of both groups were compared regarding the immnohistologiacal expressions of HIF-1 alfa, VEGF and MVD. Results: VEGF, and HIF-1 alfa values were significantly lower in the dutasteride group compared with the control group (p<0.05). Although a decrease in MVD was detected in the dutasteride group, it was not significant (p=0.205). Conclusion: Dutasteride administration in BPH results in statistically significant suppression of VEGF and HIF-1 alfa. Administration of dutasteride in patients prior to surgery may have the potential to decrease the complications related to blood loss. Keywords: Benign prostatic hyperplasia, dutasteride, hypoxia-inducible factor-1 alfa, vascular endothelial growth factor, microvessel density, transurethral resection of the prostate