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Shrinkage of prostate volume in sunitinib-treated patients with renal cell carcinoma.

Hatano T, Ishii G, Endo K, Kishimoto K, Egawa S.

Jpn J Clin Oncol. 2013;43(12):1282-5.

Department of Urology, JR Tokyo General Hospital, 2-3-1 Yoyogi Shibuya-ku, Tokyo, 151-8528, Japan. [email protected]



 Sunitinib is widely used to treat patients with advanced renal cell carcinoma; however, its influences on the prostate volume and lower urinary tract symptoms remain unclear. To investigate the influence of sunitinib on clinical findings of urinary tract, we recruited a total of 20 male patients with advanced renal cell carcinoma who are treated with sunitinib. We evaluated clinical findings during clinical visits over 24 weeks: International Prostate Symptom Score, urine flow rate, residual urine volume, serum prostate-specific antigen level andprostate volume. Residual urine and prostate volumes were significantly decreased at Week 24. The residual urine volume was especially decreased in patients with a high residual volume at baseline. No differences were observed in the International Prostate Symptom Score total score, International Prostate Symptom Score quality of life score, maximal urinary flow rate or prostate-specific antigen level. We observed a reduction in prostate volume and an improvement in urinary symptoms through relief from urinary tract obstruction during sunitinib treatment. Careful attention to urinary functions and drug dose adjustment seems to be necessary in patients with comorbid benign prostatic hyperplasia or dysuria.

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Additional Information

Sunitinib is the standard first-line treatment for advanced RCC; however, sunitinib-related adverse events such as influence on endocrine organ activity, hypothyroidism, impaired glucose tolerance, and increased levels of amylase and lipases have been reported.  To date, the influence of sunitinib on prostate volume and urinary symptoms remains unclear. We therefore examined the prostate volumes and lower urinary tract symptoms in patients with advanced RCC to investigate the influence of long-term sunitinib therapy on them.

We evaluated the findings during clinical visits over 24 weeks and found reduction of prostate volume and residual urine volume at week 24. We suspect that improvement of urinary obstruction due to the reduced prostate volume results in a decreased volume of residual urine.

Sunitinib is a multitargeted tyrosine kinase inhibitor of VEGF receptors 1-3 and platelet-derived growth factor (PDGF) receptors {Alpha} and {Beta}.  Since VEGF and PDGF are the most potent mitogenic factors stimulating both endothelial and epithelial cells in the normal prostate gland, reduction in prostate volume might be caused by the inhibition of VEGF and PDGF receptors. Sunitinib might cause vascular insufficiency in the prostate and reduce the size of the enlarged prostate.

Benign prostate hyperplasia is a common urological condition found in aging men.  In Japan, approximately 75% of male renal cancer patients have prostatic hyperplasia, and 50% receive treatment for prostatic hyperplasia. Actually, treatment of prostatic hyperplasia became unnecessary after sunitinib therapy in some of our patients. Careful attention to urinary function and drug dose adjustment are necessary in patients with comorbid benign prostatic hyperplasia or dysuria. Our findings should be of great interest to urologists and medical oncologists.