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, ..

" "-TOP 10


50
Rank

Disease

1-year prevalence (%)


(n = 963,452 person-years)

Coronary Artery Disease/Hyperlipidemia

51.3

2
3
4
5
6
7
8
9
10

Hypertension
Diabetes Mellitus Type 2
Enlarged Prostate
Osteoarthritis
Arrhythmias
Cataract
Gastroesophogeal reflux disease
Bursitis
Prostate Cancer

45.2
17.5
13.5
13.3
8.8
8.6
8.4
8.0
7.8

Issa MM et al. Am J Manag Care.


2006;12(suppl):S83S89

5




(),



5-,

(1).


5- 2,

5- 1 2 (
5-).
,

.
5-

Type II
5AR
Testos
terone

DHT
Type I
5AR

Bartsch G et al. Eur Urol. 2000;37:367380.

Type II
5AR

Testost
erone

D
H
T

Type I
5AR

Bartsch G et al. Eur Urol. 2000;37:367380.



20
Mean change in serum
PSA (%)

10
0

-10

2.8

2.2

10.
7

6.8

5.5

15.
8

Placeb
o

9.2

-20
-30

35.7
43.5

-40

48.6

50.5

-50
-60

Baseli
ne
Data on file, GlaxoSmithKline.

1
Mo 2
nth

1
5

18

Dutasteri
de

52.4

2
1

2
4





12
.



5- :
.

(3-5 ).
5-

.

DHT 70%
95% .
, DHT




6 12 .
2 4 , 5
(IPSS) 15-30%,
18-28%
Qmax
1,5-2,0 /


(. 5) (4-13).


, IPSS,
,
.
Qmax
30
40 (15,16).


,


(3).
,
5-

Kaplan-Meier estimates: time to first


event
Patients (%)
7

Double-blind

Open-label

6.7%

6
P/D

D/D

57%

3.3%

3
2
1
0
0

12
18
24
Treatment month

Roehrborn CG et al Urol 63:709-15,2004; M.Emberton et al. 2004 EAU Abstract

30

36

42

48



30 (
CombAT 55 )
, 5-
,
,
(11,12).
(
),

(19).
IPSS
58 (> 4,4)
15



5- -

/ /
(8,10,19,20).


40 (12,13,20).
5
,

.

5-

.
,
5-
( ).


.
, 5-
(),
,
, -
(23).

EAU GUIDELINES
Recommendations

- +
5-









.




, ,

.


.




.

CombAT (Combination of
AvodartR and Tamsulosin)
trials


PSA , ,

.
,
6 12
.
,


Qmax

Kaplan-Meier estimates: time to first


event
Patients (%)
7

Double-blind

Open-label

5.6%

P/D

D/D

48%

3.3%

3
2
1
0
0

12
18
24
Treatment month

Roehrborn CG et al Urol 63:709-15,2004; M.Emberton et al. 2004 EAU Abstract

30

36

42

48


MTOPS
CombAT
IPSS
4 ,
, ,

50%. MTOPS CombAT
trial, :
66% 44%
64% 41%
81% 68%
65% 26%
67% 71%

CombAT
MTOPS,


.



-
5-.

5,


,
Qmax,
.
,

.

EAU GUIDELINES
Recommendations

IPSS
12 .

6
(n=2351)

1.4

6.3

8.1*

*Statistically significant vs tamsulosin (6.7) or finasteride alone


(4.2), p<0.03

Hutchison A, et al. Eur Urol 2007;51:20715

5

finasteride (Proscar)5 mg daily
$92.99 / 30
dutasteride (Avodart)0.5 mg daily
$87.99 / 30

!

- 17 000 /
- 17 000
/
8-15 000
3 000 -5 000
5-15 000
5 000
,
2
, ,
1000-1500 USD

REDUCE Trail

1-2, n=3364,
3244
3- 4, n=2359,
2451

n=3424,
3305

0,5

578

435

280

224

858

659


P Value

95%


Mantel-Cox
<0.0001
22.8
( 15.2 to 29.8 )

Reduction by Dutasteride of
Prostate Cancer Events
(REDUCE)



, //

.

4 .

GSK , 650
, 8000
50-75 , PSA 2.5-3.0 - 10 ng/ml,

6
Andriole et al. J Urology 2004
. ( HGPIN
ASAP),

80
cc
April
27, 2009 report
at the
American Urological Association annual meeting in Chicago, IL

:
,


( , ..)
, (PSA
) .
: 2
.


3 ,

4

, ,


.
.

!
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