Emerging therapies: what's new is old and what's old is new

Researchers are constantly seeking ways to improve existing drugs, drug mechanisms of activity, find new indications for old drugs or to develop new drugs to treat urological diseases and conditions. In Canada, tadalafil in a 5 mg daily dosage (old drug), and a new drug, silodosin, have recently become available to treat patients who have benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS). In clinical studies, silodosin has shown promise as a treatment for ureteral stones, whereas it has shown conflicting results as a potential treatment for prostatitis. Two new therapies have emerged for treating overactive bladder (OAB): Mirabegron (not yet available in Canada) and fesoterodine (newly introduced in the marketplace). New therapies--denosumab (to prevent skeletal events) and abiraterone acetate and enzalutamide--were recently approved to treat certain patients with advanced prostate cancer. With the advent of new therapies to treat urological diseases, in many cases, primary management of the patient is often shifted from the urologist to the family physician, and sometimes moved from the oncologist to the urologist.