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157ETTING MEN’S HEALTH ONTO A POLICY AGENDA - CHART-NG THE DEVELOPMENT OF A NATIONAL MEN’S HEALTHOLICY IN IRELAND

oel Richardson

Institute of Technology Carlow, Science and Health, Kilkenny Rd, Carlow, Ireland-mail address: Noel.richardson@itcarlow.ie.

ackground: In January 2009, the Department of Health and Children in Ireland pub-ished a national men’s health policy. This paper will describe the background to theolicy, outline the methodologies and key principles used for policy development andummarise the key policy recommendations. It will also reflect on some of the keyessons learned and on the challenges in terms of making the policy succeed.

ethods: The policy was developed following an extensive research and consultationrocess. The need for a specific policy focus on men’s health was identified in Ire-and’s National Health Strategy in 2001. This prompted the Department of Health andhildren to fund a three-year men’s health research project, the findings of whichere launched at the first National Conference on men’s health in Ireland, which tooklace in December 2004. An inter-Departmental and multi-sectoral Steering Group wasppointed to oversee the development of the policy. Under the terms of reference of theteering Group, an extensive and nationwide consultation process was undertaken withll relevant stakeholders. The findings from this consultation process, together with anxtensive review of the evidence underpinning the issues raised, were then translatednto concrete policy recommendations and actions.

esults: The recommendations and actions from the policy address a broad range ofen’s health issues and have implications in terms of gender-mainstreaming men’sealth across a number of government departments. A number of key theoretical andhilosophical principles also informed the development of the policy. The policy isirmly positioned within existing government policy places a firm focus on the gen-ered nature of key men’s health issues; adopts a social determinants and communityevelopment approach; targets interventions at both an individual and a populationevel; focuses on prevention as well as cure; adopts a strengths perspective; and seekso support men to become more active agents and advocates for their own health.

onclusion: The publication of a national men’s health policy in the Ireland is a signif-cant and important step in being the first national policy to provide a clear blueprintnd an unequivocal evidence base for tackling men’s health. Undoubtedly, there will beuch interest in the progress of the policy in the years to come.

oi:10.1016/j.jomh.2009.08.155

158REATMENT OF ERECTILE DYSFUNCTION WITH SILDENAFILITRATE IN PARKINSON DISEASE

ulyadi Tedja Pranata

Medizone Clinic, Indonesia-mail address: medizoneclinic@yahoo.com.

bjectives: To asses the efficasy and safety of sildenafil citrate in men with erectile dys-unction due to Parkinson’s disease.

ethods: Two patients with erectile dysfunction with Parkinson’s disease we recruited.he starting dose was 50mg sildenafil citrate. The International index of erectileunction questionnaire (IIEF) was used to assess treatment efficacy and quality of lifeuestionnaire to assess the effect of treatment on sex life and whole life. Criteria forntry included a definite neurological diagnosis and standing diastolic blood pressuref 90-180mm Hg and diastolic blood pressure of 50-110mm Hg,on treatment ifecessary.Blood pressure was taken on visit 2,visit 4 lying,sitting, and standing before

nd 1 hour after taking the sildenafil citrate in Clinic.

esults: Sildenafil citrates was efficacious in men with Parkinson’s disease with a sig-ificant improvement,as demonstrated in questionnaire responses,in ability to achievend maintain an erection and improvement in quality of sex life. In Parkinson’s diseasehere was minimal change in blood pressure.

onclusions: Sildenafil citrate (50mg) is efficacious in the treatment of erectileysfunction in Parkinson’s disease, so we recommended measurement of lyingnd standing blood pressure before prescribing sildenafil to men with parkinson’sisease.Furthemore,such patients should be made aware of seeking medical advise ifhey have developed symptoms on treatment suggestive orthostatic hypotension.

eywords: Erectile dysfunction; Parkinson’s disease; Sildenafil citrate

oi:10.1016/j.jomh.2009.08.156

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WCMH Abstracts

159ROSTATE CANCER - THE PATIENT’S VIEW

erner Pokstefl

Selbsthilfegruppe Prostatakrebs, Obere Augartenstraße, Vienna, Austria-mail address: w.pokstefl@tele2.at.

The patient is confronted with the diagnosis of prostate cancer. Whathould the doctor know about the the patient’s ability to understand theiagnosis. Which is the way the doctor can explain the illness and takeway the anxiety concerning the patient’s future. How should the doctorxplain the treatment to come. The early cooperation of various specialistss strongly suggested.Which contribution should the patient make to enable the doctor toake an optimal management of his illness.Also we want to dicuss the task of the support group. What can the doc-

ors expect, what kind of support does the patient expect and what can theupport group really do.Last but not least we should discuss the performance of the public health

ystem.

oi:10.1016/j.jomh.2009.08.157

161UTASTERIDE REDUCES THE RISK OF BIOPSY-DETECTABLEROSTATE CANCER AND BPH COMPLICATIONS AMONGEN AT INCREASED PROSTATE CANCER RISK WITHONCOMITANT BPH: SUB-ANALYSIS FROM THE REDUCETUDY

ichael Marberger1,∗, Francesco Montorsi 2, Teuvo Tammela3, Geraldndriole4, Timothy Wilson5, Arturo Fueyo-Rodriguez6, Ramiro Castro7,n behalf of the REDUCE Study Group

Department of Urology, Medical University of Vienna, Vienna, Austria, 2 Departmentf Urology, Universitá Vita Salute San Raffaele, Milan, Italy, 3 Department of Urol-gy, Tampere University Hospital, Tampere, Finland, 4 Washington University Schoolf Medicine, Department of Urology, St Louis, United States, 5 Glaxosmithkline, Deptf Biostatistics, North Carolina, United States, 6 Glaxosmithkline, Urology Centre ofxcellence, Madrid, Spain, 7 Glaxosmithkline, Oncology Research & Development, Northarolina, United States-mail address: uroldep@meduniwien.ac.at (M. Marberger).

ackground: REDUCE was an international study to investigate the efficacyf dutasteride 0.5mg/day in reducing the risk of biopsy-detectable prostateancer in men (n = 8121) at increased risk of this malignancy. Given therequent epidemiological overlap between prostate cancer and benign pro-tatic hyperplasia (BPH), their similar risk factors (e.g. age, PSA levels) andhe central role of dihydrotestosterone in both conditions, we conductedsub-analysis of the efficacy of dutasteride in men in REDUCE who alsoad BPH (IPSS ≥8 at screening and prostate volume ≥30 cc at baseline;= 3812).

ethods: REDUCE was a 4-year, randomised, double-blind, placebo-ontrolled, parallel-group study. Eligible subjects were aged 50—75 years,ith a serum PSA 2.5—10 ng/ml (aged 50—60 years) or 3.0—10 ng/ml

aged>60—75 years), and had a single negative biopsy on 6—12 coresithin 6 months before enrolment. Principal exclusion criteria werevidence of high-grade prostatic intraepithelial neoplasia, evidence oftypical small acinar proliferation, and prostate volume>80 cc. Duringhe study, subjects underwent a protocol-mandated 10-core biopsy at 2nd 4 years; for-cause biopsies could be performed at any time if clinicallyndicated.

esults: In the overall population, the number of prostate cancers detectedas 857 in the placebo group and 659 in the dutasteride group (relativeisk reduction [RRR] 23%; p<0.0001). In the BPH subgroup, 365 prostateancers were detected in the placebo group and 270 in the dutasterideroup (p<0.0001), representing a RRR of 26.6% (95% CI: 14.9%, 36.6%). Treat-ent with dutasteride also significantly (p<0.0001) reduced the risk ofcute urinary retention or BPH-related surgery (237 events with placebo, 64vents with dutasteride: RRR 74.1%; 95% CI: 65.9%, 80.4%). Frequencies ofny adverse events (AEs) and serious AEs were similar in both treatmentroups. Drug-related AEs were significantly more frequent in the dutas-eride group than in the placebo group (21% vs 14%; p<0.0001). Thesencluded AEs related to sexual function such as decreased libido (dutas-eride 6%, placebo 4%) and erectile dysfunction (11.5%, 8%).

onclusions: Treatment with dutasteride significantly reduced the riskf biopsy-detectable prostate cancer and BPH complications in men atncreased risk of prostate cancer with concomitant BPH. The prostateancer risk reduction in the BPH subgroup is consistent with that in theverall study group.

oi:10.1016/j.jomh.2009.08.158

jmh Vol. 6, No. 3, pp. 229–275, September 2009 267