Biomedical subjects
Publications and source records attributed to Andrea Tubaro.
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OBJECTIVES: The association between the severity of LUTS and prostate volume, prostate-related variables and general life-style factors was investigated in a large number of patients with persistent LUTS suggestive of BPH (LUTS/BPH). METHODS: Patients with LUTS/BPH aged between 50 and 80 years, were enrolled in this Italian, multicentre, observational study. The total, storage and voiding I-PSS and I-PSS-QoL index were collected, prostate volume and urodynamic variables measured. Multiple logistic regression equations were used to obtain the odds ratio (and 95% confidence interval) of moderate plus severe I-PSS (>7) versus mild I-PSS (< or =7, reference category), with allowance for age stratification, whenever indicated. RESULTS: In total, 802 patients were evaluated. The strongest association was found between the total I-PSS and the QoL. There was a slightly increased risk to suffer from more severe LUTS with increasing age. A significant increase risk of developing storage symptoms was found in older patient cohorts. Decrease of Q(max) values, increase of Abrams-Griffith number, serum PSA levels and prostate volume as judged by digital rectal examination were significantly associated to a higher risk of developing LUTS. No association was found between symptom severity and prostate volume or post-voiding residual, estimated by ultrasound. CONCLUSIONS: No significant association between severity of LUTS and life-style factors was observed. An increased risk of developing LUTS was found in patients with lower maximum flow rate and in those with higher PSA values. The association between LUTS and prostate volume remains questionable.
Overactive bladder (OAB) is a common, disabling condition associated with considerable negative impact on quality of life, quality of sleep, and mental health. The age-specific prevalence of OAB is similar among men and women. Urge incontinence affects only a portion of the OAB population: 33% of patients have OAB with urge incontinence ("OAB wet"), while 66% have OAB without urge incontinence ("OAB dry"). The symptoms of OAB can affect social, psychological, occupational, domestic, physical, and sexual aspects of life. OAB can also lead to depression and low self-esteem. The shift away from urodynamic observation (essential in the identification of OAB) reflects increased emphasis on the symptom-specific nature of this common disorder. The overall costs of OAB to society are in the billions. Yet the condition often goes unrecognized, largely because of the reluctance of those with OAB to seek medical attention.
OBJECTIVE: To determine whether prostate specific antigen (PSA) level can usefully predict or exclude bladder outlet obstruction (BOO), in men with lower urinary tract symptoms (LUTS). PATIENTS AND METHODS: A cohort of men from 1996 to 1999 who had LUTS caused by BPH was evaluated by serum PSA and pressure-flow urodynamic studies, and a blinded comparison made. The settings were teaching hospitals in London, UK and L'Aquila, Italy. Men (302) were referred by primary-care practitioners with LUTS and a PSA of < 10 ng/mL. Regression analysis was used to predict the extent of BOO, and create likelihood ratios and predictive values for BOO according to the PSA value. RESULTS: PSA was significantly associated with BOO (P < 0.001; r2 0.07), with significant likelihood ratios altering the probability of BOO. If the PSA was > 4 ng/mL, mild or definite BOO was likely (89%), whereas if the PSA was <2 ng/mL, there was about a one-third chance each of no, mild and definite BOO. CONCLUSION: High PSA levels in patients with LUTS are significantly associated with BOO; low PSA levels mean that definite BOO is unlikely.
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PURPOSE OF REVIEW: This is a concise and timely update of the most recent developments in the clinical research on the investigation of benign prostatic hyperplasia. RECENT FINDINGS: Analysis of the peer-review literature confirms a high level of consensus as to the management of prostatic hyperplasia; analysis of practice trends suggests a satisfactory degree of adoption of the proposed guidelines. The evaluation of lower urinary tract symptoms remains the mainstay in the investigation of prostatic hyperplasia although problems concerning the evaluation of nocturia and the differential diagnosis between hyperplasia and chronic prostatitis were identified. Lower urinary tract symptoms confirmed their value as predictors of disease progression. The extent of patient involvement in the decision making process is increasing and new tools to elicit patient preference have been developed. A growing consensus as to the concept of disease progression has been reached concerning prostatic hyperplasia. Analysis of patient sexual function is now considered an important part of patient's interview. More sophisticated instruments, such as time trade-off values were successfully tested to elicit patient preference in the management of prostate disease. The value of serum prostate specific antigen as a predictor on prostate volume growth has recently been confirmed also in unselected male population. SUMMARY: Current research into the investigation of benign prostatic hyperplasia provides new insight into the pathophysiology of lower urinary tract symptoms and identifies parameters to predict the natural history of the disease in the individual patient, particularly regarding progression of the disease and the onset of adverse events.
A significant change has occurred in the management of symptomatic benign prostatic hyperplasia (BPH) since effective pharmacological treatment became available and led to a significant decrease in the number of surgical procedures in many Western countries. The hypothesis of a causative role of benign prostatic enlargement and bladder outflow obstruction (BOO) in lower urinary tract symptoms (LUTS) was based on the association between prostate growth and symptoms of prostatism in elderly men and on the dramatic reduction of LUTS upon relief of obstruction. Careful investigation into the epidemiology of LUTS and BPH failed to confirm such an association and opened new perspectives in the pathophysiology of lower urinary tract dysfunction and symptoms. The observation that LUTS were equally distributed in male and female cohorts, when matched for age, moved attention away from the prostate and towards the urinary bladder and its aging-related disorders. When BPH surgery was developed, the management of the disease was aimed at preventing death from chronic renal failure, but the picture has changed and modern medical treatment is now aimed at improving the patient's quality of life. The increasing size of elderly populations in the Western world and the consequent financial constraints of national healthcare systems have raised the question of when pharmacological treatment of symptomatic BPH should be initiated. Retrospective and prospective analysis of various BPH populations and clinical studies has clearly defined the capacity of pharmacological treatment to reduce the incidence of complications of BPH, such as acute urinary retention and the need for surgery, but the cost/benefit ratio is unclear. Notwithstanding the limitations inherent in the experimental models, there is evidence from various animal models, investigating the pathophysiology of the urinary bladder in the presence of outflow obstruction, to indicate that a cause and effect relationship between BOO and bladder decompensation has been established and to support the hypothesis that permanent bladder damage may occur when the obstruction is not relieved early enough. Preliminary experimental evidence also suggests that alpha(1)-adrenoceptor antagonists may have a role in reducing the damaging effects of BOO on the urinary bladder. At present, there is no evidence to support the need for early pharmacological treatment of symptomatic BPH with no BOO beyond the obvious target of improving the patient's quality of life. The evidence for early treatment of BOO and the need to preserve bladder function is clear. Further experimental and clinical research is required to identify markers of early bladder damage and decompensation which can be used to select patients for early pharmacological treatment of BPH.
OBJECTIVE: Androgen antagonists inhibit prostatic cell proliferation in normal and pathological conditions and are useful antitumor agents in prostatic carcinoma (PCa). Bicalutamide (BCLT) is a well-known non-steroidal antiandrogenic agent able to interfere with androgen receptor (AR). We tested the efficacy of BCLT in inhibiting proliferation of human PCa cell lines and of primary cultures from biopsies of PCa patients. MATERIALS AND METHODS: Human prostatic carcinoma cell lines (PC3, DU145, LNCaP ALVA 31 and ND1) and short-term primary tissue cultures from PCa patients were treated with BCLT. Cell proliferation and orange acridine and ethidium bromide fluorescence staining studies were performed. RESULTS: BCLT was able to inhibit, significantly and dose-dependently, cell proliferation in AR-positive human PCa cell lines and in 10 cases of primary cultures with Gleason grades 4 to 8. Its action appears to be mainly apoptotic in AR-positive cells and cytotoxic in AR-negative cells. CONCLUSION: BCLT, which inhibits growth in both human PCa cell lines and PCa primary cultures from patients with medium and low-grade tumors, deserves attention as a potential widely effective antiandrogenic monotherapy in prostatic carcinoma. However, its efficacy in AR-negative cells requires further research.