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PubMed2001

Identification, distribution, and expression of angiotensin II receptors in the normal human prostate and benign prostatic hyperplasia.

The tissue distribution, cellular localization, and level of expression of angiotensin II (Ang II) receptors were examined in the normal human prostate and benign prostatic hyperplasia (BPH) by in vitro autoradiography, immunohistochemistry, and radioligand binding studies. In the normal human prostate, Ang II receptors were of the AT(1) subtype and localized predominantly to periurethral stromal smooth muscle. The AT(1) receptor antagonist losartan totally displaced specific [(125)I]-[Sar(1),Ile(8)]Ang II binding, in a concentration-dependent manner, whereas the AT(2) receptor antagonist PD123319 was without effect. There was no significant difference in receptor affinity, but AT(1) receptor density was markedly reduced in BPH compared with that in normal prostate. In rat prostate, Ang II (0.01-1 microM) produced a concentration-dependent increase in [(3)H]-noradrenaline release from sympathetic nerves. The findings of the present study suggest that angiotensin AT(1) receptors predominate in the human prostate. The high concentration of AT(1) receptors in the periurethral region suggests a role for Ang II in modulating cell growth, smooth muscle tone, and possibly micturition. Furthermore, down-regulation of AT(1) receptors in BPH may be due to receptor hyperstimulation by increased local levels of Ang II in BPH. Finally, Ang II may play a functional role in modulating sympathetic transmission in the prostate. These data support the novel concept that activation of the renin-angiotensin system may be involved in the pathophysiology of BPH.

Autoradiography↗
PubMed1986

Combined prostatectomy and retropubic prostatectomy on patients eighty years old or older with benign prostatic hyperplasia.

Combined prostatectomy and retropubic prostatectomy were performed on 20 patients eighty years old or older with benign prostatic hyperplasia. A comparative assessment of two surgical methods regading to operative blood loss, operating time and postoperative complications was presented. The procedure of combined prostatectomy revealed a smaller amount of operative blood loss, less operating time and lower incidence of complications when compared to retropublic prostatectomy. This modified method of suprapubic-retropubic prostatectomy appears to offer several advantages over other open methods of prostatectomy.

Aged↗
PubMed2005

Benign prostatic hyperplasia in community-dwelling elderly in Korea.

BACKGROUND: This study was done to identify the prevalence of benign prostatic hyperplasia (BPH) and BPH-related symptoms among community-dwelling elderly men in Korea. In addition, quality of life and health care-seeking behavior were explored. METHODS: A total of 417 elderly men were surveyed using the IPSS (International Prostatic Symptom Score) and a structured questionnaire on health care-seeking behaviors. RESULTS: The prevalence of BPH was 19.7%. Of those with BPH, 80.3% reported mild symptoms, 13.2% moderate symptoms, and 6.5% severe symptoms. The severity of BPH-related symptoms was significantly correlated with quality of life. Among those with BPH, 42.7% had never consulted with anyone about their symptoms. CONCLUSIONS: BPH has emerged as a serious public health problem in elderly men. Elderly people who experience worse symptoms of BPH have a lower quality of life. Many elderly with BPH do not seek health care, mainly due to misconceptions about BPH. The provision of educational programs for BPH may significantly improve the quality of life of elderly men.

Aged↗
PubMed2002

Insulin-like growth factors and risk of benign prostatic hyperplasia.

BACKGROUND: Insulin-like growth factors (IGFs) have potent growth mitogenic and anti-apoptotic effects on prostate tissue, whereas IGF binding proteins (IGFBPs) inhibit growth of prostatic tissue. The IGF axis has been implicated in prostate cancer risk, but its role in benign prostatic hyperplasia (BPH) is unclear. METHODS: Plasma levels of IGF-I, IGF-II, IGFBP-1, and IGFBP-3 were determined from the fasting bloods of 206 BPH cases admitted for treatment and 306 randomly selected population controls in Shanghai, China. RESULTS: Relative to the lowest tertile, men in the highest tertile of IGF-I levels had a significantly elevated risk of BPH (odds ratio [OR] = 2.80, 95% confidence interval [95% CI] = 1.60-4.92; P(trend) < 0.001). Results for IGF-I were more pronounced after adjustment for serum androgens. In contrast, men in the highest IGFBP-3 tertile had a significantly reduced risk (OR = 0.40; 95% CI = 0.23-0.69; P(trend) < 0.001). No associations of BPH with IGF-II and IGFBP-1 were observed. CONCLUSION: As has been previously observed for prostate cancer, we found that IGF-I and IGFBP-3 are associated with BPH risk in China. Further investigation is needed to elucidate the role of the IGF axis in BPH etiology.

Aged↗
PubMed1995

[The high risk patient with symptomatic prostatic hyperplasia--a therapeutic dilemma?].

Since a few year, a lot of new methods in therapy of symptomatic benign prostate hyperplasia are available. Until now, none of these methods could reach the outcome of surgical therapy. Therefore, surgery is remaining the golden standard in the therapy of BPH. Alternative methods are of great importance in the treatment of "high risk patients". It may be possible to improve the quality of life. Laser therapy and intraurethral catheters are superseding transurethral and suprapubic catheters. The indication for the several methods has to been proven critically.

Aged↗
PubMed1990

Inflammatory infiltrate in prostatic hyperplasia--evidence of a host response to intraprostatic spermatozoa?

The inflammatory infiltrate was characterised in 20 samples of prostatic hyperplasia using cell surface specific monoclonal antibodies. The infiltrate was composed predominantly of CD-3+ T-lymphocytes. The distribution of the T-lymphocyte subsets (CD-4 and CD-8) between the epithelial and stromal components of the gland was significantly different, with most of the intra-epithelial infiltrate being CD8+, T cytotoxic/suppressor cells. This may be a necessary immunological barrier, as in the epididymis, to prevent the development of autoimmunisation to sperm antigens. Large numbers of CD4+ T helper/inducer cells and significant numbers of CD-11c+ macrophages were demonstrated in the extra-glandular stromal tissues, suggesting a delayed type hypersensitivity reaction. Intraprostatic spermatozoa have been demonstrated recently and we have confirmed this finding on post mortem specimens. It is postulated that the presence of an intra-epithelial cytotoxic barrier and the marked stromal infiltrate may be due, in part, to the intermittent presence of spermatozoa within the prostate.

Adult↗
PubMed2004

Transurethral resection versus minimally invasive treatments of benign prostatic hyperplasia: results of treatments. Our experience.

OBJECTIVE: In this non-randomized prospective study the results of standard TURP (Transurethral Resection of the Prostate) versus other minimally invasive treatments were compared. MATERIALS AND METHODS: Among all the patients treated at our Institution for bladder outlet obstruction due to BPH (Benign Prostatic Hyperplasia) from January 1995 to June 1998, 212 patients have been evaluated; 90 patients underwent to TURP, 13 patients to TVP (Transurethral ElectroVaporization), 24 patients to TUNA (TransUrethral Needle Ablation), 71 patients to ILC (Interstitial Laser Coagulation), and 13 patients to WIT (Water-Induced Thermotherapy). RESULTS: TURP achieves the highest decrease of prostate volume (48.8%), the best increase of maximum flow rate (75.3%) and the highest decrease of residual volume (89.8%) in comparison to other methods; these results are substantially stable 24 months after treatment; on the other hand, after WIT a reduction of prostatic volume of 5.2%, an increase of maximum flow rate of 16.7% and a decrease of residual volume of 25.2% can be observed. The relief of bladder outlet obstruction is indicated by the decrease of detrusor pressure at maximum flow rate in comparison to baseline values; it decreases of 27.5% for WIT, of 34.8% for TUNA, of 38.3% for ILC, of 48.4% for TUR, and of 53.3% for T.P The recorded results are substantially stable 24 months after treatment. A marked decrease of IPSS and QL score can be observed for all the procedures after 6 months, ranging from 40.2% for WIT to 76.7% for TUNA; however, these parameters undergo to a slight worsening 24 months after treatment for TURP, TVP and TUNA, while remain substantially stable for ILC and WIT. CONCLUSION: From the analysis of our results, it appears that TURP is still the golden standard treatment for BPH; TURP remains the most effective and definitive way of treatment, but it could be less attractive from the patients' perspective, especially after minimally invasive treatments with good tolerability have become available. It is therefore evident that the choice of each method should be performed in consideration of patients' general performance status, of symptoms and of indications and contraindications of each method.

Aged↗
PubMedDate not supplied

[Validity of tests for initial diagnosis and its concordance with final diagnosis in patients with suspected benign prostatic hyperplasia].

OBJECTIVE: To assess the validity of diagnostic tools available at the primary care setting [medical history (MH), I-PSS questionnaire, digital rectal examination (DRE) and prostate specific antigen (PSA) evaluation] for the diagnosis of benign prostatic hyperplasia (BPH). SUBJECTS AND METHODS: 363 patients with suspected prostatic disease referred to urology outpatient clinics were included. For every subject initial BPH diagnosis was collected at each of the following sequential procedures: 1) MH; 2) I-PSS; 3) DRE; and 4) PSA. Each of these diagnostic decisions were compared to a final diagnosis (gold standard) reached after the addition of urinary sediment analysis, ultrasonographic assessment of residual volume and prostatic volume, and peak urinary flow measurement. A descriptive analysis was undertaken: validity and concordance between each diagnostic step and the gold standard was calculated. RESULTS: Sensitivity, specificity, positive predictive value, and negative predictive value of diagnosis based on MH+I-PSS+DRE+PSA with respect to the gold standard were 91%, 65%, 95% and 50%, respectively. The percentage of agreement and kappa index between both diagnostic strategies were 87.9% and 0.5, respectively. CONCLUSIONS: Concordance between BPH initial diagnosis based on MH+I-PSS+DRE+PSA and diagnosis based on a full range of tests was high, thus allowing recommending the use of this group of initial diagnostic procedures, which are available to the primary care physician, not only as a first diagnostic step in patients with suspected BPH, but also as a valid strategy to prevent unnecessary delay in its initial management and to facilitate appropriate referral from primary to specialized care.

Aged↗
PubMed2005

[Analysis of the causes of postoperative chest or/and abdomen colic in benign prostatic hyperplasia].

OBJECTIVE: To analyze the causes of chest or/and abdomen colic with in 1 week after prostatectomy and transurethral resection of the prostate (TURP). METHODS: Retrospective studies were made on 120 cases of benign prostatic hyperplasia (BPH) with postoperative colic in the chest or/and abdomen from October 2001 to October 2002, 35 (Group A) treated by prostatectomy and the other 85 (Group B) by TURP. RESULTS: In sequence of frequency, the causes of the postoperative chest or/and abdomen colic were bladder spasm, catheter block, acute gastroenteritis, angina and acute myocardial infarction. CONCLUSION: The causes of chest or/and abdomen colic after prostatectomy are multiple. If the causes are timely established and corresponding measures immediately taken, its complications can be minimized.

Aged↗
PubMed2006

Polymorphisms in genes involved in sex hormone metabolism may increase risk of benign prostatic hyperplasia.

BACKGROUND: This study investigates associations between polymorphisms in genes involved in sex hormone metabolism and measures of benign prostatic hyperplasia (BPH). METHODS: Community-dwelling Caucasian men (n=510, median age 60 years in 2000) from the Olmsted County, MN, participated in a longitudinal study of BPH. From 1990 through 2000, urologic measures of BPH were assessed biennially from lower urinary tract symptom severity, peak flow rates, prostate volume, serum prostate specific antigen (PSA) level, acute urinary retention, and treatment for BPH. Men were genotyped for polymorphisms in genes involved in sex hormone metabolism. RESULTS: With the wildtype genotype as reference, men with HSD3B1 (c.1100 A/C) heterozygous genotype (hazard ratio (HR)=0.7, 95% confidence intervals (CI)=0.6, 0.9) were at decreased risk of an enlarged prostate and men with CYP19 (TTTA)(n) genotype homozygous for >or=175 TTTA repeats (HR=1.5, 95% CI=1.1, 2.1), and CYP19 (c.1531 C/T) homozygous T variant (HR=1.6, 95% CI=1.1, 2.2) were at increased risk of an enlarged prostate. The homozygous A variant of the PSA gene (g.-252 G/A), was associated with treatment for BPH (HR=2.3, 95% CI=1.2, 4.4). In multivariate analyses, the homozygous variant genotypes of AKR1C3 (c.15 G/A and c.90 G/A) were associated with a decreased risk of an enlarged prostate (HR=0.56, 95% CI=0.35, 0.90 and HR=0.57, 95% CI=0.33, 0.98). CONCLUSIONS: Polymorphisms in HSD3B1, CYP19, AKR1C3 genes may be associated with an enlarged prostate in older men. These data provide insights into genes that should be examined further for their potential role in the pathogenesis of BPH.

3-Hydroxysteroid Dehydrogenases↗
PubMed2005

Prognostic role of prostate-specific antigen and prostate volume for the risk of invasive therapy in patients with benign prostatic hyperplasia initially managed with alpha1-blockers and watchful waiting.

OBJECTIVES: To investigate the prognostic role of prostate-specific antigen (PSA) level and prostate volume (PV) for the need for benign prostatic hyperplasia (BPH)-related invasive therapy among patients initially treated with an alpha1-blocker or watchful waiting (WW) in real-life clinical practice. METHODS: Data were collected from 2264 consecutive patients with clinical BPH. Patients initially treated with an alpha1-blocker or WW were included in this study. They were stratified by baseline PSA level (less than 1.5, 1.5 to less than 3.0, 3.0 to 10.0 ng/mL) and PV (less than 30 and 30 to 200 cm3), and analyzed for the time to BPH-related invasive therapy. RESULTS: Of the 2264 patients, 389 treated with alpha1-blockers and 553 who chose WW were included. Across the PSA and PV strata, the alpha1-blocker group had worse symptoms, peak flow, postvoid residual urine volumes, and obstruction than did the WW group. Increasing PSA levels produced an increase in the 5-year cumulative risk of invasive treatment: 20%, 34%, and 44% in the alpha1-blocker and 8%, 9%, and 15% in the WW group for a PSA level of less than 1.5, 1.5 to less than 3.0, and 3.0 to 10.0 ng/mL, respectively. The hazard ratio for the highest compared with the lowest PSA strata was 2.8 for alpha1-blocker and 2.7 for WW patients. An increasing PV increased the 5-year cumulative risk from 21% to 35% in the alpha1-blocker group and 8% to 11% in the WW group. The hazard ratio for the large versus small prostates in the alpha1-blocker group was 1.8 and in the WW group was 1.0. CONCLUSIONS: A higher PSA level and larger PV resulted in a greater risk of BPH-related invasive therapy that was more pronounced in the alpha1-blocker than in the WW patients. However, symptom severity, flow parameters, and obstruction grade may have contributed to the difference in risk between the two treatment groups.

Adrenergic alpha-Antagonists↗
PubMed1995

Maximum flow rate--the single uroflowmetric parameter in clinical trials for benign prostatic hyperplasia?

BACKGROUND: Uroflowmetry parameters should be examined for both reliability and optimal test conditions in patients with benign prostatic hyperplasia (BPH), since the difference between one pre- and one post-intervention uroflow rate is usually evaluated in clinical trials of BPH. PATIENTS AND METHODS: Reproducibility of maximum flow rate (Qmax) or its modified forms, and the effects of urinary volume on the reproducibility were examined in terms of Spearman's correlation coefficient (r) in 67 BPH patients. RESULTS: Qmax had a higher r (0.672) as compared to other uroflow rates, such as mathematically modified forms of Qmax and adjusted values of Qmax on nomograms. Reliability was improved by bladder instillation (r = 0.811) or when voided volume was > or = 150 ml or the ratio of volumes was < 2.0 (r = 0.690-0.736). CONCLUSION(S): Qmax, preferably performed with urinary volumes of more than 150 ml or the ratio of volumes less than 2.0, is the most practical single parameter at present in the comparison of two uroflowmetric tests in BPH treatment.

Aged↗
PubMed1998

A novel coculture model for benign prostatic hyperplasia expressing both isoforms of 5 alpha-reductase.

We have developed a coculture system for primary fibroblast and epithelial cells derived from benign prostatic hyperplasia (BPH) that retained many of the characteristics of the intact human prostate. In contrast to separately cultured prostate fibroblast and epithelial cells, cocultures of fibroblasts and epithelial cells maintained messenger ribonucleic acid expression and functional activity for both isoenzymes of 5 alpha-reductase (type I and type II) as well as maintained expression of androgen receptors and prostate-specific antigen. Furthermore, levels of prostate-specific antigen secreted by cocultured epithelial cells were increased by treatment with androgens, mimicking the situation in the human gland. This contrasted with conventionally cultured fibroblasts or epithelial cells, which failed to express 50 alpha-reductase type II and rapidly lost expression of androgen receptors and androgen sensitivity upon being placed into culture. Electron microscopy demonstrated intracellular structures indicative of the differentiated state of the cocultured cell types, including round nuclei, tonofibrils, and microvilli in epithelial cells and elongated nuclei; large amounts of Golgi and cilia; along with immature collagen fibers in fibroblasts. The present study demonstrates that the coculture model reflects more closely the in vivo system for human BPH and is thus a far more suitable model for investigating the molecular and cellular events that underlie BPH than current in vitro systems.

3-Oxo-5-alpha-Steroid 4-Dehydrogenase↗
PubMed2005

Canadian guidelines for the management of benign prostatic hyperplasia.

OBJECTIVE: To develop the first Canadian guidelines for the management of lower urinary tract symptoms in men with benign prostatic hyperplasia (BPH). METHODS: These guidelines, developed under a mandate provided by the Canadian Urological Association (CUA), were a collaborative effort between the CUA guidelines committee and the Canadian Prostate Health Council. BPH guidelines developed by the American Urological Association, the European Association of Urology, the World Health Organization International Consultation on BPH, and similar committees from Germany, Sweden and Australia were reviewed. The committee further reviewed a systematic literature search, updated to May 2004, and systematically derived Canadian urological opinion data. RESULTS: The subsequent Canadian BPH guidelines were developed as an evidence based consensus among the committee members. Mandatory evaluation includes history, physical examination and urinalysis, while a symptom inventory and PSA in selected patients are recommended. Serum creatinine, uroflow, voiding diary, post void residual and sexual function questionnaire are optional. Unless there is an indication, other related tests are not recommended. Treatment choices should be governed by the severity of the symptoms, bother and patient preference. Guidelines for medical, surgical and minimally invasive treatment as well as special considerations are described in terms of guideline, option and recommendation. CONCLUSIONS: Diagnostic and treatment guidelines for BPH reflect the Canadian social priorities, economics, socialized medical practice, manpower issues, and medicolegal considerations.

Canada↗
PubMed1997

[Drug treatment options in prostatic hyperplasia].

The following may be briefly stated about the actually known and clinically used pharmacotherapeutic strategies: Among the choices of treatment regimens for benign prostatic hyperplasia drugs are in general of only limited importance. Only early stages of hyperplasia may be successfully treated with drugs. Before and during treatment, however, prostatic cancer has to be excluded. To this end thorough and strict controls are mandatory, questions about the state of health and filling of recipies alone are by no means sufficient.

5-alpha Reductase Inhibitors↗
PubMed2006

Survey on the Italian outpatient urologists regarding the management of benign prostatic hyperplasia.

OBJECTIVES: To verify the opinion of a group of Italian Outpatient Urologists in the matter of benign prostatic hyperplasia (BPH) diagnosis and treatment. METHODS AND RESULTS: A structured questionnaire was sent to 150 Italian Outpatient Urologists joined to the Unique Union of Italian outpatient Medicine (SUMAI) and working in public outpatient departments. The first section of the questionnaire investigated the Outpatient Urologists opinions concerning the BPH diagnostic approach. The second section of the questionnaire investigated the urologists' opinion on BPH therapeutic approaches. The majority of the urologist's that took part in the survey, believe that a first-line diagnosis of BPH, in accordance to the main guidelines, necessarily the patient's medical history, physical examination and total PSA dosage. A percentage of urologists (about 60%) always include the uroflowmetry and the pelvic ultrasound scan and about the 80% the urinalysis. With respect to the different therapeutic approaches for BPH patients with mild symptoms, the urologists suggest both the watchful waiting with changing in lifestyle and alpha-blockers therapy.

Adult↗
PubMed2006

Treatment of benign prostatic hyperplasia in patients with cardiovascular disease.

Pharmacological management is the most common therapeutic approach for patients with benign prostatic hyperplasia and alpha-adrenoceptor antagonists are the most commonly prescribed initial treatment. Although all of the alpha-adrenoceptor antagonists produce similar improvements in symptom scores and urinary flow rates, they have different adverse effect profiles, especially with respect to the cardiovascular system. The older alpha-adrenoceptor antagonists, terazosin and doxazosin, were initially approved for the treatment of hypertension and are associated with higher rates of dizziness, syncope and hypotension than the newer agents, tamsulosin and alfuzosin. The older alpha-adrenoceptor antagonists are also involved in more interactions and have a greater number of precautions concerning their usage with other cardiovascular medications. Of the newer alpha-adrenoceptor antagonists, tamsulosin has a lower rate of dizziness than alfuzosin. However, both of these agents are superior to doxazosin and terazosin in that no dose escalation or titration is needed for them.

3',5'-Cyclic-GMP Phosphodiesterases↗
PubMed2000

Filling and voiding symptoms in the American Urological Association symptom index: the value of their distinction in a Veterans Affairs randomized trial of medical therapy in men with a clinical diagnosis of benign prostatic hyperplasia.

PURPOSE: We used data from a large Veterans Affairs trial of medical therapy for men with benign prostatic hyperplasia to evaluate the value of calculating separate filling and voiding subscores of the American Urological Association (AUA) symptom index. MATERIALS AND METHODS: We performed factor analysis to assess the psychometric validity of separating the 7 items of the AUA symptom index into filling and voiding subsets. To assess the clinical usefulness of calculating these subscores we correlated them against baseline measurements of symptom interference as well as urodynamic and anatomical measures of disease severity, and used them for predicting the response to medical therapy. RESULTS: Factor analysis confirmed the psychometric validity of separating the AUA symptom index into a 3-item filling and a 4-item voiding subscale. However, calculating filling and voiding subscores did not result in differential correlations with measures of disease interference or severity. It also did not enable us to predict a better symptomatic or uroflowmetry response to medical therapy. CONCLUSIONS: Calculating separate filling and voiding subscores of the AUA symptom index is psychometrically valid but not clinically useful.

Aged↗

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