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PubMed2004

A current review of medical therapy for benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) is one of the most common diseases of aging men. It is estimated that by age 60 years, greater than 50% of men will have histologically documented evidence of the disease. Therapy for this disease has evolved considerably from its inception. Recent data from long-term population-based studies have shed new light on the treatment of this common problem in aging men. The authors review the current state of diagnosis of BPH and medical therapy for this condition in the primary care setting.

Adrenergic alpha-Antagonists↗
PubMed1992

[Epidemiology and natural course of benign prostatic hyperplasia].

Benign prostatic hyperplasia (BPH) is a frequent condition in men over 50 years of age. At autopsy the histological characteristics of BPH are seen in 80% of all men older than 80 years. Although BPH is so frequent, its precise etiology is still unknown. Each of the various sources from which epidemiological data on BPH can be obtained has its own specific problems in terms of potential errors and biases, which have to be taken into account in interpretation of the data from these sources. There are clear differences in the incidence of BPH in various races. In negroids BPH is more frequent than in Caucasians, while in Asiatic races BPH is less frequent. However, in Asiatics BPH occurs more frequently in men who have immigrated into western countries. Age and hormonal status are well known to be involved in the development of BPH. Other factors, such as marital status, socioeconomic class, smoking, diet, diabetes, hypertension, and liver cir-rhosis have been implicated, but their relation with the risk of developing BPH has never been proven. The natural history of BPH is characterized by an age-dependent increase in histological changes and an increase in prostate size. The histological changes compatible with BPH are found in men below the age of 30 with an incidence of less than 10%. During the 6th decade, 42% of prostatic specimens have histological signs of BPH and during the 8th decade of life more than 80% of prostatic specimens. The histological changes of BPH precede prostatic enlargement by roughly 1 decade. There is an initial spurt of prostate growth during the period of maturation and puberty.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2000

The clinical role of alpha-blockers in the treatment of benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) is a highly prevalent condition that represents a significant health problem, which is likely to worsen as the population continues to age. alpha-1 adrenoceptor antagonists have been used in the treatment of this condition for well over 20 years and much is now known about their effects on the urinary tract. As these drugs have improved, their use as a first line treatment option in patients with lower urinary tract symptoms (LUTS), secondary to BPH, has continued to increase. This review details some of the background and rationale for the use of these drugs and, using the available information, compares their efficacy and tolerability profiles.

Adrenergic alpha-Antagonists↗
PubMed1995

Efficacy of doxazosin in normotensive and hypertensive patients with benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) and hypertension are both common conditions in older men. It is estimated that 20 to 41% of middle-aged to elderly men may have both. Alpha-1 adrenoceptor antagonists, such doxazosin, produce significant improvements in urine flow rate and symptoms in patients with BPH. The effect of doxazosin on urine flow rate and symptoms in hypertensive men with BPH is similar to that seen in normotensive men. By contrast, doxazosin produces a significant fall in blood pressure in hypertensive men, but has minimal effect in normotensives. Doxazosin is well tolerated, irrespective of blood pressure status. Thus, it can be concluded doxazosin is an effective and well tolerated treatment for BPH which appears to have additional benefits in the management of patients with concomitant hypertension.

Aged↗
PubMed2001

Primary culture of microvascular endothelial cells from human benign prostatic hyperplasia.

BACKGROUND: Prostate growth seems to be influenced by paracrine factors like IL-6 originating from the microvascular endothelium. Therefore, our efforts were focused on the primary culture and behavior of microvascular endothelial cells (HPEC) derived from tissue of human benign prostatic hyperplasia (BPH). Until now, the isolation and culture of HPEC from BPH have not been reported. METHODS: BPH tissue was cut into small cubes and gently squeezed after incubation with dispase. HPEC were cultured from the resulting cell suspension after a stepwise selection by use of superparamagnetic beads coated with antibodies against endothelial specific antigens. HPEC were characterized by flow cytometry and immunohistochemistry. gamma-Glutamyl transpeptidase activity (specific for microvascular endothelium) was measured after dissolution of the HPEC with Triton X-100. After the incubation of HPEC either with ATP, VEGF, or TNF-alpha, the release of IL-6 was measured by enzyme linked immunosorbent assay (ELISA). RESULTS: HPEC showed a typical endothelial morphology. They were positive for von Willebrand factor, CD31, CD62E (after stimulation with TNF-alpha), alpha-actin and were negative for fibroblastic antigens and PSA. Proliferation was stimulated by vascular endothelial growth factor (VEGF). gamma-Glutamyl transpeptidase activity in HPEC was 6.3 microIU/microg protein, whereas in human umbilical vein endothelial cells (HUVEC) no gamma-glutamyl transpeptidase activity was detectable. The IL-6 secretion of HPEC was stimulated by VEGF and TNF-alpha, but not by ATP and bradykinin. CONCLUSIONS: For the first time, the primary culture of microvascular endothelial cells from BPH tissue was successfully performed. Our results suggest that HPEC may be actively involved in prostate growth, due to the secretion of regulatory factors such as IL-6.

Cell Culture Techniques↗
PubMed1996

[Evaluation of symptoms in patients with benign prostatic hyperplasia].

Benign prostatic hyperplasia (BPH) is the most common cause of voiding dysfunction in elderly men. With the age related demographic changes in the western world, the epidemiological and economical burden of BPH is anticipated to increase. BPH is clinically diagnosed on a variety of more or less well defined symptomatic, macroscopical, and physiological criteria, whereas the histological diagnosis is straightforward. Yet, no symptom is specific for BPH and numerous other diseases have to be considered when a patient presents with symptoms of bladder outlet obstruction. A BPH questionnaire is useful when weighing the pros and cons for intervention. Furthermore, a symptom index represents a valuable indicator for the quality of care provided. Through the last decades a number of BPH questionnaires have been introduced. This article scrutinizes various BPH indices and provides an introduction to the prerequisites of clinical questionnaires.

Aged↗
PubMed2004

Saw palmetto and benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) is a common health issue that affects 8% of all men at the age of 40, 60% of men in their 70s, and 90% of those greater than 80 years of age. One-fourth of these men will develop moderate to severe lower urinary tract symptoms that greatly affect their quality of life. Recent evidence suggests that the use of saw palmetto leads to improvements in urinary function for those suffering from BPH. The favorable comparison of saw palmetto with tamsulosin, a well-known first line agent in the treatment of urinary tract symptoms, demonstrates promise towards a beneficial effect of this herbal agent, with very few, if any, adverse effects. However, what degree of this beneficial activity is due to placebo effects is yet to be determined. In addition, the precise mechanism of action of saw palmetto in men with BPH remains unclear.

Adrenergic alpha-Antagonists↗
PubMed1995

Controversies about the clinical assessment of benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) is a common disorder which places a considerable burden on older men and health care expenses. With advances in medical technologies and the foreseeable demographic changes in the Western world, the financial and epidemiological impact of this chronic disease is expected to increase further. The management of BPH is controversial, and this article critically reviews the clinical applicability and validity of the various measures available for assessment. Few objective modalities are indicated in the routine evaluation of BPH. There is a poor correlation between objective and subjective indicators and both measures reveal a substantial variation over time. This fluctuation is mainly attributed to the natural history of the disease. The clinical value of combining objective and subjective parameters into an analytic process seems small. Disagreements about the clinical value of BPH assessment modalities have caused inconsistent practices and consequently provision of changeable health care quality. Patients seek urological counseling and relief because of burden of illness. Quality care is provided by clinicians being perceptive to patients' preferences. Provision of quality care does not inevitably generate increasing health service expenses.

Humans↗
PubMed1978

A histochemical study of glycosidases in benign prostatic hyperplasia and in prostatic carcinoma in the human.

In benign hyperplasia marked beta-glucuronidase and N-acetyl-beta-glucosaminidase activity was seen in the prostatic epithelium whereas the reactions for 5 other glycosidases were only slight or negative. The intensity of the reaction for the glycosidases in prostatic carcinoma was dependent upon the degree of the differentiation. The possible importance of glycosidases for the invasiveness of prostatic carcinoma is briefly discussed.

Adenocarcinoma↗
PubMed1992

Volume of normal prostate, of prostate cancer, and of benign prostatic hyperplasia: are correlations with prostate specific antigen clinically useful?

This retrospective study correlated prostate volume, determined by transrectal ultrasonography, with serum prostate specific antigen (PSA), by Deming regression analysis, in patients with confirmed benign prostatic hyperplasia (BPH) and patients with non-metastatic (M0) or metastatic (M1) prostate cancer. In BPH, a highly significant correlation was found between log10[PSA] and prostate volume. When this PSA/volume regression pattern for BPH was used as a reference standard, all 17 patients with M1 prostate cancer and 83% of the 23 patients with M0 disease were discriminated from BPH.

Aged↗
PubMed2006

Dutasteride improves objective and subjective disease measures in men with benign prostatic hyperplasia and modest or severe prostate enlargement.

PURPOSE: We determined whether the effect of dutasteride for benign prostatic hyperplasia is influenced by baseline prostate volume using data from 3 phase III clinical trials. MATERIALS AND METHODS: Patients randomized to dutasteride or placebo in the double-blind portion of the phase III studies were eligible to receive 0.5 mg dutasteride daily in a 2-year open label extension in dutasteride/dutasteride and placebo/dutasteride groups. Patients were prospectively stratified according to baseline prostate volume 30 to less than 40 and 40 cc or greater. RESULTS: In patients treated with dutasteride throughout the study (dutasteride/dutasteride group) the mean reduction in prostate volume from baseline to month 48 was 30.3% in those with a baseline prostate volume of 30 to less than 40 cc and 26.2% in those with a prostate volume of 40 cc or greater. Mean improvements in peak urinary flow from baseline to month 48 were 2.7 ml per second regardless of baseline prostate volume. Improvements in the American Urological Association symptom index score were 6.3 in men with a prostate volume of 30 to less than 40 cc and 6.5 in those with a prostate volume of 40 cc or greater. No significant relationships between treatment effect and baseline prostate volume were observed for these parameters. In dutasteride/dutasteride treated patients the risk of acute urinary retention was decreased by 60% in those with a prostate volume of 30 to less than 40 cc and 55% in those with a prostate volume of 40 cc or greater vs values in placebo/dutasteride treated patients (p = 0.036 and <0.001, respectively). The corresponding values for benign prostatic hyperplasia related surgery were 27% and 48% (p = 0.35 and <0.001, respectively). CONCLUSIONS: This analysis demonstrates that dutasteride significantly improves objective (prostate volume and peak urinary flow) and subjective (symptom scores) measures even in patients with only a slightly enlarged prostate (30 to less than 40 cc). The risks of acute urinary retention and benign prostatic hyperplasia related surgery were decreased regardless of baseline prostate volume.

Aged↗
PubMed2007

A preliminary study of JM-27: a serum marker that can specifically identify men with symptomatic benign prostatic hyperplasia.

PURPOSE: Benign prostatic hyperplasia is a common disease in men that until recently was considered a single disease with varying symptoms. Our recent analysis has revealed that a molecular marker, JM-27, is able to distinguish at the tissue level between highly symptomatic individuals and those with histological disease. The goal of these studies was to determine if a serum based assay to detect JM-27 could distinguish men with different forms of benign prostatic hyperplasia. MATERIALS AND METHODS: A serum based enzyme-linked immunosorbent assay was developed using a novel anti-JM-27 monoclonal antibody. The assay was sensitive, detecting JM-27 at the low ng/ml level within the serum. A quantitative measurement of serum JM-27 levels was performed in 68 patients. The patients consisted of 3 groups of 29 patients with asymptomatic benign prostatic hyperplasia (American Urological Association symptom score of 15 or less), 39 with symptomatic benign prostatic hyperplasia (American Urological Association symptom score 16 to 32) and 17 with confirmed prostate cancer. The assay cutoff was determined after a pilot run of samples and applied prospectively. RESULTS: Using the determined cutoff, serum levels of JM-27 can distinguish between symptomatic and asymptomatic patient sets. The sensitivity and specificity of the assay are 90% and 77%, respectively. The presence of prostate cancer in these men does not appear to alter the marker levels. CONCLUSIONS: The present study is believed to represent the first characterization of a serum based marker for severe benign prostatic hyperplasia.

Antigens, Neoplasm↗
PubMed2006

Natural history of benign prostate hyperplasia.

BACKGROUND: Benign prostate hyperplasia is one of the most common diseases affecting the health of the aging males. Watchful waiting is an acceptable management strategy for benign prostate hyperplasia in which the patient is monitored by the physician but receives no active intervention. The epidemiological data on this are lacking in China. Our study was designed to evaluate the changes of signs and symptoms of patients with benign prostate hyperplasia during management by watchful waiting in China. METHODS: One hundred and forty-five patients with benign prostate hyperplasia aged > 50 years were enrolled in management by watchful waiting. All the patients were visited every 6 months and were given an International Prostate Symptom Score and Quality of Life questionnaire to complete. They also had uroflowmetry and were assessed using ultrasonography to get the volume of prostate, transition zone and amount of residual urine. The Student's t test, the Chi-square test, and variance analysis were used in the statistical analysis. RESULTS: All patients were visited after 6 months, the mean volume of transitional zone was found to have increased by 1.6 ml (P < 0.01), International Prostate Symptom Score was increased by 0.8 (P < 0.01) and Quality of Life was increased by 0.2 (P < 0.01), and there was no statistical change in other data. Among these patients, 17.9% (26/145) visited again after 12 months when the data failed to show a statistically significant difference among the three groups (0, 6, and 12 months). CONCLUSIONS: After one year's follow-up, the progression of benign prostate hyperplasia was slow and the clinical data did not undergo much change.

Aged↗
PubMed2006

Metabolic factors associated with benign prostatic hyperplasia.

CONTEXT: Benign prostatic hyperplasia poses a significant public health problem, but its etiology remains unclear. Obesity and associated abnormalities in glucose homeostasis may play a role in benign prostatic hyperplasia development by influencing prostate growth. OBJECTIVE: The objective of this study was to determine whether obesity, fasting plasma glucose concentration, and diabetes are associated with radiologically determined prostate enlargement, an objective measure of benign prostatic hyperplasia. DESIGN: This study was a cross-sectional analysis with robust variance estimates to account for multiple measures over time in the same individuals. SETTING: This prospective cohort study was composed of community volunteers. PATIENTS: Patients studied were 422 adult men enrolled in The Baltimore Longitudinal Study of Aging. MAIN OUTCOME MEASUREMENTS: Total prostate volume as determined by pelvic magnetic resonance imaging was measured. RESULTS: Among 422 participants, 91 (21.6%) had prostate enlargement (defined as total prostate volume >/= 40 cc) at first visit. Compared with men of normal weight [body mass index (BMI) < 25 kg/m(2)], the age-adjusted odds ratio (OR) for prostate enlargement for overweight men (BMI, 25-29.9 kg/m(2)) was 1.41 (95% CI, 0.84-2.37), for obese men (BMI, 30-34 kg/m(2)) was 1.27 (95% CI, 0.68-2.39), and for severely obese men (BMI >/= 35 kg/m(2)) was 3.52 (95% CI, 1.45-8.56) (P = 0.01). Men with elevated fasting glucose (>110 mg/dl) were more likely to have an enlarged prostate than men with normal fasting glucose (</=110 mg/dl) (OR, 2.98; 95% CI, 1.70-5.23), as were men with a diagnosis of diabetes (OR, 2.25; 95% CI, 1.23-4.11). CONCLUSIONS: Obesity, elevated fasting plasma glucose, and diabetes are risk factors for benign prostatic hyperplasia.

Adult↗
PubMed2005

Photoselective vaporization of the prostate: a volume reduction analysis in patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia and carcinoma of the prostate.

PURPOSE: In this study preoperative and postoperative transrectal ultrasound prostate volume was evaluated in patients undergoing photoselective vaporization of prostate using an 80 W potassium-titanyl-phosphate (KTP) laser (Greenlight PV Laser System, Laserscope, San Jose, California) for obstructive uropathy secondary to benign prostatic hyperplasia or carcinoma of the prostate. MATERIALS AND METHODS: A total of 18 patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia (8) and carcinoma of the prostate (10) were treated with an 80 W quasicontinuous KTP laser. Preoperative and immediate postoperative treatment prostate volume measurements were recorded by transrectal ultrasound. The end point of treatment was complete vaporization of the obstructive adenoma to the level of the capsular fibers and the creation of an adequate transurethral resection-like prostatic cavity. KTP/532 laser energy was delivered by a side firing glass fiber through a 27Fr continuous flow resectoscope. Photoselective vaporization of the prostate using sterile water irrigation was performed with all patients under spinal anesthesia. Mean lasting time +/- SEM was 33.5 +/- 12 minutes (range 11 to 53). RESULTS: Mean preoperative prostate volume +/- SEM was 53.2 +/- 24.7 ml (range 23.6 to 110), while mean postoperative prostate volume was decreased to 26.2 +/- 14.8 ml (range 8 to 58) during a mean followup of 2.8 +/- 2.3 months (range 1 to 10), resulting in a 51% mean decrease in prostate volume, as measured by transrectal ultrasound. There was no significant intraoperative bleeding and no change in serum sodium postoperatively. One patient sustained a small capsular perforation with persistent venous bleeding, which could not be controlled with KTP laser. Because of poor vision, the procedure was completed with electroresection. Complications included mild dysuria in 2 patients (11%) and mild hematuria longer than 2 weeks in duration in 4 (22%). CONCLUSIONS: Photoselective prostate vaporization can effectively vaporize obstructive benign and malignant prostatic tissue, leading to a significant decrease in the total volume of the treated prostate (p = 0.000).

Aged↗
PubMed2004

Serum prostate specific antigen levels in men with benign prostatic hyperplasia and cancer of prostate.

OBJECTIVE: To determine the sensitivity, specificity and positive predictive value of the PSA test at the conventional cut-off value of 4 ng/ml. DESIGN: Retrospective study. SETTING: Nairobi Hospital Laboratory, Nairobi. DATA SOURCE: Results of serum Prostate specific Antigen (PSA), estimation and prostate histology specimens at the Nairobi Hospital Laboratory between January 1997 and December 1999. RESULTS: A total of 3309 PSA tests and 524 prostate biopsies were processed during the study period. One hundred cases had both PSA test and histology, where the PSA test was done before the surgical procedure. Forty nine of them had histological diagnosis of cancer of prostate (CAP) while 71 had benign prostate hyperplasia (BPH). There was considerable overlap in the PSA concentrations between the two groups, the ranges being 0.34-36 ng/ml and 1.78-4339 ng/ml for BPH and CAP respectively. 63.4% of BPH subjects had PSA concentrations above the 4 ng/ml threshold value; 29.6% being in the diagnostic gray zone of 4-10 ng/ml. In contrast only 6% of CAP subjects had PSA values in the gray zone. Using the 4 ng/ml cut-off, the sensitivity, specificity and positive predictive value of the PSA test were 89.8, 37 and 49% respectively. CONCLUSION: Although PSA is a sensitive test, it is not sufficiently specific to discriminate between BPH and CAP at intermediate values. Additional approaches are required to enhance its specificity for CAP screening without reducing the sensitivity.

Humans↗
PubMed1999

Subtype selective alpha1-adrenoceptor antagonists for the treatment of benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) is highly prevalent in the male population beyond the age of 60. Impairment of urinary flow due to prostate enlargement gives rise to symptoms of 'prostatism' that have a detrimental impact on the quality of life. The current trend in the management of symptomatic BPH favours pharmacotherapy as a first line option, while the number of surgical procedures being performed has experienced a steady decline during the last ten years. Among the pharmacological treatments, the use of alpha1-adrenoceptor blockers has demonstrated to be an effective treatment option for BPH. These agents reduce the adrenergic tone to the prostate and increase urinary flow, with a concomitant reduction of lower urinary tract symptoms. The alpha1-blockers currently approved include compounds such as alfuzosin, terazosin and doxazosin, originally developed for the treatment of hypertension, and more recently tamsulosin, an alpha1-subtype selective drug. The blockade of alpha1-adrenoceptors present in vascular smooth muscle is largely responsible for the most prominent side effects of current drugs, which can be severe and require patients dose titration. The limitation imposed by side effects naturally raises the possibility that complete blockade of prostatic alpha1 receptors is not attained at the maximum tolerated dose. The extensive efforts by the pharmaceutical industry towards the development of uroselective alpha1-blockers, is the subject of this review. Advances in the molecular cloning of genes encoding three alpha1-adrenoceptors led to the identification of the alpha1A-subtype as the predominant receptor responsible for the contraction of prostate smooth muscle. In preclinical animal models, selective alpha1A-antagonists have consistently been found to have minimal cardiovascular effects, thus providing a pharmacological rationale for uroselectivity. It has also become apparent, however, that uroselectivity can emerge in a poorly understood manner from the pharmacodynamic properties of compounds without alpha1A-subtype selectivity. Clinical experience with tamsulosin, an alpha1A/alpha1D selective drug, has failed to demonstrate a significant improvement in efficacy beyond that demonstrated for non-subtype selective alpha1-blockers, and gives support to the notion that alpha1A-selective antagonists might achieve greater efficacy for the treatment of BPH. Given the demonstrated uroselectivity of alpha1A-selective antagonists in preclinical models, it is anticipated that third generation alpha1-blockers will exhibit improved urinary flow efficacy and be better tolerated than tamsulosin. The extent to which the improvement in urinary flow will translate to the relief of symptoms of prostatism, however, remains to be demonstrated in randomised placebo-controlled clinical trials of alpha1A-selective antagonists.

Journal Article↗
PubMed1996

Laser irradiation for the treatment of benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) is one of the most common medical problems encountered in the United States. For many years, transurethral resection of the prostate (TURP) has been the mainstay of treatment for symptomatic BPH. In recent times, newer modalities of treatment in the form of drugs (a- blockers, LHRH-agonist, anti-androgens, 5 a-reductase inhibitors), microwave hyperthermia, prostatic stents, balloon urethroplasty, laser prostatectomy, and most recently High Intensity Focal Ultrasound (HIFU) and Trans Urethral Needle Ablation (TUNA) are challenging TURP as the gold standard therapy for BPH. Today, laser prostatectomy holds a special place in therapy of BPH, as it is easy to perform, safe to apply with a vastly improved patient compliance, and is the first choice in certain special circumstances, e.g., patients on anticoagulants. In this chapter we discuss the present status of laser prostatectomy for BPH.

Journal Article↗