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At least 415 records · Page 23Linked to original sources
PubMed2003

Distribution of inflammation, pre-malignant lesions, incidental carcinoma in histologically confirmed benign prostatic hyperplasia: a retrospective analysis.

OBJECTIVES: We analyze our experience on BPH through 20 years of histopathological examinations performed by the same pathologist. METHODS: We retrospectively reviewed all histopathological examinations performed from January 1979 to December 1998 in patients undergoing surgery in our urological clinic who were diagnosed with BPH. We limited our evaluation to the following variables in each BPH case analyzed: inflammatory aspects associated with BPH, presence of focal acinar atrophy, atypical adenomatous hyperplasia (AAH), prostatic intraepithelial neoplasia (PIN), incidental prostate carcinoma (IC). These histological variables were analyzed according to some clinical parameters such as age, prostate volume and serum PSA. RESULTS: The study population was comprised of 3942 cases with histological diagnosis of BPH. The mean patient age was 68.85+/-7.67 years. In particular, inflammatory aspects were associated with BPH in a high percentage of cases (43.1% =1700 cases), predominantly as chronic inflammation. Observation of focal acinar atrophy significantly increased according to patient decade of age (p=0.027). There was a significant trend to increase with age decades (p=0.036) for high grade PIN. A significant difference was found in IC (T1a, T1b) distribution in the different decades of age and especially in regards to both T1a and T1b tumors, there was a trend to increase with patient age (p=0.020 and p=0.025, respectively). On the contrary, the distribution of inflammatory aspects (p<0.001) and AAH (p=0.003) significantly varied according to prostate volume, and particularly in regards to chronic inflammation, there was a trend to increase depending on the prostate volume (p=0.002). Only the presence of T1b tumor but not of the other histological parameters associated to BPH, was able to significantly influence serum PSA. CONCLUSION: In our analysis different histological variables associated to BPH are differently influenced by the age of patients and prostate volume, and they differently influence serum PSA levels.

Age Factors↗
PubMedDate not supplied

[Optimal treatment of benign prostatic hyperplasia (BPH) with comorbid chronic prostatitis (category IIIA)].

The trial of efficacy of physical factors in combined treatment of BPH stage I patients with concomitant abacterial chronic prostatitis (category IIIA) enrolled 42 patients who were divided into two groups. Group 1 received combined treatment including complex physical factors (CAP-ELM-01). The efficacy of the treatment was judged by dynamics of clinical and device indices and severity of leading CP syndromes. It is shown that physical factors contributed to noticeable improvement in the parameters of prostatic secretion, uroflowmetry, size of the prostate, hemodynamics, clinical manifestations of chronic prostatitis.

Chronic Disease↗
PubMed1980

[Possibilities for the evaluation of receptor sites in benign prostatic hyperplasia and carcinoma of the prostate (author's transl)].

Cytoplasmic and nuclear receptor sites of the prostate will be determined for a qualitative information about the pattern of specific bindings. Their qualitative evaluation and their selective suppression will give an idea about the hormonal influence and regulation in prostatic tissue. These investigations are performed in some cases of prostatic cancer. The difficulty of tissue preparation is caused by the individual distribution of collagen tissue in prostatic cancer which will decide the yield of purified receptor sites. Besides the elemination of unspecific binding sites like SHBG and albumin is an evidence for the value of a method. According to high amount of binding sites the most effective preparation of patients before a tissue biopsy is discussed. For the clinical application the DCC test in case of cytoplasmic sites and the exchange test for nuclear sites seem to provide a suitable method. Performing gelfiltration and additional test with denatured material is necessary because of the similar size of SHBG and receptor complexes interfering the results.

Binding Sites↗
PubMed2002

Long-term (7 to 8-year) experience with finasteride in men with benign prostatic hyperplasia.

OBJECTIVES: To evaluate the effects of finasteride, a specific type II 5-alpha-reductase inhibitor, on symptoms of benign prostatic hyperplasia, prostate volume, and urinary flow during a 7 to 8-year period. METHODS: A total of 190 men with symptomatic benign prostatic hyperplasia and enlarged prostates entered one of two Phase II double-blind 3 to 6-month studies. Of these, 156 patients continued taking open-label finasteride, and more than 70 patients completed 7 to 8 years of treatment. The symptoms were scored using a patient self-administered modified Boyarsky symptom questionnaire. Prostate volume was measured by magnetic resonance imaging or ultrasonography, and the maximal urinary flow rate was assessed noninvasively. RESULTS: Treatment with finasteride for 7 to 8 years led to sustained improvement in symptoms, reduction in prostate volume (28% from baseline), and increased urinary flow (median 2.5 mL/s from baseline). Decreases in dihydrotestosterone (86%) and prostate-specific antigen (54%) levels were also maintained. Long-term finasteride treatment was safe and generally well tolerated. CONCLUSIONS: Long-term treatment with finasteride was well tolerated and resulted in durable symptom relief and improvement in prostate volume and urinary flow.

Adult↗
PubMed2000

Dihydrotestosterone and the concept of 5alpha-reductase inhibition in human benign prostatic hyperplasia.

OBJECTIVE: The development of the human benign prostatic hyperplasia clearly requires a combination of testicular androgens and aging. Although the role of androgens as the causative factor for human benign prostatic hyperplasia is debated, they undoubtedly have at least a permissive role. The principal prostatic androgen is dihydrotestosterone (DHT). Although not elevated in human benign prostatic hyperplasia, DHT levels in the prostate remain at a normal level with aging, despite a decrease in the plasma testosterone. RESULTS: DHT is generated by reduction of testosterone. Two isoenzymes of 5alpha-reductase have been discovered. Type 1 is present in most tissues of the body where 5alpha-reductase is expressed and is the dominant form in sebaceous glands. Type2 5alpha-reductase is the dominant isoenzyme in genital tissues, including the prostate. Finasteride is a 5alpha-reductase inhibitor that has been used for the treatment of benign prostatic hyperplasia and male-pattern baldness. At doses used clinically, its major effect is through suppression of type 2 5alpha-reductase, because it has a much lower affinity for the type 1 isoenzyme. Finasteride suppresses DHT by about 70% in serum and by as much as 85-90% in the prostate. The remaining DHT in the prostate is likely to be the result of type 1 5alpha-reductase. Suppression of both 5alpha-reductase isoenzymes with GI198745 result in greater and more consistent suppression of serum dihydrotestosterone than that observed with a selective inhibitor of type 2 5alpha-reductase. Physiological and clinical studies comparing dual 5alpha-reductase inhibitors, such as GI198745, with selective type 2, such as finasteride, will be needed to determine the clinical relevance of type 1 5alpha-reductase within the prostate. Two large international multicenter, phase III trials have been published documenting the safety and efficacy of finasteride in the treatment of human benign prostatic hyperplasia. Combining these two studies, randomized, controlled data are available for 12 months. Noncontrolled extension of these data from a subset of patients, who elected to continue drug treatment for 3, 4 or 5 years, are also available. Long-term medical therapy with finasteride can reduce clinically significant endpoints such as acute urinary retention or surgery. According to the meta-analysis of six randomised clinical trial with finasteride, finasteride is most effective in men with large prostates. A more effective dual inhibitor of type 1 and 2 human 5alpha-reductase may lower circulating DHT to a greater extent than finasteride and show advantages in the treatment of human benign prostatic hyperplasia and other disease states that depend on DHT. CONCLUSION: Clinical evaluation of potent dual 5alpha-reductase inhibitors may help define the relative roles of human type 1 and 2 5alpha-reductase in the pathophysiology of benign prostatic hyperplasia and other androgen-dependent diseases.

3-Oxo-5-alpha-Steroid 4-Dehydrogenase↗
PubMed1996

A comparison of transurethral resection of the prostate and medical treatment for the patient with moderate symptoms of benign prostatic hyperplasia.

Transurethral resection of the prostate is the most common surgical treatment for benign prostatic hyperplasia. We conducted a prospective randomized clinical trial to compare this surgery with medical treatment in men with moderate symptoms of benign prostatic hyperplasia. Of 98 men over the age of 54 years who were screened between June 1993 and June 1995, 53 were studied (25 in the surgery group and 28 in the medication group). Patients' symptoms and the degree to which they were bothered by urinary difficulties were measured with standardized questionnaires and medical evaluations. The men randomly assigned to the surgery group underwent surgery within 2 weeks after the assignment. Surgery was not associated with an impotence or urinary incontinence. The follow-up period was 1 year. Surgery was significantly associated with improvement in residual urinary volume and peak flow rate; and also in the scores for urinary difficulties, sexual performance and interference with activities of daily living (P < 0.001 for all comparisons). We concluded that for patients with moderate symptoms of benign prostatic hyperplasia, surgery is more effective than medication in improving genitourinary symptoms and enhancing the quality of life. Thus, medication as treatment should be reserved for patients who are less bothered by urinary difficulty or who wish to delay surgery.

Chlormadinone Acetate↗
PubMed2001

[Expression of COX-2 in prostatic cancer and benign prostatic hyperplasia].

OBJECTIVE: To investigate the expression of COX-2 in and benign prostatic hyperplasia and prostate cancer and its clinical implications. METHODS: Forty-two patients with and benign prostatic hyperplasia and 16 with prostate cancer were studied by immunohischemistry and western blot. RESULTS: Immunohischemiscal study showed positive results in 15 of the 16 patients and 11 of the 42 patients. Western blot showed that the expression of COX-2 was higher in prostate cancer than in and benign prostatic hyperplasia tissues(P < 0.01). CONCLUSION: Overexpression of COX-2 in prostate cancer may be related to the staging of prostate cancer.

Blotting, Western↗
PubMed1991

[A case of prostatic hyperplasia in a young male].

Prostatic hyperplasia in young males is a very rare disease. A 28-year-old man was admitted to our hospital on June 24, 1989, with the chief complaints of intermittent macrohematuria and dysuria. Endoscopic examination revealed two papillary tumors in the prostatic urethra; no urinary bladder tumor was found. A transurethral resection was done for the urethral tumors. Pathological examination revealed prostatic hyperplasia. These lesions were considered ectopic prostatic tissue at first. However, imaging showed that this may in fact be prostatic hyperplasia of the apical region near the capsule. The post-operative course was uneventful and he is presently observed as an outpatient. This patient represents the seventh case reported in the literature.

Adult↗
PubMed1998

Induction of atypical prostatic hyperplasia in rats by sympathomimetic stimulation.

BACKGROUND: Prostatic innervation may participate in its homeostasis and growth. alpha-Adrenergic inhibition alleviates clinical symptoms in benign prostatic hyperplasia. However, the prostatic effect of adrenergic agonists has not been investigated. This study deals with the prostatic effect of subchronic sympathomimetic stimulation. METHODS: Male rats received daily subcutaneous injections of the alpha-adrenergic agonist phenylephrine, 1, 10, or 20 mg/kg per day, the beta-adrenergic agonist isoproterenol, 1, 2.5 or 5 mg/kg per day, or saline, for 30 days, and the prostates were removed for histopathological examination. RESULTS: Phenylephrine induced atypical prostatic hyperplasia, characterized by piling-up with papillary and cribriform patterns, and budding-out of epithelial cells. It decreased prostatic secretions and total weight. Similar results were observed in orchidectomized rats receiving exogenous testosterone supplementation. Isoproterenol had no prostatic morphological effect. CONCLUSIONS: These results raise the possibility that sympathetic stimuli play a role in normal and aberrant growth and differentiation of prostatic epithelium, and suggests neurostimulants-treated animals as a model to study the etiology and development of prostatic hyperplasia.

Adrenergic alpha-Agonists↗
PubMed2002

The pathophysiology of benign prostatic hyperplasia.

The development of human benign prostatic hyperplasia and its related signs and symptoms clearly requires a combination of testicular androgens and aging. Although the role of androgens as a causative factor for human benign prostatic hyperplasia is debated, they undoubtedly play at least a permissive role. The principle prostatic androgen is dihydrotestosterone. Two isoenzymes of 5-alpha reductase have been discovered. Type 2 is dominant in the genital issue. Testosterone is reduced by the 5-a reductase to dihydrotestosterone. Benign prostatic hyperplasia is predominantly due to stromal hyperplasia of the gland and affects more than 70% of men of 70 years or older with or without obstruction. Recent studies identified transforming growth factor-b, fibroblast growth factor and insulin-like growth factor family members as key regulators of cell proliferation and extracellular matrix turnover with interrelated activities. Furthermore, estrogens, andenergic signaling and inflammatory processes have been shown to have an impact. Without a solid understanding of the physiology and pathophysiology of benign prostatic hyperplasia it can be difficult to interpret the results of clinical trials and symptoms.

Aging↗
PubMed2002

[Effect of drug therapy on lower urinary tract symptoms indicating the presence of benign prostatic hyperplasia in transurethral resection of the prostate].

OBJECTIVE: Medical therapy of lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) has fundamentally changed. The aim of the study is to verify the suggestion that the medical therapy delayed the need of operative treatment and led to changes in characteristics of patients in need of surgery, or whether it had possibly caused deterioration of the results of surgery. MATERIAL AND METHODS: A group of 137 patients treated by TURP in 1991 (before medical therapy was introduced in Slovakia) was compared with a group of 122 patients treated by TURP in 2001 when medical therapy was offered as the primary initial therapy. We evaluated the patient's age, co-morbidity, type and length of medical therapy of LUTS, indications for operation, the weight of the resected tissue, the length of urinary bladder drainage after the operation and the period of hospitalisation. RESULTS: Patients in 2001 were on average 3.1 years older (p = 0.007), co-morbidity was present in 68.6% patients in 1991 compared to 85.2% in 2001 (not significant), and TURP for objective indications was done in 58.4% of patients in 1991 and in 50% in 2001. In 2001 71 out of 122 (58.2%) patients received medical therapy and 30 of them (24.6%) were operated on for objective indications. The weight of the resected tissue was 20.2 +/- 13.2 grams in 1991 and 24.6 +/- 15.4 grams in 2001 (p = 0.027). In 1991 the catheter was removed 4.5 +/- 1.8 days after the operation compared to 3.1 +/- 2.2 days in 2001 (p = 0.0001). The duration hospitalisation in 1991 was 7.7 +/- 5.7 days compared to 5.2 +/- 3.2 in 2001 (p = 0.0001). CONCLUSIONS: Patients receiving medical therapy have surgery at a higher age. The higher age of patients was not related to co-morbidity or the increased number of operations for objective indications, nor did the complications during surgery increase. On average more of the prostatic tissue was removed and the period of hospitalisation was shorter.

Aged↗
PubMed2003

New innovative therapies for benign prostatic hyperplasia: any advance?

PURPOSE OF REVIEW: Benign prostatic hyperplasia is the most common human neoplasm and it is the most frequent tumour requiring surgical treatment in men. Not surprisingly, interest centres on either understanding of prostatic growth during ageing or on various medical or interventional treatments. RECENT FINDINGS: Recent publications describe the interaction of various 5alpha-reductase inhibitors on the two 5alpha-reductase isoforms type 1 and 2, giving a potential new insight into the pathogenesis of benign prostatic hyperplasia. Likewise, chronic inflammation increases growth patterns of fibromuscular tissue in benign prostatic hyperplasia similar to wound healing, and a paracrine loop for chronic inflammation with overexpression of interleukin could be identified. This could be of particular importance in the further understanding of prostatic enlargement. Herbal drug treatment for lower urinary tract symptoms seems to be more effective than previously thought. According to recent publications the effectiveness is well beyond placebo effects. Likewise, alpha-blockers play an important role in treatment of lower urinary tract symptoms with alpha-1 adrenoreceptor antagonists preventing cell proliferation and apoptotic imbalances in prostatic tissue. The effect of alpha-blockers, however, may be limited by severe bladder outlet obstruction with patients at increased risk of treatment failure. Laser prostatectomy and microwave thermotherapy are under consideration as alternative treatments of benign prostatic hyperplasia. The efficacy of urodynamically proven de-obstruction as compared with transurethral resection of the prostate needs to be evaluated. Newer alternative treatments like ethanol installation or bipolar plasma kinetic vaporization have been described, but long-term results and larger patients cohort are still lacking. SUMMARY: New insights into prostatic growth and pathogenesis of benign prostatic hyperplasia are presented. Medical treatment and interventional therapies are evaluated for their safety and efficacy. Only a few new therapeutical options, however, have been published during this review period.

Adrenergic alpha-Antagonists↗
PubMed1998

Establishment and characterization of immortalized human cell lines from prostatic carcinoma and benign prostatic hyperplasia.

New human prostate cell lines were developed from prostatic carcinoma (BRF-41T) and BPH (BRF-55T). Primary cultures were initiated from cellular outgrowths of explanted tissues. A serum-free medium, BRFF-HPC1, was developed for growing human prostatic cancer cells. Cell strains were immortalized with pRSV-T plasmid to generate permanent cell lines that exhibited an epithelial morphology. Both cell lines expressed the epithelial cell markers, cytokeratins 8 and 18 as well as the prostatic marker, PSA, and the androgen receptor gene. They possess the H-ras, K-ras, and p53 genes. We hope that these new human prostatic cell lines will be useful as in vitro models for cancer research.

Cell Culture Techniques↗