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PubMed1990

Experimental treatment of benign prostatic hyperplasia with transurethral balloon dilation of the prostate: preliminary study in 73 humans.

A prospective noncontrolled study of the safety and potential efficacy of transurethral balloon catheter dilation of the prostate (TUDP) in the treatment of benign prostatic hyperplasia (BPH) was performed in 73 subjects with moderate to severe symptoms and signs of prostatism who were selected on the basis of a quantitative symptom score (SS), uroflowmetry measurements, and residual urine volume. Seven patients had urinary retention. Mean age was 69.6 years (range, 59-95 years). TUDP was successfully accomplished in 70 patients (96%). There were no significant complications. Mean follow-up was 16.2 months (range, 6-36 months). Forty-six patients (66%) showed improved SS at the most recent follow-up. In 24 patients (34%) SS was unimproved, necessitating prostatectomy in 17 subjects (24%). Reduction in mean residual urine volume was not statistically significant. Only 38% of patients with median lobe enlargement showed improvement in SS, compared with 74% for the others. The authors conclude that TUDP is safe and shows promising effectiveness and that the ultimate demonstration of effectiveness requires a controlled clinical trial.

Aged↗
PubMed1980

Levels of carbenicillin in serum and prostatic tissue after intravenous administration in patients with benign prostatic hyperplasia.

Carbenicillin (CB-PC) was administered intravenously (5 gm over one-half hour) to 25 patients suffering form benign prostatic hyperplasia. Prostatic biopsies and sera were obtained one, two, three, four, and five hours later for histology and biochemical analyses of the serum and prostatic tissue levels of CB-PC. The serum and prostatic tissue levels of carbenicillin attained were sufficient to eradicate gram-negative bacteria within the five time intervals studied. The ratio of prostatic tissue level of CB-PC to the serum level of this agent increased in proportion to the grading of round cell infiltration of the prostatic tissue. The results of this study point to the clinical usefulness of CB-PC in the treatment of chronic and acute prostatitis.

Carbenicillin↗
PubMed2006

A selective alpha1A-adrenoceptor antagonist inhibits detrusor overactivity in a rat model of benign prostatic hyperplasia.

PURPOSE: Alpha(1)-adrenoceptor antagonists relax the obstructed prostatic urethra and suppress the irritative symptoms frequently observed in patients with benign prostatic hyperplasia. We investigated the effects of 3 alpha(1)-adrenoceptor antagonists on urodynamics in rats with hormone induced benign prostatic hyperplasia to determine which alpha(1)-adrenoceptor subtype selective antagonists would suppress irritative symptoms. MATERIALS AND METHODS: Rats were treated with testosterone and 17beta-estradiol by weekly intramuscular injections. After 4 weeks a pressure flow study was done and the effects of the alpha(1)-adrenoceptor antagonists KMD-3213 silodosin, tamsulosin and prazosin on urodynamics were compared. We especially investigated the involvement of the bladder and prostatic urethra to clarify the mechanism of detrusor overactivity expression. RESULTS: Hormone treatment induced benign prostatic hyperplasia and resulted in detrusor overactivity, as determined by cystometry. Baseline perfusion urethral pressure and the phenylephrine induced increase in it were significantly higher in rats with vs without benign prostatic hyperplasia. Cystometry in hormone treated female rats did not show detrusor overactivity. KMD-3213 decreased detrusor overactivity, similar to other alpha(1)-adrenoceptor antagonists. CONCLUSIONS: These results suggest that an excessive response to sympathetic nerve stimulation, which is mainly mediated via alpha(1A)-adrenoceptor, in the hypertrophied prostate gives rise to detrusor overactivity. Furthermore, the alpha(1A)-adrenoceptor selective antagonist KMD-3213 would be suitable for improving irritative symptoms in patients with benign prostatic hyperplasia.

Adrenergic alpha-1 Receptor Antagonists↗
PubMed1994

Prostate specific antigen cannot distinguish stage T1a (A1) prostate cancer from benign prostatic hyperplasia.

To determine if serum prostate specific antigen (PSA) has decreased the prevalence of stages T1a (A1) and T1b (A2) prostate cancer, and to compare the PSA values for patients with stages T1a and T1b prostate cancer and men with symptomatic benign prostatic hyperplasia, 966 patients undergoing transurethral resection of the prostate were evaluated retrospectively. Included in the study population were 499 consecutive patients who underwent transurethral resection of the prostate for obstructive urinary symptoms in 1986 (no PSA group), and 467 consecutive patients who underwent resection in 1989 and 1990 who were evaluated with serum PSA preoperatively (PSA group). The mean age for the no PSA group was 71 years compared to 70 years for the PSA group (p = 0.36). The overall prevalence of stages T1a and T1b prostate cancer in the no PSA group was 8.6% compared to 10.3% in the PSA group (p = 0.37). The prevalence of stages T1a and T1b prostate cancer in the no PSA group was 3.6% and 5.0%, respectively, compared to 7.3% and 3.0%, respectively, for the PSA group (p = 0.01). In the PSA group the median PSA value for patients with stages T1a and T1b prostate cancer was 3.8 ng/ml compared to 3.4 ng/ml for the patients without cancer (p = 0.59). The median PSA level for the stage T1a cancer patients was 2.4 ng/ml, which was not statistically different from that in patients without cancer (p = 0.31), and the median PSA level for the stage T1b cancer patients was 5.9 ng/ml, which was statistically different than that in patients without cancer (p = 0.01). These findings suggest that the routine use of serum PSA does not decrease the prevalence of stage T1a prostate cancer and that PSA may decrease the prevalence of stage T1b tumors but a larger study would be necessary to document this finding.

Adult↗
PubMed1985

Androgen receptor content of nafoxidine treated experimentally induced canine prostatic hyperplasia.

An estrogen stimulated increase in prostatic androgen receptor content has been postulated as the mechanism by which canine prostatic hyperplasia can be induced in the castrate dog treated with androstanediol and estradiol but not by androstanediol alone. In order to determine if the potent anti-estrogen Nafoxidine would inhibit this estrogen-associated development of prostatic hyperplasia, 2 week castrate young mongrel male dogs were injected for 1 month with either a) carrier solution (group 1), b) Nafoxidine (group 2), c) androstanediol and estradiol (group 3), or d) androstanediol and estradiol and Nafoxidine (group 4). At the termination of the experimental period the prostates of the animals in groups 1 and 2 were small (3.1 +/- 0.3 g (X +/- SEM) and 8.6 +/- 1.4 g respectively) and were atrophic histologically. The prostates in groups 3 and 4 were significantly heavier (24.7 +/- 3.0 g and 23.6 +/- 3.6 g respectively) than those in groups 1 and 2 and displayed glandular hyperplasia histologically. The dihydrotestosterone content of the prostatic tissue in groups 1 and 2 were similar (4.65 +/- 2.01 ng/mg DNA (X +/- SEM) and 3.13 +/- 0.65 ng/mg DNA respectively) and were significantly less than that of groups 3 and 4 (19.98 +/- 4.70 ng/mg DNA and 19.62 +/- 2.42 ng/mg DNA). The prostates of groups 3 and 4 thus displayed gravimetric, histologic and biochemical evidence of prostatic hyperplasia.(ABSTRACT TRUNCATED AT 250 WORDS)

Androstane-3,17-diol↗
PubMed1991

Differences in the leucine aminopeptidase activity in extracts from human prostatic carcinoma and benign prostatic hyperplasia.

Extracts of tissue showed that prostatic carcinomas contain less leucine aminopeptidase activity than benign prostatic hyperplasia. This is true when activity is expressed as specific activity (P = 0.0033), specific activity/% epithelium (P = 0.0007), activity/wet weight of tissue (P = 0.0028), or activity/wet weight of tissue/% epithelium (P = 0.0005). Almost all histochemically demonstrable activity is located in the epithelium. Enzymatic activities in extracts and in histochemical preparations showed similar differences between carcinoma and benign prostatic hyperplasia and were related (R = -0.38, P = 0.0400) to Gleason's grades. The transurethrally resected prostate cancers studied contained no well-differentiated tumors and a high proportion of poorly differentiated tumors. Histochemical activity is absent in most prostatic carcinomas and decreased in others. This observation is particularly interesting in view of the growing knowledge of tumor suppressor genes.

Aged↗
PubMed2000

Doppler resistive index in benign prostatic hyperplasia: correlation with ultrasonic appearance of the prostate and infravesical obstruction.

OBJECTIVE: This study was designed to characterize the resistive index (RI) of prostatic blood flows obtained by transrectal power Doppler sonography (TRPDS) in benign prostatic hyperplasia (BPH). METHOD: In 140 patients with lower urinary tract symptoms, the RI was measured using TRPDS and compared with age and planimetric parameters of the prostate obtained by conventional transrectal sonography. In addition, the RI was related with pressure flow studies. RESULTS: The RI was significantly higher in patients with BPH (0.72+/-0.06, p<0.0001) than those with a normal prostate (0. 64+/-0.04). Although the RI correlated significantly with age and all prostatic planimetric parameters, multiple regression analysis revealed that age and presumed circle area ratio were independent predictors for RI. The RI was also higher in patients with infravesical obstruction than those without (0.74+/-0.06 vs. 0. 70+/-0.05, p<0.005). There was a significant correlation between RI and urodynamic parameters obtained in pressure flow studies. Out of 33 patients with obstruction, 28 (85%) had an RI of 0.7 or more, while 11 out of 24 patients (46%) without obstruction had an RI less than 0.7. CONCLUSION: The RI is promising as a new parameter to estimate the intraprostatic pressure to investigate BPH. Its value to represent urodynamic information during voiding remains to be studied.

Aged↗
PubMedDate not supplied

[Medical therapy of benign prostatic hyperplasia].

The aim of treatment for benign prostatic hyperplasia is relieving lower urinary tract symptoms, desreasing bladder outlet obstruction, improving bladder emptying, ameliorating detrusor instability, reversing renal insufficiency, and preventing future episodes of gross hematuria, urinary tract infection and urinary retention. A potent role of medical therapy is to prevent the development and/or progression of benign prostatic hyperplasia. Medical therapies investigated for benign prostatic hyperplasia include plant extracts, alpha adrenergic blockers and 5-alpha-reductase inhibitors. Clinical observations suggest that the efficacy of combination therapy could be superior to that of individual monotherapies.

5-alpha Reductase Inhibitors↗
PubMed1998

The University of Tennessee experience with the Indigo 830e laser device for the minimally invasive treatment of benign prostatic hyperplasia: interim analysis.

Benign prostatic hyperplasia (BPH) is the most common benign tumor in men and is responsible for urinary symptoms in the majority of men older than 50 years of age. Although transurethral resection of the prostate (TURP) is the gold standard, its complications have impacted upon its utility. As a consequence, new pharmacologic and minimally invasive approaches to the management of BPH have been developed. One minimally invasive approach that employs interstitial laser coagulation by the Indigo 830e LaserOptic system heats the prostate to the point of irreversible necrosis while preserving the urethral lining, potentially resulting in fewer complications. To test the efficacy of this device we evaluated the interim results obtained in 25 patients treated for BPH. Parameters evaluated included the AUA symptom score, uroflowometry, post-void residual, and prostate size. Following treatment, patients were discharged home and the catheter was removed within 3-7 days. Patients were assessed at 1 month and at subsequent 3-month intervals following the procedure using a questionnaire, AUA symptom score, and uroflowometry. The results of the paired t-tests demonstrated a significant increase in the maximal and average flow rates from baseline. The mean baseline maximal flow rate was 8.3 ml/s and increased to 10, 12.7, 14.1, and 12.0 ml/s at 1, 3, 6, and 9 months, respectively, and the mean baseline average flow rate was 4.4 ml/s and increased to 5.3, 6.0, 6.6, and 6.2 ml/s at 1, 3, 6, and 9 months, respectively. The AUA symptom scores decreased from 20.2 to 9.8 at 9 months. There was no intraoperative complication. Six patients developed transient retention. No patient developed bladder neck contractures, urinary incontinence, impotence, or urinary tract infections. One patient developed retrograde ejaculation and one patient required retreatment by TURP. Hence, improvements in symptom scores and voiding parameters suggest that the laser interstitial coagulation prostatectomy is safe and effective for the treatment of BPH.

Academic Medical Centers↗
PubMed1979

Concentration of dihydrotestosterone and 3 alpha-androstanediol in naturally occurring and androgen-induced prostatic hyperplasia in the dog.

Previous studies have suggested that dihydrotestosterone accumulation in the prostate may be involved in the pathogenesis of prostatic hyperplasia in man and dog. However, the fact that the administration of 10 mg dihydrotestosterone/d to castrated, mongrel dogs (0.5 mg/kg body wt) causes little growth in the prostate, whereas identical doses of 3alpha- androstanediol regularly induce prostatic hyperplasia (> 14 g weight) has raised the possibility that the dihydrotestosterone accumulation may be the result rather than the cause of the pathology. To investigate the mechanism of this phenomenon, we measured the levels of dihydrotestosterone and 3alpha-androstanediol in prostates from 75 dogs. In both naturally occurring and 3alpha-androstanediol-induced prostatic hyperplasia, the levels of dihydrotestosterone were high (>5 ng/g), whereas in immature glands and glands from dihydrotestosterone-treated animals, levels were similar (2.1 and 2.6 ng/g, respectively). 3alpha-Androstanediol levels were no different in animals treated with dihydrotestosterone or 3alpha-androstanediol.Therefore, because exogenous 3alpha-androstanediol is a better precursor of prostatic dihydrotestosterone than exogenous dihydrotestosterone itself, the effects of treatment with larger doses (2.5 mg/kg per d) of dihydrotestosterone and 3alpha-androstanediol for 12 wk were examined. In these amounts, dihydrotestosterone was as effective as 3alpha-androstanediol in inducing the development of prostatic hyperplasia and in elevating prostatic dihydrotestosterone concentration. Because dihydrotestosterone accumulates in spontaneous prostatic hyperplasia, because the administration of sufficient amounts of dihydrotestosterone to the castrated dog can induce the development of prostatic hyperplasia, and because 3alpha-androstanediol induces the development of hyperplasia via conversion to dihydrotestosterone, we conclude that accumulation of dihydrotestosterone is the cause of canine prostatic hyperplasia.

Androstenediols↗
PubMed1998

Overview of alpha-blocker therapy for benign prostatic hyperplasia.

Management of benign prostatic hyperplasia (BPH) is rapidly changing. Established surgical procedures are being replaced by minimally invasive modalities such as electrovaporization and transurethral needle ablation. Improved understanding of pathophysiology and developments in molecular biology has provided drugs for alleviating the symptoms of prostatic enlargement. Currently, medical therapy is the first-line treatment modality in the management of BPH. There are two types of medical treatment available: alpha-adrenoceptor-blockers and 5-alpha-reductase inhibitors. Alpha-blockers relieve the dynamic component of obstruction whereas 5-alpha-reductase inhibitors relieve the mechanical component of obstruction. At present, alpha-blockers are used most frequently. However, they do have significant cardiovascular side effects. More uroselective alpha-blockers have recently become available and may reduce the risk of cardiovascular side effects. This review summarizes relevant literature on the use of alpha-blockers in the treatment of BPH.

Adrenergic alpha-Antagonists↗
PubMed2001

Future concepts in the medical therapy of benign prostatic hyperplasia.

The standard medical therapy for symptomatic benign prostatic hyperplasia is still alpha-blockers and 5alpha-reductase inhibitors. Ongoing studies demonstrate the long-term safety and efficacy of these two classes of therapeutic approaches. Although there have been no new Food and Drug Administration approved medical therapies for the treatment of benign prostatic hyperplasia over the past year, interest in and the use of phytotherapeutic agents continues to increase. In this review, we will discuss the developments that have occurred over the past year in the medical management of benign prostatic hyperplasia. In addition, we present ongoing efforts at our center to obtain a better understanding of and manipulate the apoptotic pathway as it pertains to the pathophysiology of benign prostatic hyperplasia.

3-Oxo-5-alpha-Steroid 4-Dehydrogenase↗
PubMed1999

Can the intraprostatic concentration of epidermal growth factor influence the variance of serum prostate specific antigen levels in patients with benign prostatic hyperplasia?

PURPOSE: Except for prostate volume, little is known about the factors influencing serum prostate specific antigen (PSA) levels. Considering that dihydrotestosterone and epidermal growth factor are regulators of the proliferation and differentiation in the epithelial component of human prostate tissue and that PSA is produced only by the epithelial cells of the gland, studies were performed on patients with a histological diagnosis of benign prostatic hyperplasia (BPH) to establish whether a significant association exists between the intraprostatic concentration of dihydrotestosterone or epidermal growth factor and serum PSA levels. MATERIALS AND METHODS: A total of 20 patients with BPH who had not been previously treated were part of a larger study on the correlation among PSA, prostate volume and age, and were evaluated according to the algorithm in the guidelines of the international consultation on BPH. All men underwent open suprapubic prostatectomy to enucleate the entire adenoma and in each case sections were made in the periurethral, subcapsular and intermediate zones of the BPH tissue. Dihydrotestosterone and epidermal growth factor concentrations were evaluated by radioimmunoassay in the periurethral zone and in total BPH tissue. RESULTS: In these 20 patients with BPH serum PSA levels were significantly associated with epidermal growth factor but not with dihydrotestosterone concentrations in total BPH tissue (r = 0.7762, p = 0.00002836 and r = 0.3923, p = 0.0956307, respectively). A stronger association was found between PSA levels and the periurethral concentration of epidermal growth factor and dihydrotestosterone (r = 0.8117, p = 0.000005 and r = 0.5656, p = 0.0098326, respectively). On the contrary, epidermal growth factor and dihydrotestosterone were not significantly associated with prostate volume (p = 0.957415 and p = 0.531439, respectively). CONCLUSIONS: To our knowledge this study is the first report in the literature to demonstrate an association between serum PSA, and dihydrotestosterone and epidermal growth factor levels, particularly in the periurethral zone of human BPH tissue. These data suggest the importance of epidermal growth factor and dihydrotestosterone in influencing serum PSA levels.

Aged↗
PubMed1994

Morphometric quantitation of stroma in human benign prostatic hyperplasia.

OBJECTIVES: Human benign prostatic hyperplasia (BPH) consists of three major histologic components: stroma, epithelium, and luminal space. For the relief of bladder outlet obstruction caused by BPH, quantitation of the histologic composition of BPH may aid in selecting treatment. To investigate variation between patients in the stromal percentage of BPH, we performed quantitative morphometry on specimens from patients with clinically significant bladder outlet obstruction obtained by three procedures: open prostatectomy, transurethral resection of the prostate (TURP), and prostate needle biopsy (PNB) just prior to TURP. METHODS: Ten specimens obtained by each surgical procedure were analyzed. Specimens were stained with antibody to muscle-specific actin to mark the stroma; quantitation of stroma was accomplished by computer image analysis. RESULTS: The percentage of stroma in all BPH cases ranged from 49.9% to 76.7% (mean, 65.4%, SD = 7.4). No significant difference was observed when comparing samples obtained by the three procedures (p = 0.70). Smooth muscle stromal composition was also quantified in PNB specimens. For these samples, a significant inverse relationship was found between the percentage stroma in the biopsy and the percentage of stroma composed of smooth muscle (r2 = 0.49; p = 0.021). CONCLUSIONS: The data demonstrated that the largest component of BPH was stroma, which comprised approximately 50% to 75% of the total hyperplastic tissue. The mean and range of stromal percentage were similar whether investigating large tissue samples from open prostatectomies or small samples from needle biopsies. PNB data indicated that an increased percentage of stroma may be due to increased nonmuscular elements in the stroma.

Antibodies, Monoclonal↗
PubMedDate not supplied

[A computer program for the support of the treatment-diagnosis process for patients with benign prostatic hyperplasia].

The computer program "Prostate" (Windows, 1.0 version) is designed to assist the urologist in: objective assessment of the lower urinary tract in benign prostatic hyperplasia (BPH), accumulation and storage of information on the patients (data file), comparison (text, graphics) with previous data to control the course of the disease, treatment efficacy, to refer to international recommendations and recent advances in the treatment of both BPH and its complications. The status of the lower urinary tract is to be described basing on the IPSS and QOL tables, PSA findings, rhythm of spontaneous uresis, uroflowmetry, residual urine, prostate size, laboratory and microbiological urinalysis. The program "Prostate" is a new step in medical recording and efficacy of BPH treatment assessment in urology.

Diagnosis, Computer-Assisted↗
PubMed1994

Role of the sympathetic nervous system in hypertension and benign prostatic hyperplasia.

Hypertension and benign prostatic hyperplasia (BPH) have a number of features in common. For example, both occur with increasing frequency in the elderly, and both are a major source of health expenditure worldwide. However, the most striking feature linking hypertension and BPH is the aetiological role of the sympathetic nervous system. Sympathetic tone mediated by the alpha-receptor is vital in the control of blood pressure. By selectively inhibiting the alpha 1-adrenoceptors in the vasculature, thereby inhibiting the response to epinephrine and norepinephrine and thus reducing peripheral resistance, selective alpha 1-inhibitors such as doxazosin produce a physiological reduction in blood pressure. Receptors of the alpha 1 subtype are also found in the prostate, the urethra and bladder neck. Doxazosin, by reducing the tone of the prostatic smooth muscle, has the potential to improve urinary flow rate, as well as the obstructive and irritative symptoms characteristic of BPH.

Adrenergic alpha-Antagonists↗
PubMed1995

A comparison of transurethral surgery with watchful waiting for moderate symptoms of benign prostatic hyperplasia. The Veterans Affairs Cooperative Study Group on Transurethral Resection of the Prostate.

BACKGROUND: Transurethral resection of the prostate is the most common surgical treatment for benign prostatic hyperplasia. We conducted a multicenter randomized trial to compare this surgery with watchful waiting in men with moderate symptoms of benign prostatic hyperplasia. METHODS: Of 800 men over the age of 54 years who were screened between July 1986 and July 1989, 556 (mean [+/- SD] age, 66 +/- 5 years) were studied (280 in the surgery group and 276 in the watchful-waiting group). Patients' symptoms and the degree to which they were bothered by urinary difficulties were measured with standardized questionnaires and medical evaluations. The primary outcome measure was treatment failure, which was defined as the occurrence of any of the following: death, repeated or intractable urinary retention, a residual urinary volume over 350 ml, the development of bladder calculus, new and persistent incontinence, a high symptom score, or a doubling of the serum creatinine concentration. Patients were followed for three years. RESULTS: Of the men randomly assigned to the surgery group, 249 underwent surgery within two weeks after the assignment. Surgery was not associated with impotence or urinary incontinence. The average follow-up period was 2.8 years. In an intention-to-treat analysis, there were 23 treatment failures in the surgery group, as compared with 47 in the watchful-waiting group (relative risk, 0.48; 95 percent confidence interval, 0.30 to 0.77). Of the men assigned to the watchful-waiting group, 65 (24 percent) underwent surgery within three years after the assignment. Surgery was associated with improvement in symptoms and in scores for urinary difficulties and interference with activities of daily living (P < 0.001 for all comparisons). The outcomes of surgery were best for the men who were most bothered by urinary symptoms at base line. CONCLUSIONS: For men with moderate symptoms of benign prostatic hyperplasia, surgery is more effective than watchful waiting in reducing the rate of treatment failure and improving genitourinary symptoms. Watchful waiting is usually a safe alternative for men who are less bothered by urinary difficulty or who wish to delay surgery.

Aged↗