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PubMed1996

[Relationship between the quantitative morphometry and the clinical response to alpha adrenergic blocker in benign prostatic hyperplasia].

BACKGROUND: There have been few reports on the relationship between the prostatic tissue components and the effect of alpha adrenergic blocker on urination. The present study was undertaken to correlate the rates of the prostatic tissue components and the clinical response to alpha adrenergic blocker in benign prostatic hyperplasia. METHODS: 40 patients with symptomatic benign prostatic hyperplasia were treated with 0.2 mg/day tamsulosin, a alpha adrenergic blocker, for 4-8 weeks followed by transurethral resection of the prostate. The mean weight of resected prostatic tissues was 25.2 g (range 5-96 g). Specimens were stained with antibodies to muscle-specific actin and to prostate-specific antigen for the detection of the smooth muscle and the glandular epithelium, respectively. Double-immunoenzymatic stained tissue sections were divided into four groups: smooth muscle, connective tissue, glandular epithelium, and glandular lumen. The rates of the areas of respective prostatic tissue components were evaluated with computer-assisted quantitative color image analysis. RESULTS: The mean rate of the area of smooth muscle, connective tissue, glandular epithelium, and glandular lumen was 32.7%, 46.9%, 10.8%, and 9.6%, respectively. International prostatic symptom score, maximum flow rate and residual urine volume before the treatment were not related to the rates of respective prostatic tissue components. International prostatic symptom score and residual urine volume were reduced and maximum flow rate was increased after the treatment with tamsulosin. A significant relationship was proved between the rate of smooth muscle and the change in maximum flow rate. The large hyperplastic adenoma contained less smooth muscle and showed a lower sensitivity to alpha adrenergic blocker than the small one. CONCLUSION: The clinical response to alpha adrenergic blocker was related to the rate of smooth muscle in benign prostatic hyperplasia.

Adrenergic alpha-Antagonists↗
PubMed1977

Rectal invasion by benign prostatic hyperplasia.

Rectal invasion by benign prostatic hyperplasia occurred subsequent to an open transrectal biopsy of the prostate gland. Frequent transrectal resections of the prostate controlled this unusual lesion initially. However, massive intrarectal regrowth of this clinically malignant but histologically proved benign prostatic enlargement required eventual pelvic exenteration.

Humans↗
PubMedDate not supplied

Doxazosin: a new approach to hypertension and benign prostatic hyperplasia.

Doxazosin, a selective alpha 1-adrenoceptor antagonist, is an established first-line antihypertensive agent that is being introduced for the management of benign prostatic hyperplasia. Hypertension and benign prostatic hyperplasia are linked by the sympathetic nervous system, which has an aetiologic role in both conditions. The alpha 1-adrenoceptor is a mediator of increased tension, both in vascular and prostatic smooth muscle. Studies have shown that doxazosin, through its balanced action on alpha 1-adrenoceptor subtypes, reduces blood pressure and improves other risk factors for coronary heart disease, such as lipid profile, insulin sensitivity, left ventricular hypertrophy, platelet aggregation and fibrinolysis. Data are now accumulating to show that doxazosin improves urinary flow rates and symptoms in patients with benign prostatic hyperplasia. These effects have been demonstrated in controlled clinical studies, within weeks, and long term. Since hypertension and benign prostatic hyperplasia are widespread and often undiagnosed in the community, particularly with increasing age, doxazosin may be a particularly appropriate therapy for the considerable number of older men with both conditions.

Adrenergic alpha-Antagonists↗
PubMed2005

Fact or fiction: what do the benign prostatic hyperplasia data tell us?

Benign prostatic hyperplasia (BPH) is the most common benign neoplasm in men. Our understanding of this condition has improved greatly over the years and recent advances have changed our approach to management. At the end of the 19th century, prostatic enlargement was treated effectively by bilateral orchidectomy. Unsurprisingly, this treatment option never gained widespread popularity. Less than 10 years ago, surgery and watchful waiting were the only considered treatment options for BPH. We now have a number of medical therapies and minimally invasive treatment options available that can effectively manage lower urinary tract symptoms secondary to benign prostatic obstruction. However, with increased choice comes the increased need for clarity in selection and application of these various treatment options. In the current environment of evidence-based clinical practice, awareness and interpretation of data from the numerous studies is paramount. The lessons learned from these trials should be reflected clearly in our practice, with clinical management based on fact, not fiction. In this review, we critically assess the available data and understanding of the management of BPH.

Algorithms↗
PubMed2003

The importance of prostatic measuring by transrectal ultrasound in surgical management of patients with clinically benign prostatic hyperplasia.

OBJECTIVE: To study whether transrectal ultrasound volume determination of the whole prostate and of the transition zone alone correlates to resected or enucleated weight in patients operated upon with transurethral resection of the prostate and retropubic or suprapubic prostatectomy because of presumed benign prostatic hyperplasia. MATERIAL AND METHODS: The study comprised 120 patients with symptomatic benign prostatic hyperplasia. Ninety patients underwent transurethral resection of the prostate and 30 treated using suprapubic or retropubic prostatectomy. The weights of the specimens were correlated with the corresponding volumes of the transition zone and of the whole prostate, respectively, measured by transrectal ultrasound using prolate ellipsoid method. RESULTS: The mean weight of the resected or enucleated specimens was 36.79 g. The mean whole prostate volume in all patients was 63.14 cm(3). Difference between resected weight and prostate volume was statistically significant (p= 0.0001), whereas the mean transition zone volume was 40.14 cm(3) and difference with resected weight was not significant (p=0.483). Correlation coefficients between measured total prostate volume and weight of resected tissue as well as between measured transition zone volume and weight of resected tissue were calculated and were respectively r=0.925, p< 0.001 and r=0.958, p<0.001. CONCLUSIONS: Measurements of the transition zone of the prostate by transrectal ultrasound are more accurate than those for the whole prostate to predict enucleated or resected weight. The assessment of the transition zone volume may be sufficiently reliable to be used in the clinical management of benign prostatic hyperplasia and helpful to choose modality of the surgery.

Aged↗
PubMed1999

Androgen receptor gene alterations and chromosomal gains and losses in prostate carcinomas appearing during finasteride treatment for benign prostatic hyperplasia.

Finasteride is commonly used for the treatment of benign prostatic hyperplasia and has been suggested to prevent prostate cancer development. To gain insight to the molecular effects of finasteride on prostate cancer development, we studied six prostate cancers diagnosed during finasteride treatment for benign prostatic hyperplasia. Comparative genomic hybridization detected genetic alterations in four tumors (1-5 changes/tumor). Xq gains and 6q losses were the most common alterations. The recurrent Xq gains motivated us to study the involvement of the androgen receptor (AR) gene. One tumor with Xq gain had a 3-fold amplification of the AR gene, suggesting that tumor development in finasteride-treated patients may require increased AR copy number and expression, as has previously been shown for prostate cancers recurring during hormonal therapy. Furthermore, in another tumor, an Arg726Leu mutation of the AR gene was found. This mutation was also present in the germ-line DNA of the patient. Arg726Leu mutation has previously been reported to affect the transactivational properties of the AR. In summary, prostate cancers developing during finasteride therapy may have distinct biological properties, such as a low number of chromosomal alterations and frequent involvement of the AR gene. Further studies are needed to explore the role of germ-line AR mutations in these patients.

Chromosome Aberrations↗
PubMed1989

Obstructive uropathy in patients with benign prostatic hyperplasia.

In an attempt to determine the role of obstructive prostatic hyperplasia as a cause of irreversible renal function the records of 32 men with a diagnosis of benign prostatic hyperplasia and renal failure were reviewed. Patients were classified as either having a serum creatinine of more than or less than 4 mg.per 100 ml. when they were discharged from the hospital. Admission serum creatinine levels were comparable in both groups. Characteristics of the group with permanently impaired renal function included a longer mean duration of symptoms, higher incidence of urinary tract infection, lower average volume of residual urine and greater incidence of small kidneys with increased parenchymal echogenicity. These data assist in the objective prediction of patients who will have irreversible renal dysfunction when presenting with obstructive benign prostatic hyperplasia.

Acute Kidney Injury↗
PubMed2002

[An experimental study(I) on the inhibition of prostatic hyperplasia with extract of seeds of Brassica alba].

OBJECTIVE: To study the effective fraction of the extract of seeds of Brassica alba, which inhibits experimental mice prostatic hyperplasia. METHOD: An experimental model of prostatic hyperplasia of castrated male mice induced by testosterone propionate was made. Fractions I, II and III were prepared by extracting the seeds of Brassica alba successively with ether, ethanol and water under reflux. Total extract was prepared by extracting the seeds of Brassica alba with 60% ethanol under reflux. The total extract and the three fractions were used to test the activities. RESULT: Total extract, fractions I and II could not only significantly inhibit mice prostatic hyperplasia induced by testosterone propionate and activity of serum acid phosphatase, but also decrease wet weight of preputial glands, while fraction III is inactive. CONCLUSION: Extract from seeds of Brassica alba can significantly inhibit mice prostatic hyperplasia induced by exterior hormone, possessing an activity of anti-androgen. Fractions I and II show an equivalent activity of total extract, which indicate that these fractions contain active components of seeds of Brassica alba which can inhibit prostatic hyperplasia.

Acid Phosphatase↗
PubMed1997

[Tissue plasminogen activator in urine of patients with prostatic carcinoma and benign prostatic hyperplasia].

In the 20 patients with prostatic carcinoma (PC) and the 18 with benign prostatic hyperplasia (BPH) the level of tissue type plasminogen activator (t-PA:Ag) was examined. As a compared group consisted of 24 healthy volunteers. In the urine of examined patients with PC and BPH and control the t-PA:Ag was absent or present only in trace amounts. We concluded that the t-PA:Ag in the urine of patients with PC can not be as a marker in the diagnosis of prostatic diseases especially in the prostatic carcinoma.

Aged↗
PubMed1997

Prostatic stents for benign prostatic hyperplasia.

Treatment options for benign prostatic hyperplasia (BPH) have developed rapidly over the past several years. These options include surgical intervention, medical therapy, and minimally invasive modalities such as prostatic stents. Prostatectomy remains the treatment of choice for symptoms that are the result of bladder outflow obstruction, with success rates of 85-90%. Medical therapy with selective alpha-1 antagonists, 5 alpha-reductase inhibitors, LHRH antagonists, antiandrogens, and aromatase inhibitors have increased in popularity and are mainly used to treat patients with mild to moderate prostatic obstruction. Prostatic urethral stents have recently emerged as an alternative treatment for BPH throughout Europe and Asia, but few investigators have used prostatic stents in the United States because of strict regulatory forces and a debate concerning the indications for these devices. The possibility of providing a treatment option for BPH to patients who are frail and elderly, as well as to patients with multiple medical problems, has prompted enthusiasm toward prostatic stents in the urologic community. The focus of this review will be an up-to-date discussion of the types of prostatic stent available, including a review of recent clinical trials involving the use of each available stent.

Equipment Design↗
PubMed2002

Serum protein fingerprinting coupled with a pattern-matching algorithm distinguishes prostate cancer from benign prostate hyperplasia and healthy men.

The prostate-specific antigen test has been a major factor in increasing awareness and better patient management of prostate cancer (PCA), but its lack of specificity limits its use in diagnosis and makes for poor early detection of PCA. The objective of our studies is to identify better biomarkers for early detection of PCA using protein profiling technologies that can simultaneously resolve and analyze multiple proteins. Evaluating multiple proteins will be essential to establishing signature proteomic patterns that distinguish cancer from noncancer as well as identify all genetic subtypes of the cancer and their biological activity. In this study, we used a protein biochip surface enhanced laser desorption/ionization mass spectrometry approach coupled with an artificial intelligence learning algorithm to differentiate PCA from noncancer cohorts. Surface enhanced laser desorption/ionization mass spectrometry protein profiles of serum from 167 PCA patients, 77 patients with benign prostate hyperplasia, and 82 age-matched unaffected healthy men were used to train and develop a decision tree classification algorithm that used a nine-protein mass pattern that correctly classified 96% of the samples. A blinded test set, separated from the training set by a stratified random sampling before the analysis, was used to determine the sensitivity and specificity of the classification system. A sensitivity of 83%, a specificity of 97%, and a positive predictive value of 96% for the study population and 91% for the general population were obtained when comparing the PCA versus noncancer (benign prostate hyperplasia/healthy men) groups. This high-throughput proteomic classification system will provide a highly accurate and innovative approach for the early detection/diagnosis of PCA.

Aged↗
PubMed1991

Magnetic resonance imaging of the efficacy of specific inhibition of 5 alpha-reductase in canine spontaneous benign prostatic hyperplasia.

A leading role for prostatic levels of dihydrotestosterone (DHT) in the pathogenesis of benign prostatic hyperplasia is well established, if incompletely understood. The present study provides initial confirmation that 5 alpha-reductase inhibition alone is sufficient to prevent prostatic accumulation of DHT and to produce epithelial regression in the canine prostate. In dogs treated with the specific 5 alpha-reductase inhibitor finasteride, prostatic volume decreased to one-third of the baseline volume, while the prostatic concentration of DHT fell fivefold: both were constant in placebo control dogs. Demonstration that MR imaging can serve as accurate modality to assess prostatic volume was provided by serial measurements of the canine prostate and by correlation of the last imaging measurement with the weight of the excised prostate. Significant intensity changes were observed in T2-weighted images measured post-treatment; these changes correlated with the histopathology of the prostate. These results suggest that beyond quantifying regression, multiecho T2 measurements can be useful in probing accompanying changes occurring on the cellular level.

5-alpha Reductase Inhibitors↗
PubMed1989

[Endocrinologic factors in the development of benign prostatic hyperplasia].

The development of benign prostatic hyperplasia is determined by aging and a functioning testis. This concept of the pathogenesis is supported by studies showing that regression of the enlarged prostate can be achieved by means of drugs that interfere with either the synthesis or the action of testosterone. Since both these therapeutic principles lead to symptoms of hypogonadism their therapeutic value is limited. Recent observations, however, indicate the feasibility of developing agents that will relieve the obstruction of urinary outflow and cause shrinkage of the enlarged prostate without impairing the action of androgen in other tissues.

Androgens↗
PubMed1990

Inhibition of experimentally induced mouse prostatic hyperplasia by castration or steroid antagonist administration.

Mouse prostatic hyperplasia has been induced experimentally by implanting fetal urogenital sinus tissue into the prostate gland of syngeneic mice. We compared the effects of castration and steroid antagonist administration on the growth of the prostate gland during both the early (15 days) and late (30 days) phases of prostatic enlargement. Castration at the time of induction of prostatic hyperplasia is by far the most effective method of inhibiting prostatic overgrowth. A comparison of castration for 7 days with the short-term (7 days) administration of steroid antagonists showed that during the early phase of prostatic enlargement castration is more effective than antiandrogen, which is more effective than 5 alpha-reductase inhibitors. In the late phase of mouse prostatic enlargement, castration for 7 days is less effective than treatment with either antiandrogen or a 5 alpha-reductase inhibitor. Our data indicate that treatment with a combination of an antiestrogen (keoxifene) with a 5 alpha-reductase inhibitor (in particular, 6-methylene progesterone) is the most effective combination for reducing prostatic overgrowth. The antiestrogen (keoxifene) treatment alone was ineffective in both the early and late phases of prostatic overgrowth.

5-alpha Reductase Inhibitors↗
PubMed1998

Value of the Danish Prostate Symptom Score compared to the AUA symptom score and pressure/flow studies in the preoperative evaluation of men with symptomatic benign prostatic hyperplasia.

The Danish Prostate Symptom Score (DAN-PSS) is a new questionnaire for the assessment of lower tract urinary symptoms (LUTS), which claims to be able to predict bladder outlet obstruction. We evaluated the ability of the DAN-PSS to assess LUTS, to predict obstruction, and to predict treatment outcome in men with symptomatic uncomplicated BPH. Twenty-five consecutive men with symptomatic uncomplicated BPH filled in the AUA symptom score and the DAN-PSS and underwent uroflowmetry and pressure-flow studies prior to transurethral prostatic resection (TURP). Patients were reevaluated 4 days and 8 months after surgery. AUA score and DAN-PSS both assessed LUTS and were sensitive to symptom changes after therapy. Compared to pressure/flow studies, neither score correlated with bladder outlet obstruction. Peak urinary flow, however, correlated significantly with obstruction. None of the diagnostic tools used was able to improve patient selection for surgical treatment. The DAN-PSS is a valid and sensitive questionnaire for the assessment of LUTS. It is not able, however, to predict bladder outlet obstruction. In men with uncomplicated BPH, urodynamic evaluation of bladder outlet obstruction did not improve the subjective outcome of TURP.

Aged↗
PubMed1989

Alpha-adrenoceptor inhibitors in the treatment of benign prostatic hyperplasia.

Although benign prostatic hypertrophy is the most common cause of urinary tract symptoms in men, the cause is still unclear. Recently it has been suggested that treatment with alpha-adrenoceptor inhibitors may be helpful in this condition. Eighty patients with prostatic obstruction were entered into a double-blind parallel study of prazosin versus placebo. There were 25 withdrawals or exclusions, leaving 55 patients for analysis. Mean maximal flow rates increased significantly more in patients treated with prazosin than in patients treated with placebo (p less than 0.005), but there was no significant reduction in maximal voiding pressure. The mean number of voids, recorded on diary cards, was reduced from an initial 10.0/24 hours by 2.1 in the final week, a significantly greater reduction than in the placebo group (p less than 0.01). However, there were no statistically significant changes in the filling cystometrograms. When patients were classified as responders or nonresponders in terms of bladder filling, urine flow, bladder emptying, weekly average of voids/24 hours, and nocturia, the proportion of patients responding to prazosin was significantly greater in all categories except bladder filling and emptying. It was concluded that prazosin at a dose of 2 mg twice daily is a safe and effective treatment for prostatic obstruction and may be used in patients awaiting surgery and in those who are unfit for operation.

Adrenergic alpha-Antagonists↗
PubMed1983

Effects of tamoxifen on the levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin (PRL), 17 beta-oestradiol (E2), total and free testosterone (T) and total and free dihydrotestosterone (DHT) in blood of patients with benign prostatic hyperplasia.

Treatment of 9 patients with benign prostatic hyperplasia with 20 mg tamoxifen daily for 6 weeks resulted in a significant increase of LH (211%), FSH (215%), E2 (231%), total T (157%), free T (148%) and total DHT (148%) levels in blood. The increase of plasma free DHT (152%) levels was not significant and PRL concentrations in serum were unchanged during treatment. Comparison of the increases between total T and free T, total T and total DHT as well as free T and free DHT failed to reveal any significant differences. These results imply (1) a marked anti-oestrogenic effect of tamoxifen at the level of hypothalamo-hypophysial axis (2) no effect at the hepatic oestrogen receptor sites indicated by unchanged SHBG-bound T and DHT in plasma and (3) no significant inhibitory effect of tamoxifen on 5 alpha-reductase activity concluded from the T/DHT ratio in peripheral circulation. In view of these findings tamoxifen appears to be unsuitable for therapy of benign prostatic hyperplasia.

Dihydrotestosterone↗
PubMed1991

[Clinical experience of local hyperthermia for benign prostatic hyperplasia].

A total of 20 patients with benign prostatic hyperplasia underwent transrectal local hyperthermia. For heating of the prostate gland, the PROSTATHERMER (Biodan-Medical System, Israel) was used. Patients were treated twice weekly, for 1 hour, with 6 sessions on an outpatient basis. Four of the 20 patients who had acute toxicity such as urethral irritability due to urethral thermoprobe could not tolerate the treatment. In the majority of the patients who were completely treated, a significant decrease in frequency of nocturia, decrease in post-void residual urine capacity and increase in urine flow rate were observed. No significant change in prostate volume was noted. With a mean follow-up of 6 months, only 1 patient required subsequent prostatic resection. These findings indicate that local hyperthermia applied by this method is effective in the treatment of benign prostatic hyperplasia and that improvement of the thermometry system is needed.

Aged↗