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PubMed1991

Long term experience with the prostatic spiral for urinary retention due to benign prostatic hyperplasia.

Twenty high risk patients with benign prostatic hyperplasia and urinary retention were treated by insertion of an intraprostatic spiral. The device was positioned under fluoroscopic guidance using a technique developed by us. The procedure required only local anaesthesia and successfully relieved the obstruction in all patients. At the six-month follow-up full continence had been achieved in 15 patients (75%). Three patients (15%) complained of mild stress incontinence but this was not severe enough to require removal and repositioning of the spiral. A 92-year-old patient reported severe incontinence despite correct positioning of the spiral. Removal of the spiral was necessary in one of the continent patients who was receiving anti-coagulant drugs because of sudden, severe macrohaematuria with subsequent acute urinary retention. The spiral became displaced and required repositioning in one patient. Median residual urine volume was constantly lower than 50 ml and the median maximal flow rate at six-month follow-up was 13.2 ml/s. Our long term follow-up study shows the effectiveness and safety of the prostatic spiral as an alternative treatment for selected patients with urinary retention caused by benign prostatic hyperplasia.

Aged↗
PubMed2001

Differential diagnosis of prostate cancer and benign prostate hyperplasia using two-dimensional electrophoresis.

Prostate specific antigen (PSA) is a protease which is characteristic of the prostate. It is widely used as a serum marker for the early diagnosis of prostate cancer (PCa). Nevertheless, for concentrations between 4 and 10 ng/mL, PSA does not enable PCa to be distinguished from benign diseases, such as benign prostate hyperplasia (BPH). In sera, the use of a ratio between free PSA (PSA uncomplexed with protease inhibitor) and total PSA (free PSA and PSA bound to alpha-1 anti-chymotrypsin) enables the "gray zone" to be reduced, but an important proportion of patients are still wrongly classed. Using two-dimensional electrophoresis, we demonstrated using 52 PCa and 40 BPH well-documented clinical cases that BPH sera show a significantly greater percentage of low-molecular-weight free PSA elements (IwPSA) than PCa sera. In our study, the use of a ratio between IwPSA and standard free PSA enables the correct diagnosis of 100% of PCa and 82.5% of BPH cases as against when 73.1% and 42.5% respectively were correctly diagnozed using the total PSA and the free/total PSA ratio. This important finding may be related to differences in the mechanism secreting PSA from the prostate into the bloodstream. We have shown how a tissue marker may be turned into a powerful tumor marker by events probably unrelated to its expression.

Adult↗
PubMed1998

Role of the transition zone for elevating serum prostate-specific antigen in benign prostatic hyperplasia.

BACKGROUND: Patients with benign prostatic hyperplasia (BPH) have a wide range of concentrations of PSA. However, it is not known what factors influence the concentration of serum PSA other than the prostate volume. BPH is composed of an enlarged transition zone (TZ) and other zones (nonTZ). The TZ is thought to play a more important role than the nonTZ in determining the concentration of serum PSA in BPH patients. METHODS: We investigated the individual glandular zone volume, the amount of PSA produced by each zone and the PSA density in each zone in 23 patients with histologically-confirmed BPH. The PSA density in the TZ was calculated by dividing the difference between the serum PSA before and after surgical resection by the specimen weight. We examined the influence of these parameters on the concentration of serum PSA in BPH patients. RESULTS: The serum PSA concentration correlated with the amount of PSA produced by the TZ (r=0.90, P< 0.0 1), but not the nonTZ (r=0.25, P=0.29). The concentration of serum PSA also showed a significant correlation with the TZ volume (r=0.67, P< 0.01) and the PSA density in the TZ (r=0.51, P< 0.05), but not with the PSA density in the nonTZ (r=-0.06, P=0.81). Also, age was inversely correlated with the PSA density in the TZ (r=-0.69, P< 0.01). CONCLUSION: The hypertrophic prostate cell volume (TZ volume) and activity (PSA density in the TZ) significantly correlated with the concentration of serum PSA in BPH patients, and the TZ cell activity decreased inversely with age in these BPH patients.

Age Factors↗
PubMed1992

[Clinical experience of local thermotherapy in the treatment of benign prostatic hyperplasia].

Thirty-five patients with benign prostatic hyperplasia (age range: 45-88 years; average: 67.5 years) underwent local thermotherapy with prostathermer. Clinical therapeutic effect was evaluated in 30 of the 35 patients: 2 patients interrupting from therapy and 3 receiving pretherapeutic indwelling catheters were not included. A total of 6 treatments (2 per week) were performed, each lasting for 60 minutes. As for subjective improvement, improvement of nocturia was noted in 70.0% of all patients and sense of residual urine in 70.7%. Post-therapeutic nocturnal and daytime decreases in urination frequency were statistically significant (p less than 0.01). Objective improvement in residual urine volume occurred in 19 of the 30 cases, and elevation in uroflowmetric maximal flow rate following therapy was statistically significant (p less than 0.05). Among complications ascribable to catheter insertion were urethral bleeding (3 cases), epididymitis (1 case) and pyuria (1 case). Therapeutic result based primarily on subjective symptoms and partly on objective findings was fairly good in 17 cases (about 57%), and slightly good in 25 cases (about 83%). In conclusion, this therapy seems to be useful in the treatment of benign prostatic hyperplasia.

Aged↗
PubMed1989

Inhibitors of steroid 5 alpha-reductase in benign prostatic hyperplasia, male pattern baldness and acne.

Benign prostatic hyperplasia is an androgen-dependent disease which afflicts a large percentage of males over the age of fifty, and is usually treated by surgery. Dihydrotestosterone, a 5 alpha-reduced metabolite of testosterone, has been implicated as a causative factor in the progression of the disease, largely through the clinical study of males who are genetically deficient in the dihydrotestosterone-producing enzyme, steroid 5 alpha-reductase. As a result, inhibition of this enzyme has become a pharmacological strategy for the treatment of benign prostatic hyperplasia as well as other dihydrotestosterone-related disorders such as acne and male pattern baldness. In this review, Brian Metcalf and colleagues focus on the chemical and kinetic mechanisms of steroid 5 alpha-reductase, and known inhibitors of this enzyme, and discuss the rationale behind the design of a mechanistically distinct class of steroid 5 alpha-reductase inhibitors.

5-alpha Reductase Inhibitors↗
PubMed1992

Finasteride for benign prostatic hyperplasia.

The pathogenesis of benign prostatic hyperplasia is related to the action of 5 alpha-dihydrotestosterone (DHT), the physiologically active form of testosterone. The conversion of testosterone to DHT is catalyzed intracellularly in prostatic tissue by the enzyme 5 alpha-reductase. Finasteride blocks the action of 5 alpha-reductase by competitively inhibiting the binding of testosterone to 5 alpha-reductase. The maximum effect of finasteride on reducing prostatic volume occurs after three months of oral therapy. Most patients experience improvement in urine flow rates, and side effects are minimal. However, following discontinuation of treatment, serum DHT levels return to baseline within two weeks.

5-alpha Reductase Inhibitors↗
PubMed2006

The natural history of benign prostatic hyperplasia.

The progression of benign prostatic hyperplasia (BPH) can be defined as a deterioration of clinical variables such as lower urinary tract symptoms (LUTS), health-related quality of life and peak flow rate, increased prostate size, or unfavourable outcomes such as acute urinary retention (AUR) and BPH-related surgery. The natural history of BPH is best analysed from longitudinal studies of community-dwelling men. In the Olmsted county study, which followed for 12 years a randomly selected cohort of 2115 men aged 40-79 years, there was an average increase in the International Prostate Symptom Score (IPSS) of 0.18 points per year, ranging from 0.05 for men in their fifties to 0.44 for those in their seventies. There was also a decrease in peak flow rate of 2% per year and a median prostate growth of 1.9% per year. The cumulative incidence of AUR was low (2.7% over 4 years). Information can also be collected from the placebo arms of controlled studies of men with symptomatic BPH, although the strict trial inclusion criteria and indeed the taking of a placebo itself introduce biases which limit the analysis of the natural history of the disease in this way, and its applicability to the general population. Hence, in the Medical Therapy of Prostatic Symptoms study, there is clear evidence that symptom deterioration, defined by a worsening of the IPSS of > or = 4 points, was by far the most prevalent progression event (79.5%), with a cumulative incidence of 14% over a mean follow-up of 4.5 years. As in the longitudinal community-based studies, AUR was rather uncommon (14.8% of overall progression events) with a cumulative incidence of 2%. BPH-related surgery, which was a secondary criterion in the study, was required in 5% of men. Similar conclusions can be drawn from a 2-year placebo-controlled study (ALTESS) assessing the impact of alfuzosin 10 mg once daily on LUTS/BPH progression in 1522 men with symptomatic BPH at high risk of developing AUR. Symptom deterioration was clearly the main progression event, with a cumulative incidence of 16.8%, compared to BPH-related surgery (6.5%) and AUR (2.2%). Thus, there is evidence from longitudinal studies, and to a lesser extent from the placebo arms of large controlled studies, that BPH is a progressive disease. Symptom worsening is by far the most frequently occurring progression event. Identifying those patients at risk of BPH progression is crucial to optimize their management.

Adrenergic alpha-Antagonists↗
PubMed1991

[Significance of transrectal hyperthermia in the treatment of benign prostatic hyperplasia].

Though the local hyperthermia for the management of benign prostatic hyperplasia has drawn much attention as one non-surgical treatment, no definite conclusion could yet be obtained in terms of the efficacy. In this study local hyperthermia was induced in evaluable 33 cases with benign prostatic hyperplasia using Primus, and the effectiveness of this modality of treatment was investigated by analysing the subjective and objective response following hyperthermia. The prostate was heated trans-rectally up to 43 degrees C with 915 MHz microwave for one hour. Hyperthermia was carried out twice a week for ten times for the sake of thermotolerance. Urinary obstructive symptoms were divided into diurnal and nocturnal frequency, urinary urgency, the degree of urinary stream, hesitancy and dribbling. Each symptom was described before and after the treatment according to the scoring system. Moreover, objective changes of urinary flow and prostatic size were estimated by the residual urine volume, uro-flowmetry, rectal palpation of the prostate and echography. Hyperthermic treatment improved urinary flow markedly, but no appreciable alteration could be observed as to the size of the prostate. The overall efficacy, including subjective and objective response, could be summarized as 37% of effectiveness, and 33% of slight effectiveness, that is, 70% of effective ratio. As to the side effect, anal pain was noted in few cases of the present series. Therefore, transrectal hyperthermia may be a suitable modality for non-surgical treatment of benign prostatic hyperplasia.

Evaluation Studies as Topic↗
PubMed1995

Correlation of transrectal ultrasonographic findings of the prostate with the occurrence of detrusor instability in patients with benign prostatic hyperplasia.

Forty patients with benign prostatic hyperplasia were evaluated with urodynamics and transrectal ultrasonography. Seventeen patients were found to have detrusor instability while the remaining 23 did not. No significant differences were noted during ultrasonography in the estimated prostatic volume, the presumed circle area ratio and the incidence of finding prostatic calcification between these two groups. However, the incidence of detecting intravesical protrusion of the prostate is significantly higher in patients with instability than in patients with stable bladder (53 vs. 13%, p < 0.01). It is therefore postulated that intravesical protrusion may increase afferent impulses from the prostate and alter the stability status of the urinary bladder.

Aged↗
PubMed1991

Steroid hormones and the pathogenesis of benign prostatic hyperplasia.

The pathogenesis of benign prostatic hyperplasia (BPH) is still poorly understood: there is, however, general acceptance that the condition is not premalignant and that it has an etiology distinct from that of cancer. Interest now focuses on the biochemistry of the target prostate cells and the propensity of the gland for uncontrolled growth. Dihydrotestosterone (DHT) is the active intracellular androgen formed from testosterone by 5 alpha-reductase. DHT concentrations appear a little higher in BPH tissue than in normal tissue, and there is no doubt that DHT-receptor complex modulates gene expression. Current studies suggest that DHT is essential but not sufficient for proliferation, and that other regulatory factors, including peptide growth factors, are prerequisite. The growth responsiveness of prostate tissue to androgens may be dependent on the balance between epithelial and stromal tissues, with biologic processes in the epithelium indirectly controlled by androgen-dependent mediators of stromal origin.

3-Oxo-5-alpha-Steroid 4-Dehydrogenase↗
PubMed2002

[Correlation of the factors on benign prostatic hyperplasia combined with obstruction].

Benign prostate obstruction(BPO) means bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH), which concerns BPH, and lower urinary tract symptoms(LUTS). To treat the BPO is the main purpose of therapy on BPH in clinic. This review includes recent advances in study of changes on urodynamics(UDS), morphology, prostatic composition, which occur in BPO.

Humans↗
PubMed2001

[Comparisons of factors affecting voiding disorders between patients with benign prostate hyperplasia and volunteers].

PURPOSE: The prostate size and motivation to visit clinics were investigated in patients with prostate hyperplasia. OBJECTS AND METHODS: One hundred ninety-five patients who had urinary symptoms and visited our outpatient clinic between September 1994 and October 1999 and 268 age-matched volunteers in Mitaka City who underwent a medical examination of the prostate in June 1997 were compared. International Prostate Symptom Score (IPSS), Quality Of Life Score (QOL score), residual urine volume, prostate volume and urinary flow rate were measured. RESULTS: The prostate volume of the volunteers was 20-25 cm3 irrespective of the age. The prostate size of the outpatients was larger than that of the volunteers for every age group. IPSS and QOL score were significantly higher in the outpatients than in the volunteers. Diurnal urinary frequency and sense of residual urine contributed to the discrimination index of the two groups more significantly than the other scores. There was a significant correlation between prostate volume and residual urine volume. The score of weak urinary steam was inversely and significantly correlated with peak urinary flow rate. CONCLUSIONS: There was no age-related enlargement of the prostate gland. The prostate gland was significantly larger in the patients than in the volunteers even in those in their fifties. Urinary frequency and sense of residual urine are important factors for men to seek and receive medical care.

Adult↗
PubMed1995

[Benign prostatic hyperplasia: prostatectomy and alternatives].

Benign prostatic hyperplasia is a common disease of men and will lead in most cases to micturition difficulties. Up to now 2 or 4 of 10 men in their sixties are operated for BPH. As standard treatment we know the transurethral resection of the prostate and in some cases of very big adenomas the open adenomectomy carried out in a suprapubic or retropubic way. However, in view of a rare, but as a result of these treatments appearing morbidity we have to ask ourselves whether the surgical resection of the obstructive prostatic tissue remains the only way of treatment. For several years now apart from drug therapy there have also been applied less invasive alternatives. Whether these alternatives of little side effect and further complications are equally effective for the treatment of the obstructive BPH is to verify. This paper provides a general view of the possibilities of the surgical interventions as well as of their alternatives. Because of a lack of dates as to the efficiency of particular procedures a final judgement is outstanding in most cases. Where possible we hear of particular alternatives, though fully promoted, being nothing but a passing tendency. This is certainly true of the hyperthermy, the balloon dilatation and the urethral implants. These by now various conspicuous necrotising procedures (transurethral microwave thermotherapy, laser-ablation, high intensity focused ultrasound, transurethral needle-ablation) are by now in prospective random studies still subject to extensive clinical tests. The question whether one of these alternatives will one day be apt to exceed the TURP as "golden standard" of BPH-treatment, that remains as far as now the question to be put. The advantages of the necrotising procedures, at present highly recommended, consist in the first place of a rare intra- and postoperative morbidity with a simultaneous lack of mortality. These procedures can be performed as a outpatient or as a short stationary treatment and sometime even under local anaesthesia.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMed1993

Alfuzosin. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in benign prostatic hyperplasia.

Alfuzosin, a new quinazoline derivative, acts as a selective and competitive antagonist of alpha 1-adrenoceptor-mediated contraction of prostatic, prostatic capsule, bladder base and proximal urethral smooth muscle, thereby reducing the tone of these structures. Consequently, urethral pressure and resistance, bladder outlet resistance, bladder instability and symptoms associated with benign prostatic hyperplasia are reduced. A limited range of clinical studies have shown oral alfuzosin to be more effective than placebo (in studies of < or = 6 months duration), to have sustained effects on long term administration (< or = 30 months), and to be comparable with the alpha 1-adrenoceptor antagonist prazosin, in the symptomatic treatment of benign prostatic hyperplasia. This is reflected in increases in urinary flow rate and decreases in symptom score and residual urinary volume. The most marked improvements occur in patients with severe pretreatment urinary flow abnormalities. Furthermore, preliminary results suggest a beneficial effect of alfuzosin on quality of life in patients with benign prostatic hyperplasia. The overall incidence of adverse effects appears similar to that with placebo, and the incidence of vasodilatory-related adverse effects appears lower than that with prazosin. The relative selectivity of alfuzosin for alpha 1-adrenoceptors in the genitourinary tract compared with receptors in the vasculature is a potential advantage over other alpha-adrenoceptor antagonists, including prazosin, as the symptoms of benign prostatic hyperplasia may be reduced by alfuzosin at doses that have minimal vasodilatory effects, thereby minimising postural hypotension and syncope. However, vasodilatory-related adverse effects are the most common adverse effects that occur with alfuzosin, and dose and first-dose hypotensive relationships, especially in the elderly, cannot be excluded at this stage in the clinical use of alfuzosin. The full potential of alfuzosin in the symptomatic treatment of benign prostatic hyperplasia will be clarified by further long term comparative studies (with large patient numbers) against placebo and other alpha 1-adrenoceptor antagonists. Nevertheless, oral alfuzosin 7.5 to 10 mg/day in divided doses appears to be a promising first-line agent for symptomatic treatment of noncomplicated mild to moderate benign prostatic hyperplasia in patients with a high dynamic component to their obstruction. In addition, alfuzosin offers an alternative to prostatectomy (the current 'gold standard') in patients who require surgery but are unfit for this treatment, and in patients requiring symptomatic relief while awaiting surgery.

Adrenergic alpha-Antagonists↗
PubMed2001

Kinetics of acetyl coenzyme A: arylamine N-acetyltransferase from rapid and slow acetylator human benign prostatic hyperplasia tissues.

N-acetyltransferase (NAT) activity was determined in 40 human benign prostatic hyperplasia tissues using 2-aminofluorene (AF) and p-aminobenzoic acid (PABA) as substrates. These were then assayed by high performance liquid chromatography for determining the amounts of acetylated AF and PABA and non-acetylated AF and PABA. The activities (mean +/- SD) of AF-NAT from human benign prostatic hyperplasia tissues were divided into rapid (2.06 +/- 0.08 nmol/min per milligram protein), intermediate (1.25 +/- 0.26 nmol/min per milligram protein), and slow (0.58 +/- 0.30 nmol/min per milligram protein) acetylator groups. The activities (mean +/- SD) of PABA-NAT from human benign prostatic hyperplasia tissues were also divided into rapid (2.00 +/- 0.00 nmol/min per milligram protein), intermediate (1.25 +/- 0.18 nmol/min per milligram protein), and slow (0.48 +/- 0.29 nmol/min per milligram protein) acetylator groups. Kinetic constants for arylamine NAT activities were determined for each of these acetylator groups. Apparent differences in Km and Vmax for AF were found. Therefore, there seems to be a polymorphism in NAT activity with two rapid, five intermediate, and 33 slow acetylators among the 40 samples assayed. This is the first demonstration of acetyl CoA-arylamine NAT activity in human benign prostatic hyperplasia tissues.

4-Aminobenzoic Acid↗
PubMed2003

Investigation of benign prostatic hyperplasia.

PURPOSE OF REVIEW: This is a concise and timely update of the most recent developments in the clinical research on the investigation of benign prostatic hyperplasia. RECENT FINDINGS: Analysis of the peer-review literature confirms a high level of consensus as to the management of prostatic hyperplasia; analysis of practice trends suggests a satisfactory degree of adoption of the proposed guidelines. The evaluation of lower urinary tract symptoms remains the mainstay in the investigation of prostatic hyperplasia although problems concerning the evaluation of nocturia and the differential diagnosis between hyperplasia and chronic prostatitis were identified. Lower urinary tract symptoms confirmed their value as predictors of disease progression. The extent of patient involvement in the decision making process is increasing and new tools to elicit patient preference have been developed. A growing consensus as to the concept of disease progression has been reached concerning prostatic hyperplasia. Analysis of patient sexual function is now considered an important part of patient's interview. More sophisticated instruments, such as time trade-off values were successfully tested to elicit patient preference in the management of prostate disease. The value of serum prostate specific antigen as a predictor on prostate volume growth has recently been confirmed also in unselected male population. SUMMARY: Current research into the investigation of benign prostatic hyperplasia provides new insight into the pathophysiology of lower urinary tract symptoms and identifies parameters to predict the natural history of the disease in the individual patient, particularly regarding progression of the disease and the onset of adverse events.

Aged↗
PubMed2003

Development of quantitative detection assays for CYR61 as a new marker for benign prostatic hyperplasia.

Among urological diseases, benign prostatic hyperplasia (BPH) exhibits a high morbidity rate, afflicting approximately 50% of men older than age 50 years. Despite intense research efforts over the past decades, the etiology and mechanisms of BPH progression are only poorly understood. Employing oligonucleotide microarrays, the authors analyzed the gene expression profiles in normal and BPH prostate samples and found that CYR61, an immediate early gene, is markedly overexpressed in BPH. To quantify cellular CYR61 mRNA expression directly, the authors developed an assay using branched-chain DNA (bDNA) technology. A human prostatic epithelial cell line, BRF-55T, derived from a BPH patient, was treated with fetal bovine serum to stimulate gene expression, and then the induction profile of the CYR61 mRNA in these serum-stimulated cells was quantitated using both bDNA and quantitative reverse transcriptase-PCR (RT-PCR). The results obtained with the 2 detection systems were found to be very similar. The bDNA assay was also found to be sensitive and highly reproducible. To the authors' knowledge, this is the first time that identifying CYR61 as a novel marker for BPH and its quantitation has been reported. These detection methods not only may be useful for diagnostic purposes but may also be used to identify suppressors of CYR61 expression for BPH therapy employing high-throughput screening assays.

Animals↗
PubMedDate not supplied

Placental growth factor gene expression in human prostate cancer and benign prostate hyperplasia.

BACKGROUND: Angiogenesis plays a crucial role in normal development and carcinogenesis of prostate glands. Placental growth factor (PlGF) belongs to the same family as the vascular endothelial growth factor. The presence of PlGF in human prostate has not been studied. In the current study, we investigated the gene expression profiles of PlGF in human prostate. MATERIALS AND METHODS: Gene expression of PlGF-1 and PlGF-2 was assessed by RT-PCR and direct sequencing. Gene expression levels were quantified by real-time PCR, and we compared the transcript levels among benign prostate hyperplasia (BPH), prostate caner (CAP) and CAP after androgen deprivation therapy (CAP-Tx). RESULTS: Human prostate cancer cells, LNCaP, PC-3 and DU-145, expressed both PlGF-1 and -2 mRNAs. Human prostate tissues, BPH, CAP and CAP-Tx, also expressed both types of PlGF mRNA. BPH and CAP-Tx expressed similar levels of PlGF, however, CAP expressed significantly lower levels of PlGF than BPH or CAP-Tx (p < 0.01). CONCLUSION: PlGF mRNA was expressed in human prostate. Significantly lower levels of PlGF in CAP in comparison with those in BPH or CAP-Tx suggested that PlGF might have effects on vasculogenesis and angiogenesis in prostate disease.

Alternative Splicing↗