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PubMed1991

Pathogenesis of benign prostatic hyperplasia.

The pathogenesis of benign prostatic hyperplasia (BPH) remains largely unresolved. Three major theories have evolved over the years, each emphasizing a possible causative mechanism. The first theory, the dihydrotestosterone hypothesis, is based on the failure of BPH to develop in men castrated prior to puberty. The second, the embryonic reawakening theory, assumes a reawakening of the embryonic induction potential of prostatic stroma. The third, or stem cell theory, postulates the development of BPH through an increase in the number of stem cells or through an abnormal increase in clonal expansion of amplifying or transit cells. These mechanisms may act in concert.

Androgens↗

PubMed2005

[GnRH antagonists and benign prostatic hyperplasia].

Early treatment of benign prostatic hyperplasia (BPH) helps to decrease the need for surgery and thus places the medical treatment at the forefront which implies, optimising its efficacy and tolerance. Alpha-blockers and 5-alpha-reductase inhibitors are the two main classes of currently used drugs. The role in the growth of glandular, muscular and fibroblastic tissues of the prostate of androgens, testosterone and especially intraprostatic dihydrotestosterone was properly established. These physiopathological data prompted to evaluate the efficacy of inhibition of the hypothalamic-pituitary-gonadal axis, by means of LH-RH analogues. The agonists lead to a biological castration associated with a significant improvement of BPH symptoms. Unfortunately clinical relapse is systematic when treatment is discontinued. The antagonists, particulary cetrorelix, improve BPH symptoms, with a persistant benefit after treatment, discontinuation, although the effect on the prostate volume reduction is transitory. It can be suggested that beside the well known hormonal action, there is a direct apoptic effect cells as well as inhibition of the intratissue growth factors. The LH-RH antagonists could thus become an alternative to the current drugs by offering a relatively short treatment with a prolonged benefit.

Apoptosis↗

PubMed2000

Microvessel density in prostatic hyperplasia.

OBJECTIVES: To examine the prostates from patients with haematuria associated with benign prostatic hyperplasia (BPH) to determine their microvascular anatomy and thus assess histopathological differences in patients with significant haematuria. PATIENTS AND METHODS: Prospectively, 11 patients with BPH and haematuria (mean age 70 years) and 19 control patients with BPH alone (mean age 72 years) were identified. Neither group had received hormone manipulation or had been catheterized. The sub-urothelial compartment of the prostatic urethra in subsequent specimens from transurethral resection was examined using factor VIII/CD-34 immuno-histochemistry. The microvessel density (MVD) was calculated by counting vascular cross-sectional profiles within a 0.81-mm2 grid. The pathologist studying the specimens was unaware of the patients' symptoms. RESULTS: The median (range) MVD in the haematuria group was 64 (28-137) and in the controls was 27 (14-39) (P < 0.001). CONCLUSION: The MVD was significantly greater in the patients with haematuria, suggesting that suburothelial microvessel proliferation may play an important role in mediating haematuria associated with BPH. This is the first time that a difference has been shown at the cellular level in patients with haematuria and could form an important foundation for subsequent research.

Aged↗

PubMed2005

Relationship between benign prostatic hyperplasia and lower urinary tract symptoms and correlation between prostate volume and serum prostate-specific antigen in clinical routine.

OBJECTIVES: To evaluate how often benign prostatic hyperplasia (BPH) was diagnosed in men referred as a result of lower urinary tract symptoms (LUTS) and to investigate the correlation between prostate volume and serum prostate-specific antigen (s-PSA). MATERIAL AND METHODS: The study subjects comprised men (n = 119; mean age 68 years) consecutively referred to a urological clinic as a result of LUTS for whom the information in the referral forms gave no indications of malignant disease or infection. The patients were evaluated according to regional guidelines. RESULTS: BPH was estimated to be the main etiological agent in less than every second man. There was a statistically significant correlation between s-PSA and prostate size. However, among men with s-PSA < 1.5 ng/ml, one-third had a prostate volume of > 30 ml and 17% a prostate volume of > 40 ml. Among men with s-PSA > or = 1.5 ng/ml, as many as 18% had a prostate volume of < or = 30 ml and 42% a prostate volume of < or = 40 ml. Bladder and/or prostate cancer was diagnosed in 8% of men, mostly as a coincidental finding. CONCLUSIONS: BPH was considered to be the etiological factor in < 50% of men referred as a result of LUTS. The correlation between prostate volume and s-PSA was verified. However, interindividual variation in s-PSA was so large that its usefulness for making treatment decisions in men with LUTS must be questioned.

Adult↗

PubMed1994

Review of current treatment of benign prostatic hyperplasia.

The treatment of benign prostatic hyperplasia is changing, with many new modalities being tested: Some are already used routinely, others are still investigational. Surgery, however, is still the principal treatment, producing an 85-90% improvement in symptoms and urodynamics. Stents are being used more frequently, particularly in patients with a high operative risk. Balloon dilation can be performed in small glands; however, the durability of results remains in doubt. Thermotherapy has been found to produce histologic changes in the prostate and may change the urodynamics as well. Finally, drug treatment, which is currently limited to a-blocking agents and 5 a-reductase inhibitors, has proven to be effective symptomatically, with small, but significant changes in urodynamics.

Humans↗

PubMed1993

Relationship of symptoms of prostatism to commonly used physiological and anatomical measures of the severity of benign prostatic hyperplasia.

In previous studies the severity of symptoms of prostatism in men with benign prostatic hyperplasia have not correlated well with prostate size, degree of bladder trabeculation, uroflowmetry or post-void residual volume. As part of a prospective cohort study of benign prostatic hyperplasia treatment effectiveness in 4 university-based urology practices, we correlated symptom severity and these commonly used measures of disease severity. Symptom severity was quantified using the American Urological Association symptom index. Analyses were based on 198 outpatients completing a standardized evaluation (84 of these men have completed 6 months of followup after treatment with prostatectomy, balloon dilation, terazosin or watchful waiting). At baseline, symptom severity was not correlated with uroflowmetry, post-void residual, prostate size and degree of bladder trabeculation. However, symptom severity was much more strongly related to overall health status than the other measures. Reduction in symptoms with treatment did correlate with improvements in uroflowmetry. This poor baseline correlation with symptoms may reflect unreliability in measurement of the physiological/anatomical variables. Alternatively, these parameters may be measuring different pathophysiological phenomena.

Aged↗

PubMed1996

Recent advances in the treatment of benign prostatic hyperplasia.

The prevalence of benign prostatic hyperplasia (BPH) in Taiwanese men over the age of 50 years is as high as those in Western countries. BPH significantly affects the life quality of patients. Many theories of the genesis of BPH have been reported and some effective treatments have been designed according to these theories. Adequate preoperative studies can lead to satisfactory treatment results. Medical treatments including alpha-adrenergic blockers and 5-alpha-reductase inhibitors are frequently used as initial steps. Surgical treatment is necessary in more than one-quarter of patients in order to achieve good results. Transurethral resection of the prostate (TURP) remains the gold standard for treatment of BPH, although laser prostatectomy may become as popular as TURP in the future. Transurethral thermotherapy with microwave is also a promising new treatment. There are many other medical or surgical treatments under investigation. Further neuroendocrine research and studies with techniques of molecular biology may offer new concepts in BPH treatment in the future.

Humans↗

PubMedDate not supplied

Response of prostate volume, prostate-specific antigen, and testosterone to flutamide in men with benign prostatic hyperplasia.

Patients diagnosed as having benign prostatic hyperplasia (BPH) had determination of prostate volume (PV), prostate-specific antigen (PSA), and serum testosterone before consideration for entry into a double-blind, randomized trial of flutamide (750 mg/day for 6 months). The mean PSA level for these patients (N = 43) was 7.6 ng/ml (range: 1.0 to 45.7), and the mean PV was 76.8 cm3 (range: 24 to 198). Linear regression analysis demonstrated a strong correlation between the two (r = 0.876, P less than 0.05). Every 10 cm3 of prostate volume accounted for 1.02 ng/ml of PSA in the serum. Twenty-two patients (11 treated with flutamide, 11 with a placebo) agreed to enter the study. Prostate volume decreased by 35% and PSA by 65% (P less than 0.001) within 6 months. These changes occurred despite a 58.3% increase in serum testosterone levels (P less than 0.01). Patients treated with a placebo experienced no significant changes. Side effects were minimal, and flutamide was well tolerated. These data suggest that androgen deprivation therapy with flutamide may be an effective and safe treatment for BPH.

Aged↗

PubMed2002

Urodynamic effects of terazosin treatment for Japanese patients with symptomatic benign prostatic hyperplasia.

PURPOSE: For treating benign prostatic hyperplasia (BPH) 5 or 10 mg. terazosin hydrochloride daily has been routinely used in North America and Europe. We investigated the urodynamic effects of 2 mg. terazosin daily on Japanese patients with symptomatic BPH using pressure flow study. MATERIALS AND METHODS: A total of 20 Japanese patients 50 years old or older with symptomatic BPH underwent symptomatic and urodynamic evaluations, including pressure flow study, before and after terazosin treatment. Patients were given 1 mg. terazosin once daily for the first 7 days and they continued to receive 1 mg. terazosin twice daily for the following 3 weeks. RESULTS: At 4 weeks after terazosin treatment the International Prostate Symptom Score, quality of life index and maximum and average flow rates were significantly improved. Pressure flow study demonstrated decreased detrusor pressure at maximum flow, and minimum detrusor pressure during voiding and urethral resistance factor after terazosin treatment. Of the 20 patients 13 (65%) showed improvement in the linear passive urethral resistance relation. There was no significant difference in the maximum W. factor before and after terazosin treatment. CONCLUSIONS: Terazosin treatment, even 2 mg. daily, urodynamically relieved bladder outlet obstruction in Japanese patients with symptomatic BPH without any changes in detrusor contractility.

Adrenergic alpha-Antagonists↗

PubMedDate not supplied

[Combined use of 5 alpha-reductase inhibitors and alpha-l adrenergic receptor blockers in patients with benign prostatic hyperplasia].

88 patients with benign prostatic hyperplasia (BPH) were given the inhibitor of 5 alpha-reductase proscar (finasteride, Merck and Co. Inc., USA) for 12-14 months and uroselective blocker of alpha-adrenoreceptors alfuzosin (dalfas, Synthelabo Group, France) for 4-5 months. The patients were examined before the combined treatment and on the treatment month 1, 3, 6 and 12. The proscar plus alfuzosin combination produced a response after 2-3-week treatment due to alpha-blocker Further, the effect was enhanced by the action of inhibitor of 5 alpha-reductase. Combination of alfuzosin with proscar meets three principal requirements demanded of BPH chemotherapy: improves urination, inhibits the growth of adenomatous tissue, diminishes the size of the enlarged prostate.

Adrenergic alpha-Antagonists↗

PubMed1996

Prevalence of bacterial prostatitis in benign prostatic hyperplasia.

To define the prevalence of bacterial prostatitis and urinary tract infection (U.T.I) among benign prostatic hyperplasia patients (B.H.P) undergoing prostatectomy trans urethral resection of prostate (T.U.R.P.), 100 consecutive patient has their preoperative and post-operative urine cultures along with tissue culture of the resected prostatic tissue. Our data suggests that significant incidence (42%) of bacterial growth in prostatic tissue-occurs in patients with B.H.P. Pre-existing U.T.I. is not a reliable indicator by which this group could be identified pre-operatively and prostatic infection could be treated.

Anti-Bacterial Agents↗

PubMed1992

Benign prostatic hyperplasia. Its natural history, epidemiologic characteristics, and surgical treatment.

Benign prostatic hyperplasia is a nonmalignant enlargement of the prostate that is due to both epithelial and stromal hyperplasia. Although the exact origin of this condition is not well defined, it is thought to arise as microscopic nodules in the periurethral tissue of the prostate gland as early as the late '20s. With advancing age and the presence of androgens, this histologically identifiable hyperplastic tissue progresses to a macroscopic state, which is a palpably enlarged prostate. This enlarged prostate causes clinically significant obstruction of the bladder outlet in many men, necessitating therapeutic intervention. Currently, prostatectomy is the standard treatment with successful long-term results. Nevertheless, much information has become available recently on its indications, outcomes, associated morbidity and mortality, and effect on quality of life. Because of these findings as well as the rising healthcare costs and the desire among patients to avoid surgery if possible, there is much enthusiasm for developing less expensive, less invasive, but effective treatments for symptomatic benign prostatic hyperplasia. To appreciate the tremendous advances being made with regard to the treatment of benign prostatic hyperplasia, it is necessary to have a complete understanding of the disease process itself and its traditional therapies. This clinical report provides a comprehensive review of the natural history, epidemiologic characteristics, and outcomes of both open and transurethral surgery for benign prostatic hyperplasia.

Age Distribution↗

PubMedDate not supplied

[Fractionated low-intensity thermotherapy of benign prostatic hyperplasia].

120 patients with benign prostatic hyperplasia (BPH) (mean age 65.8 +/- 7.7 years) received fractional low-intensity transurethral microwave thermotherapy (FLITMT). Each patient was exposed to 4 FLITMT procedures with 3-4 day interval (duration--60 min at 48.5-49.9 degrees C, ProsTek 3000 unit, USA). Subjective and objective effects of FLITMT were observed in 87 (82.9%) and 75 (71.4%) patients, respectively. A stable effect on IPSS persisted for 3 years, on acceleration of maximal urination rate--within a year. Moreover, FLITMT was associated with a low frequency of complications. This makes the above thermotherapy usable in all BPH patients without absolute indications for surgical treatment.

Aged↗

PubMed1992

[Evaluation of new technical alternative procedures for therapy of symptomatic benign prostatic hyperplasia].

Transurethral resection of the prostate is still the gold standard in the treatment of symptomatic benign prostatic hyperplasia. It has proved possible to reduce the mortality of this treatment almost to zero, while the morbidity has remained unchanged at 18% for decades. Therefore, understandably, procedures are being looked for that will be similarly effective but have lower morbidity. Current developments in this field are transurethral implants (spiral, intraurethral catheter, Wall-Stent), the balloon dilatation, transurethral incision (TUIP), laser therapy (TULIP, ITK), ultrasound-induced aspiration of tissue and heat treatment (hyperthermia, thermotherapy). Chances and risks inherent in these different technical procedures and the amount of investment they involve are reviewed. Potential for the future can at best be attributed to the Wall-Stent, TUIP, the application of laser and the thermotherapy.

Catheterization↗

PubMed1993

Atamestane: an aromatase inhibitor for the treatment of benign prostatic hyperplasia. A short review.

Benign prostatic hyperplasia (BPH) is the most common neoplastic growth in men and is the most frequent cause of urinary flow obstruction at the bladder neck. In addition to the clear evidence in favor of the androgen dependency of BPH, the involvement of the stroma, stromal-epithelial interaction and the role of estrogens have gained much interest in connection with the pathogenesis of this disease. For this reason, specific aromatase inhibitors such as atamestane (1-methyl-1,4-androstadiene-3,17-dione) have recently attracted attention due to their potential use in the treatment of BPH. The pharmacological action of atamestane as a new competitive and irreversible inhibitor of estrogen biosynthesis has been evaluated in mice, rats, rabbits, dogs, monkeys and in man. In all species tested so far, atamestane lacks other intrinsic hormonal or antihormonal activities and shows no inhibition of other cytochrome-P450 dependent enzymes of adrenal steroidogenesis. However, it inhibits the estrogen-related negative feed-back. The extent and consequence of the induced counter-regulation of the pituitary-hypothalamic axis show major sex- and species-specific differences. In BPH animal models, atamestane is highly effective in inhibiting estrogen-induced hyperplastic changes in the fibromuscular stroma of the prostate in androstenedione-treated dogs and monkeys. In male volunteers and BPH patients, atamestane induces an expected dose-dependent reduction of serum estrogen concentrations with slight increases in androgen level. In conclusion, all available results indicate that atamestane is a selective (no inhibition of adrenal function), pure (= specific--no endocrine side-effects) and highly effective steroidal aromatase inhibitor with excellent safety profile. Based on our preliminary results aromatase inhibitors seem to be promising compounds for the treatment of BPH.

Androgens↗

PubMed1996

Prostates and profits: the social construction of benign prostatic hyperplasia in American men.

Benign prostatic hyperplasia (BPH) is clinically diagnosed in approximately three-fourths of American men, a prevalence two to three times higher than that currently reported in Scotland and Japan. Prostatectomy is the most common operation performed on American men over 65. A critical medical anthropological analysis reveals that American urologists rely on prostatectomy to maintain their practices, and the growth of urology as a specialty is significantly related to the 50% increase in the rate of surgery since 1965. Marketing campaigns and studies funded by pharmaceutical companies promote the perception of urinary difficulties as problematic, encourage men to medicalize their symptoms, and create demand for drug therapy and urologist treatment. The social construction of BPH as a progressive age-related disorder and the profit orientation of American medicine account for the elevated prevalence of BPH.

Age Factors↗

PubMed1995

Profile of doxazosin in patients with benign prostatic hyperplasia.

Alpha adrenergic receptors in prostatic smooth muscle play a major role in the development of bladder outlet obstruction in patients with benign prostatic hyperplasia (BPH). As a result, alpha adrenoceptor antagonists have been used increasingly in the treatment of this condition. Doxazosin is a selective alpha 1 antagonist with a long half-life and gradual onset of action, which make it suitable for once-daily treatment. In placebo-controlled trials, doxazosin has been shown to improve maximum and mean urine flow rates, reduce urethral resistance and bladder contractility, and improve obstructive and irritative symptoms. These changes develop within a few weeks of starting treatment and are maintained during long-term treatment over periods of years. Doxazosin is also well tolerated; adverse events are generally mild or moderate and do not interfere with treatment. These features combine to make doxazosin an effective, convenient and well-tolerated treatment for the management of patients with BPH.

Adrenergic alpha-1 Receptor Antagonists↗

PubMed1995

[High energy focused ultrasound in treatment of benign prostatic hyperplasia].

Transurethral resection of the prostate (TURP) and open adenectomy are regarded the "golden standard" in the treatment of benign prostate hyperplasia (BPH). Various alternative treatment forms (microwaves, laser, radio frequency, focused ultrasound) have been introduced recently. They are all aimed at reducing the morbidity related to TURP while achieving comparable efficacy at the same time. Since December 1992, 35 patients with BPH have been treated with high-intensity focused ultrasound (HIFU-P) in our department. By 6 weeks after HIFU-P, mean Qmax had improved from 6.5 ml/s to 12.1 ml/s. Residual volume dropped from 207 ml to 95 ml, IPSS from 20.1 to 9.7. Both subjective as well as objective improvements remained stable after 3 and 6 months. Urinary tract infections were observed in 3 patients, macrohemato-spermia in all, and macrohematuria (caused by the suprapubic catheter) requiring blood transfusion in 1 patient.

Aged↗