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PubMed2003

Determination of percent area density of epithelial and stromal components in development of prostatic hyperplasia in spontaneously hypertensive rats.

OBJECTIVES: To determine the percent area density of epithelial and stromal components in the development of prostatic hyperplasia in spontaneously hypertensive (SH) rats. METHODS: The ventral lobes of prostates obtained from male SH rats and their normotensive counterparts, Wistar Kyoto (WKY) rats, were examined histopathologically at 15, 29, 40, and 54 weeks of age (5 SH and WKY rats each at each age group). The degree of prostatic hyperplasia was evaluated with a score-chart protocol, histoscore. The percent area density of epithelium and stroma of the ventral prostate were determined using a computerized image analysis system. RESULTS: Definite lesions of hyperplastic changes were demonstrated in the ventral prostate of SH rats from 15 to 54 weeks. In comparison with WKY rats, SH rats showed a significantly increased degree of prostatic hyperplasia as reflected by the histoscore values. Furthermore, the histoscore of the ventral prostate of SH rats increased with age (from 21.7 +/- 0.7 at 15 weeks to 26.1 +/- 0.4 at 54 weeks). The percent area density of epithelium and stroma were significantly increased in SH rats, and the ratio of stroma to epithelium ranged from 1:2.94 to 1:3.50 in SH rats but was maintained at 1:1.15 to 1:1.19 in WKY rats during the observation period. CONCLUSIONS: The hyperplastic changes of the ventral prostate may develop with advancing age in SH rats. The development of prostatic hyperplasia may result from both epithelial and stromal proliferation and may be predominantly expressed as a glandular type in SH rats.

Age Factors↗
PubMed2004

Biologic feature of prostatic hyperplasia developed in spontaneously hypertensive rats.

OBJECTIVES: To investigate alterations in cell kinetic and cellular composition in prostatic hyperplasia developed in spontaneously hypertensive (SH) rats from 15 to 54 weeks of age. METHODS: Male SH rats (n = 20) and their normotensive counterparts, Wistar-Kyoto rats (n = 20), were studied. At 15, 29, 40, and 54 weeks of age, the ventral prostate was obtained to evaluate (a) cell proliferation by the proliferation index using proliferating cell nuclear antigen immunostaining and (b) apoptosis by the apoptotic index using the terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end-labeling assay. The percentage of area density of smooth muscle and fibroblastic tissues was determined with a computerized image analysis system after alpha-actin and vimentin immunostaining, respectively. RESULTS: Compared with the data in the Wistar-Kyoto rats during the observation period, a significantly increased proliferation index in both epithelium and stroma (P <0.01) and a slightly increased apoptotic index in the epithelium without apoptotic cells in the stroma, with an imbalance in favor of cell proliferation, were noted in the prostatic hyperplasia of the SH rats. The value of the proliferation index was greatly increased in both the epithelium and the stroma of the SH rats between 15 and 29 weeks (P <0.05) but continued relatively steady from 29 to 54 weeks. A significantly increased percentage of smooth muscle area (P <0.01) and a much greater percentage of area density of smooth muscle than that of fibroblastic tissues (P <0.01) were observed in the prostatic hyperplasia of the SH rats. CONCLUSIONS: The prostatic hyperplasia of SH rats may develop from both epithelial and stromal growth and could ultimately be promoted by an imbalance in favor of proliferative activity.

Age Factors↗
PubMed1995

[Hormonal therapy of benign prostatic hyperplasia].

In the last 30 years transurethral prostatectomy (TURP) has been the standard treatment for benign prostatic hyperplasia. While the mortality rate of TURP has been reduced to zero, the postoperative morbidity rate has remained unchanged at 15-18% for several decades. Increasing costs and the preference of many patients for non-surgical treatment have now led to the development of new pharmacological treatment options. All hormone therapeutic modalities known to date, such as GnRH-agonists, cyproteronacetate and flutamide, have acted on the male hypothalamic-pituitary-gonadal system. Because of their side effects they are rarely used for the treatment of symptomatic benign prostatic hyperplasia. The 5-alpha-reductase inhibitor finasteride is a new endocrinological treatment option. It can be used to reduce the volume of enlarged prostates and to improve flow rates without severe side effects. According to the available data, finasteride is a safe treatment option for symptomatic patients with benign prostatic hyperplasia if surgery is not yet indicated. It should not, however, be regarded as an alternative to surgical treatment of benign prostatic hyperplasia.

5-alpha Reductase Inhibitors↗
PubMed2006

Vascular resistance in the prostate evaluated by colour Doppler ultrasonography: is benign prostatic hyperplasia a vascular disease?

OBJECTIVE: To evaluate prostatic vascular resistance by measuring the resistive index (RI), and flow velocity using colour Doppler ultrasonography (CDUS), in normal prostates and in patients with benign prostatic hyperplasia (BPH) or prostate cancer, as BPH is considered to be a result of urogenital ageing and studies suggest that hyperplasia in the stromal and glandular compartments might be induced by stromal growth secondary to hypoxia, which in turn results from abnormal blood flow patterns. PATIENTS, SUBJECTS AND METHODS: Ninety-two men (22 with normal prostates, 45 with BPH and 25 with prostate cancer; mean age 56 years) were prospectively evaluated by CDUS. The RI values for the peripheral, central and transition zones were assessed by one investigator. The diagnosis of BPH and prostate cancer was established from histological findings. RESULTS: The mean (sd) RI in the transition zone was significantly higher only in patients with BPH, at 0.77 (0.05), vs 0.65 (0.05) in the other two groups. In the peripheral and central zones there was no significant difference in the RI among the three groups. Arterial CDUS flow velocity was increased in the transition zone of patients with BPH, but not in the peripheral and central zones. CONCLUSIONS: The present results support the hypothesis that an age-related impairment of blood supply to the lower urinary tract might have a role in the development of BPH. Although prostate cancer cannot be excluded by measuring RI, high RI values (>0.75) in the transition zone are indicative of BPH.

Adult↗
PubMed1997

Insulin-like growth factor-binding protein-2 in patients with prostate carcinoma and benign prostatic hyperplasia.

OBJECTIVE: Insulin-like growth factor-binding protein (IGFBP)-2 is a major prostatic IGFBP and may be involved in regulating prostate growth. Patients with prostate carcinoma (PC) have elevated serum IGFBP-2 levels which correlate with the specific PC marker, prostate-specific antigen (PSA). The aims of this study were (i) to investigate whether elevated serum IGFBP-2 is unique to PC or also occurs in benign prostatic hyperplasia (BPH), (ii) to examine the relationships among age, PSA and IGFBP-2 levels, and (iii) to examine longitudinal changes in serum IGFBP-2 with PSA in PC. DESIGN AND PATIENTS: Sixteen patients (61-83 years) with inoperable PC attending the Oncology Unit at a tertiary referral hospital were studied. Some serum samples were obtained retrospectively while the majority were collected prospectively over 13 months of treatment. The patients with PC were compared to eight patients (66-73 years) with histologically-proven BPH and seven male control subjects (61-82 years) with no known prostate abnormality. MEASUREMENTS: A new IGFBP-2 RIA was developed. Serum PSA (by EIA), and IGFBP-2, IGFBP-3, IGF-I and IGF-II (by RIA) were measured in all subjects, and serially in patients with PC. RESULTS: Serum IGFBP-2 was significantly higher in PC with high PSA (560 +/- 66 micrograms/l, n = 12) than PC with normal PSA (292 +/- 65 micrograms/l, n = 4, P = 0.02), BPH (364 +/- 61 micrograms/l, P = 0.03) and controls (367 +/- 44 micrograms/l, P = 0.04). Mean IGFBP-2 in BPH was not different from controls. IGFBP-2 and PSA were significantly correlated with age (r = 0.543 and r = 0.433 respectively) and with each other even when the age effect was removed. Serum IGFBP-2 and PSA levels changed concordantly in all seven PC patients who had serial sampling. Serum IGF-II but not IGF-I or IGFB-3 was higher in PC and BPH than controls (PC 332 +/- 23 micrograms/l, BPH 359 +/- 26 micrograms/l vs. controls 241 +/- 37 micrograms/l; P = 0.03 and 0.02 respectively). CONCLUSIONS: Serum IGFBP-2 levels are uniquely elevated in active prostate carcinoma but not. In benign prostatic hyperplasia. In prostate carcinoma, serum IGFBP-2 levels closely parallel those of prostate-specific antigen and probably reflect tumour burden. The relationship between prostatic-specific antigen and IGFBP-2 is partially independent of their individual relationships with age. Although serum IGFBP-2 is less sensitive than prostate-specific antigen in prostate carcinoma it may have adjunctive value in its management.

Aged↗
PubMed1998

Comprehensive patient evaluation for benign prostatic hyperplasia.

It is time to consider new approaches to benign prostatic hyperplasia (BPH). Previously, obstruction, prostatism, and hyperplasia of the prostate were considered to be almost synonymous. Today, there is increasing awareness that some men have hyperplasia, some have symptoms, and others obstruction. Currently, BPH is discussed in terms of benign prostatic enlargement (BPE), bladder outlet obstruction (BOO), and lower urinary tract symptoms (LUTS). Symptom questionnaires, uroflowmetry, prostate volume determination, residual urine volume determination, and pressure-flow studies continue to be the instruments used for assessing BPH patients. Prostate enlargement, prostatic muscle tone, and bladder function all impact voiding function. A large part of BPH symptomatology may be explained by bladder dysfunction, which tends to be discounted in discussions about BPH. In the future, bladder dysfunction must receive more attention, and better measures should be developed to quantify it. Postvoid residual urine is a sign of abnormal bladder function rather than the result of BOO. However, variability limits the predictive value of residual urine volume. Uroflowmetry is also criticized for excessive variability, which is increased among men with LUTS secondary to BPH. Approximately 70% of men with uroflow < 15 mL/sec are obstructed, which means that at least 10 million men in the United States have BOO. Therefore, alleviation of obstruction would be a daunting and overwhelming task. It is still widely believed that prostatism is due to an enlarged prostate and can be cured by reducing the size of the prostate. Prostate volume can be used to select treatment, but it is not reasonable to decide whether to treat a patient with LUTS on the basis of prostate size. One of the problems with symptom-based treatment is that LUTS is not gender specific. Questions about LUTS in patients with BPH may elicit very inconsistent responses, and numeric improvement in symptom score is not proportional to how bothered the patient is. Bother, not symptom score or objective measures such as postvoid residual urine and uroflowmetry, is what drives the decision-making process in BPH management. The most recent international guidelines for BPH treatment emphasize that the degree to which the patient is bothered is more important than symptom score. More than a third of all elderly men (and women) have moderate or severe LUTS, and not all of them should receive treatment. In the future, measuring bother due to LUTS and impact on the patients' quality of life with the BPH impact should be imperative and central to treatment decisions.

Humans↗
PubMedDate not supplied

Benign prostatic hyperplasia: it is a premalignant lesion?

Benign prostatic hyperplasia (BPH) and prostate cancer are conditions commonly affecting the prostate gland in aging men. Prior epidemiological studies investigating potential associations between the two have resulted in conflicting data. Recent morphological studies have demonstrated the occurrence of a subset of prostate cancers as arising in the transition zone of the gland, the same region where BPH occurs. A morphologic lesion, atypical adenomatous hyperplasia (AAH), providing a possible link between cancer and BPH has been described. Biological studies of this potential precursor lesion are not yet available, but will be essential in order to further investigate this possible association.

Clinical Trials as Topic↗
PubMed1993

Transurethral prostatectomy versus transurethral dilatation of the prostatic urethra for benign prostatic hyperplasia: a cost-utility analysis.

Transurethral prostatectomy is the treatment currently preferred for benign prostatic hyperplasia. A new procedure, transurethral dilatation of the prostatic urethra, has lower costs and mortality and complication rates but may be less effective. These two strategies were evaluated by using cost-utility analysis, a form of cost-effectiveness analysis in which the benefit is defined in terms of individual preferences. Under the model assumptions, the cost of transurethral dilatation is less than the cost of transurethral prostatectomy for patients with benign prostatic hyperplasia ($7084 versus $8647) and slightly more effective: 11.787 quality adjusted life years versus 11.766. Thus, transurethral prostatectomy is said to be dominated. Results indicate that if patients are rigorously selected, and if balloon catheters of 30-35mm in size are utilized, transurethral dilatation could be the initial treatment of choice for eligible patients with benign prostatic hyperplasia.

Catheterization↗
PubMed2002

[Estrogen and estrogen receptors in benign prostatic hyperplasia].

Estrogen is a strong growth regulator of the prostate stromal cells, it produces a marked effect by means of binding to specific receptors. Many researches have indicated that estrogen and estrogen receptors take part in the whole process and development of benign prostatic hyperplasia. This article gives a general description of the function of estrogen and estrogen receptors in benign prostatic hyperplasia.

Estrogens↗
PubMed2006

Development of nomogram to predict acute urinary retention or surgical intervention, with or without dutasteride therapy, in men with benign prostatic hyperplasia.

OBJECTIVES: To develop a prediction model, or nomogram, that would predict the probability that a man with benign prostatic hyperplasia would experience acute urinary retention (AUR) or require surgical intervention (SI) within 2 years, with or without dutasteride therapy. METHODS: We modeled 4294 men treated in the Phase III dutasteride benign prostatic hyperplasia trials. These men were characterized at baseline by a number of parameters, including the American Urological Association Symptom Index, Benign Prostatic Hyperplasia Impact Index questionnaire, prior use of selective alpha1-blockers, prostate volume, prostate-specific antigen level, and maximal flow rate. Cox proportional hazards regression analysis was used to relate these baseline variables to their future probability of AUR/SI within 2 years. The nomogram was internally validated with bootstrapping to assess its discrimination and calibration. Discrimination was quantified as the concordance index. RESULTS: The nomogram appeared to be accurately calibrated and discriminating (concordance index 0.71, P <0.001). CONCLUSIONS: We constructed a nomogram for predicting the probability that a man would experience AUR or require SI within 2 years of benign prostatic hyperplasia diagnosis. At 24 months of follow-up, 7.4% of placebo patients and 3.7% of dutasteride patients had experienced AUR and/or SI, representing a 50% relative risk reduction and a 3.7% absolute risk reduction. For the greatest risk patient randomized to the Phase III dutasteride trial, the nomogram predicted a maximal risk of 27%, significantly greater than the median risk of the placebo-treated patients.

Acute Disease↗
PubMed2005

[Vascular endothelial growth factor in patients with prostate cancer and benign prostatic hyperplasia].

The authors examined 25 patients with prostate cancer (PC) and 36 patients with benign prostatic hyperplasia (BPH). In the group of patients with morphologically verified PC mean serum level of vascular endothelial growth factor (VEGF) was significantly higher than in patients with BPH (p < 0.05). The study demonstrated strong negative association between VEGF and prostate specific antigen (PSA) levels (r = 0.72, p < 0.05) in PC patients. There was no association between VEGF serum level and the stage or malignancy of PC (Gleason score). In benign prostatic glands moderate VEGF expression was observed only in basal cells, whereas in cases of PC all tumor cells displayed active VEGF expression; the difference was significant (p < 0.05). High serum VEGF levels and its active expression in patients with PC suggest an important role of angiogenic factors in the pathogenesis of this disease. The negative association between VEGF and PSA serum levels in PC indirectly confirms antiangiogenic activity of PSA, shown before.

Aged↗
PubMed2002

Finasteride in the treatment of clinical benign prostatic hyperplasia: a systematic review of randomised trials.

BACKGROUND: Benign prostatic hyperplasia affects older men. This systematic review determined efficacy and adverse effects of finasteride. REVIEW METHODS: PubMed, the Cochrane Library, reference lists of reports, and reviews were searched for randomised, double-blind trials of finasteride in benign prostatic hyperplasia. Outcomes included symptom score, urinary flow rate, prostate volume, discontinuation, and adverse effects. Relative risk and NNT or NNH were calculated for dichotomous data. Sensitivity analyses assessed influences of baseline symptom severity, initial prostate volume, a dominating trial, and previous interventions. RESULTS: Three trials had active controls and 19 had placebo. In placebo-controlled trials, 8820 patients received finasteride 5 mg and 5909 placebo over 3-48 months. Over 48 months finasteride produced greater improvements in total symptom score, maximum urinary flow rate, and prostate volume. Significantly more sexual dysfunction, impotence, ejaculation disorder and decreased libido occurred with finasteride at 12 months; the NNH for any sexual dysfunction at 12 months was 14. Significantly fewer men treated with finasteride experienced acute retention or had surgery at 24 or 48 months than with placebo; at 12 months the NNT was 49 (31 to 112) to avoid one acute urinary retention and 31 (21 to 61) to avoid one surgery. Sensitivity analyses showed benefit with finasteride 5 mg to be constant irrespective of the initial prostate volume. CONCLUSIONS: Information from many patients in studies of high quality showed beneficial effects of finasteride in terms of symptoms, flow rate and prostate volume. More utility would result if patient centred outcomes were reported in dichotomous form.

Enzyme Inhibitors↗
PubMed1998

Influence of finasteride on free and total serum prostate specific antigen levels in men with benign prostatic hyperplasia.

PURPOSE: Finasteride therapy for benign prostatic hyperplasia (BPH) results in a marked lowering of serum prostate specific antigen (PSA) levels. However, little is known about the effect of finasteride on unbound or free serum levels of PSA. Such information would be important since percent free PSA may substantially improve the cancer specificity of PSA testing. Thus, we prospectively studied the effect of finasteride therapy on total and free serum PSA levels. MATERIALS AND METHODS: In a randomized, placebo controlled, double-blind trial 40 men with histologically confirmed BPH (age range 52 to 78 years) were treated with either 5 mg. finasteride daily (26 patients) for 9 months or placebo (14) for 6 months. Prostate volume was assessed by transrectal ultrasound. Serum levels of free and total PSA were measured from archived serum samples stored at -70C at baseline and for as long as 9 months of treatment. RESULTS: In the finasteride group mean total PSA levels declined from 3.0 ng./ml. at baseline to 1.5 ng./ml. after 6 months of treatment (50% decrease, p <0.01). In the placebo group, with similar baseline levels, no significant change was observed. PSA density declined significantly in finasteride treated men (p <0.01) but not in men receiving placebo. The mean percent free PSA (13 to 17% at baseline) was not altered significantly by finasteride or placebo. CONCLUSIONS: Total PSA serum levels decreased by an average of 50% during finasteride therapy but percent free PSA did not change significantly. This information is potentially useful in the interpretation of PSA data used for early detection of prostate cancer in men receiving finasteride. However, further studies are required to demonstrate the use of percent free PSA to detect the development of cancer.

Aged↗
PubMed2006

[Role of prostatic stents and transurethral microwave thermotherapy in the treatment of voiding disorders related to benign prostatic hyperplasia (CTMH-AFU forum 2005)].

Prostatic stents and microwave thermotherapy are minimally invasive techniques for the treatment of voiding disorders related to benign prostatic hyperplasia. A review of the literature evaluates the place of these treatments in 2006. Permanent prostatic stenting is rarely used, but remains a treatment option for patients with obstructive disorders and a formal anaesthetic contraindication. Temporary stenting can be used to predict the effect of resection in selected patients. Finally, microwave thermotherapy, not widely used in France, has a promising clinical efficacy and occupies a place between medical treatment and surgery.

Humans↗
PubMed1993

Quantitation of potentially undiagnosed incidental carcinoma of the prostate in patients treated non-surgically for benign prostatic hyperplasia.

Prostatectomy is the standard treatment for benign prostatic hyperplasia (BPH) and non-surgical treatment of prostatism would reduce the detection of Stage A prostate cancer. We wished to identify the number of potentially undiagnosed cancers resulting if non-surgical therapy were used to treat a presenting complaint of BPH. We also sought to identify the age group which would most clearly benefit from treatment of Stage A prostate cancer. Our series of transurethral prostatectomy specimens showed 92/996 patients (9.2%) positive for incidental carcinoma; 26/92 patients (28%) received further treatment and 25 of the 26 patients had Stage A2 disease. After evaluating life-tables and survival data on untreated A2 disease, the population aged < or = 72 years had a relative benefit of treatment ratio > 1.0, i.e. had a greater likelihood of dying from prostate cancer than from natural causes; 17/616 (2.8%) of the population aged < 72 years had their A2 disease treated and would have potentially been denied early cancer treatment if non-surgical management of BPH had been employed. The above figures assume 100% non-surgical treatment of BPH and no screening for prostate cancer pre-treatment. Stage A2 patients in this study demonstrated no significant difference in cause-specific survival rates between treated and untreated study groups (both 0%) or between treated study patients and untreated historical patients. Treated A2 patients demonstrated a significantly lower 5-year progression rate (0 vs 32%) relative to untreated patients reported in the literature, and a trend toward a significantly lower progression rate (0 vs 25%) relative to untreated study patients.

Age Factors↗
PubMed2004

[Progress in the experimental studies of traditional Chinese medicine for benign prostatic hyperplasia].

The present article reviews the progress in the experimental studies of traditional Chinese medicine for benign prostatic hyperplasia (BPH) in the recent years. Traditional Chinese medicine can inhibit prostatic hyperplasia, after the growth factor of prostate cell proliferation, regulate nerves and endocrine, and act on the kinetic factor (alpha-receptor) and static factor (augmented prostate) of BPH formation. We also investigate the selection of the animal model of prostatic hyperplasia. It has certain directive effect to further discover the action mechanism of traditional Chinese medicine in the treatment of BPH.

Animals↗
PubMed2005

Long-term efficacy and safety of tamsulosin for benign prostatic hyperplasia.

The treatment approach for recent benign prostatic hyperplasia has changed since the recent introduction of medical therapies with evidence-based efficacy. The choice of treatment to achieve symptom relief must take into account factors such as clinical benefits, potential for morbidity, probable long-term efficacy, and costs. alpha(1)1-Adrenergic receptor antagonists are the primary therapy for patients with benign prostatic hyperplasia presenting with lower urinary tract symptoms and are used by 80% of physicians as the first-line agent to treat this common condition in the aging male. Tamsulosin has been available in the United States since 1997 and has demonstrated its efficacy. Of patients completing 6 years of treatment, 80.7% demonstrated consistent positive response with extremely low incidence of orthostasis, the response being greatest during the first year and largely maintained over the following 5 years.

Journal Article↗
PubMed1997

[Benign prostatic hyperplasia. Shared care between urologists and general practitioners].

Clinical treatment of benign prostatic hyperplasia has been considered to be a task for the urologist alone. The urologist has been the only person capable of providing relief from the urethral obstruction through open and transurethral surgery. In recent years, knowledge about the physiology and pharmacology of the lower urinary tract and about the normal development of the condition has increased considerably. This has led to the development of new pharmacological drugs with positive effects on the symptoms caused by the obstructing hyperplastic prostate gland. The general practitioner now has a means of caring for patients with benign prostatic hyperplasia as long as the obstruction is not too pronounced and the symptoms are mild or moderate. Provided that urinalysis and creatinine level are normal, and there is no suspicion of malignancy, medical treatment can be considered. In cases with mild or moderate symptoms without suspicion of serious obstruction, even expectancy ("watchful waiting") may be preferred. When there is doubt about the diagnosis or when the effect of treatment is not as expected, the patient should be referred to a urologist. Benign prostatic hyperplasia is a condition where the care can suitably be shared between urologist and general practitioner.

Diagnosis, Differential↗