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PubMed1992

[Value of functional examination techniques for the assessment of the clinical aspects of benign prostatic hyperplasia].

The urodynamic relevance of benign prostatic hyperplasia (BPH) is determined by evaluation of the symptoms of prostatism, the degree of infravesical obstruction and the size of adenoma. The combination of all three findings, but also the presence of at least of two of these findings suggest a diagnosis of clinical BPH. Standard diagnostic procedures consist in elicitation of the history, evaluation of symptoms, physical examination, urinalysis and laboratory examination of serum creatinine; with evaluation of residual urine and uroflowmetry in addition, surgical therapy can be expected to be successful in 93%. Urinary flow rates exceeding 15 ml/s and/or discrepancies between symptoms and findings need further assessment by synchronous pressure-flow studies for differential diagnosis between unobstructed flow and high-flow outflow obstruction. Complete videourodynamic investigation is indicated both in patients with combined BPH and urinary incontinence without residual urine and in patients with BPH and suspected or known neurological disorder. Surgical treatment of BPH involves the risk of postoperative incontinence in patients with detrusor hyperreflexia combined with a functional or morphological lesion of the external urinary sphincter.

Diagnosis, Differential↗
PubMed1993

In vitro high resolution 1H-spectroscopy of the human prostate: benign prostatic hyperplasia, normal peripheral zone and adenocarcinoma.

1H-spectra at 360 MHz from perchloric extracts of 35 human prostate specimens were obtained. First, we sought to define what peaks can be assigned in vitro, and thus, potentially seen in vivo. Second, we sought to try to discriminate between adenocarcinoma, normal peripheral zone and benign prostatic hyperplasia using spectral fingerprints. Thirteen samples of adenocarcinoma, 11 samples of benign prostatic hyperplasia, and 11 samples of normal contralateral peripheral zone were analyzed by obtaining a ratio from the maximum area of each major peak and the area of an added standard (3-trimethyl-silyl-propionic acid). There was a significantly larger benign prostate hyperplasia citrate standardized peak area when compared to the adenocarcinoma citrate standardized peak area for each patient (P < 0.05). However, the citrate standardized peak areas from the normal peripheral zones were not significantly different from those found in the adenocarcinomas. Four out of 13 cases of stromal hyperplasia had similarly low levels of citrate as their respective gland's adenocarcinoma. We also found a sharp peak at 2.05 ppm that was seen in 4 out of 13 adenocarcinoma samples and in only 1 out of 13 of the benign prostate hypertrophy samples which has tentatively been assigned to N-acetyl neuraminic acid. Further studies are required to assess whether low citrate levels alone can serve to exclusively diagnose adenocarcinoma of the prostate.

Acetates↗
PubMed2004

[PSA and benign prostatic hyperplasia].

In the opinion of many urologists, prostate-specific antigen (PSA), which is not specific of any disease, is not considered in the diagnosis and follow-up of benign prostatic hyperplasia (BPH). Nonetheless, prostate cancer diagnosis is based on PSA screening. PSA value is thus available for a majority of men above 50. Recent data suggest that there is a link between PSA value and BPH natural history, turning PSA into a tool for BPH management and prevention of complications such as retention. It hasn't got into practice so far, as recommended criteria for PSA screening in BPH have not been issued. The debate over this topic is only at its beginning.

Humans↗
PubMed1995

International prostate symptom score and quality of life assessment versus urodynamic parameters in men with benign prostatic hyperplasia symptoms.

In 207 men with symptomatic benign prostatic hyperplasia the international prostate symptom score and score on quality of life were collected. Cystometric tests with pressure-flow studies were performed in these patients with special attention to the assessment of obstruction grade. Of the men 24% appeared not to have obstruction. A significant correlation was found between size of the prostate and grade of obstruction. No correlation was found between obstruction grade, and any symptom score or quality of life score, while symptom score and quality of life correlated well. In 41 patients the outcome of laser prostatectomy was evaluated 6 months after the procedure. Mean symptom score decreased from 19.1 to 5.4 and mean quality of life score decreased from 3.7 to 1.3 in the 31 obstruction patients, compared to decreases of 19.6 to 10.1 and 3.6 to 2.6, respectively, in 10 without obstruction. The improvement in the obstruction patients was significantly better but nonobstruction patients will benefit from prostatectomy as well.

Aged↗
PubMed1999

Immunohistochemical studies in canine prostatic hyperplasia--effect of antiandrogen.

To investigated spontaneous benign prostatic hyperplasia (BPH) in dog the effect of a synthetic steroidal antiandrogen, chlormadinone acetate (CMA) was studied. Old male beagle dogs (5-8 years old) were divided into following experimental groups: group 1 consisted of BPH controls; group 2 received CMA 0.3mg/kg/day p.o., for 6 months. In group 1 animals, glandular hyperplasia of the prostate was clearly detected. The glandular epithelial cells showed uniformly intense immunostaining for nuclear androgen receptors (AR). AR was also localized in the nuclei of the fibro-muscular cells. Immunoreactivity of 5alpha-reductase type I was positive in most glandular epithelial cells. The staining was positive in the cytoplasm but not in the nuclei. No fibro-muscular cells were stained. In contrast, CMA produced marked atrophy of the glandular epithelium. The interacinar fibro-muscular stroma was prominent. Furthermore, immunostaining of nuclear AR of both epithelial and stroma cells was remarkably decreased. The intensity of staining for 5alpha-reductase type I in most glandular epithelial cells also decreased. Interestingly, some basal cells exhibited positive staining for 5alpha-reductase type I. These results indicate that the uptake of testosterone and/or its androgenic effect on the prostate may be suppressed by CMA. We further speculate that the basal cells produce sufficient dihydrotestosterone to maintain themselves even in the presence of low testosterone levels.

Androgen Antagonists↗
PubMed1987

Anatomy of the prostate from fetus to adult--origin of benign prostatic hyperplasia.

The anatomy of the prostate was studied in specimens from humans ranging from fetal age to 79 years. At all ages, the prostate can be divided into two zones, inner and outer. The distribution and relative size of the prostatic lobes is similar in the fetus and in the adult. In the fetus, the inner zone can be subdivided into lateral, subcervical, and anterior lobes and mucosal glands. The anterior and subcervical lobes usually disappear in prepuberty but may reappear in advanced age. The outer zone can be subdivided into the middle and posterior lobes. Benign prostatic hyperplasia arises from the lateral, subcervical, and anterior lobes of the inner zone and the middle lobe of the outer zone. It is suggested that previous investigators failed to describe a demarcation line or territory between the lateral and posterior lobes.

Adolescent↗
PubMed2000

Differential response of prostate specific antigen to testosterone surge after luteinizing hormone-releasing hormone analogue in prostate cancer and benign prostatic hyperplasia.

OBJECTIVE: To investigate any differences in changes in serum prostate specific antigen (PSA) levels in patients with benign and malignant prostatic disease in response to the testosterone surge after administering a luteinizing hormone-releasing hormone (LHRH) analogue. PATIENTS AND METHODS: The study included 54 patients referred to the urology clinic with intermediate PSA levels (4-10 ng/mL) or an abnormal digital rectal examination. Forty-five patients received a single injection of LHRH analogue depot each at one week before prostate biopsy and nine served as a control group. Changes in PSA levels in response to the testosterone surge from the LHRH analogue were recorded after 5 and 7 days, and were correlated with the biopsy results. The PSA changes were compared with basal PSA levels and the free/total PSA ratio(f/tPSA). RESULTS: Of the 45 patients who underwent prostate biopsy, histopathology showed prostate cancer in 11, benign prostatic hyperplasia in 33 and prostatic intraepithelial neoplasia in one. Patients with cancer had a significantly greater increase in serum PSA levels during the first week after LHRH injection than those in the benign and control groups. Receiver operating characteristic curves showed that the percentage change in PSA level on day 5 was more diagnostic than total PSA and f/tPSA. CONCLUSIONS: There was a marked difference in the PSA response of patients with benign or malignant disease to the testosterone surge produced by the LHRH analogue. Although a larger study would be needed before LHRH-induced provocation could be proposed as a clinical test, in this small series the response was better than that for total PSA or f/tPSA in differentiating benign and malignant disease.

Aged↗
PubMed2006

To what extent do real life practice studies differ from randomized controlled trials in lower urinary tract symptoms/benign prostatic hyperplasia?

PURPOSE OF THE REVIEW: To compare the real-life practice studies and randomized controlled trials on benign prostatic hyperplasia in order to understand the applications of the data from the two types of study. RECENT FINDINGS: Until recently, much of the available information on benign prostatic hyperplasia has come from randomized controlled trials conducted by secondary care urologists on selected populations of patients, who are likely to represent the more symptomatic among the cohort of men with lower urinary tract symptoms in the community. The strict inclusion criteria in these trials led to uncertainty about the applicability of the results to community populations. Moreover, as patients in randomized controlled trials are specially recruited, rather than being drawn from a general population of men with lower urinary tract symptoms, the calculations of incidence and prevalence rates may not be possible. In the last few years, there have been a few important real-life practice studies such as the Triumph project, the Quadraet study and the ALF-ONE study, which have provided very useful data regarding the incidence and prevalence of lower urinary tract symptoms/benign prostatic hyperplasia, the incidence of acute urinary retention, the impact of therapy on the risk of surgery related to benign prostatic hyperplasia and the predictors of disease progression during treatment with alpha-blocker. SUMMARY: As the results from randomized controlled trials cannot always be generalized to daily urological practice, it is important to complement them with data made available by the real-life practice studies. In order to do that, the salient features in the methodology of both types of study must be understood.

Humans↗
PubMed2000

[Transurethral microwave thermotherapy. A therapeutic option for high-risk patients with urinary retention secondary to benign prostatic hyperplasia].

Urinary retention secondary to benign prostatic hyperplasia is considered an absolute indication for surgical treatment of the prostate. Transurethral resection of the prostate is still considered the gold standard in terms of effectiveness. One of several new techniques for treatment of BPH is transurethral microwave thermotherapy (TUMT). Our first experiences with this technique in a group of patients with urinary retention were analysed retrospectively. In the short term 16 of the 25 treated patients were able to void spontaneously with acceptable bladder emptying (64%, 95% CI: 43-85). Later on, three of these initial successes received further treatments for BPH, two had a transurethral resection of the prostate and one was given medical therapy. No serious complication was seen except in one patient who developed a urethrorectal fistula which healed following conservative treatment. The success rate following TUMT was inferior to that of standard transurethral resection, but TUMT seems an acceptable alternative in patients with pronounced co-morbidity.

Aged↗
PubMed2003

A randomized trial comparing holmium laser enucleation of the prostate with transurethral resection of the prostate for the treatment of bladder outlet obstruction secondary to benign prostatic hyperplasia in large glands (40 to 200 grams).

PURPOSE: Holmium laser enucleation of the prostate (HoLEP) is a surgical treatment for bladder outlet obstruction secondary to benign prostatic hyperplasia. HoLEP is a transurethral procedure that uses the holmium laser fiber (wavelength 2,140 nm) to dissect whole prostatic lobes off of the surgical capsule in retrograde fashion, while maintaining excellent hemostasis. The lobes are removed from the bladder by a purpose built transurethral morcellator, which means that large volume prostates can be enucleated endoscopically. We compared this procedure with transurethral prostate resection (TURP) in a randomized trial by evaluating outcomes in patients with a prostate volume of 40 to 200 ml on transrectal ultrasound. MATERIALS AND METHODS: A total of 61 patients with urodynamically proved bladder outlet obstruction secondary to benign prostatic hyperplasia were randomized to TURP or HoLEP. Perioperative parameters recorded included resectoscope, laser, electrocautery, morcellation and catheter time, hospital stay, bladder irrigation, volume blood transfusion the rate and resected tissue weight. Patients were followed 1, 3, 6 and 12 months postoperatively with peak urinary flow rate measurement and quality of life and American Urological Association symptom scores. Patients also underwent urodynamic assessment at 6 months with measurement of peak detrusor pressure at maximal flow, post-void residual volume and prostate volume by transrectal ultrasound. Continence, potency and all adverse events were recorded at each visit. RESULTS: HoLEP was superior to TURP in terms of mean catheter time (17.7 +/- 0.7 vs 44.9 +/- 10 hours) and hospital stay (27.6 +/- 2.7 vs 49.9 +/- 5.6 hours) but it required more time to perform (62.1 +/- 5.9 vs 33.1 +/- 3.7 minutes). More prostate tissue was removed in the HoLEP group (40.4 +/- 5.7 vs 24.7 +/- 3.4 gm). HoLEP was also superior to TURP in terms of relieving urodynamic obstruction at 6 months of followup (postoperative detrusor pressure at maximum flow 20.8 +/- 2.8 vs 40.7 +/- 2.7 cm H2O). HoLEP and TURP led to significant improvements in peak flow rates, symptom scores and quality of life scores compared with baseline and there was no significant difference between the 2 procedures with respect to these parameters at 12 months. Fewer adverse events were recorded in the HoLEP group. CONCLUSIONS: HoLEP is superior to TURP for relieving bladder outlet obstruction in men with benign prostatic hyperplasia. It allows more rapid catheter removal and hospital discharge. It requires more time to perform than TURP but more prostate tissue is removed, resulting in similar efficiency in tissue retrieval. HoLEP is equivalent to TURP in relieving men of lower urinary tract symptoms and in improving peak urinary flow rates at 12 months of followup.

Aged↗
PubMed2005

Benign prostatic hyperplasia: an insight into current investigational medical therapies.

Benign prostatic hyperplasia (BPH) is a leading disorder of the elderly male population that is characterised by a progressive enlargement of prostatic tissue, resulting in obstruction of the proximal urethra and causing urinary flow disturbances. The pathophysiology of BPH associated with lower urinary tract symptoms is characterised by increased adrenergic tone (dynamic component) leading to smooth muscle contraction and prostatic overgrowth due to androgenic stimulation (static component); therefore, the therapeutic armamentarium of BPH can be broadly divided into antiadrenergic and antiandrogenic approaches. alpha1-Adrenoceptor antagonists and 5alpha-reductase inhibitors are well-established representatives of the two categories, respectively. Other antiandrogenic approaches involve gonadotropin-releasing hormone agonists and antagonists for the treatment of prostate hyperplasia. Apart from these approaches, new approaches with novel targets are emerging. The advent of new therapies is, however, more oriented towards the static component. These involve metabolic factors (hexokinase inhibitor), growth factors (vitamin D3 analogues), oxytocin antagonists and gonadotropin-releasing hormone Gi agonist-based therapies. Gene therapy and photodynamic therapies are other emerging therapies for relieving symptoms in BPH patients. With the initial success of upcoming targets, the unmet need to develop an efficacious and relatively safe therapeutic modality is discussed. Nevertheless, their long-term safety and efficacy needs to be evaluated in large-scale clinical trials. The future also belongs to combination therapies to combat both dynamic and static disease components and for extended indications such as micturition disorder and non-bacterial prostatitis.

Adrenergic alpha-Antagonists↗
PubMed1990

Medical and surgical management of benign prostatic hyperplasia, diskospondylitis, and penile paresis in an ocelot.

Benign prostatic hyperplasia, diskospondylitis at the T13-L1 intervertebral disk space, and penile paresis were diagnosed in a 16-year-old male ocelot. Treatment consisted of castration for the benign prostatic hyperplasia and long-term administration of antibiotics for the diskospondylitis. On physical examination 8 weeks after initial referral, the prostate gland was no longer palpable and could not be visualized radiographically or ultrasonographically. The diskospondylitis lesion was found to be healing, on the basis of radiographic results.

Animals↗
PubMed2001

Combined effect of terazosin and finasteride on apoptosis, cell proliferation, and transforming growth factor-beta expression in benign prostatic hyperplasia.

BACKGROUND: Medical treatment of benign prostatic hyperplasia (BPH) targets relief of symptoms by causing either relaxation of the prostatic smooth muscle with alpha1 adrenergic blockade, or shrinkage of the gland with 5alpha-reductase inhibitors. We recently demonstrated that alpha1-blockers, such as terazosin, induce apoptosis in prostatic cells. In this study, we examined the combined effect of finasteride and terazosin on the rate of apoptosis and cellular proliferation to investigate their potential synergy at the cellular level. METHODS: Prostate specimens were obtained from men who were treated with either finasteride (n = 24), terazosin (n = 42), or combination therapy (n = 10) for varying time periods (1 week to 36 months) for the relief of the symptoms of BPH. The proliferative and apoptotic indices of both stromal and epithelial prostatic cell populations were determined. Antibodies against TGF-beta1 and TbetaRII were used to examine the immunoreactivity of TGF-beta1 and TbetaRII, respectively, in all prostate tissue sections. RESULTS: The apoptotic index in both prostate cell populations was significantly higher following the combination treatment compared to terazosin or finasteride alone. There were no significant changes in the rate of cellular proliferation with any treatment. Furthermore, there was a significant increase in TGF-beta1 expression in the prostates of patients treated with terazosin or combination therapy, while there was no change in TbetaRII expression. CONCLUSIONS: These results support the concept that induction of prostate apoptosis is a potential molecular mechanism underlying the combination effect of alpha1 blockade with 5alpha-reductase inhibitors in the effective treatment of BPH. The upregulation of TGF-beta1 implies a role for this ligand as an effector of apoptosis induction in response to alpha1-blockade or finasteride therapy of BPH patients.

Adrenergic alpha-Antagonists↗
PubMed1982

Decrease in creatine kinase in human prostatic carcinoma compared to benign prostatic hyperplasia.

Many previous studies have shown that a proportion of patients with carcinoma of the prostate have increased activity of the creatine kinase (E.C. 2.7.3.2) isoenzyme designated BB in sera from their peripheral blood. We have analyzed tissues from prostatic hyperplasia of 22 patients and from prostatic carcinoma of 23 additional patients. Prostatic carcinomas contain less (p less than 0.001) creatine kinase activity (units/g) than do prostates with benign prostatic hyperplasia. The facts that (a) histochemical studies that we performed confirmed the observation reported previously by others that creatine kinase activity is found primarily in the epithelial elements of hyperplastic prostates and prostatic carcinomas, (b) the carcinomas that we examined had, on the average, a somewhat larger epithelial component than the hyperplastic prostates that we examined, and (c) prostate cancer was found to contain less creatine kinase activity than hyperplastic prostates suggest that the epithelial cells in prostate cancers contain less creatine kinase activity per cell than do those from hyperplastic prostates. The BB form of creatine kinase accounts for 98% of the activity in prostatic carcinoma and in prostates without cancer. Creatine kinase has been discussed as a possible marker for prostatic carcinoma, and we had hoped that it might be useful for the assay of tumor burden. Our data suggest that, if creatine kinase is to be useful in the monitoring of tumor burden, it will be useful only in the contexts of particular patients studied longitudinally since the creatine kinase activity varies enormously among different prostatic carcinomas.

Aged↗
PubMed1999

[Clinical results of interstitial laser coagulation for benign prostatic hyperplasia using diode laser].

Interstitial laser coagulation (ILCP) is currently considered to be one of the avenues for treatment of benign prostatic hyperplasia (BPH). The efficacy and effectiveness of the treatment, however, have not been well clarified. Here we report the outcome of treatment in benign prostatic hyperplasia using ILCP. Twenty patients with BPH who underwent interstitial laser coagulation using a diode laser between March and December 1998 were investigated. Our results showed that there are significant improvements in prostate symptom score and quality of life index after the treatment. According to the efficacy criteria, 70% of the patients showed clinical improvement of both scores at 1 month, and more than 90% of the patients at 3 months. The reduction of prostate volume was observed after 1 month of treatment and continued for 6 months. The improvement on peak flow rate was observed in 50% of the patients at 3 months and in 73.3% of the patients at 6 months. The overall efficacy rates were 62.5%, 85.0% and 100% of the patients at 1, 3 and 6 months, respectively. In all 20 patients the complications were minimal. No blood transfusion was required in any patients. However, one patient experienced both epididymitis and prostatic abscess and was treated with conservative therapy. In conclusion, interstitial laser coagulation using a diode laser is a very effective means for the treatment of benign prostatic hyperplasia. Because of its less invasive nature, we strongly recommend that ILCP be the major way of treatment for benign prostatic hyperplasia.

Aged↗
PubMed1999

New concepts in tissue specificity for prostate cancer and benign prostatic hyperplasia.

Of the hundreds of species of mammals, all of which have prostate glands, only humans and dogs are known to suffer from benign prostatic hyperplasia (BPH) and prostate carcinoma. In humans, prostate carcinoma is common, yet carcinomas of other sex accessory tissues are rare. In addition, different anatomic regions within the prostate gland have very different rates of BPH and carcinoma. In this article, we explore ideas and potential mechanisms relating to these paradoxical findings that may help explain the species, organ, and zone specificity of BPH and prostate cancer. We present an evolutionary argument that attempts to relate a high-fat diet, with its potential for generating oxidative DNA damage, to the species selectivity of prostate cancer. In addition, we outline an argument based on our preliminary studies indicating that chronic inflammation and the associated increase in cell turnover in the setting of increased oxidative stress may help to account for the organ selectivity of genitourinary carcinomas.

Animals↗
PubMed1998

The need for an international classification of benign prostatic hyperplasia.

An international classification of patients suffering from benign prostatic hyperplasia is essential, as we are currently unable to categorize patients there-by allowing application of the most appropriate treatment as a function of selected items. We have adopted 4 items: weight of the prostate (P); quality of life index (Q); international prostatic symptom score (S), and maximum flow rate (F). 112 patients were analyzed according to this classification and the results are presented. We have tried to develop a simple, easy to remember classification in order to easily allocate a given patient to a particular category. This proposed classification corresponds to a real 'Prostate Who's Who', which should be evaluated and improved to act as a working basis for an international classification of benign prostatic hyperplasia.

Adult↗
PubMed1995

Microvascularity in benign prostatic hyperplasia.

The vascular density of benign prostatic hyperplasia (BPH) has not been characterized. Previously we reported vessel density (vv/mm2) in prostatic carcinoma was twice that of normal prostate [Bigler et al.: Hum Pathol 24:220-226 1993]. To further characterize vessel density in benign prostate tissue we examined 15 cases of BPH obtained by open prostatectomy. Vessels were stained with antibodies to Factor VIII-related antigen, and vessel density was measured using computer-assisted image analysis. Vessel density was analyzed between various histologic tissue types. Mean vessel density in all transition zone tissue was 70.2 vv/mm2. Vessel density in epithelial hyperplastic nodules (mean 99.3, SD 40.7) exhibited density levels similar to those found in prostatic carcinoma (mean 101.4, SD 35.6). Vessel density in epithelial nodules was significantly higher than in non-nodular epithelial tissue (mean 76.7, SD 23.1; P < 0.001, ratio = 1.3). Higher vessel densities were found in hypercellular stromal nodules (mean 64.7, SD 19.1) than in adjacent stromal areas (mean 36.5, SD 15.3; P < 0.001, ratio = 1.8). Overall, vessel density in BPH was higher than previously found in benign tissue measured in radical prostatectomy specimens, especially in areas of nodular morphology.

Capillaries↗