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PubMed1995

High intensity focused ultrasound for benign prostatic hyperplasia.

BACKGROUND: Transurethral resection of the prostate (TURP) has been the gold standard of treatment for patients with symptomatic benign prostatic hyperplasia (BPH). The present paper discusses the safety and effectiveness of transrectal high intensity focused ultrasound (HIFU) for treating patients with symptomatic BPH. METHODS: HIFU was conducted on 28 patients with BPH. At one, three and six months after treatment, all patients were examined for parameters including International Prostate Symptom Scores (I-PSS), Quality of Life (QOL) inquiry, uroflowmetry, and transrectal ultrasound for determining prostate volume. RESULTS: I-PSS and QOL showed statistically significant improvement at one, three, and six months postoperatively (P < 0.0001-0.005, Wilcoxon signed-rank test). Ten of 28 (35.7%), 13 of 28 (46.4%), and 6 of 15 (40.0%) cases were categorized as effective cases with HIFU treatment at one, three, and six months follow-up. CONCLUSIONS: Focused ultrasound is an exciting new technology by which tissue can be destroyed at a site distant from the source of energy without damage to surrounding tissue. Clinical experience with alternative power settings, more accurate spacing of treatment lesions, and further development of HIFU machines may improve the results. Longer follow-up of patients with further clinical evaluation of HIFU is necessary to define the efficacy of this technique.

Aged↗
PubMed1998

Transurethral needle ablation of the prostate: a minimally invasive treatment for symptomatic benign prostatic hyperplasia.

Transurethral needle ablation of the prostate, a relatively new minimally invasive treatment modality for patients with bladder outlet obstruction attributable to an enlarged prostate gland, has undergone extensive evaluation by numerous investigators worldwide. The results to date indicate that needle ablation is safe and effective for relieving symptoms in patients with benign prostatic hyperplasia, and the effect has been demonstrated to be durable for at least 2 years. Nevertheless, additional investigations with longer follow-up data are needed to address the important issues of extended durability (5 to 10 years) and biophysiologic mechanism of action. Comparisons between transurethral needle ablation of the prostate and transurethral resection of the prostate (TURP) have revealed that the subjective and objective measures of response are comparable, although TURP has consistently displayed a slight advantage over needle ablation for most variables analyzed, except quality of life score. The advantages of needle ablation over TURP are (1) performance in the office as an outpatient procedure, (2) no need for general or spinal anesthesia, (3) rapid recovery, (4) minimal side effects, and (5) one-time intervention. The following disadvantages exist with needle ablation: (1) it may not be indicated or effective in patients with large prostate glands (75 g or more); (2) no prostate tissue is available for histologic evaluation; and (3) no long-term efficacy or re-treatment rate data have been published. Overall, the available information indicates that transurethral needle ablation is a viable minimally invasive treatment that may be applicable in men with moderate to severe bladder outlet obstruction as a result of an enlarged prostate gland.

Clinical Trials as Topic↗
PubMed1997

Prostate tissue composition and response to finasteride in men with symptomatic benign prostatic hyperplasia.

PURPOSE: We sought to quantify prostate tissue changes induced by finasteride and to identify a predictor of finasteride response in men with symptomatic benign prostatic hyperplasia (BPH) via a randomized, placebo controlled, double-blind clinical trial. MATERIALS AND METHODS: Men with symptomatic BPH (52 to 78 years old) were randomly assigned to 6 months of treatment with finasteride (26) or placebo (15). Outcome measures were clinical (urinary symptom score and flow rate), chemical (serum prostate specific antigen and dihydrotestosterone levels), volumetric (transrectal ultrasound, and magnetic resonance imaging for whole and zonal prostate volumes) and histological (morphometry of prostate sextant biopsies, separated into inner and outer gland segments, to measure the percent epithelium, stroma and glandular lumen). RESULTS: In the finasteride group we found a suggestion of decreasing symptom scores and increasing flow rates (not significant) with significant decreases (p < 0.01) in prostate specific antigen (48%), dihydrotestosterone (74%) and prostate volume (21%). Finasteride treatment induced a 55% decrease in inner gland epithelium (p < 0.01) with little effect on stroma or lumina. We also found a linear correlation between pretreatment inner gland epithelial content and prostate volume decrease induced by the drug (tau = 0.58, p = 0.01). CONCLUSIONS: Finasteride treatment results in a major suppression of prostate epithelium, which is most pronounced in the inner gland. Moreover, a finasteride induced prostate volume decrease was predictable by quantification of epithelial tissues of the inner gland. These data lend additional support to the emerging concept of transition zone primacy in symptomatic BPH.

Aged↗
PubMed2002

Molecular characterization of prostate hyperplasia in prolactin-transgenic mice by using cDNA representational difference analysis.

BACKGROUND: Transgenic mice overexpressing the rat prolactin (PRL) gene develop a dramatic enlargement of the prostate gland. The objective of this study was to characterize the molecular mechanisms in the prostate of importance for the prostate hyperplasia seen in these transgenic mice. METHODS: cDNA representational difference analysis (cDNA RDA) was used to isolate differentially expressed transcripts in the prostate hyperplasia of the transgenic mice compared with wildtype littermates. Furthermore, cDNA microarray analysis was used to verify the RDA output. RESULTS: Here we report 10 transcripts, some of them described to be involved in proliferation and apoptosis, which are differentially expressed in the enlarged transgenic prostates compared with controls. CONCLUSION: The identified differentially expressed transcripts presented herein supports molecular similarities between the prostate hyperplasia of PRL-transgenic mice and human BPH that may contribute to explain the molecular basis of prostate hyperplasia.

Animals↗
PubMed1998

Estrogen suppression as a pharmacotherapeutic strategy in the medical treatment of benign prostatic hyperplasia: evidence for its efficacy from studies with mepartricin.

Estrogen suppression has been introduced as a pharmacotherapeutic strategy in the medical treatment of benign prostatic hyperplasia. Recent negative results obtained in placebo-controlled trials with the aromatase inhibitor atamestane raised doubts about the efficacy of estrogen reduction. However, inhibition of aromatase not only reduces estrogens but also increases androgens which promote prostatic growth. In order to reevaluate the therapeutic efficacy of estrogen suppression, we summarize clinical trials investigating the therapeutic effects of mepartricin in the treatment of uncomplicated benign prostatic hyperplasia. Mepartricin has been reported to lower the levels of circulating estrogens without causing changes in other hormones such as androgens. By applying stringent inclusion criteria, 23 studies (including 7 placebo-controlled trials, 3 post-marketing surveillance studies, and 13 open trials) published between 1982 and 1996 were selected to be included in this report. In 79.9% of 4635 patients treated with mepartricin, its therapeutic effect was rated "good" or "excellent". In 6 out of 7 placebo-controlled trials, the therapeutic efficacy of mepartricin was significantly superior to that of placebo. Comparison of these data with results obtained with alpha 1-adrenoceptor antagonists or with the 5 alpha-reductase inhibitor finasteride indicates that mepartricin is as efficient as these widely accepted medical treatments for benign prostatic hyperplasia. Since mepartricin acts selectively upon estrogens, the present results show that estrogen suppression may be considered an efficient pharmacotherapeutic strategy in the medical treatment of uncomplicated benign prostatic hyperplasia.

Clinical Trials as Topic↗
PubMed2002

[An experimental study of the inhibition of tamoxifen on rat model of benign prostatic hyperplasia].

OBJECTIVES: To study the inhibitory mechanism of tamoxifen on benign prostatic hyperplasia. METHODS: The Wistar male adult rats were injected into muscle with testosterone propionate 4-6 mg/kg, simultaneously were irrigated into stomach with tamoxifen citrate 0.21 mg/kg. The partly rats of each group were decapitated at 7, 15 and 30 days, then their index numbers of prostate were calculated, and the structural changes of the prostatic histocyte were observed in the light microscopy and scan electronic microscopy. RESULTS: At the 7th, 15th, and 30th day, the index numbers of prostate of those rats which had been injected only with testosterone propionate were higher than that of the control group and the irrigating group(P < 0.05). The hyperplasia of the prostatic epithelial cells and the ground substance of those rats, which had been irrigated with tamoxifen citrate, had not happened in light microscopy and the scan electronic microscopy. CONCLUSIONS: Tamoxifen could block the effect of the estrogen, which could suppress the prostatic hyperplasia. This study could provide the experimental evidences for using Tamoxifen to treat the human benign prostatic hyperplasia.

Animals↗
PubMed2004

Benign prostatic hyperplasia progression and its impact on treatment.

PURPOSE OF REVIEW: Management of men with benign prostatic hyperplasia should reduce the lifetime risk of acute urinary retention and the need for benign prostatic hyperplasia-related surgery. A number of recent studies demonstrate that 5alpha-reductase inhibitors are unique in providing a long-term combination of improvements in symptoms and flow, and reductions in the risks of acute urinary retention and surgical intervention. RECENT FINDINGS: The 5alpha-reductase inhibitor finasteride was shown to reduce the risk of retention and surgery in men with large prostate volumes and/or high PSA. Recent studies have examined the role of adding an alpha1-blocker to 5alpha-reductase inhibitor in short- or long-term combination. The Medical Therapy of Prostatic Symptoms study randomised 3,047 men with benign prostatic hyperplasia to treatment with a 5alpha-reductase inhibitor (finasteride), an alpha1 blocker (doxazosin), a combination of both, or placebo. Only treatment arms containing 5alpha-reductase inhibitor therapy were associated with longer-term significant reductions in the risk of acute urinary retention and invasive therapy for benign prostatic hyperplasia. Three randomised, two-year, placebo-controlled studies have assessed the clinical relevance of the >93% DHT suppression provided by dutasteride. Dutasteride was also associated with a reduction in the risk of acute urinary retention of 57%, and a reduction of 48% in the risk of surgical intervention compared with placebo after 2 years. SUMMARY: Short-term combination of 5alpha-reductase inhibitor and alpha-blockade are optimal in providing symptomatic improvement among patients who require symptom relief, while enabling the initiation of 5alpha-reductase inhibitor therapy to reduce the risk of subsequent acute urinary retention or benign prostatic hyperplasia-related surgery in men who are at greater risk of disease progression.

Adrenergic alpha-Antagonists↗
PubMed2003

[The incidence, features of the course, and treatment of arterial hypertension in patients with prostate hyperplasia].

In 144 middle-aged and elderly male subjects with benign prostate hyperplasia, a study was made into incidence and course features of concomitant arterial hypertension (AH). AH has been proved to be encountered in 144 percent of patients with benign hyperplasia of the prostate. It has been ascertained that in 84% of patients, irritative and obstructive symptoms related to benign hyperplasia of the prostate adversely affect the course of concomitant arterial hypertension. Striking reduction of manifestations of benign prostate hyperplasia-related irritative and obstructive symptoms using cardura, a selective alpha-adrenoblocker, has come to significantly enhance efficiency of treatment of concurrent AH.

Adrenergic alpha-Antagonists↗
PubMed1985

Benign prostatic hyperplasia: tissue characterization using suprapubic ultrasound.

Fifty-one patients with pathologically proved benign prostatic hyperplasia were examined with transabdominal ultrasound. The echo-textural patterns of the prostate were analyzed in detail. This analysis suggested various criteria that would be helpful in the diagnosis of this neoplasm. The most frequently encountered sonographic findings were the adenoma echo pattern (47 cases), shadowing echo-dense foci at any location, foci with an echo density brighter than that of the capsule, focal densities less than 6 mm thick, and location of a focus within the adenoma, junctional zone, or periurethral zone. Other suggestive signs included intact capsule (46 cases), uninvolved bladder (all but one case), and normal seminal vesicles (all cases). Based on these criteria, a definite diagnosis of benign prostatic hyperplasia was made in 43 cases with a diagnostic accuracy of 84%.

Aged↗
PubMedDate not supplied

Rationale for using aromatase inhibitors to manage benign prostatic hyperplasia. Experimental studies.

Today, human benign prostatic hyperplasia (BPH) is considered primarily to be a disease of the stroma, in which estrogens are thought to play a considerable causative or permissive role. The growing incidence of BPH with increasing age coincides with a shift in the androgen:estrogen ratio in favor of estrogens, not only in terms of serum hormone values, but also in the prostate itself. Furthermore, evidence has been provided for a preferential accumulation of estrogens in the stroma of human hyperplastic tissue, and the presence of an estrogen receptor satisfying the classical criteria of high affinity and low capacity has been demonstrated. Also, animal studies have emphasized the potential role of estrogens in the pathogenesis of BPH. Experimentally, stimulation of the stroma, particularly of smooth muscle, can be induced by aromatizable substrates, such as androstenedione, in the prostates of beagles and cynomolgus monkeys. These effects can be antagonized by aromatase inhibitors, such as atamestane. In addition, the increase in intraprostatic estrogen concentrations and immunohistochemically detectable estrogen receptor content induced by androstenedione in intact dogs is completely reversed by simultaneous treatment with atamestane. In conclusion, clinical data, as well as that from animal models, emphasize an important role for estrogens in the development of BPH. Estrogen deprivation might, therefore, represent a useful treatment for human BPH.

Androstenedione↗
PubMed1994

Interleukin 6 receptor mRNA in prostate carcinomas and benign prostate hyperplasia.

We investigated the presence of interleukin 6 (IL6) receptors in human prostate carcinomas and benign prostatic hyperplasias. Interleukin 6 receptor expression was measured at the mRNA level by slot blot analysis using a probe that recognizes mRNA encoding the 80-kDa subunit of the IL6 receptor. Significant expression was found in 29 of 37 (78%) samples of benign prostate hyperplasia (BPH) and in 17 of 17 prostate carcinomas. Quantitative analysis of the expression level revealed that 11 of the 29 positive hyperplasia tissues (38%) and 4 carcinoma samples (23.5%) expressed equal or higher levels of IL6 receptor mRNA than the human hepatoma cell line PLC/PRF5, which contains about 2300 IL6 receptors per cell. We also measured IL6 receptor mRNA levels in three human prostate carcinoma cell lines LNCaP, DU145 and PC3, which are known to contain IL6 receptors because they are sensitive to the cytotoxic action of an IL6-toxin fusion protein. We were not able to detect IL6 receptor expression with the slot blot procedure, but we were able to detect IL6 receptor mRNA using a very sensitive PCR assay. Our data provide evidence that IL6 may play a role in the growth of benign and malignant prostate tumors and suggest that the IL6 receptor could be a target for the delivery of therapeutic agents in prostate cancer.

Humans↗
PubMedDate not supplied

The economics of benign prostatic hyperplasia treatment: a literature review.

Benign prostatic hyperplasia (BPH) is one of the most common benign neoplasms in elderly men in the United States; it has been estimated that the annual costs of caring for these men exceed $4 billion. This condition is rarely life threatening, but often affects the individual's quality of life in varying degrees. There are several treatments for this condition, including surgery, with the most common procedure being transurethral resection of the prostate. Other treatment options include medication (such as finasteride and terazosin), balloon dilation, and watchful waiting. The cost associated with BPH depends on the severity of the disease and the appropriate course of treatment. The objective of this paper is to identify and evaluate the economic research papers that have considered either the economic burden or costs associated with alternative BPH therapy options and to identify key areas for future economic research. This review indicates that the economic studies of BPH are diverse in nature and greater attention needs to be placed on the societal appraisal of competing BPH therapies. Other research areas include the economic analysis of both short- and long-run BPH treatment options, increased cost-utility analysis, and the use of retrospective claims database analysis using regression techniques.

Aged↗
PubMed2006

Photoselective vaporization for benign prostatic hyperplasia.

(1) In photoselective vaporization of the prostate (PVP) for benign prostatic hyperplasia (BPH), laser energy is used to vaporize prostatic tissue rapidly and bloodlessly. (2) Studies suggest that PVP performs well in the short term. (3) Randomized controlled trials (RCTs) and longterm follow-up are required to determine PVP's place in the management of BPH.

Aged↗
PubMedDate not supplied

[The transurethral microwave thermotherapy of benign prostatic hyperplasia].

The authors have treated benign prostatic hyperplasia (BPH) in 50 patients aged 54-89 years (mean age 67.5 years) including 10 patients with cystostoma. The patients were exposed to transurethral microwave thermotherapy (TUMT) performed on the prostcare unit. Only 1 session (60 min at 45 degrees C) was conducted. Inflammatory complications of TUMT occurred in 4(8%) patients. A 1.5-year follow-up covered 45 patients. A subjective response was obtained in 86% of patients. An objective response by urination rate and prostatic size 3 months after TUMT was reached in 80 and 90% of patients, respectively; 1.5 years after in 48, 34 and 47%, respectively. TUMT is recommended in uncomplicated BPH as an alternative to chemotherapy or surgical treatment (in patients with cystostoma and serious intercurrent diseases).

Aged↗
PubMed1995

High-intensity focused ultrasound (HIFU) in the treatment of benign prostatic hyperplasia (BPH).

Transurethral resection of the prostate (TURP) and open adenectomy are regarded the golden standard in the management of patients with symptomatic benign prostatic hyperplasia (BPH). Various alternative treatment forms (microwaves, laser, radiofrequency, focused ultrasound) have been introduced recently. They all aim at reduction of morbidity related to TURP keeping a comparable efficacy at the same time. Since December 1992, 50 patients with BPH have been treated by high intensity focused ultrasound (HIFU-P) at our department. Six weeks following HIFU-P mean Qmax improved from 5.7 ml/s to 11.6 ml/s. Post voiding residual volume (RV) dropped from 215 ml to 100 ml, the International Prostate Symptom Score (IPSS) from 19.8 to 9.9. Both, IPSS and RV further improved during the following weeks. Follow-up data one year after treatment demonstrate that results remained stable in the majority of patients. Urinary tract infections were observed in 3 patients, macrohematospermia in all and macrohematuria (caused by the suprapubic catheter) requiring blood transfusion in 1 patient.

Aged↗
PubMed2003

Recent trends in mortality from benign prostatic hyperplasia.

BACKGROUND: We have considered trends in mortality from benign prostatic hyperplasia (BPH) over the last decades in Europe and, for comparative purposes, the USA and Japan. METHODS: Cancer death certification data for benign prostatic hyperplasia were derived from the World Health Organisation database. RESULTS: Between the early 1950s and the late 1990s, overall mortality from BPH in the European Union (EU) fell from 5.9 to 3.5 per million, and the decline since the late 1950s was over 96%. Comparable falls were observed in the USA and Japan, and BPH mortality rates in the late 1990s were lower than in the EU (1.8/10(6) in the USA, 1.4 in Japan). BPH mortality trends were downwards also in the Eastern Europe, although rates in the late 1990s were about fourfold higher than in the EU. CONCLUSION: BPH rates have been steadily declining in developed countries. The excess BPH mortality in Eastern Europe indicates the scope for further reduction too.

Aged↗
PubMed1996

Phyllodes type of atypical prostatic hyperplasia.

This report documents an uncommon prostatic hyperplasia which developed within a thick capsule between the bladder and rectum grossly showing a phyllodes type of growth. It was simply excised, but recurred locally two years later. A total prostatectomy was performed, and microscopic examination of the tissue revealed no malignant transformation.

Adult↗
PubMed2004

[Relation between benign prostatic hyperplasia and obesity and estrogen].

PURPOSE: There have been few reports on correlations between resection volume of benign prostatic hyperplasia, body mass index (BMI) and estrogen. This study was undertaken to evaluate the correlations. METHOD: In this study, we considered 50 patients who had benign prostatic hyperplasia (BPH) and underwent suprapubic prostatectomy (SPP). Men with prostate cancer or prior prostate surgery were excluded. The relationship between prostate resection volume and BMI was examined. Additionally, patients were divided into two groups according to BMI: less than 25, and more than 25. The two groups were evaluated according to stained estrogen receptors. RESULTS: BMI was correlated positively with prostate volume (p < 0.01). However, positive rates of estrogen receptors showed no significant difference between the two groups. CONCLUSIONS: This was a study describing the relationship between BMI and prostate volume. Obesity has been hypothesized to be associated with BPH because of the endocrine changes in men that occur with age, including increased estrogen and decreased testosterone. Our findings suggest that estrogen may play a pathophysiologic role in benign prostatic hyperplasia. Further studies of large populations are needed to validate this assumption.

Aged↗