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PubMed1999

Effect of transurethral resection on serum free/total prostate-specific antigen levels in patients with benign prostatic hyperplasia.

OBJECTIVES: Transurethral resection of the prostate (TURP) can cause elevation of total serum prostate-specific antigen (PSA). However, the effect of these procedures on free PSA and percent free PSA is still unknown. The aim of this study was to investigate the effect of TURP on serum total PSA, free PSA, and free/total (f/t) PSA ratio in patients with benign prostatic hyperplasia (BPH) and to determine the reliability of f/t PSA ratio after such interventions. METHODS: Fifty-three patients with BPH who underwent TURP because of severe bladder outlet obstruction symptoms were included in this study. All patients underwent digital rectal examination and transrectal ultrasound (TRUS), and routine hematologic (complete blood count) and serum biochemical tests, urine analysis, and a peak urinary flow test were performed. Serum total PSA and free PSA levels were determined 1 hour before and 24 hours after TURP by using enzyme immunometric assay. Preoperative and postoperative free and total PSA and f/t PSA ratio were statistically compared. RESULTS: Although postoperative total PSA and free PSA increased significantly compared with preoperative values (P <0.001 and P = 0.024, respectively), the difference between preoperative and postoperative f/t PSA ratios was not statistically significant (P = 0.103). CONCLUSIONS: Finding no significant change in f/t PSA ratio, although there is a significant increase in the serum levels of total and free PSA, suggests to us that f/t PSA ratio may be a more reliable parameter in the early period after such interventions as TURP.

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PubMedDate not supplied

Effects of doxazosin in patients with mild, intermediate, and severe benign prostatic hyperplasia.

Traditionally, drug therapy for benign prostatic hyperplasia (BPH) has been reserved for patients with mild or moderate symptoms. The objective of this analysis was to compare responses to an alpha 1-adrenergic receptor blocker, doxazosin, in patients with severe, intermediate, and mild disease. Data were analyzed from patients with symptomatic BPH who were enrolled in two 16-week, double-masked, placebo-controlled studies of doxazosin. In study 1, 163 hypertensive patients were stratified according to baseline maximum (Qmax) and mean (Qmean) urinary flow rate as having severe, intermediate, or mild disease. In study 2, 82 normotensive patients were stratified according to their baseline American Urological Association (AUA) BPH symptom severity score and modified Boyarsky symptom bothersomeness score. Overall, doxazosin was significantly more effective than placebo in improving Qmax and Qmean in study 1 and in improving the AUA-derived and modified Boyarsky scores in study 2. There were statistically significant differences in the response to treatment, as represented by Qmax' Qmean, and modified Boyarsky score, between patients with severe, intermediate, and mild disease. There were no significant differences in the AUA-derived scores of patients in the three severity groups. These results have important clinical implications, suggesting that the majority of BPH patients are candidates for a course of drug therapy, regardless of baseline disease status.

Adrenergic alpha-Antagonists↗
PubMed2004

A rational approach to benign prostatic hyperplasia evaluation: recent advances.

PURPOSE OF REVIEW: In this article we aim to outline the recent advances in the evaluation of a patient with symptoms suggestive of benign prostatic hyperplasia. We define the role of the clinical evaluation and techniques that are evolving for the appropriate management of a patient with benign prostatic hyperplasia. Both non-invasive and invasive investigation techniques are reviewed. RECENT FINDINGS: Initiating early and appropriate treatment is the primary aim of investigation for a patient with lower urinary tract symptoms. Both clinical history and examination and appropriate investigations are vital to establishing a diagnosis. Symptom scores, prostate specific antigen and prostate volume were found to closely relate in predicting the progression of benign prostatic hyperplasia and in recent years increased interest has centred on the progression of this disease principally related to the development of new pharmacotherapy. Despite these positive findings further research is needed to develop reliable tools to predict progression. Newer ultrasound techniques hold promise for the future. Conventional pressure flow studies have a defined role in excluding patients who are less likely to benefit from prostatic surgery by providing information on detrusor function; and non-invasive urodynamic techniques need further evaluation but appear to be promising. SUMMARY: The minimal initial evaluation of a patient with benign prostatic hyperplasia should include a thorough history, digital rectal and neurological examinations, symptom scoring (including quality of life and sexual score) and measurement of serum prostate specific antigen. Other methods should be reserved for more complex situations. Attempts should be made at identifying those patients in whom the disease process is likely to progress.

Aged↗
PubMed2005

Development of a multiregional United States Spanish version of the international prostate symptom score and the benign prostatic hyperplasia impact index.

PURPOSE: The International Prostate Symptom Score (I-PSS) and Benign Prostatic Hyperplasia Impact Index (BII) have gained widespread use in clinical practice and clinical trials. Although Spanish translations of the I-PSS are available, to our knowledge none was developed for the Spanish speaking population in the United States using a methodology to ensure appropriateness for the diverse United States Spanish speaking population. An existing translation intended for another Spanish speaking country, such as Mexico, or a translation developed without input from each language group may not be understood by those who immigrated from other Latin American regions. Hence, the development of a Spanish translation for the United States should involve input from translators from each region of Latin America. MATERIALS AND METHODS: We reviewed and modified an existing United States Spanish translation of I-PSS using a multiregional reconciliation panel comprised of representatives from each of the major Spanish language groups in the United States. For BII full translation methodology was used to develop a translation for the United States, including 2 forward translations using translators from more than 1 region, a multiregional reconciliation panel meeting, a back translation evaluation, cognitive debriefing interviews with representatives from each language group, developer review, a final evaluation for consistency and proofreading. RESULTS: The revised I-PSS better reflects common Spanish wording in the United States, while the BII translation was confirmed to be comprehended by Spanish speakers in the United States originating from multiple regions of Latin America. CONCLUSIONS: United States Spanish translations of patient reported outcome measures should consider the diversity of the growing Spanish speaking population in the United States to ensure comprehension across the broad population originating from the multiple regions of Latin America.

Cross-Cultural Comparison↗
PubMed2004

Androgen receptor gene polymorphisms and increased risk of urologic measures of benign prostatic hyperplasia.

The association between androgen receptor gene polymorphisms and benign prostatic hyperplasia was investigated among 510 men randomly selected from Olmsted County, Minnesota. From 1990 through 2000, lower urinary tract symptom severity was assessed by the American Urological Association Symptom Index (AUASI), and peak urinary flow rate, prostate volume, and serum prostate-specific antigen level were measured. Androgen receptor CAG and GGN genotyping was performed. A CAG repeat length of <21 was associated with an enlarged prostate (hazard ratio (HR) = 1.4, 95% confidence interval (CI): 1.0, 1.9) and a serum prostate-specific antigen level >1.4 ng/ml (HR = 1.5, 95% CI: 1.1, 2.0). A GGN repeat length of <16 was associated with an AUASI >7 (HR = 1.6, 95% CI: 1.1, 2.3) and a serum prostate-specific antigen level >1.4 ng/ml (HR = 1.5, 95% CI: 1.0, 2.3). Having <21 CAG repeats and <16 GGN repeats compared with having neither was associated with an enlarged prostate (HR = 2.5, 95% CI: 1.5, 4.2), a serum prostate-specific antigen level >1.4 ng/ml (HR = 2.8, 95% CI: 1.6, 4.7), a peak flow rate <12 ml/second (HR = 1.9, 95% CI: 1.1, 3.4), and an AUASI >7 (HR = 1.6, 95% CI: 1.0, 2.7). Androgen receptor gene polymorphisms may have a potential role in the pathogenesis of benign prostatic hyperplasia.

Antigens, Neoplasm↗
PubMed2000

Results of holmium laser resection of the prostate for benign prostatic hyperplasia.

PURPOSE: To assess the results of holmium laser resection of the prostate (HoLRP) in the treatment of benign prostatic hyperplasia. PATIENTS AND METHODS: Since October 1996, 259 patients have undergone elective HoLRP. Peak urinary flow rates (Qax), IPSS scores, and duration of catheterization and hospital stay from admission to discharge catheter free were used as outcome measures. RESULTS: There were no perioperative deaths nor cases of transurethral resection syndrome. Two patients required blood transfusion. The mean duration of catheterization was 1.6 days and the mean hospital stay 2.9 days. The mean IPSS decreased from 21.0 preoperatively to 7.0 at 1 year, whilst the Qmax increased from 10.5 mL/sec to 20.5 mL/sec. CONCLUSION: The HoLRP technique is a safe and effective treatment for benign prostatic hyperplasia, allowing resection of the prostate at the level of the capsule with minimal bleeding or fluid absorption and with results equivalent to those of standard transurethral resection.

Aged↗
PubMed2006

Effect of the consumption of tomato paste on plasma prostate-specific antigen levels in patients with benign prostate hyperplasia.

The consumption of tomatoes and tomato products has been associated with a reduced risk of prostate cancer. We observed a decrease of 10.77% in prostate-specific antigen (PSA) levels in patients with benign prostate hyperplasia who were submitted to daily ingestion of tomato paste. This was an experimental rather than a controlled study with a sample of 43 men ranging in age from 45 to 75 years, all with histological diagnoses of benign prostate hyperplasia and plasma PSA levels of 4-10 ng/mL. All patients received 50 g of tomato paste once a day for 10 consecutive weeks and PSA levels were analyzed before, during and after the consumption of tomato paste. ANOVA for repeated measures was used to compare PSA levels before, during and after the consumption of tomato paste. The mean +/- SD PSA level was 6.51 +/- 1.48 ng/mL at baseline and 5.81 +/- 1.58 ng/mL (P = 0.005) after 10 weeks. Acceptance was good in 88.3, regular in 9.3, and poor in 2.3% of the patients. Dietary ingestion of 50 g of tomato paste per day for 10 weeks significantly reduced mean plasma PSA levels in patients with benign prostate hyperplasia, probably as a result of the high amount of lycopene in tomato paste. This was not a prostate cancer prevention study, but showed some action of tomato paste in prostate biology. The development of prostate cancer is typically accompanied by an increase in plasma PSA levels, thus any intervention that affects plasma PSA levels can suggest an impact in the progression of disease.

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PubMed1994

Benign prostatic hyperplasia: diagnosis and treatment. Agency for Health Care Policy and Research.

This Quick Reference Guide for Clinicians contains highlights from the Clinical Practice Guideline of Benign Prostatic Hyperplasia: Diagnosis and Treatment. The Benign Prostatic Hyperplasia Guideline Panel, a private-sector panel of health care providers, developed the guideline after comprehensively analyzing the research literature. As a result, this guideline comprises the most current scientific knowledge of the development, diagnosis, and treatment of benign prostatic hyperplasia (BPH). The guideline makes specific recommendations to identify both the most effective methods for diagnosing BPH and the most appropriate treatments for BPH based on patient preference and clinical need. BPH affects quality of life and is very rarely a life-threatening disease. Motivation to seek active treatment will, for most patients, depend on how much their symptoms bother them. Many patients choose a regimen of "watchful waiting." The guideline details the relative benefits and harms associated with all diagnostic and treatment approaches. Treatment options discussed include watchful waiting, alpha blocker and finasteride medications, balloon dilation, and the surgical options of transurethral incision, transurethral resection, and open prostatectomy.

Adrenergic alpha-Antagonists↗
PubMed2000

Can prostate epithelial content predict response to hormonal treatment of patients with benign prostatic hyperplasia?

OBJECTIVES: There are large interindividual differences in response to medical therapy for men with benign prostatic hyperplasia. Selection of patients for alpha-blocker versus hormonal treatment is often based more on assumptions than on well-documented knowledge. A more scientifically based decision of therapy has a potential for economical savings and increased effectiveness. METHODS: We performed morphometry on prostate biopsy specimens and determined the amount of stroma, epithelium, and glandular lumen (pretreatment characteristics) in 34 men with benign prostatic hyperplasia before 24 weeks of androgen suppressive therapy. Androgen suppressive therapy consisted of either the luteinizing hormone-releasing hormone agonist leuprolide depot (3.75 mg intramuscularly every 28 days) or the nonsteroidal antiandrogen bicalutamide (50 mg/day orally). The evaluation of the clinical response (effectiveness parameters) was based on changes in prostate volume, peak urinary flow rate, symptom score, and bladder outlet obstruction. RESULTS: A large prostate volume before treatment was associated with more pronounced symptom score improvement, but neither prostate-specific antigen nor any of the parameters of tissue composition used (percentage of epithelium, epithelial volume, and stromal/epithelial ratio) predicted a favorable response to hormonal treatment. CONCLUSIONS: The pretreatment variables that are readily available at present have a limited role in helping clinicians to decide the optimal medical treatment for patients with benign prostatic hyperplasia.

Aged↗
PubMed2006

Diabetes and benign prostatic hyperplasia progression in Olmsted County, Minnesota.

OBJECTIVES: To examine the association of diabetes and progression of benign prostatic hyperplasia in a prospective population-based sample of residents of Olmsted County, Minnesota, with serial surrogate measures of benign prostatic hyperplasia. METHODS: A cohort of 2115 white men aged 40 to 79 years was randomly selected from an enumeration of the 1990 Olmsted County, Minnesota population (55% participation rate). Participants completed a previously validated baseline questionnaire that assessed lower urinary tract symptom severity from questions similar to the American Urological Association Symptom Index. The questionnaire also asked whether they had ever been diagnosed by a physician as having diabetes. Participants also voided into a portable urometer to measure the peak urinary flow rate. A 25% random subsample underwent transrectal ultrasonography to determine the prostate volume, and the prostate-specific antigen level was determined. Dynamic follow-up was performed biennially for 12 years with the measures repeated at each visit. RESULTS: Of the 2115 men 111 had diabetes at baseline. The men with diabetes had a significantly greater median annual percentage change in the American Urological Association Symptom Index (0.40 versus 0.15, P = 0.04) and a trend toward a greater median annual percentage of change in the peak urinary flow rate (-4.7% versus -2.9%, P = 0.06) compared with those without diabetes. However, no significant difference was found in the annual percentage of change in the prostate volume or serum prostate-specific antigen level. CONCLUSIONS: The results of this study suggest that the presence of diabetes may be more closely associated with the dynamic components of lower urinary tract function than with benign prostatic hyperplasia progression, per se.

Adult↗
PubMed2006

[Photoselective vaporization of the prostate (PVP) using 80 watt high power potassium-titanyl-phosphate (KTP) laser for benign prostatic hyperplasia: the first fifty-seven patients in Japan].

OBJECTIVE: To assess the safety and efficacy of photoselective vaporization of the prostate (PVP) using 80 watt high power potassium-titanyl-phosphate (KTP) laser for benign prostatic hyperplasia (BPH). METHODS: Fifty-seven patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia underwent 80 W KTP laser vaporization of the prostate. According to their International Prostate Symptom Score Index (IPSS) and Quality of life (QOL) score as well as measurements of their peak flow rate and postvoiding residual urine volume (RUV), they fulfilled the diagnostic criteria of BPH. Vaporization was performed with the GreenLight PV ADDStat fiber, which was inserted through a 22.5Fr. continuous flow laser cystoscope, and a saline solution was used for irrigation. KTP laser energy was generated by a GreenLight PV (Minnetonka, Minnesota) generator. The end point of the procedure was to create a cavity like in TURP. Once vaporization was completed, an18Fr Foley catheter was inserted and was removed the next morning, as a rule. Patients were evaluated preoperatively, and at 2 weeks and 1, 3 and 6 months postoperatively. RESULTS: The procedure could be performed without any intraoperative complication. None of the patients required continuous bladder irrigation or blood transfusion postoperatively. The mean age was 71.0 +/- 8.3 years (range 52 to 86). The preoperative prostate volume was 41.0 +/- 24.9 (mean +/- SD, range 6.7 to 107.2) and the preoperative serum PSA was 4.5 +/- 4.1 ng/ml. Preoperative and immediate postoperative serum sodium concentration was 141.9 +/- 1.8 mEq/L and 142.2 +/- 1.8 mEq/L, respectively (p = 0.23). The hemoglobin value changed from 14.0 +/- 1.4 mg/dl preoperatively to 13.4 +/- 1.4 mg/dl postoperatively. The operating time was 68.3 +/- 35.0 minutes (range 21 to 170) and total laser energy was 171.1 +/- 80.3 kJ (range 18.1 to 484.8). The catheter indwelling time was 18.6 +/- 3.3 hrs (range 15 to 48). At 2 weeks and 1, 3 and 6 months the International Prostate Symptom Score decreased from 20.2 +/- 8.9 to 11.4 +/- 7.8, 9.3 +/- 6.0, 6.6 +/- 5.0 and 6.1 +/- 5.0, respectively. The maximum urinary flow increased from 7.2 +/- 2.9 mL/s to 13.6 +/- 7.6, 12.2 +/- 6.1, 15.3 +/- 7.4, and 15.3 +/- 7.5 mL/s, respectively. CONCLUSIONS: Photoselective vaporization of the prostate (PVP) using the high power (80 W) potassium-titanyl-phosphate laser for benign prostatic hyperplasia (BPH) proved to be an effective and safe procedure for our patients.

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PubMed1979

The histochemical behaviour, electrophoretic mobility and distribution in cell fractions of acid phosphatase isozymes in prostatic cancer and benign prostate hyperplasia.

Acid phosphatase isozymes were investigated in cancerous prostatic tissue (4 cases) and benign prostatic hyperplasia (6 cases). Electron-microscopic histochemical examination of cancer tissue revealed irregular acid beta-glycerophosphatase staining in various cell organelles, including the plasma membrane, which was not seen in non-malignant tissue. Cancerous tissue homogenates also contained isozymic acid phosphatase species with high electrophoretic mobility, which was not detectable in benign tissue unless treated with detergent. Fractionation by differential centrifugation confirmed that much of the acid phosphatase activity in cancer tissue was extra-lysosomal. The detection of these isozyme properties may provide an opportunity, by means of tissue investigations, to define tumour stages earlier than on the basis of increased levels of serum acid phosphatase activity indicative of stage IV (D) prostatic cancer.

Acid Phosphatase↗
PubMed1996

Transurethral microwave thermotherapy for benign prostatic hyperplasia: relation between clinical response and prostate histology.

The effectiveness of transurethral microwave thermotherapy (TUMT) for BPH has been confirmed. To identify the characteristics of the ideal candidate, retrospective analysis and morphometric study of prostatic tissue were performed. Forty-two patients with symptomatic BPH were included in the study; these comprised 10 patients treated for more than 3 months with anti-androgen pre-TUMT (group A) and 32 fresh cases (group B). Subjective and objective responses were evaluated at 2 months post TUMT. In 12 fresh cases who underwent pre-TUMT biopsy of the prostate, the stromal-to-epithelial ratio was determined via quantitative image analysis on a computer-assisted morphometry system. No significant differences in baseline patient characteristics were found between the two groups: age, prostate volume, peak flow rate (PFR), or International Prostate Symptom Score (I-PSS). However, significant differences in treatment outcome were found between the two groups (group A vs. group B, respectively): total energy delivered to the prostate: 96 kJ vs. 125 kJ: I-PSS decrease from baseline: 5.9 vs. 11.6; PFR increase from baseline: 1.1 vs. 4.7 ml/sec. There was a positive correlation between the I-PSS change from baseline and the stromal-to-epithelial ratio of the prostatic tissue (r = 0.4857). The results suggest that microwave interacts poorly with the prostate due to the artificially created "lack" of glandular tissue. The morphometric study also supports the contention that the histological composition of the prostatic tissue plays an important role in terms of microwave thermal interactions and treatment outcome.

Aged↗
PubMed1996

Benign prostatic hyperplasia. Does a correlation exist between prostatic morphology and irritative symptoms?

Fifty-two consecutive patients with prostatism who underwent a prostatectomy were investigated with regard to irritative symptom score, age, prostate volume, urine culture results, degree of detrusor instability, inflammation in the prostate, and stromal, glandular or mixed prostatic histopathology. We did not find any statistical correlations between irritative symptom score and the mentioned parameters. This indicates that irritative symptoms should rather be attributed to extraprostatic factors such as e.g. bladder reaction.

Age Factors↗
PubMed1999

Treatment of benign prostatic hyperplasia with transurethral electrovaporization of the prostate (TUVP) using Vaportrode VE-B. Two years follow-up.

BACKGROUND: The authors report their experience on transurethral vaporization of the prostate with Vaportode for the treatment of BPH. METHODS: In January 1996 we treated 24 patients suffering from cervico-urethral obstruction caused by BPH with electrovaporization of the prostate using a cutting current of between 180 and 250 Watts (average 200 Watts). Exclusion criteria was: PSA > 3 ng/ml. The catheter was removed after 24 hours. Follow-up of all patients is 27 months. Twenty-three patients were evaluated. RESULTS: Results at follow-up were; mean maximum flow (Qmax) 9.31 ml/sec preoperative was 19.5 ml/sec after 6 months, 18.3 after 12 months and 18.0 after 24 months; mean symptom score decreased from 18.1 to 10.4 after 6 months, to 3.2 after 12 months and to 4.8 after 24 months; QL index decreased from 4.6 to 2.3 at 6 months, to 1.4 after 12 months and 24 months; the average avoiding pressure decreased from 62.8 cm/H2O to 23.2 cm/H2O after 6 months, to 21.2 after 12 months and to 23.8 after 24 months. There was no post voiding residual urine 2 days after treatment in all patients. CONCLUSIONS: Follow-up shows transurethral electrovaporization of the prostate is an efficient and safe technique for treatment of BPH.

Aged↗
PubMed1989

[Benign prostatic hyperplasia: a stromal disease].

Morphometric studies show that benign human prostatic hyperplasia is a stromal disease caused by the activation of smooth muscle cells. This activation manifests itself in increased amounts of cytoplasmic organelles, which are preferably localized in the perinuclear region. Moreover, marked vesicular activity is present. Besides considerable overproduction of type I and III collagens, the architecture of the extracellular matrix is altered distinctly. In spite of strong evidence that androgens and estrogens regulate the growth of epithelial and stromal cells in the prostate and the induction of fibromuscular overgrowth in various animal models, the exact role of steroids in the pathogenesis of benign prostatic hyperplasia still remains to be elucidated.

Androgens↗