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PubMed1994

The natural history of benign prostatic hyperplasia: implications for patient care and clinical trial design.

Benign prostatic hyperplasia (BPH) is a nearly universal concomitant of male aging, yet its natural history is largely undocumented. Most information on the clinical course of untreated prostatism has come from a limited number of studies. This lack of information makes it difficult for urologists to know when, how, and in whom to intervene. This is reflected by the controversy surrounding surgical indications and by the considerable variability in rates of prostatectomy. Over the last 2 years, information on the natural history of BPH has been obtained from analyses of limited data from long-term, general-purpose, government-sponsored prospective studies of human aging. This paper briefly reviews these studies and discusses implications for patient care decisions and clinical trial design.

Aging↗
PubMed1998

Transurethral microwave thermotherapy for treatment of benign prostatic hyperplasia: results obtained with the Prostalund device.

The 6-month results of treatment with transurethral microwave thermotherapy (Prostalund) of 28 patients with lower urinary tract symptoms (LUTS) due to benign hyperplasia of the prostate are reported. The median International Prostate Symptom Score (I-PSS) fell from 16.5 (range 9-33) to 10.5 (range 3-30; P < 0.00005). Quality-of-life assessment improved from a median value of 4 (range 2-6) to 2 (range 1-5; P = 0.0001). In the Danish Prostate Symptom Score (DAN-PSS) the median total score fell from 20 (range 5-55) to 5 (range 0-43; P = 0.001). The median peak urinary flow increased from 10.6 to 11.5 ml/s (P = 0.20). Pressure-flow studies revealed no decrease in the median detrusor pressure at peak uroflow (PdetQmax) from 56 cmH2O preoperatively to 56 cmH2O after 6 months (P = 0.36). No change was found in postvoid residual urinary volume or in the calculated prostate volume. Complications included hematuria in most patients, urinary tract infections in 6 (21.4%) patients, and transient retention in 3 (10.7%) patients. In all, 20 (71.4%) patients responded to treatment with good symptomatic relief, but only minor changes were observed in urodynamic parameters.

Aged↗
PubMed2006

Giant prostatic hyperplasia: case report.

The giant hyperplasia of the prostate is extremely rare pathology of prostate gland. Here, we report the successful removal of the 9th heaviest prostate ever reported in the literature.

Aged↗
PubMed2000

Endoprostatic stents for management of benign prostatic hyperplasia.

Endoprostatic stents have been developed for relieving bladder outlet obstruction secondary to benign hyperplasia of the prostate. The stents are designed either for permanent or for temporary placement. The short-term temporary stents of various biostable and biodegradable polymers are needed after minimally invasive therapy of prostate with heat. The temporary stents are a management option, whereas the permanent stents are a treatment option. Permanent stents offer immediate relief and their sustained results for 4-7 years make them ideally suited for medically compromised patients.

Biocompatible Materials↗
PubMed2002

The impact of benign prostatic hyperplasia surgery on patients' quality of life.

OBJECTIVE: To assess the impact of surgical treatment of benign hyperplasia of the prostate on patients' quality of life (QoL). MATERIAL AND METHODS: The QoL of 181 patients was assessed by the health questionnaire SF-36. The measurement was carried out before and 6 months after surgery. RESULTS: After surgery, SF-36 scales improved their scores, fundamentally General Health (57.4%) and Physical Functioning (57.1%). 70.3% improved their physical component summary (PCS) and 49.1% their mental component summary (MCS). The improved PCS and MCS were not associated with the improved I-PSS or urine flow. The improved PCS was 2.2 times higher in patients who had previously scored under 44 in the PCS, 2.2 in patients who had scored over 25 in the I-PSS, and 2.9 times higher in patients without chronic diseases. With regard to MCS improvement, this was 17.1 times higher in patients who scored under 50 previously on the MCS, 3.1 in patients who scored over 4 on the IQL, 5.7 in patients without postoperative incontinence, and 3.3 times higher in patients who lived in urban areas. CONCLUSIONS: Improvement in QoL after surgery is noted more in physical than in psychological aspects. Although a reduction in the intensity of prostatic symptoms and an increase in urine flow values were noted postoperatively, the improvement QoL was not associated with improved symptoms or urinary flow.

Aged↗
PubMed1998

[Benign prostate hyperplasia; shared care reduces care load].

Specialist associations developing guidelines and the Dutch General Practice College (NHG) issuing standards make only little use of one another's knowledge and particularly one another's insight. Medical specialists see mostly patients with severe diseases. GPs mostly 'healthy' patients with symptoms. In practice, this leads to problems in arriving at mutual agreements. After publication of a guideline by the Netherlands College of Urologists in 1993 and of the NHG standards of 1994 concerning abnormalities of micturition in males, a joint team drew up a report titled 'Benign hyperplasia of the prostate, recommendations for transmural care'. Transmural recommendations and local practical agreements based on them may reduce patients being surprised by strikingly different and sometimes redundant approaches when visiting the GP and the specialist, respectively, and offer both categories the possibility to make the outside world know that much work is being done to achieve qualitatively adequate, efficient medical care.

Aged↗
PubMed1999

[The effect of symptomatic therapy with the alpha 1-adrenoblocker Cardura in patients with benign prostatic hyperplasia on the course of cardiovascular diseases].

Forty-two patients with benign hyperplasia of the prostate were studied for the role of symptomatic therapy with a selective adrenoblocker Cardura in the prophylaxis of progression of such diseases of the cardiovascular system as arterial hypertension, angina pectoris. The obstructive and irritative symptomatology-related uresis has been shown to get normalized. Also recordable in the conducted investigations was an alleviation of arterial hypertension together with a noticeable decrease in the frequency and severity of attacks of angina.

Adrenergic alpha-1 Receptor Antagonists↗
PubMed1992

[Benign prostatic hyperplasia--alternative (nonsurgical) possibilities of therapy].

The authors summarize contemporary possibilities of alternative treatment of benign hyperplasia of the prostate which could at least partially replace surgery. The authors present also the results of the first clinical investigations using different procedures. The list comprises also experience assembled in Czechoslovak departments.

Humans↗
PubMed1995

[Diagnosis and treatment of benign prostatic hyperplasia in the North Bohemia Region in 1994].

The author investigated equipment, diagnostic and therapeutic procedures in benign hyperplasia of the prostate in urological in-patient departments in the North Bohemian region in 1994. The assembled data from nine health institutions revealed relatively good equipment with instruments for the diagnosis of BHP. The diagnostic procedures were consistent with recommendations of WHO. For surgical treatment transurethral prostatectomy was used in 62.8%, open prostatectomy in 32.1% and transurethral incision of the prostate in 5.1%. As regards non-surgical treatment, in three departments thermotherapy was used and in one laser therapy.

Aged↗
PubMed1996

Serum prostate specific antigen levels after transurethral resection of prostate: a longitudinal characterization in men with benign prostatic hyperplasia.

PURPOSE: We studied the long-term effects of adenomectomy on serum levels of prostate specific antigen (PSA) in men with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: A consecutive series of 82 men undergoing adenomectomy for BPH between 1990 and 1992 was studied. PSA levels were determined before and serially after operation for as long as 5 years. RESULTS: Mean PSA decreased from 4.6 ng/ml. preoperatively to 0.7 ng./ml. 6 months postoperatively. These low levels were maintained throughout the 5-year observation period. The PSA decrease correlated with grams of tissue removed (r = 0.54, p < 0.001) and averaged 0.11 ng./ml./gm. Postoperatively mean PSA velocity was 0.01 ng./ml. per year, that is essentially flat, and it was not influenced by patient age, race, type of operation, grams of tissue removed, baseline PSA, PSA density of T1a lesions (7). One to 5 years after adenomectomy 6 of the 82 men had invasive prostatic carcinoma, and PSA levels and velocities remained low. CONCLUSIONS: These data support the concept of transition zone primacy in determining serum PSA. Furthermore, they suggest a possible need for a modified reference range when using PSA to screen for prostatic carcinoma in the estimated 3 million men alive in the United States who previously underwent adenomectomy for BPH.

Adult↗
PubMed2003

Familial aggregation of bothersome benign prostatic hyperplasia symptoms.

OBJECTIVES: To evaluate familial aggregation and the mode of inheritance of bothersome benign prostatic hyperplasia (BPH). METHODS: During an extension of the North American Finasteride Trial, 301 of 895 patients and 158 spousal controls completed a family history questionnaire. Segregation analysis was performed to examine the mode of inheritance in first-degree relatives of the 301 probands. RESULTS: The lifetime cumulative probability of bothersome BPH was similar in relatives of those with BPH (0.35; 95% confidence interval [CI] 0.28 to 0.44) and spousal controls (0.36; 95% CI 0.22 to 0.56), but the age of onset was significantly earlier in relatives of cases than controls (P = 0.001). Fathers of those with BPH had a significantly elevated risk of bothersome BPH (unadjusted odds ratio [OR] 2.1; 95% CI 1.2 to 3.8) and brothers had a significantly elevated risk of both bothersome BPH (OR 3.5; 95% CI 1.7 to 7.3) and transurethral resection of the prostate (OR 3.6; 95% CI 1.4 to 8.8). After adjusting for family size, the risk of bothersome BPH increased approximately twofold with each additional affected first-degree relative (0 relatives, OR 1.0; 1 relative, OR 1.7; 2 relatives, OR 4.7). Segregation analysis suggested a rare autosomal codominant allele (frequency 0.0004). CONCLUSIONS: These findings confirm previous findings that family history and early age of onset are associated with an increased risk of BPH and that the most likely mode of inheritance is autosomal dominant or codominant. Bothersome BPH appears to have a weaker genetic component than more restrictive definitions of hereditary BPH. Thus, linkage studies are more likely to be successful if they focus on stricter definitions of hereditary BPH (eg, early onset, large volume, strong family history) rather than symptomatic or clinical BPH.

Adult↗
PubMed2000

The natural history of benign prostatic hyperplasia: what have we learned in the last decade?

Benign prostatic hyperplasia (BPH) frequently has a significant detrimental impact on a patient's quality of life. If the disease is left untreated, it may progress in severity, leading to recurrent bladder infections, bladder calculi, and acute urinary retention (AUR), necessitating surgical treatment. The Forth Valley, Scotland, study reported that 14% of men aged 40 to 50 years have BPH. This increases to 43% of men >60 years old. BPH has been shown to be nearly as prevalent as hypertension and diabetes among patients seeking treatment for erectile dysfunction. The effects of BPH on quality of life include lack of sleep, anxiety, reduced mobility, interference with leisure activities and usual daily activities, and a compromised sense of well-being. Three symptoms are associated with an increased risk of AUR in men with BPH: a reduction in the force of the urinary stream, a sensation of incomplete bladder emptying, and an enlarged prostate gland on digital rectal examination. Age is a strong independent risk factor for the development of AUR. Transurethral resection of the prostate was more effective than watchful waiting in preventing AUR, as shown in the Veteran's Affairs Cooperative Study. Data from the Olmsted County study revealed that urinary flow decreases and prostate size increases with advanced age. This study also showed that lower urinary tract symptoms have a negative impact on parameters of physical and mental aspects of health. More recently, studies have shown that medical treatment with 5alpha-reductase inhibitors and possibly also alpha-blockers may alter the natural history and progression of BPH.

Adrenergic alpha-Antagonists↗
PubMed1994

Semiautomated nuclear shape analysis of prostatic carcinoma and benign prostatic hyperplasia.

Nuclear shape analysis has predicted outcome better than histologic grading in patients with clinically localized prostatic carcinoma. However, the requirement for manual nuclear contour tracing makes the method tedious and slow. Currently available image analysis systems for nuclear shape analysis using light-absorption microscopy provide nuclear boundaries of insufficient clarity for automatic segmentation. We improved image resolution using confocal laser scanning microscopy, automatically detected nuclear boundaries by a multiscale segmentation algorithm and discriminated artifacts in a semiautomated way. A manual quantitative morphometry system and our semiautomated system distinguished eight cases of prostatic carcinoma from seven cases of benign prostatic hyperplasia by nuclear roundness factor, ellipticity, nuclear area and perimeter. The ease of semiautomated nuclear shape analysis should allow evaluation of large numbers of patients with known outcomes after treatment for clinically localized prostatic carcinoma to determine whether nuclear shape analysis can be extended from research to clinical usage.

Carcinoma↗
PubMed2001

Molecular genetic profiling of Gleason grade 4/5 prostate cancers compared to benign prostatic hyperplasia.

PURPOSE: Because Gleason grade 4/5 cancer is the primary cause of failure to cure prostate cancer, we examined the molecular profiles of this high grade cancer in search of potentially new therapeutic interventions as well as better serum markers than prostate specific antigen. MATERIALS AND METHODS: We compared the gene expressions in fresh frozen tissues from 9 men with Gleason grade 4/5 cancer to 8 men with benign prostatic hyperplasia (BPH) treated with radical retropubic prostatectomy. Labeled complementary RNA from each of the 17 tissues was applied to HuGeneFL probe arrays representing approximately 6,800 genes (Affymetrix, Inc., Santa Clara, California). After removing all genes undetectable in BPH and grade 4/5 cancers, and transforming the data into a parametric distribution, we chose only those up and down-regulated genes with a p difference in fluorescence between grade 4/5 cancer and BPH of p <0.0005. This value reduced the data set to 40 up-regulated and 111 down-regulated genes. We then eliminated all genes that were not expressed in all 8 BPH and 9 grade 4/5 tissues, which produced a final set of 86 genes, of which 22 were up-regulated and 64 were down-regulated. RESULTS: Cluster analysis cleanly separated men with grade 4/5 cancers from those with BPH. Only 17 of the 86 candidate genes (20%) were known to be prostate cancer related and 42 (49%) were related to other cancers. The most up-regulated gene is Hepsin, a trypsin-like serine protease with its enzyme catalytic domain oriented extracellularly. Prostate specific membrane antigen is the second most up-regulated gene (all other reports on prostate specific membrane antigen have been at the protein level). The genes for prostate specific antigen (hK3) and human glandular kallikrein2 (hK2) showed equivalent expression levels 10 times the average of other genes. Complete lists of all 22 up-regulated genes and 64 down-regulated genes, together with their locus on the chromosome, are presented in rank order. CONCLUSIONS: We characterize for the first time 64 down-regulated and 22 up-regulated genes in Gleason grade 4/5 cancer, using the gene profile from BPH as control tissue. A number of interesting new genes, previously undescribed in prostate cancer, are presented as possibilities for further study.

Aged↗
PubMed2006

Questionnaire survey of urologists' initial treatment practices for acute urinary retention secondary to benign prostatic hyperplasia in Korea.

BACKGROUND: We undertook a survey of Korean urologists to establish initial treatment practices for acute urinary retention secondary to benign prostatic hyperplasia. METHODS: Probability samples were drawn from the Korean Urological Association Registry of Physicians, and a random sample of 850 Korean urologists were asked to complete a questionnaire that explored practice characteristics and treatment strategies in the management of acute urinary retention. The returned questionnaires were statistically analyzed. RESULTS: Of the 850 questionnaires sent, 302 were returned, and 277 of those were included in the final analysis (response rate 32.6%). Korean urologists preferred urethral catheterization as the initial management. Of respondents, 154 (55.6%) and 109 (39.4%) started their patients on alpha-blockers and alpha-blockers with finasteride, respectively. Nearly half (50.2%) used a trial without catheter 7 days after catheterization. One failed trial without catheter was an indication for surgery for only 69 (24.9%) of the respondents. A second trial without catheter was advocated by 108 (39.0%). Most urologists (82.3%) expected to be successful with the above management in 50% or greater. Physician's demographics or types of initial management did not influence physician's perception of expected success rate when the expected success rate was divided as < or =50% and >50. CONCLUSIONS: These data provide a picture of current practice regarding the management of acute urinary retention secondary to benign prostatic hyperplasia in Korea. There is no uniformity in the management of acute urinary retention in Korea.

Acute Disease↗
PubMedDate not supplied

Suprapubic versus transrectal ultrasonography in assessing the volume of the prostate and the transition zone in patients with benign prostatic hyperplasia.

The reliability of suprapubic ultrasonography (SU) in assessing the size of the prostate was examined in 95 patients with benign prostatic hyperplasia (BPH). Volumetric measurements of the prostate and the transition zone of the prostate (TZP) performed by SU were compared with corresponding measurements obtained by transrectal ultrasonography measurements obtained by transrectal ultrasonography (TU). A very strong correlation was found between suprapubically and transrectally performed measurements for both the total prostate gland (r = 0.948, p < 0.001) and the TZP volume (r = 0.953, p < 0.001). According to the results of this study, SU appears to be reliable as TU in assessing the size of the prostate and the TZP and may be used effectively in the evaluation of patients with BPH, as it is less cumbersome, better tolerated, and a widely available examination technique.

Aged↗
PubMed1997

Benign prostatic hyperplasia: diagnosis and treatment guideline.

OBJECTIVE: To critique the US Department of Health and Human Services Public Health Service, Agency for Health Care Policy and Research, Clinical Practice Guideline on Benign Prostatic Hyperplasia: Diagnosis and Treatment; and to provide an update on management and treatment of benign prostatic hyperplasia (BPH) since the Guideline was published. DATA SOURCES: A review of the published medical literature in MEDLINE from 1994 to April 1996, limited in focus to drug treatment of BPH, English language, and human subjects, was performed. STUDY SELECTION: Controlled clinical studies of drug treatment for symptomatic BPH that used objective parameters (e.g., urinary flow rate, prostatic volume, voiding symptom scores) were evaluated. A single reviewer assessed each study. DATA EXTRACTION: Study methods, inclusion and exclusion criteria, and treatment outcomes were assessed for all studies. Independent extraction was performed by a single observer. DATA SYNTHESIS: Management of BPH is directed at ameliorating voiding symptoms. For moderate or severe BPH, medical or surgical therapy should be offered to the majority of patients. Medical therapy options include alpha-adrenergic antagonists and finasteride. The former offer the advantage of a more prompt onset of action (within weeks) when compared with finasteride. Finasteride produces a lower response rate and smaller improvement in voiding symptoms. Combination therapy of terazosin and finasteride has not been proven to be more effective than terazosin monotherapy. CONCLUSIONS: When medical therapy is indicated for moderate or severe BPH, alpha-adrenergic antagonists exhibit a faster onset of action and produce greater improvement of voiding symptoms than does finasteride.

Humans↗
PubMed1987

Serum hormone levels among patients with prostatic carcinoma or benign prostatic hyperplasia and clinic controls.

This study sought to identify differences in serum hormone levels between prostatic cancer (CaP) patients, benign prostatic hyperplasia (BPH) patients, and clinic controls (CC). Serum testosterone, estradiol, and prolactin values were obtained from 35 CaP, 42 BPH, and 161 CC patients attending a single medical center between January 1984 and April 1985. Relative risk estimates adjusted for age and race were calculated to compare hormone values between each case group and the CC. The distributions of hormone values and the testosterone to estradiol (T/E) ratios were grouped into thirds with the lowest third forming the reference category. The relative risk estimates for BPH in the middle and high thirds of testosterone were greater than unity (1.26 and 2.10, respectively), whereas the relative risk estimates in the middle and high thirds of estradiol were less than unity (0.63 and 0.35, respectively). For the middle and high thirds of the T/E ratio, the relative risk estimates for BPH showed statistically significant three- to fourfold increases. Modest depression of serum testosterone and estradiol was noted for CaP patients compared to CC, although the differences were not statistically significant. This depression was interpreted to be a likely result of the malignant process rather than a cause of it, whereas the development of clinically evident BPH was felt to be a biologically plausible response to an elevated T/E ratio.

Age Factors↗