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PubMed2000

Effects of mepartricin (S-160) on spontaneous canine benign prostatic hyperplasia.

OBJECTIVE: The effects of mepartricin (S-160) on spontaneous canine benign prostatic hyperplasia (BPH) were investigated by histological, histochemical and biochemical analysis. METHODS: Aged beagle dogs (5-9 years old) with spontaneously developed BPH were treated orally with a placebo or S-160 (5, 10 or 20 mg/kg/day) for 8 weeks. The methodology included measurement of prostatic volume by transrectal ultrasonography, qualitative evaluation of prostatic morphology, determination of plasma and intraprostatic estradiol level by radioimmunoassay and immunohistochemical detection of estrogen receptors and androgen receptors in the prostate. RESULTS: S-160 significantly reduced the prostatic volume and regressed histologically the hyperplastic grade of prostate, and also fairly decreased the plasma and intraprostatic estradiol concentration and the estrogen and androgen receptors in the prostate. CONCLUSIONS: These results suggest that the reduction of estradiol and estrogen receptors in the prostate may play a crucial role in the regression of BPH by S-160.

Administration, Oral↗
PubMed2004

Inhibition of prostate cell growth by BXL-628, a calcitriol analogue selected for a phase II clinical trial in patients with benign prostate hyperplasia.

OBJECTIVE: Calcitriol analogues might represent an interesting new therapy for benign prostate hyperplasia (BPH). We here report the preclinical characterization of BXL-628, an analogue selected for an ongoing double-blind, randomized, placebo-controlled phase II trial in BPH. DESIGN: Experiments with BXL-628 were carried out in human BPH cells and in the ventral prostate of intact and castrated rats. METHODS: BPH cell and rat prostate growth were evaluated along with morphological and biochemical hallmarks of apoptosis. RESULTS: BXL-628 inhibited human BPH cell proliferation and induced apoptosis even in the presence of androgens or growth factors. It also decreased prostate growth to an extent similar to finasteride, inducing DNA fragmentation and apoptosis, both in intact and in testosterone-supplemented castrated rats. Accordingly, BXL-628, like finasteride, increased the expression of clusterin, a prostatic atrophy marker. However, BXL-628 did not inhibit 5 alpha-reductase 1 and 2, did not bind to the androgen receptor (AR) in BPH homogenates and did not affect AR-coupled luciferase activity. In addition, BXL-628 did not affect rat pituitary and testis activity or calcemia. CONCLUSIONS: BXL-628 inhibited in vitro and in vivo prostate cell proliferation, and therefore might represent a novel, interesting option for the treatment of BPH.

Animals↗
PubMed2005

[Etiology and treatment of bladder spasm associated with benign prostatic hyperplasia].

OBJECTIVE: To investigate the etiology and treatment of bladder spasm associated with benign prostatic hyperplasia (BPH). METHODS: Urodynamic tests were performed in 102 cases of BPH before operation. The correlation of bladder spasm with aging, international prostate symptom score (IPSS), quality of life, prostatic volume, operation methods and urodynamic indexes was studied by t and chi2 tests. RESULTS: The incidences of bladder spasm in the lower compliant bladder and unstable bladder were 32.1% (9/28) and 42.5% (13/20), and those after suprapubic prostatectomy and transurethral resection of the prostate (TURP) were 50.9% (26/51) and 23.3% (12/51). There was significant difference between operation methods (P < 0.05). CONCLUSION: Bladder spasm easily develops in the lower compliant bladder and unstable bladder, especially after suprapubic prostatectomy. TURP might decrease the incidence of bladder spasm after BPH operation.

Aged↗
PubMed1995

Complications of invasive, urodynamic examinations and prostate biopsies in patients with benign prostatic hyperplasia.

We studied 85 men with moderate to severe symptoms of benign prostatic hyperplasia (BPH) who completed two placebo-controlled studies of drug therapy. During the 48 week period of treatment and follow-up the patients underwent 164 procedures which included urethral instrumentation, predominantly without antibiotic prophylaxis, and 187 procedures of urethral instrumentation in combination with transperineal prostate biopsy with antibiotic prophylaxis. The risk for a patient to acquire clinically significant urinary tract infection was 2.4% after urethral instrumentation alone and 7.5% when urethral instrumentation was combined with prostate biopsy. Invasive urodynamic examinations of prostate biopsies in studies of new treatment modalities for BPH should only be performed when necessary to obtain important information, and after full informed patient consent. The combination of prostate biopsy and urethral instrumentation increases the infection rate considerably and should be avoided.

Aged↗
PubMed1993

[Biodistribution of 125I labeled monoclonal antibody against gamma seminoprotein in the nude mice bearing human benign prostatic hyperplasia xenografts].

The biodistribution of 125I labeled monoclonal antibody against gamma seminoprotein (gamma-Sm) in the nude mice bearing human benign prostatic hyperplasia xenograft was evaluated by whole body autoradiography and by counting of radioactivity in organs. The monoclonal antibody (murine Ig G1, K) to gamma-Sm which was established in this institute and its F(ab')2 fragment were radioiodinated using Iodogen method. The autoradiograms demonstrated specific uptake of 125I-intact Ig G as well as 125I-F(ab')2 within the prostatic adenoma xenografts 4 days after intravenous administrations. Radioactivity in the xenograft was relatively higher than those in the liver, kidney or lung. These results suggest that radio-labeled monoclonal antibody against gamma-Sm might be applicable for radioimmunodetection of prostatic tumors which produce gamma-Sm.

Adenoma↗
PubMed1992

Localised deep microwave hyperthermia in the treatment of benign prostatic hyperplasia: long-term assessment.

A group of 133 patients with benign prostatic hyperplasia who were either poor operative risks or who had refused surgery underwent localised deep microwave hyperthermia, without supplementary drugs. In 59% of patients who had had an indwelling catheter, freedom from urological obstruction and satisfactory voiding were maintained for 7 years and catheterisation was not required. In patients with severe prostatic symptoms, 65% showed general improvement and satisfactory voiding for 8 years. There were no side effects. Patients who relapsed were given a second course of treatment and 75% responded positively. This positive response and the lack of side effects suggest that localised deep microwave hyperthermia may be an effective alternative to surgery in the management of high risk patients and those who are reluctant to undergo surgery.

Aged↗
PubMed2003

Efficacy and tolerability of doxazosin and finasteride, alone or in combination, in treatment of symptomatic benign prostatic hyperplasia: the Prospective European Doxazosin and Combination Therapy (PREDICT) trial.

OBJECTIVES: To evaluate the efficacy and tolerability of the selective alpha(1)-adrenergic antagonist doxazosin and the 5-alpha-reductase inhibitor finasteride, alone and in combination, for the symptomatic treatment of benign prostatic hyperplasia. METHODS: In a prospective, double-blind, placebo-controlled trial, 1095 men aged 50 to 80 years were randomized to treatment for 52 weeks with doxazosin, finasteride, the combination of doxazosin and finasteride, or placebo. The dose of finasteride (or its matched placebo) was 5 mg/day. Doxazosin (or its matched placebo) was initiated at 1 mg/day, and titrated up to a maximum of 8 mg/day over approximately 10 weeks according to the response of the maximal urinary flow rate (Qmax) and International Prostate Symptom Score (IPSS). The IPSS and Qmax were assessed at baseline and at weeks 10, 14, 26, 39, and 52 or at the endpoint. RESULTS: An intent-to-treat analysis of 1007 men showed doxazosin and doxazosin plus finasteride combination therapy produced statistically significant improvements in total IPSS and Qmax compared with placebo and finasteride alone (P <0.05). Finasteride alone was not significantly different statistically from placebo with respect to total IPSS and Qmax. All treatments were generally well tolerated. CONCLUSIONS: Doxazosin was effective in improving urinary symptoms and urinary flow rate in men with benign prostatic hyperplasia, and was more effective than finasteride alone or placebo. The addition of finasteride did not provide further benefit to that achieved with doxazosin alone.

5-alpha Reductase Inhibitors↗
PubMed1998

Cytokeratin 8/18 levels in patients with prostate cancer and benign prostatic hyperplasia.

OBJECTIVES: Recently, tissue polypeptide-specific antigen (TPS), a cytokeratin 18 marker, was described to be discriminative between cancer of the prostate (CaP) and benign prostatic hyperplasia (BPH). Cyfra 8/18, a marker which recognizes both cytokeratin 8 and 18 fragments, is discussed to improve sensitivity and specificity of TPS. We investigated whether Cyfra 8/18 serum concentration discriminates between patients with clinically localized CaP and BPH. METHODS: Serum Cyfra 8/18 levels were determined in patients with untreated CaP before radical prostatectomy (pT1-3pNoMo; n = 11) and with histologically confirmed BPH (n = 22). Cyfra 8/18 concentration was correlated to the prostate-specific antigen (PSA) concentration. RESULTS: Median Cyfra 8/18 level was 0.64 ng/ml in CaP patients and 0.57 ng/ml in BPH patients. This difference is statistically not significant (p = 0.91). Furthermore, no correlation to PSA levels could be established (CaP: r = 0.036; BPH: r = 0.09). CONCLUSION: In contrast to a recent report we found the Cyfra 8/18 serum concentration to be a nondiscriminative parameter between CaP and BPH.

Adenocarcinoma↗
PubMed1995

Ultrasonographic and pathologic changes in the prostate of patients with benign prostatic hyperplasia after transurethral balloon laser therapy.

Twenty-seven patients with benign prostatic hyperplasia (BPH) were treated with a transurethral flexible laser balloon (PROSTALASE) under ultrasound guidance. Three months after treatment, 22 (82%) of the patients showed a 50% or greater decrease in the AUA Symptom Score. The average uroflow rate, peak uroflow rate, and postvoiding residual urine volume also showed significant improvement. Ultrasonography showed that the prostatic volume had decreased by 17% (8%-37%). Also, a circular hyperechoic zone about 3 cm in diameter was noted around the prostatic urethra. The prostatic tissue in the hyperechoic zone was sampled by transperineal needle biopsy under transrectal ultrasound guidance, and histopathologic examination showed degenerative necrosis. The necrotic tissue was gradually absorbed, resulting in prostatic shrinkage at around the third month. These results suggest that clinical improvement, both subjective and objective, is brought about by this therapy.

Aged↗
PubMed1998

A second phase III multicenter placebo controlled study of 2 dosages of modified release tamsulosin in patients with symptoms of benign prostatic hyperplasia. United States 93-01 Study Group.

PURPOSE: In a double-blind, phase III clinical trial we evaluate the safety and efficacy of 0.4 and 0.8 mg. tamsulosin daily for the treatment of patients with symptoms of moderate to severe benign prostatic hyperplasia. MATERIALS AND METHODS: Patients meeting the basic requirements of the study underwent a 4-week single-blind placebo evaluation period. A total of 735 patients were randomized to double-blind therapy with tamsulosin or placebo. Treatment duration was 13 weeks. Efficacy and safety were evaluated at 5 visits during the double-blind treatment period. RESULTS: When efficacy data between baseline and end point were compared there was a significant reduction in total American Urological Association symptom score (25%) in each tamsulosin group compared with placebo (p = 0.01) and the percentage of patients with a 30% or more reduction in peak urinary flow rate was significantly greater in the tamsulosin versus placebo group (p <0.05). Improvements in American Urological Association symptom scores and maximum flow rate occurred at 1 week of treatment. None of the patients experienced a first dose effect. There were no significant changes in blood pressure on standing at any visit during the study except for a decrease in systolic blood pressure of 20 mm. Hg or more between the 0.8 mg. dose and placebo groups at visit 4 (p = 0.036). Positive orthostatic tests were significantly more frequent in the 0.8 mg. group compared with placebo at visit 4 (p = 0.012). The treatment groups did not differ significantly in incidence of electrocardiogram abnormalities at each post-baseline visit and at end point. CONCLUSIONS: Tamsulosin was safe and effective, and clinically and statistically superior to placebo in relieving symptoms of benign prostatic hyperplasia in men with moderate to severe symptoms at baseline. There was no evidence of a first dose effect and no clinically significant orthostatic hypertension. In addition, response to treatment was rapid.

Adrenergic alpha-Antagonists↗
PubMedDate not supplied

Zinc and magnesium serum levels in patients with benign prostatic hyperplasia (BPH) before and after prazosin therapy.

In 32 patients with benign prostatic hyperplasia (BPH) serum levels of zinc and magnesium were studied before and after prazosin therapy with (Minipress-Pfizer), 4 mg daily. Following cessation of therapy a slight increase in Zn levels was observed, i.e. from 99.79 to 103.29 micrograms/dl, whereas Mg levels did not change significantly (1.95 and 1.94 mg/dl, respectively). In comparison with other organs, the human prostate is characterized by high Zn and Mg content. In BPH the Zn levels are increased. They are markedly decreased in carcinoma of the prostate and in prostatitis [4, 5]. Zn and Mg play an important role as catalysts in various enzymatic reactions. It has been postulated that changes in concentrations of these two elements are parallel [6]. Kvist has found that Zn imparts resistance to detergent-induced decondensation of spermatozoon nuclear chromatin. The effect was more pronounced with higher Zn concentrations in a buffer fluid. Other bivalent cations were found to be ineffective in stabilizing nuclear chromatin under such conditions. A possible role for seminal zinc in prevention of the reduction of disulfide cross-links and nuclear decondensation was postulated [2]. Zinc also plays an important role in protein synthesis. Zinc ions inhibit androgen metabolism in the prostate. Physiologic Zn serum levels are equal to or above 90 micrograms/dl [4, 6]. Magnesium, unlike zinc, is uniformly distributed within different areas of the gland. In BPH, both normal and increased Mg levels in the prostate have been reported [6]. Mg plays an important role as an activator of enzymes (phosphatases) involved in ATP metabolism, thus affecting both katabolic and anabolic processes.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1999

Suprapubic prostatectomy for benign prostatic hyperplasia in rural Asia: 200 consecutive cases.

OBJECTIVES: To assess the safety and efficacy of a suprapubic prostatectomy technique performed in a rural hospital in Asia. METHODS: A retrospective study of 200 consecutive suprapubic transvesical prostatectomies with a removable bladder neck partition suture for benign prostatic hyperplasia from 1995 to 1998 in a rural mission hospital in northern Pakistan was performed. RESULTS: Despite preoperative comorbidities in 28% of patients, the postoperative morbidity (14%) and mortality (1%) was low. The partition suture is credited with a very low transfusion rate (1%) and a lower intensity of nursing care in the postoperative period. Patient satisfaction was high with regard to both relief of symptoms and cost. CONCLUSIONS: This study demonstrated that suprapubic prostatectomy with a routine bladder neck partition suture for benign prostatic hyperplasia can be carried out with a high degree of safety and efficacy in a rural setting with limited facilities in a developing country.

Adult↗
PubMed1997

On the prediction of the histologic composition of benign prostatic hyperplasia based on clinical and MRI parameters.

BACKGROUND: The histologic composition of prostate adenoma seems related to the development of clinical benign prostatic hyperplasia (BPH). Therefore, a new noninvasive prediction model as an alternative for biopsies was investigated. METHODS: In 19 patients, the data of a routine preoperative workup for transurethral resection (TURP) and of an additional MRI-examination were related to the results of morphometry on TURP-tissue. RESULTS: Statistical analysis identified age of the patient and MRI-volumetrics of the prostate adenoma as best predictors of the epithelial fraction, with a 95% confidence interval of at least 5% (range, 9-14%) (R2 = 50%). CONCLUSIONS: This prediction model is sufficiently accurate to categorize a population of patients into histologic subgroups. It seems very likely that this method will be of use as an investigative tool in medical trials to provide insight into the pathogenesis of clinical BPH and into treatment strategies for the individual patient.

Aged↗
PubMed1997

Clinical outcome at 3 months after transurethral vaporization of prostate for benign prostatic hyperplasia.

OBJECTIVES: To evaluate the clinical outcome of transurethral vaporization of the prostate (TUVP) for the management of benign prostatic hyperplasia (BPH). METHODS: Between March and June 1995, 30 patients with symptomatic BPH treated by TUVP were enrolled in this study. Transrectal ultrasonography (TRUS) was done preoperatively. American Urological Association (AUA) symptom score determination, pressure flow study, and questionnaire (for evaluating potency) were done preoperatively and 3 months postoperatively. RESULTS: The average age was 70.5 years (range 60 to 83) and estimated prostate size by TRUS before surgery was 33.8 +/- 14.0 g. The average AUA symptom score decreased significantly 3 months after TUVP (6.2 +/- 7.8 versus 18.2 +/- 9.0; P < 0.01). The maximum urine flow rate (Qmax) was 11.1 +/- 3.7 mL/min before TUVP (mean +/- SD) and 17.0 +/- 6.5 mL/min 3 months after TUVP, whereas the detrusor pressure at maximum urine flow (Pdes at Qmax) was 61.0 +/- 23.9 and 41.2 +/- 15.2 cm H2O, respectively. Qmax increased and Pdes at Qmax decreased significantly 3 months after TUVP. Of the 30 patients, 3 (10%) developed bladder neck contracture. Of the 24 patients who were potent sexually before operation, 3 (12.5%) developed impotence 3 months after surgery. CONCLUSIONS: TUVP is an effective alternative surgical procedure to relieve obstruction for patients with symptomatic BPH. However, cautious attitude on its usage is advocated based on our preliminary results indicating the occurrence of late complication such as impotence and bladder neck contracture.

Aged↗
PubMed2005

Benign prostatic hyperplasia: mode of presentation and postoperative outcome.

OBJECTIVE: To find out various modes of benign prostate hyperplasia (BPH) presentation in our region and their relation to postoperative failure to void after transurethral resection of prostate (TURP). METHODS: A study was conducted at Urology Department, Sandeman Teaching Hospital Quetta and Akram Hospital (Private) Quetta from January 2000 to December 2003. All BPH patients in whom the primary mode of presentation was accurately determined and later on underwent TURP were included in the study. Four modes of presentation were defined: (1) lower urinary tract symptoms (LUTS), (2) acute retention, (3) chronic retention and (4) and acute on chronic retention. After relevant investigations all these patients underwent TURP. Postoperatively catheter was removed when the urine was clear, usually within 48 hours of operation. Patients failing to void were recatheterized and given a second trial without catheter (TWOC) at third day of recatheterization. Resumption of spontaneous voiding on either the first or second TWOC was defined as "successful TWOC". Failure to void on second TWOC was defined as "failure to void" and was managed by a six week period of catheterization, followed by an additional TWOC. Statistical analysis was used to see any significant relation of failure to void postoperatively to mode of presentation of BPH, age of the patients and weight of the resected prostatic tissues. RESULTS: A total of 345 BPH patients were included in the study. Of these 270 (78.3%) patients presented with urinary retention and 75 (21.7%) with lower urinary tract symptoms (LUTS). Patients who presented with retention were acute retention 129 (37.4%), chronic retention 81(23.5%) and acute on chronic retention 60 (17.4%). The proportion of men failing to void after TURP was significantly higher (P < 0.05) in those with (i) acute retention as compared to LUTS (ii) chronic retention compared to acute retention and (iii) acute on chronic retention as compared to acute retention. The proportion of men failing to void postoperatively was highly significant (P < 0.005) in those with retention of any type as compared to LUTS. Age of the patients and weight of the resected prostatic tissues were found not significant factors in relation to failure to void postoperatively. CONCLUSION: BPH patients in our region present very late, most of them (> 78%) with complication of urinary retention. Mode of presentation of BPH greatly influences the postoperative outcome of this disease. Patients presenting with complications of chronic and acute on chronic retention have less favourable results regarding pOstoperative voiding after TURP. Moreover age of the patient and weight of the prostate are not significant factors in relation to failure to void postoperatively.

Aged↗
PubMed1995

The role of prostate-specific antigen in the evaluation of benign prostatic hyperplasia.

This article reviews the role of prostate-specific antigen (PSA) in the evaluation of BPH. Efficacy of the PSA test in differentiating patients with BPH from patients with early, potentially curable prostate cancer is discussed. In addition, this complete overview provides a critical analysis of various concepts (PSA density, PSA velocity, age-specific reference ranges, and free versus complexed serum PSA), that are devised to optimize the diagnostic value of the serum PSA concentration in a population in which prostate cancer and BPH are almost equally prevalent. A clinical algorithm, useful to the practicing clinician for the early detection of prostate cancer in the BPH patient, is also proposed.

Diagnosis, Differential↗
PubMed1989

5'-nucleotidase activity in prostatic carcinoma and benign prostatic hyperplasia.

In light of previous reports of alterations in 5'-nucleotidase activity in neoplastic conditions, 5'-nucleotidase activity was examined histochemically in tissue sections and quantified biochemically in extracts of human hyperplastic prostates and prostatic carcinomas obtained surgically. The 5'-nucleotidase activities per mg protein in extracts of 29 prostatic carcinomas were lower (P less than 0.0005) than in extracts from 10 samples of benign prostatic hyperplasia. The 5'-nucleotidase activity per mg protein in extracts of prostatic carcinoma from the 29 patients correlated (R = -0.369, P = 0.049) with the degree of histological differentiation; the extracts of poorly differentiated carcinomas contained low levels of 5'-nucleotidase. When age and histological differentiation (Gleason's grade) were adjusted, the enzyme activity per mg protein correlated (R = 0.242, P = 0.004) with patient survival. When all three parameters were considered together, i.e., histological grade of the tumor, 5'-nucleotidase extracted from the tumor, and age of the patient, they were found to be mutually complementary for the prediction of patient survival (R = 0.388, P = 0.0001). To our knowledge, this is the first report that prostatic epithelium expresses 5'-nucleotidase; further work will be required to define the reasons for the high levels of activity observed in prostates without cancer and for the decrease in the activity in prostatic carcinoma.

5'-Nucleotidase↗
PubMed1997

[The treatment of patients with benign prostatic hyperplasia using the selective alpha-blocker alfuzosin].

40 patients with benign prostatic hyperplasia (BPH) were treated with the alpha-blocker alfuzosin which was administered per os twice a day in a dose 5 mg. The treatment brought about a decrease of the mean symptom score from 19.6 to 12.2, of quality of life from 5.2 to 2.1, of residual urine from 152 to 82 ml. Mean and maximal urinary flow rates rose by 35 and 45%, respectively. The level of prostate-specific antigen over the treatment course did not change. The findings of the trial evidence for high efficacy of alfuzosin in the treatment of urination disorders in BPH patients.

Adrenergic alpha-Antagonists↗