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PubMed2006

[Sexual function of men with symptomatic benign prostatic hyperplasia and effect of Tamsulosin].

OBJECTIVE: To study the sexual function of men with benign prostatic hyperplasia (BPH) with the lower urinary tract symptoms (LUTS) and the effect of Tamsulosin. METHODS: One hundred and ninety-two cases of BPH accompanied with typical LUTS were investigated using the International Prostate Symptom Score (IPSS), Quality of Life (QOL), International Index of Erectile Function 5 (IIEF-5) and measuring the flow rate of urine before treatment. The patients were randomly divided into two groups, the treatment group (n = 103) given Tamsulosin 0.2 mg, and the control group (n = 89) taking placebo once a day for 8 weeks. The influence of various factors on sexual function was analyzed before and after treatment. RESULTS: The mean scores of IPSS, QOL, Qmax and IIEF-5 were (20.20 +/- 6.81), (4.51 +/- 0.76), (9.60 +/- 8.79) ml/s and (9.80 +/- 8.62), respectively. The incidence of erectile dysfunction was 75% (144/192). There was statistically significant correlation between age and IPSS score (r = 0. 203, P < 0. 005) or IIEF-5 score (r = -0.571, P < 0.001) as well as between IPSS and IIEF-5 scores (r = - 0.312, P < 0.001). Various indexes were significantly improved after Tamsulosin treatment as compared with pre-treatment (P < 0.001) and placebo administration (P < 0.001), but no significant difference in various indexes was observed in the control group. CONCLUSION: Age and LUTS are dangerous factors for sexual function, and the severity of LUTS is closely related to the development of sexual dysfunction. Tamsulosin can at once improve the sexual function and the lower urinary tract symptoms of the BPH patients.

Adrenergic alpha-Antagonists↗
PubMed1982

Microautoradiographic studies on distribution of 5 alpha-dihydrotestosterone, cyproterone acetate and oestradiol-17 beta in human prostatic hyperplasia tissue transplanted to juvenile rats.

While maintaining the actual conditions prevailing in benign prostatic hyperplasia (BPH) in man, transplantation of BPH tissue to new born rats proved a suitable model for examining the distribution of sexual hormones in different tissue compartments of BPH. In combination with the microautoradiographic method, it was possible to demonstrate the residence of the radio-active androgen 5 alpha-dihydrotestosterone (5 alpha-DHT), the antiandrogen cyproterone acetate (CA) and the oestrogen oestradiol-17 beta (E2) in the epithelium and/or stroma of human BPH tissue. Quantitative evaluation in the form of a point per area count on photographic pictures yielded a silver grain distribution ratio in epithelium and stroma of 1.3: 1 and 1.5: 1 for epithelium to stroma after administration of [3H] 5 alpha-DHT and [3H]CA administration respectively and 0.5: 1 after [3H]E2. The high tracer recovery rate throughout the stroma following E2 administration supports the current view that the stromal proliferation is attributable mainly to oestrogen influences. The relatively high silver particle proportion throughout the stroma following 5 alpha-DHT administration corroborates recent findings which suggest that the exclusive androgen dependency of the glandular epithelium can only be considered in conjunction with an active metabolization of androgens in the stroma. The correspondence in the distribution of the radioactive tracer after [3H] 5 alpha-DHT and [3H]CA administration both in the epithelium and stroma suggest that an antagonism may also exist in the stroma.

Aged↗
PubMed2006

Management of lower urinary tract symptoms secondary to benign prostatic hyperplasia with open prostatectomy: results of a contemporary series.

PURPOSE: Surgical therapy remains the definitive treatment in patients with benign prostatic hyperplasia sequelae. Many patients with a markedly enlarged prostate are often not amenable to minimally invasive therapies. In these patients open prostatectomy is a preferred treatment. Most studies of this procedure are quite dated. Therefore, we describe the clinical results and complications of open prostatectomy performed in a modern setting using serum prostate specific antigen, the American Urological Association symptom index and quality of life scores to determine outcomes. MATERIALS AND METHODS: We performed a prospective study in 56 patients who underwent open prostatectomy at our institution. Patients were evaluated by history and physical examination, American Urological Association symptom index, quality of life forms, prostate specific antigen, transrectal ultrasound and post-void urine volume. RESULTS: Patients were followed up to 11 years postoperatively (mean 39.2 months). Of the patients 80.3% presented in acute urinary retention while on medical therapy. Baseline American Urological Association symptom index decreased from a mean +/- SD of 18.5 +/- 1.9 to 4 +/- 1.7 within 1 month. Similarly the quality of life score was 3.1 +/- 0.5 preoperatively, which decreased to 0.6 +/- 0.5 postoperatively. These improvements were maintained throughout followup. The most common complication was blood loss requiring transfusion in approximately 36% of cases. Three patients had urethral strictures and 3 had bladder neck contractures that required dilation. Baseline average prostate specific antigen was 13.34 +/- 1.70 ng/dl, which stabilized at less than 1 ng/dl postoperatively. CONCLUSIONS: Open prostatectomy may be curative in a select population of men with a large prostatic burden. To our knowledge this is the first study to demonstrate durable improvements in American Urological Association symptom index, quality of life score and prostate specific antigen along with a rare need for any further treatment after open prostatectomy.

Aged↗
PubMed1994

Correlation of the AUA symptom index with urodynamics in patients with suspected benign prostatic hyperplasia.

The AUA symptom index is widely used to access patients with suspected benign prostatic hyperplasia (BPH). In order to determine how well symptoms as assessed by this index correlate with urodynamic findings, we evaluated 83 patients referred to our urology clinics with symptoms of BPH. All patients completed the AUA symptom index and then underwent a multichannel urodynamic evaluation. Patients were classified as obstructed, unobstructed, or equivocal according to the Abrams Griffiths nomogram. The AUA symptom index was recorded as the total score and, for purposes of symptom classification, further subdivided into an obstructive score (questions 3, 5, and 6) and an irritative score (questions 1, 2, 4, and 7). The mean age of the 83 patients was 67 (45-84). The mean total AUA symptom score was 16.6 (6-34), mean obstructive score was 6.1 (0-15), and the mean irritative score 10.4 (3-20). Pressure flow analysis using the Abrams-Griffiths nomogram classified 28 patients (34%) as obstructed, 17 (20%) as unobstructed, and 38 (46%) as equivocal. Using the analysis of variance procedure (ANOVA) there was no statistically significant difference in the mean total (P = 0.446), obstructive (P = 0.979), or irritative (P = 0.136) scores. Detrusor instability was present in 45 patients (54%). While total and obstructive scores were not significantly different in patients with detrusor instability vs. those with stable bladders, irritative scores were higher in patients with instability (P = 0.028) using the T-test procedure. Using ANOVA, the difference in post void residual (PVR) between the groups was not quite statistically significant (P = 0.057).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1997

Reference ranges for the concentrations of total and complexed plasma prostate-specific antigen and their ratio in patients with benign prostate hyperplasia.

OBJECTIVE: To establish the normal distribution and reference ranges of complexed and total prostate-specific antigen (PSA) and the complexed-to-total PSA ratio according to the age of the patients, so that PSA can be used to distinguish between prostate cancer and benign prostate hyperplasia (BPH). MATERIAL AND METHODS: Using specific ELISAs, total PSA and PSA complexed to alpha 1-antichymotrypsin (complexed PSA) were determined in 237 BPH patients, 160 with histologically confirmed BPH and 77 in whom prostate cancer was excluded by digital rectal examination, transrectal ultrasound and total PSA measurement. RESULTS: Both total and complexed PSA correlated with patient age (r = 0.424 and r = 0.379, p < 0.0001, respectively). However, no correlation was found between the complexed-to-total PSA ratio and age (r = 0.026, p > 0.2). The mean complexed-to-total PSA ratio for the 237 BPH patients was 0.69 +/- 0.11, and only 23 had a ratio > 0.8. CONCLUSIONS: These results show that the cut-off point of 0.8 established for the complexed-to-total PSA ratio is the same for men of all ages, and that the use of this ratio may avoid many negative prostate biopsies, confirming that PSA: alpha 1ACT is a potential marker for differential diagnosis of prostate carcinoma and BPH.

Adult↗
PubMed1996

Holmium laser resection of the prostate: preliminary results of a new method for the treatment of benign prostatic hyperplasia.

OBJECTIVES: To assess the early efficacy and safety of holmium laser resection of the prostate (HoLRP) for the treatment of patients with symptomatic benign prostatic hyperplasia (BPH). METHODS: The initial 84 patients undergoing HoLRP at this institution are reported. All patients underwent standard urologic evaluation for BPH with American Urological Association (AUA) symptom score, peak urinary flow rate (Qmax), ultrasound prostate volume estimation, prostate-specific antigen and digital rectal examination. The patients were reassessed at 1 month (72 patients) and 3 months (48 patients) postoperatively. The resection time, total operating time, holmium energy used (kilojoules), catheter time, and hospital stay were all recorded. RESULTS: The mean patient age was 65.3 years (49 to 80). The mean AUA score improved from 21.3 preoperatively to 7.6 at 1 month and 4.1 at 3 months. The mean Qmax likewise increased from 7.5 mL/s preoperatively to 17.8 mL/s at 1 month and 19.3 mL/s at 3 months. Two patients (2%) required bladder irrigation for heavy hematuria perioperatively and 4 patients (5%) required recatheterization. Few patients experienced irritative urinary symptoms and to only a mild degree. CONCLUSIONS: The technique of HoLRP produces a cavity identical in appearance to transurethral resection of the prostate. It is a relatively bloodless procedure that results in a short catheter time, immediate symptomatic improvement, and minimal postoperative irritative symptoms. The short-term results are excellent but longer-term follow-up is necessary.

Aged↗
PubMed1985

Decreased urinary 5 alpha-androstane-3 alpha,17 beta-diol glucuronide excretion in patients with benign prostatic hyperplasia.

Urinary testosterone and 3 alpha-androstanediol (3 alpha diol G) glucuronides together with plasma testosterone, 5 alpha-dihydrotestosterone (DHT), and delta 4-androstenedione (delta 4) were measured in 43 normal young men (18-36 yr old), 23 elderly men without clinically evident prostatic pathology (54-89 yr old), 68 elderly men with benign prostatic hyperplasia (BPH group; 54-91 yr old), and 26 elderly men with well differentiated cancer of the prostate (K group; 63-97 yr old). Plasma testosterone decreased slightly with age in all 3 elderly groups (from 591 to 438, 479, and 444 ng/100 ml, respectively). Plasma DHT, on the contrary, was significantly (P less than 0.01) higher in the BPH group than in the other three groups (68 vs. 30, 37, and 32 ng/100 ml, respectively). Plasma delta 4 was significantly lower (P less than 0.01) in the elderly K group than in all other groups (59 vs. 109, 83, and 78 ng/100 ml, respectively). Urinary testosterone glucuronide decreased with age in all 3 elderly groups (from 109 to 55, 38, and 44 micrograms/24 h, respectively) as a result of decreased androgen production rates with age. All 3 elderly groups also had decreased urinary 3 alpha diol G, from 194 to 123, 55, and 118 micrograms/24 h, respectively. The group of elderly patients with BPH had the lowest mean urinary 3 alpha diol G excretion together with the highest mean plasma DHT. This low urinary 3 alpha diol G excretion, which reflects a decrease in both androgen production and DHT metabolism, suggests a decrease in 3 alpha-hydroxysteroid dehydrogenase activity, which, in turn, could explain the increased DHT availability and tissue retention in most target organs. Moreover, the extent of these modifications in androgen metabolism specific to the BPH condition raises the question of an overall alteration of androgen metabolism in patients with BPH which could be the cause of the disease.

Adenocarcinoma↗
PubMed1992

Use of the ASI titanium stent in the management of bladder outflow obstruction due to benign prostatic hyperplasia.

An expandable titanium intraprostatic stent was inserted into 30 patients with infravesical obstruction due to benign prostatic hyperplasia (BPH). All of the men were considered unsuitable for transurethral resection of the prostate as a result of comorbid conditions. In 25 patients effective micturition was reestablished with this technique. In 21 of these men, who have been followed for longer than 1 year, the mean maximum flow rate at 1 year was 10.8 ml. per second and the mean residual urine was 56 ml. Although urinary tract infections occurred subsequent to stent insertion in 10 individuals, these resolved after appropriate antibiotic treatment and no stents have had to be removed for this reason. Followup cystoscopy or examination by electron microscopy of those stents that have been removed has shown partial epithelialization of the stent surface in a proportion of patients, and a minor degree of incrustation occurred in 1 case. We conclude that an expandable intraprostatic titanium stent is an acceptable alternative to transurethral resection of the prostate or long-term catheterization in this particular group of high risk patients.

Aged↗
PubMed2005

[Association study between benign prostatic hyperplasia and primary hypertension].

OBJECTIVE: To assess whether primary hypertension affects the occurrence and progression of benign prostatic hyperplasia (BPH). METHODS: A total of 423 cases of BPH, undergoing transurethral resection of prostate (TURP) or open surgery due to severe low urinary tract symptoms, were reviewed and analyzed. All cases were verified to be BPH postoperatively following histopathological examination. RESULTS: Of 423 patients, 295 cases (69.7%) were simple BPH (group BPH-NT); 128 cases (30.3%) were BPH with hypertension (group BPH-HT). The mean age and the incidence of haematuria were significantly higher in group BPH-HT than those in group BPH-NT (P < 0.05). The time of BPH occurrence and surgical treatment in group BPH-HT with mean diastolic blood pressure >/= 90 mmHg was significantly earlier than those with diastolic blood pressure < 90 mmHg (P < 0.05; P < 0.01). As compared with group BPH-NT, the time of BPH occurrence was significantly earlier in group BPH-HT with more than 10 years hypertension; the rate of urinary retention and haematuria was significantly higher and prostatic volume was significantly greater in group BPH-HT with more than 20 years hypertension; (all P < 0.05). Additionally, prostatic volume was positively correlated with the years of hypertension in group BPH-HT (Rsq = 0.056, P = 0.009). CONCLUSIONS: The present results demonstrate that BPH may be frequently accompanied by the disease of hypertension. A long-term hypertension, particularly the condition of high diastolic blood pressure may improve the occurrence and clinical progression of BPH.

Aged↗
PubMed1995

Expression of acid cysteine proteinase inhibitor (ACPI) in the normal human prostate, benign prostatic hyperplasia and adenocarcinoma.

Acid cysteine proteinase inhibitor (ACPI or cystatin A) is a protein (12 kDa) which inhibits the action of several cysteine proteinases, e.g. cathepsins B, H, L and S. In this study the cellular location of ACPI has been immunohistochemically investigated in the normal human prostate, in benign prostatic hyperplasia (BPH) and in adenocarcinoma. ACPI was found in the basal epithelial cells of the normal prostate. The secretory epithelial cells did not express ACPI. In the hyperplastic prostate, the expression of ACPI was decreased and it was also expressed more focally in the basal cells. Hyperplastic basal cells also expressed ACPI. In prostatic adenocarcinoma, no ACPI expression was found. The absence of ACPI expression was obvious and if the sections contained both benign and malignant cells, only the benign glandular structures always expressed ACPI. The results suggest that expression of ACPI might be related to prostatic epithelial cell proliferation and differentiation. Possibly the detection of ACPI in tissue sections might be helpful in identifying prostatic adenocarcinoma, especially in cases with small carcinomatous foci.

Adenocarcinoma↗
PubMed2003

Effects of finasteride on serum testosterone and body mass index in men with benign prostatic hyperplasia.

OBJECTIVES: To examine the effect of finasteride on serum testosterone in men with benign prostatic hyperplasia (BPH). METHODS: The Proscar Long-Term Efficacy and Safety Study (PLESS) was a 4-year trial comparing the safety and efficacy of finasteride 5 mg with placebo in 3040 men with moderate to severe symptomatic BPH and enlarged prostates. PLESS included the prospective measurement of annual serum testosterone in a randomly selected subset of patients comprising approximately 10% of the randomized population (n = 301). RESULTS: Finasteride treatment led to a modest, but significant (P <0.001), increase relative to placebo in serum testosterone, with this increase greatest in patients who had low baseline testosterone levels. The larger testosterone increases seen in finasteride-treated patients in the lower baseline testosterone tertiles were associated with significant mean reductions relative to placebo at year 4 in body mass index (BMI), ranging from 0.6 to 0.8 kg/m2. No statistically significant between-group difference was found in BMI in the upper testosterone tertile. The sexual adverse experience profiles for finasteride and placebo were similar across the baseline testosterone cohorts examined. CONCLUSIONS: Finasteride treatment led to a generally modest increase relative to placebo in serum testosterone, with the greatest increases occurring in men with low baseline testosterone levels. The physiologic significance of these changes in men with low baseline testosterone levels is unclear, but the associated reduction in BMI is intriguing and may be related, because BMI is known to be negatively correlated with serum testosterone levels in men.

5-alpha Reductase Inhibitors↗
PubMed2005

[Clinical study of Eviprostat for the treatment of benign prostatic hyperplasia].

OBJECTIVE: To study the efficacy and safety of Eviprostat for the treatment of benign prostatic hyperplasia (BPH). METHODS: An open, multicentral clinical trial was conducted in 100 patients with BPH. Patients received a 12-week oral administration of Eviprostat 2 tablets per-time, 3 times a day. The main indexes of efficacy include international prostatic symptom score (IPSS), maximum urinary flow rate (Qmax), residual urine ( Ru) and prostatic volume (V). The additional indexes are quality of life score (QOL) and average urinary flow rate (Qave). RESULTS: After a 12-week therapy, IPSS, QOL score, Qmax and Qave were significantly improved. IPSS was averagely decreased by 5.67 (P < 0.001); QOL score was averagely decreased by 1.44 (P < 0.001); Qmax was averagely increased by 1.70 ml/s (P <0.001); Qave was averagely increased by 1.15 ml/s (P < 0.001); Ru was averagely decreased by 5.07 ml (P = 0.046) , PSA level was averagely decreased by 0.129 microg/L (P < 0.017). The clinical adverse event rate was 1%. CONCLUSION: Eviprostat is a kind of safe, effective and preferable drug for treating BPH. It can improve the subjective symptoms and objective measures of the patients.

Aged↗
PubMed1996

The use of the holmium laser in the treatment of benign prostatic hyperplasia.

The holmium wavelength (2.1 microns) can be used for incision, ablation, and resection of prostate tissue. Four different techniques for the surgical management of benign prostate hyperplasia (BPH) have evolved using the holmium laser either alone or in combination with Nd:YAG energy. The results in 650 patients undergoing these procedures are presented. The holmium laser has been used most recently to perform a transurethral resection of the prostate in 381 patients to date. This procedure appears to be the most efficient way of using the holmium laser for the removal of obstructing prostatic tissue.

Adult↗
PubMed1992

Validation of a symptoms questionnaire for benign prostatic hyperplasia.

We developed a questionnaire to assess the effect of finasteride on symptoms of benign prostatic hyperplasia (BPH) by modifying that of Boyarsky (1977). To validate the questionnaire, a cohort study was conducted in 2 groups of patients with BPH and 3 control groups without BPH. The BPH groups were: (1) 34 patients before TURP (transurethral resection of the prostate), average age 68 years; (2) 65 patients after TURP, average age 68 years; (3) 40 patients after other nonserious nonurological surgery, average age 50 years; (4) 14 healthy non-BPH volunteers, average age 58 years; and (5) 73 healthy non-BPH volunteers, average age 37 years. The questionnaire was administered once to all subjects, and a subset responded to a second administration. Mean total symptoms scores (TSS) from the initial questioning were 6.4, 3.2, 2.9, 2.6, and 1.6 for the 5 groups, respectively (pooled SD = 3.3); mean total troublesome symptoms scores (TTSS) were 4.8, 2.1, 1.4, 1.1, and 0.6, respectively (pooled SD = 2.2). All other groups were significantly less symptomatic and troubled than the pre-TURP group, and all surgical groups were significantly more so than the younger volunteer group. These data demonstrate the discriminant validity of the questionnaire. Corroborating prior data [Gregg et al., 1990], responsiveness was shown by the 3.7-point mean TSS improvement in response to TURP, which was significantly different from the near-zero changes in the other groups. Reproducibility was shown by kappa statistics being nearly all greater than 0.75 and an intraclass correlation coefficient of 0.64; construct validity and reliability were demonstrated by correlation (r = 0.7) with a general urination problems question; and internal consistency was documented by Cronbach's alpha values of approximately 0.6. We conclude that this questionnaire is a useful and validated tool for assessing BPH symptoms.

Evaluation Studies as Topic↗
PubMed2002

[The clinical efficacy of epristeride in the treatment of benign prostatic hyperplasia].

OBJECTIVES: To estimate the clinical safety, efficacy of Epristeride in the treatment of benign prostatic hyperplasia (BPH). METHODS: One hundred and fourty-one BPH patients, aged from 50 to 83 years old [(66.18 +/- 6.41) yr], were given Epristeride tablets 5 mg p.o., twice daily for 120 days. To synthetically estimate the efficacy by the changing rate of international prostate symptom score (IPSS), maximum flow rate (Qmax), the volume of prostate (V) and the residual urine (Ru). RESULTS: The total efficacy was 81.29%. The adverse reactions include 1 case (0.72%) of exanthem, 1 case (0.72%) of nausea and vomiting, 1 case (0.72%) of insomnia, 1 case (0.72%) of tinnitus and 3 cases (2.16%) of erectile dysfunction. Two patients discontinued the treatment due to the side effects (1.44%). There was no clinical significantly abnormal laboratory index during the treatment. CONCLUSIONS: Epristeride tablets was safe and effective in the treatment of BPH.

Aged↗
PubMed2004

Three-dimensional ultrasonography in evaluation of benign prostatic hyperplasia.

BACKGROUND: The clinical application of volume estimation by 3-D ultrasound has recently gained much attention. However, there have been no reports evaluating the prostate volume by 3-D transrectal ultrasound (TRUS) before transurethral resection of the prostate (TURP). The purpose of the present study was to evaluate the value of 3-D TRUS for prediction of prostate morphology and resected weight before TURP and to investigate whether 3-D TRUS is a more useful examination than 2D TRUS in patients with benign prostatic hyperplasia (BPH). METHODS: Transurethral resection of the prostate was performed in 23 patients with BPH. We evaluated the prostate morphology and measured both the volumes of the whole prostate and the transition zone using 2-D and 3-D TRUS, respectively. The actual resected weight was recorded and compared with the volume of the whole prostate and that of the transition zone measured by 2D and 3-D TRUS. RESULTS: The volume of the transition zone measured by 3-D TRUS correlated most strongly with the resected weight (r = 0.84). A large median lobe was seen in three patients in whom the transition zone volume measured by 2-D TRUS was considerably larger than the resected weight. However, overestimation in the three patients decreased by the use of 3-D TRUS. CONCLUSIONS: It was concluded that 3-D TRUS was equal or superior to 2-D TRUS in prediction of the resected weight and 3-D TRUS offers better information as a diagnostic tool before TURP.

Aged↗
PubMed2004

Molecular profiling of benign prostatic hyperplasia using a large scale real-time reverse transcriptase-polymerase chain reaction approach.

PURPOSE: Benign prostatic hyperplasia (BPH) is characterized by a hyperplastic growth of epithelial and stromal cells in the prostate. Despite the high prevalence of the disease little is known regarding the molecular etiology of BPH. Therefore, a comparison of gene expression patterns between normal prostate, BPH and prostate cancer could provide insights into the pathogenic mechanisms of the disease and identify candidate genes that could be targeted for therapeutic use. MATERIALS AND METHODS: Prostate tissue specimen were obtained from 30 patients undergoing adenomectomy for BPH. Adenoma weight was less than 60 gm in 15 patients and more than 60 gm in the remainder. Normal prostate tissue was obtained from 15 patients undergoing radical prostatectomy for cancer from areas selected for absent tumor and BPH. Two pools of organ confined prostate cancer were also analyzed. We quantified in the 5 pools of tissues the expression of 327 genes using real-time quantitative reverse transcriptase-polymerase chain reaction. RESULTS: A total of 23 genes showed increased expression in BPH with a fold change of at least 2.5 between normal prostate and the 2 BPH groups, of which most were normal or down-regulated in prostate cancer. Seven genes showed decreased expression in BPH with a fold change of at least 3.5 between normal prostate and BPH. Most of them were also normal or down-regulated in prostate cancer. CONCLUSIONS: We identified a set of genes up-regulated in BPH compared to normal prostate tissue and often prostate cancer, including genes previously implicated in BPH and others not previously linked to this disease to our knowledge. Further investigations are now warranted to determine the clinical relevance and therapeutic potential of these genes.

Aged↗
PubMed2002

Evidence for activation of the renin-angiotensin system in the human prostate: increased angiotensin II and reduced AT(1) receptor expression in benign prostatic hyperplasia.

The expression and cellular localization of angiotensin II (Ang II) and AT(1) receptor proteins were examined in the normal human prostate and benign prostatic hyperplasia (BPH) by immunohistochemistry. In the normal prostate, Ang II immunoreactivity was localized to the basal layer of the epithelium and AT(1) receptor immunostaining was found predominantly on stromal smooth muscle and also on vascular smooth muscle of prostatic blood vessels. Ang II immunoreactivity was markedly increased in hyperplastic acini in BPH compared with acini in the normal prostate (normal: 7.4+/-0.2%, n=5 vs. BPH: 22.7+/-1.9%, n=5, p<0.001). However, AT(1) receptor immunoreactivity was significantly decreased in BPH compared with the normal prostate [normal: 16.4+/-2.2%, n=4 vs. BPH: 9.4+/-1.3%, n=5, p<0.05 (p=0.025)]. The present study demonstrates the presence of Ang II peptide in the basal layer of the epithelium and AT(1) receptors on stromal smooth muscle, suggesting that Ang II may mediate paracrine functions on cellular growth and smooth muscle tone in the human prostate. Furthermore, AT(1) receptor down-regulation in BPH may be due to receptor hyperstimulation by increased local levels of Ang II in BPH. These data extend previous findings in support of the novel concept that overactivity of the renin-angiotensin system (RAS) may be involved in the pathophysiology of BPH.

Angiotensin I↗