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PubMed2003

Nocturia and benign prostatic hyperplasia.

OBJECTIVES: To examine the frequency of and risk factors for nocturia in patients with symptomatic benign prostatic hyperplasia (BPH), and the degree of improvement of nocturia after treatment for BPH. METHODS: A total of 505 consecutively selected, newly diagnosed patients with symptomatic BPH were evaluated in studies examining frequency of and risk factors for nocturia. We analyzed the relationships between nocturia assessed by International Prostate Symptom Score (IPSS) and other parameters, including age, prostate volume, serum prostate-specific antigen level, and uroflow variables. Other studies examining the impact of conservative and invasive treatments on nocturia were also conducted using 165 patients receiving tamsulosin and 138 undergoing transurethral resection of the prostate (TURP). RESULTS: Overall, 359 of the 505 patients (71.1%) answered that they arose at least twice for urination at night. Patient age, score of urgency, and functional bladder capacity were each significantly associated with nocturia. Tamsulosin therapy and TURP significantly reduced the number of episodes of nocturia in 17.9% and 32.2% of patients, respectively. These rates of improvement were lowest for nocturia among the seven individual symptom scores. CONCLUSIONS: In this study using selected cohorts, the frequency of nocturia in patients with BPH was higher than that in community-based studies. Although we cannot estimate patients' satisfaction by the observed changes in scores, the rates of improvement were lowest for nocturia among the seven symptoms of IPSS after conservative and invasive treatments for BPH.

Adrenergic alpha-Antagonists↗
PubMed1999

Transurethral resection of benign prostatic hyperplasia using a vaporizing resecting loop, UROloop.

New electrosurgical instruments for the treatment of benign prostatic hyperplasia (BPH) have been developed during the past few years. We determined the efficacy and safety of transurethral prostatectomy (TUR-P) using a new electrosurgical device (UROloop) for the treatment of BPH. Twenty-four patients, with a mean age of 67.7 years, with BPH underwent TUR-P using the UROloop between April 1996 and March 1997. We evaluated the pre- and postoperative symptom scores and urodynamic parameters of the patients. The International Prostate Symptom Score (IPSS) was used for symptom scoring. The urodynamic parameters included peakflow rates (PFR) and postvoid residual urine (PVR). The average preoperative IPSS score for all patients was 15.4 +/- 1.4. The IPSS score was significantly improved to 4.3 +/- 0.24 at 12 weeks after the TUR-P (p = 0.0002). The average PFR was increased by 117% at 12 weeks postoperatively. The average preoperative PVR of 65.4 ml was reduced to 15.2 ml postoperatively. The changes in the urodynamic parameters were statistically significant. No severe complications were observed in the present study. The changes in the serum sodium and hemoglobin levels were small. This study revealed significantly sustained clinical improvement with minimal morbidity. The results of the present study also confirmed the usefulness of the new endoscopic treatment for BPH.

Aged↗
PubMed2000

Increased risk of prostate cancer and benign prostatic hyperplasia associated with a CYP17 gene polymorphism with a gene dosage effect.

The CYP17 gene (CYP17) codes for the cytochrome P450c17alpha enzyme, which mediates two key steps in the sex steroid synthesis. There is a polymorphism (a T-to-C substitution) in the 5'-untranslated region, which may influence the transcription level of CYP17 mRNA. There is a continuing controversy as to whether the variant allele is associated with a subset of breast cancer or polycystic ovary syndrome. In prostate cancer research, there are contradictory data concerning the CYP17 risk allele. We explored the association between CYP17 polymorphism and a risk of prostate cancer or benign prostatic hyperplasia (BPH) in a Japanese population. This study included 252 prostate cancer patients, 202 BPH patients, and 131 male controls. A 451-bp fragment encompassing the polymorphic site was amplified by PCR, treated with restriction enzyme MspA1, and electrophoresed on an agarose gel. The MspA1-undigested allele with the published sequence and the MspA1-digested variant allele were designated as A1 and A2, respectively. There was a significant difference (P < 0.05) in the genotypes between prostate cancer patients and male controls, and between BPH patients and male controls. Men with the A1/A1 CYP17 genotype had an increased risk of prostate cancer [odds ratio (OR), 2.57; 95% confidence interval (CI) = 1.39-4.78] and BPH (OR, 2.44; 95% CI = 1.26-4.72) compared with those with the A2/A2 genotype. Men with the A1/A2 genotype had an intermediate increased risk of prostate cancer (OR, 1.45; 95% CI = 0.84-2.54) and BPH (OR, 1.60; 95% CI = 0.89-2.87) compared with those with the A2/A2 genotype. The trend of an increasing risk of prostate cancer and BPH with an increasing number of the A1 allele was statistically significant (prostate cancer versus male control, P = 0.003; OR, 1.57; 95% CI = 1.16-2.12; BPH versus male control, P = 0.008; OR, 1.55; 95% CI = 1.12-2.13). There was no significant association between the CYP17 genotype and the tumor status (grade and stage) of prostate cancer. Our results suggest that the A1 allele of the CYP17 polymorphism is associated with an increased risk of prostate cancer and BPH, with a gene dosage effect. However, the CYP17 genotype does not seem to influence the disease status in prostate cancer.

Aged↗
PubMed2005

[Effect of hypertension on cell proliferation and apoptosis in benign prostatic hyperplasia].

OBJECTIVE: To evaluate the effect of hypertension on cell proliferation and apoptosis in benign prostatic hyperplasia (BPH). METHODS: The techniques of immunohistochemistry and terminal deoxynucleotidyl transferase-mediated dUTP biotin nick end labeling(TUNEL) were used to detect the proliferative index (PI) and apoptotic index (AI) in both epithelium and stroma of simple BPH (40 cases) and BPH with hypertension (40 cases), respectively. RESULTS: In both the groups of simple BPH and BPH with hypertension, the value of PI was significantly higher than that of AI in epithelium and stroma (P < 0.05), and PI was closely related to the prostate volume (P < 0.05). As compared with the simple BPH group, PI was significantly increased in epithelium and stroma in the group of BPH with hypertension( P < 0.05), in which the disease history of hypertension was positively associated with PI in epithelium and stroma (p < 0.05). CONCLUSION: Hypertension, particularly persistent hypertension state, may enhance cell proliferation in both epithelium and stroma of BPH, and consequently lead to the enlargement of the prostate.

Aged↗
PubMed1991

[Transrectal hyperthermia for benign prostatic hyperplasia].

The PRIMUS system was designed as a dedicated microwave hyperthermia system for treatment of benign prostatic hyperplasia (BPH). Completed cases were 36 patients. Hyperthermia was subjectively effective in 31 patients (86%), but no appreciable changes were noted with regard to the size of the prostate. Side effects occurred in 10 of the evaluable 49 cases (20%). However, no severe side effects were recognized except in one case. The effective ratio revealed 25 of 36 cases (69%). Therefore, transrectal prostatic hyperthermia would be a useful method especially in cases of BPH with severe complications.

Aged↗
PubMed2002

Clinical characteristics of alpha-blocker responders in men with benign prostatic hyperplasia.

BACKGROUND: Currently, alpha-blocker is becoming first-line drug therapy for benign prostatic hyperplasia (BPH). Although highly effective results are obtained with this therapy, a difference between the objective and subjective response rates is reported. To prevent unnecessary medical treatment and to predict the alpha-blocker response, we characterized the clinical features of alpha-blocker responders in men with BPH. METHODS: Twenty-two men were consecutively enrolled in this study and received tamsulosin 0.2 mg once daily for 4-6 weeks. The primary measures of efficacy were maximum urinary flow rate (Q(max)) determined from the flow measurements and international prostate symptom score (IPSS). Those with an increase in Q(max) of > or = 30% from baseline and a decrease in IPSS of > or = 25% from baseline were defined as Q(max) responders and IPSS responders, respectively. Clinical findings such as age, pretreatment IPSS and Q(max), serum prostate-specific antigen (PSA), total prostate volume, transition zone (TZ) volume, TZ index and T(2)-weighted magnetic resonance image (MRI) of the prostate TZ were compared between responders and non-responders for both criteria. RESULTS: In 17 of 22 (77.2%) patients IPSS improved by > or = 25%. In 9 of 22 (40.9%) patients Q(max) improved by > or = 30%. There were no differences in clinical findings between IPSS responders and non-responders. On the contrary, Q(max) responders showed smaller total prostate and TZ volumes, a smaller TZ index and a lower intensity of the TZ in MRI than Q(max) non-responders. CONCLUSIONS: Determination of the prostate volume and MRI findings of the inner prostate gland were useful in predicting Q(max) responders to the alpha-blocker in men with BPH. In contrast, there were no clinical characteristics of the IPSS responders. IPSS responders without a Q(max) response should be closely followed while continuing the alpha-blocker therapy for a long duration.

Adrenergic alpha-Antagonists↗
PubMed1996

A comparative study of laser ablation and transurethral electroresection for benign prostatic hyperplasia: results of a 6-month follow-up.

OBJECTIVE: To compare the efficacy of standard transurethral electroresection of the prostate (TURP) and visual laser ablation in the treatment of benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: In a randomized prospective study, the prostate glands of 60 patients with symptomatic bladder outlet obstruction caused by BPH were treated with TURP or visual ablation with the Ultraline side-firing Nd:YAG laser; the patients were assessed using standard symptom scores, the measurement of residual urine and uroflowmetry both before and at 3 and 6 months after treatment. RESULTS: All patients in both treatment groups had a significant improvement in symptoms and objective measures of voiding. The laser treatment gave significantly better improvements in symptom score than did TURP (P = 0.034), but TURP produced significantly better peak urinary flow rates (P = 0.025). CONCLUSION: These early results indicate that laser ablation of BPH may be a good alternative in the surgical treatment of this disease.

Aged↗
PubMed2004

[A pilot study of photon therapy for benign prostate hyperplasia (a report of 30 cases)].

OBJECTIVE: To investigate the clinical efficacy and safety of photon therapy for benign prostate hyperplasia (BPH). METHODS: Thirty patients with severe BPH received brachytherapy of prostate photon treatment system irradiation for one month, with the active area of the applicator located in the rectum, and at a dosage of 726-810 cGy. International prostate symptom score (IPSS), quality of life (QOL), volume of prostate gland, maximum flow rate (Qmax), and residual urine were evaluated before and after the treatment. RESULTS: After one-month treatment, 18 cases remarkably improved, 9 slightly improved and 3 had no response. There was significant improvement in IPSS, QOL, volume of prostate gland, Qmax and residual urine (P<0.01, except Qmax P = 0.038). CONCLUSION: Prostate photon treatment system can be used as a safe, effective, micro-invasive, convenient and economical therapy for severe BPH, especially applicable to older and weaker patients.

Aged↗
PubMed1995

Three-dimensional sonographic guidance for interstitial laser therapy in benign prostatic hyperplasia.

In recent years, interstitial laser therapy was introduced to provide a new treatment of benign prostatic hyperplasia (BPH). However, the precise positioning of the laser fibers has remained a major unsettled issue. Three-dimensional (3-D) transrectal ultrasound scanning permits precise differentiation of the prostatic zones, in particular the transition zone, which is enlarged in BPH. Initially, a volume scan of the prostate is obtained. On the monitor, three sections of the prostate in the coronal, sagittal, and horizontal planes are displayed simultaneously. This new 3-D technology enables precise and reproducible positioning of the laser fibers at any selected site in the adenoma under sonographic guidance, thus providing the basis for complete laser prostatectomy. Placement of the laser fibers proved to be precise, quick, and uncomplicated.

Humans↗
PubMed1992

Effects of the new steroidal antiandrogen TZP-4238 on hormone-induced canine prostatic hyperplasia.

The effects of the new steroidal antiandrogen TZP-4238 on hormone-induced canine prostatic hyperplasia (BPH) were studied in comparison with those of chlormadinone acetate (CMA), a steroidal antiandrogen used in Japan. One- to 2-year-old beagle dogs were castrated and administered 75 mg/week of androstanediol (A-diol) plus 0.75 mg/week of estradiol (E2) for 25 weeks. These dogs were treated orally with placebo, 0.5 mg/kg/day of TZP-4238, 0.1 mg/kg/day of TZP-4238, and 2.5 mg/kg/day of CMA, respectively, for 21 weeks after 4 weeks treatment with A-diol plus E2. Treatment with 0.5 mg/kg/day of TZP-4238 or 2.5 mg/kg/day of CMA suppressed prostatic growth, and treatment with 0.1 mg/kg/day of TZP-4238 suppressed prostatic growth slightly. Treatment with 0.5 mg/kg/day of TZP-4238 decreased 5 alpha-reductase activity, DHT content, and nuclear androgen receptor (AR) content in the prostate, and treatment with 0.1 mg/kg/day of TZP-4238 or 2.5 mg/kg/day of CMA also decreased or tended to decrease these parameters. In conclusion, TZP-4238 and CMA were effective in inhibiting the growth of hormone-induced canine BPH, and TZP-4238 was at least 5 times more potent than CMA. TZP-4238 inhibited prostatic growth by decreasing prostatic androgen content and the androgen-AR complex. TZP-4238 decreased 5 alpha-reductase activity by prevention of the androgen action described above.

Androstane-3,17-diol↗
PubMed2005

Lasers for lower urinary tract symptoms secondary to benign prostatic hyperplasia: when is the fuss worth it?

In the recent past, several endoscopic procedures using laser technology have evolved for the treatment of benign prostatic hyperplasia. The term "laser treatment of the prostate" comprises a variety of different application systems, different laser wavelengths, and different surgical techniques to eliminate bladder outlet obstruction. The aim of laser prostatectomy is to be less invasive than transurethral electroresection, but equally effective. Promising short-term results led to a booming laser decade in the 1990s, stimulating the development of several devices. However, the emergence of medium-term data has shown that some of these techniques did not stand the test of time due to the lack of long-term efficacy, unacceptable morbidity, and high retreatment rates. Nevertheless, the results of transurethral resection of the prostate are challenged by some of the newer laser devices, putting the so-called "gold standard" into question.

Humans↗
PubMed1994

Volume determinations of the whole prostate and of adenomas by transrectal ultrasound in patients with clinically benign prostatic hyperplasia: correlation of resected weight, blood loss and duration of operation.

OBJECTIVE: To study whether transrectal ultrasound (TRUS) volume determinations of the whole prostate and of the adenomas alone correlate to resected weight, operation time and blood loss in patients operated upon with transurethral resection of the prostate because of presumed benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: The whole prostate and the transition zone, which corresponds to the adenomas, were measured separately in 159 patients with presumed BPH, pre-operatively and 4 months post-operatively. RESULTS: The transition zone volume correlated well with the resected weight (r = 0.91; P < 0.0001), the blood loss (r = 0.67; P < 0.0001) and the operation time (r = 0.67; P < 0.0001). Four months post-operatively a reduction of the total prostate volume was recorded which corresponded well with the resected weight (r = 0.91; P < 0.0001). CONCLUSION: TRUS with high resolution 7 MHz probes successfully estimated the size of the whole prostate and that of the adenomas alone. The transition zone volume predicted the expected resection weight of adenomas and to some extent the duration of the operation and the blood loss. These calculations may be used for more accurate pre-operative planning. Together with its superior detection rate for prostate cancer, TRUS seems to be a powerful tool in the pre-operative morphological assessment of patients with prostatism.

Aged↗
PubMed2001

Natural history of benign prostatic hyperplasia.

Studies in varied settings have provided estimates of the prevalence of surrogate markers of benign prostatic hyperplasia (BPH). In population-based studies, the prevalence of moderate-to-severe lower urinary tract symptoms and depressed peak urinary flow rates increases across successively older age groups. Prostatic volume follows a similar pattern. Unlike clinic-based studies in which correlations are almost nonexistent, the population-based studies demonstrate a modest correlation among lower urinary tract symptoms, peak urinary flow rates, and prostatic volume. These cross-sectional observations extend to serum prostate-specific antigen levels and postvoid residual urine volumes. Data collected during the longitudinal follow-up study of men participating in the Olmsted County Study of Urinary Symptoms and Health Status Among Men provide a more detailed description of the natural history of changes in these surrogate markers of BPH. They also provide insights into their relation with each other and with long-term outcomes of BPH, such as acute urinary retention and treatment of BPH. These data demonstrate the progressive nature of BPH and are useful for the design and interpretation of clinical trials. Furthermore, they suggest that observational studies of etiology and prognosis should take advantage of the spectrum of disease reflected by the full range of values of these quantitative traits, rather than an arbitrary dichotomized outcome.

Age Factors↗
PubMed1993

[Antiestrogens (tamoxifen) in the alternative therapy of benign prostatic hyperplasia].

In a non-randomized study the authors administered Tamoxifen to 17 patients with benign prostate hyperplasia who met the criteria for administration of the drug. In the group of patients no significant change of symptoms according to Goldenberg's score was recorded nor changes of prostate size and postmiction residues. In uroflowmetry the significant change of values of maximum flow (p < 0.05) was not associated with a change in the mean flow. The authors assume that monotherapy with Tamoxifen is not effective enough and recommended administration of antioestrogen only in combination with other drugs.

Aged↗
PubMed2006

Under what conditions is feedback microwave thermotherapy (ProstaLund Feedback Treatment) cost-effective in comparison with alpha-blockade in the treatment of benign prostatic hyperplasia and lower urinary tract symptoms?

OBJECTIVE: Lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) are a common condition in men, and their incidence increases with age. The objective of this study was to evaluate the potential cost-utility of microwave thermotherapy, specifically the ProstaLund Feedback Treatment (PLFT), versus alpha-blockade in Swedish patients with LUTS due to BPH. MATERIAL AND METHODS: A health-economic simulation model, based on long-term disease progression and costs, was developed to analyse the cost-utility of PLFT in comparison with alpha-blockade over a 3-year period based on data from published literature, treatment programmes and official price lists. Outcome measures used in the analysis were quality of life, survival and reduction in International Prostate Symptom Score. Sensitivity analyses were performed for a number of essential variables. The perspective of the study is the healthcare sector. All costs are expressed as 2003 prices. RESULTS: Three years after an intervention with PLFT or initiation of drug treatment the cost-utility of PLFT was estimated at approximately euro 6600-9500 per quality-adjusted life-year gained. The cost-utility was further improved over a longer time period, and PLFT appears to be cost-saving after 5 years. One important finding from the model simulation was that PLFT also seems to be favourable in patients with less pronounced symptoms. This result may be further validated when additional results from controlled clinical trials become available. CONCLUSIONS: The present model simulation indicates that treatment with PLFT seems to be cost-effective compared with drug therapy with alpha-blockade. The result shows that the time-frame of the analysis has a great impact on the cost-effectiveness ratio.

Adrenergic alpha-Antagonists↗