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PubMed2003

Identification of a prostate-specific membrane antigen-derived peptide capable of eliciting both cellular and humoral immune responses in HLA-A24+ prostate cancer patients.

We tried to identify prostate-specific membrane antigen (PSMA)-derived peptides capable of eliciting both cellular and humoral immune responses in peripheral blood mononuclear cells (PBMCs) and plasma of HLA-A24(+) prostate cancer patients, respectively. For cellular response, peptide-specific and prostate cancer-reactive responses of in vitro-stimulated PBMCs were examined with regard to interferon (IFN)-gamma production and cytotoxicity against both a parental HLA-A24(-) prostate cancer cell line (PC-93) and an HLA-A24-expressing transfectant cell line (PC93-A24). For humoral response, patients' plasma was tested for reactivity to the peptides by means of an enzyme-linked immunosorbent assay (ELISA). Among 13 PSMA peptides, PSMA 624-632 peptide induced peptide-specific and tumor-reactive cytotoxic T lymphocytes (CTLs) most effectively. The PSMA 624-632 peptide-stimulated PBMCs from either healthy donors or prostate cancer patients produced a significant level of IFN-gamma in response to prostate cancer cells in an HLA-A24-restricted manner, and also showed a higher level of cytotoxicity against PC93-A24 than against PC93. Antibodies to the PSMA 624-632 peptide, but not to any others, were detected in prostate cancer patients. These results demonstrate that the PSMA 624-632 peptide could be an appropriate molecule for use in specific immunotherapy of HLA-A24(+) patients with prostate cancer.

Amino Acid Sequence↗
PubMed2005

Decreased annexin I expression in prostatic adenocarcinoma and in high-grade prostatic intraepithelial neoplasia.

AIMS: To analyse annexin I expression in prostatic carcinoma. Annexin I belongs to a family of structurally related calcium and phospholipid-binding proteins implicated in signal transduction, DNA replication, cell proliferation and apoptosis. The decreased expression of annexin I, II and VII proteins has been reported in different types of cancer. METHODS AND RESULTS: Using immunohistochemistry, we analysed annexin I expression in 77 cases of prostatic adenocarcinoma (Gleason score 6, N = 40; Gleason scores 7-8, N = 27; and Gleason scores 9-10, N = 10) and high-grade prostatic intraepithelial neoplasia (PIN, N = 50). Immunoreactivity of annexin I in tumour cells was evaluated as negative (< 5% of cells), focally positive (5-25% of cells) or positive (> 25% of cells). In contrast to positive staining in adjacent benign prostatic epithelium, annexin I expression was decreased (focally positive) in 76% of cases of high-grade PIN (P < 0.0001) and was decreased or absent in 81% of prostatic adenocarcinomas (P < 0.0001). Annexin I expression in all higher grade tumours (Gleason scores 7-10) was only focally positive or absent. CONCLUSIONS: Expression of annexin I inversely correlates with the increasing histological grade of prostatic adenocarcinoma. By showing a progressive loss of annexin I expression in high-grade PIN, intermediate-grade and high-grade cancer, our findings suggest that the loss of annexin I expression occurs early in prostatic tumorigenesis and becomes more prominent throughout tumour progression. The loss of expression of annexin I may serve as a useful marker of prostate cancer development and progression.

Adenocarcinoma↗
PubMed2006

Evaluation of a prostate biopsy strategy for cancer detection using a computer simulation system with virtual needle biopsy for three-dimensional prostate models.

AIM: We evaluated a prostate biopsy strategy for cancer detection using a computer simulation system with virtual needle biopsy for three-dimensional (3D) prostate models. METHODS: Two 3D prostate models with a volume of 25 cc or 50 cc were constructed from computed tomographic images of radical prostatectomy specimens. The peripheral zone (PZ) and transition zone (TZ) were arranged in the prostate models according to the anatomical information. Four thousand patterns of cancer lesions were automatically inserted into each prostate model with a proportion of 75% in PZ and 25% in TZ. Average hit rates (AHR) in prostate models were evaluated both with an increased number of biopsy cores and various angles of virtual needle biopsy. The influence of adding secondary tumors for hit rates was also evaluated. RESULTS: For both sizes, the laterally angled biopsy in 4-8 core biopsy schemes showed higher AHR than the vertical plane biopsy, while the vertical plane biopsy in 10-18 core biopsy schemes showed higher AHR than the laterally angled biopsy. A higher number of biopsy cores increased the AHR of secondary tumors. CONCLUSIONS: Our results suggest that it is important in prostate cancer detection to change the needle placement according to the number of biopsy cores and the size of the prostate.

Biopsy, Needle↗
PubMed1995

Changes in prostatic thickness and the location of ejaculatory ducts in autopsy prostates.

OBJECTIVE: To measure prostatic thickness and the depth of ejaculatory ducts from the urethral surface to prevent ejaculatory duct damage during transurethral balloon laser thermotherapy. MATERIALS AND METHODS: In 47 prostates obtained at autopsy, the prostatic thickness and the depth of ejaculatory ducts from the urethral surface were measured in eight directions from the centre of the urethra. RESULTS: The depth of ejaculatory ducts was approximately 6 mm from the urethral surface regardless of prostatic weight. Increase in prostatic weight was associated with increase in the thickness in all directions except the posterior one; the thickness ranged from 9 to 20 mm. The posterior thickness at the level of the transition zone was 10 mm regardless of prostatic weight. CONCLUSION: When benign prostatic hypertrophy is treated transurethrally, using laser or microwave equipment, care should be taken to avoid heating the posterior region of the prostate.

Adult↗
PubMed2006

Holmium laser enucleation of the prostate for prostates of >125 mL.

OBJECTIVE: To examine a group of patients treated with holmium laser enucleation of the prostate (HoLEP) and with the bladder outlet obstructed by an exceptionally large (>125 mL) prostate, as such men are often not considered candidates for endoscopic treatments and historically have required open surgery. PATIENTS AND METHODS: We analysed retrospectively all patients with prostates of > 125 mL on transrectal ultrasonography (TRUS) who underwent HoLEP between January 2000 and January 2005. RESULTS: Eighty-six patients were identified; their mean (range) age was 72.6 (48-90) years and prostate volume 170.2 (125-309) mL. Their mean preoperative prostate-specific antigen (PSA) level was 9.82 ng/mL and preoperative American Urologic Association symptom score (AUA-SS) was 19.6. The mean operative duration and hospital stay were 128.1 min and 26.1 h, respectively. The mean weight of tissue enucleated was 140.2 g. At the 1-month follow-up the mean AUA-SS (63 men) was 8.4 and at 6 months (35 men) it was 6.4. The mean serum PSA level in 48 patients was 0.96 ng/mL, a reduction of 90%. TRUS measurements in 20 patients gave a mean prostate volume of 30.8 mL, a reduction of 82%. At the 1-year follow-up the mean AUA-SS of 22 patients was 5.1. CONCLUSIONS: The present report details the largest series of patients, with the largest mean prostate size, treated by any endoscopic surgical method. HoLEP may be the ideal treatment for men with prostates of > 125 mL with symptoms of bladder outlet obstruction.

Aged↗
PubMed2004

Sequence variants of toll-like receptor 4 are associated with prostate cancer risk: results from the CAncer Prostate in Sweden Study.

Inflammation has been implicated as an etiological factor in several human cancers. Growing evidence suggests that chronic inflammation may also play a role in the etiology of prostate cancer. Considering that genetic susceptibility is a major risk factor for this disease, we hypothesize that sequence variants in genes that regulate inflammation may modify individual susceptibility to prostate cancer. The lipopolysaccharide receptor Toll-like receptor 4 (TLR4) is a central player in the signaling pathways of the innate immune response to infection by Gram-negative bacteria and is an important candidate inflammatory gene. We performed a systematic genetic analysis of TLR4 sequence variants by evaluating eight single-nucleotide polymorphisms that span the entire gene among 1383 newly diagnosed prostate cancer patients and 780 age- and residence-matched controls in Sweden. We found an association between a sequence variant (11381G/C) in the 3'-untranslated region of the TLR4 gene and prostate cancer risk. The frequency of the variant genotypes (CG or CC) was significantly higher in the patients (24.1%) than in the controls (19.7%; P = 0.02). The frequency of risk genotypes among patients diagnosed before the age of 65 years was even higher (26.3%). Compared with men who had the wild-type genotype of this single-nucleotide polymorphism (GG), those with GC or CC genotypes had a 26% increased risk for prostate cancer (odds ratio, 1.26; 95% confidence interval, 1.01-1.57) and 39% increased risk increased risk for early onset prostate cancer (before age 65 years; odds ratio, 1.39; 95% confidence interval, 1.02-1.91). The risk attributable to this variant for prostate cancer in Sweden was estimated to be 4.9%. Although the biological mechanism of the observed association remains to be elucidated, our finding supports a role for a bacteria-associated response pathway, possibly acting via inflammation, in the development of prostate cancer.

3' Untranslated Regions↗
PubMed2006

2-Methoxyestradiol inhibits prostate tumor development in transgenic adenocarcinoma of mouse prostate: role of tumor necrosis factor-alpha-stimulated gene 6.

PURPOSE: 2-Methoxyestradiol, an estrogenic metabolite, is in clinical trials for the treatment of hormone-refractory prostate cancer. However, neither the chemopreventive role nor the mechanism of 2-methoxyestradiol-induced biological activities is fully understood. EXPERIMENTAL DESIGN: Eight- and 24-week-old transgenic adenocarcinoma of mouse prostate (TRAMP) mice were fed a diet containing 50 mg 2-methoxyestradiol/kg body weight for 16 and 8 weeks, respectively. Chemopreventive efficacy was evaluated by magnetic resonance imaging, determining the prostate-seminal vesicle complex volume and histologic analysis of prostate tumor or tissue. Tumor invasion assays were used to show the role of tumor necrosis factor-alpha-stimulated gene (TSG-6), a 2-methoxyestradiol-up-regulated gene identified by DNA array analysis. Expression of TSG-6 was analyzed in a human tissue array containing different grades of prostate tumors. RESULTS: Dietary administration of 2-methoxyestradiol prevented the development of preneoplastic lesions independent of progression stage. TSG-6 was low or undetectable in prostate cancer cells (LNCaP, PC-3, and DU145) and TRAMP tumors but up-regulated in response to 2-methoxyestradiol. Immunohistochemistry of the human prostate tumor array showed a decrease in TSG-6-positive cells with increasing grade relative to normal prostate (P = 0.0001). Although overexpression of TSG-6 inhibited invasion of androgen-independent cells (P = 0.007), antisense TSG-6 reversed this effect. CONCLUSIONS: To the best of our knowledge, this is the first report showing the potential of 2-methoxyestradiol as a chemopreventive agent. We have also identified TSG-6 as a potential marker that could be used for early diagnosis and prognosis of cancerous or precancerous lesions.

2-Methoxyestradiol↗
PubMed1998

IL-1ra versus IL-1 levels in prostatic fluid from prostatitis patients.

Recent papers reported that the balance between the production of IL-1ra and IL-1 probably influences the regulation of host responses, the severity and prolongation of the inflammatory reaction in some diseases. Therefore, in our continuing investigation to clarify the significance of leukocytosis and its prolongation in prostatic fluid from prostatitis patients, we investigated whether low levels of IL-1ra versus IL-1 beta secreted in prostatic fluid were the cause of prolonged prostatitis, especially nonbacterial prostatitis (NBP). As a result of the present study, we concluded that a low level of IL-1ra in relation to that of IL-1 secreted in prostatic fluid is unlikely to cause prolongation of NBP for the following reasons: (1) IL-1 beta was detected in 5 of 10 cases (50.0%), but was slightly elevated in only 2 cases (20.0%) at 14 and 17 pg/ml; (2) the average IL-1ra level was not statistically low compared with that in prostatic fluid from acute bacterial prostatitis (ABP) patients who were cured promptly with antibiotics, and (3) in 5 cases of NBP in which IL-1 beta was detected, the average IL-1ra/IL-1 beta ratio was 118 which was comparable to or even higher than that in 3 ABP and 14 acute bacterial cystitis cases in which IL-1 beta was detected and the ratios were 40 and 88, respectively.

Adult↗
PubMed2005

Can we prevent prostate cancer? Rationale and current status of prostate cancer chemoprevention.

Prostate cancer has been one of the most frequent cancers among men in Western countries for the past decade. Investigation of prostate cancer prevention is very attractive, because prostate cancer has a high incidence, long-term natural history, regional difference in incidence, and is effected by sex steroids. Chemoprevention is defined as the use of specific agents to suppress or reverse carcinogenesis and to prevent the development of cancer. The development of chemoprevention strategies against prostate cancer would be of medical and economic importance. Basic and clinical research of chemoprevention of prostate cancer are under active investigation. This article aims to summarize and review the basic evidence and clinical trials on prostate cancer chemoprevention. Recent research has demonstrated that many agents, such as agents altering sex steroid signaling, drugs inducing antiproliferation/differentiation, retinoids, anti-inflammatory drugs, and antioxidants, could be potential preventatives for prostate cancer. Large-scale clinical trials have suggested that 5alpha-reductase inhibitor finasteride, selenium, and vitamin E can function as a chemopreventive agent. Although no definitely effective strategies of prostate cancer prevention have been identified yet, increasing evidence will provide effective and safe strategies that bring clinical benefits.

Anticarcinogenic Agents↗
PubMed2006

Larger prostate causes higher frequency of infectious complications in prostate biopsy.

INTRODUCTION: Prostate biopsy (PBX) is being performed more often than ever before for the early detection of prostate cancer, but some patients may have febrile infectious complications after biopsy. The risk factors of infectious complications need to be considered. METHODS: We investigated the pre-biopsy risk factors and febrile infectious complications in 120 patients who underwent PBX in our institution. The pre-biopsy risk factors set were prostate volume (> or = 40 ml), transitional zone (TZ) volume (> or = 20 ml), core number of biopsy (> or = 10 cores), and additional performance of TZ biopsy. We analyzed statistically the correlations between these risk factors and C-reactive protein and peripheral white blood cell (WBC) count elevation on day 1 and day 7 after biopsy. RESULTS: Our results showed that a prostate volume > or = 40 ml and a TZ volume > or = 20 ml caused a significantly higher elevation of the C-reactive protein level compared with a prostate volume < 40 ml (p = 0.0055 on day 1 and p = 0.0225 on day 7, respectively) on day 1 and day 7, and a TZ volume < 20 ml (p = 0.0008) on day 1. Regarding WBC count, those patients with a prostate volume > or = 40 ml and a TZ volume > or = 20 ml had a tendency to have an elevated WBC count on day 1 compared with those patients with a prostate volume < 40 ml and a TZ volume < 20 ml, and however these changes were not significant. CONCLUSIONS: This study showed that a larger prostate volume and a larger TZ volume may possibly be risk factors in infectious complications after PBX, although we can perform additional TZ biopsy and increase biopsy core number safely if necessary.

Aged↗
PubMed1996

Stromal development in the ventral prostate, anterior prostate and seminal vesicle of the rat.

The prostate and seminal vesicle (SV) are androgen-dependent secretory glands of the male genital tract. They produce the bulk of the seminal secretions. The object of the present study was to examine and document the ontogeny of stromal maturation in the rat anterior and ventral prostate and SV. These organs have a loosely organized cellular mesenchyme during fetal development. During prostatic development the mesenchyme condensed to form smooth muscle sheaths immediately surrounding the epithelium, with looser connective tissue between individual ducts. In the SV, a loose connective tissue layer called the lamina propria lies between the epithelium and developing muscle. Smooth muscle alpha-actin, myosin, desmin, laminin, vinculin, vimentin and androgen receptor (AR) expression were examined by immunocytochemical methods during the pre- and postnatal developmental periods. The first marker to be detected was vimentin, which was initially found throughout the mesenchyme. During development vimentin became mostly restricted to the interductal tissue of the prostate and the lamina propria of the SV. Smooth muscle markers were expressed in an orderly sequence in a proximal to distal manner along prostatic ducts, from the urethra towards the tips. Expression of alpha-actin was followed by vinculin, myosin, desmin, and laminin. These markers became localized to the developing smooth muscle sheaths and were not expressed in the interductal tissue of the prostate or the lamina propria of the SV. Organ culture experiments demonstrated that androgens were required for the differentiation of smooth muscle sheaths. Castration of adult rats demonstrated that androgens were required to maintain smooth muscle differentiation. In castrates, the stroma was relatively thicker but less dense than in intact animals. Following castration, expression of the smooth muscle markers was lost sequentially in the reverse order of their expression during development. In long-term castrates alpha-actin, vimentin and a small amount of vinculin were detected. AR were first detected in the urogenital sinus mesenchyme immediately surrounding the epithelium at 16 days of gestation. As development progressed expression of AR became more widespread, and postnatally was found throughout the mesenchyme. As maturation of smooth muscle occurred, stromal expression of AR became localized to the muscular sheath immediately surrounding the epithelium. In the prostate the interductal connective tissue displayed very low levels of AR expression. In the SV, AR were also observed in the lamina propria. In summary, stromal differentiation and dedifferentiation in the rat prostate and SV were found to be androgen-dependent processes with ordered sequential ontogenic expression of specific markers.

Actins↗
PubMed1989

Prostatic epithelial polyp of the prostatic urethra.

Ten cases of prostatic epithelial polyps of the prostatic urethra are reported. The ages of the patients were from 27 to 69 years, with a mean of 44 years. The most common clinical signs were gross hematuria, microhematuria, hematospermia, and dysuria. All specimens, obtained by transurethral resection, had a papillary or polypoid configuration. The tissue had a glandular structure that resembled that of the prostate. Prostate-specific antigen and prostatic acid phosphatase were found in the epithelial cells of the polyps by indirect immunoperoxidase staining. The polyps seemed to be hyperplasia of prostate-specific antigen and prostatic acid phosphatase-positive epithelial cells of the prostatic gland or duct, especially that of the latter.

Adult↗
PubMed1991

Establishment and characterization of a human prostatic carcinoma cell strain obtained from exfoliated tumor cells after prostatic massage.

During a control campaign connected to our main program on early diagnosis of prostatic carcinoma through tissue culture of prostatic fluid samples obtained after prostatic massage (M. Bologna et al., Eur. Urol., 14, 474-476, 1988), we isolated and characterized a human prostatic carcinoma cell strain from a 58-year-old patient with a grade III prostatic carcinoma. The epithelial cell strain, named PMU-23, has been passaged in vitro for 31 subculture cycles during a period of approximately 8 months, after which cell proliferation slowed down irreversibly. The isolation of this cell strain constitutes a renewed confirmation of the validity of our method for the early diagnosis of prostatic carcinoma and demonstrates some intermediate features in the progression of prostatic tumors. In addition, the study of limited-lifespan tumor cell strains in culture may extend the knowledge on prostatic cell biology, particularly toward the identification of intermediate steps of tumor progression, for a better approach of tumor therapy and prevention of metastatic spread.

Cell Division↗
PubMed1997

Family history of prostate cancer in patients with localized prostate cancer: an independent predictor of treatment outcome.

PURPOSE: To determine if familial prostate cancer patients have a less favorable prognosis than patients with sporadic prostate cancer after treatment for localized disease with either radiotherapy (RT) or radical prostatectomy (RP). PATIENTS AND METHODS: One thousand thirty-eight patients treated with either RT (n = 583) or RP (n = 455) were included in this analysis. These patients were noted as having a positive family history if they confirmed the diagnosis of prostate cancer in a first-degree relative. The outcome of interest was biochemical relapse-free survival (bRFS). We used proportional hazards to analyze the effect of the presence of family history and other potential confounding variables (ie, age, treatment modality, stage, biopsy Gleason sum [GS], and initial prostate-specific antigen [iPSA] levels) on treatment outcome. RESULTS: Eleven percent of all patients had a positive family history. The 5-year bRFS rates for patients with negative and positive family histories were 52% and 29%, respectively (P < .001). The potential confounders with bRFS rates were iPSA levels, biopsy GS, and clinical tumor stage; treatment modality and age did not appear to be associated with outcome. After adjusting for potential confounders, family history of prostate cancer remained strongly associated with biochemical failure. CONCLUSION: This is the first study to demonstrate that the presence of a family history of prostate cancer correlates with treatment outcome in a large unselected series of patients. Our findings suggest that familial prostate cancer may have a more aggressive course than nonfamilial prostate cancer, and that clinical and/or pathologic parameters may not adequately predict this course.

Aged↗
PubMed1993

Effects of neonatal estrogen exposure on prostatic secretory genes and their correlation with androgen receptor expression in the separate prostate lobes of the adult rat.

Brief administration of estrogen to newborn rats permanently restricts prostatic growth and testosterone sensitivity in adulthood. Previous work demonstrated that neonatal exposure to estradiol benzoate produced lobe-specific imprints in prostatic androgen receptor (AR) expression. Epithelial cell AR was markedly reduced or absent in the adult ventral and dorsal lobes, which correlated with a lack of epithelial differentiation and responsiveness. While the lateral lobe also showed reduced growth and testosterone responsiveness after neonatal estradiol benzoate, normal cell differentiation and AR levels were observed within the adult epithelium. To determine the impact that these receptor imprints have on the functional capacity of adult tissue, we herein examined the expression of lobe-specific, androgen-dependent, or androgen-responsive secretory genes in prostates of rats given neonatal estradiol benzoate and directly compared this with epithelial cell AR using histological techniques. Sprague-Dawley rat pups were given 25 micrograms estradiol benzoate or oil on days 1, 3, and 5 and killed on day 90. Prostatic mRNA was analyzed using Northern blots and in situ hybridization. Ventral lobe mRNA was hybridized with a prostate binding protein (PBP) cDNA probe, while lateral and dorsal mRNA were hybridized with RWB (seminal vesicle secretory protein or SVS-II), probasin, and DP1 cDNA probes. Sections adjacent to those used for in situ hybridization were stained for AR by immunocytochemistry. Neonatal estradiol benzoate significantly reduced ventral lobe PBP message on Northern blots, and this was not restored with adult testosterone administration. There was a direct correlation between epithelial cell AR and PBP expression, in that PBP message and protein were only present in epithelial AR-positive cells and were absent in all AR-negative epithelium. In the lateral prostate, probasin expression was unaffected by neonatal estradiol benzoate, whereas RWB was slightly reduced using Northern analysis. By in situ hybridization, these messages were observed at normal levels in lateral lobe epithelial cells of estrogenized rats, which directly correlated with the presence of AR in those cells. In the dorsal prostate, different response patterns to neonatal estradiol benzoate were found for the three secretory genes analyzed. On Northern blots, DP1 message significantly declined, probasin mRNA was modestly suppressed, and RWB expression was significantly elevated compared to those in control tissue. In situ hybridization revealed that RWB expression in estrogenized dorsal lobes was amplified in AR-positive epithelial cells, whereas AR-negative cells appeared unaltered. In summary, prostatic functional activity after neonatal estradiol benzoate exposure is affected in a lobe-specific manner, which correlates with the AR imprints in the separate lobes.

Aging↗
PubMed1991

Transurethral balloon dilatation of the prostatic urethra: effectiveness in highly selected patients with prostatism.

Transurethral balloon dilatation of the prostate has been shown to be a safe and potentially effective alternative to surgery in the treatment of benign prostatic hyperplasia, with a 66% success rate in relatively unselected patients. This study hypothesized that more careful patient selection might result in a significantly better rate of improvement. Ninety-one subjects with symptoms and signs of prostatism attributable to benign prostatic hyperplasia were studied. Group 1 comprised 42 patients with an initial mean symptom score of 16.8, residual urine of 249 ml, maximal flow rate of 7.9 ml/sec, and nomogram of maximal flow rate of -1.5. Group 2 comprised 49 less symptomatic patients with an initial mean symptom score of 14.5, residual urine of 105 ml, maximal flow rate of 10.7 ml/sec, and nomogram of maximal flow rate of -0.8. The difference in mean age and prostate size between groups was not statistically significant, but differences in baseline symptom score, residual urine, maximal flow rate, and nomogram of maximal flow rate were significant (p less than .04). Transurethral balloon dilatation of the prostate was performed under local anesthesia or IV sedation and analgesia with single-or double-balloon catheters with maximal diameters of 25-30 mm inflated to 2.5-4.0 atmospheres pressure for 10 min. Patients were followed up with repeat symptom scoring, uroflometry, and measurement of residual urine. After a mean follow-up of 22 months (range, 6-48 months), an improvement in symptom score was seen in 80% of group 2 patients compared with 43% in group 1. Improvement in symptom scores was statistically significant in both groups (p less than .04). We conclude that transurethral balloon dilatation of the prostate is more effective in patients with more moderate symptoms and with less marked signs of obstruction than in patients with more marked prostatism.

Aged↗
PubMed1999

Repetitive prostatic massage therapy for chronic refractory prostatitis: the Philippine experience.

Patients frustrated with failure of traditional therapy for prostatitis have traveled to the Philippines and elsewhere for repetitive prostatic massage combined with antibiotic therapy. The aim of our study was to evaluate prospectively the response of patients who traveled to Manila to undergo this treatment. Twenty-six patients consented and were registered by the Prostatitis Foundation (B.H.) and subsequently evaluated (J.C.N., J.D.) prior to and following treatment (A.E.F.). Evaluation at baseline and after treatment consisted of standardized history and previously validated prostatitis-specific Symptom Frequency Questionnaire (SFQ) and Symptom Severity Index (SSI), International Prostate Symptom Score (I-PSS) and Quality of Life (QoL) questionnaire, the O'Leary Sexual Function Inventory (SFI), and a Subjective Global Assessment (SGA). Treatment in Manila consisted of triweekly prostatic massage combined with specific culture directed and/or empirical antimicrobial therapy for 6 to 12 weeks. Twenty-two patients completed at least one follow-up assessment and 12 patients completed 2-year assessment (average follow-up of 17 months in 22 patients). There was a significant decrease in average symptom severity (SSI) by 4 months that continued for 2 years, but less improvement in symptom frequency (SFQ) and quality of life (QoL), and no significant improvement in voiding symptoms (I-PSS) or sexual function (SFI) at time of last assessment. Forty-six percent of the 22 evaluable patients had >60% decrease (significant improvement) in symptom severity (SSI), whereas 27% had similar significant improvement in frequency of symptoms (SFQ) when last assessed. Thirty-three percent reported marked subjective improvement (SGA) at last evaluation. Of the 12 patients who completed the 2-year follow-up, 5 of the original 26 had a significant and sustainable improvement in objective and subjective measurements of frequency and severity of symptoms. The combination of prostatic massage and antibiotics for treating difficult refractory cases of prostatitis may be promising, but its ultimate value needs to be confirmed. Studies in patients with less refractory and shorter duration disease may allow us to predict who will respond to this therapeutic approach.

Adult↗
PubMed2000

Prostate Cancer Shared Decision: a CD-ROM educational and decision-assisting tool for men with prostate cancer.

Prostate Cancer Shared Decision, a CD-ROM program produced with the guidance of leading prostate cancer specialists, educates prostate cancer patients and suggests possible treatments. As the first portable, interactive prostate cancer decision-making tool, Prostate Cancer Shared Decision offers expert, plain-language explanations of prostate anatomy, cancer diagnosis, and treatment options. Through answers to lifestyle and attitude questions entered into a series of user-friendly questionnaire screens, Prostate Cancer Shared Decision helps patients understand their disease and feel comfortable with their treatment decision. This type of educational tool is representative of the new technology that is becoming available to patients with prostate cancer.

CD-ROM↗