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PubMed2002

Rationale and assessment of minimally invasive approaches to benign prostatic hyperplasia therapy.

Benign prostatic hyperplasia affects quality of life, with most patients complaining of symptoms related to urination. For this reason, successful treatments can be defined by (1) their effect on lower urinary tract symptoms, (2) their impact on quality of life, and (3) their ability to unobstruct the flow of urine through the prostate. Minimally invasive therapy (MIT), which includes transurethral microwave thermotherapy, water-induced thermotherapy, interstitial devices (eg, transurethral needle ablation), and interstitial laser treatments, offers physicians and their patients cost-effective alternatives for achieving a substantially improved quality of life at an acceptable level of risk. Evidence-based medicine indicates that MIT is safe and achieves significant symptomatic improvement. Compared with long-term medical management, minimally invasive procedures offer effective, well-tolerated 1-time intervention with lasting effects that can be achieved on an outpatient basis. This article reviews the options for MIT.

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PubMed2006

[Old and new interventional therapies in the treatment of symptomatic benign prostate hyperplasia (BPH)].

Benign Prostatic Hyperplasia is a common entity among the aging male population. Its prevalence is increasing with age and is around 80% in the over 80-years old. The androgen-estrogen ratio changes in favor of the estrogens, which leads to a growth of prostatic tissue, presenting histologically as hyperplasia. BPH can cause irritative or obstructive symptoms or both. Nowadays we speak of bladder storage or bladder voiding symptoms, summarised as LUTS (Lower Urinary Tract Symptoms). LUTS has a structural and a functional component, the structural being caused by the size of the adenoma itself the functional depending on the muscle tone of the bladder neck and the prostatic urethra. To investigate LUTS, we use validated symptom scores, sonography for residual urine and eventually a urodynamic evaluation. There are 3 grades of BPH. The indication for an interventional therapy is relative in BPH II, and absolute in BPH III. Prior to treatment, other diseases mimicking the same symptoms, have to be ruled out and adequatly treated. Electro-resection of the prostate (TUR-P) remains the standard therapy and the benchmark any new technology has to compete with. TUR-P has good short- and longterm results, but can be associated with a considerable perioperative morbidity, and the learning curve for the operator is long. The most promising of the newer techniques is the Holmium-Laser-Enucleation of the prostate (Laser-TUR-P), showing at least identical short- and median-term results, but a lower perioperative morbidity than TUR-P For several minimally-invasive techniques, indications are limited. TUMT TUNA, WIT and laser-coagulation all produce a coagulation necrosis of the prostatic tissue by thermic damage with secondary tissue shrinking. Urodynamic results however, are not comparable to TUR-P or Laser-TUR-P, and significantly more secondary interventions within 2 to 5 years are required. Minimal-invasive techniques present a favorable alternative for younger patients without complications of BPH, and for older patients with relevant comorbidities, and can usually be performed under local anaesthesia. The morbidity is low and further therapies remain possible later, if necessary.

Catheter Ablation↗

PubMed2004

Abnormalities of apoptotic and cell cycle regulatory proteins in distinct histopathologic components of benign prostatic hyperplasia.

INTRODUCTION: Benign prostatic hyperplasia (BPH) is a slowly progressive abnormal glandular enlargement with heterogeneous morphology. Disruption of apoptotic pathways has been suggested as an important regulatory mechanism in this common and significantly morbid disease. METHODS: Prostatic tissue from 20 patients with BPH and no prior or subsequent prostatic carcinoma was obtained by transurethral prostatectomy (TURP) at the University of California Davis. Apoptotic regulatory proteins: BCL2, BAX and p27 were analyzed by immunohistochemistry and evaluated for expression in four distinct histologic patterns: hyperplastic epithelium, nodules, dilated glands and atrophic/inflammatory glands. RESULTS: Particularly striking was the decreased expression of BAX and an abnormal BCL2 : BAX ratio within all nodules relative to expression in other epithelial patterns. p27 expression was decreased in 35% of the hyperplastic epithelial areas and 10% of the nodules. DISCUSSION: Overall, abnormal expression of BCL2, BAX and/or p27 was identified in the hyperplastic epithelium of 19 (90%) of specimens and all 12 (100%) of the hyperplastic nodules. The high frequency of abnormalities in apoptosis regulatory genes, suggests that alteration of apoptotic pathways is important for the development of this condition.

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PubMed2002

Intakes of energy and macronutrients and the risk of benign prostatic hyperplasia.

BACKGROUND: Benign prostatic hyperplasia (BPH) is a common disease of older men. Although the etiology remains unclear, nutritional factors may have an effect on the disease. OBJECTIVE: Because the literature on the relations between macronutrient intakes and BPH risk is limited, we examined these relations among men in the Health Professionals Follow-up Study. DESIGN: We followed men aged 40-75 y from baseline in 1986 to 1994. Total BPH cases (n = 3523) comprised men who reported BPH surgery (n = 1589) or who did not undergo surgery but scored 15-35 points on the lower urinary tract symptom questionnaire of the American Urological Association (n = 1934); non-cases were men who scored < or = 7 points (n = 24388). Odds ratios (ORs) and 95% CIs were calculated by using multivariate logistic regression. RESULTS: The ORs rose with increasing total energy intake in a comparison of the highest and lowest quintiles for total BPH (OR: 1.29; 95% CI: 1.14, 1.45) and symptoms of BPH (1.43; 1.23, 1.66). Energy-adjusted total protein intake was positively associated with total BPH (1.18; 1.05, 1.33) and BPH surgery (1.26; 1.06, 1.49). Energy-adjusted total fat intake was not associated with risk of total BPH, but intakes of eicosapentaenoic, docosahexaenoic, and arachidonic acids were associated with a moderate increase in risk of total BPH. CONCLUSIONS: We observed modest direct associations between BPH and intakes of total energy, protein, and specific long-chain polyunsaturated fatty acids. Because eicosapentaenoic, docosahexaenoic, and arachidonic acids are highly unsaturated fatty acids, our findings support a possible role of oxidative stress in the etiology of BPH.

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PubMed2006

Systematic review and meta-analysis of Transurethral Needle Ablation in symptomatic Benign Prostatic Hyperplasia.

BACKGROUND: Benign prostatic hyperplasia (BPH) constitutes a major clinical problem. Minimally invasive therapies for the treatment of symptomatic BPH include Transurethral Needle Ablation (TUNA), but it is unclear what impact this technique has on the disease and its role among other currently available therapeutic options. The objective of this study is to ascertain the efficacy and safety of TUNA in the treatment of BPH. METHODS: Systematic review of the literature until January 2005 and meta-analysis of clinical studies assessing TUNA in symptomatic BPH. Studies were critically appraised. Estimates of effect were calculated according to the random-effects model. RESULTS: 35 studies (9 comparative, 26 non-comparative) were included. Although evidence was limited by methodological issues, the analysis of relevant outcomes indicates that while TUNA significantly improves BPH parameters with respect to baseline, it does not reach the same level of efficacy as TURP in respect to all subjective and objective variables. Further, its efficacy declines in the long-term with a rate of secondary-treatment significantly higher than of TURP [OR: 7.44 (2.47, 22.43)]. Conversely, TUNA seems to be a relatively safe technique and shows a lower rate of complications than TURP [OR:0.14 (0.05, 0.14)] with differences being particularly noteworthy in terms of postoperative bleeding and sexual disorders. Likewise, TUNA has fewer anesthetic requirements and generates a shorter hospital stay than TURP [WMD: -1.9 days (-2.75, -1.05)]. Scarce data and lack of replication of comparisons hinder the assessment of TUNA vs. other local therapies. No comparisons with medical treatment were found. CONCLUSION: The body of evidence on which TUNA has been introduced into clinical practice is of only moderate-low quality. Available evidence suggest that TUNA is a relatively effective and safe technique that may eventually prove to have a role in selected patients with symptomatic BPH. TUNA significantly improves BPH parameters with respect to baseline values, but it does not reach the same level of efficacy and long-lasting success as TURP. On the other hand, TUNA seems to be superior to TURP in terms of associated morbidity, anesthetic requirements and length of hospital stay. With respect to the role of TUNA vis-à-vis other minimally invasive therapies, the results of this review indicate that there are insufficient data to define this with any degree of accuracy. Overall cost-effectiveness and the role of TUNA versus medical treatment need further evaluation.

Humans↗

PubMed1981

Changes in dihydrotestosterone metabolism associated with the development of canine benign prostatic hyperplasia.

Canine benign prostatic hyperplasia (BPH) is associated with, if not actually induced by, an increased prostatic ability for the net formation of dihydrotestosterone (DHT). This conclusion is based upon the observation in this study that: 1) when spontaneous BPH develops in the beagle there is a concomitant increase in the potential capacity for prostatic tissue to metabolize steroids favoring the net formation of DHT; 2) there is a similar change in steroid metabolism in the prostate when BPH is experimentally induced in young beagles by the combined administration of exogenous androgens and estrogens; 3) various hormonal treatments of young intact or castrate dogs which did not increase the prostate tissue's ability to produce DHT also did not induce a high incidence of experimental BPH; and 4) a highly significant linear correlation (r = 0.95) was observed between the size of the prostate gland and an increased prostatic ability for the net formation of DHT, as estimated by relative prostatic index values which quantitatively reflect such increased metabolic activities. These overall alterations in prostatic steroid metabolism favor an increase in the net formation of DHT and may account for the well documented increase in DHT concentration associated with BPH in both dog and man. The enhancement of these events by estrogens could play a major role in the etiology of BPH. (Endocrinology 108: 445, 1981)

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PubMed1995

[A study on international prostate symptom score in the assessment of therapeutic effects and severity of symptoms due to benign prostatic hyperplasia].

BACKGROUND: Benign prostatic hyperplasia (BPH) is a common disease among elderly men in Japan. Recently, various non-invasive treatment modalities have been developed, however the criteria for the diagnosis and therapeutic effects of BPH have not been established yet. World Health Organization sponsored International Prostate Symptom Score (I-PSS) was devised. The criteria, however, were limited to evaluate the frequency of the subjective symptoms of BPH. In addition, this criteria did not include the quality of life (QOL) score. PATIENTS AND METHODS: We examined I-PSS and a new by modified symptom score for patients who underwent TUR-P. RESULTS: The efficacy of TUR-P could be confirmed by I-PSS, however the criteria proposed in I-PSS and in our modified symptom score were shown to be inadequate to evaluate QOL, and to be not specific scale for BPH. It was demonstrated that objective findings such as peak flow rate, residual urine volume and prostate volume did not correlate with the QOL score, however each objective and subjective significantly improved after TUR-P. CONCLUSION: These results suggested that further effort should be made to establish reliable criteria for the diagnosis and evaluation of therapeutic efficacy considering QOL in BPH patients.

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PubMedDate not supplied

The pathophysiology of benign prostatic hyperplasia.

Although benign prostatic hyperplasia (BPH) is one of the most common disease processes affecting the aging male, surprisingly little is known about its pathophysiology. Cause-and-effect relationships have not been established, despite intense research efforts in the last four or five decades aimed at elucidating the underlying etiology of prostatic growth in older men. Previously held notions that the clinical symptoms of BPH (prostatism) are due simply to a mass-related increase in urethral resistance are too simplistic. It is now clear that a significant portion of the symptoms are due to obstruction-induced detrusor dysfunction. Moreover, obstruction may induce a variety of neural alterations in the bladder and prostate that contribute to symptomatology. Undoubtedly, the constellation of cellular pathologies that give rise to the symptoms of BPH will be far more complex than we currently realize. Only by unraveling these complexities, however, will we be able successfully to design alternative strategies to treat, and possibly prevent BPH.

Humans↗

PubMed1995

[The value of self-assessment in management of patients with benign prostatic hyperplasia].

Since benign prostatic hyperplasia (BPH) is a very common and slowly progressive disease which requires surgical treatment in only one-third of those affected, surveillance of the condition on the basis of subjective symptoms is of considerable importance. For this reason, the WHO developed a prostate symptom score (WHO-PSS or I-PSS), which includes both irritative and obstructive symptoms, and which has become accepted all over the world. This score can be used both in investigative studies as a means of monitoring the efficacy of therapy, and as a very good instrument for patient management in the doctor's office.

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PubMedDate not supplied

Androgen concentrations and their receptors in the periurethral region are higher than those of the subcapsular zone in benign prostatic hyperplasia (BPH).

Benign prostatic hyperplasia (BPH) is an androgen-dependent disease that initially develops in the inner prostate, where the highest concentrations of testosterone (T) and dihydrotestosterone (DHT) are found. In this study, we have evaluated the cytosolic androgen receptors (ARc), the nuclear androgen receptors (ARn), and the concentrations of T, DHT, and 3alpha-androstanediol (3alphaDiol) in BPH tissue to verify the existence of a possible correlation between androgens and their receptor concentrations. Prostatic samples, removed by suprapubic prostatectomy in 15 untreated patients, were sectioned in periurethral, intermediate, and subcapsular zones. Testosterone, DHT, and 3alphaDiol were evaluated by radioimmunoassay after extraction and purification on celite microcolumns, and ARc and ARn were evaluated by means of dextran-coated charcoal method. In total tissue, mean levels of DHT, T, and 3alphaDiol were 2,531+/-308, 260+/-36, and 403+/-35 pg/mg of DNA (mean+/-SE), respectively. Cytosolic androgen receptors, detectable in all cases, were 16+/-2.8 fmol/mg of protein (mean+/-SE), and ARn, detectable in 12 cases, were 108+/-15 fmol/mg of DNA (mean+/-SE). A linear correlation between DHT and 3alphaDiol, T and DHT, and 3alphaDiol and ARn was found. If the different regions are considered, the periurethral zone, site of the primitive BPH nodule, presents the highest levels of androgens and ARn with respect to the other regions. This relative hyperandrogenism may be responsible for the growth-promoting processes of this area, leading to urinary obstruction.

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PubMed2006

[Influence of antioxidants on the development of benign prostatic hyperplasia].

The main objectives of the study was the evaluation of concentration of endogenous antioxidants (Vitamins E, A, C and Beta-carotene) in the blood plasma of elderly men and to determine their roles in the development of benign prostatic hyperplasia. There were carried out investigations in 110 men during 2003-2006 in the Urological Clinic of the Tbilisi State Medical Academy. 71 patient entered into the main group (65-81 years old), who were diagnosed for benign prostate hyperplasia. The control group included 30 men (60-80 years old) who did not suffer from the typical signs of benign prostatic hyperplasia. Besides, to evaluate normal levels of endogenous antioxidants (Vitamins E, A, C and Beta-carotene) concentration in the blood plasma additionally were studied young practically healthy 10 persons (20-35 years old), they compiled the second control group. Our study showed that endogenous antioxidants concentration reduces in the blood plasma with the age, this reduction becomes more obvious with the clinical detection of prostate benign hyperplasia. It is recommended for elderly patients to control periodically the endogenous antioxidants level (Vitamins A, C, E and Beta-carotene) in the blood plasma and in the case of changes to get food enriched with vitamins or combined vitamins preparations. This will be accomplice factor for the prophylactic of benign prostatic hyperplasia. This will be prophylactic activity during the conservative treatment process (by alpha-adrenoceptor blocking drugs, phytotherapy medicines, 5 alpha-reductase inhibitors and others). Inclusion of vitamins complexes which contains antioxidants is necessary. Prescription of antioxidants complex after the operative treatment will accelerate the healing process and reduce the rehabilitation period.

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PubMed2006

How do patients with familial benign prostatic hyperplasia differ clinically from those with sporadic benign prostatic hyperplasia?

INTRODUCTION: The aim of this study was to compare age, prostatic volume, International Prostate Symptom Score (IPSS), maximal flow rate, serum total prostate-specific antigen (PSA), serum free PSA, free/total PSA ratio and PSA density values of familial and sporadic benign prostatic hyperplasia (BPH) patients suffering moderate or severe lower urinary tract symptoms. MATERIALS AND METHODS: Between September 1999 and August 2004, 511 patients with moderate or severe lower urinary tract symptoms (IPSS > or =8) due to BPH were included in the study. Patients with at least 2 first-degree relatives who had undergone surgery or received medication for BPH were classified as having the familial form of the disease, while the remaining patients were taken as sporadic cases. Mean age, prostatic volume, symptom score, maximal flow rate, PSA, free PSA, free/total PSA ratio and PSA density values of the familial and sporadic groups were compared using student's t test. RESULTS: Thirty-eight patients had a positive family history and formed the familial group, while the remaining 473 made up the sporadic group. No significant difference was observed in the parameters studied, except that mean prostate volume of the familial group was found to be greater and the mean age to be lower than those of sporadic patients in accordance with the literature. CONCLUSIONS: Patients with familial BPH need treatment significantly earlier and have larger prostates than those with sporadic BPH.

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PubMed1989

Alpha-adrenoceptor inhibitors in the treatment of benign prostatic hyperplasia.

Although benign prostatic hypertrophy is the most common cause of urinary tract symptoms in men, the cause is still unclear. Recently it has been suggested that treatment with alpha-adrenoceptor inhibitors may be helpful in this condition. Eighty patients with prostatic obstruction were entered into a double-blind parallel study of prazosin versus placebo. There were 25 withdrawals or exclusions, leaving 55 patients for analysis. Mean maximal flow rates increased significantly more in patients treated with prazosin than in patients treated with placebo (p less than 0.005), but there was no significant reduction in maximal voiding pressure. The mean number of voids, recorded on diary cards, was reduced from an initial 10.0/24 hours by 2.1 in the final week, a significantly greater reduction than in the placebo group (p less than 0.01). However, there were no statistically significant changes in the filling cystometrograms. When patients were classified as responders or nonresponders in terms of bladder filling, urine flow, bladder emptying, weekly average of voids/24 hours, and nocturia, the proportion of patients responding to prazosin was significantly greater in all categories except bladder filling and emptying. It was concluded that prazosin at a dose of 2 mg twice daily is a safe and effective treatment for prostatic obstruction and may be used in patients awaiting surgery and in those who are unfit for operation.

Adrenergic alpha-Antagonists↗

PubMed2006

Men's theories about benign prostatic hyperplasia and prostate cancer following a benign prostatic hyperplasia decision aid.

OBJECTIVE: To use qualitative methods to explore audiotape evidence of unanticipated confusion between benign prostatic hyperplasia (BPH) and prostate cancer in using a videotape BPH treatment decision aid (DA). DESIGN: Qualitative analysis of semi-structured interviews and surveys originally collected to study men's interpretation of a DA. SETTING AND PARTICIPANTS: Community sample of college and noncollege educated African American and white men (age> or =50; n=188). MEASURES: Transcript analysis identified themes in men's comments about BPH and cancer. Surveys measured BPH general and prostate cancer-specific knowledge, literacy (Short Test of Functional Health Literacy in Adults), BPH symptoms, and demographics. RESULTS: In transcript analysis, 18/188 men spontaneously talked about BPH and cancer as being related to each other, despite explicit statements to the contrary in the video. Survey data suggest that up to 126/188 men (67%) persisted in misconceptions even after viewing the DA video. Three themes were identified in the transcripts: (1) BPH and cancer are equated, (2) BPH surgery is for the purpose of removing cancer, and (3) BPH leads to cancer. CONCLUSIONS: Overall knowledge increases with DA use may mask incorrect theories of disease process. Further research should identify decision support designs and clinical counseling strategies to address persistence of beliefs contrary to new information presented in evidence-based DAs.

Black or African American↗

PubMed2005

Juvenile prostatic hyperplasia.

Benign prostatic hyperplasia is common in aging men, but rare in childhood. We report a case of juvenile prostatic hyperplasia in a 10-year-old boy, who visited our clinic for hematuria and voiding symptoms. Radiologic studies revealed a huge prostate protruding into the bladder. The prostate was 33 g. The prostate biopsy showed no evidence of cancer. At 13 years of age, he was seen again because of general weakness, fever, and voiding difficulty. Bilateral hydroureteronephrosis was found on radiologic studies, and his serum creatinine was elevated. The prostate was 55 g. Suprapubic prostatectomy was performed.

Age Factors↗

PubMed1993

Platelet derived growth factor (PDGF), androgens and inflammation: possible etiologic factors in the development of prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) is characterized by varying degrees of epithelial and stromal hyperplasia in association with inflammation. Although androgens are known to be important for the growth and function of the prostate, their role in the development of BPH is unclear. The release of platelet-derived growth factor (PDGF) in response to inflammation suggests that PDGF may participate in the development of BPH. Cultured prostate cells derived from patients with BPH were examined for the presence of functional PDGF and androgen receptors. The cells expressed PDGF receptors and responded to PDGF stimulation by the activation of the PDGF signal transduction pathway and a dose-dependent stimulation of cell proliferation. Even though the cells expressed androgen receptors, dihydrotestosterone failed to elicit a mitogenic response. While the role of androgens in BPH remains unclear, these results suggest that inflammation and, specifically, PDGF may be important etiologic factors in the development of BPH.

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PubMedDate not supplied

Ultrastructural changes in prostate cells during hormone-induced canine prostatic hyperplasia.

Benign prostatic hyperplasia is a prevalent disease that has received relatively little attention in spite of its morbidity and remarkable social impact. There are few animal models of prostatic hyperplasia. The dog is the only species, along with humans, in which prostatic hyperplasia develops spontaneously and almost universally with age. The aim of the present study has been to compare the ultrastructural findings in a model of experimentally induced canine prostatic hyperplasia with those of the spontaneously developed changes in untreated dogs. An experimental group of 5 male beagle dogs were castrated and treated with combined steroids (3 weekly doses for over 30 weeks). Prostate samples were surgically obtained every 42 days (experimental stages 0 through 6). The control group consisted of 3 noncastrated dogs that were treated with vehicle and in which samples were taken only at stages 0, 1, 4, and 6. Changes in the control groups were similar but of lower intensity compared to those of the experimental groups. In luminal cells, crowding with papillary projections, prominent, branching microvilli, and abundant, often compartmentalized granules were observed. The most striking change was the previously unreported finding of caveolae in basal cells. They were mostly located in the basal aspect of basal cells and were more prominent in the experimental group and in advanced stages of treatment. These ultrastructural findings have not been previously reported in canine or human prostatic hyperplasia and merit further research. The model of experimentally induced canine prostatic hyperplasia provides an adequate setting for the understanding of this disease.

Androstane-3,17-diol↗

PubMedDate not supplied

Comparison of MR imaging and urodynamic findings in benign prostatic hyperplasia.

OBJECTIVE: In benign prostatic hyperplasia (BPH), it is uncertain whether the size of the prostate is related to the degree of urodynamically demonstrated bladder outlet obstruction. We compared MR imaging findings and urodynamic data in patients with surgically confirmed BPH. MATERIALS AND METHODS: We prospectively studied 43 benign prostatic hyperplasia (BPH) patients in whom transurethral resection of the prostate (TURP) was planned. We obtained T1- and T2-weighted images in the transverse and sagittal planes with a 1.5 Tesla superconducting unit. The predicted volume of the inner gland and the peripheral zone were obtained on T2-weighted transverse images. Prostatic protrusion into the urinary bladder (IB protrusion) and the inner gland ratio (IG ratio: inner gland volume/total prostatic volume) were determined. RESULTS: IB protrusion and inner IG ratio were significantly greater in patients with severe stenosis than in those without. A surgical capsule (SC) was seen in 20 of 25 patients (80%) with severe stenosis and 8 of 18 (44%) of those without it. The accuracy of IB protrusion + IG ratio, IB protrusion + surgical capsule, and IB protrusion + IG ratio + surgical capsule was 89%, and that of IG ratio + surgical capsule was 86%. CONCLUSION: The inner gland ratio, protrusion into the bladder, and presence of surgical capsule were the most important factors in bladder outlet obstruction. The probability of outlet stenosis increases in patients with more than two of these criteria.

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