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[5 alpha-reductase and prostate].

The human prostate is a complex organ composed of four glandular zones that differ in their histology and biology. In addition to this anatomical organization, the prostate is mainly composed of epithelial and mesenchymal tissues. Two pathologies affect the growth of the prostate: cancer and benign prostatic hyperplasia. Anatomical and pathological studies have shown that stromal enlargement is the first step in the process of BPH and that both transition and periurethral regions are the exclusive sites of origin. Because the first step of androgen action is the reduction of testosterone into dihydrotestosterone by the 5 alpha-reductase, it have been postulated that modification of this enzymatic activity may play an important role in BPH development. However DHT production alone cannot explain the hyperplastic development of the gland. Thus it has also been postulated that androgen-growth factor interaction may be an important feature of this growth: these growth factors include the IGF axis. An interaction between androgen pathway and sympathethic system, via alpha-adrenoreceptor may also be suspected.

3-Oxo-5-alpha-Steroid 4-Dehydrogenase↗

[Use of transrectal ultrasonography in prostate pathology: determination and clinical usefulness of the prostate transition zone].

The prostate gland comprises a central or transition zone which is the object of an important hypertrophy in case of benign prostatic hypertrophy and a peripheral zone where the vast majority of cancers occurs. The ultrasonographic measurement of the prostate transition zone volume has become a very important parameter to consider in the assessment of the severity of symptoms or the therapeutic options in case of benign prostatic hyperplasia. When a prostate cancer is suspected, a new concept, the prostate specific antigen density related to the transition zone volume, has been demonstrated as a very effective mean for prostate cancer early detection in men with PSA levels below 10 ng/ml.

5-alpha Reductase Inhibitors↗

[Medical-economic models of benign prostatic hypertrophy].

This article is designed to explain the importance of medico-economic models for evaluation of the impact of treatments of benign prostatic hyperplasia. The authors illustrate this approach by comparing two hypotheses: transurethral resection of the prostate versus watchful waiting using a Markov type of model. This model is able to simulate the probability of development of events such as transurethral resection of the prostate, acute urinary retention over a 40-year period by 3-month cycles. The model is also able to simulate the mean cost of management of a patient over this period. This type of model may appear slightly artificial and complicated, but it is the only model which could allow long-term simulations of the respective value of the various therapeutic strategies for BPH. This type of model is also evolutive, its performance is gradually improved as new data become available in the literature, allowing refinement of a number of hypotheses.

Acute Disease↗