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Background: Primary urothelial carcinoma in the prostate (UCP) is extremely rare and occurs most frequently in the bladder. There are only dozens of primary cases reported in the literature. Here, we describe a rare case of primary UCP and review the literature. Case presentation: A 67-year-old widowed male, was referred to our hospital due to the frequency, and urgency of dysuria. Magnetic resonance imaging (MRI) examination revealed prostate size was about 57 mm x 50 mm x 54 mm, increased prostatic transitional zone, and surrounding of prostatic duct indicate bar isointense T1, short T2, hyperintense DWI, and hyposignal ADC (PI-RADS 3); posterior of peripheral zone indicate patchy isointense T1, short T2, hyperintense DWI, and hyposignal ADC (PI-RADS 5). Subsequently, the patient underwent a transrectal prostate biopsy. Histopathological and immunohistochemical (IHC) assessments showed prostatic high-grade urothelial carcinoma with benign prostatic hyperplasia. Finally, the patient underwent laparoscopic radical prostatectomy. Four months after surgery, CT plain and enhanced scan revealed thickening of the bladder wall. On further workup, cystoscopy revealed lymphoid follicular changes in the cut edge of the radical prostatectomy, and cystoscopic biopsies showed the malignant tumor. Conclusions: Prostatic urothelial carcinoma should always be considered if the patient with severe lower urinary tract symptoms or hematuria, PSA, and digital rectal examination without abnormalities, without a personal history of urothelial cancer, but contrast-enhanced MRI showed the lesion located in the prostate. As of right now, radical surgical resections remain the most effective treatment. The effectiveness of neoadjuvant or adjuvant chemotherapy is still controversial. [ABSTRACT FROM AUTHOR]

Inflammation and epithelial-mesenchymal transition (EMT) play important roles in the occurrence and development of benign prostatic hyperplasia (BPH); curcumin exerts anti-proliferative, anti-inflammatory, and anti-EMT effects. To explore the anti-inflammatory and anti-EMT mechanisms of curcumin in BPH. Ten-week-old male C57BL/6 mice were administered lipopolysaccharide (LPS, 100 µg/kg) in the prostate lobules to establish an inflammatory BPH model (LPS group), and curcumin (120 mg/kg) was administered into the abdominal cavity for 2 weeks (three times a week, curcumin-treated group). A group of healthy mice served as the control group. The expression of Toll-like receptor 4 (TLR4), bone morphogenetic protein and activin membrane-bound inhibitor (BAMBI), EMT markers, inflammatory cytokines, and transforming growth factor β1 (TGF-β1) was detected by PCR and western blotting. TGF-β1 (0.1 ng/mL) and LPS (100 ng/mL) were used to induce EMT in benign prostatic hyperplasia epithelial cells (BPH-1). In vivo, curcumin reduced the size of the prostate, suppressed the expression of vimentin and TLR4, and increased the expression of E-cadherin and BAMBI in the LPS-induced BPH mouse model. Moreover, curcumin decreased the levels of IL-6 and TNF-α by 44.52 and 46.17%, respectively. In vitro, curcumin attenuated cell proliferation, suppressed the expression of vimentin and TLR4, and increased the expression of E-cadherin and BAMBI in BPH-1 cells. Furthermore, BAMBI knockdown reversed the expression of vimentin and E-cadherin induced by curcumin. This study demonstrated that curcumin alleviated hyperplasia, EMT, and inflammation in vivo. Furthermore, curcumin suppressed EMT by targeting BAMBI via the TLR4/BAMBI/TGF-β1 signalling pathway in vitro, demonstrating its potential utility in BPH treatment. [ABSTRACT FROM AUTHOR]

Benign prostatic hyperplasia (BPH) is a common disorder in men aged over 60 years and significantly contributes to the distressing lower urinary tract symptoms. Cucurbitacins are triterpene derivatives with diverse medicinal uses including prostate diseases. Cucurbitacin E glucoside was evaluated against testosterone-induced prostatic hyperplasia in mice. Our data indicate that it significantly inhibited the increase in prostate weight and prostate index. The compound ameliorated histopathological changes in prostatic architecture and inhibited the increase in glandular epithelial length induced by testosterone. These results were confirmed by decreased expression of cyclin D1 in prostatic tissues compared to those obtained from the testosterone-alone group. Also, it showed significant antioxidant activity as evidenced by inhibiting lipid peroxides accumulation, glutathione depletion and superoxide exhaustion. Further, it exhibited anti-inflammatory activity as it decreased cyclooxygenase-2 and interleukin-1β protein expression in prostatic tissues. Masson's trichrome staining of prostate sections indicated obvious antifibrotic activity that was supported by decreased α-smooth muscle actin expression. In conclusion, Cucurbitacin E glucoside inhibits testosterone-induced experimental BPH in mice due to, at least partly, its antiproliferative, antioxidant, anti-inflammatory, and antifibrotic effects. [ABSTRACT FROM AUTHOR]

Objective: Assess the association between serum sex hormone level and prostate volume in men with benign prostatic hyperplasia (BPH).Material and methods: The study involved 239 BPH patients from January 2013 to June 2015 in our hospital. Each patient collected age, medical history, height, weight, body mass index, as well as a full examination of sex hormones, and transrectal ultrasound results.Results: Estradiol (E2) was significantly associated with prostate volume (r = 0.151, p = .02) and transitional zone volume (r = 0.136, p = .035). The association was more significant after adjusting age and BMI (r = 0.253 and 0.250, p <.001). Patients were divided into two groups according to prostate volume and E2, respectively. E2 in patients with prostate volume ≤50 ml was significantly lower than those with prostate volume >50 ml. Prostate volume, transitional zone volume and age were all significantly higher in the patients with E2 ≥ 160 umol/l than those in the patients with E2 < 160 umol/l. Through logistics regression, E2 (p = .012, OR = 1.004) are the only independent risk factor for prostate volume.Conclusions: E2 is significantly associated with prostate volume. High concentrations of E2 may be a risk factor for the large volume of prostate. [ABSTRACT FROM AUTHOR]

Context:Lespedeza cuneata G. Don (Fabaceae), has been used as a traditional treatment of various diseases. There is a report L. cuneata effects on hormone replacement therapy for endocrine-related disease. However, studies related to benign prostatic hyperplasia (BPH) have not been investigated. Objective: The effects of L. cuneata aqueous extract (LCW) on testosterone-induced prostatic hyperplasia (TPH) were examined. Materials and methods: Male Wistar rats (10 weeks, 330–350 g) were randomly divided to 6 groups (n = 6): Control group; TPH group (3 mg/kg, s.c, daily); TPH + LCW (25, 50, 100 mg/kg); TPH + Finasteride 10 mg/kg for 6 weeks. At the end of treatment, histological change of prostate, serum dihydrotestosterone (DHT) level, mRNA expression of 5α-reductase, inflammatory factors, proliferating cell nuclear antigen (PCNA) and fibroblast growth factor-2 (FGF-2) in prostate were examined. Then, LCW was treated with BPH-1, a human BPH cell line, at 25, 50, 100 μg/mL for 24 h and examine mRNA level of androgen receptor (AR) and prostate-specific antigen (PSA). In addition, the content of vicenin-2 was analyzed. Results: LCW treatment of TPH inhibited serum DHT levels by 54.5, 51.2 and 54.1% and mRNA expression of 5α-reductase were inhibited 54.3, 61.3 and 73.6%, respectively. In addition, mRNA expression of inflammatory factors, PCNA and FGF-2 were decreased in the prostate of rats. Also, LCW attenuated mRNA level of AR and PSA in BPH-1 cell. The content of vicenin-2 in the LCW was analyzed to 0.89 mg/g. Discussion and conclusions: Based on the results, LCW is a potential pharmacological candidate for the treatment of prostatic hyperplasia. [ABSTRACT FROM AUTHOR]

Purpose: To compare the efficacy and safety of sildenafil 25 mg qd, 25 mg bid or 50 mg qd - on treating lower urinary tract symptoms with benign prostatic hyperplasia (LUTS/BPH).Materials and Methods: Men aged > 45 years with LUTS/BPH were randomly assigned to receive sildenafil 25 mg qd (n = 42), bid (n = 41), 50 mg qd (n = 38) or placebo (n = 41) for 8 weeks. Changes from baseline in International Prostate Symptom Score (I-PSS), maximum urinary flow rate (Qmax) and postvoid residual urine volume (PVR) were assessed at week 4 and week 8.Results: Sildenafil 25 mg qd (-7.3 ± 5.8) and 25 mg bid (-7.0 ± 5.7) exhibited significant improvements of I-PSS compared to placebo (-5.2 ± 6.4) (p = 0.020, 0.025, respectively). In particular, voiding domain was more affected than storage domain. Only sildenafil 50 mg qd improved nocturia significantly (versus placebo, p = 0.027). Quality of life score was improved in all treatment groups. Qmax and PVR did not change significantly in all groups. All regimens were well tolerated.Conclusions: Sildenafil 25 mg qd, 25 mg bid and 50 mg qd are safe and effective to improve LUTS/BPH in long term, along with coexisting ED. In particular, nocturia is most well-controlled by 50 mg qd. [ABSTRACT FROM AUTHOR]

Purpose: Study of validity of the Medication Adherence Self-Report Inventory (MASRI) for use in clinical practice to treat patients with benign prostatic obstruction (BPO) accompanied with overactive bladder (OAB) symptoms.Methods: During 12 weeks of the randomized study, 452 patients with BPO and OAB symptoms (mean age of 61.3 (12.7)) were studied for adherence to the treatment with Tamsulosin, Solifenacin and Trospium using the MASRI. External monitoring instruments included the Brief Medication Questionnaire (BMQ) and the visual remaining pill count. The state of the prostate gland and the lower urinary tract was monitored using questionnaires I-PSS, OAB Awareness Tool, uroflowmetry and voiding diaries.Result: Correlation between the percentage of men non-adherent to treatment (MASRI) and the percentage of patients having a belief barrier on the screen of the BMQ was r = 0.89, p ≤0.05, r = 0.92, p ≤0.01, r = 0.85, p ≤0.05, a number of missed doses on the Regimen Screen of the BMQ was r = 0.79; p ≤0.05; r = 0.81; p ≤0.05; r = 0.75, p ≤0.05, a number of non-adherent patients according to the BMQ was r = 0.83 (p ≤0.05), r = 0.88 (p ≤0.05), r = 0.79, p ≤0.05, the results of the pill count were r = 0.65-0.76; p ≤0.05-0.01. These data confirm high validity of the MASRI.Conclusion: The MASRI is a valid tool for rapid assessment of adherence to treatment of patients with BPO and OAB receiving Tamsulosin and antimuscarinic drugs and may be recommended for use in clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: The etiology of benign prostatic hyperplasia (BPH) remains a mystery to scientists; estrogen/androgen imbalance in aged men has been implicated.Methods: Thirty (30) apparently healthy men and newly diagnosed BPH patients were recruited from the Ghana Police Hospital. Lower urinary tract syndrome (LUTS) and prostate volume were assessed via the prostate symptom score sheet (IPSS) and abdominopelvic scan, respectively. Laboratory assays for total prostate specific antigen (tPSA) and hormones [androstenedione (AED), testosterone (T), dihydrotestosterone (DHT), androstanedioladiol (3α-adiol), androstanediol (3β-diol), estrone (E1) and estradiol (E2)] were performed via ELISA techniques. Non-parametric analyses were employed. p < 0.05 was considered significant.Results: AED was significantly higher in controls compared to the BPH patients. AKRIC2 (3α-diol/DHT) was significantly higher in the BPH group (p < 0.001) whiles AKRIC1 (3β-diol/DHT) was significantly lower. Estradiol was significantly higher in BPH (p= 0.029). Age correlated negatively with T, while a negative correlation was observed between TIPSS and 3β-diol and AKRIC1. Also, prostate volume correlated negatively with fT.tPSA correlated positively with E2 and aromatase activity (E2/T) and negatively with fT. On multiple linear regression, DHT and 3β-diol remained independent predictors for TIPSS and fT for tPSA.Conclusion: Estrogens and androstanediols seem to play a role in BPH development. [ABSTRACT FROM AUTHOR]

Introduction: We investigated if "thermobalancing" therapy (TT), using Dr Allen's therapeutic device (DATD) in men with benign prostatic hyperplasia (BPH), can aid in understanding the etiology and pathophysiology of BPH.Methods: We compared urinary and other parameters of BPH patients who received TT over 6 months (treatment group) with those of healthy volunteers who had not received the treatment (control group). Dynamics of symptoms and indicators in each group were evaluated in comparison with their data at the beginning and end of the study. Parameters were the International Prostate Symptom Score (IPSS) for urinary symptoms and quality of life (QoL), ultrasound measurement of prostate volume (PV) and uroflowmetry (maximum flow rate, Qmax). TT effectiveness was examined in 124 men with BPH and PV <60 mL. We also investigated the data of five patients with BPH and PV >60 mL.Results: TT decreased urinary symptoms and PV, increased Qmax and improved QoL in men with BPH, PV <60 mL, and in men with BPH, PV >60 mL.Conclusions: The present study demonstrated that TT is effective for BPH, suggesting that blood circulation plays a crucial role in its cause. The continuous heat exposure that does not exceed the normal body temperature terminates the trigger of BPH development, "micro-focus" of hypothermia, and the following spontaneous expansion of capillaries. TT could be considered to be a useful tool in BPH treatment. [ABSTRACT FROM AUTHOR]

Background: The prostate undergoes gradual growth throughout men's lives, resulting in development of lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH). The aim of this review was to determine whether Thermobalancing could be used for conservative treatment of LUTS/BPH. Methods and Results: Men older than 55 with LUTS derived to BPH used Thermobalancing therapy enabled by therapeutic device as mono-therapy. The main group consisted of 124 patients with the prostate volume (PV) up to 60 ml, however, there were also men with the prostate volume (PV) over 60 ml that were studied separately. Before and after six months Thermobalancing the International Prostate Symptom Score (IPSS) lessened (p < 0.001), quality of life (QoL) index improved, ultrasound PV reduced (p < 0.001) and uroflowmetry maximum flow rate (Qmax) increased (p < 0.001). The dynamics of the same measurements in the watchful waiting or active surveillance control group have shown negative outcomes. Discussion and Conclusions: The observed positive effect of therapeutic device for BPH has allowed us to recommend this side-effect-free therapy in watchful waiting or active surveillance approach. Therefore, Thermobalancing can be used as safe physiotherapeutic solution for men with enlarged prostate in order to reduce LUTS. [ABSTRACT FROM AUTHOR]

We prospectively evaluated erectile function (EF) using the Sexual Health Inventory for Men (SHIM) and the erectile hardness score (EHS) as well as urinary statuses using the International Prostate Symptom Score (IPSS) and Overactive Bladder Symptom Score (OABSS) before and 3, 6, and 12 months after a daily treatment with 0.5 mg dutasteride (DUT). Significant improvements were observed in IPSS and OABSS in 98 patients with the DUT treatment, and the effects were similar between 28 patients with potency with baseline SHIM of 8 or greater and 70 severe erectile dysfunction (ED) patients at baseline. In the 28 patients with potency, significant decreases were observed in SHIM and EHS after 3, 6, and 12 months of the DUT treatment, with the severity of ED according to SHIM deteriorating in half of these patients after 12 months of the DUT treatment. Eighteen out of 28 patients (64.3%) with potency at baseline had awareness of the occurrence of ED before the DUT treatment, were younger, and had higher SHIM and EHS just before the DUT treatment than their counterparts. Regular assessments of EF may be needed, especially in younger patients and those with higher levels of EF before the administration of DUT. [ABSTRACT FROM PUBLISHER]

Objective. The aims of this study were to explore the role of high-mobility group box 1 (HMGB1) in benign prostatic hyperplasia (BPH) and to perform a preliminary investigation of the mechanisms underlying BPH. Materials and methods. HMGB1 expression in 160 BPH cases was analyzed using immunohistochemistry. HMGB1 expression in primary prostate epithelial cells and the concentration of HMGB1 in the surrounding culture medium were detected by Western blotting and enzyme-linked immunosorbent assay, respectively. Cell proliferation was evaluated by the carboxyfluorescein succinimidyl ester (CFSE) dilution assay. Student's t test or a one- or two-way analysis of variance test, followed by Bonferroni post hoc analysis, were used to test differences between groups and time-course data. Results. HMGB1 expression was higher in BPH with prostatitis than in BPH alone and was positively correlated with prostate volume in BPH patients with prostatitis, but not in BPH patients without prostatitis. HMGB1 expression in primary prostate epithelial cells as well as its release into the extracellular environment increased when the cells were treated with the proinflammatory molecule lipopolysaccharide (LPS). In addition, HMGB1 overexpression promoted the proliferation of primary prostate epithelial cells under LPS stimulation, and this could be inhibited by the HMGB1 antagonist boxA. Conclusions. These findings provide novel insights into the pathogenic role of HMGB1 in BPH with prostatitis, and suggest that HMGB1 is a potential biomarker and therapeutic target for BPH. [ABSTRACT FROM AUTHOR]

Background: To evaluate the efficacy and safety of GreenLight HPS™ (High Performance System) laser photoselective vaporization prostatectomy (PVP) for the treatment of benign prostatic hyperplasia (BPH) in patients of different age groups. Methods: 164 consecutive patients were stratified into two groups: age <70 (group I, n == 93) and age ≥70 (group II, n == 71) years. Transurethral PVP was performed using a GreenLight HPS™ side-firing laser system. Voiding parameters were measured preoperatively and at 1 and 4 weeks and 3, 6, 12, 18, 24 and 36 months postoperatively. Results: Among the preoperative parameters evaluated, there were significant differences ( p < 0.05) in prostate volume (I: 58.7; II: 73.6 mL) and serum prostate-specific antigen (I: 1.9; II: 2.9 ng/mL), while American Urological Association Symptom Score (AUASS), Quality of Life (QoL), maximum flow rate (Qmax), Sexual Health Inventory for Men (SHIM) and post void residual (PVR) were similar ( p > 0.05) between groups. No significant differences in laser utilization, energy usage and operating time were noted. Clinical outcomes (AUASS, QoL, Qmax, PVR) showed immediate and stable improvement from baseline ( p < 0.05) within each group, but no significant differences between the two groups were observed during the follow-up period. The incidence of adverse events was low and similar in both groups. Conclusions: The results suggest that age has little effect on the efficacy and safety of GreenLight HPS™ laser PVP. [ABSTRACT FROM AUTHOR]

Senescence is one of the main aetiological factors which are responsible for natural androgen ablation in men and occurrence of prostatic diseases. However, it is unclear how the prostatic lesions are signallised in the prostate. Thus, the aim of this study is to characterise the structural, the ultrastructural and the proliferative aspects of the peripheral prostatic zone in the elderly men with and without diagnoses of prostatic lesions and with potential precursors of prostate cancer. Sixty samples of prostatic tissue, from 60 to 90-year-old patients with and without lesions obtained from autopsied or prostatectomised patients were divided into four groups (15 samples per group): standard group (no lesions), benign prostatic hyper-plasia group, high-grade prostatic intra-epithelial neoplasia group and prostatic carcinoma group. The samples were submitted to morphometrical, structural and ultrastructural analyses in addition to cellular apoptosis and proliferative analyses. The results showed morphological damages in the stroma and cellular organelles involved in the secretory process of the prostate. Moreover, the prostatic lesions in elderly men demonstrated disturbance in the proliferation/apoptosis rate, indicating a prevalence of the proliferative process. Finally, the imbalance in prostatic stroma-epithelium interaction was a harmful feature in the elderly men as a result of structural changes, which are crucial factors for the development and progression of carcinogenesis. [ABSTRACT FROM AUTHOR]

Objective. To evaluate the effect of intraprostatic botulinum toxin type A (BoNTA, Dysport™) injection on lower urinary tract symptoms, prostate-specific antigen (PSA), prostate volume (PV), peak urine flow rate ( Qmax) and postvoiding residue (PVR), and to evaluate the role of PV in the treatment outcome. Material and methods. Seventy-two men with PSA < 4 ng/ml, International Prostate Symptom Score (IPSS) ≥ 8, Qmax < 12 ml/s and PV < 60 ml were enrolled. A total of 300–600 U Dysport was injected transperineally under transrectal ultrasound guidance. Initial IPSS, quality of life (QoL) score, Qmax and PVR were compared with their measures at 1, 6 and 12 months after the injection. Initial PSA and PV were compared with their values after 6 months. Parameters were also compared between patients with PV ≤ 30 ml and those with PV > 30 ml. Results. The mean age of participants was 63.5 years. At follow-up sessions, IPSS and QoL score were significantly decreased ( p < 0.001). PVR reduced significantly and Qmax increased considerably ( p < 0.001). PSA and PV substantially decreased after 6 months ( p < 0.001). No serious complications were reported. Similar to patients with larger prostates, IPSS and QoL score decreased statistically significantly after 12 months in those with PV ≤ 30 ml; however, changes in PV, PSA, PVR and Qmax did not persist during 12 months' follow-up. Conclusions. The procedure is safe and efficacious and the results are comparable to previous experiences with Botox®. It seems that the toxin efficacy depends directly on PV in prostates < 60 ml. [ABSTRACT FROM AUTHOR]

Objective. This study evaluated the 5-year failure rate of naftopidil (NAF) or tamsulosin hydrochloride (TAM) in lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH/LUTS) and compared the prognostic factor of two α1-blockers. Material and methods. A total of 131 patients with International Prostate Symptom Score (IPSS) ≥ 8 or IPSS quality of life (IPSS-QOL) ≥ 3 with BPH/LUTS receiving treatment with α1-blockers had been administered NAF or TAM, and failure rates were calculated for 5 years. Age, prostate volume (PV), acute urinary retention (AUR), overactive bladder (OAB), IPSS, IPSS-QOL and postvoiding residual volume (PVR) were evaluated as prognostic factors. Results. No significant differences in failure rate were observed between the drugs. The failure rate was significantly high for patients with a PV ≥ 35 ml, PVR ≥ 30 ml, a history of AUR or complications of OAB symptoms. The failure rate for patients with a history of AUR was significantly higher than in those without AUR in the NAF group. By contrast, in the TAM group, it was significantly higher in patients who had OAB symptoms than in those without OAB. Conclusions. No significant differences were observed between the drugs for the failure rate. Each treatment had a unique factor for prognosis, such as history of AUR for NAF and complications of OAB for TAM. Therefore, it will be necessary to use the two α1-blockers properly, considering the patient's background. [ABSTRACT FROM AUTHOR]

Objective. To assess the efficacy and safety of propiverine hydrochloride (antimuscarinic), naftopidil (α1-adrenoceptor antagonist) or both in patients with male lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia and concomitant overactive bladder (OAB). Material and methods. Men aged at least 50 years who had a total International Prostate Symptom Score (IPSS) of 8 or higher and bladder dairy documenting micturition frequency (more than eight micturitions/24 h) and urgency (more than one episode/24 h), with or without urgency urinary incontinence were randomized into three groups: group N, naftopidil (50 mg once daily) only; group P, propiverine hydrochloride (20 mg once daily); and group NP, naftopidil (50 mg once daily) plus propiverine hydrochloride (20 mg once daily) for a 4-week treatment regimen. Results. A total of 66 men, including 20 in group N, 23 in group P and 23 in group NP, were treated and 58 (87.9%) completed the 4 weeks of treatment. IPSS improved significantly in groups N and NP. Urinary frequency improved significantly in groups P and NP. Postvoid residual urine volume increased significantly in groups P and NP. Significant improvements in urgency episodes were noted in each group. One patient in group P required catheterization owing to acute urinary retention and another stopped medication because of difficulty in voiding. Conclusion. These results suggest that each treatment showed effectiveness for male LUTS with OAB. However, there are some possibilities of adverse effects with propiverine hydrochloride monotherapy. [ABSTRACT FROM AUTHOR]

The effectiveness and safety of tamsulosin and terazosin for patients with benign prostatic hyperplasia (BPH) was evaluated by literature review. PubMed, Embase, the Cochrane Library, Chinese biomedicine literature database (CBM), reference lists of reports, and reviews were searched for randomized controlled trials (RCTs), or quasi-RCTs of tamsulosin versus terazosin in BPH. Twelve studies involving 2,816 men were included. Outcomes included international prostate symptom score (IPSS), quality of life (QOL), maximum urinary flow rate (Qmax), average urinary flow rate (Qave), residual volume, prostate volume, and adverse effect (dizziness, severe hypotension, dry mouth). Relative risk was calculated for dichotomous data. Sensitivity analyses assessed the influence of baseline symptom severity. We found that tamsulosin is better than terazosin when assessed by IPSS (weighted mean difference (WMD)=-1.24 95% CI [-1.98, -0.51], there was no significant difference between the two groups in QOL (WMD=0.04 95% CI [-0.16, 0.24]), Qmax (WMD=-0.38 95% CI [-1.18, 0.41]), Qave (WMD=-0.39 95% CI [-0.84, 0.06]), residual volume (WMD=-4.32 95% CI [-10.96, 2.33]), and prostate volume (WMD=-0.28 95% CI [-3.37, 2.81]). Fewer patients receiving tamsulosin experienced dizziness (relative risk (RR)=0.38 95% CI [0.30, 0.48]), severe hypotension (RR=0.16 95% CI [0.04, 0.68]), and dry mouth (RR=0.14 95% CI [0.03, 0.77]), compared with patients receiving terazosin. Many of the high quality RCTs showed beneficial effects of tamsulosin in terms of improving IPSS. However, whether tamsulosin proves more efficacious than terazosin in long term therapy requires confirmation by additional large sample, high quality trials. [ABSTRACT FROM AUTHOR]

Objective. The genitourinary tract is considered to be a target for the actions of sex steroid hormones. Decreased ovarian function and lack of estrogen after menopause are associated with lower genitourinary tract symptoms as well as bladder dysfunctions such as incontinence. Estrogen may also affect urothelial cells. The estrogen receptors (ERs) are found in the mucosa of the urinary tract. The purpose of this study was to culture human urothelial cells (HUCs) originating from urothelial tissue biopsies and to use them as a reproducible test platform to evaluate the effect of 17β-estradiol (E2). Material and methods. Urothelial tissue biopsies were obtained from 95 patients undergoing gynaecological open surgery for urinary incontinence, paediatric vesicoureteral reflux or transurethral resection of the prostate (TURP) for benign prostatic hyperplasia. HUCs originating from biopsies were cultured in vitro in the absence or in the presence of 0.1 nmol, 0.01 µmol and 1 µmol of E2. ER expression of the cultured HUCs was examined by Western analysis and immunofluorescence microscopy, which was also used for HUC characterization. The effect of E2 in the proliferation of the HUCs was determined by tetrazolium salt 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT)-assay. Results. HUCs were cultured successfully in four to six passages but there was variation between samples. The cultured cells showed expression of β4-integrin, E-cadherin and cytokeratins 7, 8, 9 and 19, indicating the epithelial origin of the cells. Both types of ERs, ERα and ERβ, were found in the in vitro cultured HUCs. E2 treatment of HUCs did not affect remarkably the expression of ERα but cell proliferation was induced. However, no concentration-dependent effect was seen. Conclusions. This study indicates that HUCs originating from small tissue biopsies can be cultured in several passages in vitro and could have potential in repairing or restoring urinary tract tissue by tissue engineering therapy. HUCs serve as a good in vitro test platform, as shown by analysing E2-treated HUCs. E2 induced the proliferation of cultured HUCs even though concentration dependency was not observed. The findings of this study may have relevance in determining the mechanisms of estrogen therapy in postmenopausal urinary tract symptoms and in the future development of tissue engineering technology. [ABSTRACT FROM AUTHOR]

Objective. Botulinum toxin A (BoNT-A) injections into the prostate have been reported to be effective and durable in the treatment of small benign prostatic hyperplasia (BPH). This study evaluated the effectiveness of BoNT-A in patients with large BPH with an unsatisfactory response to combined α-blocker and 5-α-reductase inhibitor therapy. Material and methods. Sixty patients with BPH and total prostate volume (TPV) of > 60 ml with unsatisfactory response to combination medical therapy were randomly assigned to receive add-on intraprostatic BoNT-A injection (n=30) or continued medical therapy (control group). Patients in the treatment group received 200-600 U of Botox® injected into the prostate. Outcome parameters including International Prostate Symptom Score (IPSS), quality of life index (QoL-I), TPV, maximum flow rate (Q max) and postvoid residual (PVR) were compared between treatment and control groups at baseline, 6 months and 12 months. Results. Significant decreases in IPSS, QoL-I and TPV, and increase in Q max were observed at 6 months and remained stable at 12 months in the treatment group. Improvements in IPSS and QoL-I were also observed at 6 months and a decrease in TPV at 12 months was noted in the control group. However, no significant changes in any parameters except for QoL-I at 6 and 12 months were noted between the treatment and control groups. Acute urinary retention developed in three patients receiving BoNT-A treatment. Three BoNT-A and two medical treatment patients converted to transurethral surgery at the end of study. Conclusions. This study shows that add-on prostatic BoNT-A medical treatment can reduce prostate volume and improve lower urinary tract symptom score and QoL-I within 6 months in the treatment of large BPH. However, the therapeutic effect at 12 months was similar to combination medical treatment. [ABSTRACT FROM AUTHOR]

Vascular endothelial growth factor (VEGF) is one of the most potent mitogenic factors stimulating both prostate endothelial and prostate epithelial cells. Recently, some studies reported on the endothelial secretion of a soluble VEGF receptor 2 (sVEGFR-2) that modifies the free VEGF concentration by binding VEGF. For the first time in this study, we report on the secretion and the regulation of the secretion of sVEGFR-2 by microvascular endothelial cells derived from the tissue of human benign prostatic hyperplasia (HPEC). HPEC were isolated and cultured from fresh prostate tissue. The prostate epithelial cell line BPH-1 was cultured with the supernatant of the HPEC cell culture (fractioned by fast protein liquid chromatography) and the VEGF concentration was subsequently measured. HPEC were incubated with VEGF or tumor necrosis factor α (TNF-α). Afterwards, the concentration of sVEGFR-2 in the supernatant of unstimulated and stimulated HPEC was measured by ELISA. HPEC showed a typical endothelial morphology. Under cell culture conditions sVEGFR-2 binds VEGF: The measured VEGF concentration in the supernatant of BPH-1 cells was reduced when the fractions of HPEC conditioned medium with the highest sVEGFR-2 concentration were incubated with the BPH-1 cells. The sVEGFR-2 secretion of HPEC was stimulated by VEGF and TNF-α. For the first time we report on the secretion of sVEGFR-2 by microvascular endothelial cells of prostate origin. The secretion of sVEGFR-2 by HPEC was stimulated by VEGF and TNF-α. Our data suggest that sVEGFR-2 secreted by prostate endothelial cells could modify the effect of VEGF on prostate endothelial and prostate epithelial cells. [ABSTRACT FROM AUTHOR]

The heterogeneous and multifactorial nature of prostate cancer that generates differential gene expression patterns in tumor cells leads us to investigate the molecular mRNA profiling of 14 genes through streptavidin-alkaline phosphatase-labeled RNA probes from tissue samples with prostate cancer and benign prostatic hyperplasia. Hybridizations were performed using cDNA amplification for each gene spotted onto positively charged nylon membranes and densitometry readings. The constitutive gene GAPDH was used to normalize the data. The methods developed in this study may be applicable to the prostate cancer diagnosis using AR, CEACAM-1, DD3 (also called PCA3), OPN-1, and PSMA significant differential expression. [ABSTRACT FROM AUTHOR]

Objectives: Several clinical studies have indicated that the rates of invasive growth and metastatic disease in cancer depend on the degree of hypoxia, which is mediated by hypoxia-inducible factor 1 α (HIF-1α). To determine its potential role as a marker for prostate cancer (CaP) diagnosis, HIF-1α mRNA levels were measured in blood samples of patients diagnosed with different stages of prostatic disease. Methods: HIF-1α mRNA levels were measured by quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) and correlated with accurate clinicopathological data. Quantitative data were compared with serum prostate-specific antigen (PSA) measurements to determine variations in the accuracy of the CaP diagnosis. Results: HIF-1α mRNA levels were significantly upregulated in patients with localized CaP (LocCaP; n=63; p<0.0001), compared with patients with no evidence of malignancy (NEOM) and benign prostatic hyperplasia (BPH) (n=35 for both patient groups combined). Receiver operator characteristic (ROC) curve analysis demonstrated that HIF-1α specificity for the NEOM/BPH diagnosis was 88.6%. Sensitivity for LocCaP was 74.6% with an overall diagnostic efficiency of 79.6%. Specificity of the NEOM diagnosis at PSA levels of 4.0 ng ml-1 was 28.6% and sensitivity of the LocCap diagnosis was 65.1%, demonstrating a reduced overall diagnostic efficiency, compared with that given by HIF-1α measurements, of 52.0%. Levels of HIF-1α in patients with metastatic CaP (MetCaP; n=27)) were similar to those in the NEOM/BPH group. Conclusions: HIF-1α is upregulated early in CaP development with subsequent downregulation at later metastatic stages. This study demonstrates increased accuracy of early-stage disease diagnosis using HIF-1α qRT-PCR compared with serum PSA measurements. HIF-1α may therefore be a useful adjunct, together with other diagnostic markers used in relative qRT-PCR and current diagnostic techniques (including serum PSA and PSA velocity) to minimize unnecessary biopsies indicated by elevated serum PSA levels alone. [ABSTRACT FROM AUTHOR]

Better knowledge of the bioavailability and metabolism of isoflavones in prostate tissue is needed to further investigate their mechanisms of action in the context of prostate cancer prevention. A total of 12 men with benign prostatic hyperplasia received soy extract supplementation (3 Evestrel® capsules, providing a total of 112.5 mg isoflavones aglycone eq/day) for 3 days before prostate surgery. Blood and prostate tissues were sampled and metabolites were identified using electrospray ionization liquid chromatography tandem mass spectrometry (LC-ESI-MS/MS) and chemically synthesized standards of glucuronidated isoflavones. The main metabolites were the same in prostate tissue and in plasma, namely, 2 monoglucuronides of daidzein and 2 monoglucuronides of genistein. Concentrations of total isoflavones measured in prostate reached 1.05 ± 0.62 nmol/g tissue (range 0.30-2.23) at the time of sampling, 12 h after the last isoflavone supplementation. At that time point, prostate concentrations were lower than plasma concentrations in all volunteers: 0.47 nmol/g vs. 0.66 μM for daidzein and 0.58 nmol/g vs. 0.78 μM for genistein. Isoflavone mechanisms of action should thus be investigated in in vitro cell studies using physiological conditions, intracellular concentrations below 5 nmol/g and no intracellular deconjugation of the monoglucuronide metabolites. [ABSTRACT FROM AUTHOR]

D-004 is a lipid extract of royal palm (Rosytonea regia) fruits that prevents prostate hyperplasia induced with testosterone in rodents. Previous studies have shown no D-004-related toxicity in rats, but no study in mice had been reported. D-004 (500, 1000, and 2000 mg/kg) was evaluated in a subchronic (eight weeks) study in NMRI mice. No evidences of treatment-related toxicity were detected. Thus, body-weight gain, clinical observations, food consumption, blood biochemical, hematology, organ-weight ratios, and histopathological findings were similar in control and treated groups. This study supports that D-004 orally administered up to 2000 mg/kg did not induce treatment-related toxicity. [ABSTRACT FROM AUTHOR]

Objectives. To evaluate morphological changes in the hyperplastic prostate tissue following transurethral microwave thermotherapy and to investigate the dependence of the treatment outcome on structural and physiological features of the prostate. Material and methods. In this prospective study, 13 patients with chronic urinary retention due to benign prostatic hyperplasia (BPH) underwent Coretherm (ProstaLund, Lund, Sweden) microwave thermotherapy. Prior to the treatment and 1 week and 6 months after, the patients were examined with MRI using morphologic, contrast medium-enhanced perfusion and diffusion-weighted imaging. Such advanced MRI techniques permit an assessment of parameters that have a hypothetical influence on microwave thermotherapy (e.g. prostate blood perfusion, water content and prostate microstructure). Results. Morphologic and perfusion MRI showed a clear prostatic tissue defect in all 13 patients after 1 week and in all 12 patients at 6 months' follow-up. The mean size of the defect was 22.5 cm3 (27%) (range 3.7-47.3 cm3) and 4.1 cm3 (1.1-10.1 cm3) at 1 week and 6 months, respectively. The cell kill volume was estimated to be 20.5±7.4 cm3 and correlated significantly with the size assessed by MRI at 1 week (r=0.8; p=0.002) and 6 months (r=0.69; p=0.05). At 6 months, the mean decrease in prostate volume was 20.1 cm3 (p<0.0001). The microstructure of the prostate expressed as the apparent diffusion coefficient was shown to have a strong influence on the treatment process. All patients (n=12) were catheter-free at 6 months. Another patient experienced persistent obstruction and underwent transurethral resection of the prostate. Conclusions. Coretherm microwave treatment leads to significant intraprostatic necrosis, which is detectable with MRI even 6 months after the treatment. Diffusion-weighted MRI is capable of identifying structural features of the prostate that can predict the length of treatment and the amount of energy needed. [ABSTRACT FROM AUTHOR]

Objective. To determine whether subjective or objective seasonal changes occur in patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). Material and methods. A total of 31 patients with LUTS were observed for >5 years. Their International Prostate Symptom Score (IPSS), quality of life (QOL) score, maximum flow rate (Qmax), voided volume (VV) and post-void residual (PVR) were measured every month. Results. Total IPSS, QOL, VV or PVR did not show any seasonal changes between the three seasons: summer (hot season: June to September); winter (cold season: December to March); and spring and fall (comfortable season: April, May, October and November). Furthermore, when the IPSS was examined by dividing it into storage symptoms (frequency, urgency and nocturia) and voiding symptoms (incomplete emptying, intermittency, weak stream and straining), no significant seasonal changes were detected. Only Qmax showed a significant seasonal change, being higher in both the cold season (median 10.4 ml/s) and the comfortable season (median 10.1 ml/s) than in the hot season (median 9.4 ml/s). Conclusions. It has generally been thought that LUTS worsen in winter. Our results indicate that the IPSS and the QOL score remain nearly constant if they are determined regularly over an extended period of time. Qmax may however be influenced by seasonal changes in temperature. [ABSTRACT FROM AUTHOR]

Finasteride is a specific inhibitor of the 5α reductase enzyme originally approved for the treatment of benign prostatic hypertrophy and also for the treatment of androgenetic alopecia (AGA) in men at a dose of 1 mg/day. We report on three cases of young men recruited at our Centre for Male Infertility who had used finasteride for five years. Semen quality was investigated by light microscopy to evaluate sperm concentration and motility. Sperm morphology was performed by transmission electron microscope (TEM) and the data were analyzed. The presence of Y microdeletions was investigated by PCR. Meiotic segregation was explored by fluorescence in situ hybridization (FISH). Patient 1 was azoospermic, patients 2 and 3 showed a normal sperm concentration and severely reduced progressive motility. TEM analysis revealed altered sperm morphology consistent with necrosis and FISH data revealed elevated diploidy and sex chromosome disomy frequencies. This examination was repeated 1 year after the men had suspended the use of finasteride, without receiving any other treatment. A recovery of spermatogenetic process was observed. Motility and morphology improved whereas the meiotic pattern did not change presenting elevated diploidy and sex chromosome disomy frequency. [ABSTRACT FROM AUTHOR]

Objective. To estimate and compare the costs of dutasteride, finasteride, tamsulosin and transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH) from a Norwegian health service perspective. Material and methods. A Markov model was developed to estimate the clinical progression that a cohort of 1000 men would undergo and the care they would receive over 4- and 15.5-year periods. Transitions between health states [BPH symptoms, improvement in symptoms, acute urinary retention (AUR), TURP, prostate cancer and death] were estimated from the published literature and knowledge of the Norwegian healthcare system. Sensitivity analyses were conducted of indirect costs, discount rates, the costs and probabilities of AUR and TURP and the probability of symptom improvement. Results. The total costs of BPH management for patients initially treated with dutasteride, finasteride, tamsulosin or TURP at 4 years were NOK 13 946 (€1703), NOK 16 111 (€1967), NOK 16 833 (€2054) and NOK 46 309 (€5655), respectively and at 15.5 years NOK 32 137 (€3924), NOK 37 173 (€4539), NOK 40 528 (€4946) and NOK 50 471 (€6164), respectively. One- and multi-way sensitivity analyses did not significantly alter the relative order of the total costs. Conclusions. Given the conservative nature of the model and the robustness of the sensitivity analysis, it is concluded that dutasteride is less costly than finasteride, TURP or tamsulosin at both 4 and 15.5 years. Therefore, considering cost containment restraints in Norway, dutasteride is an appropriate choice of therapy for patients with moderate/severe symptoms and an enlarged prostate (>30 ml). [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to compare costs and treatment patterns between men with concomitant benign prostatic hyperplasia (BPH) and CVD to men with CVD (but not BPH).Study design: A retrospective, matched cohort study was utilized to assess costs and treatment between two study populations.Methods: The data source was administrative claims from managed care organizations between January 1, 1997 and December 31, 2004. A control group of men with CVD only was created matching by age, index CVD diagnosis date, and CVD diagnoses. Diagnosis and procedure codes identified men with BPH and CVD. Differences in medical costs, co-morbidities, and drug treatments were assessed.Results: Approximately 39% of men identified with BPH also had some form of CVD at the time of BPH diagnosis. Men with BPH and CVD were more likely to have additional co-morbidities, more frequently received medications for CVD and non-CVD disorders, had 44% higher total medical costs than men with CVD only (p < 0.001), and had 42% higher CVD-related costs (p < 0.001) than men with CVD only.Limitations: The population studied in this analysis was primarily working individuals with health benefits provided by managed care plans; therefore, the results may not generalize to other populations.Conclusions: This study demonstrates in a commercial payer population that men with concomitant BPH and CVD have more co-morbidities, receive pharmacologic agents more frequently, and have higher health care resource utilization than men with CVD only. Due to the high prevalence of co-morbid BPH and CVD, screening for BPH in men presenting with CVD may assist with earlier disease identification and cost management over time. [ABSTRACT FROM AUTHOR]

Objectives. Firstly, to describe self-reported urinary symptoms and bothersomeness, including disease-specific quality of life (QOL), in patients with symptomatic benign prostatic obstruction (BPO) before and 6 months after intervention. Secondly, to identify factors which predict disease-specific QOL. Thirdly, to develop and test the reliability of an instrument to evaluate incontinence, the Linköping Incontinence Questionnaire (LIQ). Finally, to translate and test the reliability of Swedish versions of the International Prostate Symptom Score, including the bother question, the American Urological Association Symptom Problem Index (SPI) and the Benign Prostatic Hyperplasia Impact Index. Material and methods. Disease-specific QOL was studied in 572/720 consecutively treated patients using structured questionnaires. The reliability of the instruments was tested in 122 patients with lower urinary tract symptoms (LUTS) or BPO. Results. The frequency and weak stream items of the SPI were among those that best explained the patients' disease-specific QOL both before and after intervention. Before and after intervention the prevalence of urinary incontinence, assessed using the LIQ instrument, was 46% and 16%, respectively. Symptoms and disease-specific QOL improved most in the surgery group, intermediately in the transurethral incision of the prostate/transurethral microwave thermotherapy group and least in the drug therapy group. Conclusions. The frequency and weak stream items of the SPI were the factors that best explained disease-specific QOL. The prevalence of incontinence before and after intervention was higher than that previously reported. [ABSTRACT FROM AUTHOR]

Dear Editor, With the great interest in the recent-online article entitled "High serum concentration of estradiol may be a risk factor of prostate enlargement in aging male in China", we found some significant question that need to discuss [[1]]. The authors in the paper found that serum estradiol (E2) levels in the patients with larger prostate volume was also significantly high than these with smaller prostate volume [[1]]. [Extracted from the article]

Objective. We compared the 2-year safety and efficacy of two transurethral resection techniques—transurethral vapor resection of the prostate (TUVRP) and conventional loop transurethral resection of the prostate (TURP)—in the surgical management of benign prostatic hyperplasia. Material and methods. Between August 1997 and September 2002, 441 patients underwent transurethral prostatectomy, either TUVRP (n=221) or TURP (n=220). TUVRP was performed using a “RollerLoop” resection loop. All patients were assessed preoperatively by means of International Prostate Symptom Score (IPSS), quality of life (QOL) score, prostate volume, peak urinary flow (Qmax) and post-void residual volume (PVR) measurements and a sexual function questionnaire. Patients were followed up for 3, 6, 12 and 24 months after surgery, and this was followed by a comparison of the incidences of sexual dysfunction, complications and re-treatment. Results. After 2 years of follow-up, no differences were noted between the TUVRP and TURP groups with respect to average IPSS (p&VeryThinSpace;=&VeryThinSpace;0.9), QOL scores (p&VeryThinSpace;=&VeryThinSpace;0.56), Qmax (p&VeryThinSpace;=&VeryThinSpace;0.89) or PVR (p&VeryThinSpace;=&VeryThinSpace;0.55), as well as the incidences of bladder neck contracture or urethral stricture (p&VeryThinSpace;=&VeryThinSpace;0.34), re-treatment (p&VeryThinSpace;=&VeryThinSpace;0.49) or sexual dysfunction (p&VeryThinSpace;=&VeryThinSpace;0.57). However, significant reductions in operative time (p&VeryThinSpace;=&VeryThinSpace;0.005), decrease in serum hemoglobin levels (p&VeryThinSpace;<&VeryThinSpace;0.001), catheterization time (p&VeryThinSpace;<&VeryThinSpace;0.001), postoperative hospital stay (p&VeryThinSpace;<&VeryThinSpace;0.001) and hospitalization costs (p&VeryThinSpace;<&VeryThinSpace;0.001) were observed in the TUVRP group compared to the TURP group. Conclusion. Our results suggest that TUVRP provides equivalent safety and efficacy to TURP during a 2-year follow-up period, in which short-term advantages in perioperative morbidity and cost savings were also demonstrated. [ABSTRACT FROM AUTHOR]

Objective. To examine factors affecting prostatic growth in young men treated for cryptorchidism in childhood. Material and methods. Prostatic volume was measured in 76 formerly cryptorchid 16–28-year-old men treated by means of orchidopexy and/or hormonally for cryptorchidism in childhood. Correlations between prostatic volume and different hormonal parameters, sperm quality and body dimensions were investigated. Results. There were no significant correlations between adult prostatic volume and age, body dimensions or testicular size. There was, however, a significant positive correlation between prostatic volume and semen volume (R=0.341; p=0.0143), as well as a negative correlation between prostatic volume and serum testosterone concentration (R=0.459; p=0.0008). There was a trend towards smaller prostatic volumes in men who had received human chorionic gonadotropin as hormonal treatment than in those who had been treated with surgery only (median 9.5 vs 12 ml; p=0.1595). Conclusions. Measured prostatic volumes were small in previously cryptorchid men. However, small prostatic volumes did not result from low testosterone levels. [ABSTRACT FROM AUTHOR]

Objective . To investigate the effects of mepartricin, a polyene macrolide antibiotic, on estrogen-induced hyperplastic prostate and seminal vesicle (SV) growth in castrated rats. Material and methods . Immature rats aged 3 weeks were castrated and left untreated for 1 week. Then, 17β-estradiol benzoate (E 2 -BA) was subcutaneously injected at a dose of 10 µg/day twice weekly, and mepartricin was orally administered at doses of 2.5, 5 and 10 mg/kg once daily for 3 weeks. The weights and hydroxyproline contents of the prostate and SV, the activity of growth factors (GFs) in the dorsolateral prostate (DLP) and the serum estrogen level were measured. Histological examination of the prostate and SV was also performed. Results . Mepartricin dose-dependently suppressed the increase in the serum estrogen level, the weights and hydroxyproline contents of the DLP and SV and the elevation of GF activity in the DLP induced by E 2 -BA treatment. Histological examination also revealed that treatment with mepartricin reduced collagen accumulation and thickening of the smooth muscle layer in the DLP and SV, and proliferation of the glandular epithelium in the DLP. Conclusions . These results suggest that mepartricin suppresses hyperplastic growth of the DLP and SV induced by estrogen in immature castrated rats, the underlying mechanism being a reduction in the serum estrogen level, thereby suppressing stromal cell proliferation and activation. [ABSTRACT FROM AUTHOR]

Objective To study the characteristics of patients with incidental prostate cancer. Material and methods The proportion of incidentally diagnosed prostate cancer was investigated in patients who underwent transurethral resection of the prostate (TURP) at our clinic over a 5-year period. "True" incidental prostate cancer was defined as cases where the preoperative digital rectal examination (DRE) and the prostate-specific antigen (PSA) value were normal. Patients with known malignancy of the prostate were excluded, together with those with PSA >4 ng/ml and/or a positive DRE. The characteristics of these patients were compared to those of benign prostatic hyperplasia patients and the group as a whole. Results Of the 786 patients operated on between 1999 and 2003, 34 (4.3%) had a positive pathology report for "true" incidental prostate cancer. An increased frequency of poorly differentiated tumors (32.3%) was noted. Of the 34 patients, 17 were stage T1a and 17 T1b; 11 patients had a Gleason sum of 7-10, all of them in the T1b group. In the T1b group the mean age was 74 years, the mean PSA level 2.9 ng/ml and the mean weight of tissue resected 11.1 g. Corresponding values in the T1a patients were 70.1 years, 3.32 ng/ml and 18.2 g. Conclusions Compared to previous studies, we noticed a low incidence of "true" incidental prostatic carcinoma but a high ratio of poorly differentiated tumors (all stage T1b). Compared to the group as a whole, patients with incidental prostate cancer were older and had smaller prostate and transition zone volumes. Further research is needed to identify parameters that may aid in the earlier identification of incidental prostate cancer, as patients may benefit from curative treatment. [ABSTRACT FROM AUTHOR]

Six microsomal populations of estradiol and androgen receptors have been characterized in human benign prostatic hypertrophy (BPR) and prostate cancer (PCa). Estradiol receptor (ER) and androgen receptors (AR) were extracted using O.6M KGL and determined by the dextran-coated charcoal method. ER and AR levels were smaller in BPI-1 plasma membranes (PM) than in PCa cases. For fractions 3, 4, 5, the ER values in PCa were 25-38% less with regard to BPH ER values. Whereas in PCa, AR values obtained in all fractions were higher when compared to BPH AR values. In benign prostatic hypertrophy and prostatic cancer, ER and AR levels were significantly higher in the nuclear fraction. In the nuclear fraction, ER and AR levels in BPH and PCa were significantly different. The subcellular distribution of AR and ER in BPH and PCa constitutes a reservation mechanism and processing of receptors for their continued growth. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the importance of transition zone (TZ) biopsy in benign prostatic hyperplasia (BPH) patients with serum prostate-specific antigen (PSA) >10 ng/ml and prior negative peripheral zone (PZ) biopsy and to estimate the sensitivity of TZ biopsy. Material and methods A total of 273 BPH patients with PSA >10 ng/ml and prior negative PZ biopsy underwent an extended biopsy protocol. In patients with a TZ volume <25 cm 3 , four TZ biopsies were taken (two cores per side from the apex and base). In patients with a TZ volume ≥25 cm 3 ( n =183), six TZ biopsies were taken (three cores per side from the apex, middle and base). Overall, 215 patients were subjected to either transurethral resection of the prostate ( n =162) or open enucleation of the adenoma ( n =53). Results The extended biopsy revealed prostate cancers in 21.2% of cases (58/273). The zonal distribution of the positive cores was as follow: PZ cancers only in 67.2% of cases (39/58), TZ cancers only in 13.8% (8/58) and PZ+TZ cancers in 19% (11/58). Overall, 73.6% (14/19) and 36.8% (7/19) of TZ cancers were detected at the apex and middle of the TZ, respectively, while no TZ cancers at all were detected at the base ( p =0.00015). The incidence of carcinoma on definitive pathology was 5.6% (12/215). Consequently, TZ biopsy detected only 61.3% (19/31) of TZ cancers. The incidence of pure TZ cancers was 7.3%. On the χ 2 test, patient age, serum PSA, transrectal ultrasonography findings and PSA density did not correlate significantly with the detection rate of TZ cancer. Prostate volume ( p =0.023), TZ volume ( p =0.027) and PSA/TZ density ( p =0.007) were predictive of TZ cancers. Conclusions Although TZ biopsy was the sole site of cancer in only 2.9% of cases (8/273), it improved the cancer detection rate by 14% in this selected group of patients. The majority (74%) of TZ cancers were detected at the apex site. TZ biopsy has a low sensitivity (61%). [ABSTRACT FROM AUTHOR]

Estradiol and androgen receptor levels were determined in benign prostatic hypertrophy tissue by means of dextran-coated charcoal method. 80% of the cases contained estrogen receptor, whereas 85% of cases contained the androgen receptor. In 50 year old patients, nuclear estradiol and androgen receptors were 48% and 34% higher than the cytosolic values, respectively, whereas in 70 year old patients, the levels of nuclear estradiol and androgen receptors were 6% and 57% higher than the cytosolic values, respectively. Nuclear androgen receptor in 50 year old patients was 34% higher than the estradiol receptor, and in 70 year old patients, androgen receptor was 23% higher than the estradiol receptor. Cytosolic values of estrogen receptor in 50 year old patients were diminished 50%, whereas in 70 year old patients, the ER value was increased 40% with regard to androgen receptor. On the other hand, estradiol receptor values measured in microsomal fractions, and were higher when compared to androgen receptor levels (mean percentage±50%). These findings suggest that the biological effects due to the subcellular distribution of AR or ER and that their microsomal distribution would constitute a reserve mechanism and activation of receptors for the continued growth of benign prostatic hypertrophy. [ABSTRACT FROM AUTHOR]

Prostate growth seems to be influenced by paracrine factors like endothelin-1 (ET-1), originating from the microvascular endothelium. Recently, we reported on the first isolation and primary culture of microvascular endothelial cells (HPEC) derived from tissue of human benign prostatic hyperplasia (BPH). Therefore, direct investigation of growth factor secretion by HPEC is now possible. BPH tissue was cut into small cubes and gently squeezed after incubation with dispase. HPEC were cultured from the resulting cell suspension after a stepwise selection by use of superparamagnetic beads coated with antibodies against endothelial specific antigens. HPEC were characterized by flow cytometry. After the incubation of HPEC either with vascular endothelial growth factor (VEGF), tumor necrosis factor α (TNF-α), or adenosine triphosphate (ATP), the secretion of ET-1 was measured by ELISA. HPEC showed a typical endothelial morphology. They were positive for von Willebrand factor and CD31. The ET-1 secretion of HPEC was inhibited by VEGF, but was unaffected by TNF-α or ATP. Furthermore, histochemistry revealed that in vivo microvascular endothelial cells were negative for ET-1. Because of the suppression by the widespread VEGF, it is unlikely that ET-1 from the microvascular endothelium acts as a growth factor in human BPH. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the intensity of lower urinary tract symptoms in patients with benign prostatic hyperplasia (BPH) with and without diabetes. We also determined whether α1-blockers improve subjective and objective symptoms similarly in these patients. Material and Methods: The study subjects comprised 281 patients (60 with diabetes and 221 non-diabetics with clinically diagnosed BPH) who were treated with α1-blockers (doxazosin, terazosin, alfuzosin and tamsulosin). The international prostate symptom score (IPSS), bother score, maximum flow rate (Qmax) and post-void residual urine volume (PVR) were determined at baseline and after treatment for a minimum of 6 months. Results: Diabetic patients had a lower baseline Qmax than non-diabetics ( p < 0.001), while the IPSS, bother score and PVR did not differ significantly between the two groups. After treatment with α1-blockers, lower urinary tract symptoms improved significantly. The improvement rates of the IPSS and bother score were significantly higher in the diabetic patients than in the non-diabetics ( p < 0.01). The relationship between the duration of diabetes and the effect of α1-blockers on IPSS, bother score, Qmax and PVR was not statistically significant ( p > 0.05). Conclusions: The voiding function of the bladder may be more affected by diabetes than the storage function in patients with BPH. Treatment with α1-blockers appears to be useful for diabetic patients with BPH and its effectiveness is not altered by the duration of diabetes. [ABSTRACT FROM AUTHOR]

N -(Dicyclohexyl)acetyl-piperidine-4-benzylidene-4-carboxylic acid ( 1 ), although a very potent in vitro 5α-steroid reductase (5αR) type 2 inhibitor, showed only marginal in vivo activity in rats. Since this could be due to hindered cellular uptake of the carboxylic acid, acid ( 1 ) and its corresponding methyl ester ( 1a ) were compared with respect to their permeation properties. In the parallel artificial membrane permeation assay (PAMPA), 1a showed a higher %flux of 55 versus 6 for 1 . Considering the high potency of 1 and better permeation of 1a , the use of 1a as a prodrug for 1 was explored using the human prostate carcinoma cell line DU145. Esterase activity, a prerequisite for this prodrug concept was detected employing 4-nitrophenyl acetate (4-NPA) as a substrate. After incubation of DU145 cells with 1 and 1a , respectively, permeated 1a and its hydrolysis to 1 were unequivocally observed by MALDI-TOF MS analyses, whereas 1 could not be detected inside the cells above the detection limit. Regarding biological activity, 1a showed a stronger inhibition of 5αR in intact DU145 cells than 1 (IC 50 values, 4 μM and >10 μM for 1a and 1 , respectively). These results suggest that the in vivo activity of 1 might be increased by the use of its methyl ester prodrug 1a . [ABSTRACT FROM AUTHOR]

The prostate has only one function, namely to secrete fluid containing substances that are needed for reproduction. This requires an extremely high concentration of androgens in the tissues. Benign prostatic hypertrophy (BPH) seems to be related to the long-term exposure of the prostate to the strong androgen 5alpha-dihydrotestosterone (DHT) and, possibly, to estrogens. The relation between prostate cancer and androgens is suggested to be U-shaped, with both extremes of androgen concentrations being associated with increased risk of invasive cancer. In the treatment of patients with BPH, the lipidic liposterolic extracts of Serenoa repens were as effective as the pharmaceutical inhibitors of the 5alpha-reductase enzyme or alpha1-adrenergic blockers in relieving urinary symptoms. In addition to moderately inhibiting the 5alpha-reductase activity, Serenoa seems to exert anti-inflammatory and complementary cellular actions with beneficial effects on the prostate. Unlike the pharmaceutical 5alpha-reductase inhibitors, finasteride and dutasteride, Serenoa does not suppress serum PSA, facilitating the follow-up and the early detection of prostate cancer. We suggest a strategy to prevent prostate cancer that aims at providing men with partial androgen deficiency correct testosterone substitution with a sustained release buccal bio-adhesive tablet. In addition, food supplementation with extracts of Serenoa repens and a combination of the antioxidants selenium, (cis)-lycopene and natural vitamin E, together with fish oil rich in long-chain polyunsaturated essential fatty acids of the omega-3 group seems warranted. Clearly, a holistic approach including careful clinical and biological monitoring of the aging man and his prostate remains mandatory. [ABSTRACT FROM AUTHOR]

The successful management of BPH with minimally invasive thermal therapies requires a firm understanding of the temperature-time relationship for tissue destruction. In order to accomplish this objective, the present in vitro study assesses the cellular viability of human BPH tissue subjected to an experimental matrix of different temperature-time combinations. Hyperplastic prostate tissue was obtained from 10 radical prostatectomy specimens resected for adenocarcinoma. A portion of hyperplastic tissue from the lateral lobe of each prostate was sectioned into multiple 1 mm thick tissue strips, placed on a coverslip and thermally treated on a controlled temperature copper block with various temperatures (45-70°C) for various times (1-60 min). After heat treatment, the tissue slices were cultured for 72 h and viability was assessed using two independent assays: histology and dye uptake for stromal tissue and using histology alone for the glandular tissue. The hyperplastic human prostate tissue showed a progressive histological increase in irreversible injury with increasing temperature-time severity. The dye uptake and histology results for stromal viability were similar for all temperature-time combinations. In vitro thermal injury showed 85-90% stromal destruction (raw data) of human BPH for temperature-time combinations of 45°C for 60 min, 50°C for 30 min, 55°C for 5 min, 60°C for 2 min and 70°C for 1 min. Apoptosis was also identified in the control and milder treated tissues with the degree of glandular apoptosis (about 20%) more than that seen in the stromal regions (<5%). The Arrhenius model of injury was fitted to the data for conditions leading to a 90% drop in viability (normalized to control) obtained for stromal tissue. The activation energies ( E ) were 40.1 and 38.4 kcal/mole for the dye uptake study and histology, respectively, and the corresponding frequency factors ( A ) were 1.1 × 10 24 and 7.78 × 10 22 /s. This study presents the first temperature-time versus tissue destruction relation for human BPH tissue. Moreover, it supports the concept that higher temperatures can be used for shorter durations to induce tissue injury comparable with the current clinically recommended lower temperature-longer time treatments (i.e. 45°C for 60 min) for transurethral microwave thermotherapy of the prostate. [ABSTRACT FROM AUTHOR]

Analyzes the efficacy of African plum for the treatment of benign prostatic hypertrophy (BPH). Symptoms of BPH; Complications of untreated BPH; Active components of the plum.

This paper describes the design, construction and evaluation of a two-dimensional ultrasound phased array to be used in the treatment of benign prostatic hyperplasia. With two-dimensional phased arrays, the focal point position can be controlled by changing the electrical power and phase to the individual elements for focusing and electronically steering in a three-dimensional volume. The array was designed with a steering angle of ±14° in both transverse and longitudinal directions. A piezoelectric ceramic (PZT-8) was used as the material of the transducer, since it can handle the high power needed for tissue ablation and a matching layer was used for maximum acoustic power transmission to tissue. Analysis of the transducer ceramic and cable impedance has been designed for high power transfer with minimal capacitance and diameter. For this initial prototype, the final construction used magnet compatible housing and cabling for future application in a clinical magnetic resonance imaging system for temperature mapping of the focused ultrasound. To verify the capability of the transducer for focusing and steering, exposimetry was performed and the results correlated well with the calculated field. Ex vivo experiments were performed and indicated the capability of the transducer to ablate tissue using short sonications. For sonications with exposure time of 10, 15 and 20 s, the lesion size was roughly 1.8, 3.0 and 4.3 mm in diameter, respectively, which indicates the feasibility of this device. [ABSTRACT FROM AUTHOR]

With the recent availability of transdermal formulations, androgen supplementation therapy is increasingly being prescribed for men in their 50s and 60s. With the growing use of testosterone products, there is concern about the long-term risks of androgen supplementation therapy, particularly on the prostate. This article reviews what is known about the safety of testosterone replacement therapy in terms of the potential risks for development of symptomatic benign prostatic hypertrophy (BPH) and prostate cancer. Androgens are undoubtedly involved in the growth of benign prostatic nodules, as a permissive factor in the etiology of prostate carcinoma and in the enhancement of the growth of active prostate cancer. Their role in the initiation of either disease is less clear. Available data support the safety of such treatment in the short term. Caution is still advised in the interpretation of these findings, as the studies producing the data have involved relatively small numbers of participants. Until large, long-term, placebo-controlled studies have been conducted and analyzed, questions about the long-term safety of testosterone supplementation therapy in older men will remain. [ABSTRACT FROM AUTHOR]

To investigate whether the pre- and post-operative International Prostate Symptom Score (IPSS) change predicts the outcome of transurethral prostatectomy in a Taiwanese population, 99 patients (transurethral prostatectomy candidates) were assessed with the IPSS before and 6-12 months after surgery. All symptoms improved significantly postoperatively. Patients with a greater preoperative IPSS benefited the most. Improvements in preoperative obstructive symptoms (incomplete emptying, intermittency, straining, and weak stream) were greater than those in irritable symptoms (urgency, frequency, and nocturia). A significant correlation was found between IPSS and quality of life (QOL) before and after transurethral prostatectomy. A change of 1 unit on the IPSS scale was found to decrease the QOL score 0.282 units. The positive predictive value of a ≥7-IPSS point decrease depended on the predictive IPSS criteria applied. When the preoperative IPSS was more than 17, the sensitivity was 83.5% and specificity was 30%. Postoperative improvement did not differ significantly between acute urinary retention (AUR) and non-AUR patients. Change in IPSS of more than 7 points predicted symptomatic improvement with high sensitivity. The predictive value depends on the definition of significant improvement (magnitude of IPSS change) and on the level of IPSS symptoms (sufficient to warrant transurethral prostatectomy). [ABSTRACT FROM AUTHOR]

Benign prostatic hyperplasia (BPH) is one of the most common diseases in elderly men. It describes an overgrowth of the epithelial and fibromuscular tissues in the human prostate, in which both epithelium and stroma continue to proliferate at different rates. There is lack of suitable techniques for direct evaluation of the biophysical structure of molecular constituents and the proliferative changes in the structure of both compartments at the microscopic level. Reflectance Fourier transform infrared (FT-IR) microspectroscopy was used to pathologically image and examine the structural changes in the proliferation of epithelial and stromal tissues of human BPH. Two successive thin tissue slices were obtained by cutting the tissue with a microtome: one unstained slice was used for FT-IR spectroscopic analysis and the other stained slice was used for position referencing. The result indicates that the amide I maximum for BPH epithelial tissue was near 1,638 cm[sup -1] and showed its protein secondary structure by a combination of unordered and β-sheet structures. However, an intense absorption band of amide I was at 1,630 cm[sup -1] for stromal BPH tissue due to the predominant β-sheet structure. The higher peak intensity of several IR bands at 1,337, 1,281, 1,238, 1,206, 1,055, and 1,034 cm[sup -1], assigned to the C-O stretching mode of collagen, was observed in BPH stromal tissue. This suggests that the obvious collagen will be more enriched in the stroma of BPH tissue. [ABSTRACT FROM AUTHOR]

Objective: Whether there is an association between the development of benign prostatic hyperplasia (BPH) and clinical prostate cancer is controversial. The present report tests the hypothesis of an association between BPH growth and the development of clinical prostate cancer by examining stage, grade and PSA-level in men with recently discovered clinical prostate cancer with slow or fast-growing BPH. If the hypothesis is true, men with fast-growing BPH would have a more advanced clinical prostate cancer. Material and Methods: Two hundred and twenty patients in whom a clinical prostate cancer was diagnosed were consecutively included. The prevalence of atherosclerotic disease, non-insulin-dependent diabetes mellitus (NIDDM) or treated hypertension was provided by the respective patient's medical history. Tallness, body weight, waist measurement, hip measurement and blood pressure were determined. The body mass index (BMI) and waist/hip ratio (WHR) were calculated. Blood samples were drawn to determine triglycerides, total cholesterol, HDL-cholesterol, LDL-cholesterol, uric acid, ALAT and the fasting plasma insulin level. The prostate gland volume was measured using transrectal ultrasound. The annual BPH growth rate was calculated, assuming that the total prostate gland volume was 20 mL at the patient age of forty. The prostate cancer diagnosis was established using the technique of transrectal ultrasound-guided automatic needle biopsy of the prostate. Results: Men with clinical prostate cancer, PSA <50 ng/mL, and with fast-growing BPH had a higher systolic (p = 0.009) and diastolic (p = 0.020) blood pressure, were taller (p < 0.001) and more obese, as determined by body weight (p < 0.001), BMI (p = 0.005), waist measurement (p < 0.001) and hip measurement (p = 0.003). They also had a higher fasting plasma insulin level (p = 0.014) and a lower HDL-cholesterol level (p = 0.067) than men with slow-growing BPH. Moreover, men with clinical prostate cancer, PSA <50 ng/mL, and fast-growing BPH had more pronounced clinical prostate cancer, as measured by grade (p = 0.029) and PSA-level (p = 0.016), than men with slow-growing BPH. In the total material, including men with clinical prostate cancer, PSA ≥50 ng/mL, men with fast-growing BPH also had a higher prevalence of NIDDM (p = 0.039) and a borderline statistical significance for higher stage (p = 0.09) than men with slow-growing BPH. The BPH growth rate was significantly associated with the clinical prostate cancer grade (p = 0.018) and PSA-level (p = 0.002) but not with the clinical cancer stage in a multivariate statistical analysis. Conclusions: This report confirms findings in previous studies that fast-growing BPH is a risk factor for NIDDM, hypertension, tallness, obesity, dyslipidaemia and hyperinsulinaemia. The present report extends this list of risk factors to include atherosclerotic disease manifestations, hyperuricaemia and higher ALAT levels. The study suggests that fast-growing BPH is a risk factor for developing clinical prostate cancer and, thus, supports the hypothesis of an association between the development of BPH and clinical prostate cancer. The study generates the hypothesis that clinical prostate cancer is a component of the metabolic syndrome and that insulin is a promoter of clinical prostate cancer. [ABSTRACT FROM AUTHOR]