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Tissue changes and the enlargement of the prostate, whether benign or malignant, are among the most common groups of diseases that affect men and can have significant impacts on length and quality of life. The prevalence of benign prostatic hyperplasia (BPH) increases significantly with age and affects nearly all men as they grow older. Other than skin cancers, prostate cancer is the most common cancer among men in the United States. Imaging is an essential component in the diagnosis and management of these conditions. Multiple modalities are available for prostate imaging, including several novel imaging modalities that have changed the landscape of prostate imaging in recent years. This review will cover the data relating to commonly used standard-of-care prostate imaging modalities, advances in newer technologies, and newer standards that impact prostate gland imaging. [ABSTRACT FROM AUTHOR]

Objective To better risk stratify patients, using baseline characteristics, to help optimise decision-making for men with moderate-to-severe lower urinary tract symptoms ( LUTS) secondary to benign prostatic hyperplasia (BPH) through a secondary analysis of the Medical Therapy of Prostatic Symptoms ( MTOPS) trial. Patients and Methods After review of the literature, we identified potential baseline risk factors for BPH progression. Using bivariate tests in a secondary analysis of MTOPS data, we determined which variables retained prognostic significance. We then used these factors in Cox proportional hazard modelling to: i) more comprehensively risk stratify the study population based on pre-treatment parameters and ii) to determine which risk strata stood to benefit most from medical intervention. Results In all, 3047 men were followed in MTOPS for a mean of 4.5 years. We found varying risks of progression across quartiles. Baseline BPH Impact Index score, post-void residual urine volume, serum prostate-specific antigen (PSA) level, age, American Urological Association Symptom Index score, and maximum urinary flow rate were found to significantly correlate with overall BPH progression in multivariable analysis. Conclusions Using baseline factors permits estimation of individual patient risk for clinical progression and the benefits of medical therapy. A novel clinical decision tool based on these analyses will allow clinicians to weigh patient-specific benefits against possible risks of adverse effects for a given patient. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the unclear relationship between depression and benign prostatic hyperplasia (BPH) by assessing depression''s effect on the American Urological Association Symptom Index (AUA-SI) scores. Depression is a common illness associated with chronic inflammatory disease states. Data have suggested a significant role of inflammation in the progression of BPH. Methods: The present prospective study involved 547 male patients who completed the Geriatric Depression Scale and the AUA-SI. We evaluated whether the mean AUA-SI score and the severity categories differed by the state of depression. We then conducted binary logistic regression analysis with forward stepwise regression to assess the relationship between depression and the severity symptoms as determined by the AUA-SI score. Results: Of the cohort, 22% screened positive for depressive symptoms. The depressed patients (Geriatric Depression Scale score >5) reported significantly more severe symptoms (mean AUA-SI score 16.61 ± 9.89) compared with the nondepressed patients (Geriatric Depression Scale score of ≤5 and mean AUA-SI score 10.65 ± 7.29; F = 40.19, P <.001). After controlling for socioeconomic and demographic variables, depressed patients were 3 times more likely to present with severe symptoms (odds ratio 3.079, 95% confidence interval 1.129-8.402, P = .028). Conclusions: A significant association was found between depression and BPH. However, it remains unclear whether this relationship represents unidirectional or bidirectional causality. Additional research is imperative to assess the nature of this correlation, either to address comorbid depression in patients with BPH or to ensure that depressed patients do not report falsely elevated symptoms. [Copyright &y& Elsevier]

The article offers information on how to manage patients with benign prostatic hyperplasia (BPH) in the U.S. It recommends the use of a urinary symptom scoring system, such as the 7-question Symptom Index for BPH and the International Prostate Symptom Score, to determine the severity of BPH and monitor the success of subsequent therapy. It highlights suggestions on dealing with other causes of BPH-like symptoms, focusing on lower urinary tract symptoms. It also indicates several approaches for the treatment of the disease that include nonselective and selective adrenergic alpha blockers as well as 5-alpha-reductase inhibitors.

The successful management of prostate cancer requires early detection, appropriate risk assessment and optimum treatment. To this end, much research has been conducted over many years with the goal of identifying a reliable and easily measurable tumour marker that could be used on a large scale for the diagnosis, staging and monitoring of the disease. Prostate-specific antigen (PSA) was independently discovered by two groups in the 1960s and 1970s, in semen and prostate tissue, and given different names. It later became evident that these proteins were encoded by the same gene and were the same protein. PSA was then identified as a useful marker for assessing patients with prostate cancer during their follow-up. In 1986, PSA was approved by the United States Food and Drug Administration to monitor prostate cancer, and in 1994 approved as a tool for detecting the disease in men aged ≥50 years. PSA is now the most widely used serum marker for detecting and monitoring prostate cancer, but its use as a diagnostic marker is controversial because it has several limitations, including its low specificity (PSA levels are also increased in benign prostatic hyperplasia, and in general inflammatory responses) and low sensitivity. Furthermore, PSA levels are highly variable over time, and PSA poorly distinguishes indolent from aggressive cancers. As such, the use of PSA level as a diagnostic tool can lead to over-detection of cancers that pose little threat to health and/or life. Moreover, the impact of PSA screening on prostate cancer mortality rates remains controversial, and will do so until the results of currently ongoing randomized controlled studies in Europe and the USA become available. To overcome the limitations of using PSA, research on PSA kinetics has developed considerably in the last decade. We review publications on the added value of PSA kinetics compared with single PSA measurements in the early detection of prostate cancer, and in predicting the outcome of patients with localized and advanced disease. [ABSTRACT FROM AUTHOR]

OBJECTIVES To evaluate the intermediate-term clinical efficacy and the rate of complications in 80 W photoselective vaporization of the prostate (PVP) with the potassium-titanyl-phosphate laser (GreenlightTM, (AMS, Minnetonka, MN, USA) compared with transurethral resection of the prostate (TURP) in a prospective non-randomised two-centre study. PATIENTS AND METHODS From December 2003 to August 2006, 396 patients (PVP 269, TURP 127) with lower urinary tract symptoms secondary to benign prostatic hyperplasia were included in the study. There was a significant difference in mean age (72 years for PVP vs 68 for TURP, P = 0.001). Patients were therefore stratified in age categories (<70, 70–80, >80 years) and compared for perioperative variables, functional outcome and complications, with a follow-up of up to 24 months. RESULTS The mean prostate size was greater (overall, 62 vs 48 mL, P < 0.001) and mean operative duration longer (overall 72 vs 53 min; P = 0.001) for PVP in all age categories. The rate of intraoperative bleeding (3% vs 11%), blood transfusions (0% vs 5.5%) and capsule perforations (0.4% vs 6.3%), and early postoperative clot retention (0.4% vs 3.9%) was significantly lower for PVP. Hospitalization time was significantly shorter in the PVP group for patients aged <70 years (3.0 vs 4.7 days) and 70–80 years (4.0 vs 5.0 days; P = 0.001). The improvement of peak urinary flow rate was higher after TURP for any age category. The International Prostate Symptom Score and postvoid residual volume during the follow-up showed no significant difference. After 12 months the overall prostate size reduction was 63% (−30 mL) after TURP and 44% (−27 mL) after PVP. The rate of repeat TURP/PVP was higher in the PVP group (6.7% vs 3.9%, not significant) within the follow-up of up to 2 years. The incidence of urethral and bladder neck strictures was comparable. CONCLUSIONS PVP was more favourable in terms of perioperative safety. Although patients assigned for PVP were older and had larger prostates, PVP resulted in a similar functional outcome. Further follow-up is needed to draw final conclusions about the long-term efficacy of PVP. [ABSTRACT FROM AUTHOR]

OBJECTIVE To systematically review the placebo arms of randomized trials of medical therapy for benign prostatic hyperplasia (BPH) and thus estimate rates of progression. METHODS We searched PubMed, the Cochrane Trials Register and the USA Food and Drug Administration website. Retrieved citations were reviewed in two stages: a title and abstract screen, followed by a review of selected full-length articles. The inclusion criterion for studies were trials of BPH with >100 patients in the placebo group. RESULTS From 1774 citations screened, 16 eligible studies were found with a total of 12 158 patients. The range of mean baseline age was 62.6–66.5 years, for prostate volume 33.9–61.0 mL and for maximum urinary flow 8.6–11.6 mL/s. With studies spanning 12–48 months, the rates of surgery were 1–10% and for acute urinary retention 0.4–6.6%. Most studies showed progression, based on a worsening in clinical outcomes of the change from baseline in prostate volume and maximum urinary flow. Statistical heterogeneity prevented a quantitative synthesis of the data. CONCLUSION This systematic review confirms BPH disease progression in the form of increased prostate volume, reduction in maximum urinary flow rate and an increase in the risk of acute urinary retention and surgery. To provide quantitative estimates of effect, access to data from individual participants would be required. [ABSTRACT FROM AUTHOR]

Provides information on drugs that have been approved by the U.S. Food and Drug Administration in 2003. Revision on the labeling for valacyclovir or Valtrex to include its use in the reduction of heterosexual transmission of genital herpes to susceptible partners; Adverse effects of alfuzosin extended-release tablets for the treatment of benign prostatic hypertrophy; Mechanism of action of the intranasal Influenza Virus Vaccine Live or FluMist.

Discusses the United States Agency for Health Care Policy & Research's (AHCPR) diagnostic and treatment guidelines for benign prostatic hyperplasia. Composition of group selected for study of prostatism; Eligibility of men for treatment options; Assessment of potential impact of guidelines on elderly population. INSET: Subjects and methods..

Reports the diagnosis of men with symptoms associated with benign prostatic hyperplasia (BPH) in the U.S. Basis of the diagnosis on the American Urological Association symptom index; Age range of men affected by BPH; Implications of BPH symptoms for nursing.

Examines the usability of potassium titanyl phosphate (KTP) laser for the treatment of symptomatic benign prostatic enlargement in San Jose, California. Effectiveness in the creation of large cavities in human cadaveric prostates; Involvement of the passing of the laser repeatedly in the periurethral tissue surface; Pros and cons of KTP.

Reports on developments in urology. Patient assessment of symptoms as guide in the evaluation and treatment of benign prostatic hyperplasia; Controversies over the diagnosis and treatment of prostate cancer; Health-related quality of life as a clinical end point in the evaluation of new and established therapies for prostate cancer.

The article presents information on a study which determines how saw palmetto did not vary from placebo for benign prostatic hyperplasia in men. The study is supported by the National Institute of Diabetes and Digestive and Kidney Disease and the National Center for Complementary and Alternative Medicine in the United States. The study findings suggest that in men with moderate-to-severe symptoms, is saw palmetto more effective than placebo for benign prostatic hyperplasia. The study has 90% power to detect a 3-point difference between groups on the American Urological Association Symptom Index score.

Reports on the U.S. Food and Drug Administration's approval of the changes to the labeling of finasteride from Merk. Effect of finasteride in combination with doxazosin mesylate on benign prostatic hyperplasia; Manufacturer of doxazosin.