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Mahaveer Chand N, Tekumalla PK, Rosenberg MT, Dobi A, Ali A, Miller GM, Aristizabal-Henao JJ, Granger E, Freedland SJ, Kellogg MD, Srivastava S, McLeod DG, Narain NR, Kiebish MA. Filamin A Is a Prognostic Serum Biomarker for Differentiating Benign Prostatic Hyperplasia from Prostate Cancer in Caucasian and African American Men. Cancers (Basel) 2024; 16:712. [PMID: 38398103 PMCID: PMC10887407 DOI: 10.3390/cancers16040712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 01/31/2024] [Indexed: 02/25/2024] Open
Abstract
Prostate cancer represents a significant health risk to aging men, in which diagnostic challenges to the identification of aggressive cancers remain unmet. Prostate cancer screening is driven by the prostate-specific antigen (PSA); however, in men with benign prostatic hyperplasia (BPH) due to an enlarged prostate and elevated PSA, PSA's screening utility is diminished, resulting in many unnecessary biopsies. To address this issue, we previously identified a cleaved fragment of Filamin A (FLNA) protein (as measured with IP-MRM mass spectrometry assessment as a prognostic biomarker for stratifying BPH from prostate cancer and subsequently evaluated its expanded utility in Caucasian (CA) and African American (AA) men. All men had a negative digital rectal examination (DRE) and PSA between 4 and 10 ng/mL and underwent prostate biopsy. In AA men, FLNA serum levels exhibited diagnostic utility for stratifying BPH from patients with aggressive prostate cancer (0.71 AUC and 12.2 OR in 48 men with BPH and 60 men with PCa) and outperformed PSA (0.50 AUC, 2.2 OR). In CA men, FLNA serum levels also exhibited diagnostic utility for stratifying BPH from patients with aggressive prostate cancer (0.74 AUC and 19.4 OR in 191 men with BPH and 109 men with PCa) and outperformed PSA (0.46 AUC, 0.32 OR). Herein, we established FLNA alone as a serum biomarker for stratifying men with BPH vs. those with high Gleason (7-10) prostate cancers compared to the current diagnostic paradigm of using PSA. This approach demonstrates clinical actionability of FLNA alone without the requirement of prostate volume measurement as a test with utility in AA and CA men and represents a significant opportunity to decrease the number of unnecessary biopsies in aggressive prostate cancer diagnoses.
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Affiliation(s)
| | | | | | - Albert Dobi
- Center for Prostate Disease Research, John P. Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, Bethesda, MD 20817, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA
| | - Amina Ali
- Center for Prostate Disease Research, John P. Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, Bethesda, MD 20817, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA
| | | | | | | | - Stephen J Freedland
- Center for Integrated Research in Cancer and Lifestyle, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Mark D Kellogg
- Department of Laboratory Medicine, Boston Children's Hospital Department of Pathology, Harvard Medical School, Boston, MA 02115, USA
| | - Shiv Srivastava
- Department of Biochemistry and Molecular & Cell Biology, Georgetown University School of Medicine, Washington, DC 20057, USA
| | - David G McLeod
- Center for Prostate Disease Research, John P. Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, Bethesda, MD 20817, USA
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Oelke M, Abt SD, Becher KF, Dreikorn K, Madersbacher S, Magistro G, Michel MC, Muschter R, Reich O, Rieken M, Salem J, Schönburg S, Höfner K, Bschleipfer T. [Diagnostic work-up of benign prostatic hyperplasia : The German S2e-guideline 2023 part 1]. UROLOGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00120-023-02142-0. [PMID: 37401972 DOI: 10.1007/s00120-023-02142-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH; in German guidelines: benign prostatic syndrome [BPS]) is the most frequent urological disease in men and can result in a considerable deterioration of quality-of-life. BPS can be associated with LUTS, benign prostatic enlargement (BPE), and bladder outlet obstruction (BOO) or benign prostatic obstruction (BPO), respectively. The expert group on BPS of the German Society of Urology has re-evaluated the tests for the assessment of BPH and provides evidence-based recommendations. OBJECTIVES Presentation and evidence-based rating of tests for the assessment of patients with BPS. MATERIALS AND METHODS Summary and overview of chapters 5, 6, and 8 of the latest long version of the German S2e guideline on BPS. RESULTS The diagnostic work-up should clarify (1) whether the complaints of the patient are caused by BPS, (2) how relevant the complaints are and whether treatment is necessary, (3) whether complications of the lower or upper urinary tract already exist, and (4) which treatment will be most suitable. Baseline assessment should be done in all BPS patients and include history, measurement of LUTS and quality-of-life, urinalysis, serum prostate-specific antigen, post-void residual, ultrasound of the lower urinary tract, including measurements of prostate volume, intravesical prostatic protrusion and detrusor wall thickness, and ultrasound of the upper urinary tract. Additional tests can follow when questions remain unanswered after baseline assessment. These optional tests include bladder diaries, uroflowmetry, serum creatinine, urethrocystoscopy, other noninvasive tests for the determination of BOO/BPO such as penile cuff test, condom catheter method and near-infrared spectroscopy, and other imagining tests such as X‑ray and MRI investigations. CONCLUSIONS The updated German S2e guideline summarizes evidence-based recommendations on the diagnostic work-up, including the assessment of the BPS components BPE, LUTS, and BOO/BPO.
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Affiliation(s)
- Matthias Oelke
- Klinik für Urologie, Urologische Onkologie und Roboter-assistierte Chirurgie, St. Antonius-Hospital GmbH, Möllenweg 22, 48599, Gronau, Deutschland.
| | - S Dominik Abt
- Klinik für Urologie, Spitalzentrum Biel, Biel, Schweiz
| | - Klaus F Becher
- Klinik für Rehabilitation, Klinik Wartenberg Professor Dr. Selmair GmbH & Co. KG, Wartenberg, Deutschland
| | | | | | - Giuseppe Magistro
- Klinik für Urologie, Asklepios Westklinikum GmbH, Hamburg, Deutschland
| | - Martin C Michel
- Abteilung Pharmakologie, Johannes Gutenberg Universität, Mainz, Deutschland
| | - Rolf Muschter
- Urologische Abteilung, ALTA Klinik, Bielefeld, Deutschland
| | - Oliver Reich
- Urologische Privatpraxis Prof. Dr. Oliver Reich, München, Deutschland
| | | | - Johannes Salem
- CUROS urologisches Zentrum, Klinik LINKS VOM RHEIN, Köln, Deutschland
- Klinik für Urologie und Kinderurologie, Universitätsklinikum, Medizinische Hochschule Brandenburg Theodor Fontane, Brandenburg a.d. Havel, Deutschland
| | - Sandra Schönburg
- Universitätsklinik und Poliklinik für Urologie, Martin-Luther Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Klaus Höfner
- Klinik für Urologie, Evangelisches Krankenhaus, Oberhausen, Deutschland
| | - Thomas Bschleipfer
- Klinik für Urologie und Kinderurologie, Regiomed Klinikum, Coburg, Deutschland
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Advances in Molecular Regulation of Prostate Cancer Cells by Top Natural Products of Malaysia. Curr Issues Mol Biol 2023; 45:1536-1567. [PMID: 36826044 PMCID: PMC9954984 DOI: 10.3390/cimb45020099] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023] Open
Abstract
Prostate cancer (PCa) remains both a global health burden and a scientific challenge. We present a review of the molecular targets driving current drug discovery to fight this disease. Moreover, the preventable nature of most PCa cases represents an opportunity for phytochemicals as chemopreventive when adequately integrated into nutritional interventions. With a renovated interest in natural remedies as a commodity and their essential role in cancer drug discovery, Malaysia is looking towards capitalizing on its mega biodiversity, which includes the oldest rainforest in the world and an estimated 1200 medicinal plants. We here explore whether the list of top Malay plants prioritized by the Malaysian government may fulfill the potential of becoming newer, sustainable sources of prostate cancer chemotherapy. These include Andrographis paniculate, Centella asiatica, Clinacanthus nutans, Eurycoma longifolia, Ficus deltoidea, Hibiscus sabdariffa, Marantodes pumilum (syn. Labisia pumila), Morinda citrifolia, Orthosiphon aristatus, and Phyllanthus niruri. Our review highlights the importance of resistance factors such as Smac/DIABLO in cancer progression, the role of the CXCL12/CXCR4 axis in cancer metastasis, and the regulation of PCa cells by some promising terpenes (andrographolide, Asiatic acid, rosmarinic acid), flavonoids (isovitexin, gossypin, sinensetin), and alkylresorcinols (labisiaquinones) among others.
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Huang J, Shao D, Liu H, Xiang Y, Ma L, Yi S, Xu H. A lightweight segmentation method based on residual U-Net for MR images. JOURNAL OF INTELLIGENT & FUZZY SYSTEMS 2022. [DOI: 10.3233/jifs-211424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Automatic segmentation of Magnetic Resonance Imaging (MRI), which bases on Residual U-Net (ResU-Net), helps radiologists to quickly assess the condition. However, the ResU-Net structure requires a large number of parameters and storage model space. It is not convenient to apply to mobile MRI device. To solve this problem, Depthwise Separable Convolution and Squeeze-and-Excitation Residual U-Networks (DSRU-Net) is proposed to segment MRI. Squeeze-and-Excitation method is a channel attention mechanism. The proposed method is conducive to simplify ResU-Net model, making ResU-Net more convenient to be applied to mobile MRI device. The fuzzy comprehensive evaluation method, which includes three evaluation factors are that the required parameters of the model, the value of Dice Similarity Coefficient (DSC), and the value of Hausdorff Distance (HD), is used to evaluate the test results of the proposed method on the MICCAI 2012 Prostate MR Image Segmentation (PROMISE12) challenge dataset and Automatic Cardiac Diagnosis Challenge (ACDC) dataset. The fuzzy comprehensive evaluation values obtained by the proposed method in 5 PROMISE12 samples and 15 ACDC samples are 0.9889 and 0.9652, respectively. Combining the average results of the two datasets, the proposed method has the best effect in balancing the accuracy of segmentation and the amount of model parameters.
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Affiliation(s)
- Junhui Huang
- Faculty of Information Engineering and Automation, Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Dangguo Shao
- Faculty of Information Engineering and Automation, Kunming University of Science and Technology, Kunming, Yunnan, China
- Yunnan Key Laboratory of Artificial Intelligence, Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Han Liu
- Faculty of Information Engineering and Automation, Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Yan Xiang
- Faculty of Information Engineering and Automation, Kunming University of Science and Technology, Kunming, Yunnan, China
- Yunnan Key Laboratory of Artificial Intelligence, Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Lei Ma
- Faculty of Information Engineering and Automation, Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Sanli Yi
- Faculty of Information Engineering and Automation, Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Hui Xu
- First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
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Welliver C, Feinstein L, Ward JB, Kirkali Z, Martinez-Miller EE, Matlaga BR, McVary K. Poor clinical guideline adherence and inappropriate testing for incident lower urinary tract symptoms associated with benign prostatic hyperplasia. Prostate Cancer Prostatic Dis 2022; 25:269-273. [PMID: 34545201 PMCID: PMC8934314 DOI: 10.1038/s41391-021-00435-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/01/2021] [Accepted: 07/23/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND The American Urological Association makes recommendations for evaluation and testing for lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) to help primary care providers and specialists identify LUTS/BPH and harmful related conditions including urinary retention and prostate or bladder cancer. Our understanding of provider adherence to these Guidelines is limited to single-site or nonrepresentative settings. METHODS We analyzed two insurance claims databases: the Optum® de-identified Clinformatics® Data Mart database for privately insured males aged 40-64 years (N ≈ 1,650,900 annually) and the Medicare 5% Sample for males aged ≥65 years (N ≈ 546,000 annually). We calculated the annual prevalence of LUTS/BPH and comorbid bladder cancer and bladder stones from 2004 to 2013. We additionally examined LUTS/BPH incidence and adherence to testing guidelines in a cohort of men newly diagnosed with LUTS/BPH in 2009. RESULTS While LUTS/BPH prevalence and incidence increased with increasing age, evaluation testing became less common. Urinalysis was the most common testing type but was performed in <60% of incident patients. Serum prostate-specific antigen (PSA) was the second most common test across age groups (range: 15-34%). Prevalence of comorbid bladder cancer (range: 0-4%), but not bladder stones (range: 1-2%), increased with increasing age. CONCLUSIONS Although older men were at greater risk of LUTS/BPH than younger men, they were less likely to undergo testing at diagnosis. Recommended testing with urinalysis was poor despite higher prevalence of bladder cancer in older men and a standard recommendation for urinalysis since 1994. Providers should be more cognizant of AUA Guidelines when assessing LUTS/BPH patients.
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Affiliation(s)
| | - Lydia Feinstein
- Social & Scientific Systems, Inc., a DLH Holdings Company, Durham, NC, USA. .,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
| | - Julia B. Ward
- Social & Scientific Systems, Inc., a DLH Holdings Company, Durham, NC,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Ziya Kirkali
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Erline E. Martinez-Miller
- Social & Scientific Systems, Inc., a DLH Holdings Company, Durham, NC,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | - Brian R. Matlaga
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kevin McVary
- Loyola University Medical Center, Center for Male Health, Maywood, IL
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Sun F, Lucas-Cava V, Sánchez-Margallo FM. Clinical predictive factors in prostatic artery embolization for symptomatic benign prostatic hyperplasia: a comprehensive review. Transl Androl Urol 2020; 9:1754-1768. [PMID: 32944536 PMCID: PMC7475690 DOI: 10.21037/tau-20-437] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Prostatic artery embolization (PAE) has been established as a routine treatment for symptomatic benign prostatic hyperplasia (BPH) all over the world. With increasing clinical experience in the last decade, investigators have sufficient data to assess predictive factors with the purpose to guide patient selection and counseling for PAE or to individualize therapeutic plans after PAE. This paper is a comprehensive review to introduce the concept of clinical predictors and give a systemic classification of various predictive factors in PAE. The authors review each individual factor and its predictive capability and discuss the possible reasons for the inconsistent or conflicting findings in the literature. Based on current evidence, the baseline prostate volume, in particular the transition zone volume and transition zone index; 24 h post-PAE prostate-specific antigen (PSA) level; and prostate infarction and prostate volume reduction at 1–3 months have potential in prediction of treatment outcomes. Patients with Adenomatous-dominant BPH or with indwelling bladder catheter before PAE may have more benefits from PAE. Baseline intravesical prostatic protrusion (IPP), C-reactive protein (CRP) level at 48 h and early detection of prostate infarct at 1 day and 1 week after PAE need further investigating.
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Affiliation(s)
- Fei Sun
- Jesus Uson Minimally Invasive Surgery Centre, Caceres, Spain
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7
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Khera M, Than JK, Anaissie J, Antar A, Song W, Losso B, Pastuszak A, Kohn T, Mirabal JR. Penile vascular abnormalities in young men with persistent side effects after finasteride use for the treatment of androgenic alopecia. Transl Androl Urol 2020; 9:1201-1209. [PMID: 32676403 PMCID: PMC7354335 DOI: 10.21037/tau.2020.03.21] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background The constellation of persistent sexual, neurological, and physical adverse effects in patients who discontinue 5α-reductase inhibitors (5ARIs) has garnered recent concern. The objective of this study was to evaluate potential penile vascular changes and persistent adverse effects of 5ARIs in men treated for androgenic alopecia (AGA). Methods This was a prospective case-control study with 25 subjects with a history of 5ARI use for AGA and 28 controls. Patient self-reported questionnaires including the International Index of Erectile Function (IIEF), International Prostate Symptom Score (IPSS), Patient Health Questionnaire-9 (PHQ-9), the Epworth Sleepiness Scale (ESS) and the Androgen Deficiency in the Aging Male (ADAM) were used. Penile duplex Doppler ultrasound (PDDU) results were evaluated in men with a history of 5ARI use. Results A significant difference in total IIEF score between the 5ARI (median: 35; IQR: 29–43) and control group (median: 29; IQR: 27–32) (P=0.035) was observed. Seventeen 5ARI subjects (68%) had a vascular abnormality on PDDU. The median (IQR) for total IPSS score for the 5ARI group was 10 [5–16] compared to 3 [2–8] for the controls (P<0.01). The 5ARI group had a higher median total PHQ-9 score than controls [10 (6.5–16) vs. 1 (0–2) (P<0.001)]. Two subjects (8%) committed suicide during or after the study. Conclusions While the sexual side effects of 5ARIs are well known, there may be persistent genitourinary, physical, psycho-cognitive, anti-androgenic and penile vascular changes after 5ARI discontinuation. Use of 5ARIs for treatment of AGA may lead to persistent sexual, genitourinary, physical, psycho-cognitive, and anti-androgenic sequelae even after cessation of 5ARI therapy.
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Affiliation(s)
- Mohit Khera
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | | | - James Anaissie
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Ali Antar
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Weitao Song
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Boriss Losso
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Alexander Pastuszak
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Taylor Kohn
- The James Buchanan Brady Urological Institute at Johns Hopkins School of Medicine, Baltimore, MD, USA
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Kim HB, Kim YI, Jeon JH, Kim E, Kim JY, Kwon O, Choi YE, Yang C, Han CH. Effectiveness and safety of electroacupuncture and its cotreatment with electronic moxibustion in the treatment of patients with moderate benign prostatic hyperplasia using alpha blocker: Study protocol for an assessor-blinded, randomized controlled clinical trial. Medicine (Baltimore) 2020; 99:e19678. [PMID: 32282720 PMCID: PMC7220246 DOI: 10.1097/md.0000000000019678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Benign prostatic hyperplasia (BPH) is a medical condition that affects the quality of life by causing lower urinary tract symptoms (LUTS) in 40% to 70% of men aged ≥60 years. Medication treatment is primarily recommended for patients with BPH if their symptom score based on the International Prostate Symptom score (IPSS) is above the moderate level. However, electroacupuncture (EA) and electronic moxibustion (EM), one of the most recent complementary and alternative treatments, are suggested as adjuvant treatments in the improvement of LUTS caused by BPH with respect to the limitations of medication treatments, such as side effects or no improvement in LUTS despite treatment. Therefore, this study aimed to evaluate the effectiveness and safety of EA and its cotreatment with EM for the improvement of LUTS in patients diagnosed with BPH using an alpha blocker but with moderate symptoms on the basis of IPSS. METHODS/DESIGN This protocol is a 2-arm parallel-design, randomized, controlled assessor-blinded clinical trial. Seventy-eight patients diagnosed with BPH are randomized to one of the following groups: [EA and its cotreatment with EM + alpha blocker group] and [alpha blocker group]. [EA and its cotreatment with EM + alpha blocker group] continues to use the previously prescribed alpha blocker and visits the study institution 3 times a week for 6 weeks to receive the cotreatment of EA and EM. [Alpha blocker group] continues to use the previously prescribed alpha blocker for 6 weeks. To evaluate the effectiveness of the EA and its cotreatment with EM, the followings are measured: total score of the IPSS, IPSS quality of life assessment, EuroQol-Five dimension, maximum and average urinary flow rate (Qmax and Qave), and prostate size at the baseline, 3rd, 6th, and 12th weeks. The primary effectiveness endpoint measures the average change in the total score of the IPSS at the 6th week. Side effects are recorded at each visit. DISCUSSION The results of this study are expected to provide useful information on the effectiveness and safety of the EA and its cotreatment with EM for patients with BPH with regard to the improvements in LUTS. TRIAL REGISTRATION Clinical Research Information Service of Republic of Korea (CRIS-KCT0004411), October 31, 2019.
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Affiliation(s)
- Hyo Bin Kim
- Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Daejeon University, Daejeon
| | - Young Il Kim
- Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Daejeon University, Daejeon
| | - Ju Hyun Jeon
- Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Daejeon University, Daejeon
| | - Eunseok Kim
- Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Daejeon University, Daejeon
| | - Jin Youp Kim
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul
| | - Ojin Kwon
- Clinical Medicine Division, Korea Institute of Oriental Medicine
| | - Young Eun Choi
- Clinical Medicine Division, Korea Institute of Oriental Medicine
| | - Changsop Yang
- Clinical Medicine Division, Korea Institute of Oriental Medicine
| | - Chang-Hyun Han
- Clinical Medicine Division, Korea Institute of Oriental Medicine
- Korean Convergence Medicine, University of Science and Technology (UST), Campus of Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
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[How to evaluate BPH-related SBAUs in clinical practice and research?]. Prog Urol 2018; 28:830-838. [PMID: 30220536 DOI: 10.1016/j.purol.2018.07.277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 07/31/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe the useful explorations in the clinical evaluation of the symptoms of the lower urinary tract symptoms possibly related to BPH (LUTS/BPH), and to list the information necessary to allow an evaluation of an instrumental or surgical intervention in the treatment of the hypertrophy and benign prostatic obstruction. METHOD Bibliographic research in English using the European, American and French recommendations on the evaluation of BPH, supplemented by a Pubmed search. RESULTS AND CONCLUSIONS A number of systematic investigations into the evaluation of a man with LUTS/BPH include interrogation, clinical examination with rectal examination, urinalysis, flowmeter and post-micturition residual volume. The voiding catalog is necessary to understand the mechanism of a nocturia. PSA has a triple potential of interest: evaluation of the risk of progression, evaluation of the prostatic volume and diagnosis of a cancer of the prostate. Creatinine is needed only when chronic retention is observed and before surgery. Urethrocystoscopy is essential in case of hematuria, suspicion of stenosis of the urethra or bladder tumor. Ultrasound for evaluation of prostate volume is essential before surgery, and may be helpful in guiding the decision to prescribe a 5 alpha reductase inhibitor. No non-invasive technique has proven its possible substitution for pressure flow studies when indicated. When a researcher is considering evaluating a surgical or instrumental treatment for BPH, preoperative, perioperative and follow-up parameters are expected from readers to get a fair idea of the technique being evaluated. LEVEL OF EVIDENCE 5: Consensus d'experts.
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10
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Ruetten H, Wegner KA, Romero MF, Wood MW, Marker PC, Strand D, Colopy SA, Vezina CM. Prostatic collagen architecture in neutered and intact canines. Prostate 2018; 78:839-848. [PMID: 29740846 PMCID: PMC6356104 DOI: 10.1002/pros.23641] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 04/06/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Prostate stiffness and increased collagen content both associate with the presence of urinary symptoms in men but mechanisms responsible, including impact of age and androgens, are unknown. Dogs develop prostate-related urinary dysfunction similar to humans, but mechanisms are also unknown. Mice have been used to examine how prostatic collagen accumulation affects voiding but whether mouse prostatic collagen organization resembles human or dog has not been evaluated. Here, we have constructed the first comprehensive, comparative maps of collagen architecture in canine, human, and mouse prostate and test whether canine prostatic collagen content is increased by aging and reduced by castration. METHODS Complete transverse prostate sections were stained with picrosirius red and imaged with confocal microscopy to reveal and compare collagen architecture across species. Canine prostatic collagen fiber length, diameter, and density in prostatic urethral, periurethral, peripheral, and capsular regions were quantified and compared among four experimental groups: young intact, young neutered, old intact, and old neutered dogs. RESULTS Surprisingly, the majority of collagen was localized to the prostatic urethra in canine, human, and mouse. In canine and human, capsular regions also featured a dense collagen network but it appeared less dense than around prostatic urethra. Older, intact male canines exhibited overall denser prostate collagen fibers and had thicker capsular fibers than young, intact males. Prostatic glandular regions undergo dramatic atrophy and regression following castration, and our finding of neutered animals having increased collagen fiber density in both periurethral and peripheral regions is consistent with glandular contraction and increased proportion of stroma. CONCLUSIONS Collagen architecture in dog appears similar to that in humans when cross sections are compared side-by-side. Canine collagen organization is affected by both age and androgen status, suggesting these factors may contribute to collagen accumulation in some males.
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Affiliation(s)
- Hannah Ruetten
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
- George M. O'Brien Benign Urology Center, University of Wisconsin-Madison, Madison, Wisconsin
| | - Kyle A Wegner
- George M. O'Brien Benign Urology Center, University of Wisconsin-Madison, Madison, Wisconsin
- Molecular and Environmental Toxicology Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Michael F Romero
- Physiology & Biomedical Engineering and Nephrology & Hypertension, George M. O'Brien Urology Research Center, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Michael W Wood
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Paul C Marker
- George M. O'Brien Benign Urology Center, University of Wisconsin-Madison, Madison, Wisconsin
- Division of Pharmaceutical Sciences, School of Pharmacy, University of Wisconsin-Madison, Madison, Wisconsin
| | - Douglas Strand
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sara A Colopy
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Chad M Vezina
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
- George M. O'Brien Benign Urology Center, University of Wisconsin-Madison, Madison, Wisconsin
- Molecular and Environmental Toxicology Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
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Vinarov AZ, Spivak LG, Platonova DV, Rapoport LM, Korolev DO. 15 years' survey of safety and efficacy of Serenoa repens extract in benign prostatic hyperplasia patients with risk of progression. Urologia 2018; 86:17-22. [PMID: 29741118 DOI: 10.1177/0391560318772466] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM: The aim of this study is to investigate the efficacy and safety of long-term therapy with Serenoa repens extract with regard to halting benign prostatic hyperplasia progression. MATERIAL AND METHODS: An open non-comparative observational study of the continuous use of S. repens plant extract at a dosage of 320 mg once a day for 15 years was performed in 30 patients at risk for benign prostatic hyperplasia progression. Changes in IPSS (International Prostatic Symptoms Scale) and QoL (Quality of life) scores and changes in Qmax, voided volume, residual urine volume, and prostate volume were evaluated during the study. RESULTS: The study showed an absence of progression based on both subjective (the sum of scores on the IPSS and QoL scales) and objective (prostate volume, urination rate, residual urine volume) criteria. Furthermore, the patients had no adverse events related to the study drug, including prostate cancer. CONCLUSIONS: The 15 years' study results suggest that taking S. repens plant extract continuously at a daily dose of 320 mg is an effective and safe way to prevent the progression of benign prostatic hyperplasia.
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12
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Esmat AY, Refaie FM, Shaheen MH, Said MM. Chemoprevention of Prostate Carcinogenesis by DFMO and/or Finasteride Treatment in Male Wistar Rats. TUMORI JOURNAL 2018; 88:513-21. [PMID: 12597149 DOI: 10.1177/030089160208800616] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In the present study the chemopreventive activities of DFMO, the irreversible inhibitor of ornithine decarboxylase, and finasteride, the inhibitor of prostatic 5a-reductase, against the development of chemically induced prostate adenocarcinoma by methylnitrosourea/testosterone propionate in male Wistar rats were investigated. According to histological examination, oral administration of DFMO and finasteride, either alone or combined, for two months to MNU/TP-inoculated rats reduced the tumor incidence to 11.11%, 10% and 10%, respectively, compared to tumored controls (64.3%). DFMO and/or finasteride treatment resulted in significant reductions in the wet weight of the prostate gland and seminal vesicles and its ratio relative to the total body weight, as well as the levels of prostate total protein, DNA, RNA and DNA/RNA ratio, compared to tumored controls. However, the effect of the combined treatment was of no statistical significance compared to single DFMO or finasteride treatment, as demonstrated by the non-significant differences between the mean values of most of the studied parameters. The tumor chemopreventive activity and the prostate growth inhibitory effect of DFMO and finasteride were due to suppression of prostate polyamine synthesis. ANOVA test revealed that the relative weight of the prostate as well as blood and tissue polyamine levels could be used as significant endpoint biomarkers for DFMO and finasteride as cancer chemopreventive agents.
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Affiliation(s)
- Amr Y Esmat
- Department of Biochemistry, Faculty of Science, Ain Shams University, Cairo, Egypt
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Strand DW, Costa DN, Francis F, Ricke WA, Roehrborn CG. Targeting phenotypic heterogeneity in benign prostatic hyperplasia. Differentiation 2017; 96:49-61. [PMID: 28800482 DOI: 10.1016/j.diff.2017.07.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 07/17/2017] [Accepted: 07/18/2017] [Indexed: 02/07/2023]
Abstract
Benign prostatic hyperplasia and associated lower urinary tract symptoms remain difficult to treat medically, resulting in hundreds of thousands of surgeries performed annually in elderly males. New therapies have not improved clinical outcomes since alpha blockers and 5 alpha reductase inhibitors were introduced in the 1990s. An underappreciated confounder to identifying novel targets is pathological heterogeneity. Individual patients display unique phenotypes, composed of distinct cell types. We have yet to develop a cellular or molecular understanding of these unique phenotypes, which has led to failure in developing targeted therapies for personalized medicine. This review covers the strategic experimental approach to unraveling the cellular pathogenesis of discrete BPH phenotypes and discusses how to incorporate these findings into the clinic to improve outcomes.
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Affiliation(s)
- Douglas W Strand
- Department of Urology, University of Texas Southwestern Medical Center, USA.
| | - Daniel N Costa
- Department of Radiology, University of Texas Southwestern Medical Center, USA
| | - Franto Francis
- Department of Pathology, University of Texas Southwestern Medical Center, USA
| | - William A Ricke
- Department of Urology, University of Wisconsin School of Medicine, USA
| | - Claus G Roehrborn
- Department of Urology, University of Texas Southwestern Medical Center, USA
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14
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Sun F, Báez-Díaz C, Sánchez-Margallo FM. Canine prostate models in preclinical studies of minimally invasive interventions: part II, benign prostatic hyperplasia models. Transl Androl Urol 2017; 6:547-555. [PMID: 28725598 PMCID: PMC5503960 DOI: 10.21037/tau.2017.03.62] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Canine prostate is widely used as animal model in the preclinical evaluation of emerging therapeutic interventions. Spontaneous benign prostatic hyperplasia (BPH) is common in adult intact male dogs with two distinct pathological types: glandular and complex form of prostatic hyperplasia. The complex form of prostatic hyperplasia, usually occurring in older dogs, represents an ideal model because of its unique pathologic feature, including not only glandular hyperplasia but also an increase in prostate stromal components. The limited commercial availability of adult dogs with spontaneous BPH motivates experimentally induced BPH in young dogs. Hormone-induced canine BPH model has been well established with various hormonal treatment regimens and administration approaches. The goal of this review is to provide the veterinary background in spontaneous BPH in dogs, summarize the techniques in hormonal induction of canine BPH, and highlight the pathological and clinical limitations of the canine models that may lead to distinct therapeutic responses compared to clinical trials in humans.
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Affiliation(s)
- Fei Sun
- Jesus Uson Minimally Invasive Surgery Centre, Cáceres, Spain
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15
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Sener TE, Butticè S, Macchione L, Netsch C, Tanidir Y, Dragos L, Pappalardo R, Magno C. Thulium laser vaporesection of the prostate: Can we operate without interrupting oral antiplatelet/anticoagulant therapy? Investig Clin Urol 2017; 58:192-199. [PMID: 28480345 PMCID: PMC5419103 DOI: 10.4111/icu.2017.58.3.192] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 01/31/2017] [Indexed: 12/28/2022] Open
Abstract
Purpose Thulium vaporesection of the prostate (ThuVARP) is a new and safe approach for patients receiving anticoagulant therapy in whom transurethral resection of the prostate (TURP) may possess a high bleeding risk. We aimed to demonstrate the efficacy and safety of ThuVARP in patients receiving oral antiplatelet/anticoagulant (OAP/OAC) therapy. Materials and Methods A total of 103 patients who underwent ThuVARP between 2011 and 2013 were enrolled in the study. Patients were divided into 2 groups. Group A consisted of 47 patients who underwent low molecular weight heparin (LMWH) bridging and group B consisted of 56 patients who were operated on while receiving OAP/OAC therapy. Results The drop in hemoglobin levels in the pre- and postoperative periods was significantly higher in group A than in group B. When subgroups were analyzed, the mean drop in hemoglobin was significantly lower in the warfarin and ticlopidine subgroups of group B than in group A. International Prostate Symptom Scores were significantly lower 3, 12, 18, and 24 months after surgery in group A than in group B. Quality of life scores, maximal flow rate values, and postmicturition residual urine volumes (mL) were similar between the 2 groups. A total of 38 and 41 patients in groups A and B, respectively, had no complications. Conclusions Our study showed the safety profile of continuing different OAP/OAC therapies in terms of bleeding problems in patients undergoing ThuVARP. We strongly recommend abandoning LMWH bridging and maintaining the OAP/OAC regimen patients are already receiving.
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Affiliation(s)
- Tarik Emre Sener
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Salvatore Butticè
- Department of Human Pathology, Section of Urology, University of Messina, Messina, Italy
| | - Luciano Macchione
- Department of Human Pathology, Section of Urology, University of Messina, Messina, Italy
| | | | - Yiloren Tanidir
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Laurian Dragos
- Department of Urology, Emergency County Hospital, Pius Branzeu, Timisoara, Romania
| | - Rosa Pappalardo
- Department of Human Pathology, Section of Urology, University of Messina, Messina, Italy
| | - Carlo Magno
- Department of Human Pathology, Section of Urology, University of Messina, Messina, Italy
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16
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Nunes RV, Manzano J, Truzzi JC, Nardi A, Silvinato A, Bernardo WM. Treatment of benign prostatic hyperplasia. Rev Assoc Med Bras (1992) 2017; 63:95-99. [PMID: 28355368 DOI: 10.1590/1806-9282.63.02.95] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2016] [Indexed: 11/21/2022] Open
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17
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Luo F, Sun HH, Su YH, Zhang ZH, Wang YS, Zhao Z, Li J. Assessment of noninvasive predictors of bladder detrusor underactivity in BPH/LUTs patients. Int Urol Nephrol 2017; 49:787-792. [DOI: 10.1007/s11255-017-1539-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 02/08/2017] [Indexed: 01/09/2023]
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Long-term Combination Therapy With α-Blockers and 5α-Reductase Inhibitors in Benign Prostatic Hyperplasia: Patient Adherence and Causes of Withdrawal From Medication. Int Neurourol J 2017; 20:356-362. [PMID: 28043104 PMCID: PMC5209571 DOI: 10.5213/inj.1632526.263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 02/19/2016] [Indexed: 12/02/2022] Open
Abstract
Purpose To investigate long-term therapeutic effects and patient adherence to a combination therapy of a 5α-reductase inhibitor and an α-blocker and to identify causes of withdrawal from medication in patients with clinical benign prostatic hyperplasia (BPH). Methods BPH patients with lower urinary tract symptoms (LUTS) receiving combination therapy with follow-ups for 1–12 years were retrospectively analyzed. Therapeutic effects were assessed at baseline and annually by measuring International Prostatic Symptoms Score, quality of life index, total prostate volume (TPV), maximal flow rate, voided volume, postvoid residual volume and prostate-specific antigen level. Causes of discontinued combination therapy were also investigated. Results A total of 625 patients, aged 40–97 years (mean, 73 years) were retrospectively analyzed. All measured parameters showed significant improvements after combination therapy. Three hundred sixty-nine patients (59%) discontinued combination therapy with a mean treatment duration of 2.2 years. The most common reasons for discontinued treatment were changing medication to monotherapy with α-blockers or antimuscarinics (124 patients, 19.8%), receiving surgical intervention (39 patients, 6.2%), and LUTS improvement (53 patients, 8.5%). Only 64 patients (10.2%) were loss to follow-up and 6 (1.0%) discontinued combined treatment due to adverse effects. Smaller TPV after short-term combination treatment caused withdrawal from combination therapy. Conclusions BPH patients receiving long-term combination therapy showed significant improvement in all measured parameters. Changing medication, improved LUTS and choosing surgery are common reasons for discontinuing combination herapy. A smaller TPV after short-term combination treatment was among the factors that caused withdrawal from combination therapy.
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19
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Zhao SC, Xia M, Tang JC, Yan Y. Associations between metabolic syndrome and clinical benign prostatic hyperplasia in a northern urban Han Chinese population: A prospective cohort study. Sci Rep 2016; 6:33933. [PMID: 27653367 PMCID: PMC5032014 DOI: 10.1038/srep33933] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 09/05/2016] [Indexed: 12/30/2022] Open
Abstract
Biologic rationales exist for the associations between metabolic syndrome (MetS) and benign prostatic hyperplasia (BPH). However, epidemiologic studies have yield inconsistent results. The aim of the present study was to prospectively evaluate the associations of MetS with the risk of BPH. The presence of MetS, the number of MetS components, and the individual MetS components were evaluated. After adjusting for potential confounders, MetS was associated with increased risk of BPH (HR: 1.29; 95% CI, 1.08-1.50; p < 0.001). Compared with subjects without any MetS components, the HRs were 0.88 (95% CI, 0.67-1.09; p = 0.86), 1.18 (95% CI, 0.89-1.47; p = 0.29) and 1.37 (95% CI, 1.08-1.66; p = 0.014) for subjects with 1, 2, or ≥3 MetS components, and there was a biologic gradient between the number of MetS components and the risk of BPH (p-trend < 0.001). Central obesity and low high-density lipoprotein cholesterol were the two main divers of the associations between these two conditions, with HRs of 1.93 (95% CI, 1.14-2.72; p = 0.001) for central obesity, and 1.56 (95% CI, 1.08-2.04; p = 0.012) for low HDL-C. Our findings support the notion that MetS may be an important target for BPH prevention and intervention.
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Affiliation(s)
- Si-Cong Zhao
- Department of Urology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Ming Xia
- Department of Urology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Jian-Chun Tang
- Department of Cardiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Yong Yan
- Department of Urology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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20
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Pajovic B, Radojevic N, Dimitrovski A, Tomovic S, Vukovic M. The therapeutic potential of royal jelly in benign prostatic hyperplasia. Comparison with contemporary literature. Aging Male 2016; 19:192-196. [PMID: 27045321 DOI: 10.3109/13685538.2016.1169400] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The aim of this study is to establish the scientific benefit of royal jelly (RJ) on prostatic-specific antigen (PSA), post-void residual (PVR) volume and International Prostate Symptom Score (IPSS) in benign prostatic hyperplasia. For the study, a group of 40 men were administered 38 mg of RJ over a period of three months, their PSA values, prostate volumes and the volumes of their transitory prostate zones, PVR and IPPS values were measured at the end of the first month, and at the end of the third month. The results of this study confirm the potential of RJ in reducing PSA scores and improving IPSS values. Since the use of RJ did not lead to any significant reduction in PVR, prostate volume, or to any involution of the transitory zone, it appears that it may only affect the blood marker of prostatic hyperplasia and to improve quality-of-life (QoL) in those patients. Overall, in comparison to phytotherapy and conventional therapy, RJ had similar positive effects on QoL in patients with BPH, however it exhibited markedly better effects on reducing PSA levels in blood. The therapeutical use of RJ exhibited no side effects.
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Affiliation(s)
| | - Nemanja Radojevic
- b Department of Forensic Medicine , Clinical Centre of Montenegro, Faculty of Medicine, University of Montenegro , Podgorica , Montenegro
| | | | - Savo Tomovic
- d Faculty of Mathematics and Natural Sciences , University of Montenegro , Podgorica , Montenegro
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Macey MR, Raynor MC. Medical and Surgical Treatment Modalities for Lower Urinary Tract Symptoms in the Male Patient Secondary to Benign Prostatic Hyperplasia: A Review. Semin Intervent Radiol 2016; 33:217-23. [PMID: 27582609 DOI: 10.1055/s-0036-1586142] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS) is one of the most common ailments affecting aging men. Symptoms typically associated with BPH include weak stream, hesitancy, urgency, frequency, and nocturia. More serious complications of BPH include urinary retention, gross hematuria, bladder calculi, recurrent urinary tract infection, obstructive uropathy, and renal failure. Evaluation of BPH includes a detailed history, objective assessment of urinary symptoms with validated questionnaires, and measurement of bladder function parameters, including uroflowmetry and postvoid residual. In general, treatment of LUTS associated with BPH is based on the effect of the symptoms on quality of life (QOL) and include medical therapy aimed at reducing outlet obstruction or decreasing the size of the prostate. If medical therapy fails or is contraindicated, various surgical options exist. As the elderly population continues to grow, the management of BPH will become more common and important in maintaining patient's QOL.
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Affiliation(s)
- Matthew Ryan Macey
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Mathew C Raynor
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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22
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23
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Strand DW, Aaron L, Henry G, Franco OE, Hayward SW. Isolation and analysis of discreet human prostate cellular populations. Differentiation 2016; 91:139-51. [PMID: 26546040 PMCID: PMC4854811 DOI: 10.1016/j.diff.2015.10.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 10/27/2015] [Indexed: 02/03/2023]
Abstract
The use of lineage tracing in transgenic mouse models has revealed an abundance of subcellular phenotypes responsible for maintaining prostate homeostasis. The ability to use fresh human tissues to examine the hypotheses generated by these mouse experiments has been greatly enhanced by technical advances in tissue processing, flow cytometry and cell culture. We describe in detail the optimization of protocols for each of these areas to facilitate research on solving human prostate diseases through the analysis of human tissue.
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Affiliation(s)
- Douglas W Strand
- Department of Urology, UT Southwestern University Medical Center, Dallas, TX, USA
| | - LaTayia Aaron
- Department of Cancer Biology, Meharry Medical College, Nashville, TN, USA
| | - Gervaise Henry
- Department of Urology, UT Southwestern University Medical Center, Dallas, TX, USA
| | - Omar E Franco
- Department of Surgery, NorthShore University Health System, Research Institute, Evanston, IL, USA
| | - Simon W Hayward
- Department of Surgery, NorthShore University Health System, Research Institute, Evanston, IL, USA.
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Yeo JK, Choi H, Bae JH, Kim JH, Yang SO, Oh CY, Cho YS, Kim KW, Kim HJ. Korean clinical practice guideline for benign prostatic hyperplasia. Investig Clin Urol 2016; 57:30-44. [PMID: 26966724 PMCID: PMC4778754 DOI: 10.4111/icu.2016.57.1.30] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 12/24/2015] [Indexed: 11/18/2022] Open
Abstract
In 2014, the Korean Urological Association organized the Benign Prostatic Hyperplasia Guideline Developing Committee composed of experts in the field of benign prostatic hyperplasia (BPH) with the participation of the Korean Academy of Family Medicine and the Korean Continence Society to develop a Korean clinical practice guideline for BPH. The purpose of this clinical practice guideline is to provide current and comprehensive recommendations for the evaluation and treatment of BPH. The committee developed the guideline mainly by adapting existing guidelines and partially by using the de novo method. A comprehensive literature review was carried out primarily from 2009 to 2013 by using medical search engines including data from Korea. Based on the published evidence, recommendations were synthesized, and the level of evidence of the recommendations was determined by using methods adapted from the 2011 Oxford Centre for Evidence-Based Medicine. Meta-analysis was done for one key question and four recommendations. A draft guideline was reviewed by expert peer reviewers and discussed at an expert consensus meeting until final agreement was achieved. This evidence-based guideline for BPH provides recommendations to primary practitioners and urologists for the diagnosis and treatment of BPH in men older than 40 years.
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Affiliation(s)
- Jeong Kyun Yeo
- Department of Urology, Inje University College of Medicine, Busan, Korea
| | - Hun Choi
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Jae Hyun Bae
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Jae Heon Kim
- Department of Urology, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Seong Ok Yang
- Department of Urology, VHS Medical Center, Seoul, Korea
| | - Chul Young Oh
- Department of Urology, Hallym University College of Medicine, Chuncheon, Korea
| | - Young Sam Cho
- Department of Urology, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Kyoung Woo Kim
- Department of Family Medicine, Inje University College of Medicine, Busan, Korea
| | - Hyung Ji Kim
- Department of Urology, Dankook University College of Medicine, Cheonan, Korea
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Mangera A, Chapple C. Update summarising the conclusions of the international consultation on male lower urinary tract symptoms. World J Clin Urol 2015; 4:83-91. [DOI: 10.5410/wjcu.v4.i2.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 10/07/2014] [Accepted: 05/11/2015] [Indexed: 02/05/2023] Open
Abstract
The International Consultation on Urological Disease have recently published comprehensive conclusions, based on evidence reviewed by eight committees, on aspects of male lower urinary tract symptoms (LUTS). In this review, we summarise the conclusions from four of the committees, namely, the evidence regarding the epidemiology of male LUTS, patient assessment, nocturia and medical management. It is indisputable that with an expanding and ageing global population the prevalence of male LUTS is likely to increase. Therefore symptom prevention and preservation of quality of life (QoL) feature highly in the guidelines. There are now a number of different medical options, proven to lead to significant improvements in symptom scores, flow rate and QoL available to men with LUTS. Meta-analyses have shown the benefits for alpha blockers, antimuscarinics, 5-α reductase and phosphodiesterase-5 inhibitors. High level evidence also exists for combinations of all of the above with alpha blockers and so men with concomitant storage symptoms, prostate volume > 30 mL, PSA > 1.4 or erectile dysfunction may be considered for combination treatment of an alpha blocker with an antimuscarinic, 5-α reductase inhibitor or phosphodiesterase-5 inhibitor respectively. In an era of personalised medicine, appropriate patient selection is likely to provide the key to the most effective clinical management strategy.
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26
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Lim J, Bhoo-Pathy N, Sothilingam S, Malek R, Sundram M, Tan GH, Bahadzor B, Ong TA, Ng KL, Abdul Razack AH. Cardiovascular Risk Factors and Ethnicity Are Independent Factors Associated with Lower Urinary Tract Symptoms. PLoS One 2015; 10:e0130820. [PMID: 26098884 PMCID: PMC4476577 DOI: 10.1371/journal.pone.0130820] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 05/26/2015] [Indexed: 11/22/2022] Open
Abstract
Objectives To determine the lower urinary tract symptoms (LUTS) profile and factors affecting its degree of severity including cardiovascular risk profile, age, ethnicity, education level and prostate volume in a multiethnic Asian setting. Materials and Methods We conducted a cross-sectional study of 1021 men aged 40–79 years with no clinical evidence of prostate cancer, prostate surgery or 5α-reductase inhibitor treatment of known prostate conditions. The severity of LUTS was assessed using the International Prostate Symptom Score (IPSS). Potential factors associated with LUTS including age, ethnicity, education, history of hypertension, diabetes and hypercholesterolemia, height, weight, and prostate volume were evaluated using univariable and multivariable analyses. Results There were 506 (50%) men found to have moderate-to-severe LUTS attaining an IPSS above 7. Overall, nocturia (45.5%) was the most frequently reported symptom. Multivariable analysis showed that age, ethnicity, prostate volume and history of hypertension and hypercholesterolemia were independent factors associated with severity of LUTS (p < 0.05). Considering individual lower urinary tract symptoms, we found a strong association of storage symptom with history of hypertension and hypercholesterolemia. Malay men were significantly bothered by post micturition symptom compared to their Chinese and Indian counterparts. Stratified analyses of LUTS demonstrated a mutually exclusive cardiovascular risk factors profile defined by ethnicity. Conclusion Severity of LUTS varies between different ethnicities across all age groups. In addition to age and prostate volume, ethnicity and cardiovascular risk factors including hypertension and hypercholesterolemia may also need to be taken into account in managing men with LUTS.
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Affiliation(s)
- Jasmine Lim
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nirmala Bhoo-Pathy
- Julius Center University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Primary Care, University Medical Center Utrecht, 3508GA, Utrecht, Netherlands
| | | | - Rohan Malek
- Department of Urology, Selayang Hospital, Selangor, Malaysia
| | - Murali Sundram
- Department of Urology, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Guan Hee Tan
- Department of Surgery, University Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - Badrulhisham Bahadzor
- Department of Surgery, University Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - Teng Aik Ong
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Keng Lim Ng
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Centre for Kidney Disease Research, School of Medicine, University of Queensland, Translational Research Institute, Brisbane, Australia
| | - Azad Hassan Abdul Razack
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- * E-mail:
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Differential Response to Medical Therapy for Male Lower Urinary Tract Symptoms. CURRENT BLADDER DYSFUNCTION REPORTS 2015. [DOI: 10.1007/s11884-015-0295-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lubetzky M, Ajaimy M, Kamal L, de Boccardo G, Akalin E, Kayler L. Kidney transplant complications from undiagnosed benign prostatic hypertrophy. Clin Transplant 2015; 29:539-42. [DOI: 10.1111/ctr.12548] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Michelle Lubetzky
- Montefiore-Einstein Center for Transplantation; Montefiore Medical Center; Albert Einstein College of Medicine; Bronx NY USA
- Renal Division; Montefiore Medical Center; Albert Einstein College of Medicine; Bronx NY USA
| | - Maria Ajaimy
- Montefiore-Einstein Center for Transplantation; Montefiore Medical Center; Albert Einstein College of Medicine; Bronx NY USA
- Renal Division; Montefiore Medical Center; Albert Einstein College of Medicine; Bronx NY USA
| | - Layla Kamal
- Montefiore-Einstein Center for Transplantation; Montefiore Medical Center; Albert Einstein College of Medicine; Bronx NY USA
- Renal Division; Montefiore Medical Center; Albert Einstein College of Medicine; Bronx NY USA
| | - Graciela de Boccardo
- Montefiore-Einstein Center for Transplantation; Montefiore Medical Center; Albert Einstein College of Medicine; Bronx NY USA
- Renal Division; Montefiore Medical Center; Albert Einstein College of Medicine; Bronx NY USA
| | - Enver Akalin
- Montefiore-Einstein Center for Transplantation; Montefiore Medical Center; Albert Einstein College of Medicine; Bronx NY USA
- Renal Division; Montefiore Medical Center; Albert Einstein College of Medicine; Bronx NY USA
| | - Liise Kayler
- Montefiore-Einstein Center for Transplantation; Montefiore Medical Center; Albert Einstein College of Medicine; Bronx NY USA
- Department of Surgery; Montefiore Medical Center; Albert Einstein College of Medicine; Bronx NY USA
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Gratzke C, Bachmann A, Descazeaud A, Drake MJ, Madersbacher S, Mamoulakis C, Oelke M, Tikkinen KAO, Gravas S. EAU Guidelines on the Assessment of Non-neurogenic Male Lower Urinary Tract Symptoms including Benign Prostatic Obstruction. Eur Urol 2015; 67:1099-1109. [PMID: 25613154 DOI: 10.1016/j.eururo.2014.12.038] [Citation(s) in RCA: 588] [Impact Index Per Article: 65.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 12/26/2014] [Indexed: 11/25/2022]
Abstract
CONTEXT Lower urinary tract symptoms (LUTS) represent one of the most common clinical complaints in adult men and have multifactorial aetiology. OBJECTIVE To develop European Association of Urology (EAU) guidelines on the assessment of men with non-neurogenic LUTS. EVIDENCE ACQUISITION A structured literature search on the assessment of non-neurogenic male LUTS was conducted. Articles with the highest available level of evidence were selected. The Delphi technique consensus approach was used to develop the recommendations. EVIDENCE SYNTHESIS As a routine part of the initial assessment of male LUTS, a medical history must be taken, a validated symptom score questionnaire with quality-of-life question(s) should be completed, a physical examination including digital rectal examination should be performed, urinalysis must be ordered, post-void residual urine (PVR) should be measured, and uroflowmetry may be performed. Micturition frequency-volume charts or bladder diaries should be used to assess male LUTS with a prominent storage component or nocturia. Prostate-specific antigen (PSA) should be measured only if a diagnosis of prostate cancer will change the management or if PSA can assist in decision-making for patients at risk of symptom progression and complications. Renal function must be assessed if renal impairment is suspected from the history and clinical examination, if the patient has hydronephrosis, or when considering surgical treatment for male LUTS. Uroflowmetry should be performed before any treatment. Imaging of the upper urinary tract in men with LUTS should be performed in patients with large PVR, haematuria, or a history of urolithiasis. Imaging of the prostate should be performed if this assists in choosing the appropriate drug and when considering surgical treatment. Urethrocystoscopy should only be performed in men with LUTS to exclude suspected bladder or urethral pathology and/or before minimally invasive/surgical therapies if the findings may change treatment. Pressure-flow studies should be performed only in individual patients for specific indications before surgery or when evaluation of the pathophysiology underlying LUTS is warranted. CONCLUSIONS These guidelines provide evidence-based practical guidance for assessment of non-neurogenic male LUTS. An extended version is available online (www.uroweb.org/guidelines). PATIENT SUMMARY This article presents a short version of European Association of Urology guidelines for non-neurogenic male lower urinary tract symptoms (LUTS). The recommended tests should be able to distinguish between uncomplicated male LUTS and possible differential diagnoses and to evaluate baseline parameters for treatment. The guidelines also define the clinical profile of patients to provide the best evidence-based care. An algorithm was developed to guide physicians in using appropriate diagnostic tests.
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Affiliation(s)
- Christian Gratzke
- Department of Urology, Urologische Klinik und Poliklinik, Klinikum der Universität München-Grosshadern, Munich, Germany
| | | | - Aurelien Descazeaud
- Department of Urology, Dupuytren Hospital, University of Limoges, Limoges, France
| | - Marcus J Drake
- Bristol Urological Institute and School of Clinical Sciences, University of Bristol, Bristol, UK
| | | | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | - Matthias Oelke
- Department of Urology, Hannover Medical School, Hannover, Germany
| | - Kari A O Tikkinen
- Departments of Urology and Public Health, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Stavros Gravas
- Department of Urology, University of Thessaly, Larissa, Greece.
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Inahara M, Sugiura M, Kaga K, Hou K, Araki K, Masuda H, Kojima S, Naya Y. [Clinical outcomes after combined therapy with dutasteride in patients with unsuccessful trial without catheter after treatment with an alpha1-adrenergic receptor blocker monotherapy for acute urinary retention caused by prostatic hyperplasia]. Nihon Hinyokika Gakkai Zasshi 2014; 105:190-195. [PMID: 25757349 DOI: 10.5980/jpnjurol.105.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The outcome of trial of voiding without catheter in patients treated combination therapy with dutasteride and alpha1-adrenergic receptor blocker for acute urinary retention caused by benign prostatic hyperplasia was not reported. We evaluated the clinical efficacy of combination therapy with dutasteride in patients with unsuccessful trial without catheter after treatment with an alpha1-adrenergic receptor blocker monotherapy for acute urinary retention caused by benign prostatic hyperplasia. PATIENTS AND METHODS Patients with acute urinary retention due to prostatic hyperplasia were catheterized and treated alpha1-adrenergic receptor blocker monotherapy. After two weeks later, patients were put on trial without catheter. 52 patients who were unsuccessful trial without catheter administered combination therapy with dutasteride and alpha1-adrenergic receptor blocker. We use criteria that voiding urine volume over 100 ml and post-void residual urine volume below 100 ml in deciding whether catheter should be removed. RESULTS 33 (63.5%) men did not require re-catheterization within 7 months after combination therapy. The successful rate of Performance Status (PS) 0-1 group was significantly superior to that of PS 2-4 group. CONCLUSIONS PS 0-1 men catheterized for AUR can void more successfully after catheter removal than PS 2-4 men if treated with combination therapy.
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Application of guidelines to the evaluation of the male patient with urgency and/or incontinence. Curr Opin Urol 2014; 24:547-52. [PMID: 25144144 DOI: 10.1097/mou.0000000000000110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To review and evaluate the evidence from contemporary evidence-based guidelines regarding the assessment of men with urinary urgency and/or incontinence. RECENT FINDINGS There are a number of evidence-based guidelines which describe the pathways for assessing men with the symptoms of urgency and/or incontinence. We summarize the conclusions of the European Association of Urology, American Urological Association and National Institute of Clinical Excellence guidelines. SUMMARY All guidelines recommend a directed history, examination (including digital rectal examination), urinalysis and bladder diary as being essential in the assessment of men with lower urinary tract symptoms, although there are no high levels of evidence studies to support this. Creatinine estimation and prostate-specific antigen are recommended in selected groups of men, the latter after appropriate counselling. Uroflowmetry with postvoid residual assessment is recommended for at specialist assessment. Pad tests may be useful to quantify leakage. Ultrasound assessment of prostatic size and protrusion into the bladder base may be useful. Cystometry is recommended for men considering prostatic surgery, although there is a poor level of evidence underpinning this. Noninvasive surrogates for cystometry, such as penile plethysmography, lack sufficient evidence to allow recommendations to be made.
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Tanik S, Albayrak S, Zengin K, Borekci H, Bakirtas H, Imamoglu MA, Gurdal M. Is the Neutrophil-Lymphocyte Ratio an Indicator of Progression in Patients with Benign Prostatic Hyperplasia? Asian Pac J Cancer Prev 2014; 15:6375-9. [DOI: 10.7314/apjcp.2014.15.15.6375] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Lacy JM, Kyprianou N. A tale of two trials: The impact of 5α-reductase inhibition on prostate cancer (Review). Oncol Lett 2014; 8:1391-1396. [PMID: 25202340 PMCID: PMC4156162 DOI: 10.3892/ol.2014.2388] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 07/01/2014] [Indexed: 01/06/2023] Open
Abstract
The use of 5α-reductase inhibitors (5α-RIs) as prostate cancer chemoprevention agents is controversial. Two large randomized trials, the Prostate Cancer Prevention Trial (PCPT) and the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) Trial, have both shown a decreased incidence of prostate cancer in patients administered with 5α-RIs. Both studies showed, however, an increased risk of higher-grade prostate cancer. Numerous studies have since analyzed the inherent biases in these landmark studies and have used mathematical modeling to estimate the true incidence of prostate cancer and the risk for high-grade prostate cancer in patients undergoing 5α-RI treatment. All primary publications associated with the PCPT and REDUCE studies were reviewed in detail. Pertinent references from the above publications were assessed and a literature search of all published articles associated with PCPT, REDUCE or 5α-RIs as chemopreventative agents through October 2013 was performed using Pubmed/Medline. PCPT and REDUCE both showed a significant decrease in the incidence of prostate cancer following the administration of 5α-reductase inhibitor, as compared with placebo, suggesting that 5α-RIs may be effective agents for prostate cancer chemoprevention. Inherent biases in the design of these two studies may have caused an artificial increase in the number of high-grade cancers reported. Mathematical models, that integrated data from these trials, revealed neither an increased nor decreased risk of high-grade disease when taking these biases into consideration. Moderately strong evidence exists that 5α-RIs may reduce the risk of prostate cancer. PCPT and REDUCE showed a decreased prevalence of prostate cancer in patients taking 5α-RIs. Urologists should have a working knowledge of these studies and discuss with patients the risks and benefits of 5α-RI treatment. Further studies to evaluate the cost-effectiveness of chemoprevention with 5α-RIs and appropriate patient selection are warranted.
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Affiliation(s)
- John M Lacy
- Department of Urology, University of Kentucky College of Medicine, Lexington, KY 40536-0293, USA
| | - Natasha Kyprianou
- Department of Urology, University of Kentucky College of Medicine, Lexington, KY 40536-0293, USA ; Department of Molecular and Cellular Biochemistry, University of Kentucky College of Medicine, Lexington, KY 40536-0293, USA
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Yang SL, Tang KQ, Bai WK, Zhao YW, Shen E, Tao JJ, Hu B. Combined low-frequency ultrasound and microbubble contrast agent for the treatment of benign prostatic hyperplasia. J Endourol 2014; 27:1020-6. [PMID: 23607285 DOI: 10.1089/end.2012.0637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Benign prostatic hyperplasia is one of the most common conditions in middle-aged and elderly men. The aim of the study was to investigate the treatment effects of low-frequency ultrasound combined with a microbubbles agent on benign prostatic hyperplasia. METHODS Eighteen 7-year-old male beagles with prostatic hyperplasia were randomly divided into six groups (n=3): Control group, 21 kHz ultrasound group, 21 kHz ultrasound and microbubble contrast agent group, 1 MHz ultrasound group, 1 MHz ultrasound and microbubble contrast agent group, and microbubble contrast agent group. The histopathologic damage to prostate cells was assessed via transmission electron microscopy and optical microscopy. The protein expressions of prostate-specific antigen (PSA), inducible nitric oxide synthase (iNOS), and super oxidase dimutase (SOD) were detected by enzyme-linked immunosorbent assay. Levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), blood urea nitrogen (BUN), and creatinine (Cr) were detected by the Biochemistry Automatic Analyzer. RESULTS Significant tissue injury, mitochondria injury, and cell apoptosis were observed in 21 kHz ultrasound and the microbubble contrast agent group. Compared with the control and microbubbles contrast agent groups, the decrease in levels of PSA or increase in levels of iNOs and SOD in the other four groups were statistically significant (P<0.05). The lowest level of PSA and the highest levels of iNOs and SOD were observed in the 21 kHz ultrasound and microbubbles contrast agent group. No significant changes in levels of AST, ALT, BUN, and Cr were observed between the six groups. CONCLUSIONS Our results suggest that lower frequency ultrasound may have a better effect on benign prostatic hyperplasia, and microbubble contrast agent application further strengthens this biological effect.
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Affiliation(s)
- Shao-ling Yang
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated 6th People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
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Bechis SK, Otsetov AG, Ge R, Olumi AF. Personalized medicine for the management of benign prostatic hyperplasia. J Urol 2014; 192:16-23. [PMID: 24582540 DOI: 10.1016/j.juro.2014.01.114] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Benign prostatic hyperplasia affects more than 50% of men by age 60 years, and is the cause of millions of dollars in health care expenditure for the treatment of lower urinary tract symptoms and urinary obstruction. Despite the widespread use of medical therapy, there is no universal therapy that treats all men with symptomatic benign prostatic hyperplasia. At least 30% of patients do not respond to medical management and a subset require surgery. Significant advances have been made in understanding the natural history and development of the prostate, such as elucidating the role of the enzyme 5α-reductase type 2, and advances in genomics and biomarker discovery offer the potential for a more targeted approach to therapy. We review the current understanding of benign prostatic hyperplasia progression as well as the key genes and signaling pathways implicated in the process such as 5α-reductase. We also explore the potential of biomarker screening and gene specific therapies as tools to risk stratify patients with benign prostatic hyperplasia and identify those with symptomatic or medically resistant forms. MATERIALS AND METHODS A PubMed® literature search of current and past peer reviewed literature on prostate development, lower urinary tract symptoms, benign prostatic hyperplasia pathogenesis, targeted therapy, biomarkers, epigenetics, 5α-reductase type 2 and personalized medicine was performed. An additional Google Scholar™ search was conducted to broaden the scope of the review. Relevant reviews and original research articles were examined, as were their cited references, and a synopsis of original data was generated with the goal of informing the practicing urologist of these advances and their implications. RESULTS Benign prostatic hyperplasia is associated with a state of hyperplasia of the stromal and epithelial compartments, with 5α-reductase type 2 and androgen signaling having key roles in the development and maintenance of the prostate. Chronic inflammation, multiple growth factor and hormonal signaling pathways, and medical comorbidities have complex roles in prostate tissue homeostasis as well as its evolution into the clinical state of benign prostatic hyperplasia. Resistance to medical therapy with finasteride may occur through silencing of the 5α-reductase type 2 gene by DNA methylation, leading to a state in which 30% of adult prostates do not express 5α-reductase type 2. Novel biomarkers such as single nucleotide polymorphisms may be used to risk stratify patients with symptomatic benign prostatic hyperplasia and identify those at risk for progression or failure of medical therapy. Several inhibitors of the androgen receptor and other signaling pathways have recently been identified which appear to attenuate benign prostatic hyperplasia progression and may offer alternative targets for medical therapy. CONCLUSIONS Progressive worsening of lower urinary tract symptoms and bladder outlet obstruction secondary to benign prostatic hyperplasia is the result of multiple pathways including androgen receptor signaling, proinflammatory cytokines and growth factor signals. New techniques in genomics, proteomics and epigenetics have led to the discovery of aberrant signaling pathways, novel biomarkers, DNA methylation signatures and potential gene specific targets. As personalized medicine continues to develop, the ability to risk stratify patients with symptomatic benign prostatic hyperplasia, identify those at higher risk for progression, and seek alternative therapies for those in whom conventional options are likely to fail will become the standard of targeted therapy.
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Affiliation(s)
- Seth K Bechis
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alexander G Otsetov
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rongbin Ge
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Aria F Olumi
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
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Glass AS, Hilton JF, Cowan JE, Washington SL, Carroll PR. Serial Prostate Biopsy and Risk of Lower Urinary Tract Symptoms: Results From a Large, Single-institution Active Surveillance Cohort. Urology 2014; 83:33-8. [DOI: 10.1016/j.urology.2013.05.070] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 05/24/2013] [Accepted: 05/30/2013] [Indexed: 11/30/2022]
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Involvement of fibroblast growth factor receptor genes in benign prostate hyperplasia in a Korean population. DISEASE MARKERS 2013; 35:869-75. [PMID: 24385678 PMCID: PMC3871704 DOI: 10.1155/2013/792941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 11/01/2013] [Accepted: 11/15/2013] [Indexed: 11/18/2022]
Abstract
Fibroblast growth factors (FGFs) and their receptors (FGFRs) have been implicated in prostate growth and are overexpressed in benign prostatic hyperplasia (BPH). In this study, we investigated whether single nucleotide polymorphisms (SNPs) of the FGFR genes (FGFR1 and FGFR2) were associated with BPH and its clinical phenotypes in a population of Korean men. We genotyped four SNPs in the exons of FGFR1 and FGFR2 (rs13317 in FGFR1; rs755793, rs1047100, and rs3135831 in FGFR2) using direct sequencing in 218 BPH patients and 213 control subjects. No SNPs of FGFR1 or FGFR2 genes were associated with BPH. However, analysis according to clinical phenotypes showed that rs1047100 of FGFR2 was associated with prostate volume in BPH in the dominant model (GA/AA versus GG, P = 0.010). In addition, a significant association was observed between rs13317 of FGFR1 and international prostate symptom score (IPSS) in the additive (TC versus CC versus TT, P = 0.0022) and dominant models (TC/CC versus TT, P = 0.005). Allele frequency analysis also showed significant association between rs13317 and IPSS (P = 0.005). These results suggested that FGFR genes could be related to progression of BPH.
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Yang SL, Tang KQ, Bai WK, Shen E, Zhao YW, Lin YD, Nan SL, Bing H. Effects of low-frequency ultrasound combined with microbubbles on benign prostate hyperplasia. Can Urol Assoc J 2013; 7:E681-6. [PMID: 24282457 DOI: 10.5489/cuaj.354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Our objective is to assess the effects of low-frequency ultrasound combined with microbubbles on benign prostate hyperplasia (BPH). METHODS Sixteen Beagle dogs with BPH were randomly assigned into 4 groups (n = 4): control group (without treatment), G1 group (injection with 2 mL of microbubble contrast agent); G2 group (21 kHz ultrasound); and G3 group (injection with 2 mL of micro-bubble contrast agent +21 kHz ultrasound). The histopathological damage to prostate cells was assessed via transmission electron microscopy and optical microscopy. The protein expressions of prostate-specific antigen (PSA), inducible nitric oxide synthase (iNOS), superoxide dismutase (SOD) of vessels were detected by enzyme-linked immunosorbent assay (ELISA). RESULTS Histopathologically, the prostate cells exhibited nuclear chromatin contraction, mitochondrial swelling, degranulation of rough endoplasmic reticulum, basement membrane rupture and cell apoptosis in the G2 and G3 groups; it was especially obvious in the G3 group, while no changes were observed in the control and G1 groups. Although prostate volume using imaging was not significantly changed in all groups after treatment, PSA was significantly reduced in the G2 and G3 groups, and especially obvious in the G3 group (p < 0.05). The iNOS and SOD, which are important oxidative stress factors, significantly increased after treatment in the G2 and G3 groups, but not in the control and G1 groups (p < 0.05). CONCLUSIONS Low-frequency ultrasound is effective in treating BPH; low-frequency ultrasound combined with microbubbles improves the treatment efficacy.
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Affiliation(s)
- Shao-Ling Yang
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated 6th People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, PR China; ; Department of Ultrasound in Medicine, Branch Hospital in Fengxian of Shanghai 6th People's Hospital, Shanghai, PR China
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Bechara A, Casabe A, Rodriguez Baigorri G, Cobreros C. Effectiveness of tadalafil 5 mg once daily in the treatment of men with lower urinary tract symptoms suggestive to benign prostatic hyperplasia with or without erectile dysfunction: results from naturalistic observational TadaLutsEd study. J Sex Med 2013; 11:498-505. [PMID: 24224728 DOI: 10.1111/jsm.12386] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Naturalistic clinical trials provide data on the effectiveness of drugs in nonexperimental and everyday situations and are extremely helpful for decision-making purposes and for confirming experimental findings in clinical trials. No data have been published from naturalistic studies performed in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) with or without erectile dysfunction (ED) and treated with phosphodiesterase type 5 inhibitors. AIM The aim of this study (TadaLutsEd Study) was to assess, in the context of medical practice, the effectiveness of tadalafil 5 mg once daily in patients with LUTS/BPH with or without erectile dysfunction. METHODS The study was a 6-week uncontrolled, prospective, open-label, multicentric, observational study. The patient population involved sexually active males aged ≥ 50 years, diagnosed with LUTS/BPH with or without concomitant ED, and treated with tadalafil 5 mg daily in accordance with standard urological practice. MAIN OUTCOME MEASURES Effectiveness was assessed through the self-administered International Prostate Symptom Score (IPSS) questionnaire; quality of life was evaluated through the IPSS quality of life section (IPSS-QoL). The patients were also evaluated with the International Index of Erectile Function (IIEF-5). Adverse events were recorded. Statistical analyses using paired data samples was applied (Wilcoxon signed-ranks test). RESULTS Sixty-two patients (mean age 62.2 years) completed the treatment, of whom 85.5% showed improvement in their urinary symptoms. Pre- and post-treatment differences in the IPSS, IPSS-QoL, and IIEF-5 scores were statistically significant at 4.4, 1, and 5.4 points, respectively (P < 0.0001). Tadalafil was well tolerated, and adverse events were mild, with a discontinuation rate of 1.6%. CONCLUSION According to study results, the use of tadalafil 5 mg once daily in a nonselected patient population with LUTS/BPH with or without ED led to improvements in terms of symptoms and quality of life and exhibited a safety profile similar to that obtained in controlled tadalafil clinical trials.
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Affiliation(s)
- Amado Bechara
- División Urología, Hospital Durand, Buenos Aires, Argentina
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Lin VC, Liao CH, Wang CC, Kuo HC. 5α-Reductase inhibitor is less effective in men with small prostate volume and low serum prostatic specific antigen level. J Formos Med Assoc 2013; 114:865-71. [PMID: 24064231 DOI: 10.1016/j.jfma.2013.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 08/16/2013] [Accepted: 08/20/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND/PURPOSE Large total prostate volumes (TPVs) or high serum prostate-specific antigen (PSA) levels indicate high-risk clinical progression of benign prostatic hyperplasia. This prospective study investigated the treatment outcome of combined 5α-reductase inhibitor and α-blocker in patients with and without large TPVs or high PSA levels. METHODS Men aged ≥ 45 years with International Prostate Symptom scores (IPSS) ≥ 8, TPV ≥ 20 mL, and maximum flow rate ≤ 15 mL/s received a combination therapy (dutasteride plus doxaben) for 2 years. Patients with baseline PSA ≥ 4 ng/mL underwent prostatic biopsy for excluding malignancy. The changes in the parameters from baseline to 24 months after combination therapy were compared in those with and without TPV ≥ 40 mL or PSA levels ≥ 1.5 ng/mL. RESULTS A total of 285 patients (mean age 72 ± 9 years) completed the study. Combination therapy resulted in significant continuous improvement in IPSS, quality of life index, maximum flow rate, and postvoid residual (all p < 0.0001) regardless of baseline TPV or PSA levels. However, only patients with baseline TPV ≥ 40 mL had significant improvements in IPSS-storage subscore, voided volume, reduction in TPV, transitional zone index, and PSA levels. In addition, patients with baseline TPV < 40 mL and PSA < 1.5 ng/mL had neither a reduction in TPV nor a decrease in serum PSA level. CONCLUSION A high TPV indicates more outlet resistance, whereas elevated serum PSA level reflects glandular proliferation. Thus, patients with TPV<40 mL and low PSA levels has less benefit from 5α-reductase inhibitor therapy. The therapeutic effect of combined treatment may arise mainly from the α-blocker in these patients.
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Affiliation(s)
- Victor C Lin
- Department of Urology, E-Da Hospital, Kaohsiung, Taiwan; Department of Healthcare Administration, I-Shou University, Kaohsiung, Taiwan
| | - Chun-Hou Liao
- Department of Urology, Cardinal Tien Hospital, and School of Medicine, Fu-Jen Catholic University, Taipei, Taiwan
| | - Chung-Cheng Wang
- Department of Urology, En Chu Kong Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Buddhist Tzu Chi General Hospital, and Tzu Chi University, Hualien, Taiwan.
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Nicholson TM, Sehgal PD, Drew SA, Huang W, Ricke WA. Sex steroid receptor expression and localization in benign prostatic hyperplasia varies with tissue compartment. Differentiation 2013; 85:140-9. [PMID: 23792768 DOI: 10.1016/j.diff.2013.02.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 02/16/2013] [Accepted: 02/27/2013] [Indexed: 11/17/2022]
Abstract
Androgens and estrogens, acting via their respective receptors, are important in benign prostatic hyperplasia (BPH). The goals of this study were to quantitatively characterize the tissue distribution and staining intensity of androgen receptor (AR) and estrogen receptor-alpha (ERα), and assess cells expressing both AR and ERα, in human BPH compared to normal prostate. A tissue microarray composed of normal prostate and BPH tissue was used and multiplexed immunohistochemistry was performed to detect AR and ERα. We used a multispectral imaging platform for automated scanning, tissue and cell segmentation and marker quantification. BPH specimens had an increased number of epithelial and stromal cells and increased percentage of epithelium. In both stroma and epithelium, the mean nuclear area was decreased in BPH relative to normal prostate. AR expression and staining intensity in epithelial and stromal cells was significantly increased in BPH compared to normal prostate. ERα expression was increased in BPH epithelium. However, stromal ERα expression and staining intensity was decreased in BPH compared to normal prostate. Double positive (AR and ERα) epithelial cells were more prevalent in BPH, and fewer double negative (AR and ERα) stromal and epithelial negative cells were observed in BPH. These data underscore the importance of tissue layer localization and expression of steroid hormone receptors in the prostate. Understanding the tissue-specific hormone action of androgens and estrogens will lead to a better understanding of mechanisms of pathogenesis in the prostate and may lead to better treatment for BPH.
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Mishriki SF, Aboumarzouk O, Graham JT, Lam TB, Somani BK. Baseline symptom score and flow rate can predict failure of medical treatment of lower urinary tract symptoms: prospective 12-year follow-up study. Urology 2013; 81:390-4. [PMID: 23374812 DOI: 10.1016/j.urology.2012.08.104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 08/28/2012] [Accepted: 08/31/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess predictors of failure of medical treatment of lower urinary tract symptoms (LUTS) and evaluate long-term outcome. METHODS Between January 1993 and September 1994, 178 men referred with LUTS were prospectively recruited. Assessments included maximum urine flow (Qmax), postvoiding residuals (PVR), transrectal ultrasound (TRUS) prostate volumes, American Urological Association symptom score, and validated quality of life (QOL) and bother scores. Treatment failure was defined as need for transurethral resection of the prostate (TURP). Data were collected at baseline, with final follow-up at 12 years. Univariate and multivariate analyses used Kaplan-Meier and the Cox proportional hazards regression model, respectively, to assess covariates on risk of failure and independent variable prognostic values. RESULTS Median follow-up was 7.9 years (range, 0-12 years). The mean QOL baseline score of 7.1 improved to 3.6 at 6 years and to 3.3 at 12 years (P <.05 for all). Fifty patients (28%) underwent TURP, with 36 undergoing TURP within 3 years. By univariate analysis, Qmax, AUA and bother scores, and PVR were significantly associated with treatment failure. Independent predictors of failure by multivariate Cox regression were Qmax (>15 vs <15 mL/s; hazard ratio, 3.37; 95% confidence interval, 1.74-6.52; P <.0001) and bother score (<13 vs >13; hazard ratio, 2.37; 95% confidence interval, 1.29-4.35; P = .005). At 12 years, AUA, QOL, and bother scores statistically improved compared with baseline (13 vs 8, 10 vs 6, and 5 vs 2, respectively). Limitations included attrition bias from nonresponders. CONCLUSION The beneficial effect of medical treatment persisted for up to 12 years. Treatment is more likely to fail within the first 3 years in patients with low baseline Qmax and high bother scores.
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Affiliation(s)
- Said Fadel Mishriki
- Department of Urology, Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom.
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Spatafora S, Casarico A, Fandella A, Galetti C, Hurle R, Mazzini E, Niro C, Perachino M, Sanseverino R, Pappagallo GL. Evidence-based guidelines for the treatment of lower urinary tract symptoms related to uncomplicated benign prostatic hyperplasia in Italy: updated summary from AURO.it. Ther Adv Urol 2013. [PMID: 23205056 DOI: 10.1177/1756287212463112] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The first Italian national guidelines were developed by the Italian Association of Urologists and published in 2007. Since then, a number of new drugs or classes of drugs have emerged for the treatment of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH), new data have emerged on medical therapy (monotherapies and combination therapies), new surgical techniques have come into practice, and our understanding of disease pathogenesis has increased. Consequently, a new update of the guidelines has become necessary. METHODS A structured literature review was conducted to identify relevant papers published between 1 August 2006 and 12 December 2010. Publications before or after this timeframe were considered only if they were recognised as important milestones in the field or if the literature search did not identify publications within this timeframe. The quality of evidence and strength of recommendations were determined according to the Grading of Recommendations Assessment, Development and Evaluation framework. MAIN FINDINGS Decisions on therapeutic intervention should be based on the impact of symptoms on quality of life (QoL) rather than the severity of symptoms (International Prostate Symptom Score (IPSS) score). A threshold for intervention was therefore based on the IPSS Q8, with intervention recommended for patients with a score of at least 4. Several differences in clinical recommendations have emerged. For example, combination therapy with a 5α-reductase inhibitor plus α blocker is now the recommended option for the treatment of patients at risk of BPH progression. Other differences include the warning of potential worsening of cognitive disturbances with use of anticholinergics in older patients, the distinction between Serenoa repens preparations (according to the method of extraction), and the clearly defined threshold of prostate size for performing open surgery (>80 g). While the recommendations included in these guidelines are evidence based, clinical decisions should also be informed by patients' clinical and physical circumstances, as well as patients' preferences and actions. CONCLUSIONS These guidelines are intended to assist physicians and patients in the decision-making process regarding the management of LUTS/BPH, and support the process of continuous improvement of the quality of care and services to patients.
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Affiliation(s)
- Sebastiano Spatafora
- Department of Surgery, Azienda Ospedaliera S. Maria Nuova, viale Risorgimento 80, 42100 Reggio Emilia, Italy
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Oelke M, Burger M, Castro-Diaz D, Chartier-Kastler E, Cidre MAJ, McNicholas T, Radziszewski P, Kirby M. Diagnosis and medical treatment of lower urinary tract symptoms in adult men: applying specialist guidelines in clinical practice. BJU Int 2011; 110:710-8. [DOI: 10.1111/j.1464-410x.2011.10808.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dutasteride Improves Outcomes of Benign Prostatic Hyperplasia When Evaluated for Prostate Cancer Risk Reduction: Secondary Analysis of the REduction by Dutasteride of Prostate Cancer Events (REDUCE) Trial. Urology 2011; 78:641-6. [DOI: 10.1016/j.urology.2011.03.063] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 03/08/2011] [Accepted: 03/08/2011] [Indexed: 11/19/2022]
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Crawford ED, Moul JW, Rove KO, Pettaway CA, Lamerato LE, Hughes A. Prostate-specific antigen 1.5-4.0 ng/mL: a diagnostic challenge and danger zone. BJU Int 2011; 108:1743-9. [PMID: 21711431 DOI: 10.1111/j.1464-410x.2011.10224.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- E David Crawford
- University of Colorado, Anschutz Medical Campus, Aurora, 80045, USA.
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Toth R, Bloch BN, Genega EM, Rofsky NM, Lenkinski RE, Rosen MA, Kalyanpur A, Pungavkar S, Madabhushi A. Accurate prostate volume estimation using multifeature active shape models on T2-weighted MRI. Acad Radiol 2011; 18:745-54. [PMID: 21549962 DOI: 10.1016/j.acra.2011.01.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Revised: 01/10/2011] [Accepted: 01/11/2011] [Indexed: 11/16/2022]
Abstract
RATIONALE AND OBJECTIVES Accurate prostate volume estimation is useful for calculating prostate-specific antigen density and in evaluating posttreatment response. In the clinic, prostate volume estimation involves modeling the prostate as an ellipsoid or a spheroid from transrectal ultrasound, or T2-weighted magnetic resonance imaging (MRI). However, this requires some degree of manual intervention, and may not always yield accurate estimates. In this article, we present a multifeature active shape model (MFA) based segmentation scheme for estimating prostate volume from in vivo T2-weighted MRI. MATERIALS AND METHODS We aim to automatically determine the location of the prostate boundary on in vivo T2-weighted MRI, and subsequently determine the area of the prostate on each slice. The resulting planimetric areas are aggregated to yield the volume of the prostate for a given patient. Using a set of training images, the MFA learns the most discriminating statistical texture descriptors of the prostate boundary via a forward feature selection algorithm. After identification of the optimal image features, the MFA is deformed to accurately fit the prostate border. An expert radiologist segmented the prostate boundary on each slice and the planimetric aggregation of the enclosed areas yielded the ground truth prostate volume estimate. The volume estimation obtained via the MFA was then compared against volume estimations obtained via the ellipsoidal, Myschetzky, and prolated spheroids models. RESULTS We evaluated our MFA volume estimation method on a total 45 T2-weighted in vivo MRI studies, corresponding to both 1.5 Tesla and 3.0 Tesla field strengths. The results revealed that the ellipsoidal, Myschetzky, and prolate spheroid models overestimated prostate volumes, with volume fractions of 1.14, 1.53, and 1.96, respectively. By comparison, the MFA yielded a mean volume fraction of 1.05, evaluated using a fivefold cross-validation scheme. A correlation with the ground truth volume estimations showed that the MFA had an r(2) value of 0.82, whereas the clinical volume estimation schemes had a maximum value of 0.70. CONCLUSIONS Our MFA scheme involves minimal user intervention, is computationally efficient and results in volume estimations more accurate than state of the art clinical models.
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Affiliation(s)
- Robert Toth
- Department of Biomedical Engineering, Rutgers, The State University of New Jersey, Piscataway, 08854, USA
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Haillot O, Fraga A, Maciukiewicz P, Pushkar D, Tammela T, Höfner K, Chantada V, Gagnier P, Morrill B. The effects of combination therapy with dutasteride plus tamsulosin on clinical outcomes in men with symptomatic BPH: 4-year post hoc analysis of European men in the CombAT study. Prostate Cancer Prostatic Dis 2011; 14:302-6. [DOI: 10.1038/pcan.2011.13] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Ho EL, Tong SF, Tan HM. Prostate size: Is size all that matters? (When does size matter?). JOURNAL OF MEN'S HEALTH 2011. [DOI: 10.1016/s1875-6867(11)60014-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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