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Gabr AH, Abdelatif A, sharkawy MSE, Ismail AH, Batnanonuy AE, Eissawy MG, Ali AI. Benign prostatic hyperplasia morphological parameters for assessing risk of acute urinary retention. AFRICAN JOURNAL OF UROLOGY 2022. [DOI: 10.1186/s12301-022-00294-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Aim of the study
To evaluate objective measurements of morphological changes of the prostate in Benign Prostatic Hyperplasia (BPH) as predictors of acute urinary retention (AUR).
Methods
Overall 169 consecutive patients older than 50 years of age were prospectively divided into group A (n = 61); men with acute urinary retention (AUR), or group B (n = 108); men with different degrees of lower urinary tract symptoms (LUTS). Transrectal ultrasound (TRUS) measurements of total prostate volume (TPV), transitional zone volume (TZV), ratio of TZV to TPV (TZV/TPV), and vesico-urethral angle (VUA) were recorded. Group B patients also had post-void residual (PVR) and maximum flow rate (Q-max) recorded. TZV/TPV and VUA were correlated with Q-max and PVR, and a comparison was made between the two groups.
Results
Group A had significantly larger TPV (p = 0.03) and TZV/TPV (p = 0.04) compared to Group B. VUA in Group A had a significant correlation with AUR (p = 0.02). In Group B, both TZV/TPV and VUA had significant correlation with PVR and Q-max. A TZV/TPV cutoff ratio of 0.67 as a predictor of AUR had a 68% overall accuracy with sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 88%, 53%, 44%, and 97%, respectively. VUA of < 90º as a predictor factor of AUR had a 67% overall accuracy with sensitivity, specificity, PPV and NPV of 88%, 50%, 44%, and 97%, respectively.
Conclusion
Morphological changes in BPH can be objectively quantified using ultrasound by TZV/TPV and VUA. These parameters may potentially serve as predictors of AUR in patients with BPH.
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Elterman D, Aubé-Peterkin M, Evans H, Elmansy H, Meskawi M, Zorn KC, Bhojani N. UPDATE - Canadian Urological Association guideline: Male lower urinary tract symptoms/benign prostatic hyperplasia. Can Urol Assoc J 2022; 16:245-256. [PMID: 35905485 PMCID: PMC9343161 DOI: 10.5489/cuaj.7906] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Affiliation(s)
- Dean Elterman
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | | | - Howard Evans
- Division of Urology, University of Alberta, Edmonton, AB, Canada
| | - Hazem Elmansy
- Division of Urology, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Malek Meskawi
- Division of Urology, Université de Montréal, Montreal, QC, Canada
| | - Kevin C. Zorn
- Division of Urology, Université de Montréal, Montreal, QC, Canada
| | - Naeem Bhojani
- Division of Urology, Université de Montréal, Montreal, QC, Canada
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Functional Results after First- and Second-Generation Temporary Implantable Nitinol Device (TIND) for BPH: A Narrative Review of the Literature. CURRENT BLADDER DYSFUNCTION REPORTS 2022. [DOI: 10.1007/s11884-022-00644-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Purpose of review
In the last decades, new promising technologies for the treatment of BPH-related lower urinary tract symptoms (LUTS) have been widely experienced in clinical practice, with the aim of offering fewer complications but similar functional outcomes compared with the gold standard transurethral resection of the prostate (TURP). Among these so-called minimally invasive approaches, transurethral implantation of first- and second-generation temporary implantable nitinol device (TIND and iTIND, respectively) (Medi-Tate; Medi-Tate Ltd., Or Akiva, Israel) has been included by the European Association of Urology (EAU) Guidelines as one of the available alternative treatments to TURP. In the present paper, we conducted a systematic review of the current literature on TIND and iTIND implantation focusing on functional outcomes. Medline, Embase, and Cochrane databases were queried for relevant Literature in May 2021.
Recent findings
Data regarding the use of temporary implantable nitinol device for BPH are still very limited, with only seven studies currently available in Literature. All the studies report that both TIND and iTIND procedures are safe, effective, and well tolerated. Moreover, such treatments seem to not affect patient’s sexual and ejaculatory functions.
Summary
Current clinical evidence suggests that temporary implantation of first- and second-generation temporary implantable nitinol devices are valid options for the minimally invasive surgical treatment of BPH-related LUTS. Further studies are required in order to confirm the functional results, especially over a long-term follow up.
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Csikós E, Horváth A, Ács K, Papp N, Balázs VL, Dolenc MS, Kenda M, Kočevar Glavač N, Nagy M, Protti M, Mercolini L, Horváth G, Farkas Á. Treatment of Benign Prostatic Hyperplasia by Natural Drugs. Molecules 2021; 26:molecules26237141. [PMID: 34885733 PMCID: PMC8659259 DOI: 10.3390/molecules26237141] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 12/08/2022] Open
Abstract
Benign prostatic hyperplasia (BPH) is one of the most common urinary diseases affecting men, generally after the age of 50. The prevalence of this multifactorial disease increases with age. With aging, the plasma level of testosterone decreases, as well as the testosterone/estrogen ratio, resulting in increased estrogen activity, which may facilitate the hyperplasia of the prostate cells. Another theory focuses on dihydrotestosterone (DHT) and the activity of the enzyme 5α-reductase, which converts testosterone to DHT. In older men, the activity of this enzyme increases, leading to a decreased testosterone/DHT ratio. DHT may promote prostate cell growth, resulting in hyperplasia. Some medicinal plants and their compounds act by modulating this enzyme, and have the above-mentioned targets. This review focuses on herbal drugs that are most widely used in the treatment of BPH, including pumpkin seed, willow herb, tomato, maritime pine bark, Pygeum africanum bark, rye pollen, saw palmetto fruit, and nettle root, highlighting the latest results of preclinical and clinical studies, as well as safety issues. In addition, the pharmaceutical care and other therapeutic options of BPH, including pharmacotherapy and surgical options, are discussed, summarizing and comparing the advantages and disadvantages of each therapy.
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Affiliation(s)
- Eszter Csikós
- Department of Pharmacognosy, Faculty of Pharmacy, University of Pécs, H-7624 Pécs, Hungary; (E.C.); (K.Á.); (N.P.); (V.L.B.); (G.H.)
| | - Adrienn Horváth
- Department of Pharmaceutical Biology, Faculty of Pharmacy, University of Pécs, H-7624 Pécs, Hungary;
| | - Kamilla Ács
- Department of Pharmacognosy, Faculty of Pharmacy, University of Pécs, H-7624 Pécs, Hungary; (E.C.); (K.Á.); (N.P.); (V.L.B.); (G.H.)
| | - Nóra Papp
- Department of Pharmacognosy, Faculty of Pharmacy, University of Pécs, H-7624 Pécs, Hungary; (E.C.); (K.Á.); (N.P.); (V.L.B.); (G.H.)
| | - Viktória Lilla Balázs
- Department of Pharmacognosy, Faculty of Pharmacy, University of Pécs, H-7624 Pécs, Hungary; (E.C.); (K.Á.); (N.P.); (V.L.B.); (G.H.)
| | - Marija Sollner Dolenc
- University of Ljubljana, Department of Pharmaceutical Chemistry, Faculty of Pharmacy, SI-1000 Ljubljana, Slovenia; (M.S.D.); (M.K.)
| | - Maša Kenda
- University of Ljubljana, Department of Pharmaceutical Chemistry, Faculty of Pharmacy, SI-1000 Ljubljana, Slovenia; (M.S.D.); (M.K.)
| | - Nina Kočevar Glavač
- University of Ljubljana, Department of Pharmaceutical Biology, Faculty of Pharmacy, SI-1000 Ljubljana, Slovenia;
| | - Milan Nagy
- Department of Pharmacognosy and Botany, Faculty of Pharmacy, Comenius University in Bratislava, SK-832-32 Bratislava, Slovakia;
| | - Michele Protti
- Research Group of Pharmaco-Toxicological Analysis (PTA Lab), Department of Pharmacy and Biotechnology (FaBiT), Alma Mater Studiorum—University of Bologna, 40126 Bologna, Italy; (M.P.); (L.M.)
| | - Laura Mercolini
- Research Group of Pharmaco-Toxicological Analysis (PTA Lab), Department of Pharmacy and Biotechnology (FaBiT), Alma Mater Studiorum—University of Bologna, 40126 Bologna, Italy; (M.P.); (L.M.)
| | - Györgyi Horváth
- Department of Pharmacognosy, Faculty of Pharmacy, University of Pécs, H-7624 Pécs, Hungary; (E.C.); (K.Á.); (N.P.); (V.L.B.); (G.H.)
| | - Ágnes Farkas
- Department of Pharmacognosy, Faculty of Pharmacy, University of Pécs, H-7624 Pécs, Hungary; (E.C.); (K.Á.); (N.P.); (V.L.B.); (G.H.)
- Correspondence:
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Olweny EO, Jow SL, Jow WW. Prolieve® Transurethral Thermodilatation for treatment of Symptomatic Benign Prostatic Hyperplasia: 5-Year Results from a Prospective Multi-Center Trial. J Endourol 2021; 36:117-123. [PMID: 34314241 DOI: 10.1089/end.2021.0240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction & Objective Prolieve® transurethral thermodilatation (TUTD) is the only third-generation transurethral microwave thermotherapy (TUMT) device that incorporates balloon dilation/compression of the prostatic urethra with cooled TUMT, at ≤50W power. We evaluated its 5-year efficacy in the treatment of symptomatic benign prostatic hyperplasia (BPH) in an open-label prospective multi-center trial. Methods Eligible patients with AUA symptom score (AUASS) ≥ 9, peak urine flow rate (Qmax) <12 ml/s, and prostate size 20-80 g without obstructing median lobe anatomy were enrolled. Prolieve® TUTD was delivered in the office setting under local anesthesia. AUASS, Quality of Life (QOL), BPH impact index (BPHII), Qmax and other measures were assessed at baseline, and at least annually thereafter to year 5. Adverse events (AEs) were recorded. Treatment success over time was analyzed using the Kaplan-Meier method while changes from baseline were evaluated using paired t-tests. Results Intention to treat (ITT) population was 225, of whom 220 with a mean (SD) age of 65 (5.9). completed treatment. 187/220 (85%) did not require urethral catheterization. AUAS, QOL and BPHII scores significantly improved from baseline in ≤ 3 months, with sustained improvements to year 5. Qmax also significantly improved from baseline at each annual follow up evaluation. Cumulative 5-year surgical retreatment rate was 14.2% (95% CI 9.5-20.8%). Transient urinary urgency and dysuria were the most commonly reported AEs. Conclusions Prolieve® TUTD is a safe and effective treatment option for BPH, with durable long-term improvements in voiding subjective symptoms and urinary flow rates. It is deliverable in the office setting and has a low catheterization rate and sexual side effects are rare.
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Affiliation(s)
| | - Steven L Jow
- MedStar Georgetown University Hospital, 71541, Washington, District of Columbia, United States;
| | - William W Jow
- Hackensack Meridian Health-Bayshore Medical Center, Holmdel, New Jersey, United States;
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Qian S, Zhang S, Xia W, Xu D, Qi J, Shen H, Wu Y. Correlation of prostatic morphological parameters and clinical progression in aging Chinese men with benign prostatic hyperplasia: Results from a cross-sectional study. Prostate 2021; 81:478-486. [PMID: 33860949 DOI: 10.1002/pros.24128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/14/2021] [Accepted: 03/26/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Our study aimed to investigate the correlation of prostatic morphological parameters and benign prostatic hyperplasia (BPH) clinical progression in aging Chinese men. METHODS In this retrospective study, a total of 1038 patients were reviewed. Prostatic morphology was measured by transrectal ultrasound (TRUS). Detailed medical history of all candidates was recorded and analyzed after being classified by specific prostatic measurements. Univariate and multivariate logistic regression analyses were used to estimate the correlation between variables. RESULTS The cumulative incidence of BPH clinical progression was 63.68% (661/1038) in the study population. Prostate volume (PV), transitional zone volume (TZV), transitional zone index (TZI), and intravesical prostatic protrusion (IPP) were all positively associated with BPH progression (all p < .001). Patients with a PV > 60 ml, TZV > 15 ml, TZI > 0.5, or IPP > 5 mm had a significantly higher possibility of overall BPH clinical progression (adjusted odds ratio (OR): 2.485, 1.678, 1.886, and 1.924, respectively; 95% confidence interval (CI): 1.559-3.960, 1.131-2.489, 1.379-2.579, and 1.357-2.728, correspondingly). CONCLUSION Prostatic morphological parameters are significantly associated with BPH clinical progression. Patients with larger prostatic morphological parameters are more easily prone to clinical progress. As a result, reasonable managements should be timely considered for those patients before clinical progression occurs.
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Affiliation(s)
- Subo Qian
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shun Zhang
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Weimin Xia
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ding Xu
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jun Qi
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Haibo Shen
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yu Wu
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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7
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Esposito C, Santarcangelo C, Masselli R, Buonomo G, Nicotra G, Insolia V, D'Avino M, Caruso G, Buonomo AR, Sacchi R, Sommella E, Campiglia P, Tenore GC, Daglia M. Epilobium angustifolium L. extract with high content in oenothein B on benign prostatic hyperplasia: A monocentric, randomized, double-blind, placebo-controlled clinical trial. Biomed Pharmacother 2021; 138:111414. [PMID: 33765581 DOI: 10.1016/j.biopha.2021.111414] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/11/2021] [Accepted: 02/16/2021] [Indexed: 11/30/2022] Open
Abstract
Benign prostatic hyperplasia (BPH) is a common condition in adult men. Especially in Europe, increasing attention has been focused on E. angustifolium extracts (EAEs), which are widely used for their positive effects on the symptoms of BPH, although human clinical trials are limited. The aim of this monocentric, randomized, double-blind, placebo-controlled clinical trial is to evaluate if a daily intake of hard, gastric-resistant capsules containing a chemically characterized EAE (500 mg) for 6 months may allow a significant improvement in symptoms in subjects with BPH. This study was conducted in 128 adult men, randomly assigned to receive either EAE food supplement (N = 70) or placebo (N = 58), who underwent four visits (baseline = t0, after 15 days = t1, after 2 months = t2 and after 6 months = t3) in an outpatient setting to evaluate post-void residual (PVR) and prostate volume (PV) by means of prostate ultrasound, prostate-specific antigen (PSA) and neutrofile/lymphocyte ratio (N/L), nocturia before the clinical visits and International Prostate Specific Score (IPSS) registered by the physicians. EAE food supplement induced a significant decrease in the PVR and consequently nocturia improving the quality of life as suggested by the decrease of IPSS. No subjects reported adverse effects related to oral intake of EAE food supplement. Moreover, EAE food supplement did not show hepatic or renal toxicity. In conclusion, EAE food supplements can be used in subjects with BPH, to improve their quality of life and general renal function.
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Affiliation(s)
- Cristina Esposito
- Department of Pharmacy, University of Naples Federico II, via Domenico Montesano 49, 80131 Naples, Italy
| | - Cristina Santarcangelo
- Department of Pharmacy, University of Naples Federico II, via Domenico Montesano 49, 80131 Naples, Italy
| | - Raffaello Masselli
- Department of Pharmacy, University of Naples Federico II, via Domenico Montesano 49, 80131 Naples, Italy
| | - Giuseppe Buonomo
- Samnium Medical Soc. Cooperative, viale Cristoforo Colombo 18, 82100 Benevento, Italy
| | | | | | - Maria D'Avino
- Department of Internal Medicine, Hospital Cardarelli, via Antonio Cardarelli, 80131 Naples, Italy
| | - Giuseppe Caruso
- Department of Internal Medicine, Hospital Cardarelli, via Antonio Cardarelli, 80131 Naples, Italy
| | - Antonio Riccardo Buonomo
- Department of Clinical Medicine and Surgery - Section of Infectious Diseases, University of Naples Federico II, via Sergio Pansini 5, 80131 Naples, Italy
| | - Roberto Sacchi
- Applied Statistic Unit, Department of Earth and Environmental Sciences, University of Pavia, viale Taramelli 24, 27100 Pavia, Italy
| | - Eduardo Sommella
- Department of Pharmacy, University of Salerno, 84084 Fisciano, SA, Italy
| | - Pietro Campiglia
- Department of Pharmacy, University of Salerno, 84084 Fisciano, SA, Italy; European Biomedical Research Institute of Salerno, via De Renzi 50, I-84125 Salerno, Italy
| | - Gian Carlo Tenore
- Department of Pharmacy, University of Naples Federico II, via Domenico Montesano 49, 80131 Naples, Italy
| | - Maria Daglia
- Department of Pharmacy, University of Naples Federico II, via Domenico Montesano 49, 80131 Naples, Italy; International Research Center for Food Nutrition and Safety, Jiangsu University, 212013 Zhenjiang, China.
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8
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Wu D, Shi ZE, Xu D, Wu Y, Qian SB, Qi J. Serum interleukin 6 and acute urinary retention in elderly men with benign prostatic hyperplasia in China: a cross-sectional study. Transl Androl Urol 2021; 10:455-465. [PMID: 33532333 PMCID: PMC7844514 DOI: 10.21037/tau-20-914] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background While acute urinary retention (AUR) is a severe complication of benign prostatic hyperplasia (BPH), it can also indicate the progression of this common disease in aging men. This study aimed at exploring the possible relationship between serum interleukin 6 (sIL-6) and AUR in BPH patients. Methods A cross-sectional study was conducted based on 256 elderly men with BPH in China. The association between the sIL-6 level and the occurrence of AUR was evaluated by univariate and multivariable logistic regressions. The receiver operating characteristic (ROC) curve was utilized to determine the discriminant validity of the sIL-6 level and the optimal cut-off value. Results The concentration of sIL-6 was significantly elevated in the AUR group (P<0.001). A positive correlation was observed between the sIL-6 level and AUR in BPH patients [odds ratio (OR) =1.365, 95% confidence interval (CI): 1.174-1.586, P<0.001]. Based on the ROC curve analysis for sIL-6, the optimal cut-off point of 4.475 pg/mL was set to identify the occurrence of AUR in these patients [area under the curve (AUC) =0.7596, 95% CI: 0.6976-0.8216, P<0.001]. A high sIL-6 level (≥4.475 pg/mL) had a significantly stronger correlation with AUR (OR =9.666, 95% CI: 4.347-21.491, P<0.001). Conclusions There was a positive correlation between the sIL-6 level and the occurrence of AUR in elderly Chinese patients with BPH. This study provides potential strategies for the screening of BPH individuals with a possible risk of AUR, which may contribute to the early implementation of effective interventions to improve the quality of life and prognosis. Long-term prospective studies are still required to further illustrate the causal relationship.
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Affiliation(s)
- Di Wu
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Urology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Zhi-En Shi
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ding Xu
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Wu
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Su-Bo Qian
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Qi
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Sun K, Sun F, Yao H, Zhang D, Wu G, Wang T, Wang J, Wu J. Efficacy and Safety of Combination Comprising Tamsulosin and PDE5-Is, Relative to Monotherapies, in Treating Lower Urinary Tract Symptoms and Erectile Dysfunction Associated With Benign Prostatic Hyperplasia: A Meta-Analysis. Am J Mens Health 2020; 14:1557988320980180. [PMID: 33342335 PMCID: PMC7756049 DOI: 10.1177/1557988320980180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
We report safety and efficacy of a combination therapy, comprising tamsulosin and phosphodiesterase type 5 inhibitors (PDE5-Is), relative to monotherapy, to ascertain its potential in treating lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) secondary to benign prostatic hyperplasia (BPH) after 3 months’ treatment. We screened MEDLINE, EMBASE, and the Cochrane Controlled Trials Register databases, for randomized controlled trials, and obtained eight articles comprising 1144 participants. Results showed that the combination group had superior outcomes with regard to International Prostate Symptom Score (IPSS) and Qmax, compared to the other two groups. The combination group also had superior efficacy with regard to International Index of Erectile Function (IIEF) than the tamsulosin group, but not over the PDE5-Is group. Further, the combination group showed better efficacy in IPSS voiding and quality of life (QoL) compared to the PDE5-Is group. An analysis of safety outcomes revealed extremely high adverse events (AEs) and pain in the combination group. However, therapy discontinuation due to pain and AEs did not increase with increase in AEs. Overall, our findings indicate that a combination of tamsulosin and PDE5-Is is superior to individual tamsulosin and PDE5-Is monotherapy, with regard to improving LUTS and ED secondary to BPH.
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Affiliation(s)
- Kai Sun
- Department of Urology, Affiliated Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Fengze Sun
- Department of Urology, Affiliated Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Huibao Yao
- Department of Urology, Affiliated Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Dongxu Zhang
- Department of Urology, Affiliated Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Gang Wu
- Department of Urology, Affiliated Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Tianqi Wang
- Department of Urology, Affiliated Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Jipeng Wang
- Department of Urology, Affiliated Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - JiTao Wu
- Department of Urology, Affiliated Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
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10
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Zhou Z, Zheng X, Wu J, Gao Z, Xu Z, Cui Y. Meta-Analysis of Efficacy and Safety of Tadalafil Plus Tamsulosin Compared with Tadalafil Alone in Treating Men with Benign Prostatic Hyperplasia and Erectile Dysfunction. Am J Mens Health 2020; 13:1557988319882597. [PMID: 31625449 PMCID: PMC6801893 DOI: 10.1177/1557988319882597] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This meta-analysis was performed to evaluate the efficacy and safety of tadalafil
plus tamsulosin compared with tadalafil alone in treating men with benign
prostatic hyperplasia (BPH) and erectile dysfunction (ED) after 12 weeks’
treatment. Systematic review was carried out using the Preferred Reporting Items
for Systematic Reviews and Meta-analyses. MEDLINE, EMBASE, and the Cochrane
Controlled Trials Register were searched to collect randomized controlled
trials. The references of related articles were also searched. Four articles
including 621 patients were involved in the analysis. The study identified that
combination-therapy had significant improvements in total international prostate
symptom score (IPSS), quality of life (QoL) and maximum urine flow rate (Qmax)
compared with monotherapy, and there were no obvious significance in respects of
post-void residual volume, international index of erectile function and IPSS
storage. The difference of total IPSS was mainly reflected in the change of IPSS
voiding. For safety, combination-therapy had a higher incidence rate of any
adverse events (AEs) and discontinuation due to AEs than monotherapy with the
exception of pain. In conclusion, the combination of tadalafil and tamsulosin
provided a better improvement of IPSS voiding, QoL and Qmax compared with
tadalafil alone in treating men with BPH and ED, and the former therapy appeared
to show a higher incidence of AEs.
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Affiliation(s)
- Zhongbao Zhou
- Binzhou Medical University, Yantai, Shandong, China.,Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Xuesong Zheng
- Department of Urology, Qixia People's Hospital, Yantai, Shandong, China
| | - Jitao Wu
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Zhenli Gao
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Zhunan Xu
- Binzhou Medical University, Yantai, Shandong, China.,Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Yuanshan Cui
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China.,Department of Urology, Beijing TianTan Hospital, Capital Medical University, Beijing, China
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11
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Wu D, Tang HX, Wu Y, Qian SB, Xu D, Qi J. The possible association between serum interleukin 8 and acute urinary retention in Chinese patients with benign prostatic hyperplasia. Andrologia 2020; 52:e13763. [PMID: 32829482 DOI: 10.1111/and.13763] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/28/2020] [Accepted: 06/28/2020] [Indexed: 11/28/2022] Open
Abstract
Acute urinary retention (AUR) is one of the progressive manifestations of benign prostatic hyperplasia (BPH). This cross-sectional study was conducted to analyse the possible association between serum interleukin 8 (sIL-8) and AUR in BPH patients to provide evidence of sIL-8 as a potential biomarker for the prediction of AUR. The relationship between sIL-8 levels and AUR was evaluated by logistic regressions in 245 ageing Chinese men with BPH. The discriminant validity of sIL-8 and the optimal cut-off value were determined by a receiver operating characteristic curve. The levels of sIL-8 increased significantly in BPH patients with AUR (p < 0.001). The sIL-8 concentration was positively correlated with AUR in BPH patients (OR = 1.024, 95% CI: 1.009-1.040, p = 0.002). The correlation with AUR in the group with a high sIL-8 level (≥43.05 pg/ml) was significantly enhanced (OR = 8.853, 95% CI: 2.433-32.205, p = 0.001). The sIL-8 level correlated with AUR in Chinese BPH patients independently. As a possible predictor, sIL-8 may contribute to the screening of high-risk populations for AUR to create opportunities for the early effective interventions to improve prognosis and enhance the quality of life. Prospective studies are needed to support all these results.
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Affiliation(s)
- Di Wu
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hai-Xiao Tang
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Wu
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Su-Bo Qian
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ding Xu
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Qi
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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12
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Zhou Z, Cui Y, Wu J, Jin H. Efficacy and safety of dutasteride compared with finasteride in treating males with benign prostatic hyperplasia: A meta-analysis of randomized controlled trials. Exp Ther Med 2020; 20:1566-1574. [PMID: 32742388 PMCID: PMC7388259 DOI: 10.3892/etm.2020.8851] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 01/30/2020] [Indexed: 12/02/2022] Open
Abstract
The present study was an updated meta-analysis that aimed to confirm the efficacy and safety of dutasteride (0.5 mg) and finasteride (5 mg) in treating males with benign prostatic hyperplasia (BPH) over a treatment period of at least 6 months. Randomized controlled trials were retrieved using the MEDLINE, EMBASE and the Cochrane controlled trials register databases. The references of the associated articles were also searched. A systematic review was performed by using the preferred reporting items for systematic reviews and meta-analyses. The data were analyzed with RevMan v5.3.0. A total of six articles including 2,041 participants were studied. The analysis demonstrated a significantly greater decrease in international prostate symptom score [IPSS; mean difference (MD), -0.86; 95% CI, -1.62 to -0.11; P=0.02] and prostate-specific antigen (PSA; MD, -0.13; 95% CI, -0.26 to -0.01; P=0.03) in the dutasteride group compared with that in the finasteride group, whereas no significant differences were observed in prostate volume (PV; P=0.64), maximum urine flow rate (Qmax; P=0.29) and post-void residual volume (PVRV; P=0.14). With regard to safety assessment, including any adverse event (P=0.66), decreased libido (P=0.39) and impotence (P=0.17), there was no significant difference between dutasteride and finasteride. In conclusion, in patients with BPH, dutasteride produced a greater decrease in IPSS and PSA compared with finasteride, whereas no significant differences were identified in PV, Qmax and PVRV. The two drugs appeared to have similar rates of adverse effects, particularly with regard to sexual dysfunction.
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Affiliation(s)
- Zhongbao Zhou
- School of Clinical Medicine, Binzhou Medical University, Yantai, Shandong 264000, P.R. China.,Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, P.R. China
| | - Yuanshan Cui
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, P.R. China.,Department of Urology, Beijing TianTan Hospital, Capital Medical University, Beijing 100070, P.R. China
| | - Jitao Wu
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, P.R. China
| | - Hairong Jin
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, P.R. China
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13
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Meng Y, Yu W, Liu Z, Zhang M, Chen Y, Li S, Fan Y, Hu S, Zhang K, Zhang Q, Jin J. The inflammation patterns of different inflammatory cells in histological structures of hyperplasic prostatic tissues. Transl Androl Urol 2020; 9:1639-1649. [PMID: 32944525 PMCID: PMC7475681 DOI: 10.21037/tau-20-448] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background The distribution characteristics of inflammatory cells in hyperplastic prostatic tissue and its influences on disease development remain unknown. We aimed to explore the infiltration characteristics of different inflammatory cells in histological structures of benign prostatic hyperplasia (BPH) in combination with clinical data. Methods The present study included 76 cases of BPH patients underwent transurethral resection of prostate (TURP). Hematoxylin-eosin staining was performed to identify the degree of general inflammation in prostatic tissues. The infiltration of T-lymphocytes (CD3), B-lymphocytes (CD20), and macrophages (CD68) were recorded by immunohistochemistry. Results The present study included 76 BPH patients with the mean age of 69.5 years old (range, 49-83 years) and the mean prostate volume of 91.9 mL (range, 24-218 mL). Periglandular inflammation was the most common pattern, being presented in 94.7% (72/76) patients, followed by stromal inflammation (67/76, 88.2%) and glandular inflammation (57/76, 75.0%). However, the stroma presented the highest rate of severe inflammation (14.6%). And the grades of glandular inflammation and stromal inflammation were independently correlated with prostate volume. T-lymphocytes, B-lymphocytes and macrophages had different infiltrated patterns in histological structures of prostate. And stromal hyperplasia dominated BPH was only significantly correlated with the T-lymphocytes infiltration condition (P=0.001). Meanwhile, overweight patients had more severe glandular inflammation in the prostate (P=0.010). The grade of glandular inflammation could independently increase prostate-specific antigen (PSA). Conclusions We characterized infiltrated patterns of different inflammatory cells in histological structures of hyperplasic prostatic tissues from surgically treated BPH specimens. The role of inflammation in BPH development was highlighted by its correlation with the prostate volume, metabolism and PSA level.
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Affiliation(s)
- Yisen Meng
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Research Center for Genitourinary Oncology, Beijing, China
| | - Wei Yu
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Research Center for Genitourinary Oncology, Beijing, China
| | - Zhenhua Liu
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Research Center for Genitourinary Oncology, Beijing, China
| | - Muqiu Zhang
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Research Center for Genitourinary Oncology, Beijing, China
| | - Yuke Chen
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Research Center for Genitourinary Oncology, Beijing, China
| | - Shaobo Li
- School of Basic Medicine, Fudan University, Shanghai, China
| | - Yu Fan
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Research Center for Genitourinary Oncology, Beijing, China
| | - Shuai Hu
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Research Center for Genitourinary Oncology, Beijing, China
| | - Kai Zhang
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Research Center for Genitourinary Oncology, Beijing, China
| | - Qian Zhang
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Research Center for Genitourinary Oncology, Beijing, China
| | - Jie Jin
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Research Center for Genitourinary Oncology, Beijing, China
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Relationship between Lower Urinary Tract Symptoms and Prostatic Urethral Stiffness Using Strain Elastography: Initial Experiences. J Clin Med 2019; 8:jcm8111929. [PMID: 31717594 PMCID: PMC6912549 DOI: 10.3390/jcm8111929] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 11/01/2019] [Accepted: 11/07/2019] [Indexed: 12/29/2022] Open
Abstract
We attempted to visualize the periurethral stiffness of prostatic urethras using strain elastography in the midsagittal plane of transrectal ultrasonography (TRUS) and to evaluate periurethral stiffness patterns in relation to lower urinary tract symptoms (LUTS). A total of 250 men were enrolled. The stiffness patterns of the entire prostate and individual zones were evaluated using strain elastography during a TRUS examination. After excluding 69 men with inappropriate elastography images, subjects were divided according to periurethral stiffness into either group A (low periurethral stiffness, N = 80) or group B (high periurethral stiffness, N = 101). There were significant differences in patient age (p = 0.022), transitional zone volume (p = 0.001), transitional zone index (p = 0.33), total international prostate symptom score (IPSS) (p < 0.001), IPSS-voiding subscore (p < 0.001), IPSS-storage subscore (p < 0.001), and quality of life (QoL) score (p = 0.002) between groups A and B. After adjusting for relevant variables, significant differences in total IPSS, IPSS-voiding subscore, and QoL score were maintained. Men with high periurethral stiffness were associated with worse urinary symptoms than those with low periurethral stiffness, suggesting that periurethral stiffness might play an important role in the development of LUTS.
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15
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Robles Rodríguez A, Garibay Huarte TR, Acosta Arreguín E, Morales López S. La próstata: generalidades y patologías más frecuentes. REVISTA DE LA FACULTAD DE MEDICINA 2019. [DOI: 10.22201/fm.24484865e.2019.62.4.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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16
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Zhou Z, Cui Y, Wu J, Ding R, Cai T, Gao Z. Meta-analysis of the efficacy and safety of combination of tamsulosin plus dutasteride compared with tamsulosin monotherapy in treating benign prostatic hyperplasia. BMC Urol 2019; 19:17. [PMID: 30871552 PMCID: PMC6419503 DOI: 10.1186/s12894-019-0446-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/03/2019] [Indexed: 01/27/2023] Open
Abstract
Background We performed a meta-analysis to confirm the efficacy and safety of the combination of tamsulosin plus dutasteride compared with tamsulosin monotherapy in treating benign prostatic hyperplasia (BPH) during a treatment cycle of at least 1 year. Methods Randomized controlled trials were searched by using MEDLINE, EMBASE, and the Cochrane Controlled Trials Register. Systematic review was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-analyses. The data was evaluated and statistically analyzed by using RevMan version 5.3.0. Results Five studies including 4348 patients were studied. The analysis found that the combination group was significantly greater effect in international prostate symptom score (mean difference [MD], − 1.43; 95% confidence interval [CI], − 2.20 to − 0.66; P = 0.0003), prostate volume (MD, − 10.13; 95% CI, − 12.38 to − 7.88; P < 0.00001), transitional zone volume (MD, − 3.18; 95% CI, − 3.57 to − 2.79; P<0.0001), maximum urine flow rate (MD, 1.05; 95% CI, 0.82 to 1.29; P < 0.00001), prostate specific antigen (MD, − 0.54; 95% CI, − 0.80 to − 0.29; P < 0.0001) and post-void residual volume (MD, − 3.85; 95% CI, − 4.95 to − 2.76; P < 0.00001) compared with the tamsulosin group. In terms of safety, including adverse events (odds ratio [OR], 2.06; 95% CI, 1.34 to 3.17; P = 0.001), erectile dysfunction (OR, 2.24; 95% CI, 1.73 to 2.92; P < 0.00001), ejaculation disorder (OR, 3.37; 95% CI, 1.97 to 5.79; P < 0.0001), retrograde ejaculation (OR, 2.30; 95% CI, 1.08 to 4.93; P = 0.03), decreased libido (OR, 2.25; 95% CI, 1.53 to 3.31; P < 0.0001) and loss of libido (OR, 3.38; 95% CI, 1.94 to 5.88; P<0.0001), the combination group showed poor tolerance than the tamsulosin group with the exception of dizziness (OR, 1.16; 95% CI, 0.75 to 1.80; P = 0.50). The combination group significantly reduced the risk of clinical progression than the tamsulosin group especially in incidence of BPH-related symptom progression (OR, 0.56; 95% CI, 0.46 to 0.67; P < 0.00001) and acute urinary retention (OR, 0.61; 95% CI, 0.38 to 0.98; P = 0.04). Conclusion The combination of tamsulosin plus dutasteride provides a preferable therapeutic effect for BPH with a higher incidence of sexual side effects, but combination-therapy can markedly reduce risk of BPH-related symptom progression and acute urinary retention relative to tamsulosin monotherapy.
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Affiliation(s)
- Zhongbao Zhou
- Binzhou Medical University, Yantai, Shandong, China.,Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, NO. 20 East Yuhuangding Road, Yantai, 264000, Shandong, China
| | - Yuanshan Cui
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, NO. 20 East Yuhuangding Road, Yantai, 264000, Shandong, China
| | - Jitao Wu
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, NO. 20 East Yuhuangding Road, Yantai, 264000, Shandong, China
| | - Rui Ding
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, NO. 20 East Yuhuangding Road, Yantai, 264000, Shandong, China
| | - Tong Cai
- Binzhou Medical University, Yantai, Shandong, China
| | - Zhenli Gao
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, NO. 20 East Yuhuangding Road, Yantai, 264000, Shandong, China.
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17
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Nickel JC, Aaron L, Barkin J, Elterman D, Nachabé M, Zorn KC. Canadian Urological Association guideline on male lower urinary tract symptoms/benign prostatic hyperplasia (MLUTS/BPH): 2018 update. Can Urol Assoc J 2018; 12:303-312. [PMID: 30332601 PMCID: PMC6192748 DOI: 10.5489/cuaj.5616] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | - Lorne Aaron
- Service d’Urologie and Centre de la Prostate, Longueuil, QC, Canada
| | - Jack Barkin
- Division of Urology, University of Toronto, Humber River Hospital, Toronto, ON, Canada
| | - Dean Elterman
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Mahmoud Nachabé
- Service d’Urologie and Centre de la Prostate, Longueuil, QC, Canada
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18
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Sheng J, Yang Y, Cui Y, He S, Wang L, Liu L, He Q, Lv T, Han W, Yu W, Hu S, Jin J. M2 macrophage-mediated interleukin-4 signalling induces myofibroblast phenotype during the progression of benign prostatic hyperplasia. Cell Death Dis 2018; 9:755. [PMID: 29988032 PMCID: PMC6037751 DOI: 10.1038/s41419-018-0744-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/23/2018] [Accepted: 04/26/2018] [Indexed: 12/24/2022]
Abstract
Benign prostatic hyperplasia (BPH) is a progressive disease in elderly men, but potential factors accelerating its progression remain largely unknown. The aim of this study was to elucidate the factors affecting BPH progression by understanding the complex mechanisms causing early- progressed BPH, which progresses rapidly and requires surgical intervention before the age of 50. Three groups of human prostate tissue samples, from patients with early-progressed BPH, age-matched prostate and elderly BPH tissues, were collected (n = 25 each). We compared these tissues to determine the histologic features and molecular mechanisms underlying BPH progression. We found that early-progressed BPH samples were characterised by aberrant stromal hyper-proliferation, collagen deposition and increased M2 macrophage infiltration, compared to those from age-matched prostate and elderly BPH tissues. The M2 macrophage–fibroblast co-culture system demonstrated that the myofibroblast phenotypes were strongly induced only in fibroblasts from the early-progressed BPH samples, while the co-cultured M2 macrophages expressed high levels of pro-fibrotic cytokines, such as IL4 and TGFβ1. M2 macrophage-derived IL4, but not TGFβ1, selectively induced the myofibroblast phenotype through the JAK/STAT6, PI3K/AKT and MAPK/ERK signalling pathways in the early-progressed BPH prostate fibroblasts. Taken together, our results indicate that induction of the myofibroblast phenotype may lead to BPH progression through M2 macrophage-mediated IL4 signalling, and that IL4 may represent a potential therapeutic target, allowing the prevention of M2 macrophage activation and fibroblast-to-myofibroblast differentiation.
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Affiliation(s)
- Jindong Sheng
- Department of Urology, National Research Center for Genitourinary Oncology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034, China
| | - Yang Yang
- Department of Urology, National Research Center for Genitourinary Oncology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034, China
| | - Yun Cui
- Department of Urology, National Research Center for Genitourinary Oncology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034, China.,Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Gongti South Road, Chaoyang District, Beijing 100020, China
| | - Shiming He
- Department of Urology, National Research Center for Genitourinary Oncology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034, China
| | - Lu Wang
- Department of Urology, National Research Center for Genitourinary Oncology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034, China
| | - Libo Liu
- Department of Urology, National Research Center for Genitourinary Oncology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034, China
| | - Qun He
- Department of Urology, National Research Center for Genitourinary Oncology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034, China
| | - Tianjing Lv
- Department of Urology, National Research Center for Genitourinary Oncology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034, China
| | - Wenke Han
- Department of Urology, National Research Center for Genitourinary Oncology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034, China
| | - Wei Yu
- Department of Urology, National Research Center for Genitourinary Oncology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034, China
| | - Shuai Hu
- Department of Urology, National Research Center for Genitourinary Oncology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034, China.
| | - Jie Jin
- Department of Urology, National Research Center for Genitourinary Oncology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034, China.
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19
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Patel DN, Feng T, Simon RM, Howard LE, Vidal AC, Moreira DM, Castro-Santamaria R, Roehrborn C, Andriole GL, Freedland SJ. PSA predicts development of incident lower urinary tract symptoms: results from the REDUCE study. Prostate Cancer Prostatic Dis 2018; 21:238-244. [PMID: 29795141 DOI: 10.1038/s41391-018-0044-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 02/06/2018] [Accepted: 02/17/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND The relationship between baseline prostate-specific antigen (PSA) and development of lower urinary tract symptoms (LUTS) in asymptomatic and mildly symptomatic men is unclear. We sought to determine if PSA predicts incident LUTS in these men. METHODS A post-hoc analysis of the 4-year REDUCE study was performed to assess for incident LUTS in 1534 men with mild to no LUTS at baseline. The primary aim was to determine whether PSA independently predicted incident LUTS after adjusting for the key clinical variables of age, prostate size, and baseline International prostate symptom score (IPSS). Incident LUTS was defined as the first report of medical treatment, surgery, or sustained clinically significant symptoms (two IPSS >14). Cox proportional hazards, cumulative incidence curves, and the log-rank test were used to test our hypothesis. RESULTS A total of 1534 men with baseline IPSS <8 were included in the study cohort. At baseline, there were 335 men with PSA 2.5-4 ng/mL, 589 with PSA 4.1-6 ng/mL, and 610 with PSA 6-10 ng/mL. During the 4-year study, 196 men progressed to incident LUTS (50.5% medical treatment, 9% surgery, and 40.5% new symptoms). As a continuous variable, higher PSA was associated with increased incident LUTS on univariable (HR 1.09, p = 0.019) and multivariable (HR 1.08, p = 0.040) analysis. Likewise, baseline PSA 6-10 ng/mL was associated with increased incident LUTS vs. PSA 2.5-4 ng/mL in adjusted models (HR 1.68, p = 0.016). This association was also observed in men with PSA 4.1-6 ng/mL vs. PSA 2.5-4 ng/mL (HR 1.60, p = 0.032). CONCLUSIONS Men with mild to no LUTS but increased baseline PSA are at increased risk of developing incident LUTS presumed due to benign prostatic hyperplasia.
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Affiliation(s)
- Devin N Patel
- Department of Surgery, Division of Urology, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Tom Feng
- Department of Surgery, Division of Urology, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ross M Simon
- Department of Urology, University of South Florida, Tampa, FL, USA
| | - Lauren E Howard
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Adriana C Vidal
- Department of Surgery, Division of Urology, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel M Moreira
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Claus Roehrborn
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Gerald L Andriole
- Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Stephen J Freedland
- Department of Surgery, Division of Urology, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Urology Section, Veterans Affairs Medical Center, Durham, NC, USA
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20
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Kardasevic A, Milicevic S. The Correlation Between Prostate Volume in Patients with Benign Prostatic Hyperplasia in Relation to Erectile Dysfunction. Med Arch 2018; 70:449-452. [PMID: 28210019 PMCID: PMC5292219 DOI: 10.5455/medarh.2016.70.449-452] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: The exact etiology of lower urinary tract symptoms caused by benign prostatic hyperplasia (BPH) has not yet been determined, and the etiology of erectile dysfunction (ED) is often multicausal and includes organic and/or psychogenic causes, as well as their combinations. Although the relation of BPH, and thus the volume of the prostate (VP) with ED is indisputable, precise mechanisms of integration are still under examination. Goal: The objective was to evaluate the correlation between prostate volume and degree of erectile dysfunction in patients with symptoms of lower urinary tract caused by benign prostatic hyperplasia. Material and Methods. 150 subjects with BPH, and before starting the BPH treatment, which can affect the sexual function, were divided into three groups: 50 patients with prostate volume of 30 to 40 ml (group A), 50 patients with a volume of 40 to 60 ml (group B) and 50 patients with prostate volume above 60 ml (group C). Quantification of erectile function is performed in all respondents by International Index of Erectile Function with five questions (IIEF-5). Results: The mean IIEF-5 in group A was 20.52 points with a standard deviation of 3.22, in group B 17.08 points with a standard deviation of 4.10, while in group C 10.78 points, with a standard deviation of 3.29. Comparing the results of a statistical analysis from all three groups of patients with the degree of ED, Group A had the highest value of IIEF-5, group C the lowest mean value of IIEF-5. The results of ANOVA (F=96.375, p=0.000) indicated that there was a statistically significant difference (p<0.05) between groups at high values of IIEF-5. Additional analysis by Turkey test revealed that there was a statistically significant difference between the first and second groups (p=0.000 <0.05), the first and third groups (p=0.000 <0.05) and the second and third groups (p=0.000 <0.05). Results of Fisher’s exact test (p=0.000) confirmed that there was a statistically significant relationship (p<0.05) between prostate volume and the degree of erectile function. Results of Spearman correlation (ρ=-0.720; p=0.000) showed that prostate volume is negatively correlated with IIEF-5 score with a reliability of 99% (p<0.05), or that increase in the volume of the prostate reduces the IIEF score. Conclusion: Results of IIEF-5 score are inversely proportional to the volume of the prostate or the prostate volume increase, the more severe erectile dysfunction, because the increase in prostate volume leads to a decline in IIEF score.
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Affiliation(s)
- Amel Kardasevic
- Department of Urology. Cantonal Hospital "dr Irfan Ljubijankic" Bihac, Bosna and Hercegovina
| | - Snjezana Milicevic
- Urology Clinic. University Clinical Center of the RS, Banja Luka, Bosnia and Herzegovina
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21
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Kim EH, Brockman JA, Andriole GL. The use of 5-alpha reductase inhibitors in the treatment of benign prostatic hyperplasia. Asian J Urol 2017; 5:28-32. [PMID: 29379733 PMCID: PMC5780290 DOI: 10.1016/j.ajur.2017.11.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Benign prostatic hyperplasia (BPH) is characterized by an enlarged prostate, lower urinary tract symptoms (LUTS), and a decreased urinary flow rate. Common in older men, BPH is a progressive disease that can eventually lead to complications including acute urinary retention (AUR) and the need for BPH-related surgery. Both normal and abnormal prostate growth is driven by the androgen dihydrotestosterone (DHT), which is formed from testosterone under the influence of 5-alpha reductase. Thus, 5-alpha reductase inhibitors (5-ARIs) effectively reduce the serum and intraprostatic concentration of DHT, causing an involution of prostate tissue. Two 5-ARIs are currently available for the treatment of BPH—finasteride and dutasteride. Both have been demonstrated to decrease prostate volume, improve LUTS and urinary flow rates, which ultimately reduces the risk of AUR and BPH-related surgery. Therefore, either alone or in combination with other BPH medications, 5-ARIs are a mainstay of BPH management.
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Does Peak Urine Flow Rate Predict the Development of Incident Lower Urinary Tract Symptoms in Men with Mild to No Current Symptoms? Results from REDUCE. J Urol 2017; 198:650-656. [PMID: 28428110 DOI: 10.1016/j.juro.2017.04.075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE We determined whether decreased peak urine flow is associated with future incident lower urinary tract symptoms in men with mild to no lower urinary tract symptoms. MATERIALS AND METHODS Our population consisted of 3,140 men from the REDUCE (Reduction by Dutasteride of Prostate Cancer Events) trial with mild to no lower urinary tract symptoms, defined as I-PSS (International Prostate Symptom Score) less than 8. REDUCE was a randomized trial of dutasteride vs placebo for prostate cancer prevention in men with elevated prostate specific antigen and negative biopsy. I-PSS measures were obtained every 6 months throughout the 4-year study. The association between peak urine flow rate and progression to incident lower urinary tract symptoms, defined as the first of medical treatment, surgery or sustained and clinically significant lower urinary tract symptoms, was tested by multivariable Cox models, adjusting for various baseline characteristics and treatment arm. RESULTS On multivariable analysis as a continuous variable, decreased peak urine flow rate was significantly associated with an increased risk of incident lower urinary tract symptoms (p = 0.002). Results were similar in the dutasteride and placebo arms. On univariable analysis when peak flow was categorized as 15 or greater, 10 to 14.9 and less than 10 ml per second, flow rates of 10 to 14.9 and less than 10 ml per second were associated with a significantly increased risk of incident lower urinary tract symptoms (HR 1.39, p = 0.011 and 1.67, p <0.001, respectively). Results were similar on multivariable analysis, although in the 10 to 14.9 ml per second group findings were no longer statistically significant (HR 1.26, p = 0.071). CONCLUSIONS In men with mild to no lower urinary tract symptoms a decreased peak urine flow rate is independently associated with incident lower urinary tract symptoms. If confirmed, these men should be followed closer for incident lower urinary tract symptoms.
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Lee HN, Lee YS, Han DH, Lee KS. Change of Ultrasound Estimated Bladder Weight and Bladder Wall Thickness After Treatment of Bladder Outlet Obstruction With Dutasteride. Low Urin Tract Symptoms 2017; 9:67-74. [PMID: 28394496 DOI: 10.1111/luts.12110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 05/30/2015] [Accepted: 06/14/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To investigate the change of bladder wall hypertrophy to relieve bladder outlet obstruction (BOO) by treatment with 5α-reductase inhibitor. METHODS Men who have BOO confirmed by urodynamic study (BOO index ≥40) were treated with dutasteride 0.5 mg once a day for 6 months. We measured ultrasound estimated bladder weight (UEBW), UEBW divided by body surface area (UEBW/BSA), and bladder wall thickness (BWT) before and after treatment. Changes in LUTS parameters were assessed by using the International Prostate Symptom Score, uroflowmetry, residual urine volume, prostate volume, serum prostate-specific antigen (PSA), and LUTS outcome scores (LOS). Correlation between the change of LUTS parameters and UEBW, UEBW/BSA, and BWT were evaluated. We assessed the changes of bladder wall hypertrophy according to the results of benefit, satisfaction, and willingness to continue (BSW) questionnaire. RESULTS Thirty patients completed the 6-month study. The mean UEBW was 47.10 ± 7.79 g before and 50.07 ± 5.39 g after dutasteride treatment (P = 0.259). The mean UEBW/BSA was 26.47 ± 4.30 g/m2 before and 28.2 ± 3.53 g/m2 after treatment (P = 0.253), and there was no definite change in mean BWT after treatment (P = 0.301). Most LUTS parameters including LOS significantly improved. Increased BOO index value was related to decreased BWT (ρ = 0.361, P = 0.049). There was no definite change in mean UEBW, UEBW/BSA, and BWT according to the results of the BSW questionnaire. CONCLUSIONS There was no change in UEBW, UEBW/BSA and BWT despite improving most clinical parameters suggesting BOO. The changes of bladder wall hypertrophy parameters still have limitations to directly reflect the relief of BOO.
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Affiliation(s)
- Ha Na Lee
- Department of Urology, Seoul Seonam Hospital, Ewha Womans University, Seoul, Korea
| | - Young-Suk Lee
- Department of Urology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Deok Hyun Han
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyu-Sung Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, , Seoul, Korea
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Egan KB. The Epidemiology of Benign Prostatic Hyperplasia Associated with Lower Urinary Tract Symptoms: Prevalence and Incident Rates. Urol Clin North Am 2017; 43:289-97. [PMID: 27476122 DOI: 10.1016/j.ucl.2016.04.001] [Citation(s) in RCA: 263] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This article assesses the reported prevalence and incidence rates for benign prostatic hyperplasia and lower urinary tract symptoms (BPH/LUTS) by age, symptom severity, and race/ethnicity. BPH/LUTS prevalence and incidence rates increase with increasing age and vary by symptom severity. The BPH/LUTS relationship is complex due to several factors. This contributes to the range of reported estimates and difficulties in drawing epidemiologic comparisons. Cultural, psychosocial, economic, and/or disease awareness and diagnosis factors may influence medical care access, symptom reporting and help-seeking behaviors among men with BPH/LUTS. However, these factors and their epidemiologic association with BPH/LUTS have not been thoroughly investigated.
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Affiliation(s)
- Kathryn Brigham Egan
- Yale University, 2 Whalley Ave, New Haven, CT 06520, USA; New England Research Institutes Inc., 480 Pleasant Street, Watertown, MA 02472, USA.
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Alan B, Utangaç M, Göya C, Dağgülli M. Role of Acoustic Radiation Force Impulse (ARFI) Elastography in Determination of Severity of Benign Prostate Hyperplasia. Med Sci Monit 2016; 22:4523-4528. [PMID: 27876713 PMCID: PMC5132425 DOI: 10.12659/msm.898676] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background The aim of this study was to investigate the potential contribution of acoustic radiation force impulse (ARFI) elastography to the determination of the severity of benign prostate hypertrophy (BPH) by performing shear wave velocity (SWV) measurements of the prostate using ARFI technology. Material/Methods Sixty BPH patients and 40 healthy volunteers were included in this study. SWV measurements of the prostate were performed by transabdominal ultrasonography (US), both in the BPH patients and control subjects. The BPH patients also underwent uroflowmetry measurements. Using the International Prostate Symptom Score (IPSS), the BPH patients were divided into two subgroups, a mild-to-moderate BPH group and a severe BPH group, to compare SWV values. Results The BPH patients had higher SWV values for the central area of the prostate compared to the control subjects (2.52±0.59 m/s and 1.47±0.42 m/s, p<0.01). The SWV values of the central area of prostate were higher in the severe BPH group compared to the mild-to-moderate BPH group (2.62±0.58 and 2.25±0.55, p=0.02). Conclusions Our ARFI elastography results indicated that the central prostate SWV values of BPH patients were significantly higher relative to those of a healthy control group. The central prostate SWV values increased in proportion to the increased severity of BPH. Measurement of SWV by ARFI technology constitutes a non-invasive alternative to other methods for the determination of BPH severity.
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Affiliation(s)
- Bircan Alan
- Department of Radiology, Dicle University, Medical Faculty, Diyarbakır, Turkey
| | - Mazhar Utangaç
- Department of Neurology, Dicle University, Medical Faculty, Diyarbakır, Turkey
| | - Cemil Göya
- Department of Neurology, Dicle University, Medical Faculty, Diyarbakır, Turkey
| | - Mansur Dağgülli
- Department of Neurology, Dicle University, Medical Faculty, Diyarbakır, Turkey
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Prostate Zonal Volumetry as a Predictor of Clinical Outcomes for Prostate Artery Embolization. Cardiovasc Intervent Radiol 2016; 40:245-251. [DOI: 10.1007/s00270-016-1518-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 11/15/2016] [Indexed: 10/20/2022]
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Đorđević I, Milutinović M, Kostić M, Đorđević B, Dimitrijević M, Stošić N, Ranđelović M, Banković S, Kitić D. PHYTOTHERAPEUTIC APPROACH TO BENIGN PROSTATIC HYPERPLASIA TREATMENT BY PUMPKIN SEED (CUCURBITA PEPO L., CUCURBITACEAE). ACTA MEDICA MEDIANAE 2016. [DOI: 10.5633/amm.2016.0310] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Sarbishegi M, Khajavi O, Arab MR. Withania coagulans Extract Induces Cell Apoptosis and Inhibits COX-2 Expression in a Rat Model of Benign Prostatic Hyperplasia. Nephrourol Mon 2016; 8:e39284. [PMID: 27878112 PMCID: PMC5111096 DOI: 10.5812/numonthly.39284] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 06/25/2016] [Indexed: 12/11/2022] Open
Abstract
Background Phytotherapy is a popular treatment option in cases of benign prostatic hyperplasia (BPH), with many different herbal products being used for the treatment of this condition. Withania coagulans (WC) is an herbal medicine that has shown anti-tumoral, anti-inflammatory, and antioxidant effects. Objectives This study examined the effect of Withania coagulans extract (WCE) on prostatic cell apoptosis and cyclooxygenase-2 (COX-2) expression in cases of benign prostatic hyperplasia (BPH) in rats. Methods Forty Wistar rats were equally divided into five groups: control, sham, BPH, BPH + WCE, and BPH + CLX (celecoxib) as a positive control group. The induction of BPH was achieved via the subcutaneous injection of 3 mg/kg of testosterone propionate (TP) daily for 28 days. The animals received WCE, celecoxib, or distilled water by oral gavage accompanied by the TP injection. After four weeks, the prostate glands of the rats were weighed to measure the prostatic index (PI). The ventral lobes of the prostates were dissected and processed with paraffin blocks in order to study the number of mast cells. A TUNEL analysis was performed to evaluate the cell apoptosis, while the expression of COX-2 was examined using immunohistochemistry. Results BPH was obvious in the ventral lobe of the prostate, and the administration of WCE markedly decreased the PI and the number of mast cells (P < 0.001) in the BPH rats. Additionally, the WCE treatment induced prostatic cell apoptosis when compared to the BPH group. Furthermore, following the WCE treatment, the expression of COX-2 in the prostatic tissues was significantly decreased when compared to the BPH groups. Conclusions According to the results of this study, WCE was effective in the treatment of BPH in rats. It may therefore have beneficial effects in the treatment of patients with BPH.
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Affiliation(s)
- Maryam Sarbishegi
- Cellular and Molecular Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran
- Department of Anatomy, School of Medicine, Zahedan University of Medical Sciences, Zahedan, IR Iran
- Corresponding author: Maryam Sarbishegi, Department of Anatomy, School of Medicine, Zahedan University of Medical Sciences, Zahedan, IR Iran. Tel: +98-3329571519, Fax: +98-33291124, E-mail:
| | - Ozra Khajavi
- Department of Anatomy, School of Medicine, Zahedan University of Medical Sciences, Zahedan, IR Iran
| | - Mohammad Reza Arab
- Cellular and Molecular Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran
- Department of Anatomy, School of Medicine, Zahedan University of Medical Sciences, Zahedan, IR Iran
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Does Prostate Size Predict the Development of Incident Lower Urinary Tract Symptoms in Men with Mild to No Current Symptoms? Results from the REDUCE Trial. Eur Urol 2016; 69:885-91. [DOI: 10.1016/j.eururo.2015.12.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 12/01/2015] [Indexed: 11/21/2022]
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[CLINICOPATHOLOGICAL STUDY OF PROSTATE BIOPSY IN PATIENTS RECEIVING DUTASTERIDE FOR BENIGN PROSTATIC HYPERPLASIA]. Nihon Hinyokika Gakkai Zasshi 2015; 106:156-62. [PMID: 26419072 DOI: 10.5980/jpnjurol.106.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Dutasteride is a 5-alpha reductase inhibitor used to treat benign prostatic hyperplasia. Dutasteride lowers prostate-specific antigen (PSA) levels, which may lead to delays in the diagnosis and treatment of prostate cancer (PCa). This study investigated patients who underwent prostate biopsy (PBx) while receiving dutasteride to investigate whether this agent affects the diagnosis and treatment of PCa. PATIENTS AND METHODS PBx was performed on six patients receiving dutasteride for > 3 months at our medical institutions between January 2010 and June 2013. No patients underwent PBx before dutasteride administration. We performed PBx both for patients with high initial PSA levels and for those with elevated PSA levels with or without initial PSA decline after dutasteride administration. We also investigated clinicopathological findings. RESULTS Mean age at the start of administration was 69.5 ± 5.9 years (range, 59-77 years), mean duration of administration was 14.1 ± 7.4 months (range, 4.0-23.5 months), mean prostate volume at the start of administration was 70.4 ± 30.7 ml (range, 18.8-104.6 ml), and mean PSA level at the start of administration was 7.7 ± 3.3 ng/ml (range, 4.9-14.2 ng/ml). PSA density was 0.098 ± 0.045 ng/ml/cm3 (range, 0.042-0.181 ng/ml/cm3), and PSA level at PBx was 5.4 ± 2.7 ng/ml (range, 2.5-10.7 ng/ml). We detected three PCa patients, and clinical stage in each case was cT1cN0M0. Radical retropubic prostatectomy was performed in two cases, and androgen-deprivation therapy was performed in one case. CONCLUSION All PCa were detected in the early clinical stage. No delays in detection or treatment of PCa were seen in any cases. Careful observation of PSA levels is simple and useful for detecting PCa in patients under dutasteride administration.
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What do we know about phytotherapy of benign prostatic hyperplasia? Life Sci 2015; 126:42-56. [DOI: 10.1016/j.lfs.2015.01.023] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 12/22/2014] [Accepted: 01/21/2015] [Indexed: 02/08/2023]
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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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Kozminski MA, Wei JT, Nelson J, Kent DM. Baseline characteristics predict risk of progression and response to combined medical therapy for benign prostatic hyperplasia (BPH). BJU Int 2014; 115:308-16. [PMID: 24825577 DOI: 10.1111/bju.12802] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To better risk stratify patients, using baseline characteristics, to help optimise decision-making for men with moderate-to-severe lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) through a secondary analysis of the Medical Therapy of Prostatic Symptoms (MTOPS) trial. PATIENTS AND METHODS After review of the literature, we identified potential baseline risk factors for BPH progression. Using bivariate tests in a secondary analysis of MTOPS data, we determined which variables retained prognostic significance. We then used these factors in Cox proportional hazard modelling to: i) more comprehensively risk stratify the study population based on pre-treatment parameters and ii) to determine which risk strata stood to benefit most from medical intervention. RESULTS In all, 3047 men were followed in MTOPS for a mean of 4.5 years. We found varying risks of progression across quartiles. Baseline BPH Impact Index score, post-void residual urine volume, serum prostate-specific antigen (PSA) level, age, American Urological Association Symptom Index score, and maximum urinary flow rate were found to significantly correlate with overall BPH progression in multivariable analysis. CONCLUSIONS Using baseline factors permits estimation of individual patient risk for clinical progression and the benefits of medical therapy. A novel clinical decision tool based on these analyses will allow clinicians to weigh patient-specific benefits against possible risks of adverse effects for a given patient.
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Affiliation(s)
- Michael A Kozminski
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA
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Ząbkowski T. Evaluation of the clinical indications, adverse drug reactions, and finasteride use in patients with benign prostatic hyperplasia in Poland. Pharmacol Rep 2014; 66:565-9. [PMID: 24948055 DOI: 10.1016/j.pharep.2014.02.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 10/24/2013] [Accepted: 02/13/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Benign prostatic hyperplasia (LUTS/BPH) is one of the most common urinary disorders in elderly men. The symptoms of the disease include prostate gland enlargement, bladder outlet obstruction, and lower urinary tract symptoms (LUTSs). BPH predisposes patients to bladder infections and bladder stone formation and increases their risk of urinary retention, which in turn causes renal failure. Hence, the disease requires surgical treatment. However, over the recent years, the number of surgical interventions performed in pharmacotherapy has significantly reduced because of the increased efficacy of conservative therapy, including combination treatment mostly with 2 groups of drugs, namely, alpha-1-adrenolitics and other 5-alpha-reductase blockers, with a different pharmacological activity [5]. The aim of this study was to evaluate the clinical indications, adverse drug reactions, and finasteride use in patients with diagnosed BPH in Poland. MATERIALS AND METHODS We conducted a clinical trial from November 2009 to November 2010 that included 5751 patients who were enrolled in 46 urological centres in Poland. The researchers who conducted the clinical trial were urologists from different regions of Poland. The clinical trial involved 6 follow-up visits. The mean age of the patients was 67 years (range, 45-93 years; median, 67.00; SD, 8.507). The inclusion criteria were as follows: LUTSs, finasteride therapy for at least 2 weeks, age>40 years, and BPH. RESULTS Patients self-reported data on LUTSs, the symptom frequency, concurrent diseases, and intensification of urinary system symptoms. In addition, additional examinations were performed, including prostate-specific antigen test, urinary tract ultrasonography with evaluation of residual urine and prostate, and uroflowmetry. The study did not exclude data on the combined treatment with finasteride and alpha-1-adrenolitics. CONCLUSION Finasteride was demonstrated to be effective, as evidenced by the significant decrease in TPV by 40% even after 12 months. It was also found to contribute to the attenuation of LUTSs, improvement in maximum flow rate, decrease in nocturia, and improvement in QoL.
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Affiliation(s)
- Tomasz Ząbkowski
- Urology Clinic of the Military Medical Institute, Warszawa, Poland.
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Haider A, Meergans U, Traish A, Saad F, Doros G, Lips P, Gooren L. Progressive Improvement of T-Scores in Men with Osteoporosis and Subnormal Serum Testosterone Levels upon Treatment with Testosterone over Six Years. Int J Endocrinol 2014; 2014:496948. [PMID: 24688541 PMCID: PMC3943258 DOI: 10.1155/2014/496948] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 12/31/2013] [Indexed: 02/01/2023] Open
Abstract
Testosterone deficiency leads to bone loss and testosterone treatment has a beneficial effect. This study investigated the effects of normalizing serum testosterone on bone mineral density in 45 men with osteoporosis, diagnosed with testosterone deficiency (serum testosterone levels <12.1 nmol/L, T-scores: (mean ± SD) -3.12 ± 0.45, minimum: -4.10, and maximum: -2.60). In a cumulative, prospective, registry study of hypogonadal men (mean age: 53 ± 7 years) they received parenteral testosterone undecanoate of 1000 mg/12 weeks for up to six years. After one year 44 men were included in the registry, after two years 36 men, after three years 32 men, after four years 25 men, after five years 10 men and after six years 4 men. The declining numbers do not reflect drop-out rates but are a result of the registry design. Over the 6 year period there was a significant and progressive improvement of the T-scores in these men. Normalizing of serum testosterone leads to an improvement of bone mineral density and this improvement was progressive with the time period of testosterone administration. In this study of 6-years many men with testosterone deficiency suffered from classical diagnoses (Klinefelter's syndrome and testicular pathology) hitherto undiagnosed.
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Affiliation(s)
- Ahmad Haider
- Private Urology Practice, 27570 Bremerhaven, Germany
| | - Ulrich Meergans
- Department of Orthopedics, Wesermuende Hospital, 27607 Langen, Germany
| | - Abdulmaged Traish
- Departments of Biochemistry and of Urology, Boston University School of Medicine, Boston, MA 02118, USA
| | - Farid Saad
- Bayer Pharma, Global Medical Affairs Andrology, 13353 Berlin, Germany
- Gulf Medical University School of Medicine, Ajman, UAE
- *Farid Saad:
| | - Gheorghe Doros
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
| | - Paul Lips
- Endocrine Section, Department of Internal Medicine, VU University Medical Center, 1081 HV Amsterdam, The Netherlands
| | - Louis Gooren
- Endocrine Section, Department of Internal Medicine, VU University Medical Center, 1081 HV Amsterdam, The Netherlands
- Chiang Mai 50220, Thailand
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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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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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Cindolo L, Pirozzi L, Fanizza C, Romero M, Sountoulides P, Roehrborn CG, Mirone V, Schips L. Actual medical management of lower urinary tract symptoms related to benign prostatic hyperplasia: temporal trends of prescription and hospitalization rates over 5 years in a large population of Italian men. Int Urol Nephrol 2013; 46:695-701. [DOI: 10.1007/s11255-013-0587-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 10/05/2013] [Indexed: 02/02/2023]
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Seitz M, Herlemann A, Magistro G, Stief CG. [Diagnostics of benign prostate syndrome]. Urologe A 2013; 52:193-6. [PMID: 23417045 DOI: 10.1007/s00120-012-3085-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The diagnostic work-up of lower urinary tract symptoms (LUTS) in the German guidelines consists of obligatory and optional diagnostic parameters. Recommendations for assessing LUTS include patient history, symptom questionnaires (IPSS international prostate symptoms score), physical examination, urine analysis, prostate-specific antigen, uroflowmetry, ultrasound examination of the urinary bladder, including postvoid residual urine and ultrasound examination of the upper urinary tract. Optional tests are voiding diary, pressure-flow studies, ultrasound measurement of detrusor wall thickness, urethrocystography and urethrocystoscopy. Ultrasound measurement of detrusor wall thickness in particular has a 95 % positive predictive value in diagnosing bladder outlet obstruction. With all diagnostic parameters it is possible to treat LUTS in a risk-adapted manner.
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Affiliation(s)
- M Seitz
- UroClinic Bogenhausen, Richard-Strauss-Straße 82, Munich, Germany.
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Turkbey B, Huang R, Vourganti S, Trivedi H, Bernardo M, Yan P, Benjamin C, Pinto PA, Choyke PL. Age-related changes in prostate zonal volumes as measured by high-resolution magnetic resonance imaging (MRI): a cross-sectional study in over 500 patients. BJU Int 2012; 110:1642-7. [PMID: 22973825 DOI: 10.1111/j.1464-410x.2012.11469.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED Study Type--Diagnosis (case series) Level of Evidence 4. What's known on the subject? and What does the study add? Benign prostatic hyperplasia is the most common symptomatic disorder of the prostate and its severity varies greatly in the population. Various methods have been used to estimate prostate volumes in the past including the digital rectal examination and ultrasound measurements. High-resolution T2 weighted MRI can provide accurate measurements of zonal volumes and total volumes, which can be used to better understand the etiology of lower urinary tract symptoms of men. OBJECTIVE • To use ability of magnetic resonance imaging (MRI) to investigate age-related changes in zonal prostate volumes. PATIENTS AND METHODS • This Institutional Review Board approved, Health Insurance Portability and Accountability Act-compliant study consisted of 503 patients who underwent 3 T prostate MRI before any treatment for prostate cancer. • Whole prostate (WP) and central gland (CG) volumes were manually contoured on T2-weighted MRI using a semi-automated segmentation tool. WP, CG, peripheral zone (PZ) volumes were measured for each patient. • WP, CG, PZ volumes were correlated with age, serum prostate-specific antigen (PSA) level, International Prostate Symptom Score (IPSS), Sexual Health Inventory for Men (SHIM) scores. RESULTS • Linear regression analysis showed positive correlations between WP, CG volumes and patient age (P < 0.001); there was no correlation between age and PZ volume (P= 0.173). • There was a positive correlation between WP, CG volumes and serum PSA level (P < 0.001), as well as between PZ volume and serum PSA level (P= 0.002). • At logistic regression analysis, IPSS positively correlated with WP, CG volumes (P < 0.001). • SHIM positively correlated with WP (P= 0.015) and CG (P= 0.023) volumes. • As expected, the IPSS of patients with prostate volumes (WP, CG) in first decile for age were significantly lower than those in tenth decile. CONCLUSIONS • Prostate MRI is able to document age-related changes in prostate zonal volumes. • Changes in WP and CG volumes correlated inversely with changes in lower urinary tract symptoms. • These findings suggest a role for MRI in measuring accurate prostate zonal volumes; have interesting implications for study of age-related changes in the prostate.
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Affiliation(s)
- Baris Turkbey
- Molecular Imaging Program Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892-1088, USA
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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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Chung JW, Choi SH, Kim BS, Kim TH, Yoo ES, Kim CI, Lee KS, Kwon TG. Efficacy and Tolerability of Tamsulosin 0.4 mg in Patients with Symptomatic Benign Prostatic Hyperplasia. Korean J Urol 2011; 52:479-84. [PMID: 21860769 PMCID: PMC3151636 DOI: 10.4111/kju.2011.52.7.479] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 06/16/2011] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate the efficacy and tolerability of tamsulosin 0.4 mg once daily in Korean patients with symptomatic benign prostatic hyperplasia (BPH) and investigate whether tamsulosin 0.4 mg can improve symptoms in patients with refractory lower urinary tract symptoms (LUTS) who were previously receiving tamsulosin 0.2 mg once daily. Materials and Methods A total of 116 patients from 3 urology centers participated. All study subjects entered a nonblind phase consisting of 8 weeks of tamsulosin 0.2 mg monotherapy followed by an additional 8 weeks of tamsulosin 0.2 mg (0.2 mg group) or 8 weeks of tamsulosin 0.4 mg (0.4 mg group). At week 8, we chose the 0.4 mg group on the basis of International Prostate Symptom Score (IPSS), quality of life (QoL), maximal urinary flow rate (Qmax), and adverse effects. At week 16, we compared the efficacy and tolerability of tamsulosin between the 0.2 and 0.4 mg groups. Results A total of 26 patients (22.4%) were escalated to tamsulosin 0.4 mg at week 8. There were significant differences in IPSS, QoL, and Qmax at week 8 in both groups. There were significant differences in improvement in IPSS, QoL, Qmax, and postvoid residual urine volume from baseline to week 16 in both groups. There were no significant differences in efficacy or tolerability between the groups at week 16. Conclusions Our trial demonstrated that tamsulosin 0.4 mg has favorable efficacy and tolerability in Korean patients with symptomatic BPH refractory to tamsulosin 0.2 mg. No patients experienced any serious adverse effects when we escalated the dose of tamsulosin to 0.4 mg.
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Affiliation(s)
- Jae-Wook Chung
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
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Nickel JC, Méndez-Probst CE, Whelan TF, Paterson RF, Razvi H. 2010 Update: Guidelines for the management of benign prostatic hyperplasia. Can Urol Assoc J 2011; 4:310-6. [PMID: 20944799 DOI: 10.5489/cuaj.10124] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Nickel JC, Gilling P, Tammela TL, Morrill B, Wilson TH, Rittmaster RS. Comparison of dutasteride and finasteride for treating benign prostatic hyperplasia: the Enlarged Prostate International Comparator Study (EPICS). BJU Int 2011; 108:388-94. [PMID: 21631695 DOI: 10.1111/j.1464-410x.2011.10195.x] [Citation(s) in RCA: 121] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE • To assess the efficacy and safety of dutasteride compared with finasteride in treating men with symptomatic benign prostatic hyperplasia (BPH) for 12 months. PATIENTS AND METHODS • The Enlarged Prostate International Comparator Study was a multicentre, randomized, double-blind, 12-month, parallel-group study. • Men aged ≥ 50 years with a clinical diagnosis of BPH received once-daily treatment with dutasteride 0.5 mg (n= 813) or finasteride 5 mg (n= 817). After a 4-week placebo run-in period, patients were randomized to receive dutasteride or finasteride for 48 weeks, followed by an optional 24-month, open-label phase, during which patients received dutasteride 0.5 mg once daily. • The primary endpoint was change in prostate volume, and the secondary endpoints included improvement in American Urological Association Symptom Index (AUA-SI) scores, improvement in maximum urinary flow rate (Q(max)) and long-term safety in the 24-month open-label phase. RESULTS • Both dutasteride and finasteride were effective at reducing prostate volume with no significant difference between the two treatments during the study. • Similar reductions in mean AUA-SI scores and Q(max) were also observed for men in both treatment groups. • A similar percentage of adverse events was experienced by patients of both treatment groups, and no new adverse events were reported in the open-label phase. CONCLUSION • Dutasteride and finasteride, when administered for 12 months, were similarly effective in reducing prostate volume and improving Q(max) and urinary symptoms associated with BPH in men with an enlarged prostate.
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Affiliation(s)
- J Curtis Nickel
- Department of Urology, Queen's University Kingston, ON, Canada.
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St Sauver JL, Lieber MM, Slager SL, Jacobson DJ, McGree ME, Jacobsen SJ. Associations between variants in the cyclooxygenase 2 enzyme gene (PTGS2) and development of benign prostate enlargement. BJU Int 2011; 108:1610-5. [PMID: 21481131 DOI: 10.1111/j.1464-410x.2011.10161.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine if polymorphisms in the cyclooxygenase 2 (COX-2) enzyme gene (prostaglandin synthase 2; PTGS2) were associated with development of benign prostate enlargement (BPE), and whether associations were modified by use of nonsteroidal anti-inflammatory drugs (NSAIDs). MATERIALS AND METHODS Participants were men residing in Olmsted County, MN, who were between 40 and 79 years of age in 1990 (N= 356). Prostate volume was measured by transrectal ultrasound and men reported all the medications that they were taking at the time of the examination. Men were followed biennially for 16 years. Ten tagging single nucleotide polymorphisms (SNPs) in the PTGS2 gene were typed using the Illumina GoldenGate(TM) Assay. Associations between SNPs and development of BPE (volume >30 mL) were assessed by Cox proportional hazards models. Models were also stratified by NSAID use. RESULTS We observed significant associations between four polymorphisms in the PTGS2 gene and development of BPE (all P < 0.05). These associations were not observed among men who used NSAIDs. CONCLUSION Variants in the PTGS2 gene may increase the risk of prostate enlargement, but the increased risk may be minimized by use of NSAIDs.
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Affiliation(s)
- Jennifer L St Sauver
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA.
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Moreno Sierra J, Fernandez Pérez C, Cano Escudero S, Fuentes Ferrer M, Tolosa LB, Silmi Moyano Á. Progression of Null or Mild Lower Urinary Tract Symptoms Indicative of Benign Prostatic Hyperplasia After 2 Years of Follow-up in Non-treated Men Aged 40 Years or Older. Urology 2011; 77:693-8. [DOI: 10.1016/j.urology.2010.07.459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 06/30/2010] [Accepted: 07/09/2010] [Indexed: 10/18/2022]
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Barkin J. Review of dutasteride/tamsulosin fixed-dose combination for the treatment of benign prostatic hyperplasia: efficacy, safety, and patient acceptability. Patient Prefer Adherence 2011; 5:483-90. [PMID: 22003286 PMCID: PMC3191925 DOI: 10.2147/ppa.s14032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) will usually affect older men, of whom 50% over the age 60 years and almost 90% in their nineties will be bothered enough by their symptoms that they request some type of treatment. However, symptomatic bother may also affect men in their forties with a prevalence rate of almost 18%. The International Prostate Symptom Score (IPSS) has become the most widely used and best validated questionnaire to allow the patient to quantify the severity of his LUTS/BPH symptoms. This score has become the cornerstone in demonstrating the "rate of symptom response" for the patient who has been exposed to any type BPH management. Question 8 on the IPSS score is what is defined as the "Quality of Life" question or what is also termed the "Bothersome Index." The score out of 6 as declared by the patient will reflect the degree of concern that the patient is feeling about his symptoms and the reduction of the score after treatment is a statement of their improved quality of life. There are 2 families of accepted medical therapy to treat the symptoms of BPH and potentially prevent the most worrisome long-term sequelae of progression of BPH: urinary retention or the need for surgery. When defining the impact of the main types of medical therapy, the alpha blockers have been termed the "openers" and the 5 alpha-reductase inhibitors are described as the "shrinkers." Since they each offer a different mechanism of effect, the concept of combination therapy was raised and trialed many times over recent years. The final aspect of any medical therapy is the patient's satisfaction with the treatment and the side effects. In the CombAT (Combination of Avodart and Tamsulosin) trial a new assessment was developed and tested called the Patient's Perception of Study Medication (PPSM) which told the investigators if the patients, given free choice, would choose to take that combination of medication to treat their problem and stay on the medication.
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Affiliation(s)
- Jack Barkin
- Correspondence: Jack Barkin, 960 Lawrence Ave, West Suite 404, Toronto, Ontario, Canada M6A 3B5, Tel +1 416 256 2737, Fax +1 416 256 9098, Email
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Analysis of initial baseline clinical parameters and treatment strategy associated with medication failure in the treatment of benign prostatic hyperplasia in Korea. Int Neurourol J 2010; 14:261-6. [PMID: 21253339 PMCID: PMC3021819 DOI: 10.5213/inj.2010.14.4.261] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 12/23/2010] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To analyze the baseline clinical factors and medication treatment strategy used in cases with medication treatment failure of benign prostatic hyperplasia (BPH). METHODS From January 2006 to December 2009, 677 BPH patients with at least 3 months of treatment with medication were enrolled. We analyzed clinical factors by medication failure (n=161) versus maintenance (n=516), by prostate size (less than 30 g, n=231; 30 to 50 g, n=244; greater than 50 g, n=202), and by prostate-specific antigen (PSA) levels (less than 1.4 ng/mL, n=324; more than 1.4 ng/mL, n=353). RESULTS Age, combination medication rate, PSA, and prostate volume were statistically different between the medication treatment failure and maintenance groups. By prostate size, the PSA and medication failure rates were relatively higher and the medication period was shorter in patients with a prostate size of more than 30 g. The combination medication rate was higher in patients with a prostate size of more than 50 g. The medication failure rate and prostate volume were higher in patients with a PSA level of more than 1.4 ng/mL. However, the combination treatment rate was not significantly different in patients with a PSA level lower than 1.4 ng/mL. Suggestive cutoffs for combination medication are a prostate volume of 34 g and PSA level of 1.9 ng/mL. CONCLUSIONS The clinical factors associated with medication failure were age, treatment type, and prostate volume. Combination therapy should be considered more in Korea in patients with a PSA level higher than 1.4 ng/mL and a prostate volume of between 30 and 50 g to prevent medication failure.
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Effect of a hypercholesterolemic diet on serum lipid profile, plasma sex steroid levels, and prostate structure in rats. Urology 2010; 76:1517.e1-5. [PMID: 20974489 DOI: 10.1016/j.urology.2010.07.515] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Revised: 07/04/2010] [Accepted: 07/31/2010] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The purpose of this study was to examine the impact of a hypercholesterolemic diet (HD) on serum lipid profile, plasma sex steroid levels, and ventral prostate structure in rats. METHODS Beginning at 120 days of age, male Wistar rats were fed for 5 months with either standard rat chow (15 animals) or standard chow enriched with 4% cholesterol and 1% cholic acid (15 animals). The body and ventral prostate weights (VPWs), plasma sex steroid levels, and lipid profiles were determined, and prostate morphology in fixed tissue sections were studied. RESULTS The body weight of rats fed with HD did not differ from that of controls. However, both absolute and relative VPWs of HD animals were significantly lower than those of controls. HD resulted in significant elevation in total serum cholesterol and LDL levels, whereas HDL and triglyceride levels were comparable. Plasma total testosterone and estriol levels did not differ between groups, but their free fraction, along with sex hormone-binding globulin levels, were significantly affected. HD also affected the microscopic structure of the ventral prostate. Epithelial cells of the distal area formed papillary projections within the acinar lumen and had more cytoplasm than controls. In most cases, vesicular formations within the cytoplasmic area were also noted. CONCLUSIONS Hypercholesterolemia causes marked changes in the ventral prostate, serum lipid profile, and plasma sex steroid profile in rats and possibly alters prostate morphology by affecting the sex steroid axis, thus contributing to prostatic disease pathogenesis.
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