Benign Prostatic Hyperplasia

Background: Combination therapy with dutasteride and tamsulosin provides significantly greater benefit than either monotherapy for various patient-reported outcomes in men with moderate-to-severe lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) and prostatic enlargement. Objective: To investigate whether combination therapy is more effective than either monotherapy in reducing the relative risk for acute urinary retention (AUR), BPH-related surgery, and BPH clinical progression over 4 yr in men at increased risk of progression. Design, setting, and participants: The Combination of Avodart 1 and Tamsulosin (CombAT) study was a 4-yr, multicenter, randomised, double-blind, parallel-group study in 4844 men !50 yr of age with a clinical diagnosis of BPH, International Prostate Symptom Score !12, prostate volume !30 cm 3 , prostate-specific antigen 1.5-10 ng/ml, and maximum urinary flow rate (Q max ) >5 and 15 ml/s with minimum voided volume !125 ml. Intervention: Oral daily tamsulosin, 0.4 mg; dutasteride, 0.5 mg; or a combination of both. Measurements: The 4-yr primary end point was time to first AUR or BPH-related surgery. Secondary end points included BPH clinical progression, symptoms, Q max , prostate volume, safety, and tolerability. Results and limitations: Combination therapy was significantly superior to tamsulosin monotherapy but not dutasteride monotherapy at reducing the relative risk of AUR or BPH-related surgery. Combination therapy was also significantly superior to both monotherapies at reducing the relative risk of BPH clinical progression. Combination therapy provided significantly greater symptom benefit than either monotherapy at 4 yr. Safety and tolerability of combination therapy was consistent with previous experience with dutasteride and tamsulosin monotherapies, with the exception of an imbalance in the composite term of cardiac failure among the three study arms. The lack of placebo control is a study limitation. Conclusions: The 4-yr CombAT data provide support for the long-term use of dutasteride and tamsulosin combination therapy in men with moderate-to-severe LUTS due to BPH and prostatic enlargement. Clinicaltrials.gov identifier: NCT00090103 ().

The prostate is a gland that surrounds the posterior urethra in man and, along with seminal vesicles, produces prostatic and seminal fluids. Prostatitis, benign prostatic hyperplasia (BPH), and prostate cancer are the most frequent pathologies of this gland. Zinc is an important element in the makeup of prostatic fluid and plays an important role in the immunology of the infectious and neoplastic pathologies of the prostate. The aim of this study was to determine zinc concentrations in prostatic fluid of patients with prostate pathologies and to use this measurement as a diagnostic parameter. Thirty patients with prostatic pathologies and ten healthy controls were studied. Prostatic fluid samples were collected using prostatic massage. Zinc concentration was determined using electrothermal atomizeratomic absorption spectrometry (ETA-AAS). The mean zinc concentrations obtained in the studied population were as follows: 11 patients with BPH: 15.087,78 micromol/dL, 10 patients with pro...

Aim : The aim of the present study was to determine the frequency of lower urinary tract symptoms (LUTS), assess the impact of LUTS on quality of life (QOL) and compare the results with recent reports from other population-based studies. Methods : A total of 266 men participated in the study. The men were stratified into 10-year age groups between 40 and 79 years. All participants were asked to complete a questionnaire that included a Turkish translation of the International Prostate Symptom Score (IPSS) with QOL questions, and void into a uroflowmeter to obtain voided urine volume, peak and mean flow rate. Results : While 14.8% of men had no symptoms (IPSS = 0), 24.9% had moderate to severe symptoms (IPSS > 7). Severity of symptoms increased with age ( P = 0.0018). There was a strong relationship between bother score and IPSS ( rs = 0.79, P = 0.0001). Fifty-five percent of moderately symptomatic and 78% of severely symptomatic men reported poor QOL (QOL score ≥ 3). The results of the survey provide a general picture of the symptomatology and urinary flow profiles of elderly men living in Turkey. The prevalence of LUTS in the Turkish community is fairly high, it increases with age and has an impact on QOL that is not negligible.

Estrogens play a physiologic role during prostate development with regard to programming stromal cells and directing early morphogenic events. However, if estrogenic exposures are abnormally high during the critical developmental period, permanent alterations in prostate branching morphogenesis and cellular differentiation will result, a process referred to as neonatal imprinting or developmental estrogenization. These perturbations are associated with an increased incidence of prostatic lesions with aging, which include hyperplasia, inflammation, and dysplasia. To understand how early estrogenic exposures can permanently alter the prostate and predispose it to neoplasia, we examined the effects of estrogens on prostatic steroid receptors and key developmental genes. Transient and permanent alterations in prostatic AR, ERα, ERβ, and RARs are observed. We propose that estrogeninduced alterations in these critical transcription factors play a fundamental role in initiating prostatic growth and differentiation defects by shifting the prostate from an androgen-dominated gland to one whose development is regulated by estrogens and retinoids. This in turn leads to specific disruptions in the expression patterns of key prostatic developmental genes that normally dictate morphogenesis and differentiation. Specifically, we find transient reductions in Nkx3.1 and permanent reductions in Hoxb-13, which lead to differentiation defects particularly within the ventral lobe. Prolonged developmental expression of Bmp-4 contributes to hypomorphic growth throughout the prostatic complex. Reduced expression of Fgf 10 and Shh and their cognate receptors in the dorsolateral lobes leads to branching defects in those specific regions in response to neonatal estrogens. We hypothesize that these molecular changes initiated early in life predispose the prostate to the neoplastic state upon aging.

Free prostate-specific antigen (fPSA), the minor form of total PSA, contains different molecular subforms, including BPSA and proPSA. Whereas BPSA is associated with benign prostate hyperplasia, proPSA is associated with prostate tumor. The serum levels of PSA, fPSA and proPSA were measured using automated electrochemiluminescent immunoassays (Elecsys 2010, Roche Diagnostics) in 87 patients with prostate cancer and 138 patients with benign prostate hyperplasia. Also, we calculated the derived tests of these assays through the subtraction or the ratio between the measured tests. Receiver operating characteristics curves were used for comparison of the diagnostic utility of tests assessed. The biggest areas were obtained for the free/total PSA ratio (0.705), the calculated Bfree PSA/total PSA ratio (0.719) and the calculated Bfree PSA/bound PSA ratio (0. 726). Applying a multivariate logistic regression analysis, it was determined that the combination of the proPSA concentration, the ...

With the emergence of minimally invasive therapies for the management of symptoms of benign prostatic hyperplasia (BPH), as well as the reality of a changing medical economic environment, there is a need for a reliable local anesthesia protocol. The protocol described here for prostate anesthetic block is a safe, economical, and effective way to perform interstitial laser coagulation and other minor endoscopic urologic procedures in the office setting. Most patients experience little discomfort and recover quickly, with prompt return to normal activities. Urologists should be aware of and comfortable with these techniques.

The categorization of prostate cancers that are progressing after castration as ‘hormone-refractory’ evolved from the clinical observation that surgical or medical castration (i.e. androgen ablation therapy; AAT) is not curative and, despite an initial response, virtually all tumors eventually regrow. Successful AAT is contingent on the dependence of prostate cancer cells for androgen signaling through an intracellular mediator, the androgen receptor (AR) for survival. Current preclinical and clinical data imply that the AR is expressed and continues to mediate androgen signaling after failure of AAT. As AAT does not completely eliminate circulating androgens, sufficient concentrations of dihydrotestosterone may accumulate in tumor cells to maintain AR signaling, especially in the context of upregulated receptor levels or increased sensitivity of the AR for activation. In addition, ligands of non-testicular origin or ligand-independent activation can contribute to continued AR signa...

This paper proposes a methodological framework for standardizing surgeon experience in comparative studies of benign prostatic hyperplasia (BPH) surgical techniques. Recognizing the substantial variability in surgeon proficiency and its impact on outcomes, the study introduces a classification model that categorizes operators into beginner, intermediate, and expert levels based on their cumulative procedure volume. A comprehensive inventory of BPH surgical techniques, including transurethral, laserbased, and minimally invasive approaches, is presented, along with associated experience thresholds derived from the literature. The document also analyzes economic factors such as equipment costs and hospital stay durations and identifies key directly observable and indirectly evaluated parameters for assessing procedural outcomes. This standardization aims to mitigate confounding variables, enhance the validity and interpretability of comparative studies, and inform clinical practice.

The digital rectal examination (DRE) may be underutilized. We assessed the frequency of DREs among a variety of providers and explored factors affecting its performance and utilization. A total of 652 faculty, fellows, medical residents, and final-year medical students completed a questionnaire about their use of DREs. On average, 41 DREs per year were performed. The yearly number of examinations was associated with years of experience and specialty type. Patient refusal rates were lowest among gastroenterology (GI) faculty and highest among primary-care doctors. Refusal rates were negatively correlated with comfort level of the physician in performing a DRE. More gastroenterologists used sophisticated methods to detect anorectal conditions, and gastroenterologists were more confident in diagnosing them. Confidence in making a diagnosis with a DRE was strongly associated with the number of DREs performed annually. The higher frequencies of performing a DRE, lower refusal rate, degre...

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The main objective of this paper is to examine the psychometric properties of the Malay Version of the Hospital Anxiety and Depression Scale (HADS), tested on 67 husbands of the women who were diagnosed with breast cancer. The eligible husbands were retrieved from the Clinical Oncology Clinic at three hospitals in Kuala Lumpur, Malaysia. Data was collected at three weeks and ten weeks following surgery for breast cancer of their wives. The psychometric properties of the HADS were reported based on Cronbach' alpha, Intraclass Correlation Coefficients (ICC), Effect Size Index (ESI), sensitivity and discriminity of the scale. Internal consistency of the scale is excellent, with Cronbach's alpha of 0.88 for Anxiety subscale and 0.79 for Depression subscale. Test-retest Intraclass Correlation Coefficient (ICC) is 0.35 and 0.42 for Anxiety and Depression Subscale, respectively. Small mean differences were observed at test-retest measurement with ESI of 0.21 for Anxiety and 0.19 fo...

The prostate is a gland that surrounds the posterior urethra in man and, along with seminal vesicles, produces prostatic and seminal fluids. Prostatitis, benign prostatic hyperplasia (BPH), and prostate cancer are the most frequent pathologies of this gland. Zinc is an important element in the makeup of prostatic fluid and plays an important role in the immunology of the infectious and neoplastic pathologies of the prostate. The aim of this study was to determine zinc concentrations in prostatic fluid of patients with prostate pathologies and to use this measurement as a diagnostic parameter. Thirty patients with prostatic pathologies and ten healthy controls were studied. Prostatic fluid samples were collected using prostatic massage. Zinc concentration was determined using electrothermal atomizeratomic absorption spectrometry (ETA-AAS). The mean zinc concentrations obtained in the studied population were as follows: 11 patients with BPH: 15.087,78 micromol/dL, 10 patients with pro...

This study evaluated the phytochemical profile and mineral content of the n-hexane extract of Pyrenchantha staudtii Engl leaves, a plant used traditionally in herbal medicine in Okwagbe community, Ughelli South Local Government, Delta State, Nigeria. Phytochemical screening was conducted using standard qualitative methods, and mineral content was analyzed via atomic absorption spectrophotometry. The phytochemical analysis revealed the presence of alkaloids, glycosides, tannins, and proteins. Mineral analysis indicated magnesium as the most abundant element (270.01mg/kg), followed by potassium (25.73mg/kg), calcium (10.20mg/kg), copper (5.30mg/kg), and iron (2.10mg/kg), with zinc (0.02mg/kg) and manganese (0.90mg/kg) being the least abundant. Spectrochemical analysis showed strong ultraviolet/visible spectroscopy peaks at 300nm and 410nm with absorbances of 0.191 and 0.286, respectively, and infrared spectroscopy revealed peaks at 1700, 2910, 1350, 1450, and 1236. These findings suggest that the bioactive compounds in Pyrenchantha staudtii Engl support its potential use as an antiviral, anticancer, antidiabetic, and cardiovascular therapeutic agent, validating its ethnomedicinal applications.

Diagnosis of prostate cancer (PCa) is currently much reliant on the invasive and timeconsuming transrectal ultrasound-guided biopsy of the prostate gland, particularly in light of the inefficient use of prostate-specific antigen as its biomarker. In the present study, we have profiled the sera of patients with PCa and benign prostatic hyperplasia (BPH) using the gel-and lectin-based proteomics methods and demonstrated the significant differential expression of apolipoprotein AII, complement C3 beta chain fragment, inter-alpha-trypsin inhibitor heavy chain 4 fragment, transthyretin, alpha-1-antitrypsin, and high molecular weight kininogen (light chain) between the two groups of patients' samples. Our data are suggestive of the potential use of the serum proteins as complementary biomarkers to effectively discriminate PCa from BPH, although this requires further extensive validation on clinically representative populations.

To determine the lower urinary tract symptoms (LUTS) profile and factors affecting its degree of severity including cardiovascular risk profile, age, ethnicity, education level and prostate volume in a multiethnic Asian setting. We conducted a cross-sectional study of 1021 men aged 40-79 years with no clinical evidence of prostate cancer, prostate surgery or 5α-reductase inhibitor treatment of known prostate conditions. The severity of LUTS was assessed using the International Prostate Symptom Score (IPSS). Potential factors associated with LUTS including age, ethnicity, education, history of hypertension, diabetes and hypercholesterolemia, height, weight, and prostate volume were evaluated using univariable and multivariable analyses. There were 506 (50%) men found to have moderate-to-severe LUTS attaining an IPSS above 7. Overall, nocturia (45.5%) was the most frequently reported symptom. Multivariable analysis showed that age, ethnicity, prostate volume and history of hypertension and hypercholesterolemia were independent factors associated with severity of LUTS (p < 0.05). Considering individual lower urinary tract symptoms, we found a strong association of storage symptom with history of hypertension and hypercholesterolemia. Malay men were significantly bothered by post micturition symptom compared to their Chinese and Indian

Background and Objectives: The significant prevalence of Lower Urinary Tract Symptoms (LUTS), erectile dysfunction (ED), and associated adverse effects calls for increased attention in primary care settings. In Greece, there is a lack of sufficient data for LUTS and ED screening in primary care. Therefore, the aim of our study was to estimate the prevalence of LUTS and ED, identify associated risk factors, and evaluate their impact on quality of life among adult primary healthcare users aged 40 years and older in Crete, Greece. Materials and Methods: A cross-sectional study was conducted to explore the prevalence of LUTS and ED in 1746 primary health care users visiting rural primary health care practices in Crete, Greece. Participants underwent a comprehensive evaluation including demographic parameters, screening for LUTS utilizing the validated International Prostate Symptoms Score (IPSS) questionnaire and for ED using the International Index of Erectile Function (IIEF-5), in males, and for urinary incontinence in women with the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF). Participants with a prior diagnosis of LUTS or ED were excluded (n = 183). Results: Out of 536 participants finally included (n = 1746 screened), 32% of males and 36% of females exhibited moderate to severe LUTS. Following adjustments, we identified advanced age, retirement, and the presence of diabetes type 2 as factors associated with the occurrence of LUTS in men. Patients with LUTS also had a substantially increased likelihood of experiencing ED. Moreover, it was observed that women with hypertension or diabetes type 2 and lower education levels face an increased likelihood of developing LUTS, which adversely affects their quality of life. Conclusions: In conclusion, the findings of this study reveal a high occurrence of LUTS and ED in adults aged 40 years and older who utilize primary healthcare services, with a negative impact on their quality of life.

Background: Vitamin A and D are both fat-soluble vitamins that are crucial for maintaining overall health and are highly indispensable, despite their minimal daily requirements. Their involvement in cell proliferation, differentiation, and apoptosis has linked them to the development of various tumours, particularly those associated with an increased risk of benign prostatic hyperplasia (BPH) and cancer of the prostate (CAP). Objective: This study aims to assess the levels of vitamin A and D among adult men with BPH and prostate cancers attending the clinic at the Lagos University Teaching Hospital, to establish any form of relationship between these vitamins and the disease conditions. Methods: A total of one hundred thirty-eight consenting male subjects 50 years and above diagnosed with prostate enlargement (68) and prostate cancer (70) with Prostate Specific Antigen (PSA) above 4ng/ml and attended the urology clinic as well as healthy non-prostate diseased subjects' men (69) attending general clinic all at the Lagos University Teaching Hospital, Idi-araba were recruited for the study. A 5 mL venous blood sample was collected from subjects and controls, and the samples were dispensed into specimen containers to determine the total PSA and Vitamins A and D levels using the ELISA method. Data generated were subjected to statistical analysis using SPSS version 20 with the application of mean, student's test, one-way ANOVA and Pearson's correlation coefficient, adopting a p-value less than 0.05 (p<0.05) as statistically significant. Results: Vitamin D levels among individuals in the hyperplasia and prostate cancer group were significantly higher than those in the control subjects. In contrast, vitamin A levels showed no significant difference compared to the hyperplasia and prostate cancer group. Additionally, a positive correlation was observed between vitamin A and D, as well as between serum total PSA and both disease conditions. However, no correlation was found between the vitamins (A and D) and serum PSA in the control group. Conclusion: Maintaining normal serum vitamin A and D levels among males will not only help to reduce the risk or severity of prostate cancer but also be of great benefit to prostate health.

Background: Many types of tumors are organized in a hierarchy of heterogeneous cell populations with different molecular signature. Such heterogeneity may be associated with different responsiveness to microenvironment stimuli. In the present study, the effects of lipopolysaccharide (LPS) and lipoteichoic acid (LTA), as well-known mediators of inflammation, on cancerous behavior of three prostate tumor cells, LNCaP, PC3 and DU145, were investigated. Methods: Expression of TLR1-10, CD14 and MyD88 transcripts was investigated by RT-PCR. Protein expression of TLR2 and 4 was scrutinized by flow cytometry, immunofluorescent staining and Western blotting. Experiments were set up to assess the effects of LPS and LTA at different concentrations and times on cell proliferation, extracellular matrix invasion, adhesion and cytokine production. Results: We showed that prostate cancer cell lines differentially express TLR1-10, MyD88 and CD14 transcripts. DU145 failed to express TLR4 gene. Positively-identified TLR2 protein in all prostate cancer cells and TLR4 protein in PC3 and LNCaP by Western blotting was not accompanied by cell surface expression, as judged by flow cytometry. Immunofluorescent staining clearly demonstrated predominantly perinuclear localization of TLR2 and TLR4. LTA activation of all prostate cancer cells significantly increased cell proliferation. Regardless of lacking TLR4, DU145 cells proliferated in response to LPS treatment. While LPS caused increased invasiveness of LNCaP, invasive capacity of PC3 was significantly reduced after LPS or LTA stimulation. Stimulation of all prostate tumor cells with LTA was associated with increased cell adhesion and IL-8 production. IL-6 production, however, was differentially regulated by LPS stimulation in prostate tumor cells. The data shows that cancer cells originated from the same histologically origin exhibit heterogeneous response to the same TLR ligand. Therefore, a thorough and comprehensive judgment on how and to what extent a particular cancer is affected by TLR agonist could not be inferred by studying an individual cell line.

Arginase 2, inducible-and endothelial-nitric-oxide synthase (iNOS and eNOS), indoleamine 2,3dioxygenase (IDO) and TGF-beta, might impair immune functions in prostate cancer (PCA) patients. However, their expression was not comparatively analysed in PCA and benign prostatic hyperplasia (BPH). We evaluated the expression of these genes in PCA and BPH tissues. Seventy-six patients (42 BPH, 34 PCA) were enrolled. Arginase 2, eNOS and iNOS gene expression was similar in BPH and PCA tissues. TGF-beta1 gene expression was higher in BPH than in PCA tissues (p=0.035). IDO gene expression was more frequently detectable (p=0.00007) and quantitatively higher (p=0.00001) in PCA tissues than in BPH. IDO protein, expressed in endothelial cells from both BPH and PCA, was detectable in tumour cells in PCA showing evidence of high specific gene expression. In these patients, IDO gene expression correlated with kynurenine/tryptophan ratio in sera. Thus high expression of IDO gene is specifically detectable in PCA.

for the Complementary and Alternative Medicine for Urological Symptoms (CAMUS) Study Group B ENIGN PROSTATIC HYPERPLASIA (BPH) is a common cause of bothersome lower urinary tract symptoms (LUTS) among older men 1 and may be treated with medications, minimally invasive therapies, or surgery. Plant extracts are also widely used for LUTS in the United States and Europe. The most common are extracts of the fruit of the saw palmetto dwarf palm tree. In a 2007 US survey, 17.7% of adults reported use of a natural product in the last 30 days and 5.1% of users had taken saw palmetto 5 ; undoubtedly, the frequency would be higher among older men. A variety of mechanisms for saw pal-metto have been proposed including anti-androgenic, anti-inflammatory, and antiproliferative effects, but none have been conclusively proven.

Background Benign prostatic hyperplasia (BPH), a common condition among older men, confers its morbidity through potentially bothersome lower urinary tract symptoms. Treatments for BPH include drugs such as alpha-adrenergic receptor blockers and 5-alpha reductase inhibitors, minimally invasive therapies that use heat to damage or destroy prostate tissue, and surgery including transurethral resection of the prostate. Complementary and alternative medicines are gaining popularity in the US. Two phytotherapies commonly used for BPH are extracts of the fruit of Serenoa repens, the Saw palmetto dwarf palm that grows in the Southeastern US, and extracts of the bark of Pygeum africanum, the African plum tree. Purpose The objective of the Complementary and Alternative Medicines for Urological Symptoms (CAMUS) clinical trial is to determine if phytotherapy is superior to placebo in the treatment of BPH. Methods CAMUS was originally designed as a 3300-participant, four-arm trial of S. repens,...

Background: Postoperative urinary retention (POUR) is a common and serious problem faced during early postoperative period. Incidence varies between 4 to 70%. Post operative urinary retention can be treated by conservative methods like providing privacy to the patient, relaxation exercises and mobilization. If these measures fail, only then the patient should be catheterized as a last resort. Aim: To compare between in/out catheterization and overnight catheterization and determine which method is better. Methods: This randomized controlled trial was carried out on 130 patients who developed postoperative urinary retention after randomly dividing them in two groups. Group A included patients with in/out catheterization, and group B consist of patients undergoing overnight catheterization. Results: Mean age of patients was 33.70±4.6 years for group A and 38.45±3.3 years for group B. In group A (in/out catheterization) out of 65 patients, 18 required re-catheterization. But from group B, re-catheterization was done in 3 patients only.

Background: Benign prostatic hyperplasia (BPH) affects a significant number of men beyond the age of 40 years with its incidence reaching up to 90% in 80’s. Despite multiple treatment innovations, BPH still remains a nightmare for ageing men, mostly due to its distressing lower urinary tract symptoms (LUTS) and sexual dysfunction. The severity of LUTS is graded by international prostate symptom score or American urological association symptom index (AUA-SI) along with impact on quality of life (QOL). The objective of this study was to evaluate the efficacy of an Unani polyherbal formulation, Habb-i-muqil, in improving the AUA-SI and QOL in patients with BPH.Methods:In an open, standard controlled study, 76 men, diagnosed with clinical BPH, aged between 40 and 80 years were randomly allocated for treatment for duration of 90 days with Habb-i-muqil (test drug) or Tamsulosin (standard control) after ethical approval. AUA-SI and QOL were assessed at baseline (0 day) and days 15, 30, 45,...

Benign prostatic hyperplasia (BPH) is the most common disease in ageing men. It results in "lower urinary tract symptoms (LUTS)" or prostatism which is quite annoying to the individual, affecting his quality of life. Worldwide, prevalence of BPH ranges from 20% to 62% in men beyond 50 years of age with the economic cost worth billions of dollars. Despite multiple treatment innovations, BPH still remains a nightmare for the ageing men, mostly due to its distressing LUTS and sexual dysfunction. Notably, conventional treatments for BPH like 5a-reductase inhibitors and invasive surgery are associated with some obvious side effects. Conversely, evidences, though limited, have shown that alternative medicines are safer and have potential to improve the symptoms and quality of life in addition to improving sexual dysfunction in patients with BPH. The current article includes an overview of BPH, different ways of its management and particularly its appreciation in Greco-Arab (Unani) system of medicine, one of the alternative medicinal systems. In such a system of medicine, BPH, traced under the headings of Waram unuq al-math ana (bladder neck swelling) and Insid ad majr a-imath ana (bladder outlet obstruction), has been managed for centuries with herbal medicines yet demanding a comprehensive scientific validation. Among the herbs, Cucurbita pepo, Tribulus terrestris, Urtica dioica and Linum usitatissimum are worth mentioning. For achieving the goal of LUTS-free ageing men and safer and cost-effective future management of BPH, such medicine could hopefully prove beneficial.

Mesenchymal Stem Cells (MSCs) have been identified in prostate cancer, raising the critical question of their physical and temporal source. Therefore, MSCs were quantified and characterized in benign and malignant prostate tissue representing different disease states and a wide range of age groups from fetal development through adult death using analytical and functional methodologies. In contrast to lineage-restricted Mesenchymal Progenitor Cells (MPCs) found in normal prostate tissue, MSCs with tri-lineage differentiation potential (adipogenesis, osteogenesis, and chondrogenesis) are identified in prostate tissue from a subset of men with prostate cancer, consistent with an influx of more stem-like progenitors (i.e. MSCs) from the bone marrow. Additionally, prostate tissue from a subset of these patients is highly enriched in MSCs, suggesting their enumeration may have prognostic value for identifying men with aggressive disease. This influx is an ongoing process continuing throug...

During the last years, pharmaceutical innovations in primary care are dramatically less frequent and will be even more rare in the next future. In this context, preclinical and clinical research oriented their interest toward natural compounds efficacy and safety, supporting the development of a new “nutraceutical” science. Medicinal plants, in the form of plant parts or extracts of them, are commonly used for the treatment of prostate diseases such as benign hypertrophy, prostatitis and chronic pelvic pain syndrome. The pharmacological properties searched for the treatment of prostatic diseases are anti-androgenic, anti-estrogenic, antiproliferative, antioxidant and anti-inflammatory. The most studied and used medicinal plants are Serenoa repens, Pygeum africanum and Urtica dioica. Other promising plants are Cucurbita pepo, Epilobium spp, Lycopersum esculentum, Secale cereale, Roystonea regia, Vaccinium macrocarpon. In parallel, epidemiological studies demonstrated that diet may pl...

La hernie de Jean-Louis Petit constitue avec la hernie du quadrilatère de Grynfelt le groupe des hernies lombaires. Son diagnostic clinique est confirmé par la tomodensitométrie, et éventuellement l'échographie ou la radiographie. L'indication opératoire est formelle du fait de la tuméfaction ou de la gêne fonctionnelle, mais plus encore de l'étranglement toujours à craindre. Nous rapportons un cas rare de récidive de hernie primaire de Jean Louis Petit, chez un homme de 65 ans.

Castration reduces prostate size and causes intraprostatic testosterone (T) and dihydrotestosterone (DHT) to fall to very low levels. 5«-Reductase inhibition also reduces prostate size, but results in a marked increase in intraprostatic T levels. To compare the effects of 5a-reductase inhibition and castration on prostate physiology, male Sprague-Dawley rats were left intact, castrated, or given the selective 5a-reductase inhibitor finasteride for up to 9 days. To be sure that finasteride itself did not directly affect gene expression, an additional group of rats was castrated and given finasteride for 4 days. The prostates were weighed, intraprostatic RNA, DNA, and androgen levels were measured, and mRNAs for two androgen-regulated genes, prostate steroid-binding protein (PSBP; an androgen-induced gene) and testosterone-repressed prostate message (TRPM-2), were quantitated by Northern and slot blot analyses. Finasteride caused a 95% reduction in intraprostatic DHT levels and a 10-fold increase in intraprostatic T levels. Finasteride, as expected, caused a pronounced decrease in prostate weight (45% on day 4). DNA content fell correspondingly (48% on day 4). Intraprostatic DNA (micrograms of DNA per gland) on day 4 was 328 ± 53 in control rats, 171 ± 10 in finasteride-treated rats (P < 0.001 compared to controls), 115 ± 2 in castrated rats (P < 0.05 compared to finasteride), and 107 ± 43 in finasteride-treated plus castrated rats (P = NS compared to castration alone). There were no significant differences in DNA levels among the groups when expressed per mg prostate tissue, indicating that mean prostate cell size was unchanged. Castration decreased the average content of PSBP mRNA per cell by 85 ± 3% on day 4. Finasteride produced no decrease in relative PSBP mRNA expression on any day.

The tissue distribution, cellular localization, and level of expression of angiotensin II (Ang II) receptors were examined in the normal human prostate and benign prostatic hyperplasia (BPH) by in vitro autoradiography, immunohistochemistry, and radioligand binding studies. In the normal human prostate, Ang II receptors were of the AT 1 subtype and localized predominantly to periurethral stromal smooth muscle. The AT 1 receptor antagonist losartan totally displaced specific [ 125 I]-[Sar 1 ,Ile 8 ]Ang II binding, in a concentrationdependent manner, whereas the AT 2 receptor antagonist PD123319 was without effect. There was no significant difference in receptor affinity, but AT 1 receptor density was markedly reduced in BPH compared with that in normal prostate. In rat prostate, Ang II (0.01-1 Human prostate tissues were obtained from post-mortem subjects with no known history of ACE inhibitor or AT 1 receptor antagonist

The aim of this study was to conduct a randomized, double-blind and placebo-controlled study to investigate the effects of D-004, a lipid extract of the Roystonea regia fruit that prevents testosterone-and phenylepinephrineinduced prostate hyperplasia in rodents, on plasma oxidative markers in healthy men. We enrolled male volunteers (20-55 years) in good health and without lower urinary tract symptoms. Thirty-four eligible participants were randomized to placebo or D-004 (320 mg) capsules administered daily for 6 weeks. An interim check-up and a final visit were conducted after 3 and 6 weeks of therapy, respectively. Physical examinations were performed at each visit, and laboratory tests were performed at baseline and at treatment completion. Oxidative variables included plasma malondialdehyde (MDA), total hydroxyperoxides (TOH), sulphydryl (SH) groups and total antioxidant status (TAS). We assessed treatment compliance and addressed adverse experiences (AEs) at weeks 3 and 6. At week 6, with D-004, the mean reductions of plasma MDA (26.7%), TOH (18.8%) and SH groups (31.6%), and the mean increase of TAS (35.3%) were significantly different from those of placebo (P < 0.001 for plasma TAS, P < 0.0001 for all other comparisons). D-004 did not differ from the placebo in safety indicators. There were two withdrawals (both in the D-004 group), with one due to dyspepsia (the only AE during the trial). In conclusion, D-004 displayed antioxidant effects on plasma oxidative markers in healthy men, which was consistent with findings from laboratory experimental studies.

The pain associated with burn injuries is intense, unremitting and often exacerbated by anxiety, depression and other complicating patient factors. On top of this, modern burn care involves the repetitive performance -often on a daily basis for weeks to months -of painful and anxietyprovoking procedures that create additional treatment-related pain, such as wound care, dressing changes and rehabilitation activities. Pain management in burn patients is primarily achieved by

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Fourier transform infrared (FTIR) microspectroscopy has been applied to a study of prostate cancer cell lines derived from different metastatic sites and to tissue from benign prostate and Gleason‐graded malignant prostate tissue. Paraffin‐embedded tissue samples were analysed by FTIR, after mounting onto a BaF2 plate and subsequent removal of wax using Citroclear followed by acetone. Cell lines were analysed as aliquots of cell suspension held between two BaF2 plates. It was found that the ratio of peak areas at 1030 and 1080 cm−1, corresponding to the glycogen and phosphate vibrations respectively, suggests a potential method for the differentiation of benign from malignant cells. The use of this ratio in association with FTIR spectral imaging provides a basis for estimating areas of malignant tissue within defined regions of a specimen. Initial chemometric treatment of FTIR spectra, using the linear discriminant algorithm, demonstrates a promising method for the classification of...

This study aimed to investigate the scavenging effects of Annona Muricata (soursop) leaf extract against testosteroneinduced prostate hyperplasia in a rat model. A total of 78 adult male rats obtained from the laboratory animal production unit of the Department of Physiology, Abia State University, Uturu were used for the different segments of the study. Eighteen of the rats were used for acute toxicity/lethal dose evaluation of the extract while the remaining sixty (60) were used for the testosterone-induced hyperplasia study. Prostate hyperplasia was induced in the rats via daily sub-cutaneous administration of testosterone propionate (5 mg/kg body weight) for 28 days. Sixty rats used for this segment of the study were assigned to 6 groups of 10 rats and treated as follows: Group 1, Normal control, no treatment. Group 2 Testosterone propionate (5 mg/kg) only and was the BPH control. Group3, Testosterone propionate (5 mg/kg body weight) + Finesteride (3 mg/kg body weight). Group 4, Testosterone propionate (5 mg/kg body weight) + Annona Muricata Leaf extract (300 mg/kg body weight). Group 5, Testosterone propionate (5 mg/kg bw) + Annona Muricata Leaf extract (600 mg/kg body weight). Group 6, Annona Muricata Leaf extract (600 mg/kg bw) only. At the end of treatment, animals were sacrificed and blood samples were collected into EDTA and plain bottles for determination of enzymatic antioxidants on serum samples for superoxide dismutase (SOD), catalase, glutathione peroxidase, was determined while reduced glutathione and Malondialdehyde (MDA) was determined spectrophotometrically. The Statistical Package for Social Sciences (SPSS, Version 20.0, IBM SPSS Inc., Chicago, IL) was used to analyze the collected data. One-way analysis of variance (ANOVA) was used to determine the level of significance. Data were analyzed using Duncan Multiple Range Test and complemented with Student's t test for post-hoc test for comparisons of the means of the various doses and fractions. P-values less than 0.05 were considered statistically significantly different between the test and control groups as well as among test groups for measured value. From this present study, Annona muricata (soursop) leaf extract displayed a diverse phytochemical profile rich in vitamins and antioxidants, which likely contributed to its observed antioxidant properties and ability to mitigate oxidative stress. These antioxidative effects were crucial in preserving cellular integrity and mitigating pathological changes induced by testosterone.

Purpose: To evaluate the preferred position used by Brazilian Urologists to perform DRE, the position that Brazilian patients prefer or think it is less embarrassing to have a DRE, and to evaluate the results of DRE with patients in left lateral decubitus, modified lithotomy, standing-up, or the physician will have them place their elbows on the table and squat down slightly. Materials and Methods: Brazilian Urologists were contacted by e-mail, and 200 patients answered a questionnaire while undergoing prostate cancer screening. Results: The preferred position was modified lithotomy position reported by 63.4% of Urologists, and left lateral position reported by 42.7% of the patients. Total DRE time was lower in the standing-up position. Pain and urinary urgency scores were similar regardless of the position used, and bowel urgency score was higher in patients squatting down. Patients were similar in terms of age and PSA level, but there was a significant difference between the standard deviations of estimated prostate weight in left lateral position. There were no differences in prostate asymmetry, positive DRE, or incomplete palpation of the prostate rates among different examination positions. Conclusions: Despite individual subjective preferences, a faster examination time in the standing-up position, and higher bowel urgency scores in patients with their elbows placed on the table and squatting down slightly, there were similar rates of prostate asymmetry, positive DRE, and incomplete palpation of the prostate, and comparable patient tolerability among different examination techniques.

Most of the prostatic ductal adenocarcinomas of the prostate are characterized by cribriform and/or papillary architecture lined by columnar pseudostratified malignant epithelium. We report 28 cases of ductal adenocarcinomas on needle biopsy and transurethral resection of prostate closely resembling high-grade prostatic intraepithelial neoplasia (HGPIN) composed of simple glands with flat, tufting, or micropapillary architecture. The mean age of the patients was 68 years (range, 50 to 91 y). Prostate specific antigen serum level at diagnosis ranged from 1.2 to 12.1 ng/mL. Treatment included radical prostatectomy (n = 9), hormone therapy (n = 7), radiotherapy (n = 5), and cryotherapy (n = 1). Three patients had recent biopsies without information on treatment and 3 patients were lost to follow-up after diagnosis. The number of cores involved by tumor in each case ranged from 1 to 18, with more than 1 core involved in 13 cases. Flat was the most common pattern (42%), followed by tufted (41%), and micropapillary (17%) (some with more than 1 pattern). Fourteen cases revealed segments of dilated gland on the edge of the biopsies, suggesting a large gland component. In radical prostatectomies, tumor was primarily composed of small (25%), medium (17%), or cystically dilated (58%) cancer glands, with all cases demonstrating a mixture of different gland sizes. Cytologically, tumors were characterized by tall columnar atypical cells, basally located nuclei, and amphophilic cytoplasm. The tumors lacked marked pleomorphism, necrosis, solid areas, cribriform formation, or true papillary fronds. Immunohistochemically, a-methyl acyl coenzyme-A racemase staining was seen in 93% of cases, with the majority showing strong and diffuse staining. No basal cells were present on p63 and/or high molecular weight cytokeratin staining. In the radical prostatectomy specimens, tumor volumes ranged from a small focus (less than 0.01 cm 3 ) to 1.2 cm 3 . Concurrent conventional acinar Gleason score 6 adenocarcinomas were seen in 6 of the 9 radical prostatectomy cases, in all cases as separate nodules from the PIN-like ductal adenocarcinomas. Only one of the PIN-like ductal adenocarcinomas at radical prostatectomy had extraprostatic extension, which was focal. PIN-like ductal adenocarcinoma differs from HGPIN by the presence of cystically dilated glands, a

Résultats. -L'analyse de 501 évènements inhabituels rapportés au cours des dix dernières années a montré une diminution substantielle du nombre d'erreurs significatives observées. En tout, 57 % des évènements inhabituels ont été signalés par les manipulateurs en radiothérapie, y compris au cours de la préparation du traitement. La surveillance est censée être la cause la plus fréquente d'évènements inhabituels. Conclusion. -Cette étude sur dix ans de déclaration et de documentation d'évènements inhabituels a abouti à une culture de la sécurité où chaque individu est disposé à partager tout type d'incident avec un accès libre. Notre expérience à l'hôpital universitaire Aga Khan (AKUH) montre que la raison principale de la survenue d'incidents était la surveillance ; la majorité des évènements inhabituels a été signalée par des manipulateurs en radiothérapie, comme prévu, puisqu'ils gèrent l'essentiel du processus de planification des traitements.

The role of oxidative stress in prostate cancer has been increasingly recognised. Acute and chronic inflammations generate reactive oxygen species that result in damage to cellular structures. Haeme oxygenase-1 (HO-1) has cytoprotective effects against oxidative damage. We hypothesise that modulation of HO-1 expression may be involved in the process of prostate carcinogenesis and prostate cancer progression. We thus studied HO-1 expression and localisation in 85 samples of organ-confined primary prostate cancer obtained via radical prostatectomy (Gleason grades 4 -9) and in 39 specimens of benign prostatic hyperplasia (BPH). We assessed HO-1 expression by immunohistochemical staining. No significant difference was observed in the cytoplasmic positive reactivity among tumours (84%), non-neoplastic surrounding parenchyma (89%), or BPH samples (87%) (P ¼ 0.53). Haeme oxygenase-1 immunostaining was detected in the nuclei of prostate cancer cells in 55 of 85 (65%) patients but less often in nonneoplastic surrounding parenchyma (30 of 85, 35%) or in BPH (9 of 39, 23%) (Po0.0001). Immunocytochemical and western blot analysis showed HO-1 only in the cytoplasmic compartment of PC3 and LNCaP prostate cancer cell lines. Treatment with hemin, a well-known specific inducer of HO-1, led to clear nuclear localisation of HO-1 in both cell lines and highly induced HO-1 expression in both cellular compartments. These findings have demonstrated, for the first time, that HO-1 expression and nuclear localisation can define a new subgroup of prostate cancer primary tumours and that the modulation of HO-1 expression and its nuclear translocation could represent new avenues for therapy.

A total of89 patients in the age group of50-92 years having different histopathologically proven prostatic conditions were analysed with prostate specific antigen (PSA) and clinical co-relation undertaken. PSA levels were found to be significantly higher (p < 0.05) in 48 carcinoma prostate cases (mean 93.16 ± 50.75 nglml) as compared to 32 benign prostatic hyperplasia (mean 4.66 ± 3.85 nglml). Similarly, levels were considerably reduced in IS post-operative adenocarcinoma cases (mean 10.77 ± 9.65 nglml) as compared to their pre-operative samples (mean 93.16 ± 60.75 ng/ml). PSA levels were moderately higher in 9 cases of prostatitis (mean 13.28 ± 4.53 nglml). A very high degree of sensitivity, specificity and positive predictive value of PSA e.g. 95.8%, 75.6% and 82.2% respectively was found in adenocarcinoma cases, when levels of PSA were> 10 nglml. Thus it necessitates a detailed and thorough examination in such cases to come to final conclusion and early management of the cases.

Benign prostatic hyperplasia is a common disease of ageing men worldwide. Though transrectal ultrasonography (TRUS) is the standard in most parts of the world in evaluation of benign prostatic hyperplasia (BPH), it is rarely done in some less developed countries because of non availability of appropriate probes and or specialists. Transabdominal ultrasonography (TAUS) remains the mainstay in these areas. Some controversies still exist in literature about the accuracy of TAUS evaluation of prostatic volume in patients with BPH. This study aimed at comparing the transition zone volume estimation of the prostate on transrectal and transabdominal ultrasound with post-operative enucleated adenoma volume in Nigeria patients with BPH and to suggest better predictor of prostate volume in evaluation of BPH. Methods: Forty-six (46) patients with lower urinary tract symptoms due to BPH attending the urologic clinic were evaluated ultrasonographically and eventually managed with open surgery (prostatectomy) after due counselling. The post operative samples were weighted using a sensitive top loading weighing balance and converted to volume.Since the specific gravity of the prostate is equivalent to that of water,the weight is the same as volume. Results: Patients' ages ranged between 59 and 90 years with a peak age incidence at seventh decade. Transition Zone (TZ) volume estimation on both transrectal and transabdominal ultrasound showed positive correlation with the post operative enucleated adenoma(r=0.594, p<0.001) but the transrectal method was more accurate. There was no significant relationship between the TZ volume and patients' symptoms(r=0.491, p = 0.007). Both TRUS and TAUS are comparable at TZ volume estimation and therefore TAUS can be utilized in regions where intracavitary probes and or the expertise is/are not available.

This machine learning study aims to identify -prior to treatment -the patients who are not likely to respond to drug therapy -with α-blockers -of Benign Prostatic Hyperplasia (BPH). Medical records of 310 BPH patients are used. The data set is divided into two classes, namely positive and negative-response groups, with respect to the change in the patient's International Prostate Symptom Score (IPSS) after drug therapy. Age, IPSS, Prostate Volume, Post Void Residual Urine (PVR), Prostate Specific Antigen (PSA), free-PSA, and Creatinine are examined as baseline clinical factors, along with our novel synthetic features in order to propose a decision tree to classify a new patient. Our learning scheme, which uses synthetic variable generation and selection routines along with the C4.5 Decision Tree Algorithm correctly classifies 71.5% of patients, with sensitivity 71.3%, and specificity 71.6%. Synthetic variables do enhance its performance. Our prototypical classifier's success rate reveals that failure is predictable prior to medical treatment of BPH.

MicroRNAs have been demonstrated to be stably detectable in peripheral blood, thus representing important sources of non-invasive biomarkers of various diseases, including cancer. Recently, microRNA-18a (miR-18a) has been revealed to be highly expressed in prostate cancer (PC) tissues, acting as an oncogenic miRNA. The present study evaluated miR-18a expression in the peripheral blood of patients with PC, patients with benign prostatic hyperplasia (BPH), and healthy individuals, to assess the feasibility of using peripheral blood miR-18a as a potential non-invasive biomarker for PC. Total RNA was extracted from peripheral whole blood samples from 24 PC patients, 24 BPH patients and 23 healthy control individuals. The expression of miR-18a was assessed by reverse transcription quantitative polymerase chain reaction. The results revealed that miR-18a expression was significantly higher in PC patients than in BPH patients and healthy controls [fold change (mean ± standard deviation), 5.5±1.4 for PC, 1.5±0.5 for BPH and 1.2±0.6 for controls; P<0.005]. Higher miR-18a expression was strongly associated with PC [odds ratio (OR), 4.602; 95% confidence interval (CI), 2.194-9.654; P=0.001], but was not significantly associated with BPH (OR, 1.2; 95% CI, 0.7-2.02; P=0.332). Despite the small number of patients, which limits the statistical power of the study, higher miR-18a expression was observed to be significantly correlated with certain clinicopathological parameters, including Gleason score >7 and pathological tumor stage 3/4 (P<0.005). A receiver operating characteristic (ROC) analysis revealed that miR-18a discriminated PC patients from BPH patients and healthy controls [area under the curve (AUC), 0.805; 95% CI, 0.704-0.906). Furthermore, use of the ROC curve to discriminate PC from BPH patients yielded an AUC of 0.878 (95% CI, 0.783-0.972). In summary, the present results indicate that miR-18a expression is significantly increased in peripheral blood of patients with PC compared with that of BPH patients and healthy individuals, and that higher miR-18a expression is associated with progression of PC. Peripheral blood oncogenic miR-18a may serve as a potential novel non-invasive biomarker for PC that also facilitates discrimination between PC and BPH.

Introduction Prostatic cancer is a major contributor to mortality among men globally. Prostate-specific antigen (PSA) is a screening investigation for cancer of the prostate. The combination of serum PSA and digital rectal examination (DRE) allows early detection of prostate cancer. Studies have revealed that DRE causes an elevation in serum PSA levels. This rise following DRE may be mistaken for the rise associated with malignancy. Most clients in our setting come to the urology clinic as referrals from primary physicians when DRE has been done. There is a significant knowledge gap regarding whether the PSA change following DRE is significant enough to warrant withholding PSA measurement in these patients that come after having DRE; the reason this study was done. Methods This was a single centre prospective longitudinal study done at Ishaka Adventist hospital in which an interviewer administered questionnaire was filled for each patient that consented. After filling the questionna...