Benign Prostatic Hyperplasia Group Research Articles

Impact of diabetes mellitus on urinary continence after holmium laser enucleation of the prostate due to lower urinary tract symptoms: a retrospective study.

IntroductionDiabetes mellitus (DM) is known as a risk factor of stress urinary incontinence after Holmium laser enucleation of the prostate (HoLEP). We aimed to compare the postoperative continence status of patients with and without DM, after HoLEP surgery.Material and methodsA total of 214 patients who underwent HoLEP between January 2017 and January 2020 were retrospectively assessed. Functional outcomes, perioperative total operation time (TOT)(min), enucleation time (ET)(min), enucleation efficiency (EE)(g/min), enucleated tissue weight (ETW)(g), morcellation efficiency (ME)(g/min), morcellation time (MT)(min), continence status, intraoperative and postoperative complications according to Clavien–Dindo classification were recorded.ResultsA total of 96 patients had DM additional to benign prostate hyperplasia (BPH) (Group 1), while 118 patients had only benign prostate hyperplasia without DM (Group 2). When comparing preoperative and postoperative functional outcomes, a statistically significant improvement was observed in both groups from baseline to the 1st and 6th month follow-up (p ≤0.001). There were no statistically significant differences between groups in postoperative stress urinary incontinence at postoperative months 1 and 6 (1.7% vs 2.1%, p = 1 and 0.8% vs 1%, p = 1; respectively). There was no significant difference between groups in intraoperative and postoperative complications (p >0.05).ConclusionsHoLEP is safe to perform in patients with DM at low complication and urinary incontinence rates.

The diagnostic value of a new formula combining age and prostate volume in prostate cancer

Background and objective: This study combined two clinical indicators (age and prostate volume (PV)) to generate age to PV (AVR) ratio, whose diagnostic value for prostate cancer (PCa) was examined based on prostate specific antigen (PSA) in the range of 4--20.0 ng/mL. Methods: The medical records of patients who underwent transrectal ultrasound-guided biopsy of the prostate in our hospital from June 2015 to June 2019 were examined retrospectively. According to the pathological results of the biopsy, the patients were divided into the PCa and benign prostatic hyperplasia (BPH) groups. Receiver operating characteristic (ROC) curves for TPSA, PSAD, PV, (F/T)PSA, AVR, and PSA-AV were plotted with SPSS 26.0 and GraphPad Prism 5.0, and areas under the ROC curves (AUROCs) were determined and compared by Delong test. A log-linear model was used to compare AVR and other parameters with similar high sensitivities, for specificity. Results: The AUROC for AVR was significantly different from those of TPSA (p < 0.001), PV (p = 0.004),(F/T)PSA (p < 0.001), and PSA-AV (p = 0.006), and similar to that of PSAD (p = 0.064). With the same high sensitivity (90.0%), log-linear model analysis showed that the specificity of AVR was significantly higher than those of TPSA and (F/T)PSA (p < 0.01), while there were no significant differences among AVR and PSAD, PV and PSA-AV. Conclusion: With PSA in the range of 4--20.0 ng/mL, AVR may be useful in sparing an invasive intervention for a number of patients.

Evaluation of Matrix Metalloproteinase 2 and 9 Activity in Patients with Prostate Cancer and Benign Prostate Hyperplasia Compared with Healthy Individuals

Background and Aim: Prostate cancer (PC) is one of the most prevalent cancers with high mortality and morbidity in men, which can be treated in different ways before the progression and metastasis to distant organs. Destruction of extracellular matrix by matrix metalloproteinase (MMP), particularly by the 2 and 9 subtypes, has an important role in the metastasis of PC. We aimed to assess the activity of MMP 2 and 9 and some related metalloproteinases in PC and with benign prostate hyperplasia (BPH) patients in comparison to healthy individuals. Methods: In this case-control study, 72 individuals referred to Imam Khomeini hospital (Tehran, Iran), have been divided into 3 groups, including PC, BPH, and healthy control. Age and body mass index (BMI) for all groups have been matched. Venous blood samples were used to assess the enzyme activity by the zymography technique. Results: The activity of MMP-2 and 9 was significantly higher in PC than BPH and control groups. But there was no difference in the activity of enzymes in patients with PC according to the Gleason score. Conclusion: The results suggested that MMPs activity can be considered a diagnostic marker for PC. However, further studies are required to establish this concept. *Corresponding Author: Abbas Khonakdar-Tarsi; Email: a.khonakdar@mazums.ac.ir Please cite this article as: Shojaee M, Mohammadi P, Jafarpour H, Pouriamehr S, Barmaki H, Khonakdar-Tarsi A. Evaluation of Matrix Metalloproteinase 2 and 9 Activity in Patients with Prostate Cancer and Benign Prostate Hyperplasia Compared with Healthy Individuals. Arch Med Lab Sci. 2020;6:1-6(e12). https://doi.org/10.22037/amls.v6.32378

HALP score and albumin levels in men with prostate cancer and benign prostate hyperplasia.

To evaluate the diagnostic significance of the novel index combining preoperative haemoglobin, albumin levels, lymphocyte and platelet counts (HALP) in prostate cancer (PCa) patients. Between 1 January 2015 to 31 December 2018 at the Hitit University Erol Olçok Education and Research Hospital 225 patients who had undergone transrectal ultrasound guided prostate biopsy or prostate surgery were analysed retrospectively. A total of patients, 155 had benign prostate hyperplasia (group 1) and 70 had PCa (group 2). The preoperative serum levels of haemoglobin, albumin, lymphocyte counts and platelet counts were recorded. The HALP scores and the sub-parameters of this index for each of the two groups were compared. The total Prostate-Specific Antigen (PSA), albumin and lymphocyte differences between the groups were statistically significant (P= 0.0002, P= 0.0001, P= 0.005). The median value of HALP scores in Group 1 and 2 were 49.43 and 51.2, respectively, and this was not statistically significant between groups (P=0.737). The HALP score had the least Area Under Curve (AUC) value compared with the others (0.514). The AUC of Albumin was larger than PSA for diagnostic efficacy in PCa patients (0.696-0.656). However, albumin levels were statistically significant compared with platelet count and the HALP score (P= 0.0033, P= 0.0068), except PSA and lymphocyte (P= 0.4580, P=0.1717). Further prospective clinical studies that include more patients from multiple centres are needed to show the diagnostic role of the HALP score and its compounds on the patients with PCa.

Serum Levels of miR-223-3p and miR-223-5p in Prostate Diseases.

Prostate Cancer (PCa) is the second most common cancer in males and the fifth in cancer-associated mortality. Although the Prostate-Specific Antigen (PSA) test is widely used in PCa screenings, it has significant limitations in the differential diagnosis of PCa. Therefore, studies on developing new biomarkers for PCa diagnosis are ongoing. MiRNAs are good candidate biomarkers for the diagnosis of cancers, including prostate cancer, as they can be easily detected from circulation. In this study, it is aimed to determine the diagnostic value of serum levels of miR-223-3p and -223-5p in Benign Prostate Hyperplasia (BPH), Chronic Prostatitis (CP) and Prostate Cancer (PCa). Serum samples were collected from 68 patients in total (25 BPH, 10 CP, 33 PCa). MiR-223- 3p and -223-5p levels were measured in serum with qRT-PCR. The Ct values of miRNAs were normalized according to the Ct value of ce-miR-39 and calculated -ΔCt values were used for statistical analyses. The serum levels of miR-223-3p and -223-5p were downregulated in the PCa and CP groups, compared to the BPH group. There was no statistically significant difference between PCa and CP groups. The sensitivity and specificity of miR-223-3p, -223-5p and their combination were calculated as 88% and 88%; 86% and 79%; 93% and 92% in discriminating BPH and PCa groups, respectively. In this study, it was shown that miR-223-3p and -223-5p were both detectable in circulation. miR-223-3p, -223-5p, and their combination may be good candidate biomarkers for prostate cancer diagnosis. Also, observation of similar serum levels of miR-223-3p and -223-5p between CP and PCa groups suggests that miR-223 may play a role in prostate cancer development originated from chronic inflammation.

Cranberry Powder Attenuates Benign Prostatic Hyperplasia in Rats.

Cranberry powder (CR) is reported to be effective against lower urinary tract symptoms (LUTS) and recurrent urinary tract infections. Benign prostatic hyperplasia (BPH) in men older than 50 years is a common cause of LUTS. Here, we attempted to evaluate if CR is also effective for treating BPH using a BPH-induced rat model, which was orally administered CR. Male Sprague-Dawley rats weighing 200-250 g were randomly divided into the following six groups (n = 9): noncastration group; castration group; BPH group; BPH and cranberry for 8-week (CR8W) group; BPH and cranberry for 4-week (CR4W) group; and BPH and saw palmetto group (saw palmetto). Compared with the BPH group, the CR8W group showed a significant decrease in prostate weight (by 33%), dihydrotestosterone (DHT) levels (by 18% in serum and 28% in prostate), 5-alpha reductase levels (18% reduction of type 1 and 35% of type 2), and histological changes. These results indicate that CR could attenuate BPH by inhibiting 5-alpha reductase and by reducing other biomarkers such as prostate weight and DHT levels. Thus, CR may be an effective candidate for the development of a functional food for BPH treatment. IACUC (USW-IACUC-R-2015-004).

Modulation of complement activation by pentraxin-3 in prostate cancer

Pentraxin 3 (PTX3) is an essential component of the innate immune system and a recognized modulator of Complement cascade. The role of Complement system in the pathogenesis of prostate cancer has been largely underestimated. The aim of our study was to investigate the role of PTX3 as possible modulator of Complement activation in the development of this neoplasia. We performed a single center cohort study; from January 2017 through December 2018, serum and prostate tissue samples were obtained from 620 patients undergoing prostate biopsy. A group of patients with benign prostatic hyperplasia (BPH) underwent a second biopsy within 12–36 months demonstrating the presence of a prostate cancer (Group A, n = 40) or confirming the diagnosis of BPH (Group B, N = 40). We measured tissue PTX3 protein expression together with complement activation by confocal microscopy in the first and second biopsy in group A and B patients. We confirmed that that PTX3 tissue expression in the first biopsy was increased in group A compared to group B patients. C1q deposits were extensively present in group A patients co-localizing and significantly correlating with PTX3 deposits; on the contrary, C1q/PTX3 deposits were negative in group B. Moreover, we found a significantly increased expression of C3a and C5a receptors within resident cells in group A patient. Interestingly, C1q/PTX3 deposits were not associated with activation of the terminal Complement complex C5b-9; moreover, we found a significant increase of Complement inhibitor CD59 in cancer tissue. Our data indicate that PTX3 might play a significant pathogenic role in the development of this neoplasia through recruitment of the early components of Complement cascade with hampered activation of terminal Complement pathway associated with the upregulation of CD59. This alteration might lead to the PTX3-mediated promotion of cellular proliferation, angiogenesis and insensitivity to apoptosis possible leading to cancer cell invasion and migration.

Possible role of the receptor of advanced glycation end products (RAGE) in the clinical course of prostate neoplasia in patients with and without type 2 diabetes mellitus.

The expression of the cognate receptor of advanced glycation end products (RAGE) in malignant tissues of patients with type 2 diabetes has been suggested as a co-factor determining the clinical course and prognosis. We aimed to investigate the relationship between RAGE expression and clinicopathological features of prostate neoplasia. Tissue samples of 197 patients, 64 (24 patients with type 2 diabetes and 40 controls) with benign prostate hyperplasia (BPH) and 133 (71 patients with type 2 diabetes and 62 controls) with localised or metastatic prostate cancer (LPCa/MetPCa) were included in the study. The expression of RAGE in prostate specimens was studied immunohistochemically. RAGE scores were determined according to the extent of immunoreactivity and staining intensity. RAGE expression in BPH group (patients with type 2 diabetes and controls) was negative. Patients with both LPCa and MetPCa had significantly higher scores than those with BPH (P < .001). The mean RAGE scores of patients with type 2 diabetes LPCa and MetPCa were 4.71±3.14 and 4.97±3.69. The mean scores of control LPCa and MetPCa were 1.52±1.87 and 1.69±1.58, respectively. The scores of patients with type 2 diabetes LPCa and MetPCa were significantly higher than those of control LPCa and MetPCa (P = .01 and P < .001, respectively). We found higher RAGE expression levels in malignant prostate neoplasia than in BPH. As expected, patients with diabetes had higher scores than control patients. Disease progression and survival parameters were worse in patients with high RAGE levels. RAGE expression may be a useful biomarker for the diagnosis and prognosis of prostate cancer.

Reproductive and endocrinological effects of Benign Prostatic Hyperplasia and finasteride therapy in dogs

Benign prostatic hyperplasia (BPH) is one of the most important reproductive disorders in aging dogs. Therapeutic measures include orchiectomy and pharmacological treatment, leading to reduction of prostate volume and clinical signs. One of the most common drugs used in BPH treatment is finasteride, but data regarding its possible side effects are scarce. Thus, the aim of this study was to evaluate the effects of BPH and short-term (2 months) finasteride therapy on clinical, endocrinological, and reproductive parameters in dogs. Dogs were allocated into four experimental groups: Non-affected (n = 5), BPH (n = 5), Non-Affected-Finasteride (n = 5) and BPH-Finasteride (n = 5) groups. Dogs were evaluated monthly during 2 months by a complete breeding soundness examination, B-mode ultrasound and Doppler ultrasonography of the testicular artery, hormonal profile (testosterone, estrogen and dihydrotestosterone) and oxidative profile of the prostatic fluid. After 2 months, dogs were gonadectomized and testicles were subjected to histologic analysis. Finasteride treatment reduced dihydrotestosterone concentrations, without negative influence on semen quality and also reverted testicular hemodynamics changes of BPH. On the other hand, BPH was accompanied by significant changes in testosterone and estrogen concentrations and semen quality, mainly related to sperm kinetics alterations. In conclusion, BPH dogs have important hormonal and sperm alterations, however, short-term finasteride treatment (2 months) was able to reduce overall effects of BPH, thus representing a method of therapy for BPH treatment.

Identification of plasma lipid species as promising diagnostic markers for prostate cancer

BackgroundProstate cancer is a very common and highly fatal in men. Current non-invasive detection methods like serum biomarker are unsatisfactory. Biomarkers with high accuracy for diagnostic of prostate cancer are urgently needed. Many lipid species have been found related to various cancers. The purpose of our study is to explore the diagnostic value of lipids for prostate cancer.ResultsUsing triple quadruple liquid chromatography electrospray ionization tandem mass spectrometry, we performed lipidomics profiling of 367 lipids on a total 114 plasma samples from 30 patients with prostate cancer, 38 patients with benign prostatic hyperplasia (BPH), and 46 male healthy controls to evaluate the lipids as potential biomarkers in the diagnosis of prostate cancer. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway database was used to construct the potential mechanism pathway. After statistical analysis, five lipids were identified as a panel of potential biomarkers for the detection of prostate cancer between prostate cancer group and the BPH group; the sensitivity, specificity, and area under curve (AUC) of the combination of these five lipids were 73.3, 81.6%, and 0.800, respectively. We also identified another panel of five lipids in distinguishing between prostate cancer group and the control group with predictive values of sensitivity at 76.7%, specificity at 80.4%, and AUC at 0.836, respectively. The glycerophospholipid metabolism pathway of the selected lipids was considered as the target pathway.ConclusionsOur study indicated that the identified plasma lipid biomarkers have potential in the diagnosis of prostate cancer.

Abstract 5591: Differential profiles of pro-inflammatory chemokines identified in patients with prostate cancer and benign prostatic hyperplasia

Abstract Background: Prostate cancer (PCa) is the most frequently diagnosed malignant disease and the second leading cause of cancer-related deaths of men in the United States. The development of PCa has been linked to inflammation; thus, systemic inflammatory biomarkers may be useful to differentiate PCa from other prostatic disorders, such as benign prostatic hyperplasia (BPH). Proinflammatory chemokines are among the factors that regulate inflammatory processes through the recruitment of leukocytes to the sites of infection or injury. The aim of the present study was to compare the serum profiles of pro-inflammatory chemokines of patients newly diagnosed either with PCa or BPH. Methods: Serum was prepared from blood samples collected at the time of diagnosis from a cohort of patients newly diagnosed with PCa or BPH. Protein concentrations of chemokines were measured in each group of samples with a multiplex ELISA kit specific for the quantification of 12 proinflammatory chemokines: CCL2, CCL3, CCL4, CCL5, CCL11, CCL17, CCL22, CXCL1, CXCL8, CXCL9, CXCL10 and CXCL11. Results were further validated for selected chemokines using single analyte ELISA kits. This work was approved by the Institutional Review Board of the University of Cartagena. Results: Our study showed that PCa patients had a significantly different proinflammatory chemokine profile compared to BPH patients. Serum samples in the PCa group had significant higher levels of CXCL8, CCL2, CCL3, CCL4, CXCL11 and CXCL1 compared with the BPH group. Conclusion: Our study showed that PCa patients had a high proinflammatory chemokine profile. Additional studies are required to determine whether proinflammatory chemokine profiles can serve as a diagnostic signature to differentiate between PCa and BPH, and whether proinflammatory chemokine profiles are correlated with clinical outcomes of PCa patients. Keywords: Prostate cancer, chemokine, inflammation, Benign Prostatic Hyperplasia Citation Format: Niradiz Reyes, Raj Tiwari, Jan Geliebter. Differential profiles of pro-inflammatory chemokines identified in patients with prostate cancer and benign prostatic hyperplasia [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5591.

Quisqualis indica extract ameliorates low urinary tract symptoms in testosterone propionate-induced benign prostatic hyperplasia rats

Benign prostate hyperplasia (BPH) is a common disease in old-age males, accounting for approximately 77% of morbidity within the age range of 40 to 70 years. It has been shown that morbidity increases with social graying. Quisqualis indica linn (QI) has been used to treat inflammation, stomach pain, and digestion problems. In this study, we evaluated the symptom-regulating effects of QI extract on a testosterone-induced BPH rat model. After inducing BPH in rats using testosterone propionate (TP) injection, we assessed basal intraurethral pressure (IUP) and increments of IUP elicited by electrical field stimulation (5 V, 5, 10, or 20 Hz) or phenylephrine (Phe) (0.01, 0.03, 0.1 mg/kg IV). To induce BPH, 8-week-old rats were subjected to a daily subcutaneous TP (3 mg/kg) injection for 4 weeks. Finasteride (Fina) (10 mg/kg PO) was administered to the rats in the first treatment, while QI (150 mg/kg PO) was administered to those in the second group. Blood pressure was measured together with IUP, after which low urinary tract (LUT), ventral prostate (VP), testicle, and corpus spongiosum were isolated and weighed. Basal IUPs for the Fina- and QI-treated groups were 87.6 and 86.8%, respectively.LUT and VP organ weights in the QI group were lower than those in the Fina group. However, the QI group showed significantly reduced electrical stimulated or Phe-induced IUP increment compared to the Fina and BPH groups. These results proved that QI can be beneficial for BPH symptoms by inhibiting 5α-reductase and consequently decreasing prostate and releasing urinary pressure.

The Value of Prostate-Specific Antigen-Related Indexes and Imaging Screening in the Diagnosis of Prostate Cancer.

ObjectiveThe aim of this study was to explore the value of the prostate-specific antigen (PSA) levels, the ratio of free PSA to total PSA (fPSA/TPSA), the PSA density (PSAD), digital rectal examination (DRE), transrectal prostate ultrasound (TRUS), and multiparameter MRI (MP-MRI) in the differential diagnosis of benign prostatic hyperplasia (BPH) and prostate cancer (PCa).MethodsFrom February 2016 to September 2019, data from 620 patients who underwent systematic transrectal ultrasound-guided prostate biopsy (STURS-PB) in our hospital were retrospectively collected, including the PSA levels, the fPSA/TPSA ratio, the PSAD, DRE, TRUS, MP-MRI, prostate volume, and other clinical data.ResultsAmong the 620 patients, 249 patients were in the PCa group, and 371 patients in the BPH group. The positive puncture rate was 40.16%. The positive predictive values of DRE, TRUS, mpMRI, and TPSA levels for PCa were 39.91%, 39.38%, 64.14%, and 41.57%, respectively; the sensitivity of these parameters was 37.35%, 51.41%, 74.69%, and 57.43%, respectively; and the specificity of these parameters was 62.26%, 46.90%, 71.97%, and 45.82%, respectively. When the TPSA concentration was in the range of 4–20 ng/mL, the positive puncture rate of STURS-PB was 23.18%, with a high rate of misdiagnosis. When the TPSA concentration was in the range of 4–20 ng/mL, the fPSA/TPSA ratio was 0.15, the PSAD was 0.16, the comprehensive evaluation of PCa was optimal (the sensitivity of these parameters was 88.85% and 84.09%, respectively; the specificity was 80.17% and 67.29%, respectively; the positive predictive value was 57.41% and 51.39%, respectively). When the TPSA concentration >4 ng/mL, the fPSA/TPSA ratio ≤0.15 and the PSAD ≥0.16, the sensitivity, specificity, and correctness index of the PCa and BPH diagnosis were 80.54%, 82.75%, and 67.07%, respectively.ConclusionWhen using DRE, TRUS, and MP-MRI to screen for PCa, MP-MRI has a relatively high sensitivity and specificity. Using these three thresholds (TPSA >4 ng/mL combined with an fPSA/TPSA ratio ≤0.15 and a PSAD ≥0.16) is significantly better than using TPSA levels alone for the differential diagnosis of PCa and BPH.

Role of p-ERK1/2 in Benign Prostatic Hyperplasia during Hyperinsulinemia.

Using a rat model of hyperinsulinemia, the present study investigated the role of p-ERK1/2 in benign prostatic hyperplasia (BPH). Forty male Sprague-Dawley rats were randomly selected and assigned to four groups: high fat diet (HFD)+BPH (n=10), HFD (n=10), BPH (n=10), and control (n=10) groups. Hyperinsulinemia was induced by HFD feeding, while BPH was induced using testosterone propionate. Plasma glucose, plasma insulin and bodyweight were examined weekly. Immunohistochemistry (IHC) and western blot analysis were used to analyze the expression of ERK1/2 and p-ERK1/2 in rat prostates. Plasma glucose and plasma insulin levels were significantly greater in the HFD+BPH and HFD groups, when compared to the other two groups (P<0.05). Prostate weights were significantly greater in the HFD+BPH, HFD and BPH groups, than in the control group (P<0.05). IHC and western blot analysis revealed that p-ERK1/2 expression was greater in the HFD+BPH group than in the other three groups (P<0.05). Androgens plus a hyperinsulinemic condition induced by HFD can result in prostatic cell hyperplasia, and this mechanism may be correlated to the upregulation of p-ERK1/2. Further investigations of this possibility are required.

Evaluation of the plasma level of long non-coding RNA PCAT1 in prostatic hyperplasia and newly diagnosed prostate cancer patients.

Prostate cancer (PCa) is generally detected by prostate-specific antigen (PSA) as one of the most widely applied tumor markers over decades for its high sensitivity. Nevertheless, it causes overtreatment or an unnecessary biopsy because of its limited specificity. PCa-associated ncRNA transcript 1 (PCAT1), the newly identified long non-coding RNA (lncRNA) has been reported to associate with the progress of PCa. In vitro studies proposed that PCAT-1 may be an appealing candidate for diagnostic accuracy improvement with regard to its notable overexpression in PCa cells. The present study aimed to evaluate the diagnostic potential of the plasma PCAT1 expression levels in PCa patients in comparison to benign prostatic hyperplasia (BPH) patients and healthy controls. The plasma lncRNA PCAT1 level was measured by a real-time quantitative reverse transcriptase-polymerase chain reaction in 40 men newly diagnosed with PCa, 20 patients with BPH and 20 healthy subjects. The results were analyzed statistically using SPSS, version 25 (IBM Corp., Armonk, NY, USA). The expression of PCAT1 was significantly higher in healthy subjects compared to BPH patients (p = 0.03). The diagnostic accuracy of the plasma lncRNA PCAT-1 for discrimination of the healthy subjects than BPH patients was reasonable (area under the receiver operating characteristic curve = 0.799; sensitivity = 71%; specificity = 74%; negative predictive value = 74%; positive predictive value = 71%). It appears that the plasma levels of PCAT1 expression have reasonable diagnostic accuracy for the discrimination of healthy individuals compared to those with BPH, although no significant difference of PCAT1 expression levels was observed in comparisons between the PCa with BPH and normal groups.

Evaluation of Voiding Position on Uroflowmetry Parameters and Post Void Residual Urine in Patients With Benign Prostatic Hyperplasia and Healthy Men

Uncertainty remains whether it is best for men to void in a sitting or standing position. The objective of this study is to evaluate the effect of standing and sitting voiding position on uroflowmetry parameters and post void residual urine (PVRU) in patients with lower urinary tract symptoms (LUTS) due to benign prostate hyperplasia (BPH) and healthy men. A total of 116 participants with BPH (Group 1) and 78 healthy men (Group 2) were enrolled in the study. The uroflowmetry parameters were measured in both positions. The PVRU volume was measured using transabdominal ultrasound after each voiding. Uroflowmetry parameters and PVRU were measured and compared between the two different voiding positions using Wilcoxon signed rank test. In Group 1, there were significant statistical differences in uroflowmetry parameters between standing and sitting voiding position. The median of maximum flow rate in Group 1 in standing and sitting position was 14.7 ml/s (IQR; 11.7–17.5) and 11 ml/s (IQR; 8.9–13.3), respectively (p < .0001). The median voided volume at standing position was 340 ml (IQR; 276–455) while it was 267 ml (IQR; 194–390) at sitting position (p < .0001). Median average flow rate in standing position was 5.9 ml/s (IQR; 4.5–7.5) and 5 ml (IQR; 3.2–6.4) in sitting position. There was a statistically significant difference between the median of PVRU in standing and sitting position (p < .0001). In patients with BPH, voiding in standing position showed better uroflowmetry parameters and significant less PVRU volume.

The auxiliary diagnostic value of prostate-specific antigen and α-methylacyl-CoA racemase in prostate cancer.

Prostate cancer (PCa) is one of the most common types of malignant tumor, which places a major burden on the health of men, worldwide. A prerequisite to ensure good treatment outcomes for patients with PCa is an accurate diagnosis. The present study aimed to investigate the diagnostic value of prostate-specific antigen (PSA) and α-methylacyl-CoA racemase (P504S) in PCa, using the tumor-associated immunolabels. In total, clinical data was collected from 125 patients undergoing prostate biopsy or surgery between January 2015 and September 2019, and stratified into: PCa (45), benign prostatic hyperplasia (BPH) (60) and unconfirmed diagnosis (20). Immunohistochemistry analysis was performed to assess PSA and P504S expression levels in each group compared with that in the controls (the normal tissue in each group was the internal control). The results demonstrated that the expression level of P504S was significantly higher in the PCa group compared with that in the BPH group. Furthermore, no significant association was observed in the PCa group between PSA and P504S expression levels, and the Gleason grading groups. A total of 20 unconfirmed diagnoses was verified via PSA/P504S. Taken together, the results suggest that combination PSA and P504S have a positive effect in identifying prostate cancer. However, PSA and P504S still have limitations in their diagnosis and the final results need to be carefully and comprehensively analyzed, thus further studies are required to determine their diagnostic values.

Circulating miRNAs as Biomarkers for Prostate Cancer Diagnosis in Subjects with Benign Prostatic Hyperplasia.

Body fluids often contain freely circulating nucleic acids, many of which can be exploited as noninvasive tools for the diagnosis of cancer as well as for clinical prognostication. Identifying microRNAs (miRNAs) in subjects' blood with various malignancies means that they can serve as novel biomarkers for prostate cancer (PCa) diagnosis. This study analyzed serum-circulating miRNAs as a noninvasive biomarker in subjects with PCa and subjects with benign prostatic hyperplasia (BPH). In total, 31 PCa subjects and 31 BPH subjects were included, with the BPH group serving as the control group. RT-qPCR was used to quantify the levels of 10 miRNAs, which included miR-18a, miR-34a, miR-106b, miR-183, miR-200a, miR-301a, miR-141, miR-182, miR-200b, and miR-375 in serum. Statistical tests were used to assess the relationship between the levels of miRNAs and the clinicopathological data. A significant increase was observed in the relative expression ratios of miR-141, miR-182, miR-200b, and miR-375 (1.89-, 2.09-, 2.41-, and 2.27-folds, respectively) in the PCa group when compared to the BPH group. Based on the receiver operating characteristic (ROC) analysis, the largest area under the curve (AUC), 0.923, was associated with the miR-200b group, indicating effective diagnostic properties for this biomarker. A correlation was observed between total prostate-specific antigen (TPSA) and the relative levels of miR-141, miR-182, miR-200b, and miR-375. The Gleason score and the miR-200b expression level were also correlated. These results are consistent with previous studies regarding the possibility of differentiating between PCa subjects and healthy controls based on the detection of miRNA. The findings attest to a distinctive expression profile of miRNA that is detectable in the blood of PCa subjects, thereby confirming the role of miRNAs as diagnostic biomarkers for PCa.

Serum omentin-1 level in patients with benign prostatic hyperplasia

BackgroudTo evaluate the relationship between omentin-1 and benign prostatic hyperplasia (BPH). BPH is the most common urological disease in elderly men worldwide. Lower serum omentin-1 levels were reported to be negatively associated with the incidence of inflammation, diabetes, obesity and metabolic syndrome, which all play a role in the development of BPH. To the best of our knowledge, the relationship between omentin-1 and BPH has not been investigated previously.MethodsA total of 70 males participated in this study, including forty patients diagnosed with BPH and thirty healthy males. The anthropometric measurements and the biochemical parameters were measured in this study. We evaluated serum omentin-1 levels and the correlation with those data. We also test the gene expression of IL-8, IL-18 in BPH group using the TURP tissues.ResultsThe serum omentin-1 levels were lower in the BPH patients than in the control group (27.95 ± 4.18 versus 32.03 ± 5.46, p < 0.001). The general characteristics and biochemical parameters were investigated, and a negative correlation was found between serum omentin-1 levels and BMI in the BPH group (r = − 0.391, p = 0.013) as well as the whole group (r = − 0.457, p < 0.001). Multiple-factor binary regression analysis revealed that serum omentin-1was a protective factor of BPH development. Furthermore, lower serum omentin-1 levels were associated with higher mRNA expression of IL-8 or IL-18 in the BPH group.ConclusionOmentin-1 may suppress the development of BPH and Lower serum omentin-1 levels in BPH patients might associated with higher prostate volume and higher IL-8 and IL-18 expression levels in their prostatic cells.

Is Benign Prostatic Hyperplasia a Perpetrator for Periprosthetic Joint Infection?: Commentary on an article by Hamidreza Yazdi, MD, et al.: "Symptomatic Benign Prostatic Hyperplasia. A Risk Factor for Periprosthetic Joint Infection in Male Patients".

Commentary In the current era, total joint arthroplasty (TJA) is considered to be safe and cost-effective and a successful procedure to improve quality of life. However, a periprosthetic joint infection (PJI) is a huge setback to the patient, family, and surgeon alike. Although the overall incidence of PJI following TJA is low, there is high morbidity (persistent pain, prolonged hospital stay, multiple surgical procedures, functional loss) and even mortality associated with PJI. Over the last couple of decades, several hundred studies have been done on the prevention, diagnosis, treatment, and outcomes of PJI. We are certainly making progress by lowering the incidence of infection, but the search for causes is relentless. In the current study, Yazdi et al. performed a retrospective study to explore another potential cause for PJI: benign prostatic hyperplasia (BPH) in male patients. Anecdotally, I have also observed BPH to be a potential cause for PJI, given that my current practice is dominated by male patients. Yazdi et al. reviewed 12,902 patients from their institution registry database and grouped them into symptomatic and non-symptomatic BPH groups. They further matched patients with symptomatic BPH (n = 250) with a non-symptomatic BPH control group in a 1:3 ratio. The PJI rate was 7.9% in the symptomatic group compared with 2.8% in the control group. Multivariate regression analysis in unmatched groups showed that symptomatic BPH was a strong independent risk factor for PJI. Symptomatic BPH remained a significant risk factor for PJI after matching for variables related to outcomes. Yazdi et al. concluded that symptomatic BPH might be a reason for the high incidence of PJI in male patients. Interestingly, in the current study, multivariate analysis also showed that symptomatic BPH carried a risk higher than even diabetes mellitus for PJI. Another interesting finding in the current study is that symptomatic BPH showed a higher trend toward acute PJI. However, there is no obvious pathomechanism as to why BPH could cause PJI. It is hypothesized that the collection of excess urine in the bladder in the perioperative period or high post-void residual urine in patients with symptomatic BPH increases the bacterial load, subsequently potentiating the spread of the infection to the newly implanted joint prosthesis. With the current trend of patients undergoing fast-track TJA under spinal anesthesia, the incidence of postoperative urinary retention is on the rise1. The incidence of postoperative urinary retention may even be higher with symptomatic BPH and may potentially increase the risk of PJI, especially if BPH is not treated before the surgical procedure. Similarly, the current trend of multimodal perioperative pain management for TJA includes a scopolamine (anticholinergic) patch, given its ease of use and successful avoidance of postoperative nausea and vomiting2. In patients with symptomatic BPH, scopolamine might further increase BPH-related urinary retention or post-void residual urine and subsequent risk of PJI. This preliminary study identifies BPH as a potential cause for PJI in male patients. The study had several limitations: it was a retrospective study, there were potential concerns with regard to the data collection method, the duration of follow-up was 1 year, and there were no explicit data on catheterization done in the perioperative period. There are several strengths to this study as well. The Rothman Institute has a reputation for good patient follow-up with low dropout rates, this is a single-institution study, and there was a matched-cohort study design to minimize the effect of confounding variables. For these reasons, I consider this a well-conducted outcome study. The total number of TJAs performed annually has been on an upward trend globally. It is expected to reach 4 million annually by 2030 in the United States3 alone, in contrast to about 1 million per year currently. Any and every step to reduce the incidence of PJI is worth taking into consideration considering the economic and individual patient burden of treating a PJI. Kee et al. demonstrated that nearly half of all patients undergoing early revision arthroplasties had at least 1 modifiable risk factor and emphasized proper patient selection and preoperative optimization of modifiable risk factors to minimize the risk of adverse outcomes following TJA4, but BPH was not a part of the study. It would be worthwhile to also include symptomatic BPH as a modifiable risk factor and to preoperatively optimize patients to reduce PJI. This study by Yazdi et al. will serve as a great precursor for further multicenter, larger population-based studies to assess any regional or geographical biases and confounding factors.