Benign Prostate Research Articles

Canagliflozin alleviates experimentally induced benign prostate hyperplasia in a rat model: exploring potential mechanisms involving mir-128b/EGFR/EGF and JAK2/STAT3 signaling pathways through in silico and in vivo investigations

Benign prostatic hyperplasia (BPH) poses a significant health concern amongst elderly males. Canagliflozin (Cana), a selective sodium-glucose co-transporter 2 (SGLT2) inhibitor, has a powerful anti-inflammatory influence. Nevertheless, its role in treating BPH has not been clarified. Therefore, the study aimed to investigate the potential ameliorative effect of Cana on experimentally induced BPH in rats and explore the underlying mechanisms compared to the standard finasteride (Fin). The study employed histological analysis, biochemical assays using ELISA, and western blotting. Animals were categorized into four groups: Control (2.5 ml/kg CMC, orally + 3 ml/kg olive oil, subcutaneous), BPH (3 mg/kg testosterone, subcutaneous + CMC orally), Fin-treated BPH (5 mg/kg, orally), and Cana-treated BPH (5 mg/kg, orally), for 28 days. The BPH group showed obvious BPH manifestations including an increase in prostate weight (PW), prostate index (PI), dihydrotestosterone (DHT) level, and histological aberrations compared to control. Fin and Cana therapy had a comparable impact. Cana treatment significantly reduced PW and PI, besides it improved prostatic biochemical, and histopathological features compared to BPH, consistent with in silico study findings. Cana was associated with downregulation of the androgen axis, increased miR-128b expression, with a lowered expression of epidermal growth factor (EGF) and its receptor. Phosphorylation of STAT3 and its downstream proliferative markers were significantly reduced suggesting apoptotic activity. Cana markedly rescued the BPH-induced upregulation of IL-1β, and iNOS levels. Altogether, the current study demonstrates that Cana could impede BPH progression, possibly by modulating miR-128b/EGFR/EGF and JAK2/STAT3 pathways and downregulating AR, cyclin D1, and PCNA immunoreactivity.

Benson's Relaxation Therapy to Reduce Postoperative Pain Intensity of TUR-P: A Case Study

Introduction: Benign Prostate Hyperplasia (BPH) is a disease condition in which there is enlargement of the prostate gland. This study aims to conduct a case study by analyzing nursing care by providing benson relaxation therapy on pain levels in TUR-P postoperative patientsMethods: Research design using case studies. The respondents used were 3 postoperative TUR-P people with acute pain nursing problems. The intervention provided was Benson's relaxation therapy. The instrument used is a pain assessment sheet. Data was analyzed using descriptive analysisResults: The results showed the main complaints of lower abdominal pain, pain like being stabbed, pain intensity disappeared arising and pain scale 6. The nursing diagnosis that emerged in 3 patients was acute pain with pain management intervention. The implementation of benson relaxation is carried out for 15 minutes Decrease in pain level 6 to 5 on the first day, 5 to 4 on the second day and 4 to 3 on the third day.Conclusion: Benson's relaxation therapy can reduce acute pain in patients with postoperative TUR-P.

When is the best surgical time for benign prostate hyperplasia treatment?

When is the best surgical time for benign prostate hyperplasia treatment?

To Determine the Association of Transabdominal Sonographic Findings of Prostatic Volume and Post Void Residual Urine with the Severity of Symptoms as per International Prostate Symptom Score, in Cases of Benign Prostate Hypertrophy

Abstract Introduction: Benign prostatic hyperplasia is a common condition in elderly men and is a major cause of bladder outflow obstruction. Various parameters are used in clinical practice, to be able to assess the severity of the enlarged prostate and its direct effect on the quality of life of the patient in terms of evaluation of lower urinary tract symptoms (LUTSs). These are the International Prostate Symptom Score (IPSS); urodynamic studies such as uroflowmetry, measurement of postvoid residual urine (PVRU), prostatic volume (PV), intravesical prostatic protrusion, and digital rectal examination. Out of these, sonographic measurement of prostate volume and postvoid residual urine is the most widely used and readily available noninvasive methods. The present hospital-based study aims to establish an association between the PV, PVRU, and clinical symptom scores derived as per IPSS. Methods: This prospective, hospital-based study was done over a sample group of 748 symptomatic males with LUTS, referred from outpatient departments over a period of 2 years, for the assessment of PV and postvoid residual urine. The ordinal data sets were compared using the Chi-square test and a P < 0.05 was taken as statistically significant. Results: The Chi-square statistics for the association of prostate volume with IPSS were 13.1678. P value was = 0.01. The Chi-square statistics for the association between PVRU and IPSS scores were 1.613. P value was = 0.80645. Conclusion: The results derived from the data establish that the statistical association between prostate volume and IPSS scores is weakly significant and association between PVRU and IPSS scores is not statistically significant at all.

Homoeopathic Approach to Benign Prostate Hypertrophy

Benign prostatic hyperplasia is one of the common medical conditions affecting the geriatric male. This causes dysuria, constant urgency to urinate, frequent urination and retention of urine, which makes it difficult to carry out daily tasks as usual. BPH can develop when the transitional zone of the prostate’s stromal and epithelial cells proliferates due to processes through to be driven by inflammation and sex hormones leading to prostate enlargement for the majority of patient, Treatment options for men with BPH begin with careful wating and continue from medication to surgical intervention. The beginning point on the treatment pathway will be determined by the patient’s symptoms and the severity. With Homeopathy, we can reduce the conversion of testosterone into Dihydrotestosterone and increasing level of estrogen. Keywords: Benign prostate hypertrophy, Homoeopathy, Prostate, Benign prostatic enlargement.

Prostate cancer in patients with suspected benign prostate hypertrophy in Juba, South Sudan: A retrospective study

Introduction: Prostate cancer carries a high morbidity and mortality especially when not diagnosed early. Patients in resource limited countries tend to be diagnosed late and hence delayed surgery for benign prostate hypertrophy (BPH).Method: This was a retrospective study, from 1st January 2019 to 31st December 2020, on patients who underwent prostatectomy. Demographic and clinical data were extracted from their medical records.Results: This study involved 101 patients who had had simple open prostatectomy. Ages ranged from 49 to 98 years, mean 68 +/- 8.98 years. The largest group (37.6%) was aged 71- 80 years, p=0.001. Two thirds (66%), presented with urinary retention, p=0.03. Histopathological examination showed that 49.5% had BPH. Prostate cancer was found in 28.8%, p=0.082. Almost half (49.5%) were diagnosed histopathologically as having BPH. Prostate cancer made up 28.8% with most patients in the age range 61-80 years, p= 0.456. Conclusion: The prevalence of prostate cancer remains high among patients undergoing prostatectomy for suspected BPH. A national awareness campaign coupled with targeted screening of patients above 40 years could increase early detection of prostate cancer and reduce morbidity and mortality .

CYP1A1 gene polymorphism and heavy metal analyses in benign prostatic hyperplasia and prostate cancer: An explorative case-control study.

The prostatic disorder is associated with benign prostatic hyperplasia (BPH) and prostate cancer (CaP). Evidently, prevalent transcription factors and signaling pathways define their relationship. The etiology of the prostatic disorder is multifactorial including heavy metal toxicity like lead (Pb), Cadmium (Cd), and genetic factors. This study elucidates the association between heavy metal toxicity Pb, Cd, and CYP1A1 gene polymorphism with BPH and CaP. a case-control study with (BPH, n = 104), (CaP, n = 58) and (controls, n =107) patients. Heavy metal Pb and Cd estimation by atomic absorption spectrophotometer. The polymorphism of the CYP1A1 T>C (rs4646903) gene was analyzed byPCR-RFLP. Higher levels of Pb and Cd were found in BPH and CaP followed by the control group (P-value: < 0.05). Pb and Cd show a significant correlation among prostate volume in CaP. Additionally, PSA, IPSS score, and pre void volume were positively co-related with Pb in BPH patients. The posthoc test defines the level of Pb and Cd as significantly elevated in the mutant genotype, highest among homozygous mutant genotype of CYP1A1gene among BPH. In CaP, Pb is significantly higher among the homozygous mutant type of CYP1A1 gene. The risk is also influenced by smoking, tobacco, and alcohol. The heavy metal toxicity Pb and Cd were reported to raise the risk of BPH and CaP. However, a person with heavy metal toxicity especially in BPH has a high-risk genetic susceptibility to the CYP1A1 gene in the north Indian population.

Preclinical Pharmacokinetics and CYP Modulation Activity of Chebulinic Acid: A Potent Molecule Against Metabolic Disease.

Chebulinic acid (CA) is an active constituent of Terminalia chebula fruits with therapeutic potential against multiple metabolic diseases, including dementia, benign prostate hyperplasia, and osteoporosis. The present work intends to explore the preclinical pharmacokinetics, including the absolute bioavailability of CA and its influence on the gene expression of cytochrome P450 enzymes in the liver. Quantifying CA and probe drugs in vitro samples and preclinical serum samples of male SD rats were performed using LC-MS/MS. The influence of CA on the hepatic CYPs and their gene expression was analyzed in rat liver by quantitative real-time polymerase chain reaction. The plasma protein binding was found to be 84.81 ± 7.70 and 96.34 ± 3.12, blood-to-plasma ratio of 0.62 ± 0.16 and 0.80 ± 0.23 at 1 μM and 10 μM concentrations, respectively. Again, the absolute oral bioavailability of CA at 100 mg/kg was found to be 37.56 ± 7.3%. The in-vivo pharmacokinetic profile of probe drugs revealed CA to have significant inducing effects on CYP1A2, 2C11, 2D2, and 2E1 after 14 days, which correlates to both in-vitro rat microsomal data and gene expression results. Altogether, pharmacokinetic parameters reveal CA to have an affinity to distribute across different extravascular tissues and induce rat liver CYP enzymes.

Initial Postoperative Prostate Specific Antigen and Prostate Specific Antigen Velocity Are Important Indicators of Underlying Malignancy After Simple Prostatectomy.

Background: There is a paucity of guidelines for prostate-specific antigen (PSA) monitoring after simple prostatectomy (SP) despite these patients remaining at risk for prostate cancer (PCa). Our objective was to determine if PSA kinetics can be a potential indicator of PCa after SP. Methods: A retrospective review was performed of all simple prostatectomies at our institution from 2014 to 2022. All patients who met criteria were included in the study. Relevant clinical variables were collected preoperatively, including PSA value, prostate size, and voiding symptoms. Surgical and urinary function outcomes were analyzed. Results: A total of 92 patients were divided into two groups based on malignancy status. Sixty-eight patients did not have PCa, while 24 patients had known PCa before surgery (14) or were diagnosed as having incidental PCa from the pathological specimen (10). Patients with benign prostates had an initial postoperative PSA value of 0.76 ng/mL compared with 1.68 ng/mL for those with cancer (p < 0.01). PSA velocity for the first 24 months after surgery was 0.042 ± 1.61 ng/(mL·year) for the benign cohort compared with 1.29 ± 1.02 ng/(mL·year) for the malignant cohort (p = 0.01). Voiding improvements were noted by objective (postvoid residual and flow rate) and subjective (American Urological Association symptom score and quality of life score) measures in both groups. Conclusions: PSA interpretation and monitoring after SP have not been well established. Our study indicates that initial postoperative PSA value and PSA velocity are important indicators of underlying malignancy in patients after SP. Further efforts are needed to establish threshold values and formal guidelines.

Benign prostate obstruction in the primary care setting: A Case Report and Review

Benign prostate obstruction in the primary care setting: A Case Report and Review

Impact of Duration of Catheterization on the Success Rate of Trial Without Catheter in Acute Urinary Retention Due to Benign Prostatic Enlargement.

The most common cause of acute urinary retention in men over 50is benign prostate enlargement (BPE). Following the urethral catheterization, a trial without a catheter (TWOC) under the cover of alpha-blockers is given. The timing of TWOC varies from Day 3 to Day 7 of the retention episode. There is a need to study the improvement in the success rate of TWOC with the increasing number of days of catheterization. To measure the success rate of TWOC in acute urinary retention due to benign prostatic enlargement with increasing days of catheterization. The study was conducted in Social Security Teaching Hospital Lahore. Patients who presented with acute urinary retention due to benign prostatic enlargement were catheterized and given alpha-blockers. The patients were divided into two groups, one group having TWOC after three days and the other having TWOC after seven days. The success rate of TWOC was calculated and compared in the two groups. All patients included in the study had the first episode of acute retention with a moderately enlarged prostate and no element of second pathology or neurological deficit. A total of 48 patients were included in the study, divided into two groups of 24 patients each. In the first group who underwent TWOC after seven days of catheterization, 15 out of 24 patients had successful TWOC with a success rate of 62.5%. In the second group of 24 patients, who had TWOC after three days of catheterization, only 11 patients had successful TWOC with a success rate of 45.8%. There was a marked improvement in the success rate of TWOCwith increasing days of catheterization after an acute retention episode, secondary toBPE.

MIR663AHG as a competitive endogenous RNA regulating TGF-β-induced epithelial proliferation and epithelial-mesenchymal transition in benign prostate hyperplasia.

Benign prostate hyperplasia (BPH) is the most commonly seen disease among aging males. Transforming growth factor(TGF)-β-mediated epithelial-mesenchymal transition (EMT) and epithelial overproliferation might be central events in BPH etiology and pathophysiology. In the present study, longnoncoding RNAMIR663AHG, miR-765, and FOXK1 formed a competing endogenous RNAs network, modulating TGF-β-mediated EMT and epithelial overproliferation in BPH-1 cells. miR-765 expression was downregulated in TGF-β-stimulated BPH-1 cells; miR-765 overexpression ameliorated TGF-β-mediated EMT and epithelial overproliferation in BPH-1 cells. MIR663AHG directly targeted miR-765 and negatively regulated miR-765; MIR663AHG knockdown also attenuated TGF-β-induced EMT and epithelial overproliferation in BPH-1 cells, whereas miR-765 inhibition attenuated MIR663AHG knockdown effects on TGF-β-stimulated BPH-1 cells. miR-765 directly targeted FOXK1 and negatively regulated FOXK1. FOXK1 knockdown attenuated TGF-β-induced EMT and epithelial overproliferation and promoted autophagy in BPH-1 cells, and partially attenuated miR-765 inhibition effects on TGF-β-stimulated BPH-1 cells. In conclusion, this study provides a MIR663AHG/miR-765/FOXK1 axis modulating TGF-β-induced epithelial proliferation and EMT, which might exert an underlying effect on BPH development and act as therapeutic targets for BPH treatment regimens.

Ethnobotanical Study of Plants Used in the Management of Benign Prostate Hyperplasia in Ilorin, Nigeria

Background: Benign Prostate Hyperplasia (BPH) is a prevalent illness in older men. It is a condition where the prostate becomes enlarged and blocks the ease of urine passage out of the bladder. Around 50% of the male population develops symptoms of BPH around 51- 60 years of age. Current therapeutic management options come with undesirable side effects like weight gain, dizziness, and impotence, hence, the need to source for safer alternatives initiated by the acquisition, recording, and preservation of traditional knowledge of medicinal plants.&#x0D; Objective: This study aims to preserve indigenous knowledge by documenting medicinal herbs in use as therapy for BPH.&#x0D; Materials &amp; method: Ethnobotanical survey was carried out in the study areas through interviews using a semistructured questionnaire. Respondents included elderly members of the communities, herbalists, and practitioners of traditional medicine. Quantitative ethnobotany index (Use value index) and descriptive statistics were used to analyse data.&#x0D; Results: 50 respondents were interviewed, 64% were Herb sellers, 22% TMPs, Others 14%. 37 plants belonging to 24 plant families were mentioned in the survey. Methods of preparation of recipes mentioned includes: maceration (37%), decoctions (52%), juice (7%), infusions and paste/powder (4%). Method of administration were majorly oral route. The plant family Fabaceae (19%) had the highest representation. This was followed by the families Annonaceae (8%), Euphorbiaceae (6%), Curcubitaceae, Menispermaceae, Combretaceae, Apocynaceae and Rutaceae with 5% each. Other plant families represented 42% of the total number of plants mentioned.&#x0D; Conclusion: The study areas are endowed with abundant flora which serves as a repository for researchers in the quest to develop less toxic drugs with little or no side-effect for the management of BPH

Comparison of Serum Gamma Glutamyl Transferase Levels between Prostate Cancer Patients and Their Healthy Peers.

Prostate cancer (PCa) is the most common cancer affecting men, apart from cutaneous cancers. Serum prostate specific antigen (PSA) levels are frequently used to predict prostate cancer diagnosis. However, many causes (e.g., prostatitis, benign prostate obstruction, urethral catheterization) may cause elevated PSA, in addition to PCa. We aimed to investigate the gamma glutamyl transferase (GGT) levels, a serum biomarker not affected by situations other than cancer causing elevated PSA. The study evaluated male patients with prostate biopsy due to high serum PSA levels and/or abnormal digital rectal examination (DRE) examined in Ordu University Education and Research Hospital, Ordu/Turkey urology clinic from April 2019 to April 2021. The patient group in the study included 261 men with PCa diagnosis and the control group included 245 healthy men with normal PSA levels, and no PCa and/or benign prostate obstruction (BPO). The two groups were compared in terms of serum GGT levels. GGT was significantly low in the PCa group and might be a predictor in terms of PCa (P=0.000). In the malignant (PCa) group, the GGT cut-off value was identified as 21.5 (sensitivity 68.6%, specificity 54.4%). Serum GGT levels might assist in diagnosis of PCa. However, diagnostic power is weak due to low specificity. There is a need for studies investigating the efficacy of GGT levels for prediction of PCa diagnosis and assessing other parameters alongside GGT.

Change in Hemodynamics with Saddle versus Spinal Block in Patients Undergoing Elective Transurethral Resection of Prostate for Benign Prostate Hyperplasia

Objective: To compare the mean change in hemodynamics with saddle block versus spinal block in patients undergoing elective transurethral resection of prostate surgery for benign prostate hyperplasia. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Anesthesia, Combined Military Hospital, Lahore Pakistan, from Oct 2019 to Apr 2020. Methodology: A total of 80 patients were divided into two groups. Group-A (n=40) was dealt with spinal anesthesia and Group-B (n=40) with saddle anesthesia. MAP and HR were measured at 0 and 5 minutes after anesthesia and change was noted. Hyperbaric bupivacaine 0.75% was administered at level of L3 and L4 spinal levels. Midline approach was used under aseptic conditions. Results: The mean age of patients in spinal block Group-A was 56.40±12.01 years and in saddle block Group-B was 62.35±10.96 years. The mean change in MAP of spinal Group-A was 30.45±14.32mmHg and in saddle Group-B was 12.23±7.00mmHg. The mean HR in spinal Group-A was 66.35±4.91/min and in saddle Group-B was 74.88±5.17/min (p&lt;0.05). Conclusion: There was significantly more change of hemodynamics with spinal block than to saddle block undergoing elective Trans-urethral resection of prostate.

Prostate Cancer and Its Mimics-A Pictorial Review.

Multiparametric prostate MRI (mpMRI) is gaining wider recommendations for diagnosing and following up on prostate cancer. However, despite the high accuracy of mpMRI, false positive and false negative results are reported. Some of these may be related to normal anatomic structures, benign lesions that may mimic cancer, or poor-quality images that hamper interpretation. The aim of this review is to discuss common potential pitfalls in the interpretation of mpMRI. mpMRI of the prostates was performed on 3T MRI scanners (Philips Achieva or Siemens Magnetom Vida) according to European Society of Urogenital Radiology (ESUR) guidelines and technical requirements. This pictorial review discusses normal anatomical structures such as the anterior fibromuscular stroma, periprostatic venous plexus, central zone, and benign conditions such as benign prostate hyperplasia (BPH), post-biopsy hemorrhage, prostatitis, and abscess that may imitate prostate cancer, as well as the appearance of prostate cancer occurring in these locations. Furthermore, suggestions on how to avoid these pitfalls are provided, and the impact of image quality is also discussed. In an era of accelerating prostate mpMRI and high demand for high-quality interpretation of the scans, radiologists should be aware of these potential pitfalls to improve their diagnostic accuracy.

Thulium laser enucleation of the prostate in patients with large benign prostate hyperplasia and acute urinary retention

Thulium laser enucleation of the prostate in patients with large benign prostate hyperplasia and acute urinary retention

Relationship between PSA and Serum Zinc in BPH-Afflicted Iraqi Men

Background: Benign prostatic hyperplasia (BPH) is a common benign tumor of the prostate that becomes more common as men age. The enlarged prostate may compress the urinary tube (urethra), which runs through the middle of the prostate, preventing urine from flowing from the bladder to the outside. Complete obstruction can develop if BPH is severe enough. BPH usually appears after the age of 40 and progresses slowly. Aim of the Study: Studying the connections between serum zinc and PSA in Iraqi BPH patients is the aim of this investigation. Patients and Methods: The case-control study lasted three months, from mid-November to the end of February, at Al-Kindi Teaching Hospital and Ghazy Al-Hariri Hospital in Baghdad Governorate, Iraq. It entailed gathering 90 blood samples, which were separated into two groups. The first group (A) consisted of 60 patients with benign prostatic hyperplasia ranging in age from 45 to 80 years, while the second group (B) consisted of 30 apparently be healthy males aged 45 to 80 years. All participants in this study provided diagnose permission. Patients diagnosed with benign prostate hyperplasia had an international prostate symptom score of 18 or higher; the patient's prostate volumes (PV) were equal to or more than 25 milliliters. Radiologists with competence in the department used transabdominal ultrasound equipment manufactured in Germany by Siemens to figure out how big the prostate gland is. Both groups had their serum zinc and PSA levels measured by ELISA (Enzyme-Linked Immunosorbent Assay) assays The calculation of BMI was be calculated with the help of given standard formula. BMI = [(Weight in Kilograms / (Height in Meters x Height in Meters)]. Results: The study that the mean prostate size was elevated significantly in the BPH group (54.0 ± 8.4 cc ) as compared with the control group (19.66 ± 2.88 cc (P:0.01). There is a significant increase in the PSA concentration of benign prostatic hyperplasia patients, (3.14 ± 0.95 ng/ml), as compare with control subjects, (0.84 ± 0.10 ng/ml) (P:0.01). There is significant reduction in the serum zinc concentration of benign prostatic hyperplasia patients, (70.4 ± 9.63 ng/ml), as compare with control subjects, (99.3 ± 10.5; p≤0.01). The higher percentage of benign prostatic hyperplasia in patients above 66 years, and the lowest is in age group 45-55 years. Conclusion: Benign prostatic hyperplasia patients of all ages had considerably higher serum PSA than age-matched healthy controls. Benign prostatic hyperplasia patients of all ages had considerably lower serum zinc than age-matched healthy controls. Prostate size and PSA are greater in benign prostatic hyperplasia patients of all BMIs. Benign prostatic hyperplasia patients had significantly lower serum zinc than healthy controls of the same BMI.

Development and validation of a clinic machine-learning nomogram for the prediction of risk stratifications of prostate cancer based on functional subsets of peripheral lymphocyte

BackgroundNon-invasive risk stratification contributes to the precise treatment of prostate cancer (PCa). In previous studies, lymphocyte subsets were used to differentiate between low-/intermediate-risk and high-risk PCa, with limited clinical value and poor interpretability. Based on functional subsets of peripheral lymphocyte with the largest sample size to date, this study aims to construct an easy-to-use and robust nomogram to guide the tripartite risk stratifications for PCa.MethodsWe retrospectively collected data from 2039 PCa and benign prostate disease (BPD) patients with 42 clinical characteristics on functional subsets of peripheral lymphocyte. After quality control and feature selection, clinical data with the optimal feature subset were utilized for the 10-fold cross-validation of five Machine Learning (ML) models for the task of predicting low-, intermediate- and high-risk stratification of PCa. Then, a novel clinic-ML nomogram was constructed using probabilistic predictions of the trained ML models via the combination of a multivariable Ordinal Logistic Regression analysis and the proposed feature mapping algorithm.Results197 PCa patients, including 56 BPD, were enrolled in the study. An optimal subset with nine clinical features was selected. Compared with the best ML model and the clinic nomogram, the clinic-ML nomogram achieved the superior performance with a sensitivity of 0.713 (95% CI 0.573–0.853), specificity of 0.869 (95% CI 0.764–0.974), F1 of 0.699 (95% CI 0.557–0.841), and AUC of 0.864 (95% CI 0.794–0.935). The calibration curve and Decision Curve Analysis (DCA) indicated the predictive capacity and net benefits of the clinic-ML nomogram were improved.ConclusionCombining the interpretability and simplicity of a nomogram with the efficacy and robustness of ML models, the proposed clinic-ML nomogram can serve as an insight tool for preoperative assessment of PCa risk stratifications, and could provide essential information for the individual diagnosis and treatment in PCa patients.

Transperineal laser ablation of the prostate as a treatment for benign prostatic hyperplasia and prostate cancer: The results of a Delphi consensus project

ObjectiveTo evaluate transperineal laser ablation (TPLA) with Echolaser® (Echolaser® TPLA, Elesta S. p.a, Calenzano, Italy) as a treatment for benign prostatic hyperplasia (BPH) and prostate cancer (PCa) using the Delphi consensus method. MethodsItalian and international experts on BPH and PCa participated in a collaborative consensus project. During two rounds, they expressed their opinions on Echolaser® TPLA for the treatment of BPH and PCa answering online questionnaires on indications, methodology, and potential complications of this technology. Level of agreement or disagreement to reach consensus was set at 75%. If the consensus was not achieved, questions were modified after each round. A final round was performed during an online meeting, in which results were discussed and finalized. ResultsThirty-two out of forty invited experts participated and consensus was reached on all topics. Agreement was achieved on recommending Echolaser® TPLA as a treatment of BPH in patients with ample range of prostate volume, from <40 mL (80%) to >80 mL (80%), comorbidities (100%), antiplatelet or anticoagulant treatment (96%), indwelling catheter (77%), and strong will of preserving ejaculatory function (100%). Majority of respondents agreed that Echolaser® TPLA is a potential option for the treatment of localized PCa (78%) and recommended it for low-risk PCa (90%). During the final round, experts concluded that it can be used for intermediate-risk PCa and it should be proposed as an effective alternative to radical prostatectomy for patients with strong will of avoiding urinary incontinence and sexual dysfunction. Almost all participants agreed that the transperineal approach of this organ-sparing technique is safer than transrectal and transurethral approaches typical of other techniques (97% of agreement among experts). Pre-procedural assessment, technical aspects, post-procedural catheterization, pharmacological therapy, and expected outcomes were discussed, leading to statements and recommendations. ConclusionEcholaser® TPLA is a safe and effective procedure that treats BPH and localized PCa with satisfactory functional and sexual outcomes.