Prostate Volume Measurement Research Articles

A mathematical model for predicting putative association between E2/T ratio and the development of benign prostate hyperplasia in rats.

Benign prostatic hyperplasia (BPH) develops more likely with increasing age and changing serum concentrations of circulating estradiol (E2) and/or testosterone (T). In this study, we explored the relationship between serum E2/T ratio and BPH risk in rats by fitting a mathematical model. A total of 176 rats were randomized to one of the following treatment groups: normal control, castrated control, and 20 more groups of castrated animals treated with increasing dose combinations of T and E2, once daily for 30 days. Serial blood samples were obtained to determine serum T and E2 levels by magnetic bead enzyme-linked immunosorbent assay. Prostate tissue was taken to measure prostate volume. MATLAB software was used to simulate the relationship between prostate/body weight ratio (PBR) and E2/T ratio with a mathematical equation. The values of PBR, E2 and T in the treatment groups were significantly higher than those in the control groups. Stepwise regression showed that PBR was a function of E2 and T. PBR=-0.1782+0.0081 E2+0.063 T - 0.6×10-5 E22 - 0.28×10-3 T2. E2/T ratio change may be one of the risk factors for PBR, which is associated with the development of BPH.

Value of computed tomography in calculating prostate volume when transrectal ultrasonography is not applicable.

The aim of this study was to evaluate the value of computed tomography (CT) in determining total prostate volume (TPV), as an alternative to transrectal ultrasonography (TRUS) when TRUS is not available. The patient cohort included patients who underwent both CT and TRUS within a 3-month interval from January 2012 to December 2013 at a single institution. In all, 67 non-contrast and 217 contrast-enhanced CT images were reviewed twice by 3 independent observers 2 months after the initial evaluation. Prostate length and width were measured on axial images and height was measured on sagittal images. To compare differences between CT and TRUS in TPV estimation, the CT/TRUS ratio of TPV was calculated and a Bland-Altman plot was constructed. Inter- and intraobserver variabilities and the effect of contrast enhancement were also evaluated statistically. The mean (± SD) age of patients was 64.5 ±10.8 years and the mean time interval between CT and TRUS was 16.3 ± 22.6 days. The mean TRUS-measured TPV was 44.7 ± 24.9 mL and the mean CT/TRUS TPV ratio was 0.80 ± 0.20, indicating that TPV estimated by CT is 20% lower than that determined by TRUS, regardless of contrast enhancement (P > .05). The mean difference in TPV between TRUS and CT was 11.3 ± 14.3 mL, with differences of 1.7, 9.9, and 32.9 mL for prostate volumes of ≤30, >30-60, and >60 mL, respectively. Interobserver variability was excellent (r > 0.9), whereas intraobserver variability was very good (r > 0.7). CT is a reliable method for prostate volume measurement and is well correlated with TRUS. Although CT estimates of TPV are 20% lower than those obtained using TRUS, CT can be used as an alternative to TRUS when TRUS is not available.

PD23-09 MULTIVARIABLE RISK-STRATIFICATION IN A PRIMARY HEALTHCARE SETTING: REFERRAL RATE AND BIOPSY RESULTS FROM A UROLOGY OUTPATIENT CENTER.

You have accessJournal of UrologyProstate Cancer: Detection & Screening II1 Apr 2018PD23-09 MULTIVARIABLE RISK-STRATIFICATION IN A PRIMARY HEALTHCARE SETTING: REFERRAL RATE AND BIOPSY RESULTS FROM A UROLOGY OUTPATIENT CENTER. Daniël Osses, Arnout Alberts, Gonny Bausch, and Monique Roobol Daniël OssesDaniël Osses More articles by this author , Arnout AlbertsArnout Alberts More articles by this author , Gonny BauschGonny Bausch More articles by this author , and Monique RoobolMonique Roobol More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1190AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The use of multivariable risk-stratification in primary care could optimize the diagnostic pathway by reducing unnecessary referrals to specialist care. Dutch primary care physicians (PCPs) refer men with prostate-specific antigen (PSA) level ≥3.0 ng/ml to the urologist for risk-based patient selection for prostate biopsy using the Rotterdam Prostate Cancer Risk Calculator (RPCRC). Here, we calculated the risk and assessed the rate of men referred to the urologist with PSA level ≥3.0 ng/ml by implementing the RPCRC in a primary care setting. METHODS PCPs were given the possibility to refer men with a suspicion of prostate cancer (PCa) or screening wish to a primary care clinic (STAR-SHL) where further assessment including next to PSA, digital rectal examination and transrectal ultrasound with prostate volume measurement was performed by specially trained personnel. Risk-based advice on referral to the urologist was given to the PCP on the basis of the RPCRC results (lower part Table 1). If requested, advice on treatment of lower urinary tract symptoms (LUTS) was given. All men signed informed consent. RESULTS Between January 2014 and September 2017 a total of 243 men, median age 64 yr (range 39-91) were referred by their PCP for a consultation at the primary care clinic. Of 108 men with PSA level ≥3.0 ng/ml and a referral related to PCa, PCPs were advised to refer 58 men to the urologist (54%) (Table 1). Of the men with available follow-up (FU) (N=187, median FU 16 months; range 1-37) 54 men (8 men PSA <3.0 and 46 men PSA ≥3.0) were considered high-risk. Of these men 51 (94%) men were actually referred to specialist care by their PCP and so far 38 men underwent biopsy. PCa was detected in 30 men (47% had Gleason score [GS] ≥3+4 PCa), translating into an overall positive predictive value of 79%. Within the available FU time 2 of 38 (5%) men with PSA level ≥3.0 ng/ml considered low-risk have been diagnosed with GS 3+3 PCa. CONCLUSIONS Use of the RPCRC in a primary healthcare setting could prevent almost half of referrals of men with PSA level ≥3.0 ng/ml to the urologist. In more than three-quarter of men referred for prostate biopsy, the suspicion of PCa was confirmed. These data show huge potential for multivariable risk-stratification in primary care. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e483 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Daniël Osses More articles by this author Arnout Alberts More articles by this author Gonny Bausch More articles by this author Monique Roobol More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Effects of benign prostatic hyperplasia and finasteride therapy on prostatic blood flow in dogs

Benign prostatic hyperplasia (BPH) is characterized by an enlargement of the prostate accompanied by an increase in prostatic blood perfusion and vascularization. The most indicated treatment is to perform orchiectomy, however, medical treatment with finasteride can be an option for breeding dogs or elderly animals with a critical health status. In dogs, the influence of medical treatment on prostatic hemodynamics is still unknown. Therefore, this study aimed to evaluate the effects of benign prostatic hyperplasia and finasteride therapy on hemodynamic and vascular features of the canine prostate. For this purpose, twenty dogs of different breeds, body weights (10–30 kg) and ages (5–13 years) were used, assigned for: Healthy-non treated group (n = 5), BPH-non treated group (n = 5), Healthy-finasteride treated group (n = 5) and BPH-finasteride treated group (n = 5). Dogs that presented hematospermia and at least one general clinical sign (tenesmus, hematuria or dysuria) were presumptively diagnosed with BPH. Dogs were evaluated ultrasonographycally by B-mode and Doppler of the prostatic artery in a monthly interval (day 0, 30 and 60) in order to measure prostate volume (PV), expected prostate volume (EPV), prostate vascularization score (scored as minimum, intermediary and maximum) and prostatic artery blood flow parameters with the use of spectral and color Doppler ultrasound. It was possible to observe a decrease in prostate vascularization score between Day 0 (intermediary degree) and 60 (minimum degree) in finasteride treated dogs. Moreover, non-treated dogs had higher score of vascularization at Day 60 compared to animals treated with finasteride, regardless of BPH diagnosis. Healthy-non treated animals presented higher peak systolic:diastolic velocity (S/D) than BPH-non treated dogs. Furthermore, BPH-non treated dogs had lower S/D than BPH-finasteride treated dogs. In 30 and 60 days, no difference on PV was observed between BPH-finasteride treated group and Healthy-non treated group. At day 60, no difference between PV and EPV was observed for the BPH-finasteride treated group. In conclusion, finasteride treatment reduces simultaneously the volume, local vascularization and blood flow of the prostate, thus, being considered an effective and additional choice of therapy for BPH. Moreover, the course of therapy in dogs can be followed by analyzing changes in prostatic artery.

Hubungan Prostate Volume dan Intravesical Prostatic Protrusion terhadap International Prostate Symptom Score pada Pasien Benign Prostate Hyperplasia (Relationship between Prostate Volume and Intravesical Prostatic Protrusion and International Prostate

&#x0D; Diagnosis of benign prostate hyperplasia (BPH) can be established through transabdominal ultrasonography (TAUS), a noninvasive supportive examination which measure prostate volume (PV), and intravesical prostatic protrusion (IPP). The severity of obstructive symptoms experienced by the patient was assessed by international prostate symptom score (IPSS) questionnaire. This study aimed to analyse the relationship between both PV and IPP and IPSS in BPH patients. This was an observational analytic study with cross sectional design conducted at Department of Urology Surgery Bina Sehat Hospital Jember, Paru Hospital Jember and Bhayangkara Hospital Bondowoso during October-November 2016 in 30 respondents. The average of PV was 52.01±25.18 mL, IPP was 12.67±6.69 mm and IPSS score was 25.60±9.20. The results of Spearman correlation between the PV and Voiding-IPSS, Storage-IPSS, or total score IPSS and IPP and Voiding IPSS showed no significant correlation (p =0.319; p=0.067; p=0.085; p=0.183). Spearman correlation between the IPP and Storage-IPSS or total score IPSS resulted p value equal to 0.012 and r=0.451 and p=0.027 and r=0.404, which showed a significant correlation with moderate correlation strength. Statistically, IPP correlated to IPSS score better than PV.&#x0D; &#x0D; Keywords: BPH, international prostate symptom score, transabdominal ultrasonography&#x0D;

Safety and efficacy using a low-powered holmium laser for enucleation of the prostate (HoLEP): 12-month results from a prospective low-power HoLEP series.

To analyze the 12-month outcomes of low-powered holmium laser enucleation of the prostate (LP-HoLEP) for patients with symptomatic benign prostatic obstruction (BPO). A total of 54 patients with symptomatic BPO were treated with LP-HoLEP. All patients were treated by two experienced LP-HoLEP surgeons. A 50-W Ho:YAG laser was used at 39.6-W (2.2J, 18Hz). All patients were assessed preoperatively by International Prostate Symptom Score (IPSS), quality of life (QoL), maximum flow rate (Qmax), post-void residual urine (PVR), PSA, and whole prostate volume measurement by transrectal ultrasound. The patients were reassessed at 1-, 6-, and 12-month follow-up. The complications were classified according to the modified Clavien classification system. Patient data were expressed as median (interquartile range) or numbers (%). The median age was 72.5 (67-77.25) years and the median preoperative prostate volume 74.5 (45-110) ml. 12 (22.2%) patients were treated with ongoing anticoagulant treatment. The median operative time was 65 (41-81)min and the enucleation efficiency 1.11 (0.82-1.79)g/min, respectively. Clavien 1 (11.1%), Clavien 2 (3.7%), Clavien 3a (3.7%), and Clavien 3b (5.5%) complications occurred. At 6-month follow-up, median prostate volume (74.5 vs. 15.5ml) and PSA (4.03 vs. 0.54µg/l) had improved significantly compared to baseline (p≤0.009). At 12-month follow-up, Qmax (12 vs. 29.3ml/s), PVR (155 vs. 11.15ml), IPSS (22 vs. 6) and QoL (5 vs. 1) had improved significantly (p<0.001). LP-HoLEP is technically feasible, safe and effective for the treatment of symptomatic BPO. For experienced surgeons, power is less relevant than technique.

Prostate-specific antigen (PSA) density in the diagnostic algorithm of prostate cancer.

Screening for prostate cancer using prostate-specific antigen (PSA) alone leads to un-necessary biopsying and overdiagnosis. PSA density is easily accessible, but early evidence on its use for biopsy decisions was conflicting and use of PSA density is not commonly recommended in guidelines. We analyzed biopsy outcomes in 5291 men in the population-based STHLM3 study with PSA ≥ 3 ng/ml and ultrasound-guided prostate volume measurements by using percentages and regression models. PSA density was calculated as total PSA (ng/ml) divided by prostate volume (ml). Main endpoint was clinically significant cancer (csPCa) defined as Gleason Score ≥ 7. The median PSA-density was 0.10 ng/ml2 (IQR 0.075-0.14). PSA-density was associated with the risk of finding csPCa both with and without adjusting for the additional clinical information age, family history, previous biopsies, total PSA and free/total PSA (OR 1.06; 95% CI:1.05-1.07 and OR 1.07, 95% CI 1.06-1.08). Discrimination for csPCa was better when PSA density was added to a model with additional clinical information (AUC 0.75 vs. 0.73, P < 0.05). The proportion of men with Gleason Score 6 (ISUP 1) was similar across stratas of PSA-density. Omitting prostate biopsy for men with PSA-density ≤0.07 ng/ml2 would save 19.7% of biopsy procedures, while missing 6.9% of csPCa. PSA-density cutoffs of 0.10 ng/ml2 and 0.15 ng/ml2 resulted in detection of 77% (729/947) and 49% (461/947) of Gleason Score ≥7 tumors. PSA-density might inform biopsy decisions, and spare some men from the morbidity associated with a prostate biopsy and diagnosis of low-grade prostate cancer.

Genetic alterations in benign prostatic hyperplasia patients.

Background: Benign prostate hyperplasia (BPH) is a classical age-related disease of the prostate, present in 20% of men at the age of 40 years with progression to 70% by the age of 60 years. BPH is associated with various lower urinary tract symptoms, which affect their day-to-day life.Materials and methods: Our objective was to evaluate the association between HER-2/neu, c-myc, p53, and clinicopathological variables in 45 patients diagnosed with benign prostatic hyperplasia using fluorescence in situ hybridization (FISH). The patients underwent transurethral prostate resection to address their primary urological problem. All patients were evaluated by use of a comprehensive medical history and rectal digital examination. The preoperative evaluation also included serum prostate specific antigen (PSA) measurement and ultrasonographic measurement of prostate volume. Results: The mean (± standard deviation) age of the 45 patients was 69.65 ± 8.97 years. The mean PSA value of the patients was 9.25 ± 5.12 ng/mL. The mean prostate volume was 65.46 ± 11.43 mL. Amplification of HER-2/neu was seen in 4/45 (8.9%) cases and amplification of c-myc was seen in 5 of 45 (11.1%) cases; both genes were not associated with adverse clinicopathological variables. Deletion of p53 was seen in 20/45 (44.4%) cases. p53 gene was significantly associated with a severe AUASI (American Urological Association Symptom Index) score.Conclusion: In this study, we discussed important genetic markers in benign prostatic hyperplasia patients which may, in the future, be used as markers for diagnosis and prognosis, as well as targets for therapeutic intervention.

Analysis of Suprapubic ultrasonographic measurements in Assessment of Prostate dimensions and Volume

Objective: As far the prostate size is an important parameter to determine the way to treat the patient with BPH and the type of surgery used, so the objective of our study was to compare and evaluate the ultrasonographic size of the prostate by suprapubic rout with the real postoperative prostate size .Materials and Methods: between July 2011 and May 2012 forty three patients underwent both preoperative suprapubic ultrasonography (SPUS) and either transvesical or retropubic prostatectomy for BPH was included in this study. Using ellipse volume calculation (height, length and width), SPUS prostate volume was determined, and was compared with the measured volume of the specimen post-operative.Results: Prostate volume measured by SPUS, correlated closely with real specimen volume. The study revealed no significant difference between SPUS prostate volume and real post-operative specimen volume.Conclusion: Prostate volume measured by SPUS closely correlates with real prostate volume. Furthermore, we suggest that when measuring prostate volume in this way, it’s more comfortable to the patients and noninvasive procedure.

PD23-06 THULIUM VAPOENUCLEATION OF THE PROSTATE VERSUS HOLMIUM LASER ENUCLEATION OF THE PROSTATE: 6-MONTH SAFETY AND EFFICACY RESULTS OF A PROSPECTIVE RANDOMIZED TRIAL

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology III1 Apr 2017PD23-06 THULIUM VAPOENUCLEATION OF THE PROSTATE VERSUS HOLMIUM LASER ENUCLEATION OF THE PROSTATE: 6-MONTH SAFETY AND EFFICACY RESULTS OF A PROSPECTIVE RANDOMIZED TRIAL Christopher Netsch, Benedikt Becker, Christian Tiburtius, Christina Moritz, Arcangelo Venneri Becci, Thomas Herrmann, and Andreas Gross Christopher NetschChristopher Netsch More articles by this author , Benedikt BeckerBenedikt Becker More articles by this author , Christian TiburtiusChristian Tiburtius More articles by this author , Christina MoritzChristina Moritz More articles by this author , Arcangelo Venneri BecciArcangelo Venneri Becci More articles by this author , Thomas HerrmannThomas Herrmann More articles by this author , and Andreas GrossAndreas Gross More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1070AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To compare the 6-month outcomes of thulium vapoenucleation of the prostate (ThuVEP) with holmium laser enucleation of the prostate (HoLEP) for patients with symptomatic benign prostatic obstruction (BPO). METHODS A prospective randomized trial comparing ThuVEP with HoLEP was conducted from February 2015 to February 2016 at the Asklepios Klinik Barmbek. A total of 94 patients with symptomatic BPO were prospectively randomized to ThuVEP (n=48) or HoLEP (n=46). All patients were assessed preoperatively by International Prostate Symptom Score (IPSS), Quality of Life (QoL), maximum urinary flow rate (Qmax), post-void residual urine (PVR), PSA, and prostate volume measurement by transrectal ultrasound. The patients were reassessed with the same tests at 1-month and 6-month follow-up. The complications were noted and classified according to the modified Clavien classification system. Patient data were expressed as median (interquartile range) or numbers (%). RESULTS There were no statistically significant differences in any baseline characteristics between the groups. Median age at surgery was 73 (67-76) yrs. and median prostate volume was 80 (46.75-100) cc. 43 (45.7%) patients presented in urinary retention with an indwelling catheter. The median operative time was 60 (41-79) minutes without significant differences between the groups. There were no significant differences between the groups regarding catheter time (2 (2-2) days) and postoperative stay (2 (2-3) days). Clavien 1 (13.8%), 2 (3.2%), 3a (2.1%), and Clavien 3b (4.3%) complications occurred without significant differences between the groups. However, the occurrence of acute postoperative urinary retention was significantly higher after HoLEP compared to ThuVEP (15.2% vs. 2.1%, p≤0.022) at 4-week follow-up. At 6-month follow-up, median Qmax (10.7 vs. 25.9 ml/s), PVR (100 vs. 6.5 ml), IPSS (20 vs. 5), QoL (4 vs. 1), PSA (4.14 vs. 0.71 μg/l), and prostate volume (80 vs. 16 ml) had improved significantly (p<0.001) compared to baseline without differences between the groups. The median PSA decrease was 79.7% (58.8-90.6%) and the median prostate volume reduction was 74.5% (68.57-87.63%) without differences between the groups. The reoperation rate was zero at 6-month follow-up. CONCLUSIONS ThuVEP and HoLEP are both safe and effective procedures for the treatment of symptomatic BPO. Both procedures give equivalent and satisfactory micturition improvement with low morbidity and sufficient prostate volume reduction at 6-month follow-up. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e449 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Christopher Netsch More articles by this author Benedikt Becker More articles by this author Christian Tiburtius More articles by this author Christina Moritz More articles by this author Arcangelo Venneri Becci More articles by this author Thomas Herrmann More articles by this author Andreas Gross More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Patients with small prostates and low-grade intravesical prostatic protrusion – A urodynamic evaluation

ObjectiveDespite high-grade intravesical prostatic protrusion (IPP) being closely related to bladder outlet obstruction (BOO), up to 21% of patients with low IPP remain obstructed. This study evaluates the characteristics and urodynamic findings of men with small prostates and low IPP. MethodsOne hundred and fourteen men aged >50 years old with lower urinary tract symptoms (LUTS) were assessed with symptoms, uroflowmetry, serum prostate-specific antigen (PSA), transabdominal ultrasound measurement of prostate volume (PV), IPP and post-void residual urine (PVRU). All patients underwent pressure flow studies. Patients with PV < 30 mL and IPP ≤ 10 mm were examined for parameters correlating with BOO or impaired detrusor contractility. ResultsThirty-six patients had PV < 30 mL and IPP <10 mm. Nine patients (25.0%) had urodynamic BOO, all with normal bladder contractility. Fourteen patients (38.9%) had poor detrusor contractility and all had no BOO. PV, PVRU and IPP were significantly associated with BOO, with IPP showing greatest positive correlation. Both Qmax and IPP were significantly associated with detrusor contractility. At 5-year follow-up, most patients responded to medical therapy. Only three out of nine patients (33.3%) with BOO eventually underwent surgery, and all had a high bladder neck seen on the resectoscope. Only one patient (7.1%) with poor detrusor contractility eventually required surgery after repeat pressure flow study revealed BOO. ConclusionIn men with small prostates and low IPP, the presence of BOO is associated with higher PV, PVRU and IPP, and most respond well to medical management. BOO can possibly be explained by elevation of the bladder neck by a small subcervical adenoma.

Analysis of transrectal and suprapubic ultrasonography for prostate size evaluation

ObjectiveThe aim of this study is to evaluate the correlation between suprapubic ultrasonography (SPUS) and transrectal ultrasonography (TRUS) in the measurements of prostate dimensions and volume. Materials and methodsA total of 90 patients presenting with prostate enlargement and lower urinary tract symptoms were enrolled. All SPUS and TRUS were performed by a single experienced urologist at the same clinic visit. We analyzed the correlations of prostate volume measured by SPUS and TRUS using the Pearson correlation coefficient. Data were further analyzed in the subgroups to determine the correlation between uroflowmetry, prostate volume, postvoid residue, and prostate specific antigen level and the presence of intravesical growth. ResultsThe mean prostate volume of the 90 patients measured by SPUS and TRUS were 65.8 ± 46.5 mL and 65.4 ± 43.9 mL, respectively (r = 0.944; p < 0.001). The anteroposterior diameters had the strongest correlation among dimension measurements (r = 0.874; p < 0.001). SPUS and TRUS measurements had better correlation in the prostate size larger than 50 mL. ConclusionThere was a strong correlation of prostate sizes measured by SPUS and TRUS. We believe that SPUS can be a reliable alternative for TRUS, especially in the patients with anal diseases. It can shorten the examination time and make the patient more comfortable.

Evaluation of intraoperative magnetic resonance imaging/ultrasound fusion optimization for low-dose-rate prostate brachytherapy.

PurposeIntraoperative planning with transrectal ultrasound (US) is used for accurate seed placement and optimal dosimetry in prostate brachytherapy. However, prostate magnetic resonance imaging (MRI) has shown superiority in delineation of prostate anatomy. Accordingly, MRI/US fusion may be useful for accurate intraoperative planning. We analyzed planning with MRI/US fusion to compare differences in dosimetry and volume to that derived from the postoperative computed tomography (CT).Material and methodsTwenty patients underwent preoperative prostate MRI, which was fused intraoperatively with US during prostate brachytherapy. Intraoperative 125I or 103Pd seed placement was modified by the use of MRI fusion when indicated. Following implantation, dose comparisons were made between data derived from MRI/US and that from post-operative CT scans. Plan parameters analyzed included the D90 (dose to 90% of the prostate), rectal D30, V30 (volume of the rectum receiving 30 percent of dose), and prostate V100.ResultsThe median number of seeds implanted per patient was seventy-six. The MRI measured prostate volume, which was on average 4.47 cc larger than the CT measured prostate volume. In 9 patients, the apex of the prostate was better identified under MRI with the fusion protocol, and an average of 4 fewer seeds were required to be placed in the apex/urinary sphincter region. Both MRI and US individually showed a reduced intraoperative prostate D90 in comparison to the postoperative CT, with a larger mean difference for MRI in comparison with US (9.71 vs. 4.31 Gy, p = 0.007). This was also true for the prostate V100 (5.18 vs. 2.73 cc, p = 0.009). Post-operative CT underestimated rectal D30 and V30 in comparison to both MRI and US with MRI showing a larger mean difference than US for D30 (40.64 vs. 35.92 Gy, p = 0.04) and V30 (50.20 vs. 44.38 cc, p = 0.009).ConclusionsThe MRI/US fusion demonstrated greater prostate volume compared to standard CT/US based planning likely due to the better resolution of the prostate apex. Furthermore, rectal dose was underestimated with CT vs. MRI based planning. Additional study is required to assess long-term clinical implications of disease control and effects on long-term toxicity, especially as related to the rectum and urinary sphincter. MRI/US intraoperative fusion may improve prostate dosimetry while sparing the rectum and urethra, potentially impacting disease control and late toxicity.

Use of thermobalancing therapy in ageing male with benign prostatic hyperplasia with a focus on etiology and pathophysiology

Introduction: We investigated if “thermobalancing” therapy (TT), using Dr Allen’s therapeutic device (DATD) in men with benign prostatic hyperplasia (BPH), can aid in understanding the etiology and pathophysiology of BPH.Methods: We compared urinary and other parameters of BPH patients who received TT over 6 months (treatment group) with those of healthy volunteers who had not received the treatment (control group). Dynamics of symptoms and indicators in each group were evaluated in comparison with their data at the beginning and end of the study. Parameters were the International Prostate Symptom Score (IPSS) for urinary symptoms and quality of life (QoL), ultrasound measurement of prostate volume (PV) and uroflowmetry (maximum flow rate, Qmax). TT effectiveness was examined in 124 men with BPH and PV <60 mL. We also investigated the data of five patients with BPH and PV >60 mL.Results: TT decreased urinary symptoms and PV, increased Qmax and improved QoL in men with BPH, PV <60 mL, and in men with BPH, PV >60 mL.Conclusions: The present study demonstrated that TT is effective for BPH, suggesting that blood circulation plays a crucial role in its cause. The continuous heat exposure that does not exceed the normal body temperature terminates the trigger of BPH development, “micro-focus” of hypothermia, and the following spontaneous expansion of capillaries. TT could be considered to be a useful tool in BPH treatment.

Abdominal or Transrectal Ultrasonographic Prostate Volume and Cystoscopic Prostatic Urethral Length Measurements to Determine the Surgical Technique for Prostatectomy in Patients with Benign Prostate Hyperplasia

Abdominal or Transrectal Ultrasonographic Prostate Volume and Cystoscopic Prostatic Urethral Length Measurements to Determine the Surgical Technique for Prostatectomy in Patients with Benign Prostate Hyperplasia

Prostate size, nocturia and the digital rectal examination: a cohort study of 30 500 men.

To evaluate the utility of the digital rectal examination (DRE) in estimating prostate size and the association of DRE with nocturia in a population-based cohort. We identified all men randomized to the screening arm of the Prostate, Lung, Colorectal, and Ovarian Cancer Screening (PLCO) trial for whom DRE results were available. Men were excluded if they had a history of prostate surgery or incident prostate cancer. Prostate posterior surface area was derived from DRE sagittal and transverse estimates. Relationships between prostate posterior surface area, transrectal ultrasonography (TRUS), prostate-specific antigen (PSA) and nocturia were analysed using intraclass correlation coefficients (ICCs), Spearman's rank correlation and multivariable logistic regression. A total of 30 500 men met the inclusion criteria, with 103 275 screening visits containing paired DRE and PSA data. Digital rectal examination posterior surface area estimates had an ICC of 0.547 (95% CI 0.541-0.554) and were significantly yet modestly correlated with elevated PSA level (rs = 0.18, P < 0.001) and TRUS prostate volume (rs = 0.32, P < 0.001). Prostate posterior surface area was significantly associated with nocturia on multivariable analysis, but was not significant in stratified analysis of men with cardiovascular risk factors (hypertension, diabetes, high body mass index, stroke). In men without these risk factors, the highest quintile of DRE posterior surface area had 22% greater odds of nocturia than the lowest quintile (odds ratio 1.216, 95% CI 1.036-1.427). Digital rectal examination is a modestly accurate tool for measuring prostate volume. While DRE posterior surface area represents a statistically significant predictor of nocturia, the magnitude of effect suggests it has limited clinical utility for assessing this condition, particularly in the presence of cardiovascular risk factors.

Transurethral 160-W straight beam green laser vaporesection of the prostate: initial experience after 180 procedures.

Although the photoselective vaporization of the prostate has been considered one of the most promising alternatives for treatment of benign prostatic hyperplasia (BPH), published clinical data with the surgical technology of straight beam lithium triborate laser (LBO) is still lacking. To evaluate the technical improvement and initial experience of the 160-W straight beam LBO laser photoselective vaporesection of the prostate (PVRP) for the surgical treatment of BPH. From September 2012 to September 2014, including a 12-month follow-up, a prospective randomized study was performed. 180 patients undergoing PVRP were included in the study. All patients were preoperatively assessed by International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), post-void residual urine (PVR), prostate-specific antigen level, and prostate volume measurement. Perioperative parameters and complications were recorded. Patients were reassessed at 1, 3, 6 and 12 months postoperatively. PVRP resulted in a significant improvement of IPSS, Qmax, and PVR. Mean operative time was 48.3 ± 14.4 min. A significant improvement for PVRP was achieved regarding the catheter indwelling and hospital stay time. No severe perioperative complications were recorded. No requiring blood transfusion in all patients. Capsule perforation was observed in four patients in the group. There were four patients experienced bladder neck contracture and another four patients were diagnosed urethral stricture, all of whom were treated well by dilatation finally without reoperation. 160-W straight beam LBO laser PVRP appears to be a feasible and safe alternative for symptomatic BPH with decreased length of catheter indwelling and hospital stay time postoperatively.

Correlation between prostate volume and single nucleotide polymorphisms implicated in the steroid pathway.

A few preliminary studies have suggested a link between some genetics variants and benign prostatic hyperplasia (BPH). Our goal was to study the link between a set of single nucleotide polymorphisms (SNPs) implicated in the steroid pathway and accurate measurement of prostate volume in a cohort of men who underwent radical prostatectomy. Clinical and pathological data including prostate weight were obtained from 611 Caucasian patients with small volume, localized prostate cancer treated by radical prostatectomy. Patients were genotyped for 90 SNPs located inside or nearby genes implicated in the steroid pathway (Sequenom iPLEX). Correlation between prostate weight and genotypes from each SNP was studied by analysis of covariance, adjusted on age and tumor stage. A Bonferroni correction was applied, and the SNPs implicated were then incorporated in a multivariable model. Seven SNPs located in or nearby genes implicated in steroid hormone metabolism were significantly associated with prostate volume: HSD17B2 (rs1119933), ESR2 (rs8006145), SULT2B1 (rs279451), NQO1 (rs2917670), ESR1 (rs1569788), GSTP1 (rs1138272), and CYP19A1 (rs17523880). Significant association was maintained after multivariate analysis for four SNPs, indicating their independent association with prostate volume. The power of the association of each SNP with prostate volume was comparable to the effect of age. The strongest associations were found with variants in ESR1, ESR2, HSD17B2, and CYP19A1 genes, indicating a potential role of the estrogen signaling pathway in genesis of BPH. Our results are in favor of an implication of estrogen biotransformation and signaling pathways in the pathophysiology of BPH.

External Evaluation of a Novel Prostate Cancer Risk Calculator (ProstateCheck) Based on Data from the Swiss Arm of the ERSPC

We externally validated a novel prostate cancer risk calculator based on data from the Swiss arm of the ERSPC and assessed whether the risk calculator (ProstateCheck) is superior to the PCPT-RC and SWOP-RC in an independent Swiss cohort. Data from all men who underwent prostate biopsy at an academic tertiary care center between 2004 and 2012 were retrospectively analyzed. The probability of having any prostate cancer or high grade prostate cancer (Gleason score 7 or greater) on prostate biopsy was calculated using the ProstateCheck. Risk calculator performance was assessed using calibration and discrimination, and additionally compared with the PCPT-RC and SWOP-RC by decision curve analyses. Of 1,615 men 401 (25%) were diagnosed with any prostate cancer and 196 (12%) with high grade prostate cancer. Our analyses of the ProstateCheck-RC revealed good calibration in the low risk range (0 to 0.4) and moderate overestimation in the higher risk range (0.4 to 1) for any and high grade prostate cancer. The AUC for the discrimination of any prostate cancer and high grade prostate cancer was 0.69 and 0.72, respectively, which was slightly but significantly higher compared to the PCPT-RC (0.66 and 0.69, respectively) and SWOP-RC (0.64 and 0.70, respectively). Decision analysis, taking into account the harms of transrectal ultrasound measurement of prostate volume, showed little benefit for ProstateCheck-RC, with properties inferior to those of the PCPT-RC and SWOP-RC. Our independent external evaluation revealed moderate performance of the ProstateCheck-RC. Its clinical benefit is limited, and inferior to that of the PCPT-RC and SWOP-RC.

Positive Response to Thermobalancing Therapy Enabled by Therapeutic Device in Men with Non-Malignant Prostate Diseases: BPH and Chronic Prostatitis

Background: The most common types of non-malignant prostate diseases are benign prostatic hyperplasia (BPH) and chronic prostatitis (CP). The aim of this study was to find out whether thermobalancing therapy with a physiotherapeutic device is effective for BPH and CP. Methods: During a 2.5-year period, 124 men with BPH over the age of 55 were investigated. Clinical parameters were tested twice: via the International Prostate Symptom Score (IPSS) and via ultrasound measurement of prostate volume (PV) and uroflowmetry maximum flow rate (Qmax), before and after six months of therapy. In 45 men with CP under the age of 55, the dynamics of the National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI) were studied. Results: The results of the investigated index tests in men with BPH confirmed a decrease in IPSS (p < 0.001), a reduction in PV (p < 0.001), an increase in Qmax (p < 0.001), and an improvement of quality of life (QoL) (p < 0.001). NIH-CPSI scores in men with CP indicated positive dynamics. Conclusions: The observed positive changes in IPSS, PV, and Qmax in men with BPH and the improvement in NIH-CPSI-QoL in patients with CP after using a physiotherapeutic device for six months as mono-therapy, support the view that thermobalancing therapy with the device can be recommended for these patients. Furthermore, the therapeutic device is free of side effects.