Presence Of Benign Prostatic Hyperplasia Research Articles

Multi-omic diagnostics of prostate cancer in the presence of benign prostatic hyperplasia

There is an unmet need for improved diagnostic testing and risk prediction for cases of prostate cancer (PCa) to improve care and reduce overtreatment of indolent disease. Here we have analysed the serum proteome and lipidome of 262 study participants by liquid chromatography-mass spectrometry, including participants diagnosed with PCa, benign prostatic hyperplasia (BPH), or otherwise healthy volunteers, with the aim of improving biomarker specificity. Although a two-class machine learning model separated PCa from controls with sensitivity of 0.82 and specificity of 0.95, adding BPH resulted in a statistically significant decline in specificity for prostate cancer to 0.76, with half of BPH cases being misclassified by the model as PCa. A small number of biomarkers differentiating between BPH and prostate cancer were identified, including proteins in MAP Kinase pathways, as well as in lipids containing oleic acid; these may offer a route to greater specificity. These results highlight, however, that whilst there are opportunities for machine learning, these will only be achieved by use of appropriate training sets that include confounding comorbidities, especially when calculating the specificity of a test.

Frequency of Occurrence and Clinical Picture of Urolithiasis on the Background of Benign Prostatic Hyperplasia

The purpose of the study was to identify the frequency of occurrence of urolithiasis against the background of benign prostatic hyperplasia, to find out whether the presence of benign prostatic hyperplasia in a patient affects the frequency of occurrence of urolithiasis, to study the clinical picture to understand whether there is some general or specific clinical picture or some feature inherent in the clinic when occurrence of urolithiasis and benign prostatic hyperplasia are accompanying each other. Materials and methods. The clinical data of 152 patients aged over 45 years who underwent examination and treatment in 2005-2015 at the A. Aliyev Azerbaijan State Institute of Advanced Medical Training and at the Shirvan Medical Diagnostic Center in 2008-2015 were analyzed. Against the background of benign prostatic hyperplasia, 85 (55.92%) patients had upper urinary tract stones. Of these, 52 (34.21%) had kidney stones, and 33 (21.71%) had ureteral stones. Bilateral nephrolithiasis was detected in 16 (10.5%) patients, unilateral – in 36 (23.68%), bilateral ureterolithiasis – in 2 (1.32%), unilateral – in 31 (20.39%) patients. Of 152 patients, bladder stones were detected in 112 (73.4%) patients. The bulk of the examined patients were patients who had bladder stones on the background of benign prostatic hyperplasia. Of these 112 patients, 25 (16.45%) had kidney stones along with cystolithiasis, one (0.89%) had left-sided ureterolithiasis, and one (0.89%) had bilateral nephrolithiasis and left-sided ureterolithiasis. To characterize the clinical signs of infravesical obstruction in benign prostatic hyperplasia, the Guyon classification was applied. Most of the patients – 102 (67.12%) patients according to this classification were at the II stage of benign prostatic hyperplasia. The number of patients at stage I was 29 (19.08%), and at stage III – 21 (13.82%). Results and discussion. In this study in patients over 45 years, nephrolithiasis on the background of benign prostatic hyperplasia was detected in 34.21% of cases, ureterolithiasis on the background of benign prostatic hyperplasia – in 21.71% of cases, cystoliasis on the background of benign prostatic hyperplasia – in 73.4% of cases, and cystolithiasis and upper urinary stones on the background of benign prostatic hyperplasia – in 17.8% of cases. As can be seen from the data presented, the bulk of the examined patients were patients who had bladder stones on the background of benign prostatic hyperplasia. Conclusion. The presence of bladder outlet obstruction and the aggravation of the stage of benign prostatic hyperplasia increase the incidence of cystolithiasis and aggravate the clinical picture of urolithiasis, leading to its complications. At the same time, the presence of concomitant urolithiasis aggravates the clinical picture of benign prostatic hyperplasia, that is, there is a syndrome of mutual weighing of clinical symptoms. There is no general and specific clinical picture in the clinic. There are the same signs and complications that are inherent in both pathologies. Therefore, there is a need for a deeper study of such patients for the correct diagnosis and choice of a rational method of treatment

Alterations in fecal short chain fatty acids (SCFAs) and branched short-chain fatty acids (BCFAs) in men with benign prostatic hyperplasia (BPH) and metabolic syndrome (MetS).

Gut microbiome-derived short-chain fatty acids (SCFAs) emerge in the process of fermentation of polysaccharides that resist digestion (dietary fiber, resistant starch). SCFAs have a very high immunomodulatory potential and ensure local homeostasis of the intestinal epithelium, which helps maintain the intestinal barrier. We analyzed the association between stool SCFAs levels acetic acid (C 2:0), propionic acid (C 3:0), isobutyric acid (C 4:0i), butyric acid (C 4:0n), isovaleric acid (C 5:0i) valeric acid (C 5:0n), isocaproic acid (C 6:0i), and caproic acid (C 6:0n)) in aging man with benign prostatic hyperplasia (BPH) and healthy controls. The study involved 183 men (with BPH, n = 103; healthy controls, n = 80). We assessed the content of SCFAs in the stool samples of the study participants using gas chromatography. The levels of branched SCFAs (branched-chain fatty acids, BCFAs): isobutyric acid (C4:0i) (p = 0.008) and isovaleric acid (C5:0i) (p < 0.001) were significantly higher in patients with BPH than in the control group. In healthy participants isocaproic acid (C6:0i) predominated (p = 0.038). We also analyzed the relationship between stool SCFA levels and serum diagnostic parameters for MetS. We noticed a relationship between C3:0 and serum lipid parameters (mainly triglycerides) in both healthy individuals and patients with BPH with regard to MetS. Moreover we noticed relationship between C4:0i, C5:0i and C6:0i and MetS in both groups. Our research results suggest that metabolites of the intestinal microflora (SCFAs) may indicate the proper function of the intestines in aging men, and increased BCFAs levels are associated with the presence of BPH.

Association of Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Lymphocyte-to-Monocyte Ratio with Benign Prostatic Hyperplasia: A Propensity Score-Matched Analysis

Introduction: The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) have recently been proposed as easily accessible inflammatory biomarkers and as surrogate markers for metabolic disease, cardiovascular disease, and malignancies, including prostate cancer. However, scant studies have investigated the association of NLR, PLR, and LMR with benign prostatic hyperplasia (BPH). Methods: Data from 8,727 middle-aged men who had participated in a health checkup were analyzed. BPH was defined as prostate volume ≥30 mL, International Prostate Symptom Score > 7, and maximal flow rate <15 mL/s. Propensity score matching was considered for 269 men with BPH (cases), and 7,136 men with no BPH (controls), but ultimately, propensity scores were matched at a 2:1 ratio of controls to cases (538 men in the control group and 269 men in the case group). Results: After propensity score matching, age, International Index of Erectile Function-5, testosterone, and number of metabolic syndrome component variables were evenly distributed and did not differ significantly between the groups. After matching, PLR and LMR were not significantly different between the 2 groups. However, NLR was significantly higher in the case group than in the control group (median [interquartile range]: 1.4 [1.1; 1.8] vs. 1.5 [1.2; 1.9]; p = 0.024) after matching. Conclusion: High NLR was significantly associated with the presence of BPH. Our results suggest the possible effect of inflammation on BPH development. A prospective study is needed to investigate the potential role of NLR as a candidate biomarker of BPH.

Comparison of Motion-Insensitive T2-Weighted MRI Pulse Sequences for Visualization of the Prostatic Urethra During MR Simulation

PurposeThe use of magnetic resonance imaging (MRI) for radiation therapy simulation is growing because of its ability to provide excellent delineation of target tissue and organs at risk. With the use of hypofractionated schemes in prostate cancer, urethral sparing is essential; however, visualization of the prostatic urethra can be challenging because of the presence of benign prostatic hyperplasia as well as respiratory motion artifacts. The goal of this study was to compare the utility of 2 motion-insensitive, T2-weighted MRI pulse sequences for urethra visualization in the setting of MRI-based simulation. Methods and MaterialsTwenty-two patients undergoing MRI simulation without Foley catheters were imaged on a 3 Tesla MRI scanner between October 2018 and January 2019. Sagittal multislice data were acquired using (1) MultiVane XD radial sampling with parallel imaging acceleration (MVXD) and (2) single-shot fast-spin-echo (SSFSE) sequences with acquisition times of 2 to 3 minutes per sequence. For each examination, 2 genitourinary radiologists scored prostatic urethra visibility on a 1-to-5 scale and rated the signal-to-noise ratio and the presence of artifacts in each series. ResultsUrethral visibility was scored higher in the MVXD series than in the SSFSE series in 18 of 22 cases (Reader 1) and 17 of 22 cases (Reader 2). The differences in scores between MVXD and SSFSE were statistically significant for both readers (P < .0001 for both, paired Student's t-test) and interobserver agreement was high (Cohen's kappa = 0.67). Both readers found the signal-to-noise ratio of the MVXD sequence to be superior in all cases. The MVXD sequence was found to generate more artifacts than the SSFSE sequence, but these tended to appear in the periphery and did not affect the ability to visualize the urethra. ConclusionsA radial T2-weighted multislice pulse sequence was superior to an SSFSE sequence for visualization of the urethra in the setting of magnetic resonance simulation for prostate cancer.

Diagnostic value of the density of prostatspecific antigen in the detection of the prostate gland

The problem of diseases of the prostate gland (PG) today is extremely urgent. This is due to an increase in the number of cases of diseases, including malignant neoplasms, the spread of pathology among young men, difficulties in diagnosing, especially in the early stages, late detection, and an increase in mortality. Therefore, the issue of early detection of this nosology is very important. Purpose. Conduct a comprehensive analysis, which consists in comparing the specificity and ratio of indicators such as total PSA, free PSA, PSA-index, the presence or absence of acute urinary retention, and especially the PSA-density indicator with histopathological examination after transrectal biopsy of the prostate gland for early verification clinical diagnosis of prostate cancer. Material and methods. The study involved 112 patients who received treatment in the urology department of the City Clinical Hospital for Emergency and Emergency Medical Aid in Zaporozhye for the period October 2017 – October 2018 about the symptoms of the lower urinary tract and elevated levels of total PSA. All patients underwent general clinical and X-ray examination, laboratory tests, ultrasound of the urinary system, determination of the level of total and free prostate-specific antigen (PSA), digital rectal examination and transrectal biopsy of the prostate gland. All patients had a total PSA above 4 ng/ml. In this regard, a transrectal biopsy of the prostate gland was performed under the control of a transrectal ultrasound transducer. As a result, PHE patients were divided into three groups. The first group consisted of 50 patients who, as a result of PHE, received a conclusion about the presence of benign prostatic hyperplasia in them in the absence of signs of cancer. The second group consisted of 56 patients who, according to the results of PHE, had moderately differentiated (G2) adenocarcinoma of the prostate. Group 3 consisted of 6 patients who were diagnosed with poorly differentiated (G3) adenocarcinoma of the prostate in histopathology report. Results. As a result of this clinical study, it was found that patients with low-grade (G3) adenocarcinoma of the prostate gland had chronic urinary retention more often and had occurred in 83% of patients, in patients with moderately differentiated (G2) adenocarcinoma, and in patients with BPH, this figure was correspondingly 70% and 56%. Chronic urinary retention in patients with adenocarcinoma of the prostate gland was detected more frequently, and in patients with BPH, acute urinary retention was more frequent. (44% in the first group versus 30% and 17% in patients with adenocarcinoma G2 and G3, respectively). The average total PSA in patients of group 1 was 20.09 ng/ml, and in patients with moderately differentiated (G2) adenocarcinoma, it was more than 2 times and amounted to 42.45 ng/ml. It is worth noting that in patients with a diagnosis of low-grade (G3) adenocarcinoma of the prostate gland, this indicator was almost 10 times higher than in patients of group 1 and 5 times compared with patients of group 2 and was respectively 192.46 ng/ml. The maximum indicator of total PSA was also higher in patients of group 3 and amounted to 1046.0 ng/ml, and in patients with BPH and moderately differentiated (G2) adenocarcinoma, this indicator was 71.9 ng/ml and 764.0 ng/ml, respectively. The average PSA index was higher in patients with BPH (26.78%), and in patients with adenocarcinoma of G2 and G3, this figure was 22.14% and 20.5%, respectively. Special attention needs to be stopped as such an indicator as PSA density. In patients with low-grade (G3) prostate adenocarcinoma, this indicator was only in one case in the normal range and its average in group 3 was almost 3 times higher than in patients with moderately differentiated (G2) prostate adenocarcinoma and 12 times higher than in patients with group 1 and amounted to 2.8 ng/ml/cm3. The PSA density levels in patients of groups 1 and 2 were 0.23 ng/ml/cm3 and 1.1 ng/ml/cm3, respectively. The maximum PSA density values †were also significantly higher in patients with G2 and G3 adenocarcinoma and amounted to 15.3 ng/ml/cm3 and 9.5 ng/ml/cm3, respectively, against the results of group 1, where this indicator was 0.65 ng/ml/cm3. Findings. A clinical study allows us to see that the indicators existing in the routine practice of a urologist cannot with great certainty compared with a transrectal prostate biopsy indicate a prostate cancer. Prostate biopsy in the diagnosis of prostate cancer is the gold standard present in identifying this disease.

The Clinical Value of DWI and T2WI MRI in the Detection of Transitional Zone Prostatic Cancer

Background: The prostate cancer is one of the commonest non-cutaneous cancers detected among elderly men. The difficulty in interpretation of the transitional zone prostate MRI arises mainly from the presence of benign prostatic hyperplasia (BPH) nodules in the transitional zone. Objective: The objective of this study is to evaluate the clinical efficacy of DWI in combination with T2WI for the detection of transitional zone prostate cancer, compared with T2WI alone. Patients and methods: A total of 58 patients with clinical suspicion of prostatic cancer were evaluated by 1.5 T MRI. Two diagnostic protocols were designed, protocol A consists of only data obtained from T2WI, protocol B consists of T2WI and DWI. The likelihood of the presence of prostate cancer in transitional and central zone was assigned using a 5 point scale after evaluating the entire prostate in each reading session, scales of 5, 4, and 3 were considered positive results and scales 1 and 2 were considered negative results. Results: Transitional zone prostate cancer was identified histopathologically in 23/58 patients. MRI diagnostic performance: In protocol A, the sensitivity is 56.5%, specificity is 62.9% and accuracy is 60.3%. Positive predictive value PPV is 50% while negative predictive value NPV is 68.8%. In protocol B, the sensitivity is 91.3%, specificity is 80% and accuracy is 84.5%. Positive predictive value is 75% while negative predictive value is 93.3%. Diagnostic protocol B has a significantly better sensitivity and specificity than protocol A (p˂0.05). According to ROC curve analysis, the cut point of protocol A scale is 2, so protocol A scale (≥ 2) is predictive for the diagnosis of malignant lesions (AUC=67.5%). The cut point of protocol B scale is 4, so protocol B scale (≥ 4) is predictive for the diagnosis of malignant lesions (AUC=87.3%). The cut off ADC value is 0.99 × 10-3 mm2/sec, so ADC value (<0.99 × 10-3mm2/ sec) is predictive for the diagnosis of malignant lesions with 91.3% sensitivity, 76% specificity, and 83.3% accuracy. Conclusion: Combination of DWI (ultra-high b value) with T2WI significantly increases the diagnostic accuracy of transitional zone prostatic cancer and scale ≥ 4 is associated with high proportion of malignancy.

Association of Prostatic Volume and Carotid Intima-media Thickness in Patients With Benign Prostatic Hyperplasia

To assess cardiovascular risk factors and carotid intima-media thickness in patients with benign prostatic hyperplasia. One hundred and twenty-three patients who were evaluated for the presence of benign prostatic hyperplasia with accompanying symptoms were included in the study. Patients were also examined by cardiology department to assess and measure cardiovascular risk factors, left ventricular functions, and carotid intima-media thickness. Cardiovascular risk factors adjusted carotid intima-media thickness was found to be different between 3 groups, being highest in the severely symptomatic group and lowest in the mildly symptomatic group. Significant correlation of prostatic volume was shown with carotid intima-media thickness after adjusting prostatic volume for body mass index and age, and carotid intima-media thickness for cardiovascular risk factors (r = 0.75 P = .01). Linear regression analysis revealed that carotid intima-media thickness significantly associated with prostatic volume (beta coefficient: 0.628; confidence interval: 37.02-60.1; P = .001). We have demonstrated that prostatic tissue has significant association with carotid intima-media thickness in patients with benign prostatic hyperplasia.

Association of Functional Ability and Benign Prostatic Hyperplasia With Urinary Incontinence in Older Korean Men.

Purpose:The purpose of this study was to determine the prevalence of urinary incontinence (UI) and analyze its association with instrumental activities of daily living (IADL) and benign prostatic hyperplasia (BPH) in community-dwelling older men in Korea.Methods:This study was a secondary analysis of data from the Actual Living Condition of the Elderly and Welfare Need Survey conducted in the year 2008. Data was subjected to hierarchical logistic regression analysis to examine the association of IADL and BPH with UI in older men, entering IADL and BPH in model 1, and age, body mass index (BMI) and education in model 2, and then comorbidities and walking speed in model 3.Results:Of 6,185 men, 243 (3.9%) had self-reported UI. The prevalence of UI was 1.8% in men aged 60–64 years and 11.7% in those aged 85 years and above, indicating an increase in the prevalence of UI with their age. IADL and BPH remained the only significant factors associated with UI in model 1 (odds ratio [OR], 1.54; 95% confidence interval [CI], 1.44–1.64 and OR, 2.73; 95% CI, 1.47–5.10, respectively), model 2 (OR, 1.50; 95% CI, 1.40–1.61 and OR, 2.68; 95% CI, 1.42–5.07), and model 3 (OR, 1.43; 95% CI, 1.32–1.54 and OR, 2.58; 95% CI, 1.36–4.90).Conclusions:IADL limitations and presence of BPH were associated with UI in older men after controlling for BMI, education, comorbidities, and walking speed. Thus, UI should be assessed in older Korean men with IADL decline and BPH. Gender-sensitive interventions to attenuate IADL limitations and manage BPH should be developed and applied to improve UI in older men.

Algorithm for management of patients with X-ray endovascular artery embolization of the prostate for its benign hyperplasia

X-ray endovascular prostatic artery embolization (XEPAE) is a comparatively new alternative treatment for benign prostatic hyperplasia (BPH), which has shown good results in Russia and foreign countries. The dissimilarity from other treatments for this nosology is the use of superselective artery ischemia of the prostate, which leads to a decrease in its sizes and a progressive reduction in lower urinary tract symptoms. Twelve patients aged 59–71 years (mean age, 66 years) with BPH have been operated on since 2014. The mean follow-up period was 8.4 months (3–17 months). The patients were divided into 3 groups in accordance with prostate volume: 1) 60–100 cm3 (n = 3); 2) 100–200 сm3 (n = 5); 3) ≥ 200 см3 (n = 4). The mean prostatic specific antigen level was 5.1 ± 2.7 ng/ml (2.7–6.3 ng/ml). Due to the increased pro static specific antigen level up to 4 ng/ml, 6 patients underwent transrectal and/or targeted biopsy of the prostate, which failed to reveal the morphological signs of its malignant process. The examination algorithm included all necessary laboratory and clinical examinations, as those during surgery for BPH, as well as multislice spiral computed tomography and/or magnetic resonance imaging, angiography of small pelvic vessels and organs. Postoperative patient monitoring revealed that the total International Prognostic Scoring System scores decreased by 41.3 and 61.4 % at 3- and 6-month follow-ups, respectively; then these values were insignificant. The prostate volume substantially decreased at 3 months; but at 6 months it was 47 % of the baseline one. The urine flow rate rose from 6.7 to 15.9 ml/sec. The quality of life index became summarily quite satisfactory at 6-month follow-up and amounted to 3.3 ± 1.3. Thus, it may be stated that XEPAE is a safe and highly effective treatment for BPH if its medical treatment is ineffective. This surgical treatment performed for 3–6 months substantially decreases the prostate, normalizes urination, and restores quality of life. Patients with severe comorbidity and a high operative-anesthetic risk should be a promising area in the use of this technique. Patients with cystostome and preserved bladder capacity and those with acute urinary retention in the presence of BPH will serve as important additional areas in the application of XEPAE.

BPH and prostate cancer risk.

Introduction:With the exclusion of non-melanomatous skin malignancy, prostate cancer (PCa) is the second most prevalent cancer in men globally. It has been reported that the majority of men will develop benign prostatic hyperplasia (BPH) by the time they reach their 60s. Together, these prostatic diseases have a significant morbidity and mortality affecting over a billion men throughout the world. The risk of developing prostate cancer of men suffering BPH is one that has resulted in a healthy debate amongst the urological community. Here, we try to address this conundrum with clinical and basic science evidence.Materials and Methods:Data from an online search and contemporary data presented at international urological congresses was reviewed.Results:BPH and PCa can be linked together at a molecular and cellular level on genetic, hormonal, and inflammatory platforms suggesting that these prostatic diseases have common pathophysiological driving factors. Epidemiological studies are weighted towards the presence of BPH having a greater risk for a man to develop PCa in his lifetime; however, a conclusion of causality cannot be confidently stated.Conclusion:The future workload healthcare practitioners will face regarding BPH, and PCa will substantially increase. Further basic science and large epidemiological studies using a global cohort of men are required prior to the urological community confidently counseling their patients with BPH with regards to their PCa risk.

A novel algorithm for the prediction of prostate cancer in clinically suspected patients

Prostate cancer (PCa) represents the most common solid tumor affecting men and its early detection remains the best approach to improve survival rates. The assessment of serum levels of PSA is currently used for PCa screening but the low specificity of the test results in a high number of false positives. Other forms of PSA may be detected in the bloodstream including PSA associated with immunoglobulin M (PSA-IgM) which, alone or combined with PSA, has shown diagnostic accuracy for PCa. The aim of the study is to improve the diagnostic accuracy of PSA-IgM by developing a multivariable model which includes serum biomarkers and routine diagnostic parameters to obtain a predictive index useful in the post-screening clinical practice. One hundred sixty male patients with clinical suspect of PCa underwent a trans-rectal ultrasound guided first prostate biopsy with a standardized sampling scheme. To generate the model, we assessed the presence of PSA and PSA-IgM complexes in sera of patients and the prostate volume of each patient. A novel predictive probability for PCa (iXip) was obtained combining non-overlapping biomarkers normalized with diagnostic parameters. The study population included 49 patients with PCa diagnosed at biopsy and 111 controls in which prostate biopsy showed the presence of benign prostatic hyperplasia, inflammation, atypical small acinar proliferation or high-grade prostatic intraepithelial neoplasia. The iXip values for patients with PCa (mean ± SD=0.467 ± 0.160) were significantly higher (p-value < 0.001) than control subjects (mean ± SD=0.314 ± 0.098) and the iXip AUC (0.787) was significantly greater (p-value < 0.001) than the AUCs of each biomarker. iXip shows a significant increase in diagnostic performance compared to PSA and PSA-IgM and its post-screening use may facilitate decision-making in recommending for biopsy clinically suspected patients.

Management of acute urinary retention: a worldwide survey of 6074 men with benign prostatic hyperplasia

OBJECTIVESTo evaluate the management of acute urinary retention (AUR) associated with benign prostatic hyperplasia (BPH) in real-life practice.To identify predictors of successful trial without catheter (TWOC).MATERIALS AND METHODSIn all, 6074 men catheterized for painful AUR were enrolled in a prospective, cross-sectional survey conducted in public and private urology practices in France, Asia, Latin America, Algeria and the Middle East.Patient clinical characteristics, type of AUR and its management (type of catheterization, hospitalization, TWOC, use of α1-blockers, immediate or elective surgery) and adverse events observed during the catheterization period were recorded.Predictors of TWOC success were also analysed by multivariate regression analysis with stepwise procedure.RESULTSOf the 6074 men, 4289 (71%) had a spontaneous AUR and 1785 (29%) had a precipitated AUR, mainly as the result of loco-regional/general anaesthesia (28.5%) and excessive alcohol intake (18.2%).Presence of BPH was revealed by AUR in 44% of men. Hospitalization for AUR varied between countries, ranging from 1.7% in Algeria to 100% in France. A urethral catheter was inserted in most cases (89.8%) usually followed by a TWOC (78.0%) after a median of 5 days. Overall TWOC success rate was 61%.Most men (86%) received an α1-blocker (mainly alfuzosin) before catheter removal with consistently higher TWOC success rates, regardless of age and type of AUR. Multivariate regression analysis confirmed that α1-blocker before TWOC doubled the chances of success (odds ratio 1.92, 95% CI 1.52–2.42, P < 0.001).Age ≥70 years, prostate size ≥50 g, severe lower urinary tract symptoms, drained volume at catheterization ≥1000 mL and spontaneous AUR favoured TWOC failure. Catheterization >3 days did not influence TWOC success but was associated with increased morbidity and prolonged hospitalization for adverse events.In the case of TWOC failure, 49% of men were recatheterized and had BPH surgery and 43.5% tried another TWOC with a success rate of 29.5%. Elective surgery was preferred to immediate surgery.CONCLUSIONSTWOC has become a standard practice worldwide for men with BPH and AUR.In most cases, an α1-blocker is prescribed before TWOC and significantly increases the chance of success.Prolonged catheterization is associated with an increased morbidity.

Evaluation of Prostatitis in Autopsied Prostates—Is Chronic Inflammation More Associated With Benign Prostatic Hyperplasia or Cancer?

Chronic inflammation is associated with prostate cancer and benign prostatic hyperplasia. However, the prevalence of chronic inflammation in malignant and benign glands has not been compared. We evaluated the association of inflammation, benign prostatic hyperplasia and cancer in autopsied prostates. We prospectively analyzed 167 autopsied prostates. Pathological analysis identified each focus of cancer, benign prostatic hyperplasia nodules and areas of acute or chronic inflammation. Any cancer focus or benign prostatic hyperplasia nodule involved directly with inflammation was recorded. The association of the prevalence of prostate cancer, benign prostatic hyperplasia and inflammation was statistically assessed. Inflammation was present in 113 (67.6%) of 167 cases. Chronic inflammation was identified in 88 (53%), acute inflammation in 6 (4%), and chronic inflammation and acute inflammation in 19 (11%) glands. In the majority of cases inflammation was present in the transitional zone. A total of 93 glands (56%) were involved with benign prostatic hyperplasia and 49 (29%) with cancer. Of the glands harboring benign prostatic hyperplasia 75% were also involved with chronic inflammation compared to only 50% of those without benign prostatic hyperplasia (p <0.01). Comparatively the glands with or without any evidence of cancer were similarly involved with chronic inflammation (55% vs 58%, p >0.1). Of the 27 glands involved with cancer and benign prostatic hyperplasia, chronic inflammation was more associated with benign prostatic hyperplasia than cancer (p = 0.006). Acute inflammation was not significantly associated with either benign prostatic hyperplasia or cancer. Chronic inflammation was a common finding in autopsied prostates. It appeared to be directly associated with the presence of benign prostatic hyperplasia but not with cancer.

Prostate volume and prostate-specific antigen levels in men enrolled in a large screening trial

Objectives Prostate volume correlates both with prostate-specific antigen (PSA) values and with the presence of benign prostatic hyperplasia (BPH). Here we examine the relationship between prostate volume and PSA level in a large, geographically diverse sample of men undergoing prostate cancer screening. Methods We followed 35,323 men enrolled in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial. Each man was screened with digital rectal examination (DRE) and PSA levels for up to 4 years. Prostate volume was estimated by DRE performed by trained examiners at the PLCO sites. Linear and logistic regression was used to assess the effect of prostate volume and age on PSA levels. Regression coefficients were adjusted for the effect of prostate volume measurement error. Results Prostate volume estimated by DRE showed considerable measurement error. Averaging volume over screening visits and accounting for examiner bias greatly reduced this error. Linear regression analysis showed a slope of 0.030/cm 3 of log PSA on prostate volume when correcting for measurement error (95% confidence interval [CI], 0.029 to 0.031). Age was independently associated with (log) PSA, with a slope of 0.022 per year. Logistic regression analysis of the risk of having an elevated PSA value (exceeding 4 ng/mL) showed an odds ratio of 1.9 (95% CI, 1.8 to 2.0) associated with a 10 cm 3 increase in prostate volume. The correlation of log PSA and prostate volume was 0.37. Prostate volume was not correlated with body mass index and showed weak correlation ( r = 0.14) with age. Conclusions Prostate volume and age are independently associated with increased PSA levels in a population of men undergoing screening.

Impact of age, benign prostatic hyperplasia, and cancer on prostate‐specific antigen level

The distribution of prostate-specific antigen (PSA) values for men with or without prostate carcinoma are confounded because of verification bias. Correcting for verification bias, the means and variances of PSA values were estimated in specific clinical scenarios. Existing receiver operating characteristic (ROC) curves, adjusted for the presence of verification bias in a screening population, were used to estimate the mean and variance of PSA values for men with or without prostate carcinoma, stratified by age and the presence or absence of benign prostatic hyperplasia. Men with a suspicious digital rectal exam (nodular) were excluded from analysis. Among men with cancer and the absence of benign prostatic hyperplasia, mean PSA values were 2.05 ng/mL and 2.66 ng/mL for younger (<60 yr) and older (> or =60 yrs) men, respectively. These estimates were 2.56 ng/mL and 3.90 ng/mL in the presence of benign prostatic hyperplasia for younger and older men, respectively. For men without prostate carcinoma, these values were 0.78 ng/mL and 1.23 ng/mL for younger and older men, respectively, among those without benign prostatic hyperplasia, and 0.97 ng/mL and 1.75 ng/mL for younger and older men, respectively, among those with benign prostatic hyperplasia. Accurate estimates of the mean and variance of PSA values for men with or without cancer may provide PSA thresholds for biopsy that are specific for age and prostate size as assessed by digital rectal exam. Therefore, the current threshold of 4.0 ng/mL should not be applied indiscriminately.

Molecular diagnosis of prostate cancer.

The diagnosis, staging, and management of prostate cancer as we know it today is greatly dependent on our ability to measure serum prostate-specific antigen (PSA) concentration. Nevertheless, because serum PSA concentration, particularly when less than 10 ng/mL, reflects the presence of benign prostatic hyperplasia more often than cancer, there is a clear need for more specific prostate cancer markers. The most promising new markers for prostate cancer are the various molecular forms of free PSA. Mass spectrometry also is emerging as a potential tool in prostate cancer screening. Because it is unlikely that any one marker will have 100% sensitivity and specificity, as new serum markers are tested, nomograms that incorporate multiple independently predictive parameters for the detection of prostate cancer will become indispensable in our efforts to improve prostate cancer screening.

Seminal plasma contains “BPSA,” a molecular form of prostate‐specific antigen that is associated with benign prostatic hyperplasia

BACKGROUND We previously reported that levels of BPSA, a modified form of prostate-specific antigen (PSA), are significantly elevated in prostate transition-zone tissue exhibiting nodular hyperplastic changes associated with the presence of benign prostatic hyperplasia (BPH). BPSA was purified and found to contain a characteristic clip between Lys182 and Ser183. We now describe the identification of BPSA in seminal plasma. METHODS PSA was purified from seminal plasma by immunoaffinity chromatography. The purified PSA was further resolved by hydrophobic interaction chromatography, and the individual PSA forms were analyzed by gel electrophoresis and N-terminal amino-acid sequencing. RESULTS BPSA comprised about 8% of the PSA in pooled seminal plasma, and was identical to BPSA purified from prostate tissues. BPSA was cleanly resolved from all active and inactive forms of PSA. Other inactive forms of PSA in seminal plasma consisted largely of PSA clipped at Lys145, though about 30% of the inactive seminal plasma PSA was intact, mature PSA. CONCLUSIONS BPSA represents a distinct form of inactive PSA in the seminal plasma that may represent a specific marker for the biochemical changes associated with nodular development in the prostate transition zone found in patients with BPH. Prostate 45:271–276, 2000. © 2000 Wiley-Liss, Inc.

Seminal plasma contains "BPSA," a molecular form of prostate-specific antigen that is associated with benign prostatic hyperplasia.

We previously reported that levels of BPSA, a modified form of prostate-specific antigen (PSA), are significantly elevated in prostate transition-zone tissue exhibiting nodular hyperplastic changes associated with the presence of benign prostatic hyperplasia (BPH). BPSA was purified and found to contain a characteristic clip between Lys182 and Ser183. We now describe the identification of BPSA in seminal plasma. PSA was purified from seminal plasma by immunoaffinity chromatography. The purified PSA was further resolved by hydrophobic interaction chromatography, and the individual PSA forms were analyzed by gel electrophoresis and N-terminal amino-acid sequencing. BPSA comprised about 8% of the PSA in pooled seminal plasma, and was identical to BPSA purified from prostate tissues. BPSA was cleanly resolved from all active and inactive forms of PSA. Other inactive forms of PSA in seminal plasma consisted largely of PSA clipped at Lys145, though about 30% of the inactive seminal plasma PSA was intact, mature PSA. BPSA represents a distinct form of inactive PSA in the seminal plasma that may represent a specific marker for the biochemical changes associated with nodular development in the prostate transition zone found in patients with BPH.

Tamsulosin palliates radiation-induced urethritis in patients with prostate cancer: results of a pilot study

Purpose: A pilot study was performed to determine the effectiveness of Flomax (tamsulosin HCl) in the management of acute radiation urethritis in prostate cancer patients undergoing conformal external beam radiation therapy (RT). Potential predictors of response to Flomax were evaluated. Methods and Materials: From January 1998 to April 1998, 26 consecutive patients who developed symptoms of radiation urethritis while undergoing RT for prostate cancer were treated with Flomax, a superselective α 1A-adrenergic antagonist. A genitourinary review of systems served as the instrument used to assess baseline urinary function and treatment response. Results: The initial response rate to Flomax was 62% (16/26) at the 0.4 mg level and 60% (6/10) at the 0.8 mg level. Half of the 16 patients who initially responded to 0.4 mg subsequently progressed. Three-fourths of those patients who progressed, however, achieved a durable response with the 0.8 mg dose. Therefore urinary symptoms were ultimately controlled in 77% (20/26) of the patients. After correcting for the testing of multiple hypotheses ( n = 5), the presence of benign prostatic hyperplasia (BPH) approached statistical significance for predicting the initial response to the 0.4 mg dose of Flomax (78% vs. 25%, p = 0.03). Conclusion: Flomax appears to be effective in relieving the symptoms of radiation urethritis. A Phase II trial is justified and in progress.