Prostatic Blood Flow Research Articles

Prostate perfusion mapping using Fourier-transform based velocity-selective arterial spin labeling: Choice of cutoff velocity and comparison with brain.

To develop velocity selective arterial spin labeling (VSASL) protocols for prostate blood flow (PBF) and prostate blood volume (PBV) mapping. Fourier-transform based velocity-selective inversion and saturation pulse trains were utilized in VSASL sequences to obtain blood flow and blood volume weighted perfusion signal, respectively. Here four cutoff velocities (Vcut = 0.25, 0.50, 1.00, and 1.50 cm/s) for PBF and PBV mapping sequences were evaluated with a parallel implementation in brain for measuring cerebral blood flow (CBF) and cerebral blood volume (CBV) with identical 3D readout. This study was performed at 3T on eight young and middle-aged healthy subjects comparing both perfusion weighted signal (PWS) and temporal SNR (tSNR). In contrast to CBF and CBV, the PWS of PBF and PBV were rather unobservable at Vcut of 1.00 or 1.50 cm/s and both PWS and tSNR of PBF and PBV considerably increased at the lower Vcut , indicating that blood moves much slower in prostate than in brain. Similar to the brain results, the tSNR of PBV-weighted signal was about two to four times over the corresponding values of PBF-weighted signal. The results also suggested a trend of reduced vascularity within prostate during aging. For prostate, a low Vcut of 0.25-0.50 cm/s seemed necessary for both PBF and PBV measurements to obtain adequate perfusion signal. As in brain, PBV mapping yielded a higher tSNR than PBF.

High Intensity Pulsed Magnetic Field Application in Patients with Chronic Prostatitis Complicated by Erectile Dysfunction: а Randomized Prospective Study

INTRODUCTION. Chronic prostatitis is one of the most common urological nosologies, the third most common diagnosis in men under 50 years old. Existing scientific sources testify to the effectiveness of various physiotherapeutic interventions in patients with infectious-inflammatory diseases of the male reproductive system, complicated by erectile dysfunction. AIM. The aim of the study was the scientific substantiation of high-intensity pulsed magnetic field application in patients with chronic prostatitis complicated by erectile dysfunction. MATERIAL AND METHODS. The study included 60 patients randomized into two groups. The first group (30 people) received high-intensity pulsed magnetic field; the second group (30 people) received drug therapy. RESULTS AND DISCUSSION. It was shown that the high clinical results of high-intensity pulsed magnetic field application were based on the compensation of local blood circulation conditioned by the improvement of the prostate blood flow according to the ultrasound of the prostatic vessels as well as by the elimination of the penile blood supply deficiency due to the improvement of the arterial vessels tone and elimination of venous stasis according to laser doppler flowmetry. CONCLUSION. An innovative method has been developed to treat patients with chronic prostatitis complicated by erectile dysfunction using high-intensity pulsed magnetic field.

Molecular Regulation of Concomitant Lower Urinary Tract Symptoms and Erectile Dysfunction in Pelvic Ischemia.

Aging correlates with greater incidence of lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) in the male population where the pathophysiological link remains elusive. The incidence of LUTS and ED correlates with the prevalence of vascular risk factors, implying potential role of arterial disorders in concomitant development of the two conditions. Human studies have revealed lower bladder and prostate blood flow in patients with LUTS suggesting that the severity of LUTS and ED correlates with the severity of vascular disorders. A close link between increased prostatic vascular resistance and greater incidence of LUTS and ED has been documented. Experimental models of atherosclerosis-induced chronic pelvic ischemia (CPI) showed increased contractile reactivity of prostatic and bladder tissues, impairment of penile erectile tissue relaxation, and simultaneous development of detrusor overactivity and ED. In the bladder, short-term ischemia caused overactive contractions while prolonged ischemia provoked degenerative responses and led to underactivity. CPI compromised structural integrity of the bladder, prostatic, and penile erectile tissues. Downstream molecular mechanisms appear to involve cellular stress and survival signaling, receptor modifications, upregulation of cytokines, and impairment of the nitric oxide pathway in cavernosal tissue. These observations may suggest pelvic ischemia as an important contributing factor in LUTS-associated ED. The aim of this narrative review is to discuss the current evidence on CPI as a possible etiologic mechanism underlying LUTS-associated ED.

Effects of losartan on glandular epithelial prostatic hyperplasia in spontaneously hypertensive rats

ABSTRACT Introduction Benign prostatic hyperplasia (BPH) and benign prostatic enlargement (BPE) are common disorders in aging men and cause lower urinary tract symptoms. Hypertension induces atherosclerosis in the blood vessels of the lower urinary tract, subsequently following by the development of BPH and BPE. Clinical study demonstrated that anti-hypertensive drug angiotensin II type 1 receptor blocker (ARB) treatment improved storage and voiding scores in male patients with hypertension, whereas other antihypertensive drugs were not effective. ARB could improve prostatic hyperplasia independent of reducing blood pressure. Spontaneously hypertensive rats (SHRs) are widely used as genetically hypertensive model. SHRs also demonstrate decreased prostatic blood flow and develop glandular epithelial hyperplasia and morphological abnormalities in the ventral prostate. Objective We examined the effects of an ARB, losartan on glandular epithelial prostatic hyperplasia in SHRs. Methods Thirty-six-weeks old male SHRs were orally treated with losartan (3 or 10 mg/kg/day) or vehicle once daily for 18 weeks. Wistar Kyoto rats (WKYs) were treated with vehicle were used as controls (n = 8). After the oral treatment, effects of losartan were evaluated by measuring prostate weight, blood pressure, and prostatic blood flow. The tissue levels of malondialdehyde (oxidative stress marker; MDA), interleukin-6 (inflammatory cytokine; IL-6), and basic fibroblast growth factor (bFGF) levels in ventral prostate were measured by colorimetric assay and ELISA assay. Histological analysis for the ventral prostate was performed by hematoxylin and eosin (HE) staining and TdT-mediated dUTP nick-end labeling (TUNEL) assay. The glandular epithelial area was determined by HE staining. TUNEL assay was performed to quantify the degree of apoptosis. The statistical differences were determined using one-way analysis of variance followed by the Tukey-Kramer test. Histological data were analyzed using the nonparametric Kruskal-Wallis test followed by the Mann-Whitney U test with Bonferroni's correction for multiple comparison. Results Body weight did not significantly differ among the groups. The vehicle treated SHRs had significantly higher prostate weight, prostate weight/body weight ratio (PBR), blood pressure, glandular epithelial area, and tissue MDA, IL-6, and bFGF levels in the ventral prostate and lower prostatic blood flow compared to the vehicle treated WKYs. Treatment with losartan significantly decreased PBR and improved prostatic blood flow and glandular epithelial area as well as tissue MDA, IL-6, and bFGF levels in the SHR ventral prostate without affecting blood pressure. High-dose losartan significantly decreased blood pressure and increased TUNEL-positive cells in the ventral prostate in SHRs. Conclusion Chronic losartan treatment could improve glandular epithelial prostatic hyperplasia via recovery of reduced prostatic blood flow and induction of apoptosis in the ventral prostate in SHRs. Losartan might improve not only hypertension but also prostatic hyperplasia in humans. Disclosure Work supported by industry: no.

Phosphodiesterase 5 inhibitor suppresses prostate weight increase in type 2 diabetic rats

Aims: Hyperinsulinemia is an important causative factor of prostate enlargement in type 2 diabetes (T2D), however, clinically prostate weight increases during hypoinsulinemic condition. To investigate the pathogenesis of prostate enlargement and effects of phosphodiesterase 5 inhibitor (PDE5i), male Otsuka Long-Evans Tokushima Fatty (OLETF) and Long-Evans Tokushima Otsuka (LETO) rats were used as T2D and control, respectively.Materials and Methods: OLETF and LETO rats were treated with oral tadalafil (100 μg/kg/day) or vehicle for 12 wks from at the age of 36 wks.Key findings: Prostate weight of OLETF rats was significantly higher than that of LETO at 36 wks, and increased at 48 wks. In OLETF rats, prostate blood flow was significantly lower at 48 wks versus 36 wks. Twelve-week-tadalafil treatment increased prostate blood flow and suppressed prostate weight increase in both strains. This change was inversely correlated with changes in prostate expressions of hypoxia-inducible factor-1 alpha (HIF-1α) and 8-hydroxy-2′-deoxyguanosine (8-OHdG). Increases with age were observed in mRNA and/or protein levels of cytokines interleukin (IL)-6, IL-8, and tumor necrosis factor-alpha (TNF-α) and cell growth factors insulin-like growth factor-1 (IGF-1), basic fibroblast growth factor (bFGF), and transforming growth factor-beta (TGF-β); especially IL-6, TNF-α, IGF-1, bFGF and TGF-β increased with T2D. Tadalafil suppressed these cytokines and growth factors.Significance: These data suggest chronic ischemia caused by T2D leads to oxidative stress, resulting in prostate enlargement through upregulation of several cytokines and growth factors. Treatment with PDE5i improves prostate ischemia and might prevent enlargement via suppression of cytokines and growth factors in T2D.

Лечение больных с симптомами нижних мочевых путей и эректильной дисфункции после трансуретральных операций на предстательной железе

Objective: to assess the clinical utility of a comprehensive multimodal treatment including phosphodiesterase type 5 (PDE5) inhibitors + extracorporeal shockwave therapy (ESWT) + inhalations with a heated mixture of helium and oxygen (Thermogeliox technology) in patients with urination disorders and erectile dysfunction that had undergone transurethral surgery for benign prostatic hyperplasia (BPH). Patients and methods. This prospective single-blind randomized study was conducted at the Medical Research and Educational Center, M.V.Lomonosov Moscow State University and included 60 patients aged 50 to 80 years that were randomly assigned to one of the two groups matched for the main characteristics. Patients in the experimental group received basic pharmacotherapy (tamsulosin 0.4 mg and tadalafil 5 mg daily) plus courses of anti-ischemic treatment (10 procedures in each course; two procedures per week). The anti-ischemic treatment included ESWT using the Dornier MedTech ARIES device (Germany) and oxygen-helium therapy using the BreezeLite device (InertGaz medical, Russia). Arterial blood flow in the peripheral prostate was assessed using the rectal probe of the Philips EPIQ 7 ultrasound scanner (USA); peak systolic velocity (Vps, cm/sec) and the arterial resistance index (RI) were measured in the right and left prostatic arteries. The severity of the disease was evaluated by assessing both subjective (International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF)) and objective parameters (frequency and quality of nocturnal penile tumescences using the Androscan MIT recorder and maximum urine flow at uroflowmetry). Data analysis was conducted using the Statistica 10 software; differences were considered significant at р < 0.05. Results. Patients in both groups reported a significant improvement of their condition (both IPSS and IIEF scores decreased) and maximum urine flow. Treatment also improved arterial blood flow in the peripheral prostate in both groups: in the experimental group, Vps increased from 7.95 ± 0.12 cm/sec to 14.05 ± 0.16 cm/sec; in the control group, Vps increased from 8.07 ± 0.11 cm/sec to 11.42 ± 0.17 cm/sec. Patients in the experimental group had a more pronounced treatment effect 3 months after its completion (13.01 ± 0.20 cm/sec vs 10.40 ± 0.20 cm/sec; p < 0.05). Erectile function (IIEF and androscan) was restored in 10 patients (33.3%) from the experimental group and 5 patients (16.7%) from the control group. The ratios of patients with ED of varying severity also changed: in the experimental group, the number of patients with grade I disease increased to 14 (46.7%), while the number of patients with grade II and grade III disease decreased to 5 (16.67%) and 1 (3.3%), respectively. In the control group, these numbers were 13 (43,3%), 9 (30%), and 3 (10%), respectively. Conclusion. Patients may develop prostatic ischemia in the late postoperative period due to infravesical obstruction and concomitant diseases. Further development of treatment techniques aimed to prevent the consequences of such ischemia will reduce the incidence of complications, improve the outcomes of transurethral surgeries for BPH, and significantly improve the quality of life of patients.

P–052 Structural and functional changes in the prostate gland of men following orchitis

Abstract Study question The aim of the study was to establish echometric parameters, hemodynamic and cytohistological changes in the prostate gland in men of reproductive age after orchitis. Summary answer After orchitis, volume and mass of the prostate increased compared to the control group, blood flow was reduced, histologically and electron microscopy changes were observed. What is known already According to the literature, prostate diseases in men of reproductive age are an important issue in urology and andrology. The most common among them are infectious lesions of the genitourinary system, which constitute about 45%. These include, orchitis, as a part of the infectious process of the entire reproductive system. Half of the cases of orchitis are sexually transmitted infections or associated with infections that come from urogenital tract. In the majority of patients orchitis leads to infertility. But the state of the prostate, under these conditions, remains poorly understood. Study design, size, duration We used ultrasound diagnostics and colour ultrasound angiography of the prostate gland of 10 men aged 36–42 years, who suffered from orchitis. The data of 7 healthy men of the same age served as control. For histological and electron microscopy served tissues of prostate gland obtained from the 5 men of the same age group during minor invasive surgery. Statistical processing of the results was carried out using the program Statistica 10. Participants/materials, setting, methods: The length, width, height, volume and mass of the prostate were determined in the grey scale mode. The vascular pattern was determined by colour Doppler mapping (the course of the blood vessels, their diameter, the number in the symmetric sections of prostate). Qualitative hemodynamic indicators: peak systolic blood flow velocity (Vps) cm/s, diastolic blood flow velocity (Vd) cm/s, time average velocity (TAV) cm/s, pulsatility index (PI), volumetric flow rate (V) L/min. Histological methods and TEM. Main results and the role of chance After orchitis, the volume of prostate gland increased to (26.0 ± 1.4) cm3 vs (21.2±1.3) cm3 in control and its mass increased to (27.4±1.2) g vs (22.1±1.6) g in control group. The blood flow in the prostate was reduced: peak arterial blood flow velocity in the peripheral zone decreased up to (6.8±0.46) cm/s vs (18.8±3.0) cm/s in control and diastolic blood flow velocity decreased up to (2.75 ± 0.26) cm/s vs (5.7±0.1) cm/s in the control group. The final sections of the glands were cystically enlarged, the squamous epithelium was flattened, the nuclei were pyknotic and the cell borders were indistinguishable. Epithelial folds and shape were preserved, prostatic bodies and acidophilus secretion in the gaps were preserved. The relative volume of the glandular epithelium decreased up to 56.5% and the volume of the fibrous-muscular-elastic component around the lobules increased up to 43.5%. In the capillaries of the prostate, the nuclei of the endothelial cells were deformed, the cytoplasm was vacuolated, the crysts in the mitochondria were reduced, the basement membrane was expanded and uneven. In the nuclei of the prostatic epithelium the perinuclear condensation of chromatin observed, cytoplasm was vacuolated and accumulated drops of fat, the mitochondrial cristae were homogenized. Limitations, reasons for caution The results of the investigation approved by the Commission on Biomedical Ethics of the Precarpathian National University as appropriate and those do not violate moral and ethical norms in conducting research (Protocol №3 dated 16.10.2019). Wider implications of the findings: The results of research indicated changes in the prostate, which require further investigation of hormonal balance in men under these conditions. Trial registration number *

Qianliexin capsule exerts anti-inflammatory activity in chronic non-bacterial prostatitis and benign prostatic hyperplasia via NF-κB and inflammasome.

Qianliexin capsule (QLX) is a standardized traditional Chinese herbal preparation that has long been used to treat chronic non‐bacterial prostatitis (CNP) and benign prostatic hyperplasia (BPH). This study investigated the anti‐inflammatory activity of QLX in improving lower urinary tract symptoms (LUTS) associated with CNP and BPH. Rat models of CNP and BPH were induced by oestradiol or testosterone (hormonal imbalance) or chemical inflammation (carrageenan). QLX significantly relieved LUTS in CNP and BPH rat model by reducing prostate enlargement, epithelial thickness, pain response time, urine volume and bleeding time, and by improving prostatic blood flow. The expression of the pro‐inflammatory cytokines interleukin (IL)‐1β and tumour necrosis factor (TNF)‐α, the pro‐inflammatory transcription factor nuclear factor kappa‐light‐chain‐enhancer of activated B cells (NF‐κB), and inflammasome components (NLRP3, caspase‐1 and ASC) in CNP and BPH tissues was reduced by QLX addition. QLX treatment was followed by reduced cellular malondialdehyde and increased superoxide dismutase, catalase and glutathione peroxidase activity, consistent with antioxidant activity. Increases in Beclin‐1 expression and the LC3II/I ratio following QLX treatment indicated that autophagy had been induced. QLX relieved LUTS in CNP and BPH rat models by inhibiting inflammation. The underlying mechanisms included inhibition of inflammasome activation, NF‐κB activation, oxidant stress and autophagy.

Therapeutic effects of losartan on prostatic hyperplasia in spontaneously hypertensive rats

AimsWe investigated the therapeutic effects of losartan, an angiotensin II type 1 receptor blocker, on prostatic hyperplasia in spontaneously hypertensive rats (SHRs). Main methodsMale SHRs (age, 36 weeks) were perorally treated with losartan (3 or 10 mg·kg−1) or vehicle once daily for 18 weeks. Age-matched Wistar Kyoto rats (WKYs) were used as vehicle-treated controls (n = 8). The effects of losartan were evaluated by analyzing prostate weight, blood pressure, and prostatic blood flow. The tissue malondialdehyde (MDA), interleukin-6 (IL-6), and basic fibroblast growth factor (bFGF) levels were measured. Histological analysis for the ventral prostate involved hematoxylin and eosin staining and TdT-mediated dUTP nick-end labeling (TUNEL) assay. Key findingsCompared to the vehicle-treated WKYs, the vehicle-treated SHRs had significantly higher prostate weight, prostate weight/body weight ratio (PBR), blood pressure, glandular epithelial area, and tissue MDA, IL-6, and bFGF levels in the ventral prostate and lower prostatic blood flow. Treatment with losartan caused significant recovery of blood flow and decreased PBR and glandular epithelial area as well as tissue MDA, IL-6, and bFGF levels in the SHR ventral prostate without affecting blood pressure. High-dose losartan significantly decreased blood pressure and increased TUNEL-positive cells in the ventral prostate in SHRs. SignificanceChronic losartan treatment could ameliorate prostatic hyperplasia via recovery of reduced prostatic blood flow and induction of apoptosis in the ventral prostate in SHRs. Losartan might have therapeutic effects on not only hypertension but also prostatic hyperplasia in humans.

Endocrine, prostatic vascular, and proapoptotic changes in dogs with benign prostatic hyperplasia treated medically or surgically

Benign prostatic hyperplasia (BPH) is a disorder related to hormone imbalance, local angiogenesis, and prostate growth, which can be treated surgically (orchiectomy) or medically (most commonly with finasteride). However, finasteride therapy is not completely established in dogs regarding local action and posology. This study aimed to evaluate the effect of different doses of finasteride and orchiectomy on hormonal profile, prostate apoptosis, blood flow, and biometry in dogs with BPH. Dogs were assigned to the following groups: untreated, 0.1 mg, 0.2 mg, and 0.5 mg/kg/d of finasteride and orchiectomy. All dogs were assessed monthly: day 0 (before treatment), day 30, and day 60 and subjected to prostate B-mode and Doppler ultrasonography and hormonal analysis (testosterone and dihydrotestosterone). After 60 d, prostatic biopsy was performed for histology and immunohistochemical evaluation for apoptosis (caspase-3). On day 60, percentage reduction of prostatic volume was greater in orchiectomized dogs than that in finasteride groups, which, conversely, was greater than untreated dogs. On day 60, 0.2-mg finasteride, 0.5-mg finasteride, and orchiectomy groups had higher prostatic blood flow than 0.1-mg finasteride and untreated groups. In addition, both 0.5-mg finasteride and orchiectomy groups had an increase in prostate artery resistance. Orchiectomy significantly decreased androgen concentrations at 30 d onward, differing from the remaining groups. The orchiectomy group had lower caspase-3 immunostaining, however, not different from untreated and 0.5-mg finasteride. In conclusion, 0.5 mg/kg finasteride promoted more effective prostate apoptosis and hemodynamic effects among medical treatments, whereas orchiectomy caused prostate atrophy and sharp endocrine changes in dogs with BPH.

Correlation of Prostatic Artery Blood Flow Assessed by Doppler Ultrasonography with Semen Characteristics in Beagle Dogs.

Simple SummaryThis study examined the blood flow parameters of the prostate artery before dog ejaculation assessed by pulsed-wave Doppler ultrasound (PwD) changes. The main objective of this study was to characterize the vascular parameters of the prostatic artery in beagle dogs and to explore the potential use of Doppler ultrasonography as a complementary method in dog stud selection. These findings report differences between blood flow parameters in cranial and caudal locations of the prostatic artery in comparison to subcapsular and parenchymal locations. There was a high positive correlation of peak systolic velocity with total volume and sperm concentration. In conclusion, estimation of the PwD parameters of the cranial prostatic artery may be useful in the breeding evaluation of dogs.Pulsed-wave Doppler ultrasonography (PwD) is a method used to rapidly and noninvasively assess blood flow dynamics of the canine prostate. Modifications in gland vascularization can affect seminal plasma production and consequently sperm quality. The aim of this study was to determine the normal blood flow parameters of the prostate artery in beagle dogs and to analyze the correlations between vascular flow and semen quality characteristics. PwD was performed on five beagle dogs (5–6 years) measuring vascular features in four different locations of the prostatic artery (cranial, subcapsular, parenchymal and caudal); the measured features were peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index (RI) and pulsatility index (PI). Ejaculates were obtained using digital manipulation and semen quality was evaluated by determining macroscopic (total volume, sperm-rich fraction volume, color and pH) and microscopic (sperm motility, morphology, viability and acrosome integrity) characteristics. The values of PSV, PI and RI in cranial and caudal prostatic arteries were significantly higher than in subcapsular and parenchymal arteries (p < 0.05). Moreover, a positive correlation of PSV value in the cranial region of the prostatic artery with total ejaculate volume (p < 0.01, r = 0.612) and sperm concentration (p < 0.01, r = 0.587) was determined. PI index was negatively correlated with sperm concentration (p < 0.01, r = −0.709). In conclusion, the results suggest that the prostatic artery blood flow parameters can affect macroscopic semen quality characteristics in healthy dogs.

Bladder sensation evaluation of a carrageenan-induced chronic prostatitis model using a direct measurement of the bladder mechanosensitive single-unit afferent nerve activity.

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) causes long-standing pain and/or storage symptoms. This study aimed to evaluate the likelihood of deterioration of bladder sensation in a carrageenan-induced CP/CPPS model by direct measurement of the bladder mechanosensitive single-unit afferent nerve activity. In this study, male adult Sprague-Dawley rats were used. They were injected 50 µL of 3% λ-carrageenan or its vehicle (saline) into both lobes of the ventral prostate. Seven days following injection, the pain behavior at the pelvic-perineal area (using von Frey filaments), prostatic blood flow (using a laser blood flowmeter), and histology were examined along with cystometry (under conscious free-moving condition) and mechanosensitive single-unit afferent nerve activity (under urethane anesthesia). The prostate showed increased tissue weight and decreased blood flow and inflammatory cell infiltration in the carrageenan group compared to the control group. Consequently, the threshold of the pain behavior was decreased, and the basal and threshold pressures of the bladder were increased in the carrageenan group. In contrast, no significant differences of bladder histology and other cystometric parameters were found between the groups. Regarding Aδ- or C-fibers, the mechanosensitive afferent nerve activities revealed no differences in either group. The carrageenan-induced CP/CPPS rat model showed edema, ischemia, and inflammatory pain in the prostate, whereas a little change was detected in bladder sensation. These findings, which were evaluated using a direct measurement of the mechanosensitive single-unit afferent nerve activity, suggest that the bladder sensation is unlikely deteriorated in this model.

Contrast-enhanced transrectal ultrasound can reduce collection of unnecessary biopsies when diagnosing prostate cancer and is predictive of biochemical recurrence following a radical prostatectomy in patients with localized prostate cancer

BackgroundTo investigate the value of using contrast-enhanced transrectal ultrasound (CETRUS) to reduce unnecessary collection of biopsies during prostate cancer diagnosis and its utility in predicting biochemical recurrence in patients with localized prostate cancer.MethodsThis was a prospective study of suspected prostate cancer patients who were evaluated with CETRUS followed by a prostate biopsy. Prostate blood flow via CETRUS was graded using a 5-point scale. The relationship between CETRUS score and biopsy outcome was then analyzed for all patients; univariate and multi-variate analyses were used to determine the probable prognostic factors for biochemical recurrence in patients with localized prostate cancer that underwent a radical prostatectomy.ResultsA total of 347 patients were enrolled in the study. Prostate cancer was found in 164 patients. A significant positive correlation (r = 0.69, p < 0.001) was found between CETRUS scores and prostate cancer incidence. Using CETRUS scores ≥2 as the threshold for when to biopsy could have safely reduced the number of biopsies taken overall by 12.1% (42/347) and spared 23.0% (42/183) of patients from undergoing an unnecessary biopsy. 77 patients with localized prostate cancer underwent a radical prostatectomy. The median follow-up time was 30 months (range: 8–56 months) and 17 of these 77 patients exhibited biochemical recurrence during the follow-up period. 3-year biochemical recurrence-free survival rates were 86% for patients with low CETRUS scores (≤ 3) and 59% for patients with high scores (> 3; p = 0.015). Multivariate Cox regression analysis indicated that CETRUS score was an independent predictor of biochemical recurrence (HR: 7.02; 95% CI: 2.00–24.69; p = 0.002).ConclusionsCETRUS scores may be a useful tool for reducing the collection unnecessary biopsy samples during prostate cancer diagnosis and are predictive of biochemical recurrence in patients with localized prostate cancer following a radical prostatectomy.

Protective effects of tadalafil on prostatic hyperplasia in spontaneously hypertensive rats

We investigated the effects of the phosphodiesterase type 5 inhibitor, tadalafil on prostatic hyperplasia in a hypertensive rat model. Twelve-week-old male spontaneously hypertensive rats (SHRs) were orally treated with tadalafil (2 or 10 mg/kg/day) or vehicle for six weeks. Wistar Kyoto (WKY) rats treated with vehicle were used as controls. The effect of tadalafil was evaluated by measuring prostate weight, blood pressure, and prostatic blood flow. The presence of malondialdehyde (MDA), interleukin-6 (IL-6), transforming growth factor-beta1 (TGF-β1), and basic fibroblast growth factor (bFGF) in the ventral prostate were examined. Hematoxylin and eosin staining was performed to assess the morphological change. The prostatic contractility was evaluated by an organ bath experiment. The vehicle-treated SHRs demonstrated a significantly higher prostate weight, prostate weight/body weight ratio (PBR), blood pressure, and tissue levels of MDA, IL-6, TGF-β1, and bFGF, and lower prostatic blood flow compared to the vehicle-treated WKY rats. Moreover, the SHRs showed glandular morphological abnormalities in the ventral prostate compared to the WKY rats. There was no significant difference in potassium chloride or noradrenaline-induced prostatic contractility between the WKY rats and the SHRs. Treatment with tadalafil decreased prostate weight and PBR in a dose-dependent manner, and improved prostatic blood flow and tissue levels of MDA, IL-6, TGF-β1, and bFGF in SHRs, without affecting the blood pressure. Furthermore, tadalafil ameliorated the glandular morphological abnormalities in the SHR ventral prostate. In conclusion, tadalafil could suppress the prostatic hyperplasia via recovery of reduction in prostatic blood flow in SHRs.

Can Computed Tomography Perfusion Predict Treatment Response After Prostate Artery Embolization: A Feasibility Study

Prostate artery embolization (PAE) is an emerging therapy for benign prostatic hyperplasia (BPH). Optimal patient selection is an important step when introducing new treatments and several characteristics associated with a good clinical outcome has previously been proposed. However, no prognostic tool is yet available for PAE. Computed tomography perfusion is an imaging technique that provides hemodynamic parameters making it possible to estimate the prostatic blood flow (PBF). This study investigated the relationship between PBF and the response to PAE. A post hoc analysis including prostate-specific antigen (PSA) measurements before and 24-h after embolization from two prospective studies on sixteen patients undergoing PAE with BPH or prostate cancer were performed. The primary outcome was the correlation between baseline PBF and the change in PSA as a surrogate measure of treatment response. Prostate volume strongly correlated with treatment response and the response was greater with incremental amounts of injected embolic material. PBF was not associated with elevation in PSA and added no information that could guide patient selection.

Отдаленные результаты первого опыта лечения мужчины с синдромом Мея–Тюрнера и варикозной болезнью вен органов малого таза

Recurrent and bilateral varicocele represent two least studied aspects of the disease. There is no recommendation in current urological and andrological guidelines in various countries on the diagnosis and treatment of such patients. The first experience of successful surgical treatment of a patient with recurrent varicocele due to May-Thurner syndrome is presented in this paper. The patient had a severe form of the disease and admitted with the varicocele recurrence after 5 previous intervention with chronic pelvic pain syndrome, erectile dysfunction, chronic calculous prostatitis and varicose veins of the pelvic organs. The patient underwent balloon angioplasty and stenting of the left iliac vein on 28th March, 2017 in the City hospital named after E.O. Mukhin. There was almost complete resolution of pelvic pain in the immediate postoperative period (within 1 hour). One week after surgery the patient noted a recovery of erection without any therapy. Three months later, a 45% reduction in the maximum diameter of the prostatic veins was noted according to transrectal ultrasound (TRUS) as well as a lack of antegrade blood flow according to the color Doppler TRUS at rest and during Valsalva's test. There was no deterioration of symptoms during follow-up. Overall, the venous blood flow in prostate was decreased which accompanied by the reducing in pain syndrome and restoration of sexual function without medical therapy. The reduction of diameter of testicular and epididymal varicose veins was seen 6 months after surgery. The diameter of veins of pampiniform plexus in supine position at rest was less than 2 mm. There was no retrograde flow neither in supine, nor in stand position during Valsalva maneuver. Thus, X-ray endovascular angioplasty and stenting of the iliac veins in case of arterio-venous crossing at the lower level is a pathogenetically justified and highly effective treatment of varicocele and varicose veins of the pelvic organs in men.

Prostatic blood flow as prominent targets on benign prostatic hyperplasia

Benign prostatic hyperplasia/benign prostatic enlargement (BPH/BPE) is a common proliferative disease, and giving rise to associate with lower urinary tract symptoms (LUTS). However, the pathogenesis is not well clarified, and thought to be multifactorial. There are some lines of evidence that impairment in the blood supply of the lower urinary tract causes development of BPH/BPE. Clinical data showed an association between the development of BPH/BPE and atherosclerotic disease such as hypertension, diabetes and hyperlipidemia. The spontaneously hypertensive rat (SHR) has been used as model of genetic hypertension. SHR also shows decreased blood flow and hyperplastic morphological abnormalities in the ventral prostate. Our previous studies demonstrated that chronic treatment with vasodilative drugs nicorandil (ATP sensitive potassium channel opener) and silodosin (alpha1 adrenoceptor antagonist) increased blood flow and suppressed the growth factor and morphological abnormalities in the SHR ventral prostate. These data suggested that prostatic blood flow could be therapeutic targets for BPH/LUTS.

Phosphodiesterase type 5 inhibitor attenuates chronic ischemia-induced prostatic hyperplasia in a rat model.

Many elderly men suffer from benign prostatic hyperplasia (BPH). Recently, chronic ischemia in the prostate has been suggested to be related to BPH. Thus, the impact of chronic ischemia on the development of prostatic hyperplasia and the efficacy of phosphodiesterase type 5 (PDE5) inhibitor for hyperplasia were evaluated in a rat model with chronic ischemia induced by local atherosclerosis. Eighteen male Sprague-Dawley rats were divided into three groups: sham operation, regular diet, placebo (SRP); arterial endothelial injury, high cholesterol diet, placebo (AHP); or arterial endothelial injury, high cholesterol diet, and tadalafil as a PDE5 inhibitor (AHT). The endothelial injury in the common iliac arteries was performed using a 2-Fr Fogarty arterial embolectomy catheter through an incision in the femoral artery into the common iliac artery. Diet and oral drugs were administrated for 8 weeks after surgery. At 8 weeks, blood flow to the ventral prostate (VP) was measured using laser speckle blood flow analysis, and the VP was histologically evaluated. In the AHP group, prostatic blood flow was reduced, and mean VP weight and the interstitial area were significantly enlarged compared with the SRP group. In the AHT group, tadalafil administration obviously ameliorated the reduction of prostatic blood flow relative to the AHP group. Importantly, mean VP weight and the morphological changes in the AHT group were significantly smaller than those in the AHP group. Enlargement of the VP resulted from chronic ischemia induced by local arteriosclerosis. Also, administration of tadalafil attenuated VP enlargement. Chronic ischemia in the prostate might thus contribute to the development of BPH, and PDE5 inhibitors might provide an innovative approach to preventing BPH.

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.

The state of prostate hemodynamics in patients with myophascial pain syndrome

The aim of this study was to evaluate the state of blood flow in prostate in 59 men with chronic pelvic pain due to myofascial syndrome in the absence of clinical manifestations of chronic prostatitis and its dynamics against the background of the treatment. The results of the study revealed a reliable relationship between the severity of blood flow disorders in the prostate and the intensity of pain symptoms caused by myofascial syndrome. It was concluded that the hemodynamic disorders of the prostate caused by myofascial syndrome are important in the possible formation of clinical symptoms of chronic pelvic pain in men. (For citation: Krupin VN, Krupin AV, Belova AN, Nashivochnikova NA. The state of prostate hemodynamics in patients with myophascial pain syndrome. Urologicheskie vedomosti. 2017;7(4):39-43. doi: 10.17816/uroved7439-43).