Prostatic Hypertrophy Patients Research Articles

Effects of the beta-blocker carvedilol on arrhythmia and long-term clinical outcomes in benign prostate hypertrophy patients.

Benign prostatic hypertrophy (BPH) is associated with autonomic dysfunction and sympathetic nervous system mediated by the alpha receptor. However, limited data exist regarding the effects of the beta-blocker (BB) carvedilol on arrhythmia and urologic outcomes in BPH patients. Our database of patients diagnosed with BPH from 2015 to 2020 was used to obtain echocardiography and electrocardiogram data. Inclusion criteria were BPH patients taking BBs. International Prostate Symptom Score questionnaire were used to evaluate the urinary symptoms and quality of life. Among 448 patients with BPH (69.2 ± 10.9 years) taking BBs, 219 patients took carvedilol (48.9%) and 229 patients took a non-carvedilol BB (51.1%; bisoprolol, 184 patients, 80% or nebivolol, 45 patients, 20%). Difference in the baseline characteristics was not observed. During the median 36-month follow-up, a lower incidence of arrhythmic events (P = .029), total urologic events (P < .001), and less use of additive alpha-blocker was observed in the carvedilol group (P = .022). In multivariate analysis, less carvedilol use (P = .019), heart failure (P < .001), stroke (P < .001), and cardiomyopathy (P = .046) were independent risk factors for arrhythmic events. In addition, less carvedilol use (P = .009) and older age (P = .005) were independent risk factors for urologic events based on BB type at the median 36-month follow-up. The use of carvedilol was associated with less arrhythmic events in BPH patients with palpitation and decreased the incidence of urologic events in BPH compared with the use of non-carvedilol BBs in long-term follow-up.

Day Temperature Difference and Aggravation of Low Urinary Tract Symptom in Benign Prostate Hypertrophy Patients in Korea: A National Health Insurance Service-National Cohort-based Study

To investigate the symptom deterioration of patients with benign prostatic hyperplasia (BPH) according to the difference in daily temperature. From the National Health Insurance Service database, we collected and analyzed data on patients with BPH in 6 major metropolitan areas in Korea between January 2008 and December 2017. We investigated the rate of emergency room visits as well as the rate of urethral catheter insertion. In total, 1,446,465 patients were enrolled in this study. When the daily temperature difference was below 4°C, 28.5 patients visited the emergency room daily, while 42.2 patients visited the emergency room daily when the daily temperature difference exceeded 14°C. When the daily temperature difference was more than 14°C, about 48.0% more patients visited the emergency room than when the daily temperature difference was below 4°C. After visiting the emergency room, there were 11.9 patients who had a catheter inserted daily at the daily temperature difference below 4°C. When the daily temperature difference was more than 14°C, the number of catheter insertion cases was 17.8 patients daily, which was 49.2% higher than that of below 4°C. By time, surgery was performed most frequently within 3 months after visiting the emergency room. Day temperature difference appear to be related to the Lower urinary tract symptom of BPH patients.

Evaluation of urethral stricture after transurethral resection of the prostate in benign prostatic hypertrophy patients

Evaluation of urethral stricture after transurethral resection of the prostate in benign prostatic hypertrophy patients

Sleep Quality Improvement of Benign Prostate Hyperplasia Patients After Transuretral Resection of Prostate

ABSTRACT&#x0D; Introduction. Nocturia is lower urinary tract symptoms on benign prostat hyperplasia patients that made him asleep at night to urinate. This condition impacted on many level of patient life, which are quality of life, quality of sleep, daytime function, morbidity and mortality and nocturia has the biggest impact on patient sleep quality.&#x0D; Methods. This is an observational study including 30 patient of benign prostat hyperplasia undergoing transurethral resection of the prostate as research subjects. All patient were assessed using the Pittsburgh sleep quality index and international prostate symptom score at baseline and 2 month after transuretral resection of the prostate&#x0D; Results. A total 23 patients (76,7%) had a sleep disorder as a score of 5 or more on Pittsburgh sleep quality index score. After the transurethral resection of the prostate, pittsburgh sleep quality index score of 12 patient have decreased (less than 5) and 11 others with persistent sleep disorder. Pittsburgh sleep quality index significantly decreased after transurethral resection of the prostate from ±9,36 to ±5,03 (p-value 0,000). Nocturia also significantly decreased after transuretral resection of the prostate from ±3,46 to ±2,40 (P value 0,003). Lower urinary track symptoms in this patient also getting better after surgery. The international prostat symtoms score decreased after transurethral resection of the prostat from ±21,80 to ±7,67 with P value 0,000&#x0D; Conclusion. Transuretral resection of prostate improves sleep quality dan decreased lower urinary track symptoms in benign prostate hypertrophy patients.

English

INTRODUCTION : Intravesical prostatic protrusion (IVPP) is represented as a severe parameter of the Bladder outlet obstruction (BOO) due to Benign prostatic hypertrophy (BPH) traditionally and it is considered based on the experience that it can be cured only by surgical management. But till date it is not made standard in various association guidelines and in standard textbooks except for a few publications in literature. In symptomatic Benign prostatic hypertrophy patients, there is no consensus or clear practical guidelines to define the presence and severity of obstruction, other than the pressure-flow study. The latter has been traditionally regarded as the 'reference' gold standard but the technique is invasive, uncomfortable for the patient, time-consuming and expensive and not available, especially in most developing countries. The various standard non invasive measures used for finding the severity of Bladder outlet obstruction due to Benign prostatic hypertrophy are IPSS score(International prostatic symptoms score), Uroflowmetry and Postvoid residual urine estimation(PVR). Eventhough these are not considered significant to asses the severity of Bladder outlet obstruction on individual basis they are at present used in combination to asses the severity. Each one has their own pitfalls to be a single standard non invasive mode for assessing the severity of Bladder outlet obstruction due to Benign prostatic hypertrophy. Cystoscopy and Pressure flow study are reliable in assessing the severity of Bladder outlet obstruction due to Benign prostatic hypertrophy but both are invasive. AIM : To correlate Intravesical prostatic protrusion(IVPP) with International prostate symptoms score (IPSS),Quality of life index(QOL), Uroflowmetry, Postvoid urine (PVR) and Pressure Flow study (PFS) and to asses whether the presence and increasing grades of Intravesical prostatic protrusion are directly correlated with the severity of Bladder outlet obstruction due to Benign prostatic hypertrophy. Response of patients with Intravesical prostatic protrusion of same grade to surgical therapy and drug therapy are compared to decide which modality of management is best. MATERIALS AND METHODS : 1. Prospective study. 2. Period of study is from June 2006 to June 2009. 3. Age Range- 50 to 80 years. 4. The sample size is 100. 5. The patients with co morbid illness such as Diabetes Mellitus (DM), Hypertension (HTN) ,Tuberculosis (TB) etc and associated neurological conditions are excluded from the study. Patients with a known history of previous lower urinary tract surgery, prostate or bladder carcinoma, bladder calculi, or neurological deficit are also excluded from the study. CONCLUSION : The increasing grades of IVPP are significantly directly correlated with IPSS score, Q max and Postvoid residual. Among the three Qmax is the best correlated one. The Prostatic volume and QOL index do not correlate well with IVPP. 2. IVPP have a very good positive and negative predictive value and also a good accuracy rate in comparison with all other parameters in predicting the BOO. This is especially very significant in increasing grades of protrusion. Thus the IVPP correlates significantly with BOO; it should be used as one of the variables initially assessed in men with LUTS, being a less invasive (than pressure-flow studies in every patient) and a more cost-effective way to stratify patients with LUTS for further management. The surgical intervention statistically proved to be superior to medical treatment in IVPP patients, especially most significant in Grade II & III IVPP patients. In patients presented with AUR along with IVPP surgery proved the efficacy for succeful trial voiding. The patients failed medical treatment voided succefully after TURP.

A Magnetic Bead-Based Sensor for the Quantification of Multiple Prostate Cancer Biomarkers

Novel biomarker assays and upgraded analytical tools are urgently needed to accurately discriminate benign prostatic hypertrophy (BPH) from prostate cancer (CaP). To address this unmet clinical need, we report a piezeoelectric/magnetic bead-based assay to quantitate prostate specific antigen (PSA; free and total), prostatic acid phosphatase, carbonic anhydrase 1 (CA1), osteonectin, IL-6 soluble receptor (IL-6sr), and spondin-2. We used the sensor to measure these seven proteins in serum samples from 120 benign prostate hypertrophy patients and 100 Gleason score 6 and 7 CaP using serum samples previously collected and banked. The results were analyzed with receiver operator characteristic curve analysis. There were significant differences between BPH and CaP patients in the PSA, CA1, and spondin-2 assays. The highest AUC discrimination was achieved with a spondin-2 OR free/total PSA operation—the area under the curve was 0.84 with a p value below 10−6. Some of these data seem to contradict previous reports and highlight the importance of sample selection and proper assay building in the development of biomarker measurement schemes. This bead-based system offers important advantages in assay building including low cost, high throughput, and rapid identification of an optimal matched antibody pair.

Long noncoding RNA PCA3 gene promoter region is related to the risk of prostate cancer on Chinese males

IntroductionLong noncoding RNA prostate cancer gene antigen 3 (PCA3) is one of the most prostate cancer-specific genes at present. Consequently, the prostate-specific expression and the sharp up-regulation of PCA3 RNA in prostate cancer suggest a unique transcriptional regulation, which possibly can be attributed to promoter polymorphism. In this study, we investigated a short tandem repeat (STR) polymorphism of TAAA in the promoter region of PCA3 gene found in our previous study in prostate cancer (PCa) patients and benign prostatic hypertrophy (BPH) patients, aiming to evaluate the association between the STR and increased risk for PCa. Material and methods120 PCa cases and 120 benign prostatic hypertrophy (BPH) cases were identified among participants. The region encompassing the TAAA repeat was amplified with a specific primer set we designed and screened by PCR-based cloning and sequencing in paired peripheral blood leukocytes and prostate tissues. Genotype-specific risks were estimated as odds ratios (ORs) associated with 95% confidence intervals (CIs) and adjusted for age by means of unconditional logistic regression. Results5 PCA3 TAAA STR polymorphisms and 8 genotypes were found in both peripheral blood leukocytes and prostate tissues, the carriers with more TAAA repeats were associated with increased risk for PCa than individuals having less TAAA repeats. Interestingly, 18 (15.0%) of 120 PCa patients had more (TAAA)n repeats in prostate tissues than that in peripheral blood leukocytes, and 3 (2.5%) of 120 had less (TAAA)n repeats in prostate tissues. ConclusionsThe results of this study suggest that short tandem repeat polymorphism of TAAA in the promoter region of PCA3 gene is a risk-increasing factor for prostate cancer in the Chinese population. In addition to the hereditary factor, the insertion mutation of (TAAA)n in a local tissue maybe another mechanism of the onset of PCa.

Bipolar transurethral resection versus monopolar transurethral resection for benign prostatic hypertrophy: a systematic review and meta-analysis.

To evaluate the efficacy and safety of monopolar (M-TURP) and bipolar (B-TURP) transurethral resection of the prostate in benign prostatic hypertrophy (BPH) patients. Eligible randomized controlled trials (RCTs) were identified from electronic databases without language restrictions. Database search, quality assessment, and data extraction were independently performed. The primary postoperative outcomes of topical M-TURP and B-TURP were maximum flow rate (Qmax) and/or International Prostate Symptom Score (IPSS). Safety was estimated by TUR syndrome; need for transfusion; clot retention; bladder neck contracture (BNC); urethral stricture (US); and catheter removal time. Efficacy and safety were investigated using the Review Manager. Thirty-one trials met the inclusion criteria. Pooled analysis revealed significant difference in efficacy between the M-TURP and B-TURP groups. Safety analysis revealed significant improvement in the TUR syndrome with B-TURP than with M-TURP. Pooled analysis revealed that clot retention was significantly higher in M-TURP than in B-TURP. Moreover, pooled analysis revealed no significant difference between both groups in the blood transfusion frequency or late complications (urethral strictures) and bladder neck constriction. This systematic review indicates that B-TURP was significantly better in the result of Qmax and for decreasing the incidence of TUR syndrome and clot retention. No significant differences were observed in the nature of adverse events such as transfusions, retention after catheter removal, and urethral complications between both groups. Thus, B-TURP is the next generation "gold standard" for benign prostatic obstruction (BPO) because it is associated with a lower rate of clinically relevant complications such as TUR syndrome and clot retention.

Plasma Low-Molecular-Weight Proteome Profiling Identified Neuropeptide-Y as a Prostate Cancer Biomarker Polypeptide

In prostate cancer diagnosis, PSA test has greatly contributed to the early detection of prostate cancer; however, expanding overdiagnosis and unnecessary biopsies have emerged as serious issues. To explore plasma biomarkers complementing the specificity of PSA test, we developed a unique proteomic technology QUEST-MS (Quick Enrichment of Small Targets for Mass Spectrometry). The QUEST-MS method based on 96-well formatted sequential reversed-phase chromatography allowing efficient enrichment of <20 kDa proteins quickly and reproducibly. Plasma from 24 healthy controls, 19 benign prostate hypertrophy patients, and 73 prostate cancer patients were purified with QUEST-MS and analyzed by LC/MS/MS. Among 153 057 nonredundant peptides, 189 peptides showed prostate cancer specific detection pattern, which included a neurotransmitter polypeptide neuropeptide-Y (NPY). We further validated the screening results by targeted multiple reaction monitoring technology using independent sample set (n = 110). The ROC curve analysis revealed that logistic regression-based combination of NPY, and PSA showed 81.5% sensitivity and 82.2% specificity for prostate cancer diagnosis. Thus QUEST-MS technology allowed comprehensive and high-throughput profiling of plasma polypeptides and had potential to effectively uncover very low abundant tumor-derived small molecules, such as neurotransmitters, peptide hormones, or cytokines.

Abstract 4788: A focused proteomics technology QUEST-MS identified a novel plasma prostate cancer biomarker polypeptide complementing PSA test

Abstract Prostate cancer accounted for more than 250,000 death worldwide in 2009, which was the 9th highest cause of cancer related death in Japan (The Population Survey Report 2010, the Ministry of Health, Labor and Welfare). Although the widespread use of PSA test has contributed to the early diagnosis of prostate cancer, expanding overdiagnosis cases and unnecessary biopsies have emerged as a big issue. To identify novel plasma biomarkers that could complement the specificity of PSA test and improve diagnostic accuracy, especially in the early stage of prostate cancer, we employed a focused proteomic technology QUEST-MS (Quick Enrichment of Small Targets for Mass Spectrometry). The rapid 96-well format preparation method QUEST was simply based on sequential reversed phase chromatography purifications which allowed efficient enrichment of less than 20 kDa proteins from 116 plasma samples in a half of day, prior to LC/MS/MS analysis. In this biomarker screening experiment, plasma from 24 healthy controls, 19 benign prostate hypertrophy (BPH) patients, and 73 prostate cancer patients (Gleason score 5-10) were analyzed with LTQ-Orbitrap-Velos mass spectrometer. The 116 LC/MS/MS raw data were directly loaded onto the Expressionist proteome server platform (Genedata AG) and subjected to data processing, label-free quantification analysis, and the following biomarker discovery analysis. We extracted peptides demonstrating prostate cancer-specific expression patterns by Absent-Present Search algorithm on the Expressionist Analyst module, which searched all-or-nothing peptides between two clinical groups (healthy control + BPH vs. prostate cancer). Finally 108 peptides were selected from over 100,000 peptides with the criteria; detection in at most 1 case among 43 controls and at least 12 cases among 73 prostate cancer patients. Simultaneously, protein identification analysis was processed on the Proteome Discoverer 1.3 software (Thermo Scientific) using the Sequest program, resulting in 1,126 non-redundant plasma protein identifications with false discovery rate &amp;lt; 1%. The list included the identification of PSA with 4 distinct high-confidence level peptides. Here we would like to show a successful identification of a new prostate cancer biomarker candidate polypeptide which displayed the Gleason score-dependent escalation of its plasma level among 12 prostate cancer samples, and only low level detection in 1 control sample. Although the prostate-specific expression feature of this polypeptide was quite similar with PSA, the pattern of positive cases was independent. Thus, the integration of biomarker focusing technology QUEST-MS and the high-end mass spectrometer analysis might be able to reach lots of unidentified low abundant (around 100 pg/ml) serum/plasma biomarkers. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 4788. doi:1538-7445.AM2012-4788

Determination of doripenem penetration into human prostate tissue and assessment of dosing regimens for prostatitis based on site-specific pharmacokinetic–pharmacodynamic evaluation

Prostatic hypertrophy patients prophylactically received a 0·5-hour infusion of doripenem (250 or 500 mg) before transurethral resection of the prostate. Doripenem concentrations in plasma and prostate tissue were measured chromatographically, and analysed pharmacokinetically using a three-compartment model. The approved doripenem regimens were assessed based on the time above the minimum inhibitory concentration for bacteria (T>MIC, % of 24 hours), an indicator for antibacterial effects, at the prostate. The prostate tissue/plasma ratios were 17·3% for the maximum drug concentration and 18·7% for the area under the drug concentration–time curve, and they were irrespective of the dose. Against Escherichia coli and Klebsiella species isolates, 500 mg once daily achieved a >90% probability of attaining the bacteriostatic target (20% T>MIC) in prostate tissue, and 500 mg twice daily achieved a >90% probability of attaining the bactericidal target (40% T>MIC) in prostate tissue.

Devote much attention to improve quality of life of benign prostatic hypertrophy patients with overactive bladder symptoms

随着我国经济实力的增强、大众生活水平的提高以及文化教育程度的提升,人民群众对于生活质量的要求越来越高,这一点也体现在对疾病的诊疗和防治方面.人们对于恶性肿瘤等这类置人于死地的顽疾往往较为重视,但是常常忽略一些一般不危及生命、却严重影响患者生活质量的慢性疾病,膀胱过度活动症(overactive bladder,OAB)正属于这样的情况.因此,我们组织了本期重点栏目,以期对良性前列腺增生(benign prostatic hyperplasia,BPH)合并OAB这一重要临床问题进行全面阐述。

A comparison of sunlight exposure in men with prostate cancer and basal cell carcinoma

Ultraviolet radiation exposure increases basal cell carcinoma (BCC) risk, but may be protective against prostate cancer. We attempted to identify exposure patterns that confer reduced prostate cancer risk without increasing that of BCC. We used a questionnaire to assess exposure in 528 prostate cancer patients and 442 men with basal cell carcinoma, using 365 benign prostatic hypertrophy patients as controls. Skin type 1 (odds ratio (OR)=0.47, 95% CI=0.26–0.86), childhood sunburning (OR=0.38, 95% CI=0.26–0.57), occasional/frequent sunbathing (OR=0.21, 95% CI=0.14–0.31), lifetime weekday (OR=0.85, 95% CI=0.80–0.91) and weekend exposure (OR=0.79, 95% CI=0.73–0.86) were associated with reduced prostate cancer risk. Skin type 1 (OR=4.00, 95% CI=2.16–7.41), childhood sunburning (OR=1.91, 95% CI=1.36–2.68), regular foreign holidays (OR=6.91, 95% CI=5.00-9.55) and weekend (OR=1.17, 95% CI=1.08–1.27) but not weekday exposure were linked with increased BCC risk. Combinations of one or two parameters were associated with a progressive decrease in the ORs for prostate cancer risk (OR=0.54–0.25) with correspondingly increased BCC risk (OR=1.60–2.54). Our data do not define exposure patterns that reduce prostate cancer risk without increasing BCC risk.

Liquid chromatography–mass spectrometric assay of androstenediol in prostatic tissue: Influence of androgen deprivation therapy on its level

Androstenediol (Adiol, androst-5-ene-3β,17β-diol) is suspected of being an endogenous proliferation agent of prostate cancer (PCa) even after androgen deprivation therapy (ADT). A liquid chromatography–electron capture atmospheric pressure chemical ionization–mass spectrometric (LC–ECAPCI–MS) method for the determination of Adiol in prostatic tissue was developed and validated for evaluating the influence of ADT on the prostatic Adiol level. After derivatization of Adiol with 4-nitrobenzoyl chloride, the detection response of the derivative was increased 150 times more than that of intact Adiol. The LC–MS method was specific and reliable for the measurement of a trace amount of Adiol in 30 mg of tissue. The clinical study using the developed method showed that the prostatic Adiol level was not changed by ADT. That is, the prostatic Adiol levels of PCa patients with ADT ( n = 12), benign prostate hypertrophy patients without ADT ( n = 8) and bladder cancer patients (without prostatic disease) ( n = 6) were 0.83 ± 0.28, 0.62 ± 0.31 and 0.71 ± 0.28 ng g −1 tissue, respectively, and there was no significant difference between these groups.

The usefulness of percentage of free prostate specific antigen/prostate specific antigen density in the diagnosis of prostate cancer

To investigate the usefulness of percentage of free prostate specific antigen (FPSA/TPSA) in serum/PSA density [(F/T)/PSAD] in the diagnosis of prostate cancer. Two hundred and four patients who had been carried out transrectal ultrasound guided prostate biopsy, were involved in this study. Among them, 90 patients were proved to be suffering from prostate cancer, and other 114 patients were identified as benign prostate hypertrophy. The effect of total serum PSA level, FPSA/TPSA, PSAD and (F/T)/PSAD in the diagnosis of prostate cancer were investigated, and at the same time, selecting patients who should be carried out a prostate biopsy. The mean values of (F/T)/PSAD were significantly lower for patients with prostate cancer in different PSA levels (<4.0, 4.0-, 10.1-, >20.0 microg/L), when compared with benign prostate hypertrophy patients. This difference has arrived statistical significance (P < 0.05). (F/T)/PSAD could provide higher specificity for diagnosing prostate cancer than FPSA/TPSA or PSAD. Among all patients, at the same higher sensitivity (about 90%), the specificity of FPSA/TPSA, PSAD and (F/T)/PSAD was 31.6%, 45.6% and 64.0%, respectively. At the same time, it was suggested that clinicians use different cutoffs for (F/T)/PSAD in different PSA level. When PSA level of patients was no more than 4.0 microg/L, 2.5 as the commended cutoff for (F/T)/PSAD was preferred; if PSA level was between 4.0 microg/L and 20.0 microg/L, 0.8 was a more suitable cutoff; 0.5 also could be taken as an appropriate cutoff in case of PSA level being higher than 20.0 microg/L. Keeping high sensitivity, using of (F/T)/PSAD can improve the diagnostic specificity of prostate cancer significantly.

Méthodes d'urodynamique non invasive chez l'homme

Purpose Pressure-flow studies are currently recognized as the criterion standard to quantify urethral obstruction and its consequence on detrusor contractility. These tests have some disadvantages: they are invasive, time-consuming and expensive and entail risk of disease for the patient. Less invasive methods have been proposed to give the same results without the disadvantages. In this study, we conducted a critical analysis of the devices and techniques and their results. Method After a brief reminder of the general behavior of the flow in an obstructed urethra, we describe the main non-invasive techniques: penile urethral compression-release (PCR), cuffs, and condoms. Using the VBN ® method, we tried to quantify data from these techniques to specify the relation with the usual parameters of bladder outlet obstruction. Results In the absence of brisk change of the flow rate, the voiding phases are easily analyzed. With minor corrections, recorded external or cuff pressures could be used in the ICS nomogram; unfortunately, these pressures are greatly modified by perturbations of the nervous control. The spike of flow (due to urine storage in the urethra) observed at resumption of flow after each interruption presents mathematical difficulties for quantitative and reliable modeling but could give a consistent empirical interpretation. Conclusion Of the reported non-invasive tests, all except PCR have an important instrumental heaviness and induce strong perturbations of the nervous control. If they cannot allow an accurate quantification of urethral obstruction and detrusor contractility, they could allow for classification of benign prostatic hypertrophy (BPH) patients. Despite the mathematical problems set by the theory of spikes, the empirical use of the spikes amplitude could perhaps be clinically useful.

Associations Between G/A1229, A/G3944, T/C30875, C/T48200 and C/T65013 Genotypes and Haplotypes in the Vitamin D Receptor Gene, Ultraviolet Radiation and Susceptibility to Prostate Cancer

Ultraviolet radiation (UVR) may protect against prostate cancer via a mechanism involving vitamin D. Thus, the vitamin D receptor (VDR) gene is a susceptibility candidate, though published data are discrepant. We studied the association of prostate cancer risk with five VDR single nucleotide polymorphisms (SNPs): G/A(1229) (SNP 1), A/G(3944) (SNP 2), T/C(30875) (SNP 3), C/T(48200) (SNP 4) and C/T(65013) (SNP 5), in 430 cancer and 310 benign prostatic hypertrophy (BPH) patients. The SNP 2 GG genotype frequency was lower in cancer than BPH patients (odds ratio = 0.63, 95% CI = 0.41-0.98, p = 0.039). SNPs 1 and 2, and SNPs 4 and 5, were in linkage disequilibrium. Two copies of haplotypes comprising SNPs 1-2, G-G (odds ratio = 0.63, p = 0.039), SNPs 2-3 G-C (odds ratio = 0.45, p = 0.008) and SNPs 1-2-3 G-G-C (odds ratio = 0.44, p = 0.006), but not SNPs 1-3, G-C (odds ratio = 0.81, p = 0.34), were associated with reduced risk (reference, no copies of the haplotypes). These associations were observed after stratification of subjects by extent of UVR exposure. These data show that SNP 2 GG genotype mediates prostate cancer risk, complementing studies reporting this allele is protective in malignant melanoma pathogenesis. They further suggest that published associations of risk with SNP 1 may result from linkage disequilibrium with SNP 2.

Polymorphisms in the vitamin D receptor gene, ultraviolet radiation, and susceptibility to prostate cancer.

Ultraviolet radiation (UVR) exposure may protect against prostate cancer development via a mechanism involving vitamin D. The vitamin D receptor (VDR) gene is therefore a candidate susceptibility factor for prostate cancer. This possibility has been previously investigated with conflicting results. We examined the association of VDR genotypes (variants at the CDX-2, Fok1, and Taq1 sites), haplotypes, and genotype combinations with risk by studying 368 prostate cancer and 243 benign prostatic hypertrophy (BPH) patients. CDX-2, Fok1, and Taq1 genotype and haplotype frequencies were not significantly different in cancer and BPH patients. As the impact of VDR polymorphisms may depend on UVR exposure, we studied associations of variants with risk in men stratified into low (below median) and high (above median) cumulative exposure/year groups. In men with UVR exposure above the median (1,100 hr/year), CDX-2 GA and AA (odds ratios [OR] = 2.11 and 2.02, respectively) and Fok1 ff (OR = 2.91) were associated with increased prostate cancer risk. No associations were observed for Taq1 genotypes. Of the genotype combinations, relative to all other CDX-2 and Taq1 and combinations, GGTT (P = 0.022, OR = 0.30), and relative to all other Fok1 and Taq1 combinations, FFTT (P = 0.026, OR = 0.35) were associated with reduced prostate cancer risk in the presence of the main effects. None of the other two- or three-genotype combinations was associated with risk. These data indicate that VDR variants influence prostate cancer risk and that this association is dependent on the extent of UVR exposure.

Prostate cancer risk and exposure to ultraviolet radiation: further support for the protective effect of sunlight

Recent studies have suggested that exposure to ultraviolet (UV) radiation may be protective to some internal cancers including that in the prostate. We describe a confirmatory study in 212 prostatic adenocarcinoma and 135 benign prostatic hypertrophy patients designed to determine whether previous findings showing a protective effect for UV exposure could be reproduced. We used a validated questionnaire to obtain data on aspects of lifetime exposure to UV. The data confirmed that higher levels of cumulative exposure, adult sunbathing, childhood sunburning and regular holidays in hot climates were each independently and significantly associated with a reduced risk of this cancer.

Economic evaluation of treatment for benign prostatic hyperplasia--transurethral resection vs thermotherapy vs laser vaporization

Cost containment has become an important issue in medical practice because of recent bad economic conditions. We analyzed the cost of benign prostatic hypertrophy (BPH) patients and cost-effective analysis was carried out comparing transurethral resection of prostate (TURP), visual laser ablation of the prostate (VLAP) and transurethral microwave thermotherapy (TUMT). Our series consists of 95 BPH patients treated with TURP, VLAP and TUMT between January 1, 1994 and March 31, 1997. The cost for each patient was calculated (46 were treated with TURP, 31 with VLAP and 28 with TUMT). Considering the clinical outcome, cost-effectiveness was compared in 3 groups retrospectively. The median level of total charges (insurance points) was 59,395 points for the TURP group, 66,784 points for the VLAP group and 14,927 points for the TUMT group. The median follow-up period was 12.4 months, 46.7 months and 14.4 months, respectively. Several patients needed medication after operation in the VLAP group. In the TUMT group, 3 patients needed re-operation and 5 other needed an alternative surgical method (TURP or transurethral needle ablation) and 1 needed both methods. TUMT is the most cost-effective method, however the recurent rate is highest in the follow-up period among the three groups. The costs of recurent cases were most expensive. We should select surgical treatment for BPH very carefully.