Risk Of Benign Prostatic Hyperplasia Progression Research Articles

Commentary on "Integrative multiplatform molecular profiling of benign prostatic hyperplasia identifies distinct subtypes".

Commentary on "Integrative multiplatform molecular profiling of benign prostatic hyperplasia identifies distinct subtypes".

Statička i dinamska komponenta opstrukcije kod benigne hiperplazije prostate

Introduction / Goal: Benign prostatic hyperplasia (BPH) is the most common benign neoplasm that occures in male population with an incidence of 45 to 90% between 50 and 80 years of age. BPH can cause an increase in output resistance, or an increase in resistance to urine flow, with its static and dynamic components. In clinical practice, the most common pharmacological treatment of lower urinary tract symptoms (LUTS) in patients with BPH is based on monotherapy with alpha-blockers, 5-alpha-reductase inhibitors or combination therapy. The aim of this review is to determine the main therapeutic and side effects of the most common pharmacological therapy and the recommended approaches of the European Association of Urology (EAU) and the American Urological Association (AUA) in the diagnosis of benign prostate obstruction (BPO). Method: Selective literature search with additional examination of EAU and AUA guidelines and meta-analysis. Results: The treatment of patients with BPH is complex. The factors on the basis of which treatment decisions are made are based on the patient's subjective perception of symptoms and quality of life due to LUTS and in relation to the presence of subvesical obstruction. Urodynamic pressureflow studies are the basis for the definition of BPO due to BPH or other etiology. Non-invasive uroflowmetry, determination of residual urine after urination (PVR) and non-invasive ultrasound tests are of great use in the diagnosis of BPO. Treatment with alpha1 receptor inhibitors (alpha-blockers), or 5-alpha-reductase inhibitors may be considered in patients with predominantly urinary dysfunction. Conclusion: Standard pharmacological medical treatment for BPH / LUTS is still based on alphablockers, 5-alpha-reductase inhibitors or a combination thereof. In the future, BPH / LUTS treatment is expected to become individualized, according to the type of symptoms, the presence of sexual dysfunction and the risk of BPH progression.

SNPs of Metabolic Syndrome are Associated with Benign Prostatic Hyperplasia Development and Progression in Chinese Population

Objective: Benign Prostatic Hyperplasia (BPH) is a common disease prevalent in elderly men, but the genetic determinants of BPH still remain unclear. Since metabolic syndrome, especially diabetes, may influence the progression of benign prostatic hyperplasia, we investigated whether susceptibility loci for diabetes would increase the risk of BPH development and progression in elderly Chinese men. Material and Methods: Fifteen SNPs associated with the diabetes risk in a Chinese population were genotyped in 377 BPH cases (152 aggressive and 225 non-aggressive BPH cases) and 1,008 controls. The association between the SNPs and the risk of BPH development was evaluated through logistic regression. Additionally, the effects of the 15 SNPs on BPH related clinical parameters, including Body Mass Index (BMI) International Prostate Symptom Score (IPSS), Quality of Life (QoL) and Prostate Volume (PV) were also evaluated. Results: SNP rs9864104 in IGF2BP2 at 3q27 (OR=1.24, P =0.0148) was significantly associated with BPH development. In addition, SNP rs9863780, rs9864104, rs10229583 and rs17727841 were significantly associated with baseline clinical parameters in BPH patients. Moreover, the risk allele of rs6763887 (C) and rs17727841 (C) was significantly associated with the change of storage score and voiding score after treatment. No SNPs were associated with the risk of BPH progression. Conclusions: This is a systematic investigation of the contributions of diabetes susceptibility loci to the risk of BPH development and progression. Our findings advance the understanding of the genetic basis of BPH and provide new insights into the genetic determinants shared between BPH and metabolic syndrome.

Терапия α1-адреноблокаторами и сексуальная функция

An increase in life expectancy and the number of older and elderly men, an improvement in the quality of medical care and socio-economic factors in most countries contributed to an increase in the number of patients with benign prostatic hyperplasia (BPH). Currently, improvement of the quality of life is the mainstay of strategy for managing patients with BPH, as well as prevention of complications and the need for surgery. In this regard, the pharmacotherapy with 1-adrenergic blockers (1-AB) is widely used as an effective method for improving lower urinary tract symptoms and reducing the risk of BPH progression. Given that the quality of life is becoming increasingly important in evaluating the efficiency of BPH treatment, including therapy in elderly patients, it is necessary to take into account its effect on sexual function, when choosing a particular drug. The use of 1-AB can be accompanied by side effects manifested by various sexual disorders. Alfuzosin does not adversely affect sexual function in men with BPH, may improve erectile and ejaculatory function and should be considered as the drug of choice, especially in sexually active men and patients who already suffer from worsening ejaculatory function while using another 1-AB.

Current medical treatment of lower urinary tract symptoms/BPH

The pharmacological treatment of lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH) is based on alpha-blockers and 5α-reductase inhibitors isolated or in combination. Silodosin, an alpha-1A specific alpha-blocker is the only innovation in these groups of agents. This classical paradigm is being challenged by antimuscarinics, 5-phosphodiesterase inhibitors (PDE5i) and β3-adrenoreceptor agonists. Silodosin is effective in reducing BPH/LUTS, including nocturia and shows little cardiovascular adverse events. Antimuscarinic drugs isolated or in combination with alpha-blockers improve storage symptoms without any harmful effect to the voiding function. PDE5i alone improve BPH/LUTS. Combination of PDE5i with alpha-blockers provides better symptomatic control than alpha-blockers alone. A recent head-to-head comparison of tadalafil 5 mg/day with tamsulosin 0.4 mg/day showed that these agents provided the same improvement in BPH/LUTS and, surprisingly, the same improvement in the urinary flow. In fact, previous studies with tadalafil had not shown any effect of tadalafil on flow. In addition, tadalafil but not tamsulosin improved sexual function. Mirabegron, the first β3-adrenoreceptor agonist, while improving BPH/LUTS in men with bladder outlet obstruction, do not decrease urinary flow or detrusor pressure. The standard medical treatment for BPH/LUTS is still based on alpha-blockers, 5ARIs or its combination. In the future, it is expected that BPH/LUTS treatment will become individualized, according to the type of symptoms, presence of sexual dysfunction and risk of BPH progression. This will challenge our concept of standard treatment for BPH/LUTS.

The Role of Inflammation in the Progression of Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) is the most frequent urological occurrence in elderly males, and recently prostatic inflammation has been involved in the pathogenesis and progression of the disease. Inflammatory infiltrates determine cytokine release in the prostatic microenvironment, with consequent tissue damage and subsequent chronic tissue healing that results in the development of BPH. Clinical trials have reported an association between prostatic inflammation and the risk of BPH progression. Moreover, men with metabolic syndrome appear to be at increased risk of BPH, probably for the concomitance of systemic inflammation associated with such syndrome. Understanding the immune pathways associated with BPH will aid in identifying novel therapeutic targets and improve the management of the disorder. The aim of this review is to evaluate the available evidence on the role of prostatic inflammation on BPH and its progression and to discuss the possible clinical implications.