Total Prostate Volume Research Articles

61 - The Diagnostic Role of Prostatic Urethral Angle in Diagnosis of Bladder Neck Dysfunction in Men with LUTS and Small Total Prostate Volume

61 - The Diagnostic Role of Prostatic Urethral Angle in Diagnosis of Bladder Neck Dysfunction in Men with LUTS and Small Total Prostate Volume

Prostate MRI transitional zone volume predicts Benign Prostatic Hyperplasia enucleation volume better than alternative modalities.

Guidelines for BPH interventions are volume based. The degree to which different imaging modalities actually correlate to treated volume is not known for BPH. The present study compares the accuracy of preoperative Ultrasound, CT, MRI, and MRI Transitional Zone to BPH enucleation weight. A retrospective review of patients who underwent enucleation for BPH and had preoperative TRUS, CT, and/or MRI was performed. Total prostate volumes were measured for CT, MRI, and TRUS; MRI transitional zone volume was also measured. The primary outcome was difference between enucleated pathology weight in grams and preoperative imaging volume. Differences between enucleation and imaging volume for each modality were calculated with one-way analysis of variance (ANOVA), with Tukey's honest significance test to determine pairwise significance (RStudio V1.2). From Jan - Oct 2020, there were 114 preoperative imaging studies available for 95 patients. 34 (30%) of the studies were TRUS, 46 (40%) were CT, and 34 (30%) were MRI. MRI Transitional zone most accurately predicted enucleation volume on multivariate analysis (F-statistic p-value <0.001). Preoperative imaging was greater than enucleation volume by a median of 46 cc for TRUS, 51 cc for CT, 53 cc for MRI, and 14 cc for MRI transitional zone. Pairwise significance was reached for MRI transitional zone over CT (p-adj < 0.001), MRI transitional zone over MRI (p-adj <0.001) and MRI transitional zone over US (p-adj = 0.03). Enucleation volume for BPH was most accurately predicted by transitional zone volume on MRI compared to total prostate volume on CT, TRUS, and MRI. MRI total volume was not superior to CT total volume. Focusing on MRI transitional zone volume rather than total prostate volume may more accurately stratify patients for BPH treatment. In experienced hands, median enucleation volume is within 14cc of MRI-TZ volume.

Prognostic Value of MRI-Assessed Central Gland Volume for Biochemical Recurrence after Prostate Cancer Radiotherapy

Introduction: Increasing central gland volume has been associated with less aggressive prostate cancer, theorized to be secondary to biomechanical stress from benign prostatic hyperplasia (BPH). The aim of this study was to evaluate pretreatment prostate magnetic resonance imaging (MRI) metrics and clinical characteristics in predicting biochemical recurrence (BCR) after definitive radiotherapy (RT) for prostate cancer. Methods: In this retrospective single institution study, we identified men in our database with prostate cancer who underwent MRI within 6 months prior to completing definitive RT from May 2011 to February 2023. Total prostate volume, central gland volume, and peripheral zone volume were measured by a radiologist using manual segmentation. The primary objective was to determine the association of central gland volume with biochemical recurrence, defined by Phoenix criteria. A multivariable Cox proportional hazards regression model was constructed and adjusted for clinical factors. Results: A total of 373 men (median age 68 years) were included, with a median follow-up of 28 months. 13 (3.5%) were low risk, 97 (26%) favorable intermediate ris, 201 (53.9%) unfavorable intermediate risk, and 62 (16.6%) high risk. 54 (14.5%) patients received conventionally fractionated RT, 105 (28.2%), moderately hypofractionated RT, 121 (32.4%), high-dose rate brachytherapy, and 93 (24.9%) stereotactic body RT. The 3 and 5 year rates of BCR were 7.8% and 18.3%, respectively. Taking into account NCCN risk group and RT type, higher central gland volume was associated with decreased risk of BCR (HR: 0.73, 95% CI: 0.55-0.98, p=0.03). No significant association was seen with peripheral zone volume, PI-RADS score, or RT type. Conclusions: Increased central gland volume on pretreatment prostate MRI is independently associated with a lower risk of biochemical recurrence after definitive radiation for prostate cancer. BPH appears to confer favorable outcomes in RT patients and represents a novel, easily quantifiable metric in risk-stratification.

A novel nomogram to predict clinically significant prostate cancer in MR assisted lesion biopsies: Turkish urooncology association nomogram

ObjectiveThis study aimed to develop a novel nomogram to predict clinically significant prostate cancer in patients undergoing multi-parametric prostate MRI-assisted lesion biopsies, addressing the challenges in deciding on biopsy for patients with PI-RADS 3 lesions and follow-up strategies for patients with negative PI-RADS 4 or 5 lesions. Materials and methodsA retrospective case-control study was conducted using the Turkish Urooncology Association Databases (UROCaD). The final dataset included 2428 lesion biopsy data. Univariate analysis, logistic regression, and validation were performed, with 1942 and 486 lesion biopsy data in the training and validation datasets, respectively. ResultsAge, initial total PSA value, PSA density, prostate volume, lesion length, DRE findings, and PI-RADS score were significantly different between benign or non-significant cancer and clinically significant prostate cancer groups. The developed nomogram incorporated PSA density, age, PI-RADS score, lesion length, and DRE findings. The mean area under the curve for the 6-fold cross-validation was 0.836, while the area under the curve values for the training and validation datasets were 0.827 and 0.861, respectively. The nomogram demonstrated a sensitivity of 75.6% and a specificity of 74.8% at a cut-off score of 24.9, with positive and negative predictive values of 42.2% and 92.6%, respectively. ConclusionThe TUA nomogram, based on PSA density, age, PI-RADS score, lesion length, and DRE findings, provides a reliable and accurate prediction tool for detecting clinically significant prostate cancer in patients undergoing multi-parametric prostate MRI-assisted lesion (fusion) biopsies, potentially improving patient management and reducing unnecessary biopsies.

Patient tolerance and complication rates of transperineal prostate biopsy with coaxial technique under local anesthesia: initial experience of a single institution.

Due to infectious complications of transrectal prostate biopsy (TRBx), the transperineal prostate biopsy (TPBx) technique is gaining popularity and is the first-line method in many institutions. We share our experience of the first 100 patients with TPBx, performed using the coaxial needle technique under local anesthesia. We retrospectively reviewed the records of the first 100 patients who had undergone TPBx between December 2022 and September 2023. Complication rates, cancer detection rates, patient tolerance, and pain response to the TPBx under local anesthesia at different steps of the procedure were collected. The mean age, total prostate-specific antigen (PSA), prostate volume, and PSA density were 64.5±7.5 years, 8.82±12 ng/mL, 58.4±26.4 mL, and 0.17±0.18 ng/mL2. Prostate cancer (PCa) was detected at histopathological evaluation in 51 patients. The mean positive core number and percentage of cancer involvement per core in patients who have PCa were 5.4±3.2 and 68.5±29.1, respectively. The mean pain score during the entire procedure was 2.85±1.48. When the steps are evaluated separately, the mean pain score during the probe placement step, local anesthetic, and sampling steps were 3.35±1.65, 2.54±1.45, and 0.9±0.82, respectively. Transperineal prostate biopsy with coaxial needle technique under local anesthesia is a well-tolerated procedure with feasible complication rates and patient discomfort.

Prostatic Artery Embolization in Patients with Advanced Prostate Cancer: A Prospective Single Center Pilot Study.

To assess efficacy and safety of prostatic artery embolization (PAE) in patients with advanced prostate cancer (PCa). In this prospective single-center, single-arm, pilot study, 9 men with advanced PCa underwent PAE. PAE was performed with the use of 250-400µm Embozene microspheres (Boston Scientific, Natick, Massachusetts, USA). International Prostate Symptoms Score (IPSS), urinary peak flow (Qmax) and post-void residual urine volume (PVR) was assessed at 12 weeks and up to 12 months. Changes in total prostate volume (TPV) and tumor responses by PSA, changes in tumor volume and evaluation of tumor regression by multiparametric magnetic resonance imaging were assessed at 12 weeks after PAE. IPSS reduction in median 6 points (0-19) and a significant decrease in PVR from median 70 (20-600)mL to 10 (0-280)mL could be achieved within 12 weeks after PAE. Median TPV and tumor volumes (TV) increased slightly from 19.7 (6.4-110.8)mL to 23.4 (2.4-66.3)mL and 6.4 (4.6-18.3)mL to 8.1 (2.4-25.6)mL at a median of 12 weeks after the procedure. Significant tumor necrosis (≥ 50%) was found in one patient. Eight patients showed > 50% of viable tumor on post-PAE MRI according to MRI. Only one Clavien-Dindo Grade 1 adverse event related to PAE occurred. PAE with the use of 250-400 µm microspheres is feasible, safe and effective in some patients with advanced PCa regarding functional outcomes. A cytoreductive effect might be achieved in individual patients but must be further assessed. NCT03457805.

Computerized metric assessment of glandular tissue volume within the peripheral zone of the prostate using combined magnetic resonance imaging and histopathology: Possible pathophysiological implications on prostate cancer development.

Benign prostatic hyperplasia (BPH) and prostate cancer (PCa) are prevalent urological ailments in elderly males. Numerous clinical studies have revealed an invert association between BPH/prostate size and PCa growth. This study investigates the association between prostate size and total glandular tissue volume of the peripheral zone (GVPZ) using a unique blend of magnetic resonance imaging (MRI) and histo-anatomical imaging technique. Patients were selected who underwent both radical prostatectomy and preoperative MRI scans. MRI scans provided quantitative measurements of prostatic zone dimensions, while histo-anatomical slides yielded quantitative data on glandular density of the peripheral zone (PZ) using imaging software. Integration of MRI and histopathology enabled the assessment of the GVPZ. Statistical analysis identified relationships between total prostate volume (TPV) and GVPZ. Seventy-two patients were selected and 40 cc was determined to be the optimal cutoff for small-to-moderate versus large prostates. Once the two subgroups in TPV were formed, the relationship between TPV and GVPZ was found to be highly significant (p<0.001). The combination of MRI and histopathology offers a novel approach for precise quantification of glandular tissue within the prostatic PZ. This study corroborates the hypothesis of PZ compression via an enlarging transition zone in larger BPH prostates, resulting in PZ glandular atrophy. Given that most PCa originates in the PZ, these results shed light on the potential protective role of larger BPH prostates against PCa growth.

Propensity score-matched analysis comparing perioperative, functional, and safety outcomes between thulium fiber laser and bipolar enucleation of the prostate performed by a single surgeon with two years of follow-up.

To compare perioperative, functional, and safety outcomes between thulium fiber laser enucleation of the prostate (ThuFLEP) and bipolar enucleation of the prostate performed by a single surgeon with use of propensity score (PS)-matched analysis. Data were from 675 patients, 422 of whom underwent ThuFLEP and bipolar enucleation by a single highly experienced surgeon. ThuFLEP was performed with Fiberlase U1 (IRE Polus Ltd.). Perioperative parameters, safety, and functional outcomes, such as International Prostate Symptom Score (IPSS), quality of life (QoL), postvoid residual volume (PVR), and maximum urinary flow rate (Qmax) were assessed. To control for selection bias, a 1:1 PS-matched analysis was carried out using the following variables as covariates: total prostate volume, preoperative IPSS and early sphincter release. Of 422 patients, 370 (87.7%) underwent ThuFLEP and 52 (12.3%) underwent bipolar enucleation. Operation, enucleation, and morcellation time were comparable between groups before and after PS-matched analysis (p=0.954, p=0.474, p=0.362, respectively). Functional parameters (IPSS, QoL, PVR, Qmax) were also comparable between groups at every time point before and after PS matching. Significant improvements in IPSS, QoL score, Qmax, and PVR were observed during the 24-month follow-up period for both ThuFLEP and bipolar enucleation without any significant differences between groups. Early and late postoperative complications before and after PS-matched analysis were similar. ThuFLEP was comparable to bipolar enucleation in perioperative characteristics, improvement in voiding parameters, and complication rates. Both procedures were shown to be effective and safe in the management of benign prostatic hyperplasia.

Clinical outcomes of holmium laser enucleation of the prostate: A large prospective registry-based patient cohort study under regular follow-up protocol.

To evaluate the efficacy and safety of holmium laser enucleation of the prostate (HoLEP) in a large prospective cohort of patients with benign prostatic hyperplasia (BPH) through systematic follow-up at a single institution. Clinical outcomes were analyzed between August 2008 and June 2022. Patients were followed-up at 2 weeks, 3 months and 6 months postoperatively. A total of 3,000 patients (mean age, 69.6±7.7 years) underwent HoLEP. Baseline total International Prostate Symptom Score (IPSS) was 19.3±7.7 and maximum flow rate (Qmax) was 9.4±4.8 mL/s. Mean total prostate volume was 67.7±3.4 mL. Total operation time was 60.7±31.5 minutes, and catheterization time was 1.0 days (range, 1.0-1.0 days). At 6 months postoperatively, the total IPSS decreased to 6.6±5.8 and Qmax increased to 22.2±11.3 mL/s. Complications at 6 months postoperatively included stress urinary incontinence (SUI) in 36 patients (1.9%), urgency urinary incontinence (UUI) in 25 (1.3%), bladder neck contracture (BNC) requiring transurethral incision (TUI) in 16 (0.5%), and urethral stricture in 29 (1.0%). Eleven patients (0.4%) with prostatic fossa stones required stone removal. Sixty-one patients (2.0%) required secondary surgery (transurethral coagulation, 16 [0.5%]; TUI for BNC, 16 [0.5%]; stone removal for prostatic fossa stones, 11 [0.4%]; and endoscopic internal urethrotomy for urethral stricture, 18 [0.6%]). Mid-term follow-up results after HoLEP in BPH patients showed excellent efficacy and low complication rates. Unlike previous reports, the incidence of SUI and UUI after HoLEP was low, but the occurrence of de novo stone formation in prostatic fossa was notable.

STUDY OF THE TRANSRECTAL PROSTATE BIOPSY IN KANAZAWA MEDICAL UNIVERSITY HOSPITAL, SUMMARY OF 20 YEARS

(Background) Prostate biopsy is the most important examination for the diagnosis of prostate cancer and the most common test in urology. We evaluated the results of transrectal prostate biopsy performed at Kanazawa Medical University Hospital. (Materials and Methods) Prospectively collected cases of 1,935 patients was undergone transrectal prostate biopsy between January 2002 and December 2021. We looked at patients age, serum Prostate-specific antigen (PSA) level, PSA density (PSAD), total prostate volume, number of biopsy times, and number of biopsy core. We examined the positive cancer rate. (Results) The median age of patients was 70 years (range: 36-96 years), the median serum PSA level was 7.6 ng/mL (range: 0.19-15,823 ng/mL), the mean number of biopsy times was 1.3 (range: 1-6), and the mean number of total biopsy core was 8.6 (range: 2-14). There were 880 (45.5%) positive cases and 1,055 (54.5%) negative cases. Comparing the cancer-positive and cancer-negative groups, the median age was 72 years (range: 50-96 years), 68 years (range: 36-93 years), the median PSA level was 11.0 ng/mL (range: 0.19-15,823 ng/mL), 6.6 ng/mL (range: 0.24-86.0 ng/mL), median prostate volume was 29.5 mL (range: 7.4-206 mL), 39.1 mL (range: 9.6-178 mL), median PSAD 0.376 (range: 0.003-1,582), 0.177 (range: 0.016-7.513), mean number of biopsy times 1.2 (range: 1-6), 1.4 (range: 1-6), mean number of total biopsy core 8.9 (range: 2-14), 8.5 (range: 4-14), and there was a significant difference in all comparison.

Machine learning based on radiomics features combing B-mode transrectal ultrasound and contrast-enhanced ultrasound to improve peripheral zone prostate cancer detection

PurposeTo construct machine learning models based on radiomics features combing conventional transrectal ultrasound (B-mode) and contrast-enhanced ultrasound (CEUS) to improve prostate cancer (PCa) detection in peripheral zone (PZ).MethodsA prospective study of 166 men (72 benign, 94 malignant lesions) with targeted biopsy-confirmed pathology who underwent B-mode and CEUS examinations was performed. Risk factors, including age, serum total prostate-specific antigen (tPSA), free PSA (fPSA), f/t PSA, prostate volume and prostate-specific antigen density (PSAD), were collected. Time-intensity curves were obtained using SonoLiver software for all lesions in regions of interest. Four parameters were collected as risk factors: the maximum intensity (IMAX), rise time (RT), time to peak (TTP), and mean transit time (MTT). Radiomics features were extracted from the target lesions from B-mode and CEUS imaging. Multivariable logistic regression analysis was used to construct the model.ResultsA total of 3306 features were extracted from seven categories. Finally, 32 features were screened out from radiomics models. Five models were developed to predict PCa: the B-mode radiomics model (B model), CEUS radiomics model (CEUS model), B-CEUS combined radiomics model (B-CEUS model), risk factors model, and risk factors-radiomics combined model (combined model). Age, PSAD, tPSA, and RT were significant independent predictors in discriminating benign and malignant PZ lesions (P < 0.05). The risk factors model combing these four predictors showed better discrimination in the validation cohort (area under the curve [AUC], 0.84) than the radiomics images (AUC, 0.79 on B model; AUC, 0.78 on CEUS model; AUC, 0.83 on B-CEUS model), and the combined model (AUC: 0.89) achieved the greatest predictive efficacy.ConclusionThe prediction model including B-mode and CEUS radiomics signatures and risk factors represents a promising diagnostic tool for PCa detection in PZ, which may contribute to clinical decision-making.

Effect of TNF-α Inhibitor Therapy on Growth of the Prostate Gland

BackgroundInflammation has been linked to the development of benign prostatic hyperplasia (BPH). SRD5A2 is a pivotal enzyme in the development and growth of the prostate gland and a critical target for BPH therapy. TNF-α regulates epigenetic changes in SRD5A2, leading to suppression of SRD5A2 gene and protein expression. It is unknown whether TNF-α inhibitor therapy affects prostate growth. ObjectiveTo evaluate the effect of TNF-α inhibitor therapy on prostate growth via analysis of measurements on serial pelvic imaging scans. Design, setting, and participantsIn this retrospective cohort study, we analyzed serial pelvic cross-sectional imaging (magnetic resonance imaging or computed tomography scans) for men aged ≥18 yr receiving TNF-α inhibitors. Our inclusion/exclusion criteria yielded a treatment cohort of 99 men. An age-matched cohort was constructed with the same inclusion/exclusion criteria but without TNF-α therapy (n = 99). Outcome measurements and statistical analysisProstate growth on serial pelvic cross-sectional imaging was the primary outcome measure. Results and limitationsThere was no significant difference in total prostate volume (TPV) at baseline between the two groups. The TNF-α treatment group had a lower mean TPV on follow-up (26.21 ± 9.43 vs 32.71 ± 18.89 cm3; p = 0.002) and a lower median prostate growth rate (−0.01 vs 0.68 cm3/yr; p = 0.001). A multivariable linear regression model adjusted for age, race, initial TPV, and body mass index also revealed a significantly lower growth rate for men in the treatment group. ConclusionTNF-α inhibitor use was negatively correlated with the prostate growth rate, suggesting that inflammatory mediators regulate prostate growth. Patient summaryWe examined prostate growth rates in men taking TNF-α inhibitors and found that these drugs have a shrinking effect on the prostate. We conclude that TNF-α inhibitors may impede prostate growth.

Association Between Neutrophil-to-Lymphocyte Ratio and Benign Prostatic Hyperplasia: Results from the TCLSIH Cohort Study.

The prevalence of benign prostatic hyperplasia (BPH) in the general Chinese adult male population has risen sharply over the past few decades. Increasing evidence suggests that inflammation plays an important role in the pathogenesis of BPH. To better understand the role of inflammation in the pathogenesis of BPH, we can use the neutrophil-to-lymphocyte ratio (NLR) because it is a simple and effective marker of inflammation and immunity. This study aims to prospectively investigate the association between NLR levels and the prevalence of BPH in a general Chinese adult male population. This study included a total of 15,783 male participants free from BPH at baseline. NLR was measured according to the complete blood count. BPH was defined as total prostate volume (TPV) ≥30 mL, and TPV was determined by transabdominal ultrasonography. Multivariable Cox proportional hazards models were fitted to calculate hazards ratios (HRs) and corresponding 95% confidence intervals (CIs) for BPH risk with NLR levels. During a median follow-up of 2.7 years, 5078 BPH cases were documented. After adjusting for age, body mass index, smoking, alcohol, education, occupation, income, physical activity, total energy intake, personal and family history of disease, and inflammation markers, the multivariable-adjusted HRs of BPH were 1.00 (reference), 1.08 (95% CIs 0.99, 1.17), 1.10 (95% CIs1.02, 1.19), and 1.12 (95% CIs1.03, 1.21), respectively, for participants with NLR in the first, second, third, and fourth quartiles (P for trend <0.01). Higher NLR levels were associated with a higher risk of BPH in Chinese adult male population. Our findings support the notion that NLR levels may be an important target for BPH prevention and intervention.

Risk Factors of Salvage Procedure for Refractory Morcellation During Holmium Laser Enucleation of the Prostate.

We aimed to identify the risk factors for salvage procedure (SP) required for refractory adenomatous tissue resistant to morcellation during holmium laser enucleation of the prostate (HoLEP). Patients who underwent HoLEP between January 2010 and April 2020 at Seoul National University Hospital were analyzed. SPs were defined as cases of conversion to resection of the prostatic tissue using an electrosurgical loop after morcellation or secondary morcellation a few days after surgery or conversion to open cystotomy. Among a total of 2,427 patients, 260 were identified as having SP (SP group) (transurethral resection-nodule [n = 250, 96.1%], secondary morcellation a few days after surgery [n = 9, 3.5%], and conversion to open cystotomy [n = 1, 0.4%]). Patients in the SP group were older and had higher 5-α reductase inhibitors use, higher prostate-specific antigen, larger total prostate volume, and larger transition zone volume (TZV) than those in the non-SP group. In the multivariable logistic regression analysis, only age and TZV were associated with SP. Compared to 40s and 50s, the odds ratios (ORs) were 3.84 in 60s (95% confidence interval [CI] 1.37-10.78, P = 0.011), 4.53 in 70s (95% CI, 1.62-12.62, P = 0.004), and 6.59 in 80s or older (95% CI, 2.23-19.46, P = 0.001). The ORs of the SP were analyzed per TZV quartile. Compared to TZV ≤ 20.3 mL, the OR was 3.75 in 32.0 mL < TZV ≤ 50.4 mL (95% CI, 2.00-7.04, P < 0.001) and 8.25 in 50.4 mL < TZV (95% CI, 4.06-16.77, P < 0.001). The risk of refractory morcellation increased in patients aged > 60 years or those with TZV > 32 mL. In order to more efficiently remove these resistant adenomas, it is necessary to develop more efficient morcellators in the future.

Changes of resistance indices after medication in benign prostatic hyperplasia: a prospective study.

This study aimed to determine the relationship between resistive indices (RIs) and changes in prostate size after medical treatment in patients with benign prostatic hyperplasia (BPH). A total of 86 patients with BPH were included in the study, excluding 42 patients with a total prostate volume (TPV) of <30cc or taking α1-adrenergic blockers and 5α-reductase inhibitors (5ARI) before study participation. Therefore, the data for 44 patients were analyzed. All patients were treated with α1-adrenergic blockers and 5ARIs. The variables examined were prostate-specific antigen, International Prostate Symptom Score, quality of lifescore, maximal urinary flow rate, residual urine volume, TPV, transition zone volume, and RIs of the urethral artery and left and right capsular arteries. These variables were assessed at baseline and after 3and 6months of treatment. The mean TPV was 43.5±10.9 and decreased to 35.2±11.5 and 33.9±9.8 after 3and 6months of treatment, respectively (p<0.001). The mean RI of the urethral artery, right capsular artery, and left capsular artery at pretreatment did not decrease significantly. However, comparing the baseline with 3-month data, TPV at 3months/TPV at baseline was significantly correlated with RI changes in the left capsular artery (r=758; P<0.001). In patients with BPH, α1-adrenergic blocker and 5ARI medications for 3and 6months did not result in a significant reduction in the RI of the urethral artery and both capsular arteries. Larger scale, prospective studies are needed to evaluate the relationship between TPV and RI reductions.

Association Between Mean Platelet Volume and Benign Prostatic Hyperplasia: A Population Study from the TCLSIH Cohort Study.

This study aimed to prospectively investigate the association between mean platelet volume (MPV) levels and risk of benign prostatic hyperplasia (BPH) in a general Chinese adult male population, and assessed this association in metabolic syndrome (MetS) patients. This study included a total of 14,923 male participants free from BPH at baseline. MPV was measured by the method of laser-based flow cytometric impedance according to the complete blood sample. BPH was defined as total prostate volume (TPV) ≥ 30 mL, TPV was determined by transabdominal ultrasonography. Multivariable Cox proportional hazards models were fitted to calculate hazards ratios (HRs) and corresponding 95% confidence intervals (CIs) for BPH risk with NLR levels. During a median follow-up of 2.7 years, 4848 BPH cases were documented in total male participants, and 1787 BPH cases were documented in MetS participants. After adjusting for age, body mass index, smoking, alcohol and personal and family history of disease, the multivariable-adjusted HRs of BPH were 1.00 (reference), 1.03 (95% CIs 0.96, 1.11), 1.00 (95% CIs 0.92, 1.08) and 0.98 (95% CIs 0.90, 1.06), respectively, for participants with MPV in the 1st, 2nd, 3rd and 4th quartiles (P for trend = 0.47). In MetS patients, the multivariable-adjusted HRs of BPH were 1.00 (reference), 1.03 (95% CIs 0.90, 1.16), 0.99 (95% CIs 0.87, 1.14) and 1.01 (95% CIs 0.89, 1.15) (P for trend= 0.98), respectively. A non-significant association was observed between MPV levels and risk of BPH, and no association in this association in MetS patients. Our findings support the notion that MPV levels may not be a target for BPH prevention and intervention.

Comparative study of standard and small transrectal transducers for prostate ultrasonography.

The objective of this study was to evaluate pain and image quality associated with the use of two different ultrasound transducers. Fifty healthy male participants aged 30 years or older were prospectively enrolled. All ultrasound procedures were performed using a V8 machine (Samsung Medison, Seoul, Korea) equipped with EA2-11 (conventional) and miniER7 (small-caliber) transrectal transducers, operated by a single genitourinary radiologist. To minimize bias, one group of volunteers underwent ultrasonography with the conventional transducer first, followed by the small transducer. For the remaining participants, the examinations were performed in the opposite order. Ultrasonography, including the measurement of total prostate and transitional zone volumes, was conducted in accordance with standard practice. After testing with both probes, participants were asked to rate their pain on a 10-point numerical rating scale (NRS). A radiologist then evaluated the quality of the images acquired with each probe using a 5-point numeric scale and compared the prostate volume measurements obtained by each method. The mean NRS scores associated with the conventional and small transducers were 4.7±1.8 and 2.7±1.2, respectively (P<0.05). The mean ultrasound image qualities from the two transducers were statistically similar (4.78 and 4.74, P>0.05). The whole prostate gland volume as measured with the conventional transducer (mean±standard deviation, 24.2±9.1 mL) was greater than the measurement (22.1±8.7 mL) obtained with the small-caliber transducer (P<0.05). However, only two of the 50 whole gland volume measurements differed by more than two standard deviations. The use of a small transrectal probe significantly reduced pain without compromising image quality.

Evaluation of carotid intima-media thickness and cardiovascular risk factors in benign prostatic hyperplasia patients

&lt;b&gt;Objective:&lt;/b&gt; To assess the carotid intima-media thickness and cardiovascular risk factors in patients with benign prostatic hyperplasia.&lt;br /&gt; &lt;b&gt;Material and methods:&lt;/b&gt; This was a prospective observational study conducted over two years in 100 patients who presented with benign prostatic hyperplasia (BPH). IPSS questionnaire was used to evaluate the symptomatology of BPH. Patients were examined for cardiovascular risk factors. All patients underwent echocardiographic examination for left ventricular function. A single experienced sonographer, blinded to all clinical information, assessed the common carotid artery.&amp;nbsp;&lt;br /&gt; &lt;b&gt;Results:&lt;/b&gt; The patients mean age was 69.32 years. The mean BMI was 28.91 kg/m². Of the total mild symptom score cases, 75 % (N=6) cases had Grade I prostatomegaly (26 – 40 cc). 98.38 % (N=61) cases had Grade II prostatomegaly (41 – 60 cc), 93.33 % (N=28) cases had Grade III prostatomegaly (&amp;gt;60cc). A mean carotid intima-media thickness (IMT) of 0.56 mm was found in cases having mild IPSS scores (Score 1-7), 0.73 mm was found in cases having moderate IPSS score (Score 8-19), 0.92 mm was found in cases having severe IPSS scores (Score 20-35). Significant association was present between mean BMI, diabetes mellitus, hypertension, hyperlipidemia, smoking and mean Carotid IMT with IPSS as p-value was &amp;lt;0.05. Significant association was present between total cholesterol, HDL, LDL and prostate volume with p-value &amp;lt;0.0001.&lt;br /&gt; &lt;b&gt;Conclusion:&lt;/b&gt; This study found that prostatic tissue had a strong relationship with carotid IMT and cardiovascular risk factors in BPH patients. These data suggest a possible link between carotid IMT and cardiovascular risk factors and BPH.

Prostate Stereotactic Body Radiation Therapy With a Focal Simultaneous Integrated Boost: 5-Year Toxicity and Biochemical Recurrence Results From a Prospective Trial

Stereotactic body radiation therapy (SBRT) is increasingly used as a definitive treatment option for patients with prostate adenocarcinoma. The aim of this study was to assess the late toxicity, patient-reported quality of life outcomes, and biochemical recurrence rates after prostate SBRT with simultaneous integrated boost (SIB) targeting lesions defined by magnetic resonance imaging (MRI). Patients were eligible if they had biopsy-proven low- or intermediate-risk prostate adenocarcinoma, one or more focal lesions on MRI, and an MRI-defined total prostate volume of <120 mL. All patients received SBRT delivered to the entire prostate to a dose of 36.25 Gy in 5 fractions with an SIB to the lesions seen on MRI to 40 Gy in 5 fractions. Late toxicity was defined as any possible treatment-related adverse event occurring after 3 months from the completion of SBRT. Patient-reported quality of life was ascertained using standardized patient surveys. A total of 26 patients were enrolled. Six patients (23.1%) had low-risk disease and 20 patients had intermediate-risk disease (76.9%). Seven patients (26.9%) received androgen deprivation therapy. Median follow-up was 59.5 months. No biochemical failures were observed. Three patients (11.5%) experienced late grade 2 genitourinary (GU) toxicity requiring cystoscopy, and 7 patients (26.9%) had late grade 2 GU toxicity requiring oral medications. Three patients (11.5%) had late grade 2 gastrointestinal toxicity characterized by hematochezia requiring colonoscopy and steroids per rectum. There were no grade 3 or higher toxicity events observed. The patient-reported quality-of-life metrics at the time of last follow-up were not significantly different than the pre-treatment baseline. The results of this study support that SBRT to the entire prostate to a dose of 36.25 Gy in 5 fractions with focal SIB to 40 Gy in 5 fractions has excellent biochemical control and is not associated with undue late gastrointestinal or GU toxicity or long-term quality of life decrement. Focal dose escalation with an SIB planning approach may be an opportunity to improve biochemical control while limiting dose to nearby organs at risk.

Role Of Prostate Ultrasonography To Predict The Efficacy Of Bipolar Prostatectomy In Benign Prostatic Hyperplasia.

To evaluate the role of prostatic ultrasonography in predicting the clinical outcomes of bipolar transurethral resection of the prostate. The prospective study was conducted at the Urology Department, Kafrelsheikh University Hospital, Cairo, Egypt from December 2018 to June 2019, and comprised male patients complaining of lower urinary tractsymptoms due to benign prostatic hyperplasia. The patients were subjected to pelvi-abdominal and transrectal ultrasonography and values were noted for the international prostate symptom score, uroflowmetry, post-void residual urine volume, ejaculatory domain, and the erectile function domain of the international index of erectile function. The safety of the procedure was assessed using the modified Clavien classification of complications. This was followed by cystourethroscopy under spinal anaesthesia, and then by bipolar resection of the prostate by a single experienced urologist. Operating time, length of hospitalisation, intraoperative and postoperative complications, catheterization time, and changes in haemoglobin levels were recorded. All evaluations were done at baseline and postoperatively at 1, 3 and 6 months. Data was analysed using SPSS 21. There were 109 male patients with mean age 65.53±6.27 years, mean body massindex 24.6±1.7kg/m2 . Mean total prostate volume at baseline was 86.32±43.61gm (range: 30-195m). There was a significant decrease postoperatively (p<0.001). This was associated with a concomitant improvement of international prostate symptoms score, uroflowmetry and post-void residual urine volume over six-month follow-up (p<0.001 ). Overall, 63(57.8%) subjects were sexually active, and there was no significant difference in the international index of erectile function score at baseline and postoperatively (p>0.05). Prostate ultrasonography can be used as a single investigating tool to evaluate the clinical outcomes after bipolar transurethral resection of the prostate.