Benign Prostatic Hyperplasia Volume Research Articles

Study on the correlation between glycolipids and prostate volume in patients with benign prostatic hyperplasia

To study the clinical correlation between fasting plasma glucose, lipid metabolism, prostate-specific antigen and prostate volume in patients with benign prostatic hyperplasia, and to explore the combined effect as diagnostic indicators. A total of 108 patients with benign prostatic hyperplasia treated in Beijing University of Chinese Medicine Third Affiliated Hospital from June 2021 to March 2023 were retrospectively analyzed as the hyperplasia group, and 98 healthy physical examination personnel were selected as the control group during the same period. Compare the differences in levels of fasting plasma glucose (FPG), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), small and dense low-density lipoprotein cholesterol (sdLDL-C), homocysteine, lipoprotein a (LPa), prostate specific antigen (PSA), and free prostate specific antigen (fPSA) between two groups of patients. Using Pearson analysis method to analyze the correlation between the above indicators and the size of prostate volume in patients with benign prostatic hyperplasia; using multiple linear regression to analyze the influencing factors of prostate volume enlargement; draw receiver operating characteristic (ROC) curves and analyze the application value of individual and combined detection of HDL, FPG, PSA, and fPSA. The results showed that there were significant differences in HDL, FPG, PSA, and fPSA levels between the control group and the proliferative group(P<0.05). The size of prostate volume is negatively correlated with HDL(r=-0.183, P<0.05) and positively correlated with FPG (r=0.202, P<0.05), PSA(r=0.412, P<0.05), and fPSA(r=0.425, P<0.05). The results of multiple linear regression analysis showed that HDL(P=0.000), FPG(P=0.048), PSA(P=0.044), and fPSA (P=0.012) were risk factors for increased volume of benign prostatic hyperplasia; ROC curve analysis shows that the AUC of HDL, FPG, PSA, and fPSA combined detection is 0.823, which is better than individual detection. In conclusion,HDL, FPG, PSA, fPSA has close correlation with hyperplasia of prostate, the joint detection may has better prediction for benign prostatic hyperplasia.

MP04-09 TRENDS IN HOLMIUM LASER ENUCLEATION OF THE PROSTATE FOR TREATMENT OF BENIGN PROSTATIC HYPERPLASIA

You have accessJournal of UrologyCME1 May 2022MP04-09 TRENDS IN HOLMIUM LASER ENUCLEATION OF THE PROSTATE FOR TREATMENT OF BENIGN PROSTATIC HYPERPLASIA Tenny R. Zhang, Mary O. Strasser, Samantha L. Thorogood, Christina Sze, Bilal Chughtai, Alexis Te, Richard K. Lee, and Jim C. Hu Tenny R. ZhangTenny R. Zhang More articles by this author , Mary O. StrasserMary O. Strasser More articles by this author , Samantha L. ThorogoodSamantha L. Thorogood More articles by this author , Christina SzeChristina Sze More articles by this author , Bilal ChughtaiBilal Chughtai More articles by this author , Alexis TeAlexis Te More articles by this author , Richard K. LeeRichard K. Lee More articles by this author , and Jim C. HuJim C. Hu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002521.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Compared to traditional treatment options for benign prostatic hyperplasia (BPH), holmium laser enucleation of the prostate (HoLEP) has demonstrated improved outcomes in hemostasis, urinary symptoms, and immediate complication rates. We investigated practice patterns associated with the use of HoLEP. METHODS: We obtained de-identified, self-reported American Board of Urology (ABU) certification/recertification case log data from 2008-2021. We identified 6,632 urologists who performed 73,884 surgeries with an indication for BPH. Current Procedural Terminology (CPT) codes distinguished HoLEP, transurethral resection of prostate (TURP), laser TURP, simple prostatectomy, prostatic urethral lift, transurethral incision of the prostate, and microwave and radiofrequency ablation. We identified 548 urologists (8.3%) who performed 7,386 HoLEP surgeries. Forty-three urologists (0.7%) performed HOLEP exclusively (no other BPH surgical approaches). A logistic regression model was used to determine factors independently associated with using HoLEP. RESULTS: The annual number of HoLEP procedures performed ranged from 3 to 1276, comprising 0.06% to 17.3% of total BPH surgeries annually. Highest HoLEP volumes were logged in 2019, representing 17.3% of total BPH cases. In adjusted analyses (table) factors associated with lower odds of performing HoLEP include surgeon age (odds ratio [OR] 0.93); government (OR 0.06), private practice group (OR 0.44), managed care (OR 0.14), salaried hospital (OR 0.38) vs. academic employment; and Mid-Atlantic (OR 0.28) and New England (0.45) regions vs. South Central (referent). Factors associated with higher odds of performing HoLEP include higher BPH surgical volume (OR 1.02) and endourology (OR 2.41) vs. general urology subspecialty. CONCLUSIONS: HoLEP is more likely to be performed by younger urologists, urologists in academic practice, endourology subspecialists, and those with higher BPH volume. HoLEP was less likely to be performed in Mid-Atlantic and New England regions. Additional studies are needed to elucidate practice pattern variations. Despite evidence demonstrating improved perioperative outcomes compared to competing BPH surgical approaches, HoLEP dissemination over time has been limited, possibly due to prolonged learning curve. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e60 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tenny R. Zhang More articles by this author Mary O. Strasser More articles by this author Samantha L. Thorogood More articles by this author Christina Sze More articles by this author Bilal Chughtai More articles by this author Alexis Te More articles by this author Richard K. Lee More articles by this author Jim C. Hu More articles by this author Expand All Advertisement PDF DownloadLoading ...

Inhibition of androgen induces autophagy in benign prostate epithelial cells

5-α Reductase inhibitor can reduce the volume of benign prostatic hyperplasia by lowering benign prostatic hyperplasia level and consequently inducing epithelial cells apoptosis. The present study investigated whether autophagy and apoptosis of benign prostatic hyperplasia epithelial cells are influenced by low benign prostatic hyperplasia levels. PWR-1E prostate epithelial cells transfected with GFP-LC3 plasmid were subjected to androgen deprivation conditions. Then the autophagic puncta were evaluated by fluorescence microscopy, and the cellular apoptosis rate was detected by 4, 6-diamidino-2-phenylindole staining after blocking of autophagic process by 3-methyladenine. Furthermore, autophagy status was also determined in hyperplasia prostate tissues from 5-α reductase inhibitor-treated patients by immunohistochemistry. In the androgen deprivation medium, autophagic punta increased markedly in PWR-1E cells, and blockage of autophagy by 3-methyladenine significantly promoted PWR-1E cells' apoptosis rate. In vivo, the expression of LC3 protein (an important autophagic marker) in hyperplasia prostate tissue significantly increased after 5-α reductase inhibitor treatment. Meanwhile, the prostate-specific antigen, as an inner control, decreased. 5-α Reductase inhibitor treatment increases autophagy and possibly decreases the apoptosis of prostate epithelial cells.

Transient Occlusion of Bilateral Internal Iliac Arteries Facilitates Bloodless Operative Field in Subcapsular Prostatectomy

Transurethral resection of the prostate is the gold standard of surgical treatment for benign prostatic hyperplasia (BPH). Nevertheless, open subcapsular prostatectomy is still performed for large BPH. While enucleation of prostatic adenoma is being performed, unneglectable bleeding can occur and surgeons need to rush to remove adenomas, often using fingers and in a blinded fashion. The blood supply to the prostatic capsule and adenoma can be reduced to a marked extent in subcapsular prostatectomy if the bilateral internal iliac arteries are transiently occluded. Thus, a bloodless operative field is reasonably acquired during enucleation of adenoma, which would, otherwise, be a cause for concern to surgeons due to bleeding. It is not always applicable, but it could be an option if the estimated volume of BPH is more than 100 mL. In two cases, bilateral internal iliac arteries were occluded with Bulldog clamps, and then adenomas of 159 and 97 g were enucleated.

Between-subject variations of transition zone epithelial volume and serum PSA levels in men with benign prostatic hyperplasia

We verified if the measure of transition zone epithelial volume (TZepiV) could be a valid predictor of serum PSA value in men with benign prostatic hyperplasia (BPH). Between January 2005 and July 2008, a total of 90 patients undergoing transvesical suprapubic adenomectomy for sintomatic BPH were enrolled. In case of an elevated PSA level (above 4 ng/ml) or abnormal digital rectal examination, systematic multisite biopsies were performed preoperatively to rule out prostate cancer. We have examined PSA levels before and after open surgery, TZ weight as measured by the pathologist and TZepiV by multiplying percentage of epithelium of a single biopsy core with the weight of adenoma. Means, Spearman correlation coefficients and percent change were calculated for all variables and intervals. The mean serum PSA decreased from 4.8 ng/ml preoperatively to 0.5 ng/ml postoperatively. The mean decrease in PSA was 90% (range 70-99%).The mean weight of enucleated adenoma was 67 gr.(range 18-201) and the TZepiV was 7.7 ml (0.3-28.4). Overall, both TZ volume and TZepiV were correlated to PSA value with TZepiV representing the most predictive variable for PSA (r = 0.54 P = 0.002 vs. r = 0.26 P = 0.02). When we analyzed different ranges of PSA values, only TZepiV was always significantly proportional to PSA. Ninety percentage of serum PSA level comes from TZ in range of 0.01-0.17 ng/ml/gr. In presence of equal BPH volumes, the amount of epithelium can be different and it is the main determinant in PSA increase. Thus, TZ epithelial volume could represent a new useful clinical tool able to increase the specificity of PSA in the diagnosis of prostate cancer.

A Possible Relationship Between Testosterone and Lower Urinary Tract Symptoms in Men

In this study we searched for possible associations between serum testosterone levels and the severity of lower urinary tract symptoms in men. In 278 patients with a mean age of 62 years blood levels of total testosterone, albumin, sex hormone-binding globulin, fasting glucose, fasting insulin and high sensitivity C-reactive protein were measured. Free testosterone, bioavailable testosterone and homeostasis model assessment of insulin resistance were calculated. Prostate volume was measured by transrectal ultrasonography and the severity of lower urinary tract symptoms was assessed using the International Prostate Symptom Score. Calculated free testosterone and bioavailable testosterone were negatively related to International Prostate Symptom Score total scores and subscores (voiding symptoms) after adjusting for age, prostate volume, high sensitivity C-reactive protein and homeostasis model assessment of insulin resistance (p <0.05). In addition, calculated free testosterone and bioavailable testosterone were significantly related to the presence of severe lower urinary tract symptoms (International Prostate Symptom Score 20 or greater) using unadjusted and adjusted models (p <0.05), although the odds ratio of bioavailable testosterone was lower than that of calculated free testosterone on multivariate analysis. High sensitivity C-reactive protein was negatively correlated with serum total testosterone (r = -0.128, p = 0.038) and bioavailable testosterone (r = -0.126, p = 0.041), and homeostasis model assessment of insulin resistance was negatively correlated with serum total testosterone (r = -0.236, p <0.001), calculated free testosterone (r = -0.179, p = 0.003) and bioavailable testosterone (r = -0.162, r = 0.007). However, no significant correlation was found between high sensitivity C-reactive protein or homeostasis model assessment of insulin resistance, and International Prostate Symptom Score total scores, voiding symptoms scores and storage symptoms scores. Our findings support the favorable role of endogenous testosterone in lower urinary tract function and suggest that testosterone deficiency may be a pathophysiological mechanism connecting lower urinary tract symptoms and the metabolic syndrome in men.

Obesity, Serum Prostate Specific Antigen and Prostate Size: Implications for Prostate Cancer Detection

Obesity has been associated with lower serum testosterone, theoretically resulting in decreased PSA production. Obesity has also been associated with prostatic enlargement, making the detection of existent cancer more difficult. Together these findings would result in an apparent protective effect of obesity on prostate cancer risk due to technical detection issues unrelated to cancer biology. We examined the association between BMI, and PSA and prostate weight in a cohort of men undergoing RP. We evaluated the association of BMI with prostate weight and PSA using linear regression, adjusting for patient age at RP, year of RP, race, and pathological stage and grade in 1,414 men treated with RP between 1988 and 2004 at the 5 equal access medical centers that comprise the Shared Equal Access Regional Cancer Hospital Database. On multivariate analysis increasing BMI was associated with increasing prostate weight but only in men younger than 63 years and not in men 63 years or older (p-trend <0.001 and 0.44, respectively). In men younger than 63 years mean multivariate adjusted prostate weight +/- SE in those with a BMI of less than 25 vs 30 to 34.9 kg/m was 33.8 +/- 1.4 vs 41.4 +/- 1.6 gm. There was no significant association between BMI and preoperative PSA (p-trend = 0.70). In a cohort of men undergoing RP obesity was associated with larger prostate size but only in younger men. There was no association between BMI and PSA. Assuming equal PSA, the degree of prostatic enlargement observed in younger obese men in this study would be expected to result in a modest decrease in the odds of detecting prostate cancer in a contemporary series of PSA screened men due to the decreased sensitivity of cancer detection related to larger prostate size. Obesity may appear protective for prostate cancer in younger men due to technical issues unrelated to cancer biology.

Total and Gleason Grade 4/5 Cancer Volumes are Major Contributors of Human Kallikrein 2, Whereas Free Prostate Specific Antigen is Largely Contributed by Benign Gland Volume in Serum From Patients With Prostate Cancer or Benign Prostatic Biopsies

We measured concentrations of human glandular kallikrein 2 (hK2), total prostate specific antigen (tPSA), free PSA (fPSA) and percent fPSA to evaluate their relationship to total prostate gland volume, benign prostatic hyperplasia (BPH) volume, total prostate cancer (PCa) volume (CaVol) and the volume of Gleason grades 4/5 cancer (CaVolGl4) in the serum of 256 patients with PCa undergoing radical retropubic prostatectomy and 185 with negative systematic sextant biopsies. Free and total PSA was measured using the Delfia Prostatus (Perkin-Elmer, Turku, Finland) total/free PSA assay and hK2 was measured using a research immunofluorometric assay. Transrectal ultrasound was used to determine total prostate and BPH volume. Total CaVol and CaVolGl4/5 were calculated using a volumetric program in specimens from 158 men with pT2a/b and 98 with pT3a or greater PCa. The Pearson correlation was performed after logarithmic conversion of PSA and hK2 levels. Benign gland, and pT2a/b and pT3a or greater PCa cases were subdivided into small vs large prostate gland volumes (42 cc or less vs greater than 42 cc). Total prostate and BPH volumes correlated closely with free PSA (r = 0.64 to 0.65, p <0.0001) in 143 patients with negative biopsy and a prostate of greater than 42 cc. Correlations of hK2 and tPSA with total prostate and BPH volumes were weaker (r = 0.35 to 0.36 and 0.45 to 0.46, respectively). In pT2a/b and pT3a or greater PCa cases hK2 most closely correlated with CaVol (range 0.31 to 0.62, p = 0.0072 and <0.0001) and with CaVolGl4/5 (range 0.26 to 0.56, p = 0.021 and <0.0001, respectively). The tPSA level correlated significantly with CaVol and CaVolGl4/5 except in glands 42 cc or greater harboring pT2a/b PCa (p = 0.08). Free PSA correlated significantly with CaVolGl4/5 only in pT3a or greater PCa (p <0.05), and with CaVol in pT3a or greater PCa and in small prostates harboring pT2a/b PCa. Large benign prostate gland volume affects fPSA more than tPSA in serum. In PCa hK2 more closely correlates with total cancer volume and high grade PCa volume compared with tPSA or fPSA.

Corrélations anatomoradiologiques dans l'hypertrophie bénigne de la prostate. À propos d'une série de 220 cas

In our daily practice, the reliabality of ultrasonography (US) and digital rectal examination (DRE) is limited by many factors. The aim of our study is to correlate between the prostatic volume assessed by the DRE, the pre operative US results and the actual weight of the enucleated or endoscopic resection benign prostatic hyperplasia (BPH). We report a serie of 220 patients with BPH treated by endoscopic resection or by open surgery. The mean age is 65 years (40–90 years old). Ultrasonography was performed in 92% of the cases, and transrectal ultrasound only in 8%. All our patients either underwent endoscopic resection (49.6%) or adenomectomy (50.4%). We found a high correlation between the prostatic volume assessed by DRE and by ultrasonography ( r=0.79; P<0.0001) and the weight of the piece of surgical adenomectomy ( r=0.701, P<0.0001). However, the volume of benign prostatic hyperplasia assessed by US did not correlate with the piece of endoscopic resection ( r=0.214, P<0.05). This study and a review of recent literature enabled us to notice the various anatomical and radiological factors implicated in this correlation.

Relationship between benign prostatic hyperplasia and history of coronary artery disease in elderly men.

To assess the relationship between the occurrence of benign prostatic hyperplasia (BPH), an androgen-dependent disease, and coronary artery disease (defined as history of coronary artery bypass grafting, coronary angioplasty, myocardial infarction) in elderly men. Retrospective chart review. Urology practice. Seven hundred two elderly men aged 65-80 years. The men's charts were reviewed for data pertaining to coronary artery disease, risk factors for coronary artery disease, and serum prostate-specific antigen (PSA) levels. Men who had medical conditions, pharmacologic interventions, or surgical procedures that could alter PSA, and those taking lipid-lowering agents were not included. PSA levels correlate positively with prostatic volume of BPH. In men with levels under 1.0 pg/L (no BPH) and over 1.0 microg/L (BPH present), the frequency of coronary artery disease was 9% and 29%, respectively (p<0.03). No significant differences were noted between groups in other accepted risk factors for coronary artery disease including age, smoking, diabetes mellitus, or hypertension. Smooth muscle proliferation is an important and possibly androgen-dependent step in the development of atherosclerosis and BPH. Prospective studies are required to assess the effect of antiandrogens on atherosclerosis.

Cell Kinetic in Epithelium and Stroma of Benign Prostatic Hyperplasia

The induction of benign prostatic hyperplasia (BPH) from normal prostate is obviously associated with a distinct increase in epithelial and stromal proliferation. We have shown previously that the further increase of BPH volume in aging men is not associated with a further increase in proliferation. We studied whether an imbalance between programmed cell death (apoptosis) and cell proliferation may explain continuing growth in aging men. In prostates of 17 men with BPH removed by open prostatectomy proliferating cells were localized immunohistochemically with the Ki-67 antibody. Apoptotic cells were detected with the terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labelling (TUNEL) method. Proliferation and apoptotic index was calculated with a computer assisted image analysis system. Mean proliferation index +/− standard deviation in epithelium (0.142 +/− 0.097) and stroma (0.121 +/− 0.082) was nearly identical. Mean apoptotic index in epithelium (0.172 +/− 0.156) was negligibly higher than the corresponding proliferation index. In stroma, however, no apoptotic cells were detectable. Proliferation index and apoptotic index in epithelium and proliferation index in stroma showed no correlation to patient age or prostate volume. In the epithelium of BPH, obviously the cell kinetic is balanced. On the other hand, our results indicate stromal growth due to cell proliferation in the absence of cell death. This may explain the continuous increase of BPH volume in aging men.

Total Prostate and Transition Zone Volumes, and Transition Zone Index are Poorly Correlated With Objective Measures of Clinical Benign Prostatic Hyperplasia

Purpose We determined if total prostate volume, transition zone volume or transition zone index is correlated with the severity of clinical benign prostatic hyperplasia (BPH). Materials and Methods A total of 93 men 52 to 85 years old, who were referred to a urology outpatient facility for treatment of clinical BPH, elevated serum prostate specific antigen or abnormal digital rectal examination, underwent measurement of total prostate and transition zone volume at transrectal ultrasonography. All men were requested to undergo uroflowmetry and complete the American Urological Association (AUA) symptom score. Results The pairwise correlations between AUA symptom score, versus total prostate and transition zone volumes and transition zone index were not statistically or clinically significant. A weak pairwise relationship was observed between peak flow rate versus total prostate volume (r 2 = 0.160), transition zone volume (r 2 = 0.156) and transition zone index (r ( 2) = 0.147). The pairwise relationships between AUA symptom scores versus all prostate volumes were not statistically significant for subjects with mild (score 8 or less) or moderate to severe (score more than 8) symptoms. Conclusions Total prostate and transition zone volumes, and transition zone index are not directly related to AUA symptom score and only weakly related to peak flow rate. These findings provide further evidence that the total prostate, total BPH and relative BPH volumes are not useful determinants of the severity of clinical BPH.

Influence of Age and Endocrine Factors on the Volume of Benign Prostatic Hyperplasia

To determine whether endocrine factors influence the volume of benign prostatic hyperplasia (BPH), 23 hormonal factors were measured in the serum of 64 men ages 42 to 71 years with low volume prostatic cancer and these levels were correlated with the volume of benign hyperplastic tissue in their radical prostatectomy specimens. With age there was a significant increase in the volume of BPH. Also with age there was a significant decrease in the serum levels of free testosterone, androstenedione, dehydroepiandronsterone (DHA), dehydroepiandronsterone sulphate (DHA-S), Δ5-androstenediol, and 17-hydroxypregnenolone, and a significant increase in sex hormone-binding globulin (SHBG), LH, and FSH. When BPH volume and hormone levels were corrected for age, BPH volume correlated positively with free testosterone, estradiol, and estriol.These data indicate that with age patients with larger volumes of BPH have higher serum androgen and estrogen levels suggesting that serum androgen and estrogen levels may be factors in the persistent stimulation of BPH with age. If so, therapeutic attempts at lowering plasma testosterone levels, reducing estrogen levels, or blocking androgenic stimulation through other mechanisms may interfere with the progression of BPH with age. Conversely, the fact that androgen production declines gradually with age may explain the observation that only 20 to 30% of men who live to age 80 require surgical treatment for urinary obstruction from BPH.