The extract of Celtis choseniana Nakai alleviates testosterone-induced benign prostatic hyperplasia through inhibiting 5α reductase type 2 and the Akt/NF-κB/AR pathway / 中国天然药物

Benign prostatic hyperplasia (BPH) is a chronic male disease characterized by the enlarged prostate. Celtis chosenianaNakai (C. choseniana) is medicinally used to alleviate pain, gastric disease, and lung abscess. In this study, the effect of C. choseniana extract on BPH was investigated using testosterone-induced rats. Sprague Dawley rats were divided into five groups: control, BPH (testosterone 5 mg·kg-1), Fina (finasteride 2 mg·kg-1), and C. choseniana (50 and 100 mg·kg-1). After four weeks of TP treatment with finasteride or C. choseniana, prostate weights and DHT levels were measured. In addition, the prostates were histopathologically examined and measured for protein kinase B (Akt)/nuclear factor-κB (NF-κB)/AR signaling, proliferation, apoptosis, and autophagy. Prostate weight and epithelial thickness were reduced in the C. choseniana groups compared with that in the BPH group. The extract of C. choseniana acted as a 5α reductase inhibitor, reducing DHT levels in the prostate. Furthermore, the extract of C. choseniana blocked the activation of p-Akt, nuclear NF-κB activation and reduced the expression of AR and PSA compared with BPH. Moreover, the expression of Bax, PARP-1, and p53 increased, while the expression of bcl-2 decreased. The present study demonstrated that C. choseniana extract alleviated testosterone-induced BPH by suppressing 5α reductase and Akt/NF-κB activation, reducing AR signaling and inducing apoptosis and autophagy in the prostate. These results suggested that C. choseniana probably contain potential herbal agents to alleviate BPH.

Active constituents of Urtica fissa in inhibition of benign prostatic hyperplasia / 中国中药杂志

The present study investigated the material basis of Urtica fissa for the inhibition of benign prostatic hyperplasia(BPH). The active fractions were screened, and the extracts of dichloromethane and ethyl acetate exhibited significantly inhibitory activities against 5α-reductase in vitro and BPH in model rats. The chemical constituents in the active fractions were systematically investigated, and 28 compounds were obtained, which were identified as lobechine methyl ester(1), dibutyl-O-phthalate(2), 1-monolinolein(3), epipinoresinol(4), 5-hydroxy-3,4-dimethyl-5-pentanyl-2(5H)-furanone(5), E-7,9-diene-11-methenyl palmitic acid(6), evofolin B(7), ficusal(8), threo-2,3-bis-(4-hydroxy-3-methoxyphenyl)-3-ethoxypropan-1-ol(9), α-viniferin(10),(9R,7E)-9-hydroxy-5,7-mengatigmadien-4-one-9-O-β-D-glucopyranoside(11), indole-3-carboxaldehyde(12), p-hydroxy ethyl cinnamate(13), benzyl alcohol-O-β-D-glucoside(14), L-methionine(15), 4-methoxyaniline(16), 6-aminopurine(17), 8'-acetyl oilvil(18), 4-methoxyl-8'-acetyl oilvil(19), vanillic acid(20), β-hydroxypropiovanillone(21), 7-hydroxy-6-methoxycoumarin(22), p-hydroxybenzaldehyde(23), pinoresinol(24), erythro-1,2-bis-(4-hydroxy-3-methoxyphenyl)-1,3-propanediol(25), urticol(26), urticol-7-O-β-D-glucopyranoside(27), and lobechine(28). Compounds 1-17 were isolated from U. fissa for the first time. Meanwhile, compound 1 was a new natural product. Compounds 10, 11, 19, 21, and 27 exhibited significant inhibitory effects on 5α-reductase.

Anatomic study of verumontanum during endoscopic surgeries in patients with benign prostatic hyperplasia

ABSTRACT Introduction and objective: To evaluate changes in verumontanum anatomy in patients with benign prostatic hyperplasia (BPH) who used 5-alpha reductase inhibitors (5-ARIs) and to propose an anatomical classification of the verumontanum. Materials and Methods: We studied 86 patients with BPH and 7 patients without the disease (age under 40 years-old who underwent kidney or ureteral lithotripsy). Of the patients with BPH, 34 (mean age=67.26) had 5-ARIs use and 52 (mean age=62.69) did not use the drug. During surgeries, photographs of the seminal colliculus were taken and later, with the aid of software (Image J), the length (longitudinal diameter) and width (transverse diameter) of the verumontanum were measured in all patients. During the procedure, we evaluated the different types of verumontanum. For statistical analysis, the R-Project software was used. Results: In the group of patients with BPH who were taking medication (group 1), the mean measures of length and width of the verumontanum were 4.69mm and 2.94mm respectively. In the group of patients with BPH who did not use the drug (group 2), the mean diameters were 4.54mm and 3.20mm respectively. In the control group (group 3), the average length and width were 5.63mm and 4.11mm respectively. There was an increase in longitudinal and transverse measurements of the control group with an increase in body mass index (BMI) (p=0.0001 and p=0.035 respectively). In addition, there was a reduction in transverse diameter in the group of BPH using 5-ARI with increased prostate volume (p=0.010). We found five different verumontanum types: "volcano" (51.61%), "lighthouse" (24.73%), "whale tail" (12.90%), "hood" (5.38%) and "castle door" (5.38%), which we propose as an anatomical classification. Conclusion: Veromontanum has smaller measurements in patients with BPH regardless of treatment. In the control group, there was an increase in verumontanum diameters with an increase in BMI. The volcano type of verumontanum was the most frequent regardless of groups and BMI.

The relation between the storage symptoms before and after transurethral resection of the prostate, analysis of the risk factors and the prevention of the symptoms with solifenacin

ABSTRACT Objective and Hypothesis We aimed to investigate the reasons of storage symptoms ( SS) after transurethral resection of the prostate (TURP). The hypothesis was that a positive correlation would be identified between preoperative and postoperative SS in patients with undergoing TURP and starting early solifenacin treatment in patients with high preoperative SS would be reasonable. In addition, we aimed to analyze multiple other risk factors for post-TURP SS. Materials and Methods A total of 160 patients undergoing TURP were prospectively evaluated and divided into two groups according to their OABS. Those with a score of ≥10 points were Group 1 (G1), and those with <10 points Group 2 (G2). In addition, patients in each group were randomly further divided into two subgroups: those who were started on 5 mg solifenacin succinate in the early postoperative period (G1/G2 A) and those who were not (G1/G2 B). In additions to SS Preop, perop and at the 3rd-month of postoperatively 14 variable were evaluated. The effects of these factors, surgery and the efficacy of an early medical treatment on the postoperative SS were investigated. LUTS were assessed by International Prostate Symptom Score (IPSS) and SS were assessed by sum of IPSS 2, 4 and 7 questionnaires (Storage, S- IPSS). Results Preoperative IPSS and S-IPSS were significantly higher in G1 (p<0.001); there was a significant improvement at IPSS, S-IPSS, QoL score, Qmax, and PVR for all groups after surgery. Only preoperative S-IPSS was found to have significant effect on postoperative SS (p<0.001). There was a significant difference between G1A and G1B but no significant difference between G2A and G2B in terms of SS at postoperatively. In addition to this, prostatic volume was found smaller than non-symptomatic patients in de novo SS patients. Conclusion TURP provides significant improvement in both storage and voiding symptoms. The predictive value of the preoperative S-IPSS on postop SS is significant. These results suggest that 5 mg solifenacin succinate treatment in the early postoperative period may be beneficial for patients with high preoperative SS and may not be beneficial in others. Small prostatic volume may bode ill for postoperative SS in the patients with de novo SS.

Evaluation of apoptosis indexes in currently used oral alpha-blockers in prostate: a pilot study

ABSTRACT Objectives: Apoptosis effect of oral alpha-blockers is known in the prostate. Apoptosis index of silodosin has not been proved, yet. Aims are to present apoptosis index of silodosin in prostate and to compare this with other currently used alpha-blocker's apoptosis indexes together with their clinical effects. Materials and Methods: Benign prostatic hyperplasia (BPH) patients were enrolled among those admitted to urology outpatient clinic between June 2014 and June 2015. Study groups were created according to randomly prescribed oral alpha-blocker drugs as silodosin 8mg (Group 1; n=24), tamsulosin 0.4mg (Group 2; n=30), alfuzosin 10mg (Group 3; n=25), doxazosin 8mg (Group 4; n=22), terazosin 5mg (Group 5; n=15). Pa- tients who refused to use any alpha-blocker drug were included into Group 6 as control group (n=16). We investigated apoptosis indexes of the drugs in prostatic tissues that were taken from patient's surgery (transurethral resection of prostate) and/or prostate biopsies. Immunochemical dyeing, light microscope, and Image Processing and Analy- sis in Java were used for evaluations. Statistical significant p was p<0.05. Results: There were 132 patients with mean follow-up of 4.2±2.1 months. Pathologist researched randomly selected 10 areas in each microscope set. Group 1 showed statisti- cal significant difference apoptosis index in immunochemical TUNEL dyeing and im- age software (p<0.001). Moreover, we determined superior significant development in parameters as uroflowmetry, quality of life scores, and international prostate symptom score in Group 1. Conclusions: Silodosin has higher apoptosis effect than other alpha-blockers in prostate. Thus, clinic improvement with silodosin was proved by histologic studies. Besides, static factor of BPH may be overcome with creating apoptosis.

Lysozyme gene treatment in testosterone induced benign prostate hyperplasia rat model and comparasion of its' effectiveness with botulinum toxin injection

ABSTRACT Objectives: To compare the effects and histopathological changes of botulinum neurotoxin type A and lysozyme gene injections into prostate tissue within a testosterone induced benign prostate hyperplasia rat model. Materials and Methods: 40 male Wistar rats were randomized into four Groups. Group-1: Control, Group-2: Testosterone replacement, Group-3: Testosterone+botulinum neurotoxin type A, Group-4: Testosterone+plazmid DNA/liposome complex. Results: Estimated prostate volume of the testosterone injected Groups were higher than the control (p <0.05). Actual prostate weight of the testosterone injected Groups was higher than the control Group (p <0.05). Testosterone undecanoate increased the prostate weight by 39%. Botulinum neurotoxin type A treatment led to an estimated prostate volume and actual prostate weights decreased up to 32.5% in rats leading to prostate apoptosis. Lysozyme gene treatment led to an estimated prostate volume and actual prostate weights decrease up to 38.7%. Conclusion: Lysozyme gene and botulinum neurotoxin type A treatments for prostate volume decreasing effect have been verified in the present study that could be anew modality of treatment in prostatic benign hyperplasia that needs to be verified in large randomized human experimental studies.

Preliminary assessment of neck circumference in benign prostatic hyperplasia in patients with metabolic syndrome

ABSTRACT Objectives To investigate the impact of neck circumference (NC) in the treatment of bening prostatic hyperplasia (BPH) patients with metabolic syndrome (MtS). Additionally, we determined dose response to alpha-blockers and cut-off values for NC and waist circumference (WC), in these patients. Materials and Methods Non-randomized, open-labelled, and multi-centre study was conducted between March 2014 and September 2015. The BPH patients were enrolled and were divided into 2 groups: with MtS (Group 1; n=94) and without MtS (Group 2; n=103). Demographic data, anthropometric measurements, blood analyses, uroflowmetric parameters, post voiding residual urine (PVR), prostate volume, quality of life (QoL) index, NC and WC were recorded. Both groups were administered oral alpha-blockers and response to treatment was evaluated. Receiver-operating characteristic (ROC) curves were obtained and significant p was p<0.05 . Results In total, 197 patients were enrolled with mean age of 60.5±8.1 years. Mean NC and WC were higher in MtS patients (p<0.001). Uroflowmetry parameters and QoL indexes were comparable between groups before treatment. International prostate symptom score, uroflowmetry parameters, and QoL significant improved in Group 2 than Group 1, at 1 st and 6 th months of treatment with alpha-blockers. Success rate of treatment was significant higher in Group 2 than Group 1 (p<0.001). Cut-off values were 42.5cm and 113.5cm for NC and WC respectively, for response to alpha-blockers in BPH patients with MtS. Conclusions MtS can be related with BPH and can negatively affect the response to alpha-blocker treatment. NC can be used for predicting response to alpha-blocker treatment in BPH patients with MtS.

Efectos adversos de finasteride: mitos y realidades. una revisión actualizada / Finasteride adverse effects: an update

Finasteride is a 5-α reductase inhibitor that is widely used in the management of benign prostate hyperplasia and male pattern hair loss. It is well known that these agents improve the quality of life in men suffering from these conditions. However, they are associated with some transient and even permanent adverse effects. The aim of this article is to clarify the controversies about the safety of finasteride by analyzing the evidence available in the literature.

Realización del antígeno prostático específico desde el primer nivel de atención médica / Performance of prostate specific antigen from the first level of medical attention

Introducción: el antígeno prostático específico es considerado una proteína de síntesis exclusiva de la próstata. La determinación de sus niveles en sangre ha aumentado el diagnóstico precoz de las alteraciones prostáticas, encontrándose disponible en el primer nivel de atención médica. Objetivo: caracterizar la realización del antígeno prostático específico desde el primer nivel de atención médica. Métodos: se realizó una investigación descriptiva, observacional, de corte transversal en el Grupo Básico de Trabajo 1 del Policlínico Docente "Raúl Sánchez Rodríguez" de la ciudad de Pinar del Río en el período de enero a octubre del 2015. La muestra quedó constituida por 543 pacientes a los cuales se les realizó el antígeno prostático específico. Resultados: en la distribución de pacientes con medición de antígeno prostático específico realizados se destacó marzo con 12,8 por ciento y enero con 12,7 por ciento. Dentro de los resultados de la prueba sérica en los pacientes predominó el rango < 4,0 ng/mL con 92,3 por ciento. Prevaleció la hiperplasia benigna de próstata con un 3,5 por ciento. Conclusiones: se evidenció una adecuada realización de la prueba sérica de antígeno prostático específico desde el primer nivel de atención médica. Su correcta y oportuna realización garantizará el diagnóstico precoz, seguimiento y tratamiento de las afecciones prostáticas(AU)

Introduction: prostate specific antigen is considered a protein synthesis exclusively in the prostate. Determining blood levels increased early diagnosis of prostate abnormalities, and is available at the first level of medical attention. Objective: characterize the performance of prostate specific antigen from the Primary Health Care. Methods: a descriptive, cross-sectional observational research was carried out in the Basic Working Group 1 of the "Raúl Sánchez Rodríguez" Polyclinic, city of Pinar del Río in the period from January to October 2015. The universe was composed 543 patients who underwent prostate specific antigen. Medical ethics are respected. Results: in the distribution of patients with prostate specific antigen conducted March was 12,8 percent and 12,7 percent in January. Within the prostate specific antigen results in patients predominated the range < 4,0 ng/mL with 92,3 percent. The prevailing benign prostatic hyperplasia with 3,5 percent identified from prostate specific antigen. Conclusions: a suitable performance of the prostate specific antigen was evident from the first level of medical attention. Proper and timely implementation will ensure early diagnosis, monitoring and treatment of prostate conditions(AU)

Metabolic syndrome and prostatic disease: potentially role of polyphenols in preventive strategies. A review

ABSTRACT Benign prostatic hyperplasia and prostate cancer are two common urological diseases of the elderly. Scientific community has always looked for a link that could explain the correlation between the two diseases and the role of chronic inflammation in the pathogenesis of BPH and PCa. As shown by the reports of the two diseases relationship with oxidative stress and metabolic syndrome, the use of compounds with antioxidant action could therefore affect both the symptoms and their onset. Polyphenols appear to act not only against oxidative stress but also at different levels. The aim of this review is to evaluate the role of the most important polyphenols on these two urological diseases. As antioxidants these compounds seems to have a direct action on the cell cycle and hormone function, important for both prostate cancer and BPH. Despite a large number of articles about the relationship of the polyphenols with prostate cancer, very little evidence exists for BPH. Additional clinical trials or meta-analysis are necessary on this topic.

ADME studies and preliminary safety pharmacology of LDT5, a lead compound for the treatment of benign prostatic hyperplasia

This study aimed to estimate the absorption, distribution, metabolism and excretion (ADME) properties and safety of LDT5, a lead compound for oral treatment of benign prostatic hyperplasia that has previously been characterized as a multi-target antagonist of α1A-, α1D-adrenoceptors and 5-HT1A receptors. The preclinical characterization of this compound comprised the evaluation of its in vitro properties, including plasma, microsomal and hepatocytes stability, cytochrome P450 metabolism and inhibition, plasma protein binding, and permeability using MDCK-MDR1 cells. De-risking and preliminary safety pharmacology assays were performed through screening of 44 off-target receptors and in vivo tests in mice (rota-rod and single dose toxicity). LDT5 is stable in rat and human plasma, human liver microsomes and hepatocytes, but unstable in rat liver microsomes and hepatocytes (half-life of 11 min). LDT5 is highly permeable across the MDCK-MDR1 monolayer (Papp ∼32×10-6 cm/s), indicating good intestinal absorption and putative brain penetration. LDT5 is not extensively protein-bound and is a substrate of human CYP2D6 and CYP2C19 but not of CYP3A4 (half-life >60 min), and did not significantly influence the activities of any of the human cytochrome P450 isoforms screened. LDT5 was considered safe albeit new studies are necessary to rule out putative central adverse effects through D2, 5-HT1A and 5-HT2B receptors, after chronic use. This work highlights the drug-likeness properties of LDT5 and supports its further preclinical development.

Significance of intraprostatic architecture and regrowth velocity for considering discontinuation of dutasteride after combination therapy with an alpha blocker: A prospective, pilot study

PURPOSE: We conducted a prospective single-center study to evaluate the possibility of discontinuation of dutasteride after combination therapy with an alpha blocker for benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: We prospectively treated BPH patients with an alpha blocker and dutasteride (0.5 mg/d). Patients who had been treated with alpha blockers against BPH for more than 2 months were eligible, and 20 patients were included in the study. After 6 months of combination therapy, dutasteride was discontinued. Patients were followed for 12 months after cessation. Prostate volume, intraprostatic architecture determined by transrectal ultrasound, peak urinary flow rate, postvoid residual urine volume, and the serum prostate-specific antigen level were evaluated every 6 months, and the International Prostate Symptom Score and overactive bladder symptom score (OABSS) every 3 months. Patients were allowed to restart dutasteride during the follow-up period according to their desire. RESULTS: Twelve patients (12/20, 60%) restarted the combination therapy from 6 to 12 months into the follow-up period. For patients who restarted dutasteride, the prostate volume and OABSS had increased and worsened after discontinuation, respectively. A visible transition zone with a clear border on transrectal ultrasound at baseline and regrowth of the prostate after discontinuation of dutasteride were risk factors for restarting the therapy (Mann-Whitney U test: p=0.008, p=0.017). CONCLUSIONS: Prostatic enlargement after discontinuation of dutasteride differs among patients. Rapid regrowth of the prostate leads to deterioration of storage symptoms and a tendency to restart dutasteride. Baseline intraprostatic architecture may be a predictive factor for whether the patient is a good candidate for discontinuation.

Evaluación de efectividad y seguridad de finasterida, para el tratamiento en hiperplasia benigna de próstata / Evaluation of effectiveness and safety of finasteride, for the treatment in benign prostatic hyperplasia

Introducción: La hiperplasia prostática benigna (HPB) es una enfermedad cuya incidencia se ha incrementado con el aumento de la esperanza de vida conseguido en las últimas décadas. En Colombia alrededor del 30% de los hombres mayores de 50 años presentan hiperplasia prostática benigna. El objetivo del tratamiento en HPB va dirigido a aliviar o mejorar los síntomas del tracto urinario inferior. Los medicamentos que más frecuentemente se utilizan son los antagonistas alfa-adrenérgicos (doxazosina, alfuzosina, terazosina y tamsulosina) y los inhibidores de la 5 alfa reductasa (finasterida y dutasterida). Objetivo: Evaluar la efectividad y seguridad de finasterida para el tratamiento de HPB en comparación con dutasterida, terazosina, alfuzosina, tamsulosina, doxazosina y terapia combinada. Metodología: se realizó una evaluación crítica a través de una búsqueda sistemática en bases de datos electrónicas, diseñadas con vocabulario controlado y no controlado, además, de indagar con expertos sobre la disponibilidad de estudios publicados y no publicados, en inglés y español, la tamización de los resultados fue llevada a cabo por 2 revisores expertos. Los hallazgos de efectividad y seguridad fueron extraídos de los estudios con mejor calidad metodológica, buscando obtener información para todas las comparaciones y desenlaces de interés. Resultados: La efectividad de la finasterida comparada con la terazosina y doxazosina, mostró una mejoría en la puntuación de la escala IPSS a favor de terazosina -2.80 (IC 95% -3.88 a -1.72) (p < 0.01) y a favor de doxazosina (N = 489, DM: 1.70, IC 95%: 0.58, 2.82), (P=0,001), no mostro ninguna diferencia estadísticamente significativa con tamsulosina, alfuzosina y dutasterida. En relación a la seguridad, se presenta una mayor probabilidad de hipotensión en los pacientes tratados con terazosina que en los tratados con finasterida, pero no se presentan diferencias en seguridad con respecto a doxazosina, tamsulosina, alfuzosina y dutasterida. Conclusiones: La finasterida fue menos efectiva que la terazosina y la doxazosina en la disminución de puntos de la escala IPSS, pero igualmente efectiva que la tamsulosina, alfuzosina y dutasterida. Seguridad: La finasterida tuvo un menor riesgo de hipotensión postural al compararla con terazosina, pero no se presentó ninguna diferencia estadísticamente significativa entre finasterida y doxazosina, tamsulosina, alfuzosina y dutasterida.(AU)

Does sildenafil enhance the effect of tamsulosin in relieving acute urinary retention?

Objective To compare the safety and efficacy of combined therapy using sildenafil and tamsulosin for management of acute urinary retention (AUR) with tamsulosin alone in patients with benign prostate hyperplasia (BPH). Materials and Methods 101 patients were enrolled in a randomized placebo-controlled study from June 2009 to April 2012. Patients presenting with an initial episode of spontaneous AUR underwent urethral catheterization and then prospectively randomized to receive tamsulosin 0.4mg plus sildenafil 50mg in group A and tamsulosin 0.4mg plus placebo in group B for three days. Urethral catheter was removed three days after medical treatment and patient’s ability to void assessed at the day after catheter removal and seven days later. Patients who voided successfully were followed at least for three months. Results Mean age of patients was 59.64 ± 3.84 years in group A and 60.56 ± 4.12 years in group B (p value = 0.92). Mean prostate volume and mean residual urine were comparable between both groups (p value = 0.74 and 0.42, respectively). Fifteen patients in group A (success rate: 70%) and nineteen patients in group B (success rate: 62.7%) had failed trial without catheter (TWOC) at 7th day following AUR (p value = 0.3). No significant difference was noted between both groups regarding the rate of repeated AUR at one month and three month follow-up period (p = 0.07 and p = 0.45, respectively). Conclusion It seems that combination therapy by using 5-phosphodiesterase inhibitor and tamsulosin has no significant advantages to improve urinary retention versus tamsulosin alone. .

Effects of prostatic inflammation on LUTS and alpha blocker treatment outcomes

Purpose To evaluate the association between prostatic inflammation and lower urinary tract symptoms (LUTS), and to identify the effects of prostatic inflammation on the treatment with an alpha blocker. Materials and Methods 111 Participants who were aged ≥ 50 years, the presence of LUTS (maximal flow rate < 20 m/s, IPSS ≥ 11), and an elevated PSA level (3-20ng/mL) were treated with tamsulosin 0.2mg once daily for 3 months after prostate biopsies. Prostatic inflammation was scored as none (0), mild (I), moderate (II), or marked (III). LUTS parameters including urine flow rates, IPSS, PSA, and prostate volume were evaluated. Results Inflammation grading resulted in 25, 60, and 26 patients that were grade 0, I, and II, respectively. Lower grade inflammation was related to higher urine flow rate at baseline. Patients with higher inflammation grades had larger prostate volumes, larger total and transitional zone volumes, and higher PSA levels. Overall, urine flow rates and residual urine volume were improved after 3 months of alpha blocker therapy. Eighty percent of patients with grade 0 inflammation, 73% of patients with grade I inflammation, and 92.3% of patients with grade II inflammation showed improvement of LUTS after treatment. Longer duration of treatment was related to a decreased chance of improvement of LUTS. Patients with increased IPSS voiding subscales could be predictive of improvement of LUTS. Conclusions Patients with high grade inflammation had lower flow rates and higher prostatic volumes than patients with low grade inflammation. Inflammation grade did not affect the outcomes of alpha blocker treatment. .

Maca (Lepidium meyenii Walp), una revisión sobre sus propiedades biológicas / Maca (Lepidium meyenii Walp), a review of its biological properties

La maca (Lepidium meyenii) es una planta que crece sobre los 4000 metros de altitud en los Andes Centrales del Perú, presenta diferentes variedades de acuerdo al color de su hipocótilo. La presente revisión resume los resultados de estudios sobre los efectos de la maca en la función sexual, la espermatogénesis, la función reproductiva femenina, la memoria, la depresión y la ansiedad, como energizante y contra la hiperplasia benigna de próstata, osteoporosis y síndrome metabólico. Se discute también su efecto antienvejecimiento y la seguridad en su consumo. Se han demostrado diferencias en el efecto de las variedades negra, amarilla y roja de maca. La maca negra es la que mejores resultados presenta sobre la espermatogénesis, la memoria y contra la fatiga, mientras que la maca roja es la variedad que mejor revierte la hiperplasia benigna de próstata y la osteoporosis inducida experimentalmente. Además, la maca reduce los niveles de glucosa, y su consumo se relaciona con la reducción de la presión arterial y un mejor puntaje de salud. Estudios experimentales han demostrado que el consumo a corto como a largo plazo no muestra toxicidad tanto in vivo como in vitro. A pesar que los estudios experimentales han demostrado que la maca presenta diversos efectos benéficos, son necesarios más estudios clínicos para confirmar estos resultados.

Maca (Lepidium meyenii) is a plant that grows above 4000 altitude meters in Peru’s Central Andes; it has different varieties according to the color of the hypocotyl. This review summarizes the results of studies about the effects of maca on sexual function, spermatogenesis, female reproductive function, memory, depression and anxiety, and energy as well as effects on benign prostatic hyperplasia, osteoporosis and metabolic syndrome. Its anti-aging effect is also discussed as well as safety in consumption. Differences have been shown between the effects of the black, yellow and red maca varieties. Black maca shows the best results on spermatogenesis, memory and fatigue, while red maca is the variety that reverses the benign prostatic hyperplasia and experimentally induced osteoporosis. In addition, maca reduces the glucose levels, and its consumption is related to the lowering of blood pressure and an improved health score. Experimental studies have proven that short and long term consumption don’t show in vivo and in vitro toxicity. Although experimental studies have shown that maca has diverse beneficial effects, more clinical studies are needed to confirm these results.

Five-alpha Reductase Inhibitor Influences Expression of Androgen Receptor and HOXB13 in Human Hyperplastic Prostate Tissue

Objectives Five-alpha reductase inhibitors (5ARIs) are known as chemopreventive agents in prostate cancer with a risk of high-grade disease. This study evaluated the effects of 5ARI on androgen receptor (AR) and proteins involved in prostate cell growth such as HOXB13 expression in human prostate tissue and LNCaP prostate cancer cells. Materials and Methods We retrospectively selected 21 patients who underwent TURP between March 2007 and February 2010 for previously confirmed BPH by prostate biopsy. They were grouped into control (group 1, n = 9) and 5ARI treatment (group 2, n = 12) before TURP. AR and HOXB13 expression in prostate tissue was evaluated by immunohistochemical staining. We tested the effect of 5ARI on the expression of AR, prostate specific antigen (PSA) and HOXB13 in LNCaP cells. Cells were assessed by Western blot analysis, MTT in vitro proliferation assay, and ELISA. Results: Group 2 showed stronger reactivity for AR and HOXB13 than those of the group 1. MTT assay showed death of LNCaP cells at 25uM of 5ARI. At the same time, ELISA assay for PSA showed that 5ARI inhibited secretion of PSA in LNCaP cells. Western blot analysis showed that 5ARI did not greatly alter AR expression but it stimulated the expression of HOXB13. Conclusions These results demonstrated that 5ARI influences AR and HOXB13 expression in both LNCaP cells and human prostate tissue. In order to use 5ARI in chemoprevention of prostate cancer, we still need to clarify the influence of 5ARI in ARs and oncogenic proteins and its regulation pathway. .

Evaluación de efectividad y seguridad de finasterida, para el tratamiento en hiperplasia benigna de próstata / Evaluation of effectiveness and safety of finasteride, for the treatment in benign prostatic hyperplasia

Antecedentes: Descripción de la condición de salud de interés: La hiperplasia prostática benigna es una de las enfermedades benignas más comunes en el hombre. Se define histológicamente como el crecimiento de la \r\nglándula de la próstata a partir de la hiperplasia progresiva de sus células y estroma. Clínicamente, se refiere a los síntomas del tracto urinario inferior (STUI) asociados con el crecimiento benigno de la próstata que causa eventualmente obstrucción del tracto urinario inferior. Descripción de la tecnología: Está indicada en el tratamiento de la hiperplasia prostática benigna (HPB) sintomática en varones con aumento de tamaño \r\nde la próstata con objeto de: mejorar los síntomas, reducir el riesgo de retención urinaria aguda, reducir la necesidad de cirugía, incluidas la resección transuretral de la próstata (RTUP) y la prostatectomía. Información de la tecnología: La finasterida produce regresión del crecimiento prostático, mejora el flujo urinario y mejora los síntomas relacionados con la Hiperplasia beninga prostática. Evaluación de efectividad y seguridad: ¿Cuál es la efectividad y seguridad de finasterida en comparación con alfuzosina, doxazosina, tamsulosina y terazosina, para el tratamiento de Hiperplasia Benigna de Próstata? La pregunta de evaluación fue refinada y validada con base en: autorización de mercadeo de las tecnologías para la indicación de interés (registro sanitario INVIMA), listado de medicamentos vitales no disponibles, cobertura de las tecnologías en el Plan Obligatorio de Salud (POS) (Acuerdo 029 de 2011), revisión de grupos terapéuticos (clasificación ATC: Anatomical, Therapeutic, Chemical classification system), recomendaciones de guías de práctica clínica actualizadas, disponibilidad de evidencia sobre efectividad y seguridad (reportes de evaluación de tecnologías y revisiones sistemáticas de la literatura), uso de las tecnologías (listas nacionales de recobro, estadísticas de prescripción, etc), estudios de carga de enfermedad y consulta con un experto temático (especialista clínico). No se identificaron otros comparadores relevantes para la evaluación. Población: Pacientes con diagnóstico de Hiperplasia Benigna de Próstata. Metodología: Búsqueda de literatura, Búsqueda en bases de datos electrónicas. Conclusiones: Una revisión sistemática de buena calidad, que incluyó estudios para evaluar la efectividad y seguridad del finatesterida comparado con alfa-bloqueadores como la terazosina y doxazosina, mostro que existen diferencias estadísticamente significativas en desenlaces relacionados con síntomas obstructivos bajos, medidos con escalas validadas. No se encuentran diferencias significativas con la tamsulosina, no se encontraron estudios que realicen la comparación directa con la alfuzosina por lo cual sobre este último no se puede emitir una conclusión en esta revisión. En cuanto a los eventos secundarios reportados, excepto por una mayor probabilidad de presentar hipotensión en el grupo tratado con terazosina, en comparación con finasterida, no se evidencio ninguna otra diferencia estadísticamente significativa entre finasterida y otros alfa-bloqueadores.

The Effect of Combined Therapy with Tamsulosin Hydrochloride and Meloxicam in Patients with Benign Prostatic Hyperplasia Symptoms and Impact on Nocturia and Sleep Quality

Purpose We aimed to compare the effect and feasibility of a combined therapy with tamsulosin hydrochloride plus meloxicam, and tamsulosin hydrochloride alone in patients with benign prostate hyperplasia symptoms and impact on nocturia and sleep quality. Materials and Methods Four hundred male patients were included in this study between 2008 and 2011. Patients were randomly divided into two groups: one received tamsulosin hydrochloride 0.4 mg (Group 1, 200 patients) and the other tamsulosin hydrochloride 0.4 mg plus meloxicam 15 mg (Group 2, 200 patients) prospectively. Patients were evaluated for benign prostate hyperplasia (BPH) symptoms according to the American Urological Association clinical guidelines and sleep quality according to Pittsburgh Sleep Quality Index (PSQI). Patients were reevaluated after three months of treatment. The International Prostatic Symptom Score (IPSS), IPSS-Quality of Life (IPSS-QoL), maximal urinary flow rates (Qmax), average urinary flow rates (AFR), post void residual urine volumes (PVR), nocturia and Pittsburgh Sleep Quality Score (PSQS) were recorded at baseline and after three months. Results Mean age was 63.3 ± 6.6 and 61.4 ± 7.5 years in groups 1 and 2, respectively (p = 0.245). There were no statistically significant differences between both groups. Also, baseline prostate specific antigen (PSA), prostate volume, creatinine, International Prostatic Symptom Score (IPSS), IPSS-Quality of Life (IPSS-QoL), maximal urinary flow rates (Qmax), average urinary flow rates (AFR), post void residual urine volumes (PVR), nocturia and Pittsburgh Sleep Quality Score (PSQS) were similar in both groups. In addition, the total IPSS, IPSS-QoL, PVR, nocturia, and PSQS were significantly lower in Group 2 compared with Group 1 after treatment (p < 0.05). Qmax and AFR were higher significantly in Group 2 compared with Group 1 after treatment (p < 0.05). Conclusions Cyclooxygenase (COX)-2 inhibitors ...