Effect of rape flower on benign prostatic hyperplasia in rats

We were carried out to investigate the efficacy of Rape (Rapeseed, Brassica napus L.) flower on BPH (benign prostatic hyperplasia) in rats. We found that the extract from Rape flower prevented hyperplasia in testosterone-induced BPH model, the relevant animal model of human BPH. Extract reduced the weight of prostate and induced significantly cell apoptosis in prostate in BPH model. In addition, the extract controlled expression of TGF-ß1 in prostate gland and promoted urinary output in dose-dependence in BPH model. Our data provide that Rape flower may be useful for treatment of BPH

Aging-associated prostate smooth muscle hypercontractility in rats

Abstract Benign prostatic hyperplasia (BPH) is a multifactorial disease, highly associated with aging and characterized by increased prostate smooth muscle (PSM) contractility. Animal models have been employed to explore the aging-associated PSM hypercontractility; however, studies have focused in old animals, neglecting the initial alterations in early ages. The determination of prostatic dysfunctions onset is crucial to understand the BPH pathophysiology and to propose new BPH treatments. Considering that PSM contractility in 10-month-old rats has already been explored, the aim of the present study was to characterize the PSM contractility in younger rats. Male Wistar control (3.5-month-old), 6- and 8-month-old rats were used. Concentration-response curves to phenylephrine and electrical-field stimulation (EFS) were conducted in prostate from all groups. For the first time, we showed that 6- and 8-month-old rats exhibit PSM hypercontractility. The increased prostate contractility to phenylephrine starts around at 6-month-old, worsening during the aging. The 8-month-old rats exhibited hypercontractility to phenylephrine and EFS compared to the control and 6-month-old groups. Reduced phenylephrine potency was observed in 8-month-old rats, indicating an increased age-dependent prostate sensibility to this agonist. Collectively, our findings support the use of 6- and 8-month-old aged rats as new models to explore prostate hypercontractility in BPH.

Correlation of tools for objective evaluation of infravesical obstruction of men with lower urinary tract symptoms

ABSTRACT Purpose To identify how the most frequently used parameters in daily clinical practice diagnosing bladder outlet obstruction (BOO) due to benign prostate hyperplasia (BPH) correlate to each other. Materials and methods The study included 452 patients with lower urinary tract symptoms (LUTS) of the UNICAMP urology outpatient clinic of LUTS. Inclusion criteria: patients with BOO due to BPH who agreed to participate in the study. Exclusion criteria: patients with urinary tract infection, neurological diseases that compromised the lower urinary tract, prior prostatic surgery, radiotherapy or urethral stenosis. Patient assessment: history, international prostate symptoms score (IPSS), nocturnal quality of life score (NQoL) questionnaires, physical and digital rectal examination (DRE), PSA, transabdominal ultrasound with intravesical prostate protrusion (IPP), post-mictional residue and free uroflowmetry. Results There was no strong Spearman correlation among the studied variables. The only moderate correlations occurred between IPSS and NQoL (p <0001; c=0.56) and between IPP and prostate volume (p <0001; c=0.57). Weak correlations between IPP and post-mictional residue (p <0001; c=0.31) and free uroflowmetry (p <0001; c=-0.26); and between IPSS and free uroflowmetry (p <0001, c=-0.21) were observed. Conclusion In this study, we found moderate, weak, very weak and absent correlation among the various parameters used in the diagnosis and management of BOO due to BPH. As the value of these tools is variable, the creation of a logical and objective algorithm was not possible and the treatment is based on the interpretation of clinical symptoms.

Impact of PSA density of transition zone as a potential parameter in reducing the number of unnecessary prostate biopsies in patients with PSA levels between 2. 6 and 10. 0 ng/mL

ABSTRACT Purpose: To assess the accuracy of prostate-specific antigen (PSA) adjusted for the transition zone volume (PSATZ) in predicting prostate cancer by comparing the ability of several PSA parameters in predicting prostate cancer in men with intermediate PSA levels of 2.6 - 10.0 ng/mL and its ability to reduce unnecessary biopsies. Materials and Methods: This study included 656 patients referred for prostate biopsy who had a serum PSA of 2.6 - 10.0 ng/mL. Total prostate and transition zone volumes were measured by transrectal ultrasound using the prolate ellipsoid method. The clinical values of PSA, free-to-total (F/T) ratio, PSA density (PSAD) and PSATZ for the detection of prostate cancer were calculated and statistical comparisons between biopsy-positive (cancer) and biopsy-negative (benign) were conducted. Results: Cancer was detected in 172 patients (26.2%). Mean PSA, PSATZ, PSAD and F/T ratio were 7.5 ng/mL, 0.68 ng/mL/cc. 0.25 ng/mL/cc and 0.14 in patients with prostate cancer and 6.29 ng/mL, 0.30 ng/mL/cc, 0.16 ng/mL/cc and 0.22 in patients with benign biopsies, respectively. ROC curves analysis demonstrated that PSATZ had a higher area under curve (0,838) than F/T ratio (0.806) (P<0.001) and PSAD (0.806) (P<0.001). With a cut-off value of 0.22 ng/mL/cc, PSATZ had 100% of sensitivity and could have prevented 24% of unnecessary biopsies. Conclusions: PSATZ may be useful in enhancing the specificity of serum PSA. Compared to other PSA related parameters, it was better in differentiating between prostate cancer and benign prostatic enlargement. Also, PSATZ could reduce a significant number of unnecessary biopsies.

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.

Comportamiento sindrómico de pacientes con hiperplasia benigna de la próstata según la Medicina Tradicional China / Syndrome behavior of patients with prostate benign hyperplasia according to the Traditional Chinese Medicine

Introducción: la hiperplasia benigna de la próstata se define como una entidad histopatológica caracterizada por un crecimiento fibromioadenoso de la glándula prostática. Según la Medicina Tradicional China se clasifica bajo categorías diferentes, dependiendo de cada paciente y de sus síntomas clínicos principales. Objetivo: establecer el comportamiento de esta enfermedad según la Medicina Tradicional China. Materiales y Métodos: se realizó un estudio observacional, descriptivo, en pacientes con diagnóstico de hiperplasia benigna de próstata atendidos en el Servicio de Referencia Provincial de Medicina Natural y Tradicional "Dr. Mario E. Dihigo" de Matanzas, en el período correspondiente a febrero 2013 agosto de 2014. El universo lo conformaron los pacientes diagnosticados con la patología y que asistieron a consulta de Medicina Natural y Tradicional. La muestra fueron los 100 pacientes dispuestos a participar en la investigación que firmaron voluntariamente el consentimiento informado y se les realizó historia clínica. Resultados: la deficiencia de Yin en riñón e hígado y la humedad-calor en Jiao inferior fueron los diagnósticos que prevalecieron en la investigación. Conclusiones: la realización del diagnóstico tradicional chino posibilita indicar un tratamiento individualizado a los pacientes al tratar la causa que lo origina (AU).

Introduction: the prostate benign hyperplasia is defined as a histopathologic entity characterized by the prostate gland fibromioadenomatous growth. According to the Traditional Chinese Medicine it is classified in different categories, depending on each patient and his/her main clinical symptoms. Objective: to establish this disease behavior according to the Traditional Chinese Medicine. Materials and methods: an observational, descriptive study was carried out in patients diagnosed with prostate benign hyperplasia attended at the Provincial Reference Service of Natural and Traditional Medicine "Dr. Mario E. Dihigo" of Matanzas, in the period from February 2013 to August 2014. The universe was formed by the patients diagnosed with that pathology who assisted to the consultation of Natural and Traditional Medicine. The 100 patients who were ready to participate and voluntarily gave their informed consent were the sample; medical records were written. Results: Yin deficiency in kidney and liver, and humidity-warm in lower Jiao were the diagnoses that prevailed in the research. Conclusions: to make the traditional Chinese diagnosis allos to indicate an individualized treatment to the patients while treating the originating cause (AU).

Lack of evidence of HPV etiology of prostate cancer following radical surgery and higher frequency of the Arg/Pro genotype in turkish men with prostate cancer

ABSTRACT Objectives The aim of this study was to assess the possible role of HPV in the development of prostate cancer (PCa) and investigate the distribution of the p53 codon 72 polymorphism in PCa in a Turkish population. Materials and methods A total of 96 tissues, which had been obtained using a radical surgery method, formalin-fixed and parafin-embedded, were used in this study. The study group consisted of 60 PCa tissues (open radical prostatectomy) and the control group contained 36 benign prostatic hyperplasia tissues (BPH) (transvesical open prostatectomy). The presence of HPV and the p53 codon 72 polymorphism was investigated in both groups using real-time PCR and pyrosequencing. Results The results of the real-time PCR showed no HPV DNA in any of the 36 BPH tissue samples. HPV-DNA was positive in only 1 of the 60 PCa samples (1.7%). The HPV type of this sample was identified as HPV-57. The distribution of the three genotypes, Arg/Arg, Arg/Pro and Pro/Pro was found to be 45.6, 45.6, and 8.8% in the PCa group and 57.1%, 34.3% and 8.6% in the control group, respectively. Compared with the control group, patients with PCa had a higher frequency of the Arg/Pro genotype and Proline allele (odds ratio (OR)=1.67, 95% confidence interval (CI)=0.68-4.09, p=0.044; OR=1.13, 95% CI=0.76-1.68, p=0.021, respectively). Conclusions The results of the study do not support the hyphothesis that prostate cancer is associated with HPV infection but indicated that Proline allele can be a risk factor in the development of PCa in the Turkish population.

The relationship between histological prostatitis and lower urinary tract symptoms and sexual function

ABSTRACT This prospective analysis assessed the effect of histological prostatitis on lower urinary tract functions and sexual function. The patients were separated into two groups as histologically observed prostatitis (Group A) and no prostatitis (Group B) according to the biopsy outcomes. International prostate symptom score, international index of erectile function-5 scores, maximal and average flow rate, and residual urine volumes were compared statistically between groups. There was no significant difference (P>0.05) in baseline age (t=0.64), body mass index value (t=0.51), prostate volume (t=0.87), prostate-specific antigen levels (t=0.43), maximal (t=0.84) and average flow rate (t=0.59), and post-void residual urine volume (t=0.71). Mean international prostate symptom score in patients with prostatitis was numerically but not significantly higher than that in those without prostatitis (t=0.794, P=0.066). Mean international index of erectile function-5 score in the prostatitis group was significantly lower than that in those without prostatitis (t=1.854, P=0.013). Histological prostatitis notably affected sexual function of patients and may serve as a major risk factor for sexual dysfunction while having little effect on lower urinary tract symptoms.

Holmium laser enucleation of the prostate: surgical, functional, and quality-of-life outcomes upon extended follow-up

ABSTRACT Objectives: To evaluate the long-term surgical, functional, and quality-of-life (QoL) outcomes after Holmium laser enucleation of the prostate (HoLEP) in patients with symptomatic benign prostatic hyperplasia (BPH). Materials and Methods: We retrospectively reviewed recorded data on patients who underwent HoLEP between June 2002 and February 2005. Ninety-six patients were enrolled. Demographic, perioperative, and postoperative data were recorded. On follow-up, International Prostate Symptom Scores (IPSSs), prostate-specific antigen (PSA) levels, QoL scores, peak uroflowmetric data (Qmax values), and post-voiding residual urine volumes (PVR volumes), were recorded. Complications were scored using the Clavien system. Statistical significance was set at p<0.05. Results: The mean follow-up time was 41.8±34.6 months and the mean patient age 73.2±8.7 years. The mean prostate volume was 74.6±34.3mL. Significant improvements in Qmax values, QoL, and IPSSs and decreases in PSA levels and PVR volumes were noted during follow-up (all p values=0.001). The most common complication was a requirement for re-catheterisation because of urinary retention. Two patients had concomitant bladder tumours that did not invade the muscles. Eight patients (8.3%) required re-operations; three had residual adenoma, three urethral strictures, and two residual prostate tissue in the bladder. Stress incontinence occurred in one patient (1%). All complications were of Clavien Grade 3a. We noted no Clavien 3b, 4, or 5 complications during follow-up. Conclusions: HoLEP improved IPSSs, Qmax values, PVR volumes, and QoL and was associated with a low complication rate, during extended follow-up. Thus, HoLEP can be a viable option to transurethral resection of the prostate.

Low grade urothelial carcinoma mimicking basal cell hyperplasia and transitional metaplasia in needle prostate biopsy

ABSTRACT Purpose The vast majority of urothelial carcinomas infiltrating the bladder are consistent with high-grade tumors that can be easily recognized as malignant in needle prostatic biopsies. In contrast, the histological changes of low-grade urothelial carcinomas in this kind of biopsy have not been studied. Materials and Methods We describe the clinicopathologic features of two patients with low-grade bladder carcinomas infiltrating the prostate. They reported dysuria and hematuria. Both had a slight elevation of the prostate specific antigen and induration of the prostatic lobes. Needle biopsies were performed. At endoscopy bladder tumors were found in both cases. Results Both biopsies showed nests of basophilic cells and cells with perinuclear clearing and slight atypia infiltrating acini and small prostatic ducts. The stroma exhibited extensive desmoplasia and chronic inflammation. The original diagnosis was basal cell hyperplasia and transitional metaplasia. The bladder tumors also showed low-grade urothelial carcinoma. In one case, the neoplasm infiltrated the lamina propria, and in another, the muscle layer. In both, a transurethral resection was performed for obstructive urinary symptoms. The neoplasms were positive for high molecular weight keratin (34BetaE12) and thrombomodulin. No metastases were found in either of the patients, and one of them has survived for five years. Conclusions The diagnosis of low-grade urothelial carcinoma in prostate needle biopsies is difficult and may simulate benign prostate lesions including basal cell hyperplasia and urothelial metaplasia. It is crucial to recognize low-grade urothelial carcinoma in needle biopsies because only an early diagnosis and aggressive treatment can improve the prognosis for these patients.

Giant prostatic hyperplasia: report of a previously asymptomatic man presenting with gross hematuria and hypovolemic shock / Hiperplasia prostática gigante: hematúria macroscópica com choque hipovolêmico em paciente previamente assintomático

Giant prostatic hyperplasia is a rare condition characterized by very high volume benign prostatic enlargement (>500g). Few cases have been reported so far and most of them are associated with severe lower urinary symptoms. We report the first case of asymptomatic giant prostatic hyperplasia in an elderly man who had a 720g prostate adenoma, sudden gross hematuria and hypovolemic shock. The patient was successfully treated with open transvesical prostatectomy and had an uneventful postoperative recovery.

A hiperplasia prostática gigante é uma condição rara caracterizada por aumento benigno prostático significativo, com volume maior que 500g. Existem poucos casos relatados e, em sua maioria deles está associada a sintomas graves do trato urinário inferior. Relatamos aqui o primeiro caso de hiperplasia prostática benigna assintomática em paciente idoso com próstata de 720g, hematúria macroscópica de início súbito e choque hipovolêmico. O paciente foi submetido com sucesso à prostatectomia suprapúbica, sem intercorrências no intra e pós-operatório.

A novel one lobe technique of thulium laser enucleation of the prostate: 'All-in-One' technique

PURPOSE: The thulium laser is the most recently introduced technology for the surgical treatment of benign prostatic hyperplasia (BPH). Until recently, most thulium laser enucleation of the prostate (ThuLEP) was performed by use of the three-lobe technique. We introduce a novel one-lobe enucleation technique for ThuLEP called the "All-in-One" technique. We report our initial experiences here. MATERIALS AND METHODS: From June 2013 to May 2014, a total of 47 patients underwent the All-in-One technique of ThuLEP for symptomatic BPH performed by a single surgeon. All patients were assessed with the International Prostate Symptom Score (IPSS), transrectal ultrasonography, serum prostate-specific antigen (PSA), maximal urine flow rate (Qmax), and postvoid residual urine volume (PVR) before and 1 month after surgery. We reassessed IPSS, Qmax, and PVR 3 months after surgery. To assess the efficacy of the All-in-One technique, we checked the PSA reduction ratio, transitional zone volume reduction ratio, and enucleation failure rate. RESULTS: The mean operative time was 82.1+/-33.3 minutes. The mean enucleation time and morcellation time were 52.7+/-21.7 minutes and 8.2+/-7.0 minutes, respectively. The mean resected tissue weight and decrease in hemoglobin were 36.9+/-24.6 g and 0.4+/-0.8 g/dL, respectively. All perioperative parameters showed significant improvement (p<0.05). No major complications were observed. The PSA reduction ratio, transitional zone volume reduction ratio, and enucleation failure rate were 0.81, 0.92, and 4.3%, respectively. CONCLUSIONS: The All-in-One technique of ThuLEP showed efficacy and effectiveness comparable to that of other techniques. We expect that this new technique could reduce the operation time and the bleeding and improve the effectiveness of enucleation.

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. .

Prostate Volume Measurement by Transrectal Ultrasonography: Comparison of Height Obtained by Use of Transaxial and Midsagittal Scanning

PURPOSE: The purpose of this study was to compare prostate volume measured by transrectal ultrasonography (TRUS) between transaxial scanning and midsagittal scanning. We tried to determine which method is superior. MATERIALS AND METHODS: A total of 968 patients who underwent TRUS for diagnosis of any diseases related to the prostate were included in this study. When measuring prostate volume by TRUS, we conducted the measurements two ways at the same time in all patients: by use of height obtained by transaxial scanning and by use of height obtained by midsagittal scanning. Prostate volume was calculated by using the ellipsoid formula ([heightxlengthxwidth]xpi/6). RESULTS: For prostate volume measured by TRUS, a paired t-test revealed a significant difference between using height obtained by transaxial scanning and that obtained by midsagittal scanning in all patients (28.5+/-10.1 g vs. 28.7+/-9.9 g, respectively, p=0.004). However, there were no significant differences in the prevalence of prostate volume more than 20 g (known benign prostatic enlargement [BPE]) between the two methods by chi-square test (90.5% [n=876], 90.8% [n=879], respectively; p=0.876). When analyzed in the same way, there were no significant differences in the prevalence of prostate volume more than 30 g (generally, high-risk BPE) between the two methods (34.5% [n=334], 36.3% [n=351], respectively; p=0.447). CONCLUSIONS: Although prostate volume by TRUS differed according to the method used to measure height, that is, transaxial or midsagittal scanning, we conclude that there are no problems in diagnosing BPE clinically by use of either of the two methods.

Caracterización del cáncer de próstata incidental / Characterization of incidental prostate cancer

Introducción: El Cáncer de Próstata (CaP) es uno de los principales problemas de salud en los países desarrollados. El CaP diagnosticado después de la cirugía prostática por patología benigna, se denomina incidental y oscila entre 4 por ciento y 15 por ciento. Corresponde al estadio T1a y T1b según clasificación TNM. Objetivos: Describir las características clínicas e histológicas y el manejo del Cáncer de próstata T1a y T1b diagnosticados en nuestro servicio. Material y Método: Análisis descriptivo retrospectivo de 2835 pacientes con adenoma prostático entre el año 2002 y 2012, cuyas biopsias post-cirugía fueron positivas para cáncer (63 pacientes). El análisis estadístico se realiza con test de Fisher, T-test y X2. Resultados: La edad promedio fue 72 años. PSA promedio fue 10,6 ng/dl, siendo el 50 por ciento de tamaño grado 3-4. En promedio el volumen prostático fue 79gr con un tamaño tumoral de 5,5gr y compromiso tumoral del 40 por ciento (T1a 7 por ciento y T1b 93 por ciento). 75 por ciento presento Gleason 5-7. El número de focos (+) fue mayoritariamente 1 o 2 (89 por ciento). Presentó márgenes (+) un 23 por ciento. El tratamiento posterior fue principalmente hormonoterapia (39 por ciento). Al comparar PSA, Gleason y tacto rectal entre sí y con las otras variables no se encontraron diferencias estadísticas significativas. Conclusiones: Los tumores T1a-T1b en nuestro servicio equivalen al 2,2 por ciento, menor a otras series publicadas. El no existir asociación estadística entre las variables lo atribuimos a un bajo “n” muestral. El cáncer incidental de próstata no es frecuente y la adecuada selección de los pacientes sometidos a biopsias, disminuye su incidencia.

Introduction: Prostate cancer (PCa) is a major health problem in developed countries. The PCa diagnosed after surgery for benign prostate, called incidental and ranges between 4 percent and 15 percent. Corresponds to stage T1a and T1b as TNM classification. Objectives: To describe the clinical and histological features and management of prostate cancer diagnosed in T1a and T1b our service. Methods: retrospective analysis of 2835 patients with prostatic adenoma between 2002 and 2012, whose post-surgery biopsies were positive for cancer (63 patients). Statistical analysis was performed with Fisher test, T-test and X2.Results: Mean age was 72 years. Average PSA was 10.6 ng / dl, with 50 percent grade 3-4. On average prostate volume was 79gr with a tumor size of 5.5 g and 40 percent tumor involvement (T1a 7 percent and T1b 93 percent). 75 percent showed Gleason 5-7. The number of foci (+) was mostly 1 or 2 (89 percent). Presented margins (+) 23 percent. The subsequent treatment was primarily hormonotherapy (39 percent). Comparing PSA, Gleason and DRE among themselves and with the other variables were not statistically different. Conclusions: T1a-T1b tumors in our service equal to 2.2 percent, lower than other published series. The absence of statistical association between the variables we attribute to a low “n” sample. Incidental prostate cancer is not a common and appropriate selection of patients undergoing biopsy, reduces its incidence.

Effects of Serenoa Repens, Selenium and Lycopene (Profluss®) on chronic inflammation associated with Benign Prostatic Hyperplasia: results of “FLOG” (Flogosis and Profluss in Prostatic and Genital Disease), a multicentre Italian study

Objective To evaluate the efficacy of Profluss® on prostatic chronic inflammation (PCI). Materials and Methods We prospectively enrolled 168 subjects affected by LUTS due to bladder outlet obstruction submitted to 12 cores prostatic biopsy for suspected prostate cancer + 2 cores collected for PCI valuation. First group consisted of 108 subjects, with histological diagnosis of PCI associated with BPH and high grade PIN and/or ASAP, randomly assigned to 1:1 ratio to daily Profluss® (group I) for 6 months or to control group (group Ic). Second group consisted of 60 subjects, with histological diagnosis of BPH, randomly assigned to 1:1 ratio to daily Profluss® + α-blockers treatment (group II) for 3 months or to control group (group IIc). After 6 months first group underwent 24 cores prostatic re-biopsy + 2 cores for PCI while after 3 months second group underwent two-cores prostatic for PCI. Specimens were evaluated for changes in inflammation parameters and for density of T-cells (CD3, CD8), B-cells (CD20) and macrophages (CD68). Results At follow-up there were statistical significant reductions of extension and grading of flogosis, mean values of CD20, CD3, CD68 and mean PSA value in group I compared to Ic, while extension and grading of flogosis in group II were inferior to IIc but not statistical significant. A statistically significant reduction in the density of CD20, CD3, CD68, CD8 was demonstrated in group II in respect to control IIc. Conclusions Serenoa repens+Selenium+Lycopene may have an anti-inflammatory activity that could be of interest in the treatment of PCI in BPH and/or PIN/ASAP patients. .

The histology of prostate tissue following prostatic artery embolization for the treatment of benign prostatic hyperplasia

Objective Prostatic artery embolization (PAE) for the treatment of patients with symptomatic benign prostatic hyperplasia (BPH) is believed to be a safe procedure with a low risk of adverse side effects. Artery embolization is a viable treatment option in patients who are refractory to the classic noninvasive treatments. Knowledge of the histological characteristics of prostate tissue following the procedure is still limited. In this study, we describe the microscopic aspects of the prostate following PAE for BPH. Materials and Methods Two patients underwent transurethral resections of the prostate (TURP) after PAE. Embolizations were performed under local anesthesia with an initial pelvic angiography to evaluate the iliac vessels and the prostate arteries using a 2.8 French microcatheter. The prostate was embolized with 300-500µm Microspheres (Embosphere®), using complete blood stasis as the end point. The prostate tissues were analyzed histologically to characterize the effects of the embolization. Results The embolic material within the prostate tissue was easily identified as homogeneous, bright eosin-red spheroids filling the vessel lumens. Ischemic necrosis surrounded or not by chronic inflammatory reactions containing macrophages were considered as a result of the artery embolization. Also, some aspects related to the healing process were observed being fibrotic nodules surrounded by glands with squamous metaplasia of the epithelial lining the most important. In the remaining sections, due to the precocious surgical intervention, the classic findings of BPH were still present with the glandular and stromal hyperplasia associated with nonspecific chronic prostatitis. Conclusions This is the first description of prostate histology in BPH patients treated by PAE, a new procedure that is being used increasingly as a therapeutic intervention. The recognition of the changes caused by this new modality of treatment has ...

Identificación de factor de crecimiento vascular endotelial en células glandulares de tejido prostético maligno y benigno: Relación con la recidiva tumoral al año de la prostatectomía / Vascular endothelial growth factor in malignant and non malignant prostatic tissue: Association with tumor recurrence at one year after prostatectomy

Background: Prostate cancer (PC) is the second cause of death by cancer in men in Chile. Its behavior is so variable that it is necessary to search reliable prognostic markers. Vascular Endothelial Growth Factor (VEGF) is one of the most powerful pro-angiogenic factors. There is no agreement on its validity as a diagnostic or prognostic factor. Aim: To search for VEFG in prostatic tissue. Material and Methods: This study was performed in prostatectomy tissue coming from 41 patients with PC and 39 patients with benign prostatic hyperplasia (BPH). Specimens were studied using immunohistochemical staining for VEGF. The percentage of stained glandular cells per patient was calculated and associated with pathological diagnosis in cancer patients. Results: PC biopsies had a mean of 82% of VEGF (+) stained cells, while BPH had only 1.6% (p < 0.01). No relationship was found between the percentage of staining and recurrence at one year of follow-up in the case of PC. Conclusions: These results would rule out VEGF as a prognostic factor in this series of patients.

Cellular distribution and heterogeneity of PSA and PSMA expression in normal, hyperplasia and human prostate cancer

As promising targets for in vivo diagnostic, prognostic and therapeutic approaches, the distribution and staining pattern of prostate specific antigen [PSA] and prostate specific membrane antigen [PSMA] in tumors are of significant interest. To compare the cellular distribution and heterogeneity of PSA and PSMA expression in normal prostate [NP], benign prostatic hyperplasia [BPH] and primary prostatic tumors and to analyze their relation with the angiogenic activity according to Gleason grade [low, medium and high] in primary PC. The study was carried out in 6 NP, 44 BPH and 39 PC. Immunohistochemical analysis was performed. Monoclonal antibodies 3E6 and ER-PR8 were used to assess PSMA and PSA expression respectively. The evaluation of angiogenesis was made by CD34 immune marker. In our study we noticed differences in the intracellular localization of the PSMA immunostaining which seem to be related to the normal and pathological context. A significant number of primary tumors presented with apical pattern of PSMA [28/39]; whereas a relevant part of NP samples and BPH samples showed cytoplasmic localization [4/6 and 30/44, respectively] in luminal epithelial cells. Compared to PSMA, PSA was preferentially localized in cytoplasmic compartment in all type of prostate. A direct correlation between histological grade, PSMA expression and angiogenic activity could be demonstrated in primary PC. Simultaneous stains with PSA and PSMA in individual prostate tissue will greatly improve the detection rate and identify a high risk PC that could progress to metastatic phenotype. Our findings clearly support the feasibility but also direct the potential of PSMA-targeted in vivo therapeutic approaches in PC patients rather than PSA especially those with poorly differentiated adenocarcinoma

Standard surgical treatment for benign prostatic hyperplasia is safe for patients over 75 years: analysis of 100 cases from a high-volume urologic center

OBJECTIVES: In this study, we aimed to determine the complications of standard surgical treatments among patients over 75 years in a high-volume urologic center. METHODS: We analyzed 100 consecutive patients older than 75 years who had undergone transurethral prostatic resection of the prostate or open prostatectomy for treatment of benign prostatic hyperplasia from January 2008 to March 2010. We analyzed patient age, prostate volume, prostate-specific antigen level, international prostatic symptom score, quality of life score, urinary retention, co-morbidities, surgical technique and satisfaction with treatment. RESULTS: Median age was 79 years. Forty-eight patients had undergone transurethral prostatic resection of the prostate, and 52 had undergone open prostatectomy. The median International Prostatic Symptom Score was 20, the median prostate volume was 83 g, 51% were using an indwelling bladder catheter, and the median prostatespecific antigen level was 5.0 ng/ml. The most common comorbidities were hypertension, diabetes and coronary disease. After a median follow-up period of 17 months, most patients were satisfied. Complications were present in 20% of cases. The most common urological complication was urethral stenosis, followed by bladder neck sclerosis, urinary fistula, late macroscopic hematuria and persistent urinary incontinence. The most common clinical complication was myocardial infarction, followed by acute renal failure requiring dialysis. Incidental carcinoma of the prostate was present in 6% of cases. One case had urothelial bladder cancer. CONCLUSIONS: Standard surgical treatments for benign prostatic hyperplasia are safe and satisfactory among the elderly. Complications are infrequent, and urethral stenosis is the most common. No clinical variable is associated with the occurrence of complications.