Variants of Patterns of Intra- and Extra-prostatic Arterial Distribution of the Prostatic Artery Applied to Prostatic Artery Embolization: Proposal of a Classification.

The development of prostatic artery embolization has led to better understand the complex male pelvic arterial anatomy. To the best of our knowledge, there is still no precise description of the distribution of the branches of the prostatic artery (PA) after its origin. In this study, the patterns of prostatic feeders near to and into the prostate were analyzed, and a classification was proposed. MATERIALS AND METHODS: This study is based on angiograms of 101 consecutive male patients, mean age 70, who underwent PAE between December 2013 and June 2016, to treat symptomatic benign prostatic hyperplasia. RESULTS: The proposed classification is derived from the analysis of 143 solitary PAs from 199 hemipelves (72%). Pattern A was defined as an artery feeding only the prostate, patterns B and C as a PA with a concomitant large supply to the penis (pattern B) or to the rectum (pattern C). A pattern A was found in 89/143 (62%), a pattern B in 16/143 (12%) and pattern C in 38/143 (26%). Protection of a penile/rectal supply was never required in pattern A, while it was performed in 14/16 (87%) of pattern B, and in 7/38 (18%) of pattern C PAs. The PErFecTED technique could be performed in 51%, 50 and 55% of cases in pattern A to C. CONCLUSION: This study proposes a new classification of intra-/extra-prostatic arterial distribution of the PA that could be helpful to prevent complications of PAE. Further prospective angiographic investigations are necessary to confirm its clinical value.

[Correlation between TCM syndrome types and clinical symptoms of benign prostatic hyperplasia with chronic prostatitis].

OBJECTIVE: To investigate the correlation between the syndrome types of traditional Chinese medicine (TCM) and clinical symptoms of benign prostatic hyperplasia (BPH) with chronic prostatitis (BPH-CP). METHODS: We selected 150 cases of BPH-CP in this study and divided them into 7 TCM syndrome types. Using univariate and multivariate logistic regression analyses, we studied the correlation of each TCM syndrome type with the age, disease course, prostate volume, postvoid residual urine volume (PVR), prostate-specific antigen (PSA) level, maximum urinary flow rate (Qmax), and International Prostate Symptoms Score (IPSS). RESULTS: Kidney-yin deficiency was correlated positively with the prostate volume but negatively with Qmax and IPSS; kidney-yang deficiency positively with the age and prostate volume but negatively with IPSS; the damp heat syndrome positively with the PSA level but negatively with the disease course, prostate volume and Qmax; the spleen-qi deficiency syndrome positively with the prostate volume but negatively with the disease course; liver-qi stagnation positively with the disease course but negatively with the age, prostate volume and PVR; the syndrome of qi stagnation and blood stasis positively with the disease course and IPSS but negatively with PVR; the syndrome of lung-heat and qi blockage positively with the age, Qmax and IPSS but negatively with the disease course. CONCLUSIONS: The TCM syndrome types of BPH-CP are closely correlated to their clinical symptoms. The analysis of the clinical objective indexes of BPH-CP can provide some reliable evidence for accurate identification of the TCM syndrome type of the disease.

Efficacy and safety of a fixed-dose combination of dutasteride and tamsulosin treatment (Duodart(®) ) compared with watchful waiting with initiation of tamsulosin therapy if symptoms do not improve, both provided with lifestyle advice, in the management of treatment-naïve men with moderately symptomatic benign prostatic hyperplasia: 2-year CONDUCT study results.

OBJECTIVE: To investigate whether a fixed-dose combination (FDC) of 0.5 mg dutasteride and 0.4 mg tamsulosin is more effective than watchful waiting with protocol-defined initiation of tamsulosin therapy if symptoms did not improve (WW-All) in treatment-naïve men with moderately symptomatic benign prostatic hyperplasia (BPH) at risk of progression. PATIENTS AND METHODS: This was a multicentre, randomised, open-label, parallel-group study (NCT01294592) in 742 men with an International Prostate Symptom Score (IPSS) of 8-19, prostate volume ≥30 mL and total serum PSA level of ≥1.5 ng/mL. Patients were randomised to FDC (369 patients) or WW-All (373) and followed for 24 months. All patients were given lifestyle advice. The primary endpoint was symptomatic improvement from baseline to 24 months, measured by the IPSS. Secondary outcomes included BPH clinical progression, impact on quality of life (QoL), and safety. RESULTS: The change in IPSS at 24 months was significantly greater for FDC than WW-All (-5.4 vs -3.6 points, P < 0.001). With FDC, the risk of BPH progression was reduced by 43.1% (P < 0.001); 29% and 18% of men in the WW-All and FDC groups had clinical progression, respectively, comprising symptomatic progression in most patients. Improvements in QoL (BPH Impact Index and question 8 of the IPSS) were seen in both groups but were significantly greater with FDC (P < 0.001). The safety profile of FDC was consistent with established profiles of dutasteride and tamsulosin. CONCLUSION: FDC therapy with dutasteride and tamsulosin, plus lifestyle advice, resulted in rapid and sustained improvements in men with moderate BPH symptoms at risk of progression with significantly greater symptom and QoL improvements and a significantly reduced risk of BPH progression compared with WW plus initiation of tamsulosin as per protocol.

A retrospective analysis of 111 canine prostatic samples: histopathological findings and classification.

The purpose of this retrospective study is to evaluate the frequency and further characterize the pathological features of common and uncommon histological lesions in 111 canine prostatic samples. Benign prostatic hyperplasia, suppurative and non-suppurative prostatitis, and prostate cancer were observed individually or in combination in 45, 11, 68 and 50 samples, respectively. Six growth patterns of prostatic carcinoma were differentiated: papillary, cribriform, solid, small acinar/ductal, signet ring, mucinous. In a few cases, perineurial invasion and collagenous micronodules were observed. Lesions considered preneoplastic in men, such as high-grade prostatic intraepithelial neoplasia (HGPIN) and prostatic inflammatory atrophy (PIA), were observed in 27 and 21 histological samples, respectively. This study represents a detailed characterization of the different histological subtypes of canine prostate cancer. The awareness of the unusual patterns might be critical in avoiding diagnostic misinterpretation. The high prevalence of PIA and HGPIN underlines the reasonable chance of their detection in routine biopsy specimens.

Stromal nodules in benign prostatic hyperplasia: morphologic and immunohistochemical characteristics.

BACKGROUND: One hundred forty nine stromal nodules (SNs) from transurethral resection of benign prostatic hyperplasia specimens in 39 patients (57-85 years with mean of 70.9) were investigated to characterize the SNs and to outline the etiopathogenesis of solitary fibrous tumors (SFTs) and gastrointestinal stromal tumors (GISTs) of prostate by immunohistochemistry performed on tissue microarray sections. METHODS: Antibodies used included smooth muscle actin, desmin, vimentin, and S-100 protein for subtyping, vascular endothelial growth factor, insulin-like growth factor-1, fibroblast growth factor, and TGF-ß as growth factors; CD133, c-KIT, CD34, and CD44 as stem cell markers; and estrogen (ER), progesterone (PR), and androgen receptor (AR) as hormone receptors. RESULTS: SNs were classified into four subtypes: (1) immature mesenchymal (n = 7, 4.7%); (2) fibroblastic (n = 74, 49.7%); (3) fibromuscular (n = 53, 35.6%); and (4) smooth muscular (n = 15, 10.1%) types. There were linear trends of the expression of all growth factors (VEGF, IGF-1, FGF, TGF-ß), but only CD44 stem cell marker and AR hormone receptor as maturation progressed from immature mesenchymal to smooth muscular type (Ptrend < 0.05). S-100, c-KIT, and ER were not expressed in any types of SNs. CD34 was positive in 55% of the SNs (82/149). CONCLUSIONS: The data suggest that AR and growth factors are important factors for maturation of SNs, but not influenced by the administration of 5-alpha reductase inhibitor (5ARI). Although the cells comprising the SNs seem to be not associated with the origin of prostatic GISTs, there is a possibility of a tentative link of SFTs arising from SNs of the prostate.

[Clinical impact of the intravesical prostatic protrusion: a review by the LUTS committee of the French Urological Association]. / Impact en pratique clinique de l'indice de protrusion prostatique intravésicale: une revue de la littérature du CTMH de l'AFU.

INTRODUCTION: Intravesical prostatic protrusion (IPP) is a protrusion of the lateral and/or median prostatic lobes into the bladder lumen. IPP can be estimated by suprapubic ultrasound. METHODS: A literature search was conducted in Pubmed/MEDLINE database using the following keywords: intravesical prostatic protrusion; benign prostatic enlargement; treatment outcome; ultrasonography. RESULTS: There are 3 grades of IPP: grade 1, 2 and 3 respectively if IPP ≤ 5mm, if 5-10mm, and if >10mm. IPP was a better prognosis factor than PSA and prostate volume for bladder outlet obstruction (BOO) with a sensibility of 80% and a sensitivity of 68% for grade 3. The progression risk of BOO increased with IPP (grade 1: OR=5.1 [95%CI: 1.6-16.2] and grade ≥ 2 OR=10.4 [95%CI: 3.3-33.4]). IPP was a predictive marker of failure of trial off catheter in patients with acute urinary retention with a 6 folds higher risk for grades ≥ 2. IPP was a prognosis factor for tamsulosine efficacy: 78% of patients with grade ≤ 2 had an improvement >35% of the IPSS-score versus 58% for grade >3 (P<0.01). Patients with grade >3 and a PV< 40cc had a poorer response to tamsulosine. After TURP, IPSS was more improved for grade ≥ 1 with an OR=3.43 (95%CI: 1.03-11.44, P=0.045). CONCLUSION: IPP can be a useful marker for the management of LUTS/BPH.

Subtypes of white blood cells in patients with prostate cancer or benign prostatic hyperplasia and healthy individuals.

BACKGROUND: This study aimed to evaluate the baseline white blood cell (WBC), neutrophil, lymphocyte, monocyte, basophil, eosinophil count, total prostate-specific antigen (TPSA), free PSA (FPSA) level, neutrophil- to-lymphocyte and neutrophil-to-monocyte ratios among patients with prostate cancer and benign prostatic hyperplasia (BPH), as well as healthy individuals. MATERIALS AND METHODS: 2005-2012 laboratory files of 160 patients with prostate cancer at Kayseri Training and Research Hospital, Oncology Outpatient Clinic, 285 patients who were pathologically diagnosed with BPH in Urology Outpatient Clinic and 200 healthy individuals who were admitted to Internal Medicine Outpatient Clinic were retrospectively analyzed. Baseline WBC, neutrophil, lymphocyte, monocyte, basophil, eosinophil count, TPSA, FPSA level, neutrophil-to-lymphocyte ratio and neutrophil-to-monocyte ratio were recorded and compared across groups. RESULTS: Patients with prostate cancer had a lower lymphocyte level compared to the patients with BPH and healthy controls (p<0.001). The mean monocyte count, leukocyte-to-monocyte ratio, and leukocyte-to-lymphocyte ratio were higher in patients with prostate cancer, but without significance. The mean WBC and leukocyte count were lower in patients with prostate cancer, but again without statistical significance (p=0.130). The mean TPSA and FPSA were 39.4 and 5.67, respectively in patients with prostate cancer, while they were 5.78 and 1.28 in patients with BPH. There was a significant difference in the mean TPSA and FPSA levels between the patient groups (p<0.001). CONCLUSIONS: Our study results showed that patients with prostate cancer had a lower level of lymphocytes, neutrophils and WBCs and a higher level of monocytes with a significant difference in lymphocyte count, compared to healthy controls. We suggest that lymphocyte count may be used in combination with other parameters in the diagnosis of prostate cancer, thanks to its ease of assessment.

Problems with administration of international prostate symptom score in a developing community.

BACKGROUND: The IPSS form has been found useful for assessing symptom severity, which assists in treatment choice and in monitoring patients on therapy. The form should be self-administered and requires some level of literacy. We assessed the problems associated with its administration in a developing community. MATERIALS AND METHODS: The IPSS form was administered to patients with benign prostatic hyperplasia at the Urology Clinic of the Jos University Teaching Hospital from November 2004 to October 2005. Those who did not understand the questions or who could not read English required explanations. RESULT: There were a total of 70 patients who agreed to fill out the forms. Their ages ranged from 40 to 104 years with a mean of 63.6. The IPSS scores ranged from 3 to 35 with a mean of 18.3. About 56.7% of the patients had quality of life scores of ≥ 5. Only 2 (2.9%) patients were initially uncooperative in filling out the forms. Twenty-four (34.3%) did not understand English. Of the 46 (65.7%) that understood English, 28 (40.0%) could speak but could not read English, thus 52 (74.3%) could not read English. Ten (14.3%) patients thought the questions were either not comprehensive or clear enough. CONCLUSION: Illiteracy is a major drawback with the administration of the IPSS form, with 74.3% of patients unable to read English. Attempts should be made to draft the forms in the main language(s) spoken or read in a particular locality so as to gain maximally from the benefits of the IPSS. Relevant bodies should improve on the education of the populace.

The value of international prostate symptom scoring system in the management of BPH in Jos, Nigeria.

OBJECTIVE: To determine the value of international prostate symptom scoring (IPSS) system in management of patients with benign prostatic hyperplasia (BPH) in Jos, Nigeria. MATERIALS AND METHODS: This was a prospective study of 104 newly diagnosed patients with BPH from June 2006 to July 2007. Patients' symptoms were initially evaluated by administering a pretreatment IPSS/Quality of Life Score (QOLS). This categorized patients into mild, moderate, and severe symptom groups. The mild symptom group had watchful waiting as mode of management. The moderate symptom group received doxazosin, an alpha blocker, while the severe symptom group had prostatectomy. A post-treatment IPSS/QOLS was administered 3 months after. Mean changes in IPSS/QOLS was calculated and subjected to paired student's t- test for significance in changes. Spearman's correlation coefficient was used to test significance between correlations. RESULTS: Mean age of patients was 64.3 years. 3 patients (2.9%), 53 patients (51.0%), and 48 patients (46.1%) fell into the minor, moderate, and severe symptom categories, respectively. The QOLS correlated with IPSS. There was a mean change in symptom scores of +2.3 for the minor symptom category, -8.1 (P < 0.001) for IPSS and -1.7 (P < 0.001) for QOLS in the moderate symptom category, and -24.6 (P < 0.001) for IPSS and -4.0 (P < 0.05) for QOLS in the severe symptom category. CONCLUSION: The study has shown that IPSS is a valuable tool in management of patients with BPH.

[PI-RADS classification: structured reporting for MRI of the prostate]. / PI-RADS-Klassifikation: Strukturiertes Befundungsschema für die MRT der Prostata.

PURPOSE: To flesh out the ESUR guidelines for the standardized interpretation of multiparametric magnetic resonance imaging (mMRI) for the detection of prostate cancer and to present a graphic reporting scheme for improved communication of findings to urologists. MATERIALS AND METHODS: The ESUR has recently published a structured reporting system for mMRI of the prostate (PI-RADS). This system involves the use of 5-point Likert scales for grading the findings obtained with different MRI techniques. The mMRI includes T2-weighted MRI, diffusion-weighted imaging, dynamic contrast-enhanced MRI, and MR spectroscopy. In a first step, the fundamentals of technical implementation were determined by consensus, taking into account in particular the German-speaking community. Then, representative images were selected by consensus on the basis of examinations of the three institutions. In addition, scoring intervals for an aggregated PI-RADS score were determined in consensus. RESULTS: The multiparametric methods were discussed critically with regard to implementation and the current status. Criteria used for grading mMRI findings with the PI-RADS classification were concretized by succinct examples. Using the consensus table for aggregated scoring in a clinical setting, a diagnosis of suspected prostate cancer should be made if the PI-RADS score is 4 or higher (≥ 10 points if 3 techniques are used or ≥ 13 points if 4 techniques are used). Finally, a graphic scheme was developed for communicating mMRI prostate findings. CONCLUSION: Structured reporting according to the ESUR guidelines contributes to quality assurance by standardizing prostate mMRI, and it facilities the communication of findings to urologists.

Staging of benign prostate hyperplasia is helpful in patients with lower urinary tract symptoms suggestive of benign prostate hyperplasia.

INTRODUCTION: We prospectively evaluated the staging of benign prostate hyperplasia (BPH) to decide transurethral resection of prostate (TURP) therapeutic modality and the final outcomes in patients with lower urinary tract symptoms (LUTS) suggestive of BPH. MATERIALS AND METHODS: Male patients above 50 years old presented with LUTS suggestive of BPH were included in this study. The initial assessment included the International Prostatic Symptoms Score (IPSS) and the Quality of Life (QOL) index, digital rectal examination (DRE). Transabdominal ultrasound was done to measure the prostate volume, intravesical prostatic protrusion (IPP) and the post void residual (PVR) urine. BPH was classified according to the degree of IPP using grades 1 to 3. The staging of BPH was performed according to the presence or absence of bothersome symptoms (QOL ≥3) and significant obstruction (PVR >100ml). Patients with stage I BPH with no bothersome symptoms and no significant obstruction were generally observed. Those with stage II BPH, bothersome symptoms but no significant obstruction, received pharmacotherapy in the first instance, and were offered TURP if symptoms persisted or worsened. Patients with significant obstruction, persistent PVR >100ml, irrespective of symptoms would be classified as stage III, and were advised to undergo TURP as an option. Lastly, those with stage IV (complications of BPH) were strongly recommended to undergo TURP. RESULTS: A total of 408 patients were recruited in this study and after a mean follow-up of 30 months (range, 6 to 84), 96 (24%) eventually had TURP. Sixteen (13%), 50 (21%), 28 (64%) and 2 (100%) patients who underwent TURP were initially diagnosed as stage I, II, III and IV, respectively. Eighty-seven (91%) of the 96 patients significantly improved to stage I BPH post TURP. CONCLUSIONS: These results showed that the staging of BPH can assist in the tailoring of treatment for patients with LUTS suggestive of BPH, with good outcome in 91% post TURP.

Estudio ultrasonográfico e histológico de la evolución de un modelo canino de hiperplasia benigna de próstata inducida por hormonas / Ultrasonographic histological study on the evolution of a canine model of hormone-induced benign prostatic hyperplasia

Introducción: A pesar de exhibir diferencias histológicas con el proceso en humanos, la hiperplasia benigna de prostáta (HBP) inducida por hormonas en perros representa el modelo más utilizado actualmente para la evaluación de tratamientos. Objetivos: El objetivo del presente estudio es determinar el momento óptimo para la realización de un ensayo terapéutico en este modelo. Material y métodos: En el estudio se utilizaron 6 perros beagle, machos mayores de un año, a los que se administró una combinación de hormonas, 17b-estradiol y 5a-androsteno 3a17b-diol, en días alternos durante 3 (grupo 1, n = 3) o 5 meses (grupo 2, n = 3). Se realizaron seguimientos ultrasonográficos mensuales, con determinación del tamaño prostático. A los 5 meses se procedió al sacrificio de todos los animales y el estudio histológico de las glándulas prostáticas. Resultados: Todos los animales desarrollaron una HBP, con un volumen prostático que aumentaba con el tiempo de administración hormonal (r = 0,910), evidenciándose en todos los estudios ecográficos hasta el tercer mes un aumento significativo de tamaño frente al estudio anterior. El tamaño prostático disminuyó considerablemente en el grupo 1 al retirarla hormonoterapia, al tiempo que en el grupo 2 continuó aumentando. Los animales del grupo 1 apenas evidenciaron signos histológicos de HBP, frente a los del grupo 2, que presentaron una clara hiperplasia del epitelio glandular. Conclusiones: La administración de una combinación de hormonas esteroides es efectiva para inducir hiperplasia de próstata en perro, si bien ésta desaparece en el momento que se retira la hormonoterapia. Para utilizar este modelo en estudios experimentales, se deben administrar hormonas al menos durante 3 meses antes de la actuación terapéutica, y continuar durante todo el ensayo (AU)

Introduction: Despite exhibiting histological differences from the human process, canine hormone-induced benign prostatic hyperplasia (BPH) is still the most widely used animal model for evaluating treatment strategies. Objectives: The aim of this study is to determine the optimal moment for starting a therapeutic trial in this animal model. Material and methods: Six male beagle dogs over one year of age were used in this study. All animals received a combination of steroid hormones, namely 17b-estradiol and 5a-androstene 3a 17b-diol, every other day during three (Group 1, n=3) or five months (Group 2, n=3). Transrectal ultrasonographic examinations to measure prostate volume were performed monthly. Animals were euthanized after five months for histological study of their prostates. Results: All animals developed BPH, with prostate volume increasing over time as hormones were administered (r=0,910). All ultrasonographic studies performed up to the third month evidenced a significant increase in prostate volume when compared to the prior ultrasound measurement. A significant decrease in prostate volume was seen in Group 1 once hormone administration was interrupted, whereas Group 2 animals showed a continuing increase in prostate size. Histological examination showed almost no evidence of BPH in Group 1 animals, while Group 2 animals clearly exhibited moderate epithelial hyperplasia. Conclusions: The administration of a combination of steroid hormones is effective in inducing benign prostatic hyperplasia in canines, but this hyperplasia disappears when hormone treatment is interrupted. In order to be useful for experimental studies, hormones should be administered for at least three months before commencing any treatment, and they should be continued throughout the length of the study (AU)

The psychometric validation of a US English satisfaction measure for patients with benign prostatic hyperplasia and lower urinary tract symptoms.

BACKGROUND: The purpose of the current study was to validate the US English Patient Perception of Study Medication (PPSM) questionnaire, which measures patient satisfaction with Benign Prostatic Hyperplasia (BPH) treatment and was administered to men with BPH lower urinary tract symptoms (LUTS) enrolled in a multi-national clinical trial. METHODS: Patients with moderate to severe BPH symptoms completed three disease-specific measures: The International Prostate Symptom Score (IPSS), the BPH Impact Index (BII) and the PPSM, at baseline (after completion of the placebo run-in period) and at every 13-week clinic visit thereafter for the duration of the study treatment period. The PPSM was analysed to assess its variability, reliability and validity. RESULTS: There were 879 patients included in the analyses, with a mean age of 66.7 years. The PPSM was found to comprise two factors - PPSM-Global and PPSM-Pain, with a Total Score ranging from 7 to 49. It demonstrated good internal consistency (Cronbach's alpha ranged from .95 to .97) and also demonstrated convergent validity through significant correlations with the IPSS (.48 to .58), IPSS Quality of Life (QoL) item (.41 to .63) and BII (.31 to .45) and known-groups validity against the IPSS, IPSS QoL item and BII. CONCLUSION: Results support the use of the PPSM as a measure of satisfaction in BPH patient groups.

Intraprostatic botulinum toxin injection in patients with benign prostatic enlargement.

Histological evidence of benign prostatic hyperplasia (BPH) exceeded 50% in men over 50 years of age and rose to 75% as men entered the eighth decade. Therapeutic options for BPH generally fall into one of the three categories: watchful waiting, medical treatment and surgery. Excluding watchful waiting, the other forms of intervention directed at modifying the physiologic effects of BPH with or without directly altering the prostatic mass or its configuration come with varying effectiveness and risk. Botulinum toxin (BTX-A) produce inhibition of acethylcholine release at the neuromuscular junction causes paralyzing effects and atrophy of striated as well as the smooth muscle fiber. BTX-A also causes inhibitory effects on the ganglionic and post-ganglionic fibres of autonomic nervous system inducing diffuse atrophy and apoptosis of nasal and prostate glands. Clinical series demonstrates efficacy of BTX-A in alleviating symptoms induced by BPH. Larger randomized clinical trials studies are necessary in order to identify the mechanisms by which BTX-A affects the prostate, the ideal dose and the duration of effect. BTX-A injected into prostate appears safe and effective.

[German guidelines for the assessment of BPH. What's new in 2007?]. / Deutsche Leitlinien zur Diagnostik des benignen Prostatasyndroms. Was ist neu in 2007?

The new version of the German guidelines for assessing benign prostatic hyperplasia (BPH) was written in 2006 and 2007 by experts of the BPH working group on behalf of the German Association of Urology and Federation of German Urologists. The full version is expected to be published in 2008. Recommendations for assessing BPH were modified and updated and include patient history, symptom questionnaires, physical examination, urine analysis, prostate-specific antigen, uroflowmetry, ultrasound examination of the urinary bladder (including postvoid residual urine), and ultrasound examination of the upper urinary tract or creatinine measurement. Optional tests are voiding diary, pressure-flow studies, ultrasound measurement of detrusor wall thickness, urethrocystography, and urethrocystoscopy. For the first time, tests for the differential diagnosis of bladder symptoms and BPH are described. Furthermore, the latest knowledge was added on disease progression, indications for urodynamic assessment, and ultrasound measurement of detrusor wall thickness for evaluating bladder outlet obstruction. International quality standards were applied in order to increase the guidelines' value; all tests were judged using the levels of evidence and grades of recommendation of the U.S. Department of Health and Human Services classification.