Chromosome abnormalities in benign prostatic hyperplasia

We combined conventional cytogenetic analysis and fluorescence in situ hybridization of short-term cultures of 28 samples from benign prostatic hyperplasia. Lou of the Y chromosome was the most common chromosome change, followed by trisomy 7. Trisomy 7, however, may be unrelated to the origin of benign prostate hyperplasia, in which the only and not very specific change seems to be the loss of the Y chromosome. Genes Chrom Cancer 9:227-233 (1594). © 1994 Wiley-Liss, Inc.     

Evolving patterns of tissue composition in benign prostatic hyperplasia as a function of specimen size

The tissue composition in 36 transurethral resections and four prostate enucleations for benign prostatic hyperplasia (BPH) was quantitated by computerized morphometric techniques using 15 morphologic categories. Data were compared between seven consecutive weight ranges. Nodules of glandular and/or stromal tissue comprised only 5% of tissue in the smallest resections, while bladder neck and anterior fibromuscular tissue represented more than half the specimen. Non-nodular prostatic tissue from the transition zone was the dominant resected component in all but the largest specimens (enucleations) where nodules comprised most of the tissue. Though nodules comprised only 22% of the largest transurethral resections, their contribution to hyperplasia increased more rapidly than any other component. Glandular nodules with a high ratio of epithelium to stroma dominated at all weight ranges. It was concluded that tissue resected for BPH is quite heterogeneous, that nodules comprise most of the tissue only in specimens over 50 g in weight, and that the most common hyperplastic component is histologically normal tissue. Benign prostatic hyperplasia undergoes morphologic evolution with increasing weight, and epithelial-rich nodules are the most rapidly evolving component.     

Phenotypic characterization of infiltrating leukocytes in benign prostatic hyperplasia.

This study for the first time elaborates on cells of the immune system present in benign prostatic hyperplasia (BPH). Compared with normal prostate, all BPH-derived specimens revealed a marked increase of CD45+ leukocytes, characterization of which demonstrated three major cell types, i.e., CD3+ T lymphocytes, CD11c+ macrophages and CD20+ B lymphocytes. Frequencies of CD3+ cells/mm2 of cryocut sections were increased at least 10 times in BPH specimens, and the CD8+:CD4+ T suppressor/cytotoxic:T helper cell ratio was reversed. The infiltrating leukocytes predominantly populate the interstitium and accumulate around epithelial ducts which, however, were found to be invaded and/or destroyed only in a number of cases. Phenotypic alterations of surface antigen expression on prostate epithelial cells in BPH that might be due to the presence of lymphocytes were examined by using monoclonal antibodies (mAb) directed against human leukocyte antigens (HLA). Whereas anti-HLA-DR reactivity in normal prostate is restricted to small numbers of macrophages and includes neither prostate epithelial cells nor prostate T cells, it was found to be dramatically increased in BPH, comprising CD45+ cells and prostate epithelial cells as demonstrated by double-staining with anti-cytokeratin or anti-prostate-specific antigen. A mean of 40% of analyzed epithelial glands in BPH reacted with anti-HLA-DR, but not with anti-DQ or -DP monoclonal antibodies. A new method for the enrichment of prostate-derived lymphocytes was established to facilitate phenotypic analysis by flow cytometry, demonstrating 70 to 80% of enriched CD45+ cells to stain for CD3, approximately 60% thereof for CD4, 30% for CD8, and the remaining 10% with anti-CD20, a pan-B-cell marker. Flow cytometry showed that, in contrast to peripheral T cells, both CD4+ and CD8+ prostatic T cells were positive for the T cell activation markers HLA-DR and interleukin-2-receptor.     

Prostate shape and symptom score in benign prostatic hyperplasia.

Prostates of the same volumes were found to have very variable shapes, that is, combinations of variably elongated width, height, and lengths. These were believed to be possible causes of the differences in the severity of both the obstructions and symptoms in the prostates even when their volumes were similar. We measured the transverse (width), anterior-posterior (height) and longitudinal (length) diameters of the prostates and the transition zone, and their calculated volumes using transrectal ultrasonography. To establish the relationship between the International Prostate Symptom Score (IPSS) and each of the dimensional parameters of the transition zone and the total prostate, 105 consecutive patients (mean age 66.43 +/- 9.24 years with a range o6f 46 to 90) who had voiding dysfunctions that were presumably related to BPH were analyzed using the t-test. Patients with conditions other than BPH were excluded. The results were as follows: 1. There was no significant correlation between the IPSS and any prostate volume parameter in the constant prostate volume conditions, because of the small numbers in each group. However, in the analysis of the total number of cases in all the volume categories, a significant correlation was found between the IPSS and some prostate dimensions; i.e., the longitudinal parameters in the total prostates (p < 0.01), and the transverse (p < 0.05) and longitudinal parameters (p < 0.05) in the transition zones. 2. Further investigations of the statistics of these significant parameters showed that prostates that were longer than 4 cm had significantly more severe symptoms than prostates shorter than 4 cm (p < 0.05), and that prostates with a ratio of length in the transition zone to the length in the total prostate ratio that was greater than 0.8 had significantly higher symptom scores than those with lower ratios (p < 0.05). When evaluating patients who have BPH, it is important to consider the shape of prostate. More aggressive treatment may be indicated in cases where the transition zone lengths exceeds 4 cm and the transition zone to total prostate length ratio exceeds 0.8.     

Consultation patterns in a community survey of men with benign prostatic hyperplasia.

BACKGROUND. The Stirling benign prostatic hyperplasia natural history group have previously reported a prevalence of this condition of 255 per 1000 in a community study of 1610 men aged 40-79 years. AIM. It was decided to examine the consultation patterns of men with benign prostatic hyperplasia in greater detail. METHOD. All participating men were invited to complete a previously validated lifestyle questionnaire including questions on consultations with their general practitioner during the previous year and previous history of prostatic problems. The men who had a urinary symptom score greater than 11, or who had a urinary flow rate of less than 15 ml per second were examined by transurethral ultrasonography for prostate size. RESULTS. Of 364 men with benign prostatic hyperplasia, 89% had not consulted their doctor about urinary symptoms in the year prior to the study. Men with moderate to severe urinary symptoms were six times more likely to have consulted their doctor than those with mild symptoms. Moderate to severe symptoms and greater interference with daily living activities were both associated with a greater likelihood of consultation, independent of age. Of all the men in the study referred to the specialist clinic for assessment of prostate size by transurethral ultrasonography, two thirds were referred because of low urinary flow rate and one third because of high urinary symptom scores. The reported consultation data showed a reverse ratio of one third of those consulting having a low urinary flow rate and approximately two thirds having urinary symptoms. CONCLUSION. While mass screening is unjustified, there is a need for patient education about benign prostatic hyperplasia in general and the recognition of declining strength of urinary flow as a symptom of benign prostatic hyperplasia and not of ageing alone. Furthermore, evaluation of primary care use of urinary flowmeters and the development of local protocols are suggested as elements of a case finding strategy for benign prostatic hyperplasia based on patient led consultation.     

Chronic inflammation in benign prostatic hyperplasia: implications for therapy

Benign prostatic hyperplasia (BPH) is a common age related proliferative abnormality of the human prostate. Histological features demonstrate that the typical nodules of BPH are composed of stromal and epithelial cells that are proportionally different between nodules. BPH nodules frequently occur concurrently with chronic inflammatory infiltrates, mainly composed of chronically activated T cells and macrophages. Recent studies suggest that these inflammatory cells, immunity responses and their precursors play important roles in the pathogenesis of BPH. Clinical evidences also indicate that chronic inflammation correlates with clinical progression of BPH. Therefore, we hypothesize that BPH is an inflammatory disease. Reducing inflammation may play a crucial role in the treatment of BPH and finally lead to a better clinical outcome. If our hypotheses can be further supported with clinical trials it may change the approach of the medical management for BPH.     

经尿道激光汽化术治疗良性前列腺增生的效果

目的:探讨激光汽化术治疗良性前列腺增生（BPH）的效果。方法:62 例BPH患者依据不同治疗方式分组:对照组 采用经尿道前列腺等离子电切术（TUPKP）,研究组采用经尿道1 470 nm 激光前列腺汽化术。观察并比较两组患者手术 前后血红蛋白、血钠水平,围术期指标（术后膀胱持续冲洗时间、留置尿管时间及住院时长）,国际前列腺症状（IPSS）、生 活质量（QOL）、最大尿流量（Qmax）及残余尿量PVR,术后并发症情况。结果:研究组术后血红蛋白水平显著高于对照组 （P<0.05）,两组术后血纳水平无显著性差异（P>0.05）。研究组手术时间长于对照组（P<0.05）,研究组术后膀胱冲洗时间、 术后留置尿管时间、术后住院时间短于对照组（P<0.05）。两组治疗后IPSS、QOL、Qmax及PVR均无显著性差异（P>0.05）。 术后随访3个月,研究组未发生短期并发症,对照组发生继发性出血1例。结论:BPH患者使用1 470 nm激光汽化术与TUPKP 术治疗均可显著缓解患者相关下尿路症状,患者生活质量水平得到显著提高,临床疗效相近;与TUPKP术相比,经尿道 1 470 nm激光汽化术治疗BPH的手术时间相对更长,但术后恢复快,临床安全性较高。     

The overlooked cause of benign prostatic hyperplasia: prostatic urethral angulation

Benign prostatic hyperplasia (BPH) is one of the most common problems faced by aging men and can be associated with bothersome lower urinary tract symptoms that affect quality of life by interfering with normal daily activities and sleep patterns. Despite the clinical importance of BPH, its pathogenesis is still poorly understood. Previously, our understanding of BPH was centered on bladder outlet obstruction being secondary to benign prostatic enlargement. However, prostate size itself is not correlated with the urine flow rate and symptomatology. The prostatic urethra is a bend tube and the increased prostatic urethral angulation shows a higher bladder neck on cystoscopic examination. Although some urologists suspected that the higher bladder neck might be a causal factor for BPH, the clinical significance of prostatic urethral angulation was previously underestimated. In this study, we propose a new hypothesis that prostatic urethral angulation is a causal factor for BPH. By applying the concept of fluid dynamics to the process of urination in the prostatic urethra, we show that the energy loss in this bending tube (the prostatic urethra) can occur during micturition and it increases proportionally to prostatic urethral angulation; this energy loss results in a decrease of the urine velocity and accordingly, the urine flow rate is inversely associated with prostatic urethral angulation. We also propose that BPH involves prostatic urethral angulation as well as the classical BPH triad of prostatic enlargement, bladder outlet obstruction, and symptomatology. Our hypothesis suggests that prostatic urethral angulation is an overlooked cause of bladder outlet obstruction and is a causal factor of BPH, and provides novel insight into the pathogenesis of BPH. Ultimately, the relationship between prostatic urethral angulation and urine flow rate, and other clinical factors including urodynamic parameters, the symptomatology, the response to treatment, and disease progression, need to be investigated in a clinical setting.     

Management of experimental benign prostatic hyperplasia in rats using a food-based therapy containing Telfairia occidentalis seeds

The usefulness of diet containing Telfairia occidentalis seeds, in managing benign prostatic hyperplasia (BPH) in rats was studied. Twenty male Wistar rats were divided into four equal groups. BPH was induced by sub-cutaneous injection of dihydrotestosterone (DHT) and estradiol valerate (ratio, 10:1) every other day for 28 days. Rats in the test group were placed on the test diet for 7 days following disease induction. One control group (DC) was fed on a normal diet for 7 days following disease induction. Two other control groups, HC and HDC, were given sub-cutaneous olive oil (vehicle) for the same duration, and placed on the test diet and normal diet, respectively. Markers of BPH, and hormone profile were determined using standard methods. The results show that relative prostate weight and protein content of the prostates were lower [albeit not significantly (p>0.05)] in the test group, relative to the DC group. Serum prostatic acid phosphatase concentrations (U/L) decreased significantly (p<0.05) from 2.9 ± 0.2 in the DC group to 2.1 ± 0.7 in the test group. Histological findings corroborate these data. The testosterone: estradiol ratio (× 10(3)) was increased from 4.0 ± 0.2 in the DC group to 4.6 ± 0.2 in the test group. The test diet reduced the mass and secretory activity of the enlarged prostate and may act by increasing the testosterone: estradiol ratio.     

Potential biomarkers for differentiation of benign prostatic hyperplasia and prostate cancer

This study aims to evaluate the role of free/total prostate-specific antigen (PSA) ratio, serum total sialic acid level and cathepsin D activity in the differentiation of prostate cancer and benign prostatic hyperplasia (BPH). The study looked at 100 patients with BPH, 75 patients with organ-confined or locally advanced prostate cancer, and a control group of 50 healthy volunteers. Prostate cancer patients showed significantly higher total sialic acid level and cathepsin D activity and lower free/total PSA ratio than those in the BPH group. The results suggest that combined measurement of serum total sialic acid and/or cathepsin D activity with free/total PSA ratio could serve as a useful adjunct to conventional diagnostics for the differentiation of prostate cancer and BPH.     

Up-regulation of hepatic IGFBP-1 production as a strategy for preventing benign prostatic hyperplasia

Many lines of evidence point to a prominent role for excess production and activity of stroma-derived, androgen-induced IGF-II in the stromal and epithelial hyperplasia characteristic of benign prostatic hyperplasia (BPH). Increased stromal expression of the type I IGF receptor, as well as altered local production of IGF binding proteins, appear to contribute to this increase in IGF activity. Systemic IGFBP-1, primarily of hepatic origin, is a functional antagonist of IGF-II; thus, boosting IGFBP-1 production might be expected to lessen risk for BPH. Minimizing diurnal insulin secretion, and possibly avoiding intake of animal proteins over-rich in essential amino acids, are practical strategies for increasing hepatic IGFBP-1 synthesis. This hypothesis may rationalize recent evidence that exercise and moderate alcohol consumption decrease risk for BPH, whereas heavy smoking increases this risk. A clinical impression that BPH is becoming more common in Japan, and evidence that Japanese making frequent use of meat and dairy products are at increased risk for this disorder, also appear consistent with this view.     

Relation between benign prostatic hyperplasia and obesity and estrogen

PURPOSE: There have been few reports on correlations between resection volume of benign prostatic hyperplasia, body mass index (BMI) and estrogen. This study was undertaken to evaluate the correlations. METHOD: In this study, we considered 50 patients who had benign prostatic hyperplasia (BPH) and underwent suprapubic prostatectomy (SPP). Men with prostate cancer or prior prostate surgery were excluded. The relationship between prostate resection volume and BMI was examined. Additionally, patients were divided into two groups according to BMI: less than 25, and more than 25. The two groups were evaluated according to stained estrogen receptors. RESULTS: BMI was correlated positively with prostate volume (p < 0.01). However, positive rates of estrogen receptors showed no significant difference between the two groups. CONCLUSIONS: This was a study describing the relationship between BMI and prostate volume. Obesity has been hypothesized to be associated with BPH because of the endocrine changes in men that occur with age, including increased estrogen and decreased testosterone. Our findings suggest that estrogen may play a pathophysiologic role in benign prostatic hyperplasia. Further studies of large populations are needed to validate this assumption.