Primary signet ring cell adenocarcinoma of the bladder (linitis plastica of the bladder): report of a case and review of the literature

The relative contents of gastricsinogen, the inactive zymogen precursor of gastric gastricsin (EC 3.4.23.3), and cathepsin D (EC 3.4.23.5) in normal and benign hyperplasia of the prostate gland have been determined. Gastricsinogen levels are significantly lower (0.116 +/- 0.02 U/gm. wet tissue) in the hyperplastic than in normal prostates (0.65 +/- 0.06 U/gm.). Conversely, cathepsin D levels are higher in the diseased (0.705 +/- 0.17 U/gm.) as opposed to normal prostatic tissue (0.39 +/- 0.12 U/gm.). The average gastricsin-cathepsin D differences between the 2 tissues (0.26 +/- 0.025 for normal prostates and -0.59 +/- 0.057 SEM for hyperplastic tissue) are also significantly different (p less than 0.001). It is suggested that the simple determination of these 2 acid proteinases in prostate homogenates could be used as alternative and complementary marker enzymes for the study of the physiopathologic status of the prostate gland.     

Changes in biochemical markers of hyperplastic and malignant prostatic tissues.

Some biochemical markers were evaluated in human prostatic tissue obtained from patients with benign hyperplasia. There was an almost threefold increase in the activity of acid phosphatase of these patients as compared to that of normal men. The changes in the acid phosphatase activity were directly correlated with citric acid concentration. Significant (p less than 0.001) increases in the content of citric acid, zinc, and calcium in benign hyperplastic prostates was found. There was no change in the activity of aminopeptidase. The activities of both enzymes were lower in malignant prostatic tissues.     

Magnetic resonance imaging in the diagnosis of prostatic carcinoma and benign hyperplasia

Using a 0.5 tesla superconducting magnetic system, magnetic resonance imaging (MRI) studies were performed in 42 patients (27 prostatic carcinoma and 15 benign prostatic hyperplasia) and 2 healthy volunteers. Spin echo images were produced in the transverse, coronal and sagittal directions. T1 and T2 relaxation times were calculated from these images. The images of 2 normal prostates showed 2 separate zones: an internal zone and an external zone. The images of 8 of the 15 prostates with benign prostatic hyperplasia showed 3 zones: an internal zone, a band of low intensity and an external zone. Most of the cases of prostatic carcinoma showed extracapsular extension, so we could not detect zonal distinction of the images in 25 cases out of the 27 prostates with prostatic carcinoma. Most of the images of prostates with prostatic carcinoma showed irregular and asymmetric shape and inhomogeneous signal intensity. MRI had an accuracy of 85.7% in differentiating prostatic carcinoma from benign prostatic hyperplasia. A good correlation (r = 0.936) was observed between the weight of the whole prostate as predicted by MRI and the actual weight of the adenoma enucleated by retropubic prostatectomy. The change in volume of the prostate after hormone therapy was well evaluated by MRI. We were not able to differentiate prostatic carcinoma from benign prostatic hyperplasia on the basis of the T1 and T2 relaxation times alone. The serial measurements of the T1 and T2 relaxation times might be value in following therapeutic response of prostatic carcinoma.     

The progress in diagnostic imaging for staging of bladder and prostate cancer: endorectal magnetic resonance imaging and magnetization transfer contrast]

We retrospectively studied the staging accuracy of endorectal magnetic resonance imaging (MRI) in comparison with transrectal ultrasound examination (TRUS) for 71 localized bladder cancers and 19 localized prostate cancers (PC) radically resected. The accuracy of clinical staging for bladder cancer in endorectal MRI and TRUS was 85.9% and 69.2%, respectively. The presence or absence of the continuity of submucosal enhancement on T2-weighted MRI images could be useful for the staging of bladder cancer. The accuracy of the seminal vesicular invasion for prostate cancer in endorectal MRI and TRUS was 95% and 63%, respectively. To determine whether magnetization transfer contrast (MTC) provides additional information in the diagnosis of prostate cancer, the magnetization transfer ratios (MTRs) were calculated in 22 patients with PC, 5 with benign prostatic hyperplasia (BPH) and 4 controls. The mean MTR in the peripheral zone of the normal prostate (8.0% +/- 3.4 [standard deviation]) showed a statistically significant decrease relative to that in the inner zone of the normal prostate (27.4% +/- 3.4, p < 0.01), BPH (25.5% +/- 3.7, p < 0.01), pre-treatment PC (30.6% +/- 5.9, p < 0.01), and PC after hormonal therapy (20.3% +/- 6.3, p < 0.01). The mean MTR in pre-treatment PC was significantly higher than that in BPH, or in PC after hormonal therapy (p < 0.01). MTC was considered to be useful for conspicuity of prostate cancer lesion.     

The development of human benign prostatic hyperplasia with age

In this study we report the prevalence and growth rate of human benign prostatic hyperplasia with age by combining and analyzing data from 10 independent studies containing more than 1,000 prostates. The normal prostate reaches 20 plus or minus 6 gm. in men between 21 and 30 years old, and this weight remains essentially constant with increasing age unless benign prostatic hyperplasia develops. The prevalence of pathological benign prostatic hyperplasia is only 8 per cent at the fourth decade; however, 50 per cent of the male population has pathological benign prostatic hyperplasia when they are 51 to 60 years old. The average weight of a prostate that is recognized at autopsy to contain benign prostatic hyperplasia is 33 plus or minus 16 gm. Only 4 per cent of the prostates in men more than 70 years old reach sizes greater than 100 gm. An analysis of a logistic growth curve of benign prostatic hyperplasia lesions removed at prostatectomy indicates that the growth of benign prostatic hyperplasia is initiated probably before the patient is 30 years old. The early phase of benign prostatic hyperplasia growth (men between 31 and 50 years old) is characterized by a doubling time for the tumor weight of 4.5 years. In the mid phase of benign prostatic hyperplasia growth (men between 51 and 70 years old) the doubling time is 10 years, and increases to more than 100 years in patients beyond 70 years old.     

DNA synthesis in the canine prostate: effects of androgen and estrogen treatment

Canine prostatic DNA synthesis was evaluated by measuring [3H]thymidine incorporation into DNA of tissue slices in vitro. Among untreated beagles, prostatic DNA synthesis rates in young dogs with normal prostates, young dogs with spontaneous benign prostatic hyperplasia (BPH), and old dogs with BPH were 676 +/- 186, 1,220 +/- 156, and 641 +/- 88 cpm/100 micrograms DNA/hr, respectively. Among 81 young beagles (intact or castrated) that had been treated for 4 months with various steroids, rates of DNA synthesis varied according to the type of hormonal treatment. Prostatic DNA synthesis (cpm/100 micrograms DNA/hr) was significantly different (P less than 0.001) for dogs treated with estradiol alone (1,658 +/- 221 cpm/100 micrograms DNA/hr; n = 10 dogs), androgen alone (testosterone, 5 alpha-dihydrotestosterone, or 5 alpha-androstane-3 alpha,17 beta-diol; 1,000 +/- 61 cpm/100 micrograms DNA/hr; n = 31 dogs). However, there was no correlation between prostate size and rate of DNA synthesis (cpm/100 micrograms DNA/hr). Although treatment with estrogen alone resulted in the highest rate of DNA synthesis, it produced squamous metaplasia and the smallest prostates; these results are indicative of a high rate of cell turnover. Comparing prostates that reached the same size following 4 months of treatment with androgen alone or androgen plus estrogen, the rate of prostatic cell turnover was lower in the androgen plus estrogen group. These results are interpreted to indicate an inhibitory effect of estradiol on the rate of cell death in the presence of androgens.     

Proliferative responses of cultured rat prostate and human benign prostatic hyperplasia

The proliferative responses of rat prostate and human benign prostatic hyperplasia have been followed in organ culture using [125I] iododeoxyuridine uptake to monitor DNA synthesis. In serum-free cultures, testosterone induced a marked increase in DNA synthesis (three-fold) in 4- to 6-month-old rat prostates at concentrations of 4 x 10(-9) to 4 x 10(-6) M, whereas in greater than 12-month-old rat prostates the response was less marked. Human benign prostatic hyperplasia also showed an increased uptake at similar testosterone concentrations and of a similar magnitude to the response of greater than 12-month-old rat prostates. At 10(-5) M DNA synthesis was markedly suppressed in cultures of both rat and human prostate. The proliferative response of human benign prostatic hyperplasia increases up to days 3 to 4 in culture and then declines in both control and hormone-treated groups and may represent repair processes which appear to be hormone dependent.     

Transrectal hyperthermia-induced histological and ultrastructural changes of human benign prostatic hyperplasia tissue.

This prospective study evaluated the tissutal, cellular and intracellular effects of transrectal microwave hyperthermia on human benign prostatic hyperplasia. Forty-eight patients with benign prostatic hyperplasia underwent ten 60-min-long sessions of transrectal hyperthermia with an intraprostatic calculated temperature of 42 +/- 0.5 degrees C. Ultrasound-guided transperineal biopsies of the prostate were taken before and 1 month after completion of treatment. Postoperatively, morphometric analysis of bioptic specimens showed a statistically significant (p < 0.01) increase in the number of intraprostatic arterioles and capillary-like vessels. Diffused inflammatory infiltrates were also noted. Postoperative integrity of intracellular organelles and cellular membranes was evidenced by transmission electron microscopy. Our regimen of transrectal prostatic hyperthermia did not cause any irreversible histological or ultrastructural damage to the prostatic tissue. Hyperthermia-induced increase in blood flow could enhance drug delivery to the prostate gland.     

Photoselective vaporization of the prostate: a volume reduction analysis in patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia and carcinoma of the prostate

PURPOSE: In this study preoperative and postoperative transrectal ultrasound prostate volume was evaluated in patients undergoing photoselective vaporization of prostate using an 80 W potassium-titanyl-phosphate (KTP) laser (Greenlight PV Laser System, Laserscope, San Jose, California) for obstructive uropathy secondary to benign prostatic hyperplasia or carcinoma of the prostate. MATERIALS AND METHODS: A total of 18 patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia (8) and carcinoma of the prostate (10) were treated with an 80 W quasicontinuous KTP laser. Preoperative and immediate postoperative treatment prostate volume measurements were recorded by transrectal ultrasound. The end point of treatment was complete vaporization of the obstructive adenoma to the level of the capsular fibers and the creation of an adequate transurethral resection-like prostatic cavity. KTP/532 laser energy was delivered by a side firing glass fiber through a 27Fr continuous flow resectoscope. Photoselective vaporization of the prostate using sterile water irrigation was performed with all patients under spinal anesthesia. Mean lasting time +/- SEM was 33.5 +/- 12 minutes (range 11 to 53). RESULTS: Mean preoperative prostate volume +/- SEM was 53.2 +/- 24.7 ml (range 23.6 to 110), while mean postoperative prostate volume was decreased to 26.2 +/- 14.8 ml (range 8 to 58) during a mean followup of 2.8 +/- 2.3 months (range 1 to 10), resulting in a 51% mean decrease in prostate volume, as measured by transrectal ultrasound. There was no significant intraoperative bleeding and no change in serum sodium postoperatively. One patient sustained a small capsular perforation with persistent venous bleeding, which could not be controlled with KTP laser. Because of poor vision, the procedure was completed with electroresection. Complications included mild dysuria in 2 patients (11%) and mild hematuria longer than 2 weeks in duration in 4 (22%). CONCLUSIONS: Photoselective prostate vaporization can effectively vaporize obstructive benign and malignant prostatic tissue, leading to a significant decrease in the total volume of the treated prostate (p = 0.000).     

3T体线圈三维氢质子磁共振波谱在前列腺癌鉴别诊断中的价值

目的:探讨3T体线圈三维氢质子磁共振波谱(3D 1H-MRS)在前列腺癌鉴别诊断中的应用价值。方法:对40例临床可疑前列腺癌患者先行3T核磁共振(MRI)和磁共振波谱(MRS)检查,再行直肠B超引导下前列腺穿刺活检获得病理诊断。与病理结果对照,分析良性前列腺增生、前列腺癌、癌前病变MRS代谢特点,评估其对外周带前列腺癌的诊断效能。结果:所有患者均成功完成检查。间质、腺体增生为主内腺、内腺癌灶、外周带癌灶、正常外周带及前列腺上皮内瘤(胆碱+肌酸)/枸橼酸比值分别为:0.75±0.23、0.59±0.14、1.79±0.90、1.18±0.95、0.46±0.18、0.97±0.10。内腺癌灶与增生内腺、外周带癌灶与正常外周带差异有统计学意义(P<0.01)。外周带前列腺癌最佳诊断阈值为0.68,灵敏度88.6%,特异度88.7%。结论:3T体线圈3D 1H-MRS在前列腺癌鉴别诊断中具有较好的敏感性与特异性,对癌前病变的诊断有一定的参考价值。     

Regional variation of cytosol androgen receptors throughout the diseased human prostate gland

The heterogeneous histology of the normal and diseased human prostate is well established. This study has investigated variations in cytosol androgen receptor (AR) content throughout the diseased gland to establish the most suitable sites to obtain tissue for AR assay. Only then can AR be investigated as a potential predictor of response to endocrine treatment. In a transverse slice of an enucleated prostate showing benign prostatic hyperplasia (BPH) AR levels in 1-g segments varied from 109 to 1,212 fmol/g tissue (mean 483 +/- 273; median 406), with no negative areas. Areas of higher receptor concentrations corresponded to the glandular regions of sections obtained from a slice taken in juxtaposition; areas of low receptor concentrations corresponded to the stromal regions. A significant correlation (P less than .02) was observed between AR concentration and the proportion of glandular components of each segment. Specimens were also obtained from each of three sites from 38 prostates; 45% of all specimens contained AR; however, distribution of receptor throughout the prostate was uneven. AR were significantly more likely to be measured in the peripheral zone (71% positive) than in periurethral tissue (39% positive) whilst only 24% of specimens taken from the limit of the resection possessed AR binding capacity. Similar distribution patterns were observed in both benign and malignant prostates, although 16% more specimens from carcinomatous prostates contained receptor than did those from benign glands; this difference was maintained at each site. In addition receptor levels were consistently lower in benign than in malignant specimens. It is therefore desirable to know the histological composition of specimens used for AR measurement.     

Improvement of pressure flow parameters with finasteride is greater in men with large prostates. Finasteride Urodynamics Study Group

PURPOSE: We assess the effect of finasteride, a 5alpha-reductase inhibitor, on objective voiding parameters in men with lower urinary tract symptoms and benign prostatic enlargement on digital rectal examination (known as clinical benign prostatic enlargement) in a double-blind placebo controlled multicenter study using strict standard pressure flow study techniques. MATERIALS AND METHODS: A modification of the Abrams-Griffiths nomogram was used by 1 reader to ensure that all patients met objective criteria for bladder outlet obstruction at baseline. After performing a pressure flow study patients with obstruction were randomized 2:1 to receive 5 mg. finasteride (81) or placebo (40) daily. A second pressure flow study was performed at month 12. At baseline and month 12 free urinary flow studies and transrectal ultrasound were performed, and International Prostate Symptom Score questionnaires were completed. Patients were treated between May 1994 and July 1996. RESULTS: Finasteride caused a significant decrease (-8.1 cm. water) in detrusor pressure at maximum flow (p <0.05 versus placebo p = 0.02), increase (+1.1 ml. per second) in maximum flow rate (p <0.05 versus placebo p = 0.02) and decrease (-22.8%) in prostate volume (p <0.05 versus placebo p <0.001). Men with prostates larger than 40 cc had greater improvement in detrusor pressure at maximum flow (between group difference -14.5 cm. water, 95% confidence interval -26.2 to -2.6, p = 0.02) and maximum flow rate (mean treatment effect +1.6 ml. per second, 95% confidence interval -0.2 to 3.0, p = 0.02) compared to those with prostates 40 cc or less (between group differences not significant). CONCLUSIONS: Finasteride treatment resulted in improvements in urodynamic parameters, which were greater in men with large prostates.     

The influence of reversible androgen deprivation on serum prostate-specific antigen levels in men with benign prostatic hyperplasia

This study was designed to investigate the relationship of serum prostate-specific antigen to prostatic size and hormonal stimulation. Seven patients with benign prostatic hyperplasia were treated for six months with nafarelin acetate and then followed for an additional six months. Nafarelin acetate is a potent luteinizing-hormone-releasing hormone agonist which causes reversible testosterone deprivation resulting in involution of the prostate. During therapy and follow up, serum prostate-specific antigen correlated with: 1) serum testosterone (p less than 0.001); 2) quantity of prostatic epithelium (p less than 0.001); and 3) prostatic size (p less than 0.05). Before therapy, serum prostate-specific antigen (mean +/- SD) was 0.43 +/- 0.2 ng./ml. per gram of epithelium. This did not change significantly after six months of androgen deprivation (0.48 +/- 0.36), although the ratios of prostate-specific antigen to testosterone and to prostatic size each changed significantly. Despite testosterone levels in the castrate range at six months, five of seven patients had serum prostate-specific antigen concentrations above the female range and three of seven patients had prostatic biopsies containing columnar epithelium which stained positively for prostate-specific antigen. These results demonstrate that serum prostate-specific antigen is related to prostatic size, prostatic epithelial weight, and testosterone stimulation. However, prostatic size is not a good predictor of serum prostate-specific antigen because there is tremendous variation in the relative amount of epithelium in a prostate; in this study the ratio of prostatic size to epithelial weight varied threefold. Furthermore, although testosterone determines prostatic size and amount of prostatic epithelium, it may not totally control prostate-specific antigen production.     

人乳头状瘤病毒与前列腺癌相关性研究

用高敏感聚合酶链反应（ＰＣＲ）技术检测６３例前列腺组织标本（２８例前列腺癌，３０例良性前列腺增生症和５例正常前列腺组织）中人乳头状瘤病毒（ＨＰＶ）阳性率。结果显示：前列腺癌中ＨＰＶ（１６）感染率为４６．４％（１３／２８），ＨＰＶ（１８）感染率为１０．７％（３／２８）。良性前列腺增生症患者ＨＰＶ（１６）阳性率为２０％（６／３０），ＨＰＶ（１８）阳性率为６．１７％（２／３０）。５例正常前列腺组织无ＨＰＶ感染。提示ＨＰＶ感染与前列腺癌有相关性，ＨＰＶ感染可能在前列腺癌发展中起着重要作用。     

31P MR spectroscopy and 1H MR imaging of the human prostate using a transrectal probe

Summary ¹H magnetic resonance imaging and ³¹P nagnetic resonance spectroscopy of the human prostate using transrectal surface coild are discussed. ¹H MR images were characterized by a high sensitivity, revealing many details in the prostate. Localized ³¹P spectra acquired during the same investigation showed phosphorous metabolites, which may help differentiate between benign prostatic hyperplasia and prostate carcinoma. An endoscopic transmit-receive radio frequency (RF) antenna is also described which can be used with very low RF power.A preliminary account of this work was presented at the 9th Annual Meeting of the Society of Magnetic Resonance in Medicine, New York 18–24 August 1990     

PROSTATIC VOLUME AND RATIO OF FREE-TO-TOTAL PROSTATE SPECIFIC ANTIGEN IN PATIENTS WITH PROSTATIC CANCER OR BENIGN PROSTATIC HYPERPLASIA

Purpose

We correlated prostatic volume with the ratio of free-to-total prostate specific antigen (PSA) in serum from patients with prostatic cancer or benign prostatic hyperplasia (BPH) to evaluate how prostatic volume influences the ratio.

Materials and Methods

We evaluated sera from 395 patients (mean age 65 years, range 45 to 88) with prostate cancer (239) or BPH (156) for total PSA, free PSA and ratio of free-to-total PSA. For detection of total and free PSA we used an Immulite* free and total PSA assay. Prostatic volume was determined with transrectal ultrasonography. Prostatic volume in BPH and prostate cancer patients was divided into 10 ml. groups, and mean ratio of free-to-total PSA was calculated for each volume group and both diseases. For statistical analysis Mann-Whitney U and Kruskal-Wallis tests were performed in addition to calculation of sensitivity and specificity, and receiver operator curves for prostates 60 ml. or less and greater than 60 ml.

Results

For BPH patients the mean ratio of free-to-total PSA was 14.64 to 25.14% without a close relation to prostatic volume. In prostate cancer patients a proportional increase from 8.45 to 19.37% in the ratio of free-to-total PSA with volume was found. Mann-Whitney U analysis revealed significant differences in prostate cancer versus BPH only in patients with prostates of 60 ml. or smaller (p = 0.0008 to 0.029). No significant differences were seen when prostate cancer and BPH patients with prostates larger than 60 ml. were compared (p = 0.082 to 0.868). Kruskal-Wallis test confirmed independence of the ratio of free-to-total PSA from prostatic volume in BPH patients (p = 0.285) but dependence in prostate cancer patients (p <0.0001). Sensitivity was higher in patients with prostates 60 ml. or smaller (86.72%) than in patients with prostates larger than 60 ml. (66%), and specificity was lower at 45.78 and 56.16%, respectively.

Conclusions

We have shown that the ratio of free-to-total PSA is influenced by prostatic volume in patients with prostate cancer. The ratio of free-to-total PSA provides useful information for differentiate BPH from prostate cancer in patients with small prostates but it is less useful in patients with larger prostates, probably because of the larger proportion of benign hypertrophic tissue.     

Androgen concentration in blacks with benign and malignant prostatic disease

We measured the concentrations of testosterone and its metabolites in serum and prostate glands of Nigerians, a low risk population for prostatic tumours, by means of radioimmunoassay after solvent and chromatographic extractions. Our results show that the values of serum testosterone in normal, elderly Nigerian men (447.0 +/- 112 ng./dl.) and those with benign prostatic hypertrophy (BPH) (430 +/- 112 ng./dl.) were similar (p greater than 0.05) and compare with values reported for Caucasians. In the Nigerian patients with advanced prostatic cancer, the serum testosterone concentrations (314 +/- 202 ng./dl.) were significantly lower (p less than 0.001) than those of Nigerians with normal prostate and BPH. This again is similar to reports in Caucasians with metastatic prostatic cancer. The serum concentrations of testosterone metabolites in our patients were the same in normal BPH and cancer subjects. The ratios of testosterone to its metabolites were similar in our normal and BPH subjects but lower in cancer patients. Also the testosterone concentrations in BPH glands of Nigerians (0.5 +/- 0.03 SEM ng./gm.) compared favourably with those reported from the western world. The testosterone concentrations in malignant prostate gland (7.9 +/- .06 SEM ng./gm.) were significantly higher than those in hypertrophic glands. This again agrees with the pattern in Caucasians. The DHT concentrations (4.9 +/- 0.3 SEM ng./gm.) were considerably higher in BPH than in cancerous glands (1.7 +/- 0.2 SEM ng./gm.). This pattern has been documented elsewhere. Because the concentrations and pattern of distribution of androgens in serum and prostate gland of our patients are comparable to published Caucasian and black American values, any difference in incidence rates of BPH and carcinoma of the prostate between whites, Afro-Americans and indigenous Africans may not be related to androgens.     

Determination of transition zone volume by transrectal ultrasound in patients with clinically benign prostatic hyperplasia: agreement with enucleated prostate adenoma weight

PURPOSE: Accurately estimating transition zone volume is important for the medical or surgical management of symptomatic benign prostatic hyperplasia and determination of prostate specific antigen density of the transition zone. We evaluated whether preoperative transrectal ultrasound measurements of the transition zone predict enucleated adenoma weight. MATERIALS AND METHODS: We measured transition zone volume preoperatively using transrectal ultrasound and the prolate ellipsoid method in 50 patients with presumed benign prostatic hyperplasia who underwent suprapubic prostatectomy. Transition zone volume corresponds to the adenoma. Enucleated adenoma weight was then correlated with preoperatively determined transition zone volume. RESULTS: As measured by transrectal ultrasound, mean transition zone volume plus or minus standard deviation was 80.88 +/- 37.42 cc (range 31 to 200). Mean enucleated adenoma weight was 68.70 +/- 36.26 gm. (range 18 to 180). There was a statistically significant correlation of estimated transrectal ultrasound volume of the transition zone with enucleated prostate adenoma weight (r = 0.95, p <0.001). However, when prostate adenoma weight was determined using the formula, prostate adenoma weight = -6.00 + 0.92 x transition zone volume, we noted a significant difference in mean prostate adenoma weight and mean transition zone volume (p <0.001). Since the regression coefficient of transition zone volume was significantly different from 1, we identified no agreement of prostate adenoma weight with estimated transrectal ultrasound volume of the transition zone. CONCLUSIONS: These data reveal a significant difference in mean prostatic adenoma weight and mean transition zone volume. Although transition zone volume measurements are well described, clear agreements on such measurements should be obtained to determine transition zone volume more precisely.     

Doppler resistive index in benign prostatic hyperplasia: correlation with ultrasonic appearance of the prostate and infravesical obstruction

OBJECTIVE: This study was designed to characterize the resistive index (RI) of prostatic blood flows obtained by transrectal power Doppler sonography (TRPDS) in benign prostatic hyperplasia (BPH). METHOD: In 140 patients with lower urinary tract symptoms, the RI was measured using TRPDS and compared with age and planimetric parameters of the prostate obtained by conventional transrectal sonography. In addition, the RI was related with pressure flow studies. RESULTS: The RI was significantly higher in patients with BPH (0.72+/-0.06, p<0.0001) than those with a normal prostate (0. 64+/-0.04). Although the RI correlated significantly with age and all prostatic planimetric parameters, multiple regression analysis revealed that age and presumed circle area ratio were independent predictors for RI. The RI was also higher in patients with infravesical obstruction than those without (0.74+/-0.06 vs. 0. 70+/-0.05, p<0.005). There was a significant correlation between RI and urodynamic parameters obtained in pressure flow studies. Out of 33 patients with obstruction, 28 (85%) had an RI of 0.7 or more, while 11 out of 24 patients (46%) without obstruction had an RI less than 0.7. CONCLUSION: The RI is promising as a new parameter to estimate the intraprostatic pressure to investigate BPH. Its value to represent urodynamic information during voiding remains to be studied.     

Recovery of urinary continence following radical prostatectomy: the impact of prostate volume--analysis of data from the CaPSURE Database

PURPOSE: Improved urinary function following radical prostatectomy due to bladder outlet obstruction from subclinical benign prostatic hyperplasia has been described. We determined if prostate volume determined by preoperative transrectal ultrasound could predict recovery of urinary function and continence following radical prostatectomy. MATERIALS AND METHODS: We identified all 4,984 patients who underwent radical prostatectomy in the CaPSURE national disease registry of men with prostate cancer. Only the 2,097 men who had data available on preoperative prostate volume by transrectal ultrasound, and complete preoperative and postoperative data available on urinary function using the UCLA-PCI were selected for study. Transrectal ultrasound volume was categorized as less than 25, 25 to 50 cc or greater than 50 cc. Univariate and mixed multivariate analyses were performed to determine the association between transrectal ultrasound based prostate volume and continence, as measured by urinary function scores 6 months to 2 years following radical prostatectomy. Analyses were controlled for baseline urinary function as well as other variables, such as body mass index, time of urinary function assessment and patient age at diagnosis. Total and individual item scores on the urinary function subscale were used as outcome variables in separate models. RESULTS: Median transrectal ultrasound prostate volume was 35 cc (IQR 27-47.8). In the ANOVA for mixed models patient age, time of urinary function assessment, body mass index and transrectal ultrasound prostate volume were independent predictors of urinary continence. Patients with prostate volume greater than 50 cc had lower rates of continence, as assessed by urinary function scores 6 months and 1 year after radical prostatectomy, but scores equalized across all volume ranges by 2 years after radical prostatectomy. The individual domains most significantly affected were urinary control (p = 0.02), urine leakage during sexual activity (p = 0.0016) and urine leakage frequency (p = 0.0175). CONCLUSIONS: These data indicate that baseline prostate volume is a predictor of recovery of urinary function after radical prostatectomy. Men with larger volume prostates have lower levels of continence up to 2 years after radical prostatectomy. A potential reason could be subclinical bladder dysfunction related to benign prostatic hyperplasia that manifests after surgery.