Long-term clinical and biologic effects of the lipidosterolic extract of Serenoa repens in patients with symptomatic benign prostatic hyperplasia

Permixon, the lipidosterolic extract of Serenoa repens, is widely used for the treatment of symptoms associated with benign prostatic hyperplasia (BPH). This open study assessed the efficacy and tolerability of Permixon 160 mg twice daily administered for 2 years. One hundred fifty-five men with clinically diagnosed BPH and complaints of prostatic symptoms were enrolled in the study. At 6, 12, 18, and 24 months, the International Prostate Symptom Score (I-PSS), quality of life, and sexual function score were recorded, and urodynamics and biologic values were measured. Adverse events were recorded every 3 months. I-PSS and quality of life improved significantly from baseline at each evaluation time point. At the end of the study and at each evaluation, maximum urinary flow also improved significantly. Prostate size decreased. Sexual function remained stable during the first year of treatment and significantly improved (P = .001) during the second year. Prostate-specific antigen was not affected, and no changes in plasma hormone levels were observed. Nine patients reported 10 adverse events, none related to treatment. Improvements in efficacy parameters began at 6 months and were maintained up to 24 months. These data demonstrate the long-term efficacy and tolerability of Permixon and support its use as a first-line medical therapy for uncomplicated symptomatic BPH.     

Prostate-specific antigen and prostate cancer

Serum prostate-specific antigen (PSA) measurement is used to investigate patients with lower urinary tract symptoms and to screen for prostatic malignancy in symptom-free males over 50 years of age. Approximately 60% of patients with early (prostate-confined) occult malignancy show increased serum PSA levels, as do some 20% of patients with prostatic symptoms from benign prostatic disease. When PSA is only slightly raised, serial PSA measurements, correction for prostatic volume and especially measurement of free (unbound) PSA (which is reduced in prostatic malignancy) may assist the differentiation of prostatic cancer from benign hypertrophy. Serial measurements are also of value for monitoring treatment of prostate cancer and for post-treatment surveillance.     

The zinc and copper content of blood leucocytes and plasma from patients with benign and malignant prostates

Zinc and copper levels in plasma have been measured in 41 patients with benign prostatic hypertrophy and 44 patients with carcinoma of the prostate, 24 of whom were receiving some form of hormonal therapy. The zinc concentrations in the blood leucocytes of some of the patients were also examined.We were unable to detect any differences between the leucocyte zinc levels of the three groups examined. Similarly, plasma zinc levels were not affected by age or disease, whereas the plasma copper levels were significantly higher (p < 0.01) in the benign and malignant categories (mean = 124 μg/100 ml) when compared to a younger normal population (mean = 84.0 μg/100 ml).Hormonal therapy induced a rapid rise in the plasma copper concentrations and a concomitant marginal fall in zinc levels of the carcinoma patients. The magnitude of these hormone-induced changes were dependent on the type of therapy prescribed to the patient.     

The lipidosterolic extract of Serenoa repens in the treatment of benign prostatic hyperplasia: a comparison of two dosage regimens

This 6-month double-blind, randomized, parallel-group study compared two dose regimens of Libeprosta, the lipidosterolic extract of Serenoa repens in 100 male outpatients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH). The patients received two 80-mg tablets twice daily or two 80-mg tablets three times daily. Baseline evaluations included maximum and mean urinary flow rates, postvoid residual urine volume, and International Prostate Symptom Score (I-PSS) total and quality-of-life scores. Both regimens significantly reduced the I-PSS mean total score from baseline values (P<.001); improvements achieved statistical significance after month 3 and were maintained for the duration of the study. Significant improvements from baseline also occurred in quality-of-life scores, maximum and mean urinary flow rates, and residual urine volume (P<.05). The decrease in residual urine with both regimens was highly significant (P<.001). No significant differences in efficacy were noted between the two dose groups, and no treatment-related complications or clinical adverse events occurred. In this clinical study, the lipidosterolic extract of Serenoa repens was a well-tolerated agent that may significantly improve lower urinary tract symptoms and flow measurements in men with BPH.     

A randomized,double-blind,placebo-controlled trial to determine the effectiveness of botanically derived inhibitors of 5-alpha-reductase in the treatment of androgenetic alopecia

BACKGROUND: Androgenetic alopecia (AGA) is characterized by the structural miniaturization of androgen-sensitive hair follicles in susceptible individuals and is anatomically defined within a given pattern of the scalp. Biochemically, one contributing factor of this disorder is the conversion of testosterone (T) to dihydrotestosterone (DHT) via the enzyme 5-alpha reductase (5AR). This metabolism is also key to the onset and progression of benign prostatic hyperplasia (BPH). Furthermore, AGA has also been shown to be responsive to drugs and agents used to treat BPH. Of note, certain botanical compounds have previously demonstrated efficacy against BPH. Here, we report the first example of a placebo-controlled, double-blind study undertaken in order to examine the benefit of these botanical substances in the treatment of AGA. OBJECTIVES: The goal of this study was to test botanically derived 5AR inhibitors, specifically the liposterolic extract of Serenoa repens (LSESr) and beta-sitosterol, in the treatment of AGA. Subjects: Included in this study were males between the ages of 23 and 64 years of age, in good health, with mild to moderate AGA. RESULTS: The results of this pilot study showed a highly positive response to treatment. The blinded investigative staff assessment report showed that 60% of (6/10) study subjects dosed with the active study formulation were rated as improved at the final visit. CONCLUSIONS: This study establishes the effectiveness of naturally occurring 5AR inhibitors against AGA for the first time, and justifies the expansion to larger trials.     

腹膜外腹腔镜治疗良性前列腺增生症55例

目的探讨腹膜外腹腔镜下前列腺切除术的可行性。方法2006年2月至2009年8月采用腹腔镜下经腹膜外对55例前列腺增生症患者行前列腺切除术,术后病理证实良性前列腺增生。观察手术时间、术中出血量、术后住院天数及手术效果。结果55例手术均获成功,平均手术时间85min(67～128min),术中平均出血量210ml(130～1200ml),有5例需输血、无中转开放手术病例。术后平均住院时间8(6～12)d。随访3～18个月,IPSS由术前(24.1±1.5)分降至术后(9.5±1.4)分,Qmax由术前(7.3±1.8)ml/s提高到术后(17.1±1.5)ml/s。结论腹腔镜下前列腺切除术是安全可行的。     

Herbs for benign prostatic hyperplasia

OBJECTIVE: To review and evaluate the literature relative to the use of herbal therapies in the treatment of benign prostatic hyperplasia. DATA SOURCES: Literature was identified by MEDLINE, Embase, International Pharmaceutical Abstracts, and the International Bibliographic Information on Dietary Supplements searches and through cross-referencing of selected articles. STUDY SELECTION/DATA EXTRACTION: All articles identified from the data sources were evaluated and all information deemed relevant was included in this review. DATA SYNTHESIS: A large percentage of men >50 years old begin to experience signs and symptoms of benign prostatic hyperplasia (BPH). Herbs hold promise in the treatment of BPH. Serenoa repens, Pygeum africanum, Urtica dioica radix, and Cucurbita peponis semen are some of the botanical therapies used in the treatment of BPH. CONCLUSIONS: There are many European studies examining efficacy, dose, and adverse effects of these plants in the treatment of BPH. However, numerous questions remain. These include issues concerning long-term beneficial and adverse effects of herbal therapy, prevention of complications, standardization of extracts, and concomitant use with "mainstream" medications. Based on the information available today, these botanical therapies can be used for treatment of a number of objective and subjective symptoms in patients with BPH, stages I and II.     

Benign prostatic hypertrophy.

By age 75, between 10 and 25 percent of men require intervention for problems caused by benign prostatic hypertrophy. Symptoms of bladder outlet obstruction include hesitancy, terminal dribbling, postvoid fullness and double voiding. Symptoms of bladder irritability include frequency, urgency, dysuria and nocturia. Urinary retention, hydronephrosis, azotemia and worsening obstructive symptoms are indications for treatment. In addition to catheter drainage or surgical resection, new treatment options include the use of alpha-adrenergic blockers and antiandrogens, as well as balloon dilatation of the prostate. Transurethral resection of the prostate remains the mainstay of treatment, providing effective relief in 85 percent of patients. Since only the enlarged portion of the prostate is removed, prostatic cancer or recurrence of benign prostatic hypertrophy is possible.     

Transurethral microwave thermotherapy for prostatism: early Mayo Foundation experience.

As part of a multicenter investigative trial, transurethral microwave thermotherapy of the prostate was used in 60 men with symptomatic benign prostatic hypertrophy. A single office treatment on the Prostatron, a device that provides concurrent microwave heating of the prostate and conductive cooling of the urethra, was well tolerated and caused no major adverse events. Symptomatic improvement, especially the decrease in nocturia and urgency, was dramatic, and urinary flow was improved at 6 weeks. Continued follow-up suggests that further improvement will be achieved and that transurethral microwave thermotherapy has a role in the treatment of benign prostatic hypertrophy.     

Diffusion of tosufloxacin into prostatic tissue.

The diffusion of tosufloxacin (TFLX) into the prostatic tissue was studied in 25 patients with benign prostatic hypertrophy. TFLX concentrations in the serum and prostatic tissue were measured at scheduled intervals after oral administration of 450 mg of TFLX on the day before surgery, followed by administration of 150 mg of TFLX immediately before surgery. The mean TFLX levels in prostatic tissue (and tissue/serum levels) at 2, 4 and 6 h were 0.35 +/- 0.16 microgram/g (0.93 +/- 0.36) in 7 patients, 0.58 +/- 0.92 microgram/g (1.10 +/- 0.45) in 10 patients and 0.22 +/- 0.09 microgram/g (0.95 +/- 0.45) in 8 patients. The TFLX levels in prostatic tissue exceeded the minimum inhibitory concentration for several pathogenic bacteria detected in the infected prostatic fluid. Therefore, TFLX shows promise as a useful drug in the treatment of bacterial prostatitis and infections developing after prostatic surgery.     

KTP photoselective laser vaporization of the prostate: indications, procedure, and nursing implications

Over the past decade, there has been a concerted effort to surgically relieve the bladder outlet obstructive symptoms in men with benign prostatic hypertrophy (BPH) by using a laser. Recent improvements in laser technology have led to the development of promising new treatment modalities. The potassium-titanyl-phosphate photoselective laser vaporization of the prostate procedure effectively vaporizes the obstructing prostatic adenoma in a 1-day surgery procedure. Current results show that this procedure provides a feasible option for men seeking long-term relief of bladder outlet obstructive symptoms due to BPH.     

Ratio of serum tartrate-inhibitable acid phosphatase to total serum protein in benign prostatic hypertrophy and prostatic carcinoma.

The activity concentration and the specific activity (the ratio of enzyme activity to total serum protein) of the tartrate-inhibitable fraction of acid phosphatase [orthophosphoric monoester phosphohydrolase (acid optimum), EC 3.1.3.2; TIAP] were related to benign prostatic hypertrophy and to prostatic carcinoma. As expected, the TIAP activity concentrations assayed in the sera of patients with benign prostatic hypertrophy were within the range of those assayed in normal human sera. In contrast, the specific activities of TIAP determined in the sera of patients with benign prostatic hypertrophy were significantly higher than those determined in the control group. In the sera of prostatic carcinoma patients, both the TIAP activity concentrations and the TIAP specific activities differed significantly (F = 730) from the normal values.     

腔内超声测量不均匀增生前列腺体积新方法的探索

目的探索经直肠腔内超声（TRUS）准确测量不均匀增生前列腺体积的新方法.方法对比研究常规和本方法测量不均匀增生前列腺体积的差异.结果新方法所得值与不均匀增生前列腺实际重量之间的相关性良好,且优于常规方法.结论使用新方法更能反映不均匀增生前列腺的实际体积.     

经直肠超声分度诊断前列腺增生症的研究

目的　探讨前列腺增生症的分度方法。方法　对３２０例前列腺增生患者进行直肠指诊、经腹及经直肠超声检查尿流率及残余尿测定。结果　①直肠指诊与超声测量前列腺体积相似,无显著性差异（Ｐ＝ ０．９９１）;②前列腺体积大小与尿路梗阻程度不一致（Ｐ＜ ０．０１）, 而与增生结节压迫尿道的部位与程度有关; ③经直肠超声分度以前列腺内腺的大小、内外腺的比例、尿道内口的位置及排尿期声像图为指标, 其结果与尿路梗阻程度及临床表现一致（Ｐ＝ ０．８４８,０．９９６,０．５９２１）。结论　经直肠超声分度不仅是诊断前列腺增生症的可靠方法, 而且为选择治疗方法提供了客观依据。     

新生儿呼吸窘迫综合征患儿血清甲状腺激素检测及其意义

目的 探讨新生儿呼吸窘迫综合征(NRDS)患儿血清甲状腺激素水平变化及其临床意义.方法 采用放射免疫法检测NRDS患儿治疗前后血清甲状腺激素水平变化,并与同期出生的健康对照组进行比较.结果 NRDS组治疗前TT3、FT3均明显低于健康对照组(P<0.01),治疗后与治疗前比较,TT3、FT3水平明显增高(P<0.01),两组TSH、TT4、FT4无明显改变(P>0.05).结论 NRDS患儿伴有TT3、FT3降低,随着病情的好转,甲状腺功能可恢复正常.     

锦州地区男性吸烟、体质量指数与临床良性前列腺增生的危险性研究

背景:良性前列腺增生是一种老年男性常见的疾病,尽管发病的危险因素仍不清楚,但是诸多生活方式因素对此病具有一定的影响作用。目的:观察锦州地区男性吸烟、体质量指数与临床良性前列腺增生危险性之间的关系。设计:病例对照观察。单位:华中科技大学同济医学院流行病与统计学系;辽宁医学院预防医学教研室。对象:选择2004-05/2006-05在辽宁医学院附属第一及第三医院、锦州中心医院和锦州市第二人民医院泌尿外科收治的343例良性前列腺增生行外科手术患者为病例组,年龄50￣82岁。纳入标准:①年龄>50岁,I-PSS症状分>7。②排尿后直肠指检前列腺Ⅰ度以上(横径>3cm)。③B超检查示前列腺体积≥30g。④最大尿流率<15mL/s;选择同期入住于上述医院,因患各种与良性前列腺增生、前列腺癌以及前列腺炎危险因素无关疾病的361例患者为对照组,年龄50￣82岁,平均65岁。所有患者均对调查内容知情并同意。方法:采用标准调查表对病例组和对照组患者进行调查,定义一生总吸烟量≥20包为吸烟者,反之为不吸烟者。根据吸烟量分成不吸烟、吸烟量1￣19支/d、吸烟量20￣29支/d和吸烟量≥30支/d,并按吸烟的时间分为不吸烟、1￣19年、20￣29年和≥30年。通过询问法,获得受试对象体质量指数,分为体质量指数<18.4、正常(体质量指数18.5￣23.9)、超重(体质量指数24.0￣27.9)和肥胖(体质量指数≥28);调查患者文化程度分为文化程度<7年,7￣11年和≥12年,患者的职业分为工人、农民、知识分子及其他。将调查结果输入计算机、建立数据库,应用多元Logistic模型分析患者吸烟量、吸烟时间、体质量指数、文化程度、职业与临床良性前列腺增生的比值比(OR)和95%可信限(CI)。主要观察指标:患者吸烟量、吸烟时间、体质量指数、文化程度、职业与临床良性前列腺增生的关系。结果:纳入病例组患者343例,对照组361例均进入结果分析。①吸烟量≥30支/d患者与不吸烟者相比,发生临床良性前列腺增生的危险性增加(OR=1.32,95%CI为0.92￣2.58,P<0.01)。②超重及肥胖吸烟者发生临床良性前列腺增生的危险性较不吸烟者显著增高(OR=1.68,2.35,95%CI分别为1.32￣3.67,1.83￣4.16,P<0.01)。③体力劳动者(农民)与发生良性前列腺增生的危险性呈负相关(P<0.05)。脑力劳动者(知识分子)发生临床良性前列腺增生的危险性高于对照组(χ2=6.62,P<0.01)。结论:吸烟≥30支/d的男性与临床良性前列腺增生呈正相关,超重(体质量指数24.0￣27.9)和肥胖(体质量指数≥28.0)的男性吸烟发生临床良性前列腺增生的危险性显著地升高。     

Spontaneous benign prostatic hyperplasia in the beagle. Age-associated changes in serum hormone levels, and the morphology and secretory function of the canine prostate.

This paper is a cross-sectional study of spontaneous benign prostatic hyperplasia (BPH) in a single canine species. The effects of aging and hormonal changes on the growth, histology, and glandular secretory function of the canine prostate were studied in 42 male beagles ranging in age from 8 mo to 9 yr. The beagle prostate enlarges for at least 6 yr, whether normal or hyperplastic. In contrast, prostatic secretory function, determined by ejaculate volume and total ejaculate protein, declines markedly after 4 yr of age. These reciprocal growth and functional changes in the prostate are closely associated with a progressive increase in the incidence of BPH, which is already apparent in some dogs by age two. With age there is a modest decrease in serum androgen levels with no apparent change in serum 17 beta-estradiol levels. This suggests that the growth and functional changes that are associated with the development of BPH and are initiated very early in life reflect an altered sensitivity of the prostate to serum androgens or a response to the relative decrease in the serum androgen to estrogen ratio.     

An urodynamic study of patients with benign prostatic hypertrophy treated conservatively with phytotherapy or testosterone (author's transl)]

Conservative therapy of benign prostatic hypertrophy comprises the administration of oestrogens, gestagens, androgens and anti-androgens. Phytodrugs, which contain an extract of Sabal serrulatum or Pygeum Africana as active substance are without side effects and are, therefore, being used increasingly. 74 patients with irritable or obstructive bladder symptoms due to benign prostatic hypertrophy were treated with a phytodrug (Sabal serrulatum) or with testosterone throughout a period of three months. In group one (20 patients given phytodrugs and 10 patients given testosterone) clinical symptoms and measurements of residual urine, residual urine quotient, bladder capacity, micturition pressure and maximum urethral closure pressure were recorded at the beginning and at the end of therapy. In group two 28 patients were treated with the phytodrug in the first and third months with an intervening placebo trial lasting four weeks and 16 patients were given testosterone. Clinical symptoms and uroflow and residual urine only were charted in this group. None of the patients in either group showed an improvement in the urodynamic parameters of obstruction, but all patients felt a subjective alleviation of their symptoms.     

Effects of thyroid hormone on cardiac size and myosin content of the heterotopically transplanted rat heart.

Infrarenal heterotopic cardiac isografts maintain structural and functional integrity. We have used this transplantation model to further explore the mechanisms of thyroid hormone-induced cardiac hypertrophy. Thyroid hormone administration, 1-thyroxine (T4) 10 micrograms/animal per d, led to a significant 30% increase in total heart weight and a 40% increase in the myosin content of the in situ heart when compared with control. In contrast, T4 treatment was without effect on the heart weight, protein content, rate of protein synthesis, or calculated myosin content of the heterotopic, nonworking heart. Heterotopic hearts demonstrated a significant decrease in the percentage of the V1 myosin isoenzyme from 95% to 61%. This shift occurred in euthyroid animals but was prevented by T4 treatment. These results suggest that thyroxine-induced cardiac hypertrophy is mediated indirectly via changes in cardiac work. Myosin isoenzyme expression can be altered by changes in work load but is still responsive to increased levels of thyroid hormone.     

Acute effects of cocaine on plasma adrenocorticotropic hormone, luteinizing hormone and prolactin levels in cocaine-dependent men.

Acute cocaine administration alters secretion of anterior pituitary hormones in experimental animals, and cocaine abuse may compromise neuroendocrine function in humans. The goal of this study was to examine cocaine's acute effects on neuroendocrine hormones in cocaine-dependent men. Plasma adrenocorticotropic hormone (ACTH), luteinizing hormone and prolactin levels were measured in 18 men before and after i.v. administration of cocaine (30 mg) or placebo. Each subject served as his own control during the i.v. placebo and cocaine administration conditions. Plasma cocaine levels peaked at 260 ng/ml within 5 min after the i.v. injection. Plasma ACTH levels increased significantly above base-line levels at 5, 15, 30 (P < .01) and 45 min (P < .05) after i.v. cocaine. Plasma luteinizing hormone levels increased significantly above base-line levels at 5 (P < .05) and at 15 min (P < .01) after i.v. cocaine. No changes in plasma ACTH or luteinizing hormone levels were found after i.v. placebo injection. Plasma prolactin levels decreased significantly at 30, 45, 60, 90 and 120 min (P < .01) after both i.v. cocaine and placebo administration. Cocaine-induced increases in plasma ACTH levels may be due to its effects on dopaminergic systems which modulate corticotropin-releasing factor release in brain.