Serum hormone levels among patients with prostatic carcinoma or benign prostatic hyperplasia and clinic controls

This study sought to identify differences in serum hormone levels between prostatic cancer (CaP) patients, benign prostatic hyperplasia (BPH) patients, and clinic controls (CC). Serum testosterone, estradiol, and prolactin values were obtained from 35 CaP, 42 BPH, and 161 CC patients attending a single medical center between January 1984 and April 1985. Relative risk estimates adjusted for age and race were calculated to compare hormone values between each case group and the CC. The distributions of hormone values and the testosterone to estradiol (T/E) ratios were grouped into thirds with the lowest third forming the reference category. The relative risk estimates for BPH in the middle and high thirds of testosterone were greater than unity (1.26 and 2.10, respectively), whereas the relative risk estimates in the middle and high thirds of estradiol were less than unity (0.63 and 0.35, respectively). For the middle and high thirds of the T/E ratio, the relative risk estimates for BPH showed statistically significant three- to fourfold increases. Modest depression of serum testosterone and estradiol was noted for CaP patients compared to CC, although the differences were not statistically significant. This depression was interpreted to be a likely result of the malignant process rather than a cause of it, whereas the development of clinically evident BPH was felt to be a biologically plausible response to an elevated T/E ratio.     

改良简化的小鼠BPH模型及其特点

目的 探讨更简易和合理有效的前列腺增生(BPH)动物模型的建立方法,并对比分析其不同特点.方法 选用40只BALB/C小鼠,随机分为对照组(去势睾酮组)和实验组(非去势睾酮组),两组均为20只.对照组先作双侧睾丸切除术,而实验组则做同一切口但不切除睾丸.1周后,两组小鼠都同时给予丙酸睾酮(12.5mg/kg·d-1)腹腔内连续注射20d,第21天所有小鼠均采血处死.解剖观察前列腺特点并称重,做病理检查,血清作睾酮、雌二醇和血管内皮生长因子检测.结果 两组小鼠BPH模型均建立成功.实验组前列腺增生较对照组更明显(P＜0.05),呈单侧腹侧叶结节状非对称性增生,与临床BPH发病机制和病理相比,对照组更接近.结论 小鼠不经去势而使用睾酮原液腹腔内注射,可获更为简易和合理的BPH模型.     

Involution of spontaneous benign prostatic hyperplasia in the dog under the influence of chronic treatment with a LHRH agonist

Eight dogs with spontaneous benign prostatic hyperplasia were treated with daily subcutaneous injections of 25 micrograms of Buserelin, (D-Ser(TBU)6,des-Gly-NH2(10))ethylamide during 3 months. Prostate weight before treatment was estimated by tridimensional measurements during open surgery. After 3 months of treatment, prostate weight was decreased by 50-60% In two castrated control animals, prostate weight decreased about 70% after 3 months. Histological pattern in prostates from castrated or Buserelin-treated animals was similar and indicated considerable atrophy of glandular epithelium and predominance of stroma. At the same time, testes weight decreased with complete disappearance of spermatogenic activity. Acid phosphatase and arginine esterase activity levels, two markers of androgenic action in the prostate, were similar after Buserelin or castration. Steroid receptors for androgens, estrogens, and progesterone also behaved similarly under the influence of Buserelin and castration.     

Effect of age, castration, and testosterone replacement on the development and restoration of canine benign prostatic hyperplasia

An experiment was designed to test the effect of castration and testosterone replacement on the development of benign prostatic hyperplasia (BPH) in young and on the restoration of BPH in old beagles. Twenty beagles were divided by age into young (1.5-2.5-yr) and old (6.0-8.5-yr) groups. Each of these groups was further divided randomly into two additional groups of age-matched, intact, untreated control and castrate beagles. The latter were then treated with testosterone-filled Silastic implants designed to clamp serum testosterone at concentrations similar to those observed in adult beagles for 7 months beginning 5 months after castration. Histopathologic characterization of each prostate was completed on biopsy material obtained at the beginning and end of the experiment. Prostate weights were determined each month for 12 months via a noninvasive two-dimensional X-ray procedure. Testosterone treatment for 7 months allowed BPH to develop in young and restored BPH in old beagles. These results suggest that testosterone in the adult beagle acts permissively to allow BPH to develop in the prostate of the aging dog. Some other testicular product may be required for the continued growth of BPH in aged beagles.     

Development of a model for the induction of estrogen-related prostatic hyperplasia in the dog and its response to the aromatase inhibitor 4-hydroxy-4-androstene-3,17-dione: preliminary results

Although the presence of the testes is an absolutely necessary prerequisite for benign prostatic hyperplasia (BPH) to occur, the role of androgens in the cause of BPH is still controversial. There are increasing signs for a decisive role of estrogens in that connection. We treated castrated beagle dogs of known age with androstenedione (an androgen that can be aromatized) and with the aromatase inhibitor 4-hydroxyandrostendione. Six or 9 months of treatment with androstenedione resulted in a BPH characterized by typical androgenic effects--ie, hyperplasia and hypertrophy of the epithelium--and by typical estrogenic effects--, stimulation of the stroma, especially of the smooth muscles, and cystic enlargement of the tubules. These estrogen-related effects could be clearly antagonized by the simultaneous treatment with the aromatase inhibitor 4-hydroxyandrostenedione. The hyperplastic effects on the epithelium were also partly antagonized by the aromatase inhibitor. Our preliminary results further strengthen the effectiveness of aromatase inhibitors as an alternative treatment of human BPH, which is thought to be predominantly a stromal disease.     

Heterogeneity of 5 alpha-reductase gene expression in benign prostatic hyperplasia

PURPOSE: The search for molecular markers of benign prostatic hyperplasia in general is based on an analysis of a limited number of biopsy samples. Little is known about the homogeneity of the expression of key genes in different zones of the prostate. We studied the intraprostatic (that is within the same gland) and inter-prostatic (that is between glands) variability of 5 alpha-reductase 2 (5aR2) gene expression. MATERIALS AND METHODS: Ten tissue samples removed by open prostatectomy were the source of tissue specimens. Two frozen sections were generated from each of several random biopsies taken from each adenoma immediately after enucleation, 1 of which was used for 5aR2 gene expression analysis and 1 for morphometric analysis. Results among biopsies were compared using the 5 alpha-reductase index (ratio of 5 alpha-reductase expression to an internal standard measured as electrophoretic band intensity). Morphometric composition was determined for smooth muscle, collagen, epithelium and glandular lumens. Statistical comparisons were performed with ANOVA by pairwise multiple comparison (Dunn) and Spearman's rank correlation procedure. RESULTS: For the 71 biopsies analyzed mean 5 alpha-reductase index was 0.23 +/- 0.16 and overall tissue distribution was smooth muscle 34%, collagen 35%, epithelium 14% and glandular lumens 17%. Inter-prostate and intraprostate variability in 5 alpha-reductase index was statistically significant (p = 0.004) as was the variability in stromal-to-epithelial ratio (p = 0.012). The 5 alpha-reductase index showed strong correlation with stroma (%) and negative correlation with epithelium (%). CONCLUSIONS: Benign prostatic hyperplasia is heterogeneous in terms of tissue morphometry and expression of single important genes. This finding limits the use of single biopsy based markers to predict biological behavior, and has significant impact on the ability of distinguishing longitudinal changes in tissue composition from sampling artifacts.     

Treatment of complicated benign prostatic hyperplasia with LHRH-analogues in aged patients

The effect of administration of an LHRH-analogue (LHRH-a) was evaluated in 11 patients with benign prostatic hyperplasia (BPH) in whom there were contraindications for surgery. These patients, who already had impaired potency due to age or serious illness, were given 1500 micrograms LHRH-a in the first week and 1200 micrograms from the eighth day onwards. They all improved significantly (P less than 0.001) with regard to their urological symptoms on day 60 of treatment. Our results demonstrate the influence of androgen in maintaining established BPH, the effectiveness of LHRH-a therapy in selected patients with BPH and the usefulness of a salivary testosterone assay for the follow-up of treatments expected to lower the bioavailability of androgen to target tissues.     

Crystalloids in prostatic hyperplasia

Prostatic crystalloids previously reported only in association with carcinoma were identified in 3.6% of a series of 456 cases of prostatic hyperplasia. Seventy percent of cases with crystalloids contained multiple areas of typical hyperplasia. The incidence of crystalloids in cases of atypical hyperplasia was 9.6%. One patient subsequently developed adenocarcinoma of the prostate. The follow-up period of the majority of these patients is too short to allow evaluation of the prognostic significance of prostatic crystalloids with regard to the development of prostate carcinoma.     

腹腔镜下耻骨后腹膜外保留尿道的前列腺切除术

目的探讨腹腔镜下经耻骨后腹膜外保留尿道的前列腺切除术治疗大腺体前列腺增生症的可行性。方法自2006年1月至2007年1月对9例前列腺增生症的病人采用腹腔镜行耻骨后腹膜外前列腺切除术,病人年龄为(77.8±6.8)岁,范围为(62～83)岁。经直肠前列腺B超显示前列腺大小为(101.3±36.2)g,范围为(62～172)g,均无明显中叶增生。腹腔镜手术包括耻骨后腹膜外腔的建立、排列成倒U字形5个穿刺套管的放置、前列腺被膜的切开、增生腺瘤的切除、前列腺部尿道的保护及前列腺被膜的缝合等主要步骤。结果9例病人手术顺利,术中出血(190±160.6)ml,范围为(60～600)ml,手术时间为(174±59.8)min,范围为(90～240)min。术后恢复顺利,尿管拔除时间为(8.4±3.8)d。术后3月复查病人尿流率、国际前列腺症状评分(IPSS)评分、生活质量评分(QOL)等较术前明显好转。术前有性功能的4例病人术后性功能无损。结论对腺体大的前列腺增生症行腹腔镜下经耻骨后腹膜外行前列腺切除术是可行的,病人创伤小、恢复快、效果满意。     

纤维连接蛋白在良性前列腺增生中的表达及意义

利用免疫组织化学和计算机辅助图像分析的方法对２０例正常前列腺和２０例良性前列腺增生组织中的纤维连接蛋白（ＦＮ）进行形态学和定量研究。结果表明，ＦＮ主要分布于前列腺间质和腺体的基底膜，呈线网状或弥漫状分布。间质中ＦＮ的相对含量与年龄无明显相关。良性前列腺增生组织间质中ＦＮ的相对含量（０．１１０±０．０２２）明显多于正常前列腺组织间质中的ＦＮ相对含量（０．０８６±０．０２７，Ｐ＜０．０１），而且ＦＮ的含量与良性前列腺增生组织中间质的增生程度密切相关。提示ＦＮ在前列腺良性增生的发生中起重要作用。     

Testosterone and benign prostatic hyperplasia

The use of testosterone to treat the symptoms of late-onset hypogonadal men has increased recently due to patient and physician awareness. However, concerns regarding the effect of testosterone on the prostate, in particular any possible effect on the risk of prostate cancer have prompted further research in this regard. Surprisingly, numerous retrospective or small, randomized trials have pointed to a possible improvement in male lower urinary tract symptoms (LUTS) in patients treated with testosterone. The exact mechanism of this improvement is still debated but may have a close relationship to metabolic syndrome. For the clinician, the results of these studies are promising but do not constitute high levels of evidence. A thorough clinical examination (including history, examination and laboratory testing of testosterone) should be undertaken before considering the diagnosis of late-onset hypogonadism or instigating treatment for it. Warnings still remain on the testosterone supplement product labels regarding the risk of urinary retention and worsening LUTS, and these should be explained to patients.     

血管生长素在前列腺癌和前列腺良性增生组织中的表达

目的研究血管生长素（angiogenin，ANG）在前列腺癌和前列腺良性增生组织中的表达及其与前列腺癌生物学行为的关系。方法采用免疫组化SP法对68例前列腺癌组织和38例前列腺良性增生组织标本ANG蛋白的表达进行检测，并对不同的年龄组、病理分级、临床分期之间的表达差异通过统计学分析进行比较。结果免疫组化实验显示阳性染色为棕黄色和深棕色颗粒。ANG在前列腺癌组织中表达显著高于前列腺良性增生组织（P〈0.01）。ANG表达随前列腺癌患者临床分期的升高而上调（P〈0.05）;随着肿瘤组织Gleason病理分级的增加而呈升高趋势（P〈0.05）;而在不同年龄组前列腺癌患者之间ANG表达无统计学差异（P〉0.05）。结论前列腺癌组织中ANG的表达在判断前列腺癌侵袭性、估计其预后中有一定意义。     

Madigan前列腺增生切除术

为了提高前列腺增生症的手术治疗效果，采用Ｍａｄｉｇａｎ手术治疗前列腺增生症患者２５例。１５例尿道完整，１０例损伤尿道缝合修复；术后出血少、恢复快；随访４～２５个月，无尿道狭窄、尿失禁等并发症。对手术优点、术中注意事项及适应证的选择进行了讨论。     

前列腺结石与良性前列腺增生患者前列腺体积的相关性研究

目的探讨前列腺结石与前列腺增生症患者前列腺体积的相关性。方法回顾性分析本院2012年1月至2013年12月出院诊断为良性前列腺增生的患者392例,根据经直肠前列腺彩超结果将患者分为前列腺结石阴性组与阳性组,比较两组的年龄、前列腺特异性抗原(PSA)、前列腺总体积、内腺体积以及各经线之间有无差别。结果结石阴性组与结石阳性组前列腺总体积(TPV)、总体积宽径(TPV-b)、内腺体积宽径(TZV-b)差别有统计学意义(P0.05);结石阴性组与结石阳性组的年龄、内腺体积(TZV)、血清总PSA(TPSA)密度以及其他各经线差别无统计学意义(P0.05)。结论前列腺结石与前列腺增生程度存在一定的内在关系,结石有可能促进前列腺组织的增生。     

Evaluation for Madigan's prostatectomy in patients with benign prostatic hyperplasia

Aim: To comparatively evaluate the efficacy and post-operative complications of the Madigan's prostatectomy(MPC) and suprapubic prostatectomy (SPPC). Methods: A total of 43 patients with benign prostatic hyperplasiawere divided into two groups: 21 underwent MPC and 22, SPPC. In all the patients, the international prostate symp-tom score (IPSS) and urinary pressure-flow studies were assessed before and 6 months after operation. The InternationalContinence Society (ICS) nomogram, Abrams-Griffiths (AG) number and linear passive urethral resistance relationanalysis (L-PURR) were used to diagnose and grade bladder outlet obstruction (BOO). The IPSS and the urodynamicparameters before and after operation, as well as the advantages and post-operative complications were recorded andcompared. Results: Patients of both the MPC and SPPC groups had a significant improvement in IPSS and urody-namic parameters. Obstruction was relieved in 81.0% of MPC and 86.4% of SPPC patients. MPC has the advantagesof the absence o