Evaluation of anti-androgen therapy for benign prostatic hypertrophy by using transrectal prostatic ultrasonography]

We evaluated the effect of anti-androgen therapy for benign prostatic hypertrophy on 33 patients who had undergone transrectal prostatic ultrasonography both before and after administration of anti-androgenic drugs in our clinic. Patients treated with chlormadinone acetate (CMA) orally, or TSAA-291 intramuscularly showed a significant reduction in the prostatic weight. However, this reduction was not correlated with the degree of symptomatic improvement. In addition, patients who showed no symptomatic improvement despite a reduction in the prostatic weight often had prostatic stones or small inflammatory cell infiltrations in their prostatic tissue. Therefore, the coexistence of prostatitis or bladder neck obstruction with prostatic hypertrophy may contribute to the lack of symptomatic improvement in such patients.     

Chlormadinone acetate pellet implantation plus short-term oral administration in dogs with benign prostatic hypertrophy

Eight beagles with benign prostatic hypertrophy (BPH) were treated by subcutaneous implantation of pellets containing 10 mg/kg chlormadinone acetate (CMA), a synthetic anti-androgen, plus daily oral administration of CMA at 2 mg/kg per day for 7 days as a therapy for BPH. Prostatic and testicular size were measured and prostatic and testicular biopsies were performed by laparotomy before and after CMA treatment. Plasma levels of luteininzing hormone (LH), testosterone and oestradiol were also measured. The clinical signs of BPH, for example haematuria and dysuria, resolved within 1 week of treatment. Mean prostatic volume decreased to 56% of the pretreatment value. At 40 weeks after treatment, prostatic volume had decreased by 36%. Histological examination of the prostate 1 week after treatment revealed reduction in diameter of the alveoli and in height of the glandular epithelium. Degeneration and atrophy of the glands were marked 4–12 weeks after treatment. In the testis, the diameter of seminiferous tubules and the number of germ cells in the seminiferous tubules had decreased markedly at 12 and 24 weeks after treatment. Although plasma LH concentrations did not undergo any marked fluctuations after CMA treatment, levels of testosterone and oestradiol were lower than before treatment. The results indicate that implantation of 10 mg/kg CMA, plus 7-day oral administration of 2 mg/kg CMA, bring about resolution of the clinical signs and marked reduction in prostatic volume within 1 week of treatment.     

The significance of serum gamma-seminoprotein in prostatic cancer

The level of serum gamma-seminoprotein (gamma-Sm) was determined by enzyme immunoassay using an EIA gamma-Sm test kit in 32 patients with prostatic cancer (before treatment for 12 and after treatment was started for 20), 24 patients with benign prostate hypertrophy and 22 patients with other urogenital cancer. A gamma-Sm level of over 4.0 ng/ml was considered to be positive. The positive rate was 43.8% in prostatic cancer patients (83.3% before and 20.0% after treatment), 25.0% in benign prostate hypertrophy and 0% in other urogenital cancer. Since the positive rate of prostatic acid phosphatase (PAP) was 34.3% in prostatic cancer patients (75.0% before and 10.0% after treatment) and 16.7% in benign prostate hypertrophy patients, gamma-Sm may be more sensitive but less specific as an indicator of prostatic cancer in PAP. In 9 patients with prostatic cancer before treatment, the levels of serum gamma-Sm and PAP were serially determined for up to 11 months. The level of gamma-Sm decreased in 7 patients, and PAP in all patients after hormone therapy. One patient showed a consistently positive gamma-Sm level and the level of the others became positive only for gamma-Sm during follow-up. There was a statistical correlation between the levels of serum gamma-Sm and PAP in patients with prostatic cancer (r = 0.595, p less than 0.01), in patients with benign prostate hypertrophy (r = 0.882, p less than 0.01) and also in the patients in both groups together (r = 0.590, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)     

Three-dimensional display of the prostate based on transrectal ultrasonogram]

A software for a lap top computer to display prostatic contour three-dimensionally based on transrectal ultrasonograms was developed, and its clinical usefulness was examined. The prostatic contour of a case with prostatic cancer showed a typical irregular surface, and that of a case with prostatic hypertrophy had a smooth spherical shape, while that of a normal case had a flat shape. Each showed its characteristic shape. Estimation of the prostatic weight by assuming that the prostatic contour has ellipsoidal contour is a simple method for prostatic weight measurement, but it has a tendency to underestimate the weights, especially in normal cases. Three-dimensional display of the contour of prostatic cancer, prostatic hypertrophy, and normal prostate revealed that it could be estimated as ellipsoid in prostatic cancer or hypertrophy, while the normal prostatic contour was too flat to be calculated as such. Among 52 patients with benign prostatic hypertrophy who underwent transrectal ultrasonotomography before and during the anti-androgen therapy more than three time, nine cases showed transient reduction of more than 30% in prostatic weight and then reenlargement of more than 30%. In these cases, three-dimensional display of prostatic contour was done. The display was useful to visualize clearly which part reenlarged. Therefore, usefulness of the three-dimensional display of the prostate was verified.     

Progress in transrectal ultrasonography for prostatic disease

The accuracy of ultrasonographic measurement of volumetric changes within the prostate was assessed using a hand-held transrectal probe. This was effected by comparing the ultrasonically calculated weight change following TURP with the measured weight of resected prostatic tissue in a group of 30 patients with benign prostatic hypertrophy. A high correlation was found (r = 0.978) in BPH, but potential difficulties were found in applying the method to the malignant prostate. In the 30 benign cases studied, ultrasound indicated the presence of calculi in 60% of patients and an echo pattern consistent with malignant tissue in 23%. These findings suggest a poor diagnostic accuracy for the technique.     

Prostatic cancer after transurethral resection for benign prostatic hypertrophy]

Five cases of prostatic cancer developed after transurethral resection of prostate for benign hypertrophy are reported. Duration of transurethral resection of prostate (TUR-P) to diagnosis of prostatic cancer ranged from one year and seven months to seven years and two months, on average four years and seven months and frequency of prostatic cancer after TUR-P was estimated at 1.2%. Four of five patients complained of macroscopic hematuria. The cystourethrogram showed the mass protruded in the dilated prostatic urethra or bladder-neck in four patients (80%), a remarkable finding, and four cases were at stage D. Risk of development of prostatic cancer is not decreased even after prostatectomy and prostatic carcinoma diagnosed after TUR-P often advances in stage. Therefore, periodical examinations of the patients who had a prior prostatectomy are very important.     

Clinical results and problems of anti-androgen therapy of benign prostatic hypertrophy]

We evaluated the effect of anti-androgen therapy for benign prostatic hypertrophy. Patients showed a significant reduction in the prostatic weight measured by means of transrectal ultrasonography after 3 to 4 months of treatment. However, there were no patients who showed any symptomatic improvement despite a reduction in the prostatic weight. They had prostatic stones more frequently than the group who showed symptomatic improvement properly. We summarized some problems of anti-androgen therapy for benign prostatic hypertrophy.     

The effect of estramustine phosphate on prostatic cancer estimated by transrectal ultrasonotomography

Transrectal Ultrasonotomography was performed in 44 patients with prostatic cancer before, during, and after estramustine phosphate (Estracyt®) administration. In 75.7% of 37 previously untreated patients, the deformity of the horizontal section of the prostate with prostatic cancer was corrected considerably, while in 89.2%, prostatic weight was remarkably reduced. In 57.1% of seven previously treated patients, appreciable changes were also observed in the shape and weight of the prostate. We concluded that estramustine phosphate was effective not only for untreated prostatic cancer, but also, at least in some degree, for relapsed cases.     

The significance of prostatic serum acid phosphatase as a tumor marker in prostatic cancer

The levels of prostatic serum acid phosphatase (PSAP) were determined by radioimmunoassay using RIA-Quant PAP test kit on 14 normal females, 56 normal males, 25 patients with prostatitis, 74 patients with benign prostate hypertrophy, 129 patients with prostatic cancer, 50 patients with nonprostatic malignancies, and 16 post radical cystectomized males, making 364 cases in all. To diagnose prostatic cancer, a PSAP level of over 3.0 ng/ml was determined positive for differential diagnosis of prostatitis, benign prostate hypertrophy, and prostatic cancer. According to this criterium, the positive rate for each type of disease was: 0% for prostatitis, 5.4% for benign prostate hypertrophy, 80.6% for untreated prostatic cancer, and 2% for nonprostatic malignancies. In benign prostate hypertrophy, the cases with urethral catheters showed a tendency of high PSAP level, but no significant difference was observed. PSAP positive rates of untreated prostatic cancer by stage are 0% for Stage A, 57.1% for Stage B, 85.7% for Stage C, 100% for Stage D1, and 94.1% for Stage D2 cases at a high stage showing high positive rates. However, there seems to be a limit for the diagnosis of early prostatic cancer. As for the relationship between the grade of untreated prostatic cancer and PSAP, well differentiated tumors showed higher levels of PSAP in the study with cases of the same stage. However, with all the cases, less well differentiated tumors showed higher levels of PSAP. As a tumor marker for prostatic cancer in the observation of treatment response, the PSAP level of over 2.0 ng/ml was determined positive. The relationship between the judgement of treatment response and PSAP was: Objective stable for its increase or decrease within the normal range; progressive disease for its elevation from normal to positive level, or increase or decrease of PSAP level within the positive range; Objective partial regression or objective stable for normalization from positive level. The PSAP level in the internal iliac vein of the patients with prostatic cancer tended to be higher than that in the femoral vein or antecubital vein.     

Evaluation of weight of the prostate by transrectal longitudinal ultrasonography]

The correlation between the resected weight of prostate and the estimated weight of prostate by transrectal longitudinal ultrasound was evaluated for 53 patients with benign prostatic hypertrophy. Sonography was done with a real time linear scanner and 5.0 MHz transducer. Maximal prostatic dimensions were measured along the two major axes, namely the maximal length and the maximal thickness of total prostate and adenoma. By regarding benign prostatic hypertrophy as an ellipsoid, we calculated the weight of prostate according to the ellipsoid formula. The correlation coefficient was calculated as; r = 0.929, Y = 0.942Xt - 2.642 (Xt: total estimated weight), r = 0.962, Y = 0.965Xa + 0.028 (Xa: estimated weight of adenoma). The estimated weight of the prostate correlated with the resected weight of the prostate. These results suggested that rough estimation of the weight of benign prostatic hypertrophy was found to be possible by using this calculation technique.     

Transurethral resection for prostatic adenoma larger than 100 ml--preoperative treatment with interstitial laser coagulation of the prostate plus chlormadinone acetate as a treatment maneuver for safer operations

Between August 1985 and March 2004, we performed transurethral resection of the prostate (TURP) in 18 patients with benign prostatic hyperplasia (BPH) whose prostatic volume was larger than 100 ml. We divided the patients into two groups. Group A consisted of a total of 14 cases: 10 cases whose mean prostate volume was 114 ml (100 to 137 ml) and 4 cases whose prostate volume was not measured before TURP but whose mean resected prostatic tissue weight was 113 g (105 to 118 g). Group B consisted of 4 cases whose mean prostate volume was 110 ml (101 to 133 ml). Patients in group B underwent interstitial laser coagulation of the prostate (ILCP) followed by oral chlormadinone acetate (CMA) therapy (50 mg/day); TURP was performed 6 months later, once the prostate volume had shrunk to an average of 76 ml (66 to 91 ml). Mean resected weights and operation times were: group A, 93.1 g, 66.3 min; group B, 60.5 g, 55.7 min. There were 12 blood transfusion cases (85.7%; intraoperative) in group A, and 1 (25.0%; POD 1) in group B. Accordingly, this preoperative treatment was considered a safer method of TURP for BPH 100 ml or more. There were no cases of TURP syndrome or death in either group.     

Clinical study of allylestrenol (Org AL-25) on patients with prostatic hypertrophy--transrectal ultrasonography and urodynamic examination

Seventeen patients with benign prostatic hypertrophy were treated with 50 mg allylestrenol per day for a long period of time (mean: 37.7 weeks), and subjective and objective findings, transrectal ultrasonotomography, urodynamics, serum lipids and hormone levels were examined. Improvement rates of subjective and objective findings were 42.9-92.9%. A significant decrease in weight and diameter (antero-posterior, lateral) of the prostate was observed, but the difference in the height of the prostate was not significant. Increase in intravesical pressure was observed in 9 out of 14 cases (64.3%) and the decrease in area under the urethral pressure curve at functional profile length was observed in 6 out of 11 cases (54.5%). Slight increase of the serum lipid levels was observed in a few cases, but in many cases the fluctuation was within normal range. Although clear decrease in the testosterone levels was seen, decrease of libido and potency was observed in only one case (5.9%). No other side-effect was found. The overall efficacy rate was 58.8%, and clinical usefulness of Allylestrenol on benign prostatic hypertrophy was confirmed.     

Comparison of long-term results of transurethral incision of the prostate with transurethral resection of the prostate, in patients with benign prostatic hypertrophy

One hundred patients with benign prostatic hypertrophy (BPH) were randomized to transurethral incision (TUIP) or transurethral resection of the prostate (TURP). The average prostate weight before operation was not more than 30.0 g. Indications for the operations were based on the disease history, physical examination, digital rectal examination, laboratory values, and pressure-flow examination. All operations were performed with patients under spinal anesthesia. TUIP was performed with a Collins knife, and TURP was performed with a resectoscope. Follow-up was performed 24 months after the operations. After treatment there were statistically significant daytime and nocturnal reduction in voiding frequencies of 2.9 and 1.7, respectively, after TUIP, and 2.0 and 1.5 after TURP. In both groups, there occurred significantly better maximal flow rate from 7.6 mL/s to 16.9 mL/s in group I and from 6.9 mL/s to 17.6 mL/s in group II. The mean values of linearized passive urethral resistance relation in both groups significantly decreased from 3.6 +/- 0.6 to 1.0 +/- 0.5 after TUIP and from 3.9 +/- 04 to 1.4 +/- 0.5 after TURP. The TUIP procedure is effective and safe for patients with a small number of complications.     

An evaluation of prostate specific antigen in prostatic cancer

Prostate specific antigen levels were measured in 118 patients with prostatic cancer and 138 control individuals. Prostate specific antigen was sensitive in detecting prostatic cancer. The levels of prostate specific antigen were elevated in 10 per cent of the patients with stage A, 24 per cent with stage B, 53 per cent with stage C and 92 per cent with stage D disease. However, prostate specific antigen levels also were elevated in 9 per cent of the patients with benign prostatic hypertrophy. This lack of specificity in the presence of benign prostatic hypertrophy probably precludes prostate specific antigen from being recommended as a screening test for prostatic cancer. The ultimate role of prostate specific antigen might be as the marker of choice to monitor therapy for prostatic carcinoma.     

Local prostatic hyperthermia in the therapy of urinary obstruction caused by prostatic adenoma. Experimental, clinico histologic and structural findings]

A specifically designed system of selective prostate heating was used to treat 197 patients with prostatic diseases: 164 benign prostatic hypertrophy cases, 14 prostatic adenocarcinoma cases, 19 chronic abacterial prostatitis cases. Ninety-one benign prostatic hypertrophy patients could be evaluated at the three month follow-up date. Sixty-eight patients complained of severe obstructive symptoms and 23 had an indwelling catheter. Prostates were heated up to 42 +/- 0.5 degrees C during 60 minute long sessions, once or twice a week for five weeks. Local prostatic hyperthermia determined a marked amelioration of the clinical picture in 67% of patients who presented without an indwelling catheter. Sixteen patients (70%) were weaned off the catheter. Major complications were not encountered.     

The effect of bromocriptine in benign prostatic hypertrophy and vesicosphincteric dynamics

Four studies were carried out on 66 patients in order to examine the effect of bromocriptine in benign prostatic hypertrophy (BPH) and to clarify its mechanism of action. Two studies were clinical: the first was a double-blind, controlled trial (lasting 6 months) in which bromocriptine 5 mg/day was compared with placebo, and the second was an open study to evaluate the effect of bromocriptine 5 mg on patients with acute retention due to BPH. The other two studies were designed to investigate the action of the drug on vesicosphincteric dynamics. These were double-blind, controlled, parallel trials, one comparing bromocriptine at dosages of 2.5 and 5 mg with placebo 90 min after administration, and the other comparing bromocriptine 5 mg/day with placebo after 15 days' administration in post-prostatectomy patients. Bromocriptine had a favourable effect on patients with BPH but no effect on cases of acute retention. The urodynamic studies suggested that the drug affected urethral sphincteric mechanisms specifically. The weight and volume of the prostate remained unchanged after administration of the drug, so that any clinical response was not due to a direct effect on the gland itself.     

The Effect of Bromocriptine in Begign Prostatic Hypertrophy and Vesicospheincteric Dynamics

Summary— Four studies were carried out on 66 patients in order to examine the effect of bromocriptine in benign prostatic hypertrophy (BPH) and to clarify its mechanism of action. Two studies were clinical: the first was a double-blind, controlled trial (lasting 6 months) in which bromocriptine 5 mg/day was compared with placebo, and the second was an open study to evaluate the effect of bromocriptine 5 mg on patients with acute retention due to BPH. The other two studies were designed to investigate the action of the drug on vesicosphincteric dynamics. These were double-blind, controlled, parallel trials, one comparing bromocriptine at dosages of 2.5 and 5 mg with placebo 90 min after administration, and the other comparing bromocriptine 5 mg/day with placebo after 15 days' administration in post-prostatectomy patients. Bromocriptine had a favorable effect on patients with BPH but no effect on cases of acute retention. The urodynamic studies suggested that the drug affected urethral sphincteric mechanisms specifically. The weight and volume of the prostate remained unchanged after administration of the drug, so that any clinical response was not due to a direct effect on the gland itself.     

Alpha-adrenergic activity and urethral pressure in prostatic zone in benign prostatic hypertrophy

In order to examine to what extent adrenergic mechanism contributes to the urethral pressure in patients with benign prostatic hypertrophy, changes in the intraurethral pressure in the prostatic zone were measured in vivo by both the urethral pressure profile technique and the balloon method before and after administration of alpha-adrenergic stimulants and an alpha-adrenergic blocker. The effect of spinal anesthesia on the urethral pressure was also investigated. It is suggested that 40 per cent of the total urethral pressure in patients with benign prostatic hypertrophy is due to alpha-adrenergic tone, and the remaining 53 per cent is due to static pressure resulting from the hypertrophied prostatic bulk. The in vitro study indicates that the increase in urethral pressure and contraction of the prostate, prostatic capsule and prostatic urethra.     

Interstitial laser coagulation in benign prostatic hyperplasia: A critical evaluation after 2 years of follow-Up.

Since 1993 we have prospectively followed a cumulative cohort of males with benign prostatic hyperplasia and symptomatic bladder outlet obstruction who underwent interstitial laser coagulation (ILC) of the prostate. We evaluated the safety and efficacy of ILC with respect to relief of symptoms and bladder outlet obstruction. In addition to the critical evaluation of our clinical results, the perineal and transurethral approaches were investigated as they may make a substantial impact on the overall success rate, including prostate size, number of sticks per prostate volume and type of application. A total of 59 patients were treated with the Nd-YAG laser (mediLas fibertom) between April 1993 and December 1996. At the time of reevaluation, 47 patients had completed a follow-up of up to 24 months. A perineal approach was used in 34%, transurethral in 23%, and a combined approach in 43% of the patients, depending on the preoperative volume of the prostate. 75% were high-risk patients in accordance with the ASA score (ASA III). The efficacy of treatment was assessed 6, 12, 24 and 52 weeks postoperatively in accordance with the International Prostate Symptom Score (IPS/quality of life), cystomanometric studies, peak urinary flow rate, residual volume and volume reduction of the prostate. Reduction of prostatic volume and sticks used per prostate volume were correlated to the overall success rate. A significant improvement in all voiding parameters (flow rate, residual volume), including the symptom score, was observed. P(det) decreased from an average of 90 cm H(2)O preoperatively to 42 cm H(2)O postoperatively after 24 weeks and the mean reduction in prostate volume was 14 cm(3). Interestingly, it was noted that the overall success rate was not size-related. A distinct positive correlation was found in the number of sticks performed and the improvement in objective and subjective parameters. In view of the low morbidity outcome, especially in high-risk patients, we proclaim Nd-YAG interstitial laser coagulation of the prostate to be an effective and safe alternative method of treatment for symptomatic benign prostatic hyperplasia.     

Bladder neck incision or transurethral electroresection for the treatment of urinary obstruction caused by a small benign prostate? A randomized urodynamic study

Transurethral electroresection of the prostate (TURP) was compared with bladder neck incision (BNI) in the treatment of 24 patients with urinary obstruction caused by a small benign prostate. An evaluation of the urodynamic findings and subjective symptoms was undertaken before the operation and 6 months afterwards. Thirteen patients underwent TURP and 11 BNI. All patients except one in the BNI group subjectively considered the result good. The urodynamic evaluation showed that the detrusor pressure at maximum flow rate decreased more in the TURP group than in the BNI group and the urethral pressure profile was shorter after the operation. The maximum flow rates after the operation were similar in both groups. Retrograde ejaculation developed in 62% of the patients after TURP but none after BNI. BNI is recommended for men under 60 years with minimal prostatic hypertrophy and with an active sexual life.