Carcinoembryonic Antigen-Like Substance is a Marker of Prostatic Secretory Function

Specimens of pre- and postpubertal and adult prostatic tissue and seminal vesicles were examined for the presence of carcinoembryonic antigen-like immunoreactivity. A positive immunoreaction of the epithelium of the prostate was observed after the onset of puberty and was comparable to that of secretory acid phosphatase. It was absent from the epithelium of the seminal vesicles. The CEA-like substance of the prostate may therefore be used as a marker of prostatic secretory activity.     

Zinc concentrations and total amount of zinc in seminal plasma of infertile men with special reference to prostatic secretory function

The exact relationship between seminal plasma zinc and fertility is not known. Zinc is secreted mainly by the prostate, and zinc concentration in seminal plasma is regarded as an excellent indicator of prostatic secretory function. However, low zinc concentration may result not only from poor secretory function of the prostate but also from dilution due to excessive secretion of seminal vesicular fluid. This assumption is supported by the present result that zinc concentration was inversely correlated with fructose concentration. Therefore zinc concentration is thought to reflect prostatic function in proportion to seminal vesicular function. Total amount of zinc in seminal plasma seems to be an appropriate indicator for prostatic secretory function. In the present study, concentrations and total amount of zinc were examined in seminal plasma of men with various fertility problems. There were no significant differences between men with normal spermodiagram and those with abnormal spermodiagram, seminal inflammation or varicocele in concentration or total amount of zinc. No changes were observed in any of them after various therapies including oral zinc sulfate. However, the percentage of men with normal spermodiagram was low in the group with extremely low or high zinc concentration and total sperm count tended to increase with increase in total amount of zinc. Furthermore, the spermatozoal motility was better in the prostatic fraction than in the vesicular fraction of split ejaculates, and the percentage of men with decreased motility and normal sperm concentration was significantly high in the group with lower zinc concentration or decreased total amount of zinc. These observations indicate that prostatic secretion has a stimulatory effect on spermatozoal motility. The secretory activities of the prostate and the seminal vesicle are generally known to be closely controlled by androgens, but our findings indicate that the secretory functions of these accessory organs are independent because there was no correlation between total amount of zinc and fructose. Analysis of the relative concentrations in prostatic secretion, split ejaculates, and seminal plasma confirmed an almost exclusively prostatic origin of zinc. As part of the routine andrologic examination, measurement of concentration and total amount of zinc in seminal plasma is useful for evaluating prostatic function, but measurement of acid phosphatase, magnesium, calcium or potassium will provide almost as much information, since they also seem to be secreted primarily by the prostate.     

Microangiographic imaging of the prostate

OBJECTIVE: To present the results of microangiography in visualizing prostatic microvascularization. MATERIALS AND METHODS: A contrast medium was injected into the vessels of prostate specimens obtained during surgery, to fill small vessels; nine specimens were obtained after cystoprostatectomy and two after radical prostatectomy. Branches of prostatic or seminal vesicle arteries were used for the injection, the specimens then fixed in formalin, sectioned and X-rayed. RESULTS: In five samples the quality of the images was sufficient to visualize small arteries; the remaining vessels were partially filled. The vascular map was compared with previous results from historadiographic studies. CONCLUSIONS: Microangiographic imaging of prostate specimens provides a unique view of the angioarchitecture of the prostate and correlates closely with historadiographic studies. The correlation with other imaging methods, e.g. Doppler ultrasonography, needs further evaluation.     

男性盆腔囊性疾病17例诊治分析

目的:探讨男性盆腔囊性疾病的诊断与治疗。方法:回顾性分析我院泌尿外科2003年5月~2013年5月收治的17例男性盆腔囊性疾病患者的临床资料,探讨各疾病发生机制及辅助检查的应用。结果:17例患者中,前列腺囊肿5例(直径3.0cm)、前列腺囊腺瘤2例、精囊囊肿6例、精囊脓肿2例、精囊腺癌1例、前列腺癌(PCa)伴血肿1例;8例行腹腔镜下囊肿切除术,5例行经尿道囊肿去顶术,2例行经腹囊肿切除术,2例行根治性前列腺切除术;术后随访6个月~10年,未见下尿路症状复发。结论:超声是诊断盆腔囊性疾病的重要方法,根据超声结果,适当选取CT、MRI及膀胱镜检查,可以提高诊断的正确率。当囊肿靠近前列腺尿道时,经尿道囊肿切开术疗效确切;对于靠近膀胱颈及位于精囊的囊性肿物,腹腔镜囊肿切除术为首选;当腹腔镜切除盆腔囊性肿物困难时,可行开腹手术。     

Transrectal ultrasonography for prostatic cancer: its value in staging and monitoring the response to radiotherapy and chemotherapy

Current methods to evaluate the size and local extent of prostatic cancer are imprecise. Quantitative assessments of changes after therapy are unreliable. We have used transrectal ultrasonography in 50 patients with clinically localized prostatic cancer to determine the value of this imaging technique in staging the local tumor and in monitoring the response of the tumor to therapy. Transverse images of the prostate were obtained at 5 mm. intervals, and were used to determine the size and shape of the prostate, irregularity or discontinuity of the capsule, extracapsular extension of tumor and invasion into the seminal vesicles. Ultrasonography proved highly accurate in staging. Among 18 previously untreated patients whose tumor appeared to be confined to the prostate by rectal examination 8 (44 per cent) had extension beyond the prostate by ultrasonography, which was confirmed by operative findings. Serial ultrasonograms were performed before and after definitive radiotherapy in 7 patients and chemotherapy in 6 patients. In response to therapy the prostate decreased in size and resumed a more normal, symmetrical shape, the capsule reformed and thickened, the degree of extracapsular extension diminished and the seminal vesicles became normal. Maximal reduction in the size of the prostate usually occurred by 9 months after radiotherapy and by 3 months after chemotherapy. In patients with prostatic cancer transrectal ultrasonography is highly accurate in staging and offers an objective monitor of the response to therapy.     

The role of transrectal ultrasonography in the diagnosis and management of prostatic and seminal vesicle cysts

Cysts in the region of the prostate and seminal vesicles are interesting because of their differential diagnosis and embryological relevance. We present our experience with 5 cases that include a müllerian duct cyst, diverticulum of the spermatic tract, seminal vesicle cyst and 2 prostatic cysts. Transrectal ultrasonography had a significant role in the diagnostic evaluation of these cysts. Ultrasonographically guided transperineal needle aspiration added significant diagnostic information and might have a therapeutic value. After a review of the literature, we propose an algorithm for the evaluation and management of prostatic and seminal vesicle cysts.     

Volume estimation of the seminal vesicles by means of transrectal ultrasonotomography: a preliminary report.

The volume of the seminal vesicles was estimated in 27 cases by means of transrectal ultrasonotomography. The seminal vesicles of normal subjects were found to be generally larger than in cases of prostatic hypertrophy or cancer. The volume of the seminal vesicles in Klinefelter's syndrome was remarkably small. The correlation between the volume of the seminal vesicles and of the prostate is given.     

Prostate antigen: A new potential marker for prostatic cancer

A prostate-specific antigen, distinct from acid phosphatase, was identified by immunologic procedures in prostate tissues (normal, benign hypertrophic, and cancerous) and seminal plasma, as well as in sera of patients with prostatic cancer and of nude mice bearing human prostatic tumor. This antigen was shown by immunoperoxidase staining to be confined to epithelial cells comprising the prostatic ductal elements. Prostate antigen was purified from prostatic tissue and seminal plasma, and it was shown to have a molecular weight of 33,000-34,000 with no subunit component. The isolectric point of purified antigen was around 6.9, though several unpurified isomers with different isoelec-tric points also were observed. Serum-borne prostate antigen showed a molecular weight of 90,000-100,000, but it exhibited a molecular weight of 36,000 in the presence of sodium dodecyl sulfate. A sandwich-type, peroxidase-linked immunosorbent assay capable of detecting 0.1ng of the antigen per milliliter of blood was developed. With this technique, serum level of the antigen was found to increase in patients with prostatic cancer as compared with normal males. The prostate-specific antigen can be a useful marker for detection of prostatic cancer.     

Epidermal growth factor contents in seminal plasma as a marker of prostatic function.

Epidermal growth factor (EGF), first identified in extracts from submaxillary salivary glands of adult male mice, acts as a potent mitogen in a wide variety of cells and tissues in culture. Human EGF, a polypeptide of 53 amino acids isolated from human urine, has been identified in several biological fluids, including prostatic fluid and seminal plasma. Epidermal growth factor content in seminal plasma was measured by RIA. The EGF content in seminal fluid did not change after bilateral vasectomy and the first fraction of sample obtained by split ejaculation contained a significantly larger amount of EGF than the second fraction. Seminal EGF originates from the prostate. There was a close correlation between EGF and zinc contents in seminal fluid. The seminal fluid EGF content was lowered in patients with prostatitis and systemic androgen deficiency. The EGF content in seminal fluid seems to be a reliable indicator of prostatic function.     

Seminal plasma fructose, zinc, magnesium and acid phosphatase in cases of male infertility

Determinations of fructose, zinc, magnesium and acid phosphatase were performed in seminal plasma from male partners in 225 barren couples. No specific changes in the concentrations of these substances could be observed in men showing either visible or palpatory abnormalities of the external genitals, the prostate or of the seminal vesicles, extreme changes in the number, morphology or motility of the sperms, increased sperm antibody titre or abnormal serum levels of testosterone or gonadotrophins. However, when the prostatic fluid contained numerous leukocytes, the concentrations of zinc, magnesium and acid phosphatase were significantly lower than in men having a cytologically normal prostatic fluid. Determinations of these substances may thus be of aid in the diagnosis of chronic prostatovesiculitis.     

A case of malignant lymphoma of the prostate

We report a case of primary malignant lymphoma of the prostate. A 76-year-old man was refer to our clinic with a chief complaint of dysuria. Based on a benign prostatic hypertrophy, transurethral resection of the prostate was performed. Histological findings showed diffuse, large cell type malignant lymphoma. His clinical stage was 1 A prostate (+) according to the Ann Abor classification. The combination chemotherapy with THP-COP was performed for 3 courses, followed by irradiation at 30 Gy. His prostate has showed no recurrence for 10 month after treatment. Primary malignant lymphoma of the prostate is rare. About 30 cases have been reported in the japanese literature. Preoperative diagnosis of malignant lymphoma of the prostate is difficult. All cases have been diagnosed after prostatic surgery or biopsy.     

Volume change of the prostate and seminal vesicles in male hypogonadism after androgen replacement therapy

Before and after androgen replacement therapy prostatic and seminovesicular volume was estimated by means of transrectal ultrasonography in 13 hypogonadal men. Volume of the prostate (p<0.001) and seminal vesicles (p<0.01) significantly increased after treatment with testosterone enanthate. However, the plasma level of testosterone remained abnormally low. These results indicate that volume determination of the prostate and seminal vesicles by means of transrectal ultrasonography is suitable for evaluating the adequacy of androgen replacement therapy in male hypogonadism.     

Implications of amyloidosis on prostatic biopsy

Transrectal ultrasound-guided biopsy of the prostate is an integral step in the investigation of patients at risk of prostate adenocarcinoma. With an increasing number of biopsies being performed, uncommon forms of prostatic pathology will be identified more frequently. Amyloidosis of the prostate and/or the seminal vesicles may be noted on transrectal ultrasound-guided biopsy of the prostate and the implications of this histological diagnosis must be understood. We present our experience of two such cases of amyloidosis and review the literature regarding their management.     

Sonographic and pathological staging of patients with clinically localized prostate cancer

We evaluated 64 patients with clinically localized prostate cancer (on the basis of rectal examination, serum acid phosphatase, bone scan and pelvic computerized tomography scan) by transrectal sonography before radical prostatectomy. Of the 48 patients with histologically proved localized prostate cancer sonography overstaged the disease in 5 (10%) and correctly staged it in 43 (90%). All overstaged cancer patients were scanned after either prostatic biopsy (4) or transurethral prostatectomy (1) established the diagnosis of prostate cancer. Of the 16 patients with histologically proved, locally advanced prostate cancer (that is extracapsular extension and/or seminal vesicle invasion) sonography understaged the disease in 10 (62%) and correctly staged the disease in 6 (38%). These data suggest that sonography is associated with considerable staging errors when used to evaluate men with clinically localized prostate cancer.     

Effect of red maca (Lepidium meyenii) on prostate zinc levels in rats with testosterone-induced prostatic hyperplasia

Lepidium meyenii (maca) is a plant that grows exclusively above 4000 m in the Peruvian central Andes. Red maca (RM) extract significantly reduced prostate size in rats with benign prostatic hyperplasia (BPH) induced by testosterone enanthate (TE). Zinc is an important regulator of prostate function. This study aimed to determine the effect of RM on prostate zinc levels in rats with BPH induced by TE. Also, the study attempted to determine the best marker for the effect of RM on sex accessory glands. Rats treated with RM extract from day 1 to day 14 reversed the effect of TE administration on prostate weight and zinc levels. However, RM administered from day 7 to day 14 did not reduce the effect of TE on all studied variables. Finasteride (FN) reduced prostate, seminal vesicle and preputial gland weights in rats treated with TE. Although RM and FN reduced prostate zinc levels, the greatest effect was observed in TE-treated rats with RM from day 1 to day 14. In addition, prostate weight and zinc levels showed the higher diagnosis values than preputial and seminal vesicle weights. In conclusion, RM administered from day 1 to day 14 reduced prostate size and zinc levels in rats where prostatic hyperplasia was induced with TE. Also, this experimental model could be used as accurately assay to determine the effect of maca obtained under different conditions and/or the effect of different products based on maca.     

Bladder exstrophy-epispadias complex: prostatic evaluation by transrectal ultrasonography

Seven patients with bladder-exstrophy-epispadias complex underwent high resolution prostatic ultrasonography in order to establish the presence and appearance of their prostate gland and seminal vesicles. Six patients had been born with classic bladder exstrophy, and one patient with complete epispadias. The size of the prostate gland was in the normal range in three patients. Three patients had small glands, and in one patient no prostatic tissue could be identified. Two patients showed an unusual position or echoappearance of their glands. The seminal vesicles in five patients were relatively large, contained multiple cystic spaces, and/or extended posteriorly and inferiorly to the prostate gland proper. Our study demonstrates that the prostate gland and seminal vesicles are present in patients with bladder exstrophy. The unusual appearance, position, and size in most patients, however, suggests faulty embryologic development or changes secondary to surgery reflecting the complex nature of the condition. Likewise, the enlarged seminal vesicles may indicate impaired drainage of these structures secondary to the initial bladder closure or subsequent bladder neck reconstruction.     

Sperm motility inhibitor from human seminal plasma: presence of a precursor molecule in seminal vesicle fluid and its molecular processing after ejaculation

Human seminal plasma contains a protein factor that has the capacity to inhibit the movement of demembranated and intact spermatozoa. This factor 'seminal plasma motility inhibitor' (SPMI) has been shown to originate exclusively from the seminal vesicles. The present results demonstrate that the biological activity of SPMI in semen decreases rapidly from 1000 U/d, immediately after ejaculation, to 220 U/ml 2 h later. Immunoblots of seminal plasma proteins probed with an antibody against human SPMI, revealed the rapid processing of a predominant 52 kDa SPMI antigen, present in the seminal vesicle secretions. This precursor was degraded initially into intermediate molecular mass fragments of 25–40 kDa, and subsequently into smaller fragments of 17–21 kDa. When seminal vesicle fluid was mixed with prostatic secretions (3: 1 v/v), proteases present in prostatic secretions were shown to be responsible for processing of the SPMI precursor. Addition of protease inhibitors such as phenylmethylsulphonyl fluoride (PMSF, 5 mM), benzamidine (100 mM) or ethylenediaminetetraacetic acid (EDTA, 5 mM) to the mixture of seminal vesicle and prostate secretions partially prevented the loss of activity of SPMI by 54%, 27% and 9%, respectively. However, the simultaneous addition of PMSF and benzamidine conferred almost total stability to the SPMI precursor activity. These results demonstrate that SPMI exists as a predominant 52 kDa precursor form in the seminal vesicles and is processed rapidly after ejaculation into less active, lower molecular mass forms by one or more serine proteases and/or metallo-proteases of prostatic origin which are present in liquefied semen.     

原发性精囊癌2例诊治分析

目的探讨原发性精囊腺癌的临床表现、影像学特点及诊治方法。方法分析收治的原发性精囊腺癌患者2例,其中1例合并巨大多分隔精囊囊肿,并结合文献进行复习。结果 1例术前行前列腺穿刺活检阴性,行前列腺电切术后病理证实为偶发癌,2个月后二期行开放前列腺癌根治术后确诊为精囊癌;另一例术前经CT及经直肠超声可见盆腔巨大囊性多分隔肿物,未见正常前列腺及精囊结构,代之以多房囊肿,行腹腔镜下盆腔囊肿切除术,术中冰冻病理诊断为精囊癌,转行开放性前列腺根治术。两例术后恢复良好,分别随访10年及7个月,未见复发转移。结论原发性精囊腺癌临床罕见,术前诊断较困难,影像学表现大致可分为3类,手术为主要治疗方式,切除范围应足够广泛。     

Transurethral incision for hematospermia caused by ejaculatory duct obstruction

Hematospermia is supposed to be derived from pathological conditions in the seminal vesicle, prostate, testis, epididymis, or urethra. A recent advance in diagnostic procedures has demonstrated the seminal vesicle, the prostate, and midline cyst as potential sources of hematospermia. The authors describe a case of hematospermia caused by ejaculatory duct obstruction, in which a transurethral technique was successful. A 51-year-old male was referred to the authors' clinic with a chief complaint of hematospermia. Transurethral ultrasonography showed a cystic lesion surrounded with hyperechoic area in the middle of the prostate. Vasography demonstrated the distal dilation of the ejaculatory duct. Magnetic resonance imaging demonstrated a high signal intensity area in the middle of the prostate. Urethrocystoscopy showed an enlarged cystic lesion with an orifice at the prostatic urethra, which was incised endoscopically. There was no complication observed postoperatively. Seven months after the technique, hematospermia resolved completely. A midline cyst should be considered a cause of hematospermia and the incidence of such cysts may be higher than that previously recognized. The transurethral technique is expected to be a successful treatment approach.