Relationship between lower urinary tract symptoms and serum levels of sex hormones in men with symptomatic benign prostatic hyperplasia

Study Type – Aetiology (case series)
Level of Evidence 4

OBJECTIVES

To investigate a possible association between the severity of lower urinary tract symptoms (LUTS) and the serum levels of sex hormones in men with symptomatic benign prostatic hyperplasia (BPH) that underwent surgery for severe benign prostatic obstruction.

PATIENTS AND METHODS

In all, 127 selected men with symptomatic BPH attending our urology clinic were recruited. The clinical conditions of BPH were assessed by digital rectal examination, serum prostate‐specific antigen (PSA) determination, International Prostate Symptom Score (IPSS), transrectal ultrasonography and maximum urinary flow rate (Q_max) value at uroflussimetry. Before surgery, we measured the serum concentrations of total testosterone (TT) and free testosterone (FT), oestradiol, prolactin, luteinizing hormone and follicle‐stimulating hormone. We excluded men with endocrine diseases, those with prostate disease who were receiving antiandrogen therapy and those with psychological diseases. The relationships between the IPSS score and serum sex hormone levels were determined.

RESULTS

The final study population consisted of 122 men (mean age of 70.66 years), as five were excluded (three due to incomplete evaluation and two who were diagnosed with prostate cancer). On statistical analysis, the total IPSS was significantly associated with age (r= 0.405, P < 0.001) and TT (r= 0.298, P= 0.020) but not with FT or the serum levels of the other sex hormones. The serum levels of testosterone and IPSS did not correlate with prostate volume and Q_max. PSA level and age correlated with prostate volume (r= 0.394, P < 0.001; r = 0.374, P < 0.001, respectively). We distinguished two subgroups of patients: the first group of 40 men with an IPSS of <19 and the second group of 82 with an IPSS of >19, and we evaluated the median levels of TT in each group. There was an increased risk of LUTS in men with a greater serum concentration of TT (P= 0.042), although the mean TT level was in the normal range.

CONCLUSIONS

In the present study, the severity of LUTS was associated with age and serum levels of TT but only age correlated with the measures of BPH, especially prostate volume. The potential effects of testosterone on LUTS may well be indirect. Additional large studies are needed to confirm these preliminary results.     

Association between benign prostatic hyperplasia,body mass index,and metabolic syndrome in Chinese men

Previous studies have showed that men suffering from diabetes mellitus, metabolic syndrome (MetS) and obesity have a higher risk of benign prostatic hyperplasia (BPH). The present study aimed to examine the association between BPH, obesity, and features of MetS among men of the Hunan area of China. For this cross-sectional study, 904 males (aged 50–59 years) were included. MetS parameters, International Prostate Symptom Score (IPSS), prostate-specific antigen (PSA) levels, total prostate volume (TPV), postvoid residual volume (PVR) and maximum urine flow rate (Qmax) were measured. Results showed that MetS was associated with TPV (P = 0.048), PVR (P = 0.004) and IPSS (P = 0.011), but not with other indicators of BPH progression such as PSA levels or Qmax. MetS was associated with the voiding symptoms score (P < 0.05), but not with the storage symptom score. In addition, body mass index and fasting blood glucose positively correlated with TPV (r = 0.416, P < 0.001; and r = 0.310, P= 0.011, respectively). In conclusion, results suggest that MetS is associated with higher prostatic volume, prostate symptom score and voiding symptoms, but not with other features of prostatic hyperplasia such as PSA levels or Qmax. Changes in lifestyle factors, including physical activity and prevention of MetS, might be useful to prevent BPH and its progression, but further studies are needed.     

Relationship between age and prostate size

In a community-based study, the relationship between age and human prostate size was investigated in a population of men between the ages of 40 and 70 years to determine the normal prostate increase curve equation. One thousand male volunteers were randomly recruited from the Shanghai community, and the length, width, height, volume of the transition zone (TZ) and the whole prostates were measured by transrectal ultrasound (TRUS). Each volunteer was evaluated by the International Prostate Symptom Score (IPSS). Among those who completed the examination, the mean prostate parameters were all positively associated with increased age. There were statistically significant differences between each age group (P<0.05). The mean transition zone volume (TZV) had a higher increase rate with age than the mean total prostate volume (TPV), indicating that the enlargement of the TZ contributed the most to the increase in TPV. While all prostate parameters were positively correlated with the IPSS, the strongest correlation was associated with the TZ length (TZL) and TZV. The growth curve equations for prostate width, height and length were also positively associated with increasing age.     

前列腺增生症患者C反应蛋白与下尿路症状关系的临床研究

目的探讨前列腺增生患者血C反应蛋白(CRP)与下尿路症状的关系。方法共141例在我院就诊的前列腺增生并有下尿路症状患者,所有患者行IPSS评分、体格检查、最大尿流率测定、尿量、残余尿、前列腺体积、血PSA和CRP测定。计算排尿期评分(IPSS-V)与储尿期评分(IPSS-S)的比值(用IPSS-V/S表示),当IPSS-V/S≥1时给予患者α-受体阻断剂口服,当IPSS-V/S1时给予患者抗毒蕈碱剂口服。比较血CRP水平与各参数之间的关系及服药后各参数的变化。结果所有患者平均血CRP值为(3.43±2.30)mg/L,单因素相关分析提示血CRP与年龄、PSA、排尿量相关,与残余尿、前列腺体积无关,与总IPSS、IPSS-S正相关,与IPSS-V/S负相关。多因素分析血CRP与年龄、总IPSS和IPSS-S相关。IPSS-V/S1患者给予托特罗定治疗3月后血CRP明显下降。结论前列腺增生患者血CRP与储尿期症状及膀胱功能障碍相关,表明慢性炎症是储尿期症状为主的下尿路症状的原因之一。     

BPH合并前列腺炎患者IPSS与IL-8、COX-2水平相关性研究

目的:观察良性前列腺增生(BPH)合并前列腺炎患者国际前列腺症状评分(IPSS)与前列腺按摩液(EPS)和前列腺组织中炎症因子白介素-8(IL-8)、环氧化酶-2(COX-2)水平的相关性。方法:将80例拟行经尿道前列腺电切术(TURP)BPH患者,根据术后病理学诊断分为单纯性增生组(30例)和增生伴炎症组(50例),两组均于术前行IPSS评分、EPS中IL-8、COX-2含量测定,术后前列腺组织中IL-8、COX-2的水平测定,进行统计学分析。结果:增生伴炎症组EPS中IL-8和COX-2水平显著高于单纯性增生组[IL-8:(15.31±1.22)ng/ml vs(5.89±0.91)ng/ml,COX-2:(371.09±14.99)ng/ml vs(156.96±29.47)ng/ml,P均<0.01],前列腺组织中两组IL-8和COX-2水平差异也显著(0.15±0.00 vs 0.05±0.02,0.13±0.01 vs 0.07±0.01,P均<0.01),IPSS两组差异也有显著性[(25.60±5.03)分vs(18.47±4.97)分,P<0.01];单纯增生组中IPSS与EPS和组织中IL-8及COX-2的表达呈中度相关(r=0.712、0.699、0.623、0.731,P均<0.05);增生伴炎症组中IPSS与IL-8、COX-2的表达呈高度相关(r=0.819、0.879、0.798、0.855,P均<0.05)。结论:EPS中IL-8、COX-2水平能间接反映前列腺组织中IL-8、COX-2水平,通过检测患者EPS中IL-8、COX-2水平并结合临床症状可以初步判定BPH患者是否合并前列腺组织学炎症。     

Relationship of serum sex-steroid hormones and prostate volume in African American men

BACKGROUND: Previous epidemiologic investigations of the associations of sex-steroid hormones and benign prostatic hyperplasia (BPH) have focused on predominately white populations. The objective of this study was to evaluate potential associations of body mass index (BMI), cigarette smoking, use of alcohol, and endogenous sex-steroid hormones with prostate volume in a population-based sample of African American (AA) men, ages 40-79 yr. METHODS: A total of 369 AA men without clinical evidence of prostate cancer were identified in the Flint Men's Health Study by using a population-based sampling procedure. All subjects underwent a complete urologic evaluation that included prostate volume determination by transrectal ultrasonography and serum assays for androgens and estrogens. RESULTS: After age adjustment, BMI (weight (kg)/height (m)2) was positively correlated with increasing levels of androstanediol glucuronide (AG), estradiol (E2), estrone sulfate (E1S), and the ratios of E2:total testosterone (TT) and E2:free testosterone (FT); however, increasing BMI was negatively correlated with androstenedione (AD), FT, TT, and sex hormone-binding globulin (SHBG). Multivariable regression models demonstrated that prostate volume increased with age (P < 0.001) and BMI (P = 0.02) and decreased with increasing levels of SHBG (P = 0.01). Larger prostatic volumes were also marginally associated with increasing levels of TT (P = 0.058). CONCLUSION: Circulating serum levels of SHBG and endogenous sex-steroid hormones are correlated with prostate volume and potentially impact the natural history of BPH. However, longitudinal studies are needed to demonstrate the temporal relationships of hormones and growth factors in the pathogenesis of BPH in AA men.     

Correlation between the total volume,transitional zone volume of the prostate,transitional prostate zone index and lower urinary tract symptoms (LUTS)

Objectives Currently available studies show controversial data between the symptoms of the lower urinary tract and the volume of the prostate gland. The objective of the present study is to evaluate the relationship between the score of the lower urinary tract symptoms assessed according to the International Prostate Symptoms Score (IPSS) and the total (TV) and transitional (TZV) zone volume of the prostate and transitional prostate zone index (TZI). Materials and methods From 223 men with a mean age of 59.3 years (varying from 50 to 75), the scores of lower urinary tract symptoms, measured by the IPSS and TV and TZV, determined by transrectal ultrasonographies, were obtained. Furthermore, the TZI was determined in all cases by the TZV to TV rate of the prostate. The relationship between TV, TZV, and TZI and the data obtained using the symptoms score was statistically determined. Results The TV of the prostate were 25.5 ± 10.3, 25.0 ± 9.3, and 28.9 ± 13.5 g in individuals with mild, moderate, and severe symptoms, respectively (P = 0.15). Similarly, there was no significant difference when the TZV (7.6 ± 6.3, 7.6 ± 5.8, and 9.6 ± 6.8 g, respectively; P = 0.22) and the TZI (0.26 ± 0.1, 0.27 ± 0.1, and 0.30 ± 0.1, respectively; P = 0.33) were compared in the groups of men with mild, moderate, and severe symptoms of urinary difficulty. However, the quality of life (QoL) scores presented progressively worse values (1.7 ± 1.3, 3.1 ± 1.4, and 4.4 ± 1.2) as the severity of the lower urinary tract symptoms became worse (P < 0.001). The Pearson correlation coefficient between the TV (r = 0.15; P = 0.02), TZV (r = 0.16; P = 0.02), and the TZI (r = 0.14; P = 0.03) with the prostate symptom scores showed low values although they were positive and statistically significant. The highest correlation was observed when the QoL related to urinary symptoms and symptom scores (r = 0.61; P < 0.001) was analyzed. Conclusions A low correlation was found between the score lower urinary tract symptoms assessed by IPSS and the different volumes of the prostate gland (TV, TZV) and prostate TZI, and, on the other hand, an inverse correlation between the intensity of urinary symptoms and QoL, supporting the idea of multifactorial aspects related to the genesis of urinary symptoms in men.     

Plasma estradiol,free testosterone,sex hormone binding globulin binding capacity,and prolactin in benign prostatic hyperplasia and prostatic cancer

The nature of hormonal changes with age and the possible role of these changes in the development of benign prostatic hyperplasia (BPH) and prostatic cancer (PC) were studied by assaying the plasma levels of total and free testosterone (T), estradiol (E₂), prolactin, and sex hormone binding globulin binding capacity (SHBG) in 20 normal healthy men aged 40-59 years, in 30 patients with BPH aged 63-79 years, and in 30 patients with PC of similar height, weight, and age as the BPH patients. The mean E₂ was highly significantly (P < 0.0005) lower in the PC patients and in the young controls than in the BPH patients. The mean free T was significantly higher in the young controls than in the BPH patients (P < 0.025) and PC patients (P < 0.0005). The PC patients had a slightly lower (P < 0.05) mean free T and mean E₂/free T ratio than the BPH patients. The mean E₂/free T ratio was significantly higher in the BPH patients (P < 0.0005) and in the PC patients (P < 0.0025) than in the young controls. It seems possible that the observed age-dependent significant increase in plasma estrogen concentration in the BPH patients may act as a protective factor against prostatic cancer.     

Serum sex hormones and measures of benign prostatic hyperplasia

BACKGROUND: Despite biologic plausibility, the associations between sex hormones and measures of benign prostatic hyperplasia (BPH) have not been consistently reported. METHODS: Subjects were randomly selected from the Olmsted County, MN population (n, 320; median age, 60.9 years) and followed biennially since 1990. In 2002, surrogate measures of BPH were assessed from an approximation of the American Urological Association Symptom Index (AUASI), Peak urinary flow rates (Q(max)), and a transrectal ultrasound assessment of prostate volume. Serum levels of prostate specific antigen (PSA), testosterone, bioavailable testosterone, and estradiol were also measured. RESULTS: Bioavailable testosterone levels declined with increasing cross-sectional age from 53.8, 50.2, to 41.2 ng/dl (P = 0.001) in men aged <60, 60-69, and >69 years, respectively, and the estradiol/bioavailable testosterone ratio increased from 0.042, 0.044, to 0.050 (P = 0.04). Among men with bioavailable testosterone above the median, estradiol levels had a dose response relationship with prostate size. Among men with bioavailable testosterone level 相似文献   

Influence of hypertension on lower urinary tract symptoms in benign prostatic hyperplasia

AIM: To clarify the influence of hypertension on lower urinary tract symptoms (LUTS) we examined the relationship between blood pressure, LUTS, and the effect of terazosin on LUTS in patients with benign prostatic hyperplasia (BPH). METHODS: The subjects were patients who had LUTS and BPH. They were treated with terazosin (1 mg, twice-a-day) for 12 weeks. Calculation of the International Prostate Symptom Score (IPSS), measurement of blood pressure, and uroflowmetry were performed before and after 12 weeks of therapy. Patients were divided into a normotensive (NT) group and a hypertensive (HT) group at the time of first examination. RESULTS: The IPSS for urinary frequency and nocturia in BPH-HT patients (n = 21; mean age, 71 years) were significantly higher than those in the BPH-NT patients (n = 21; mean age, 69 years) before the administration of terazosin. The total IPSS the BPH-HT patients was also significantly higher than that of the BPH-NT patients. There were no differences of uroflowmetric parameters between the two groups. After 12 weeks of therapy, systolic and diastolic blood pressure decreased in the BPH-HT patients, but not in the BPH-NT patients. However, the systolic pressure of the BPH-HT patients was still significantly higher than that of the BPH-NT patients. The score for each IPSS parameter decreased in both groups, but the difference of the score between the two groups increased. CONCLUSION: Hypertension may worsen LUTS and may decrease the improvement of symptoms by terazosin.     

Value of the Danish prostate symptom score compared to the AUA symptom score and pressure/flow studies in the preoperative evaluation of men with symptomatic benign prostatic hyperplasia

The Danish Prostate Symptom Score (DAN-PSS) is a new questionnaire for the assessment of lower tract urinary symptoms (LUTS), which claims to be able to predict bladder outlet obstruction. We evaluated the ability of the DAN-PSS to assess LUTS, to predict obstruction, and to predict treatment outcome in men with symptomatic uncomplicated BPH. Twenty-five consecutive men with symptomatic uncomplicated BPH filled in the AUA symptom score and the DAN-PSS and underwent uroflowmetry and pressure-flow studies prior to transurethral prostatic resection (TURP). Patients were reevaluated 4 days and 8 months after surgery. AUA score and DAN-PSS both assessed LUTS and were sensitive to symptom changes after therapy. Compared to pressure/flow studies, neither score correlated with bladder outlet obstruction. Peak urinary flow, however, correlated significantly with obstruction. None of the diagnostic tools used was able to improve patient selection for surgical treatment. The DAN-PSS is a valid and sensitive questionnaire for the assessment of LUTS. It is not able, however, to predict bladder outlet obstruction. In men with uncomplicated BPH, urodynamic evaluation of bladder outlet obstruction did not improve the subjective outcome of TURP. Neurourol. Urodynam. 16:9–18, 1998. © 1998 Wiley-Liss, Inc.     

Comparison of the pre-treatment testosterone levels in benign prostatic hyperplasia and prostate cancer patients

Objectives

To compare serum testosterone and prostate specific antigen (PSA) levels of patients diagnosed of prostate cancer to those with benign prostatic hyperplasia (BPH).

Doxazosin gastrointestinal therapeutic system versus tamsulosin for the treatment of benign prostatic hyperplasia: A study in Chinese patients

AIM: The efficacy and safety profiles of two alpha1-adrenoceptor antagonists, doxazosin gastrointestinal therapeutic system, a controlled-release formulation of doxazosin, and tamsulosin, were compared in Chinese men with confirmed benign prostatic hyperplasia. METHODS: After a 2-week placebo run-in phase, 117 patients were randomized to daily treatment with doxazosin gastrointestinal therapeutic system (4 mg doxazosin) (n = 60) or 0.2 mg tamsulosin (n = 57) for 6 weeks with no titration of study medications. Efficacy was measured by the International Prostate Symptom Score, maximum urinary flow rate, postvoid residual urine volume, and quality-of-life score from the International Prostate Symptom Score. Adverse events were recorded. RESULTS: Both drugs significantly improved the International Prostate Symptom Score (total, irritative subscore and obstructive subscore) and maximum urinary flow rate. Doxazosin gastrointestinal therapeutic system reduced postvoid residual urine volume significantly more than tamsulosin (-25 +/- 5 mL vs 2 +/- 5 mL, P = 0.041) in patients with residual volume >0 mL at baseline. Other differences between groups were not statistically significant. CONCLUSIONS: The doxazosin gastrointestinal therapeutic system and tamsulosin were effective and well tolerated for the treatment of benign prostatic hyperplasia in Chinese men.     

Relationship between serum prostate specific antigen and histological prostatitis in patients with benign prostatic hyperplasia

The relationship between the serum values of prostate specific antigen (PSA) and the extent of histological prostatitis was investigated in 42 patients undergoing transurethral resection of the prostate for benign hyperplasia (BPH) without clinical evidence of prostatitis. Histological prostatitis was divided into three groups: acute, chronic-active, and chronic-inactive inflammation. The extent of histological prostatitis was expressed as the number of prostatic acinar and ductal glands with inflammatory infiltrate per total number of glands (%). The serum PSA values significantly correlated with the extent of acute and chronic-active prostatitis (correlation coefficient r = 0.765 and 0.656, P < 0.01). A relationship between PSA values and the extent of chronic-inactive prostatitis was not found. In the immunohistochemical study, prostatic epithelial cells with acute and chronic-active inflammation showed negative staining for PSA antigen. These results indicate that histological acute and chronic-active prostatitis is considered an important factor for inducing the high increase in serum PSA values via the leak phenomenon. © 1994 Wiley-Liss, Inc.     

Usefulness of tamsulosin hydrochloride and naftopidil in patients with urinary disturbances caused by benign prostatic hyperplasia: A comparative, randomized, two-drug crossover study

BACKGROUND: The aim of the study presented here was to stratify drug therapy for patients with benign prostatic hyperplasia (BPH) displaying various voiding symptoms. METHODS: Two different alpha1-adrenoceptor antagonists; tamsulosin hydrochloride (Tam) and naftopidil (Naf ), were administered to 96 patients with BPH for 8 weeks in a crossover study. RESULTS: With the administration of both drugs, the International Prostate Symptom Score (I-PSS) significantly decreased and the maximum urinary flow significantly increased. Whereas Naf monotherapy decreased the I-PSS for storage symptoms, Tam monotherapy decreased the I-PSS for voiding symptoms. In both the Naf-to-Tam and Tam-to-Naf groups, crossover was effective when the initial drug was judged subjectively and objectively to have been ineffective. Compliance was acceptable with both drugs. CONCLUSION: Our results show that either Naf or Tam can be used to treat patients on the basis of objective and subjective assessment of voiding symptoms. Our findings should be helpful for patient guidance and treatment of BPH.     

经尿道前列腺切除术与开放手术治疗良性前列腺增生症的远期疗效

目的评价开放手术（OP）、经尿道前列腺切除术（TURP）不同手术方式的远期疗效,为临床治疗方案的选择提供依据。方法采用前瞻性队列研究,将入组的良性前列腺增生症（BPH）患者随机采用不同手术方式进行治疗,并分别在手术前、手术后3个月、6个月、12个月进行随访观察。采用国际前列腺症状评分（IPSS）、良性前列腺增生症患者的生活质量专用量表（BPHQLS）评价不同时间各组患者的IPSS、生活质量状况。结果两组IPSS得分呈现曲线下降趋势、生活质量得分呈现曲线上升趋势。OP、TURP组在手术后3、6、12个月时下尿路症状无差别（P〉0.05）;术后3个月、12个月时生活质量OP组（278.95±19.68,291.91±59.14）高于TURP组（252.59±18.85,253.49±29.52）（P〈0.05）。结论 OP在提高患者的远期生活质量方面优于TURP。     

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.     

Treatment outcomes of benign prostate hyperplasia by thulium vapoenucleation of the prostate in aging men

PurposeTo analyze the outcomes of thulium vapoenucleation of the prostate (ThuVEP) in the management of benign prostatic hyperplasia. The outcomes of this increasingly popular procedure are yet to be confirmed in patients with various prostate sizes and health status.Materials and methodsThree hundred and three patients who underwent ThuVEP were included and stratified in subgroups according to prostate size and age. We analyzed patient demographics, preoperative disease-related parameters, and perioperative and follow-up results. Correlation of prostate size and operation time were also assessed.ResultsBaseline mean prostate volume was 61.0 mL (range 19.3–226 mL), mean urinary peak flow rate (Qmax) was 8.6 mL/second (range 1.4–23.25 mL/second), mean postvoid residual volume was 126.2 mL (range 0–649 mL) and mean International Prostate Symptom Score was 25.1 (range 8–35). The mean operation time was 84.0 minutes and 88.6 minutes for total and prostate volume >80 mL, respectively. After laser surgery, there were mean reductions of 5.3 ng/mL, 7.5 ng/mL, 3.7 ng/mL, and 3.5 ng/mL (38.0%, 49.7%, 30.3%, and 36.5% change from baseline) in prostate-specific antigen level among the four groups. As for postvoid residual volume, there was a significant reduction in volume in the total, prostate volume >80 mL and prostate volume <80 mL (−73.9 mL, −70.8 mL, and −67 mL, respectively) but not in the elderly group (−31.4 mL, p = 0.068). Similarly, Qmax improved significantly in all (6.7 mL/second, 5.9 mL/second, and 6.0 mL/second, respectively) except the elderly group (2.3 mL/second, p = 0.103). The operation time was highly correlated with the prostate size.ConclusionThis study indicates that ThuVEP is an effective treatment option for benign prostatic obstruction in patients with different prostate size and age. The technique allows an efficient surgical course with operation time highly correlated with prostate size.