Incidence of impalpable carcinoma of the prostate and of non-malignant and precarcinomatous lesions in Greek male population: an autopsy study

OBJECTIVE: The present study investigates the incidence of impalpable carcinoma of the prostate and the pathological findings of impalpable prostate carcinoma (PC) detected in autopsy material. The frequency of pre-carcinomatous and non-carcinomatous lesions as well as their relationship to the impalpable PC, were also examined. MATERIALS AND METHODS: Data were obtained from 212 autopsy specimens of the prostate gland, of men aged above 30 and under 98 years of age, born and living in Greece, who died (between 8/2002 and 8/2004), of causes other than carcinoma of the prostate. RESULTS: The age-independent frequency of histological PC in our study's population is 18.8% (ranging from 0% to 56.2% according to different age groups), whereas the age-independent frequency of histological benign prostate hyperplasia is 65.5% (ranging from 27.7% to 90.6%), of atypical adenomatous hyperplasia 15.5% (ranging from 5.5% to 25%), of prostatic intraepithelial neoplasia (PIN) 26.4% (ranging from 5.5% to 47.2%) and of prostate atrophy (PA) 10.3% (ranging from 0% to 43.7%). There was a statistically significant correlation between PIN and PC volume. Most impalpable carcinomas found within necropsy material were characterized by small volume, favorable histological type, and relatively low aggressiveness. The prevalence of PC and pre-carcinomatous lesions in our study population appears to be lower than that of most autopsy studies. CONCLUSIONS: The frequency of clinical PC in a certain population could be related to the frequency and prevalent model of impalpable carcinoma as well as to the frequency of pre-carcinomatous lesions.     

Synchronous pulmonary atypical adenomatous hyperplasia and metastatic osteosarcoma in a young female

A 17-year-old female underwent metastasectomy of three synchronous lesions in the bilateral lungs under the diagnosis of metastatic osteosarcoma, however, one of them was found to be atypical adenomatous hyperplasia (AAH). Since AAH is very rare among young people, a careful evaluation of high-resolution computed tomographic image is important in determining the operative indications and procedures in patients with multiple metastatic tumors.     

AgNOR staining in benign hyperplasia and carcinoma of the prostate.

We have modified existing techniques for silver staining of nucleolar organizer regions of intact interphase cells by hypotonic swelling and by formic acid treatment to reduce background staining. This allowed the microscopic identification and counting of individual AgNORs in the nucleoli. The method was used on nine adenomatous prostatic samples (including one of normal prostate tissue outside a localized tumor) and on seven prostatic adenocarcinomas. In general, the adenomatous samples displayed fewer AgNORs (mean 13 dots/cell) than did the carcinomas (mean 24 dots/cell). Although no cells with very high AgNOR counts were found in specimens from nonmalignant tumors, two of the adenomatous prostates did have AgNOR profiles that to a large extent overlapped with those of carcinomas. A highly differentiated carcinoma (of which only very small amounts were present in the sample) had low AgNOR counts. The three moderately differentiated carcinomas had more silver-positive material than the nonmalignant prostates but less than the three poorly differentiated carcinomas. The latter tumors also had a substantial proportion of cells with greater than 60 AgNOR counts, something that was never seen in carcinomas with higher differentiation. The data indicate that analysis of silver staining-positive material in intact interphase cells may help distinguish between benign and malignant prostatic tumors and between highly malignant and low malignant carcinomas.     

Male breast cancer after finasteride therapy for benign prostate hyperplasia

Finasteride has been used for the treatment of benign prostate hyperplasia (BPH) for years, but some side effects, including male breast cancer (MBC), have been reported. We report a case of breast cancer in a male patient who received finasteride therapy for BPH, and to our knowledge, our report is believed to be the first in Taiwan. The patient was a 59-year-old man who received finasteride therapy for BPH for 4 years. He found a palpable mass in his left breast 2 months prior to diagnosis. Ultrasound-guided core biopsy showed invasive ductal carcinoma. A simple mastectomy was performed followed by chemotherapy with tamoxifen.     

良性前列腺增生症与阴茎勃起功能障碍的相关性研究

目的探讨良性前列腺增生症(BPH)与阴茎勃起功能障碍(ED)的相关性。方法应用勃起功能国际问卷表(IIEF-5)对符合入选条件的BPH患者进行评估,根据IIEF-5评分值表,将BPH患者分为正常、轻、中、重度ED4组,比较4组之间的国际前列腺增生症状评分(IPSS)、最大尿流率Qmax、前列腺体积之间的差异,应用方差分析探讨其内在的联系。结果共收集BPH患者80例,年龄52~91岁,平均71.4岁。其中勃起功能正常者6例,轻、中、重度ED的患者分别为20例、22例、32例,ED的发病率高达93%。4组之间的IPSS分别为:16.67±2.73,21.6±7.89,21±7.40,23.06±6.78,Qmax分别为:12.37±1.50,8.91±7.67,7.60±4.60,8.94±4.63,前列腺体积分别为:34.53±8.06,76.61±27.72,91.93±43.37,71.14±35.98,应用SPSSversion.13.0软件包行方差分析,前列腺体积正常组与轻、中、重3组比较,存在着统计学差异;IPSS评分仅正常组与重度ED组间有统计学差异(P<0.05);而各组间Qmax比较未见统计学差异(P>0.05)。结论BPH患者伴有较高的ED发生率,且ED的程度与下尿路症状的严重程度和前列腺体积有一定的关联。     

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.     

前列腺癌与良性前列腺增生患者血清细胞因子差异的蛋白质组学研究

目的:探讨前列腺癌与BPH患者血清细胞因子的差异,为前列腺癌的早期诊断提供血清蛋白质组学依据。方法:应用细胞因子抗体芯片技术,对12例PSA在灰度范围内、经穿刺活检证实的前列腺癌和BPH患者的血清进行细胞因子芯片检测。结果:筛选出19种有明显差异表达的蛋白质(差异>1.5倍),其中前列腺癌组表达明显上调的有IL-3、IL-6、IL-16等16个细胞因子,表达明显下调的有Fas/TNFRSF6、TRALR-3、IGFBP-6等3个细胞因子。其中多个蛋白与细胞的转录、增殖、信号转导和细胞凋亡等生物过程有关。结论:细胞因子抗体芯片技术能够对较小血清样本同时检测多个指标,能够筛选出与癌细胞生物学行为密切相关的"关键细胞因子",有助于寻找用于前列腺癌早期诊断、判断疗效和预后的分子标志物。     

Evaluation of MENT on primary cell cultures from benign prostatic hyperplasia and prostate carcinoma

7-alpha-Methyl-19-Nortestosterone (MENT) is a synthetic androgen more potent than testosterone (T) and cannot be reduced at 5-alpha position. No important effects of MENT on prostate growth have been reported. However, little is known about the effect of MENT on benign prostatic hyperplasia (BPH) or prostate carcinoma (CaP). We evaluate the effect of MENT, T and dihydrotestosterone (DHT) on secretion, proliferation and gene expression of primary cell cultures from human BPH and CaP. Moreover, the effect of these androgens was examined in the presence of finasteride to determine the influence of the 5-alpha reductase (5-AR) activity on the androgenic potency. BPH and CaP primary cultures were treated with 0, 1, 10 and 100 n m of T, MENT or DHT during 24 and 48 h. Prostate-specific antigen (PSA) was measured by micro particles immunoassay and proliferation rate by spectrophotometric assay (MTT) and by the immunochemical detection of the proliferation marker Ki-67. Gene expression of FGF8b (androgen sensitive gene) was evaluated by semi-quantitative RT-PCR. Results showed that MENT treatments increased PSA secretion and proliferation rate with a potency ranged between T and DHT. Similar effects of MENT were observed in both BPH and CaP cultures. The studies with finasteride showed that in BPH and CaP cells, the conversion of T into DHT significantly contributes to its effect on the proliferation and PSA secretion, and corroborated the resistance of MENT to the 5-AR. The effect of MENT on the gene expression of FGF8b in CaP cells was similar to T and lower than DHT. It is concluded that MENT increases proliferative and secretory activities and gene expression on pathological prostate cells although in less extent than the active metabolite DHT. Furthermore, the fall of endogenous concentration of T during MENT treatment anticipates that this androgen will be of low impact for the prostate.     

剥离式经尿道前列腺切除术与经尿道前列腺电切术治疗良性前列腺增生的比较研究

目的:比较经尿道前列腺电切术(TURP)与使用专用前列腺增生腺体剥离器行剥离式经尿道前列腺切除术(剥离式TURP,TUERP)治疗良性前列腺增生(BPH)的疗效与安全性。方法:BPH患者630例,均具备手术指征,随机分为TURP组(305例)和剥离式TURP组(325例)。术前两组年龄、前列腺体积、国际前列腺症状评分(IPSS)、最大尿流率(Qmax)数值比较,差异无统计学意义(P均0.05)。记录两组手术时间、手术切除率、术后需要持续膀胱冲洗时间、术后生活质量评分(QOL)、手术并发症数据,进行统计学分析。结果:手术后的资料分析显示,TUERP手术切除率优于TURP组的手术切除率[(60.1±12.3)%vs(47.0±13.3)%,P0.05)];TUERP组平均手术时间比TURP组短[(40.4±14.2)min vs(57.9±15.9)min,P0.05];术后冲洗时间较短[(2.2±1.1)d vs(2.7±0.6)d,P0.05]。TUERP组手术前后血清Na+和血红蛋白浓度变化无统计学意义,TURP组血清Na+和血红蛋白浓度变化有统计学意义[血Na+:(141.2±3.5)mmol/L vs(136.9±4.7)mmol/L,P0.01,血红蛋白:(137.6±8.8)g/L vs(124.8±9.6)g/L,P0.01]。术后3个月,两组的IPSS评分、QOL评分、Qmax评分均较术前有显著改善(P均0.01),组间比较无显著性差异。(P0.05)。结论:剥离式TURP治疗BPH和TURP比较,具有手术时间短、手术切除率高、术中出血少、术后恢复快、并发症少等优点,在临床上有良好的应用前景。     

高频能量发生器前列腺电切术治疗良性前列腺增生

目的:探讨高频能量发生器(HFG)前列腺电切术治疗良性前列腺增生(BPH)的临床应用。方法:72例BPH患者根据术式分为2组,36例行HFG前列腺电切术,冲洗液为0.9%生理盐水;36例行经尿道前列腺电切术(TURP),冲洗液为5%葡萄糖溶液。统计每例患者术前术后血红蛋白(Hb),中心静脉压(CVP)的变化及手术时间。术后随访2周、6个月,观察国际前列腺症状评分(IPSS)、最大尿流率(Qmax)和前列腺体积的变化。结果:两组之间CVP、手术时间、术后2周IPSS和Qmax的差异有统计学意义(P0.05)。不同治疗组治疗前后Hb变化、IPSS变化和Qmax变化的差异有统计学意义(P0.05)。结论:HFG前列腺电切术操作简便,其更高的切割效率,使术中基本无出血,采用等渗生理盐水为灌洗液,杜绝了电切综合症(TURS)的发生。HFG前列腺电切术是TURP的改良升级,对于快速解除膀胱出口梗阻、治疗BPH患者安全有效。     

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.     

Effect of bipolar radiofrequency thermotherapy on benign prostate hyperplasia

This study aims to evaluate the safety and efficacy of the new bipolar radiofrequency thermotherapy device (TEMPRO) in treating patients with benign prostate hyperplasia (BPH). Between December 2017 and November 2018, 72 male patients with BPH were included. All patients completed the International Prostate Symptom Score (IPSS) and International Index of Erectile Function-5 (IIEF-5) questionnaires. Physical examinations were performed, and prostate volume, prostatic urethral length and post-voiding residual urine (PVR) were measured using ultrasound. Uroflowmetry was used to calculate the maximum flow rate of urination (Qmax). Bipolar radiofrequency thermotherapy was applied with TEMPRO system containing a 16Fr applicator. All patients were re-evaluated at 6 months post-operatively. The mean age of the patients was 63.22 ± 6.68 years. All patients were treated with local anaesthesia, and three patients were unable to complete the procedure. The median (IQR) visual analogue scale score was 1 (0–3) at 6 hr post-operatively. After 6 months, significant improvements were observed in the IPSS, QoL, Qmax and PVR values of the patients (p < .001 for Qmax, IPSS and QoL; p = .03 for PMR). The success rate of the procedure was similar between patients with prostate volumes <70 and >70 ml. Due to its low rate of complication, the TEMPRO^© treatment is effective in treating BPH, especially among aged patients and those with serious symptoms.     

Oxidative stress in benign prostate hyperplasia

To assess the status of oxidative stress in benign prostate hyperplasia, a very common disease in older men which constitutes a public health problem in Jijel, prostate tissues were obtained by transvesical adenomectomy from 10 men with benign prostate hyperplasia. We measured the cytosolic levels of malondialdehyde (MDA) and glutathione (GSH) and cytosolic enzyme activities of superoxide dismutase, catalase, glutathione peroxidase and glutathione S‐transferase. The development of benign prostate hyperplasia is accompanied by impaired oxidative status by increasing levels of MDA, depletion of GSH concentrations and a decrease in the activity of all the antioxidant enzymes studied. These results have allowed us to understand a part of the aetiology of benign prostate hyperplasia related to oxidative stress.     

Apoptosis and nuclear shapes in benign prostate hyperplasia and prostate adenocarcinoma: comparison with and relation to Gleason score.

PURPOSE: To compare differences in the number of apoptotic bodies and nuclear shapes (size and roundness) between untreated benign prostate hyperplasia (BPH) and untreated advanced prostate adenocarcinoma (PCA) and to elucidate differences in apoptosis number and nuclear shapes with increasing malignant potentiality, by Gleason score, in PCA. METHODS: A retrospective study was conducted on 40 patients with BPH and 12 patients with PCA I (Gleason score 2-4), 14 patients with PCA II (Gleason score 5-7) and 14 patients with PCA III (Gleason score 8-10). The frequency of apoptotic bodies (mean percentage calculated from 200 cells/high-power field over 10 fields) was examined on immunostain. Nuclear shapes were determined by an automatic image analyzer. Over 100 hyperplastic cells or cancer cells were detected by the image analyzer. RESULTS: The mean number of apoptotic bodies in BPH and PCA I were not significantly different, but patients with PCA II and PCA III showed significantly higher numbers of apoptotic bodies than patients with BPH. Patients with PCA III had significantly more apoptotic bodies than patients with PCA I. Benign prostate hyperplasia nuclei had the smallest mean nuclear area and the largest mean nuclear peripheral ellipse among the four groups. The study showed that PCA I, II, III nuclei had significantly larger areas and a less circular shape than nuclei from patients with BPH. Nuclei from patients with PCA I were smaller in size and rounder than nuclei from patients with PCA III. CONCLUSIONS: The present study clearly shows the presence of apoptosis in BPH and PCA and shows an increasing number of apoptotic bodies with higher cellular malignancy. The nuclear shapes in PCA were more irregular and larger in size with increasing cellular malignancy. As expected, nuclei in BPH were smaller in size and rounder than those of cancer nuclei.     

前列腺支架治疗前列腺增生合并神经源性膀胱

目的观察前列腺支架治疗前列腺增生合并神经源性膀胱的疗效。方法对56例62～89岁（平均75岁）前列腺增生合并神经源性膀胱的患者应用前列腺支架治疗，分别于术前、术后进行疗效比较。结果术后有效率达到82％。结论前列腺支架治疗前列腺增生合并神经源性膀胱疗效良好。     

Analysis of the inflammatory network in benign prostate hyperplasia and prostate cancer

INTRODUCTION: The complexity of acute and chronic inflammatory processes may either lead to benign prostate hyperplasia (BPH) and/or prostate cancer. Obviously, various tissue cells are activated by chemokines via different chemotaxin receptors which then trigger subsequent processes in angiogenesis, cellular growth, and extravasation as well as neoplasia. METHODS: Using the surgically obtained tissue of patients (n = 36) with BPH or prostate carcinoma (PCA), we studied among others the expression of chemokines (Rantes, IL-8), chemotaxin receptors (CXCR-3 and -4, CCR-3, CCR-5), of matrixmetalloproteinases (MMP-2 and 9), of Toll-like (TL) receptors 1, 2, 3, 4, 5, 7, and 9 and of the inducible cyclooxygenase-2 (cox-2) by RT-PCR. Further support for the different properties of tissue from PCA was obtained using two different PCA cell lines (PC3 = androgen resistant cell) or LNCAP cells (androgen sensitive) with emphasis on IL-8, Il-6, and PGE(2) release. Cell lines were stimulated with either the tumor necrosis factor-alpha (TNF-alpha) and lipopolysacharide (LPS) over time. In addition to cytokine release, the quantification of mRNA by lightcycler for cox-2, IL-6, and IL-8 was performed on these cell lines. RESULTS: Remarkable differences in expression were obtained by RT-PCR when BPH tissue versus PCA was analyzed. Expression of CXCR-1 after incubation with LPS and TNF-alpha showed time-dependent differences for androgen-sensitive LNCAP as compared to androgen-resistant PC-3 cells. TNF-alpha incubation leads to a time-dependent induction of cox-2 expression unlike to activation with LPS. Differences with regard to cox-2, IL-6, and IL-8 expression were seen by quantitative lightcycler analysis. Significant differences were also observed when TL receptors 4, 5, 7, and 9 were analyzed which were significantly expressed in BPH- as compared to PCA-tissue. CONCLUSIONS: Our data clearly demonstrate that various inflammatory and cell biological cascades are involved which either lead to BPH or can be linked to the development of PCA. The exact cell biological mechanisms may provide novel therapeutic options in the treatment of both diseases.     

An immunohistologic characterization of human prostatic atypical hyperplasia

Summary In an effort to better distinguish the morphologic relationship of atypical hyperplasia of the prostate to benign prostatic hypertrophy and prostatic cancer, 43 prostate specimens were analyzed with ten immunohistologic markers. Two cytokeratin antibodies appeared useful (Cyto M and Cyto P, with the latter slightly more discriminatory). In summary, it appears that atypical hyperplasia is immunohistopathologically related to both benign prostatic hypertrophy and prostatic cancer, having characteristics of both.This research was generously supported in part by the American Cancer Society (RCF-86-117), the AMOCO Foundation, the Blum-Kovler Foundation, The Cancer Federation and the Julius Frankel Foundation     

高危重度前列腺增生症的经尿道汽化电切治疗

目的 探讨高危重度前列腺增生症的术前准备、术中手术技巧、术后处理对提高手术安全性和有效性的重要性。方法 分析经尿道前列腺汽化电切治疗高危重度前列腺增生症(BPH)260例。结果 经个体化准备后,全部病例均顺利承受手术。手术时间平均78min,平均切除组织48g。随访3～24个月,平均IPSS从31降至7.5,Qmax从5.7mL/s上升至18.6mL/s。结论 经尿道汽化电切术是治疗高危重度BPH安全、有效的方法。     

经尿道等离子双极电刀前列腺剜除术治疗良性前列腺增生

目的:探讨经尿道等离子双极电刀前列腺剜除术治疗良性前列腺增生(BPH)的临床应用。方法:选择单纯BPH有手术指征患者90例,年龄59~83岁,平均71岁,随机分为2组,I组(50例)行经尿道前列腺电切术(TURP),Ⅱ组(40例)行经尿道等离子双极电刀前列腺剜除术(PKEP)。统计每例患者术前前列腺体积、国际前列腺症状(IPSS)评分、生活质量指数(QOL)评分和最大尿流率(Qm ax),手术时间,术中术后有无并发症、输血,术后有无膀胱持续冲洗及术后2周、术后6个月IPSS、QOL评分和Qm ax。结果:I组、II组术前前列腺体积平均为58.9、58.3 g;I组、II组手术时间平均为58.8、93.0 m in;I组患者中2例出现轻度电切综合征(TURS),II组患者术中术后心电监护未发现异常;术后行膀胱持续冲洗分别有3例、1例;术后导尿管拔除后出现急迫性尿失禁分别有4例;90例患者术中、术后均无输血。术前、术后2周、术后6个月IPSS评分I组平均分别为19.7分、11.6分、5.1分,II组平均分别为18.6分、8.4分、4.9分;QOL评分I组平均分别为4.6分、3.3分、1.1分,II组平均分别为4.5分、2.7分、1.1分;Qm ax I组平均分别为6.3、13.0、18.1 m l/s,II组平均分别为6.9、14.2、19.0 m l/s。两组间的手术时间、术后2周IPSS、QOL评分,各组内术前与术后6个月IPSS、QOL评分、Qm ax的差异有统计学意义(P<0.01)。两组间术前前列腺体积、术前IPSS、QOL评分和Qm ax、术后6个月IPSS、QOL评分及术后2周、术后6个月Qm ax的差异无统计学意义(P>0.05)。结论:PKEP可安全、有效、彻底治疗BPH,可作为手术治疗BPH的一种选择。     

不同前列腺组织中雄激素受体的表达研究

目的:研究雄激素受体(AR)在正常前列腺、良性前列腺增生(BPH)和前列腺癌(PCa)组织中的表达,探讨AR与BPH和PCa的关系。方法:采用实时定量PCR、免疫荧光和组织蛋白电泳方法,分析15例正常前列腺、20例BPH与40例PCa标本中AR的表达情况。结果:实时定量PCR和组织蛋白电泳检测BPH组织与正常前列腺组织中AR的表达量差异无统计学意义(P>0.05)。但免疫荧光检测发现BPH组织中AR蛋白表达量增高。3种方法检测PCa组织中AR表达量较正常前列腺组织和BPH组织增高(P<0.05)。高分化PCa的AR表达比低分化PCa高(P<0.05)。随着临床分期的增高,AR的表达降低(P<0.05),激素非依赖性前列腺癌(HRPC)组织中AR表达最低。结论:AR在PCa组织中的表达较正常前列腺和BPH组织中增高,AR的表达与PCa的分级、分期相关。