|
Comparison of androgen-independent growth and
androgen-dependent growth in BPH and cancer tissue from the
same radical prostatectomies in sponge-gel matrix
histoculture.
Geller J; Partido C; Sionit L; Youngkin T; Nachtsheim D;
Espanol M; Tan Y; Hoffman R
Department of Medical Education, Mercy Hospital and Medical
Center, San Diego, CA 92103-2180, USA.
Prostate (United States) Jun 1 1997, 31 (4)
p250-4
BACKGROUND: In order to determine androgen sensitivities of
prostate cancer and benign prostatic hypertrophy (BPH) tissues
from the same patient in vitro, we used a histoculture
technique to measure androgen-independent and
androgen-dependent growth and compared them in paired
specimens of BPH and prostate cancer from 23 radical
prostatectomies. Both androgen-independent growth and
androgen-dependent growth are measures of important biological
characteristics of benign and malignant prostate tissue.
METHODS: The effect of hydroxyflutamide and antiandrogens
on dihydrotestosterone (DHT)-stimulated incorporation of
3H-thymidine into both paired specimens of BPH and cancer was
utilized to measure androgen-independent and
androgen-dependent growth. The percentage decrease in
3H-thymidine incorporation/microgram protein in the
flutamide-treated specimen compared to the DHT-treated
specimen represented androgen-dependent growth. Residual
3H-thymidine incorporation/microgram protein during
hydroxyflutamide administration represented
androgen-independent growth.
RESULTS: Androgen-independent growth was significantly
greater (P = 0.015) in the BPH compared to the cancer paired
tissue. Androgen-dependent growth was significantly higher in
23 paired specimens of cancer compared to BPH (P <
0.03).
CONCLUSIONS: In paired specimens of BPH and prostate cancer
from the same radical prostatectomy specimen,
androgen-independent growth appeared greater in BPH compared
to cancer specimens; androgen-dependent growth, however, was
greater in prostate cancer than in BPH. There was no
correlation of either growth parameter with Gleason tumor
grade. Future clinical correlations will indicate whether
either growth parameter represents an important prognostic
factor for prostate cancer aggressiveness stimulated
3H-thymidine incorporation into DNA.
Alpha-1 adrenoceptor subtypes (high, low) in human
benign prostatic hypertrophy tissue according to the
affinities for prazosin.
Takeda M; Hatano A; Komeyama T; Koizumi T; Mizusawa T; Kanai
T; Tomita Y; Maruyama K; Nagatomo T
Department of Urology, Niigata University, School of
Medicine, Japan.
Prostate (United States) Jun 1 1997, 31 (4)
p216-22
BACKGROUND: A novel classification of alpha-1 adrenoceptor
subtypes (High, Low) was applied to human benign prostatic
hypertrophy (BPH) tissue.
METHODS: Human BPH specimens were examined by a radioligand
binding assay method using 3H-prazosin, and those data were
compared with preoperative therapies.
RESULTS: (1) Scatchard analysis showed a high-affinity site
(Kd:27.18 +/- 6.41 pM; Bmax:9.29 +/- 0.98 fM/mg protein; mean
+/- SE) as alpha 1H, and a low-affinity site (Kd: 4088.0 +/-
744.34 pM, Bmax: 140.81 +/- 19.98 fM/mg protein) as alpha 1L
subtype, for prazosin. (2) The Kd and Bmax were not different
in the nontreated group (n = 5), alpha 1 blocker group (n =
5), and antiandrogen group (n = 5), in either alpha 1-high
affinity or alpha 1-low affinity subtype. (3) Phenoxybenzamine
had different pKi values for the above two adrenoceptor
subtypes. Scatchard analysis showed that alpha 1-high affinity
binding site disappeared in the presence of 1 microM of
phenoxybenzamine, and the Kd and Bmax values in the presence
of 1 microM of phenoxybenzamine were almost identical to the
alpha 1-low affinity site of the two subtypes.
CONCLUSIONS: Human BPH tissue possesses both alpha 1H- and
alpha 1L-adrenoceptor subtypes according to the affinities for
prazosin, and only the alpha 1H subtype can be completely
inhibited by some concentration of phenoxybenzamine. Treatment
by alpha 1 blocker may not change the conditions of alpha
1-adrenoceptors in prostatic tissue.
[Urethral opening pressure: its clinical
significance in prostatic obstruction]
Ameda K; Kobayashi S; Matsuura S; Sasaki Y; Shibata T;
Koyanagi T
Department of Urology, Hokkaido University School of
Medicine.
Nippon Hinyokika Gakkai Zasshi (Japan) Apr 1997, 88 (4)
p496-502
BACKGROUND: In the evaluation of prostatic obstruction by
using the pressure-flow study (PFS), we defined intravesical
pressure at initiation of voiding as urethral opening
pressure. This simple parameter could reflect the degree of
compressive prostatic obstruction to some extent. The aim of
this study is to analyze if a correlation exsists between
clinical signs and urethral opening pressure, and if they bear
any prognostic value in postoperative outcome of the
patients.
METHODS: We analyzed 46 patients with clinical benign
prostatic hypertrophy who underwent urodynamic evaluations
including PFS. They were divided into 2 groups according to
their urethral opening pressure. The high opening pressure was
defined as greater than 70 cm water, which was noted in 24
patients (group A). Twenty-two patients had lower opening
pressure (group B). Comparison of the clinical findings in
these patients were reviewed. Medium-filling cystometry and
PFS were performed transurethrally, by using a microtip
transducer and rectal balloon. Cystoscopy was performed when
possible, wherein we could examined the presence or absence of
detrusor trabeculation. Transurethral prostatectomy was
indicated in a total of 26 patients (16 in group A and 10 in
group B), in whom postoperative clinical findings were
analyzed with regard to the difference in preoperative
urethral opening pressure. The patients who void with
straining or who void following uninhibited detrusor
contraction were excluded from this study.
RESULTS: International Prostatic Symptoms Score (I-PSS)
revealed no significant difference in both groups, however,
patients in group A were often suffering from urge
incontinence preoperatively. Significant correlation was found
among the incidence of detrusor instability, detrusor
trabeculation and increased opening pressure. In PFS the
patients with high opening pressure tended to have higher
detrusor pressure at maximum flow and greater contractile
power of the detrusor in voiding. There were no difference in
Qmax and residual volume both groups. Postoperatively,
symptomatic improvement was significant in both groups. There
was no statistical difference in postoperative I-PSS between
group A and B. Although 6 patients in group A demonstrated
poor urinary control at 1 month, only two patients remained
incontinent at 6 months postoperatively. As to urodynamic
findings, the difference in PFS were markedly reduced between
both groups. No difference was noted in postoperative Qmax as
well.
CONCLUSION: Significant difference was found in
preoperative objective findings except the flow rate between
the patients with and without high urethral opening pressure,
while no symptomatic difference was noted except urege
incontinence in both groups. No prognostic value was
demonstrated in urethral opening pressure, however, poor
postoperative urinary control was often associated with
initial high opening pressure in the short term. It was
suggested that 1) compensatory detrusor hyperactivity improved
voiding efficacy in the patients with prostatic obstruction,
which was gradually normalized after the relief of
obstruction, 2) symptomatic improvement was highly related to
the relative improvement of the obstructive findings on
PFS.
Free and total serum PSA values in patients with
prostatic intraepithelial neoplasia (PIN), prostate cancer and
BPH. Is F/T PSA a potential probe for dormant and manifest
cancer?
Tarle M; Kraljic I
Department of Oncology and Nuclear Medicine University
Hospital Sestre Milosrdnice, Zagreb, Croatia.
Anticancer Res (Greece) May-Jun 1997, 17 (3A)
p1531-4
Free and total PSA serum concentrations were
retrospectively measured in 106 subjects: 45 patients with
intraepithelial prostatic neoplasia (PIN), 30 subjects with
benign prostatic hypertrophy (BPH) and 31 subjects with
untreated prostatic carcinoma. The (F/T) x 100 PSA value is
recorded in subjects with the elevated total PSA level (> 4
ng/ml). PIN patients were divided into two groups: a low grade
PIN (PIN 1) and high grade PIN (PIN II-III) patients. The mean
(F/T) x 100 PSA value in low grade PIN patients was 27.9 +/-
16.2 (range 17.1-41.2, median 25.1) and has been numerically
similar to the respective value in BPH subjects (29.1 +/-
13.2, 15.8-48.0, 27.7). These parameters differed markedly (P
< 0.01) from the mean (F/T) x 100 PSA value in high grade
PIN patients (16.9 +/- 9.0, range 9.9-24.9, median 16.5). The
later values were in turn comparable (P > > 0.05) with
the respective value measured in untreated prostate cancer
patients (14.4 +/- 10.8, 6.6-21.4, 12.6). Hence, values
derived from the measurement of free and total serum PSA level
may distinguish low grade PIN that prevailingly remains latent
disease from high grade PIN that is in most cases not only
early prostatic carcinoma but that is often a precursor of an
aggressive neoplasm. The published literature is incoherent
regarding the influence of tumor spread on F/T PSA level. The
cutoff point that divides BPH from cancer may depend on tumor
stage. We have not investigated F/T PSA values related to
different stages and grades of prostate cancer. The cutoff
point of (F/T) x 100 PSA in our study that divides malignant
from benign prostate, or latent from manifest cancer, was
tentatively assigned as 18 with a specificity of 91% and
selectivity of 69%. Our data are based on the application of
the CIS assay that, according to the literature, gives higher
F-PSA % compared to other respective kits.
Optimising the medical management of benign
prostatic hyperplasia.
McDermott T
Department of Urology, Meath Hospital, Dublin, Eire.
Br J Clin Pract (England) Mar 1997, 51 (2)
p116-8
The ageing population is presenting an increasing demand on
future healthcare services. In males, prostatic disease is one
of the commonest disorders contributing to this. Alternatives
to surgical intervention have to be considered as the
preferred option for individuals and whether this be a
therapeutic or a financial option to be taken. Two major
medical alternatives are alpha-blockers and 5-alpha reductase
inhibitors. The results of such treatment can be very
beneficial in selected groups of patients. Side-effects with
improved drugs electivity are reducing. Overall, while surgery
still holds the gold standard, medical therapy has a
significant role in the treatment of benign prostatic
hypertrophy. Cost analysis may be a factor in deciding which
treatment to have.
[Inferior vena cava obstruction syndrome caused by
urinary retention]
Arruti A; Plazaola I; Mata J; Amato E
Arch Esp Urol (Spain) Jan-Feb 1997, 50 (1) p61-2
OBJECTIVE: To report an unusual case of inferior vena cava
obstruction secondary to urinary retention.
METHODS/RESULTS: A 72-year-old male patient with a history
of bilateral inguinal hernia and a recent hip surgery,
presented with deep venous thrombosis in the left leg. A CT
scan disclosed significant thickening of the bladder wall and
grade III-IV hypertrophy of the prostate. Abdominal ultrasound
disclosed a cystic mass compressing the vena cava and moderate
ureterohydronephrosis. Edema spontaneously resolved following
insertion of a urethral catheter and renal function returned
to normal.
CONCLUSION: Obstruction of the inferior vena cava secondary
to an enlarged bladder is rare. To our knowledge only two such
cases have been reported in the literature. In the case
described herein, urinary retention may have been exacerbated
by prostatic hypertrophy, anesthesia and bed confinement due
to hip surgery.
[Diagnostic efficacy of free PSA/total PSA ratio in
the diagnosis of prostatic carcinoma]
Minardi D; Recchioni A; Baldassari M; Governatori D;
Giammarco L; De Sio G; Muzzonigro G; Polito M
Clinica Urologica, Universita degli Studi, Ancona.
Arch Ital Urol Androl (Italy) Feb 1997, 69 Suppl 1
p93-5
Prostate specific antigen, specific organ and tissue
marker, is a glycoprotein present in serum in different
molecular forms, i.e. not protein bound and bound to proteins
(PSA-ACT and PSA-AMG). The total PSA is expressed by the sum
of the non protein bound value (free-PSA) and PSA-ACT. The aim
of our study was to evaluate the hypothesis that measurement
of free/total PSA ratio may be helpful in the differential
diagnosis of prostatic pathology. Our study was conducted on
350 patients, to whom the total-PSA, free-PSA and f/t PSA had
been performed; 250 patients showed a total PSA between 2.5
and 10 ng/ml and 185 of them had symptoms of bladder out-flow
obstruction. In all of the 250 patients digital rectal
examination, transrectal ultrasound and prostatic biopsy were
performed. 100 patients were controls. The cut-off to
differentiate between benign and malignant prostatic disease
was 16%. The pathologic diagnosis was related to the f/t PSA
ratio, and in particular those patients with a f/t PSA lower
than 16% were expected to be prostatic carcinoma, while those
with a f/t PSA higher than 16% were expected to be benign
prostatic hypertrophy. The diagnostic accuracy of the ratio
was calculated, and it was observed that it was 88.65% in the
diagnosis of benign prostatic hypertrophy, while in the
diagnosis of prostatic carcinoma it was 84.5%. We can
therefore assume that f/t PSA can add useful information on
prostatic pathology, eventually sparing unnecessary prostatic
biopsies.
[Laser-assisted endoscopic resection: a new
surgical technique for the treatment of benign prostatic
hypertrophy. Preliminary results of a study involving 100
patients]
Albert P; Bretheau D; Taverna GL; Aimino R; Morin N; Salvo
A
Reparto di Urologia, Fondazione S. Joseph, Marsiglia,
Francia.
Arch Ital Urol Androl (Italy) Feb 1997, 69 (1)
p15-21
This study was designed to assess the efficiency of 2 kind
of laser prostatectomy devices in the treatment of Benign
Prostatic Hyperplasia: a non contact technique versus a
contact technique versus a contact one. From January 1994 to
September 1994, 100 patients were included in a randomized
comparison of 2 laser prostatectomy devices with right angle
firing laser fibers: a non contact technique with Urolase
fiber (Bard) (50 patients) versus a contact technique with
Fibertom fiber (Dornier) (50 patients). The Urolase fiber was
used at 60 Watts power setting for 60 seconds and administered
to each lobe at 2, 4, 8 and 10 o'clock positions. The Fibertom
fiber was used by dragging or the so called "painting"
technique at 3 and 6 months with 3 parameters: Madsen symptom
scores, peak urinary flow rates and post-void residual urine
volumes. Operative morbidity rate was 9%. No difference in
morbidity between both fibers. No blood transfusion was
required in any case. Statistical analysis of the
aforementioned parameters shows a p-value of < 0.001 for
all parameters. Comparing the 2 different fibers, there was no
statistical difference in outcome for any of these parameters.
From this study we conclude that the preliminary results
achieved, using the Urolase and the Fibertom fiber, are
equivocal and interesting. However, a long term follow-up is
necessary to evaluate the definitive efficiency of laser
prostatectomy and to determine the optimal procedure.
Blood haemoglobin and the long-term incidence of
acute myocardial infarction after transurethral resection of
the prostate.
Hahn RG; Nilsson A; Farahmand BY; Persson PG
Department of Anaesthesia, South Hospital, Stockholm,
Sweden.
Eur Urol (Switzerland) 1997, 31 (2) p199-203
OBJECTIVES: To study risk factors for acute myocardial
infarction (AMI) in men suffering from benign prostatic
hypertrophy.
METHODS: We followed 811 patients who underwent
transurethral resection of the prostate (TURP) between 1983
and 1992 until the end of 1993 with regard to the incidence of
AMI. The association between AMI and various potential risk
factors was evaluated by epidemiological methods.
RESULTS: Fifty-two patients developed a first-time AMI
after TURP. A pre-operative blood haemoglobin concentration in
the range of 100-129 g/l (normal range 130-165 g/l) was
associated with an increased long-term relative risk of a
first-time AMI, which was estimated to be 2.0 (95% confidence
interval = 1.0-4.1). This estimate became slightly stronger
when we also included the 76 patients with a first AMI before
surgery, 10 of whom developed a re-infarction after TURP.
Furthermore, it was largely unchanged on adjusting for
impaired health status and age > or = 75 years (patient
factors) and for fluid absorption > or = 500 ml and a blood
loss > or = 275 ml (operative factors), which had been
reported to increase the long-term risk of AMI in a previous
study.
CONCLUSION: A moderately reduced blood haemoglobin level
before TURP is associated with a doubled risk of developing
AMI in later life.
Insulin-like growth factor-binding protein-2 in
patients with prostate carcinoma and benign prostatic
hyperplasia.
Ho PJ; Baxter RC
Kolling Institute of Medical Research, Royal North Shore
Hospital, St. Leonards, NSW, Australia.
Clin Endocrinol (Oxf) (England) Feb 1997, 46 (2)
p145-54
OBJECTIVE: Insulin-like growth factor-binding protein
(IGFBP)-2 is a major prostatic IGFBP and may be involved in
regulating prostate growth. Patients with prostate carcinoma
(PC) have elevated serum IGFBP-2 levels which correlate with
the specific PC marker, prostate-specific antigen (PSA). The
aims of this study were to investigate whether elevated serum
IGFBP-2 is unique to PC or also occurs in benign prostatic
hyperplasia (BPH), to examine the relations among age, PSA and
IGFBP-2 levels, and to examine longitudinal changes in serum
IGFBP-2 with PSA in prostate carcinoma.
DESIGN AND PATIENTS: Sixteen patients (61-83 years) with
inoperable PC attending the oncology unit at a tertiary
referral hospital were studied. Some serum samples were
obtained retrospectively while the majority were collected
prospectively over 13 months of treatment. The patients with
PC were compared to 8 patients (66-73 years) with
histologically proven BPH and 7 male control subjects (61-82
years) with no known prostate abnormality.
MEASUREMENTS: A new IGFBP-2 RIA was developed. Serum PSA
(by EIA), and IGFBP-2, IGFBP-3, IGF-I and IGF-II (by RIA) were
measured in all subjects, and serially in patients with
PC.
RESULTS: Serum IGFBP-2 was significantly higher in PC with
high PSA (560 +/- 66 micrograms/l, n = 12) than PC with normal
PSA (292 +/- 65 micrograms/l, n = 4, P = 0.02), BPH (364 +/-
61 micrograms/l, P = 0.03) and controls (367 +/- 44
micrograms/l, P = 0.04). Mean IGFBP-2 in BPH was not different
from controls. IGFBP-2 and PSA were significantly correlated
with age (r = 0.543 and r = 0.433 respectively) and with each
other even when the age effect was removed. Serum IGFBP-2 and
PSA levels changed concordantly in all 7 PC patients who had
serial sampling. Serum IGF-II but not IGF-I or IGFBP-3 was
higher in PC and BPH than in controls (PC 332 +/- 23
micrograms/l), BPH 359 +/- 26 micrograms/l vs controls 241 +/-
37 micrograms/l; P = 0.03 and 0.02 respectively).
CONCLUSIONS: Serum IGFBP-2 levels are uniquely elevated in
active prostate carcinoma but not in benign prostatic
hypertrophy. In PC, serum IGFBP-2 levels closely parallel
those of PSA and probably reflect tumour burden. The relation
between PSA and IGFBP-2 is partially independent of their
individual relations with age. Although serum IGFBP-2 is less
sensitive than PSA in PC, it may have adjunctive value in the
management of prostate carcinoma.
[Ureteral jet in patients with benign prostatic
hypertrophy: prognostic evaluation during single and combined
therapy]
Sperandeo M; Sperandeo G; Carella M; Bianco G; Cera A;
Scarale MG; Viola M
Divisione di Medicina Interna, IRCCS-Casa Sollievo della
Sofferenza, San Giovanni Rotondo, FG.
Arch Ital Urol Androl (Italy) Dec 1996, 68 (5 Suppl)
p175-8
By color-Doppler ultrasound it's possible to visualize
urine flow jet from ureter into the bladder. Aim of the study
was to evaluate of ureteral jet in patients with benign
prostatic hyperplasia before, during and after with one or two
drugs medical therapy. Thirteen patients, aged 51-63 years,
were studied; they were not affected by metabolic, hepatic,
renal diseases and by prostate inflammation. Eco color Doppler
p.w. (Toshiba SSA 270A) with a convex probe of 3.5 MHz was
used. A transabdominal ultrasound study was performed,
prostate volume measured and ureteral jet visualized before
and along treatment (at six months interval) with Finasteride
and at the end of treatment. Successively, in four patients,
with relapse of prostatic synptomatology, a transabdominal
ultrasound study was performed, before and along a treatment
with Finasteride, 5 mg/die (Finastid, Neopharmed) and
Terazosin hydrochloride, 5 mg/die (Teraprost, Malesci), and at
the end of treatment.
[Laser treatment of benign prostatic hypertrophy:
the correlation of histologic results to nuclear magnetic
resonance imaging]
Sulser T; Jochum W; Huch Boni RA; Briner J; Krestin GP; Hauri
D
Urologische Klinik and Poliklinik, Universitatsspital
Zurich.
Ann Urol (Paris) (France) 1997, 31 (1) p19-26
Minimally invasive treatments for benign prostatic
hyperplasia (BPH) are currently very controversial. Nd:YAG
laser transurethral thermocoagulation of the prostate is the
technique most frequently used. The objective of this study
was to assess the correlation between the morphological
effects observed and the changes visible on magnetic resonance
imaging during this type or treatment in the human prostate,
in order to evaluate the tissue effects obtained according to
the power and the interaction time applied. In 10 patients
requiring radical prostatectomy for urological cancer, visual
laser ablation of the prostate (VLAP) was performed during the
10 days preceding the radical operation (range: 1 to 9 days).
The entire gland was submitted to pathological examination in
order to correlate the histological result with contrast
magnetic resonance imaging performed in 6 patients, using a
standard transrectal coil, 12 to 24 hours before complete
resection of the prostate. The morphological examination
showed zones of periurethral necrosis of variable volume,
accompanied by extensive peripheral haemorrhage, containing
vessels with a partially obliterated lumen. Contrast magnetic
resonance imaging (T1) showed that laser-induced lesions had a
low density appearance and were perfectly demarcated with
peripheral heterogeneous and hyperdense zones. In contrast
with the experimental investigations performed to date, we
demonstrated a clearly delayed tissue effect. Our experience
demonstrates that a period of several hours between laser
treatment and removal of the operative specimen is not
sufficient to evaluate the extent of laser-induced lesions.
High resolution magnetic resonance imaging with a standard
transrectal coil, sometimes combined with a multiple coil, is
very valuable to assess the effects of laser.
[Laser-tissue interactions in urology]
Mordon S
INSERM U279, Pavillon Vancostenobel, CHU de Lille.
Ann Urol (Paris) (France) 1997, 31 (1) p11-8
The laser-tissue interaction is a complex phenomenon which
is usually classified into 4 distinct mechanisms:
electro-mechanical action, photoablative action, thermal
action and photochemical action. Fragmentation of calculi by
means of a pulsed dye laser is a good example of the
electro-mechanical action. The thermal action can induce
coagulation and/or volatilisation of tissues. Treatments of
bladder tumors, urethral strictures and more recently benign
prostatic hypertrophy are based on the laser terminal
action.
Effect of Serenoa repens extract (Permixon) on
estradiol/testosterone-induced experimental prostate
enlargement in the rat.
Paubert-Braquet M; Richardson FO; Servent-Saez N; Gordon WC;
Monge MC; Bazan NG; Authie D; Braquet P
BIO-Inova EuroLab Research Labs, Plaisir, France.
Pharmacol Res (England) Sep-Oct 1996, 34 (3-4)
p171-9
The effect of the lipidosterolic extract of Serenoa repens
(LSESR) on experimental prostate enlargement was investigated
in three groups of rats: shams treated with LSESR (sham rats),
castrated animals treated with estradiol and testosterone
(castrated rats), castrated animals treated with
estradiol/testosterone and treated with LSESR (castrated and
treated rats). Following three months of continuous hormonal
treatment, the weight of prostates in
estradiol/testosterone-treated castrated rats was
significantly increased in comparison with sham-operated rats.
Such an increase started rapidly, reached a maximum by 30 days
and remained at a plateau or slightly declined thereafter. The
increase of prostate total weight induced by the hormone
treatment was inhibited by administration of LSESR. Indeed,
the weight was significantly lower at day 60 and day 90 for
the dorsal and lateral regions of the prostate. The weight of
the ventral region of the prostate was significantly lower
after 30 and 60 days treatment with LSESR. These results
demonstrate that administering LSESR to hormone-treated
castrated rats inhibits the increase in prostate wet weight.
This effect of LSESR may explain the beneficial effect of this
extract in human benign prostatic hypertrophy.
Immunohistochemical analysis of beta-tubulin
isotypes in human prostate carcinoma and benign prostatic
hypertrophy.
Ranganathan S; Salazar H; Benetatos CA; Hudes GR
Department of Medicine, Fox Chase Cancer Center,
Philadelphia, Pennsylvania 19111, USA.
Prostate (United States) Mar 1 1997, 30 (4)
p263-8
BACKGROUND: beta-tubulin, the intracellular target of
several antimicrotubule agents, is encoded by at least six
genes and exists as multiple isotypes with tissue-specific
expression. Previous in vitro studies indicated that tubulin
isotype composition may affect polymerization properties,
dynamics, and sensitivity to drugs.
METHODS: To investigate the isotype composition of
beta-tubulin in human prostate, tissues were collected from 26
patients after radical prostatectomy and sections were stained
with isotype-specific antibodies.
RESULTS: beta IV tubulin is the predominant isotype in
benign prostatic hyperplasia (BPH) and adenocarcinoma, showing
significantly stronger immunohistochemical expression than
beta II and beta III, particularly in Gleason's grade 3 and 4
cancers. Staining for the beta II isotype was invariably weak
and often absent in BPH and normal glands. There was a marked
increase in beta II isotype stain from BPH to cancer in 77% of
the patients, suggesting that the expression of this isotype
is related to malignant status.
CONCLUSIONS: The beta II tubulin isotype is a potential
marker for prostate adenocarcinoma. The possibility that tumor
beta-tubulin isotype composition may effect the response to
antimicrotubule drug therapy in prostate cancer and other
tumors merit investigation.
[LH-RH agonists as therapeutic alternative in
patients with benign prostatic hyperplasia (BPH) and surgical
contraindication. Long term follow up]
Granados Loarca EA; Chechile Toniolo G; Villavicencio Mavrich
H
Servicio de Urologia., Fundacion Puigvert, IUNA, Barcelona,
Espana.
Arch Esp Urol (Spain) Nov 1996, 49 (9) p923-7
OBJECTIVES: The purpose of this study is to describe the
benefits afforded by treatment with LH-RH analogues to
patients with physical or mental disorders that consult for
acute urinary retention or urinary symptomatology secondary to
benign prostatic hypertrophy (BPH).
METHODS: 52 patients with BPH in whom surgery was
contraindicated due to poor mental or physical condition were
treated with LH-RH analogue for six consecutive months a year
for a period of three years. Thirty-eight patients had acute
urinary retention and 14 had prostatic symptomatology.
RESULTS: Serum testosterone fell below 11 nmol/l. No
significant changes in PSA levels were observed. Assessment of
the prostate by DRE and US showed prostatic size had
diminished. Voiding and postvoid residual urine improved and
the bladder catheter could be withdrawn.
CONCLUSIONS: Our results show that treatment with LH-RH
analogue can reduce the urinary symptoms and improve the
quality of life of patients with BPH in whom surgery is
contraindicated.
c-erbB-2 oncoprotein: a potential biomarker of
advanced prostate cancer.
Arai Y; Yoshiki T; Yoshida O
Department of Urology, Kyoto Universit, Japan.
Prostate (United States) Feb 15 1997, 30 (3)
p195-201
BACKGROUND: Overexpression of the c-erbB-2 oncogene has
been implicated in the development and/or prognosis of several
human carcinomas, including that of the prostate. Recently,
c-erbB-2 protein was found to be released in the circulation.
The present study was undertaken to study the significance of
serum c-erbB-2 protein determination in men with prostate
cancer.
METHODS: Serum c-erbB-2 protein determination was performed
via immunoradiometric assay using two monoclonal antibodies
that react with the extracellular domain of the protein. The
study population consisted of 71 untreated prostate cancer
patients. Of those, 33 with stage D2 disease entered a
follow-up study. As control, serum c-erbB-2 protein levels
were determined in 92 patients with benign prostatic
hypertrophy. In addition, elevations of c-erbB-2 protein were
examined in patients with various disease statuses: clinically
well controlled (28 patients), disease progression (24
patients), and end-stage disease (17 patients).
RESULTS: Elevation of serum c-erbB-2 protein level was
observed in patients in advanced stages, such as stage D2
disease (30%), disease progression (42%), and end-stage
disease (82.4%). In the follow-up study, patients with an
elevated c-erbB-2 level had a significantly shorter interval
to disease progression than did those with a normal level.
CONCLUSIONS: The results suggest that c-erbB-2 can be used
as a biomarker to identify a malignant subgroup in prostate
cancer.
Role of m1 receptor-G protein coupling in cell
proliferation in the prostate.
Luthin GR; Wang P; Zhou H; Dhanasekaran D; Ruggieri MR
Allegheny University, Department of Physiology and
Biophysics, Philadelphia, PA 19102, USA.
Life Sci (England) 1997, 60 (13-14) p963-8
The prostate gland from several animal species contains
variable levels of muscarinic subtypes, but only the human
prostate expresses significant levels of the m1 subtype. We
studied muscarinic receptor activity in human benign prostatic
hypertrophy (BPH) as well as several cell lines derived from
prostate cancer. The BPH we studied expresses approximately
75% of the m1 receptor and undetectable levels of the other
receptor subtypes whereas PC3 cells express only the m3
receptor subtype. DU145 and LnCaP cells express approximately
equal levels of m1 and m3 receptor subtypes. Only the PC3
cells responded to carbachol with an increase in turnover of
polyphosphoinositides, and none of the cell lines responded
with effects on cAMP metabolism. Co-precipitation of receptors
with heterotrimeric guanine nucleotide-binding regulatory
proteins demonstrated interactions of the m1 receptors with
Gi, Gq and G16 in BPH tissue and of the m1 and m3 receptors
with Gi, Gq and G12 in PC3 and DU145 cells. Mitogen activated
protein kinase (ERK) activity was seen in response to
carbachol in PC3 and DU145 but not LnCaP cells. Finally,
carbachol promoted cell proliferation in all three cell lines.
Thus, there appears to be no consistent relationship between
ERK activity, cell proliferation, and the subtype mediating
the proliferative response, amongst these prostate cancer cell
lines.
Transurethral prostatectomy--new trends.
Churchill JA
Northern Kentucky University, Highland Heights, USA.
Geriatr Nurs (United States) Mar-Apr 1997, 18 (2)
p78-80
Treatment for benign prostatic hypertrophy has changed
drastically within the past 3 years. Two new procedures-visual
laser ablation of the prostate and transurethral
electrovaporization prostatectomy, as well as improvements in
the transurethral prostatectomy-have resulted in decreased
recovery time and early discharge. Postoperative nursing
observations for the visual laser ablation of the prostate and
transurethral electrovaporization prostatectomy are quite
different than for the transurethral prostatectomy. Discharge
teaching has become extremely important because patients are
now being discharged within 24 hours and most often with a
Foley catheter. Patient response to the new procedures has
been positive even though there are some disadvantages. (10
Refs.)
[Sabal serrulata extract in the management of
symptoms of prostatic hypertrophy]
Kondas J; Philipp V; Dioszeghy G
Fovarosi Onkormanyzat Peterfy Sandor utcai
Korhaz-Rendelointezet, Urologiai-sebeszeti Osztaly,
Budapest.
Orv Hetil (Hungary) Feb 16 1997, 138 (7) p419-21
The effectiveness of Sabal serrulata (dwarf palm) extract
was evaluated in the treatment of 38 patients with symptomatic
prostatic hyperplasia. During a 12-month treatment controlled
by investigations the subjective symptoms decreased in nearly
three fourth of the patients. Side effects were not observed.
According to uroflowmetric investigations the average peak
flow value increased from 10.36 ml/sec to 14.44 ml/sec (p <
0.0001) and the average mean flow value from 0.02 ml/sec to
7.45 ml/sec (p < 0.001). After treatment residual urine
volume decreased or was nil in more than 9/10 of the cases.
The average decrease of residue was 47 ml (p < 0.001). The
average decrease in prostatic volume was 10.6% (p < 0.02).
On the basis of their favorable experience the authors
recommend the administration of Sabal serrulata extract in the
treatment of patients with mild or moderate symptoms of
prostatic hyperplasia.
[Comparative effects of transurethral incision
(TUIP) and the combination of TUIP and LHRH agonists in the
treatment of benign prostatic hypertrophy]
Di Silverio F; D'Eramo G; Flammia GP; De Vico A; Casale P;
Sciarra A
Service d'Urologie U. Bracci, Universite La Sapienza, V. Le
Policlino, Rome, Italie.
J Urol (Paris) (France) 1996, 102 (3) p111-6
Between December 1991 and December 1993, 74 BPH patients
with an increased operative risk and concomitant diseases such
as diabetes mellitus and hypertension were submitted to a
transurethral incision of the prostate (TUIP). After TUIP,
patients were randomized to two different groups: group 1 was
followed without additional treatment and group 2 received an
LHRH analogue for the first 6 months of follow-up. With
respect to transurethral resection of the prostate (TURP),
TUIP has been shown to demonstrate a lower perioperative
morbidity. This advantage has lent further support to this
technique as a valid alternative for patients in poor general
conditions who are at high risk with more invasive procedures.
One of the limits of TUIP is the long-term effectiveness. Aim
of this study was to ascertain whether in patients with BPH
and an increased operative risk who require immediate and
definitive treatment but with a low perioperative morbidity,
the long-term effectiveness of TUIP can be stabilized by the
administration of an LHRH analogue. At present postoperative
follow-up ranges from a minimum of 24 months to a maximum 48
months (mean 38.4 months). Perioperative morbidity rate
associated with TUIP was 8.1%. In the group randomized to
combination therapy (TUIP + LHRH analogue), the clinical
condition of the patients was not modified by LHRH analogue
treatment and none of the patients withdrew from treatment.
Loss of sexual potency occurred in all patients on LHRH
analogue, however, none of these patients discontinued
treatment for this reason. At the end of the cycle of hormone
treatment, sexual potency returned to pretreatment values in
69.5% of patients after a mean of 3.2 months. In this study
the objective efficacy of the treatment was evaluated using
flow rate measurements, and the subjective assessment of
outcomes, using the International Prostate Symptom Score.
Statistically significant differences between the two groups
(TUIP alone or TUIP + LHRH analogue) (p < 0.01) were
reported at 6 months and were still maintained at 24 months of
follow up. Results emerging from this investigation confirm
that TUIP may be considered extremely safe procedure with low
operative risk. In selected BPH patients who are at high risk,
with a more invasive procedure and who must be submitted to
immediate and definitive treatment, the association of an LHRH
analogue seems to increase the long-term effectiveness of
TUIP. Five year follow-up studies are still in progress.
Immunochemical detection of 5 alpha-reductase in
human serum.
Lombardo ME; Hudson PB
Urology Section/Surgical Service, Department of Veterans
Affairs Medical Center, Bay Pines, Florida 33504, USA.
Steroids (United States) Nov 1996, 61 (11)
p651-6
This study represents a continuing effort to find a new
biomarker for the diagnosis and management of prostatic
cancer. Polyclonal antibodies were prepared to a peptide
(CAKP) representing amino acids 28 to 43 of the 5
alpha-reductase type 2 isozyme. Using immunoaffinity-purified
antibodies, the sera of 62 patients were examined by Western
blot following polyacrylamide gel electrophoresis. A positive
band was detected in the sera of several patients at 42 kDa
compatible with the purified native glycosylated 5
alpha-reductase type 2. These bands were nullified on
coincubation of the antibody with the CAKP peptide. Analysis
by high-performance liquid chromatography and amino acid
sequencing by N-terminal Edman degradation of the
immunoaffinity-purified antigen to the antipeptide antibodies
of a patient with adenocarcinoma of the prostate suggests that
the 5 alpha-reductase type 2 isozyme may be linked to an
immunoglobulin. An identical immunoaffinity-purified antigen
to the CAKP peptide was isolated from a section of prostatic
tissue from a different patient showing benign prostatic
hypertrophy with severe dysplasia. It is suggested that an
immunological response to the 5 alpha-reductase type 2 isozyme
was elicited in both instances.
Nd:YAG laser transurethral evaporation of the
prostate (TUEP) for urinary retention.
Fournier GR Jr; Tewari A; Induhara R; Gajenderan V; Narayan
P
Department of Veterans Affairs, Division of Urology, San
Francisco, California 94121, USA.
Lasers Surg Med (United States) 1996, 19 (4)
p480-6
BACKGROUND AND OBJECTIVE: Little information is available
regarding the effectiveness of laser prostatectomy in patients
with urinary retention from benign prostatic hyperplasia since
there is no paper specifically dealing with laser
prostatectomy in patients in urinary retention.
STUDY DESIGN/MATERIALS AND METHODS: Twenty two unselected
consecutive patients presenting with urinary retention due to
benign prostatic hypertrophy underwent transurethral
evaporation of the prostate (TUEP) using a neodymium:YAG laser
and total internally reflecting side-firing free beam quartz
fiber. All patients failed at least one voiding trial and
averaged > 30 days of urinary catheter drainage
preoperatively. A contact evaporation technique was used to
evaporate a "TURP-like" channel in the prostatic fossa by
means of a series of parallel evaporation troughs.
RESULTS: Eighteen of 22 patients completed 6 months of
follow up. Two patients were lost to follow up and two failed
TUEP. The average AUA score dropped from 26 to 9 at 1 month
and to 3.4 by 6 months postoperatively. All patients who
successfully underwent TUEP were urinating spontaneously by 10
days. Average time to catheter removal was 3.5 days. Maximal
uroflow was 15.7 ml/sec at 1 month and 20.3 ml/sec by 6
months. Postvoid residual preoperatively averaged 784 ml and
decreased to 76 ml by 1 month. Pre- and postoperative
hematocrit and serum sodium values did not vary by more than
5%.
CONCLUSION: From this preliminary series we conclude that
aggressive evaporation of prostatic tissue is feasible
endoscopically and provides a reliable method of near
bloodless removal of tissue.
Possible mechanisms of action of transurethral
needle ablation of the prostate on benign prostatic
hyperplasia symptoms: a neurohistochemical study
Zlotta AR; Raviv G; Peny MO; Noel JC; Haot J; Schulman
CC
Department of Urology, Erasme University Hospital, Brussels,
Belgium.
J Urol (United States) Mar 1997, 157 (3) p894-9
PURPOSE: Transurethral needle ablation of benign prostatic
hypertrophy (BPH) is a rapid, anesthesia-free outpatient
procedure using low level radiofrequency energy that produces
coagulative necrosis lesions at temperatures of approximately
100C. Clinically, significant improvement in objective and
subjective parameters has been observed in BPH patients.
Transurethral needle ablation has also been shown to be
effective in relieving urinary retention. However, the precise
mechanism of action of this procedure remains to be clarified.
Ablation could produce its action on the dynamic component of
the infravesical outlet obstruction. We analyzed the possible
effects of transurethral needle ablation on the intraprostatic
innervation.
MATERIALS AND METHODS: Histological sections from 10 open
prostatectomy specimens (BPH) recovered 1 to 46 days after
transurethral needle ablation were stained with hematoxylin
and eosin and an immunohistochemical technique, using
antibodies against S100 proteins and nonspecific enolase as
specific nerve markers, and against anti-prostate specific
antigen and anti-desmin for glandular and muscle cells,
respectively. We used 5 BPH specimens as controls.
RESULTS: Microscopic examination of the treated areas
showed necrotic lesions affecting epithelial and smooth muscle
cells in the transition zone at a depth of 0.3 to 1.0 cm, from
the preserved urethra. Nerve fibers in the control specimens
and untreated prostatic areas were predominant in the urethral
submucosal layer and in the stroma surrounding the epithelial
nodules. No staining of any axon or isolated nerve cell was
observed in any specimen treated by transurethral needle
ablation, and there was a sharp and clear delineation between
treated and untreated areas.
CONCLUSIONS: Our study demonstrated severe thermal damage
to intraprostatic nerve fibers caused by transurethral needle
ablation. A long-term denervation of alpha-receptors and/or
sensory nerves could explain the clinical effects of
transurethral needle ablation of the prostate. Theoretically,
the best location to produce necrotic lesions should include
submucosal and subcapsular nerve endings. Differences in the
distribution of the adrenoreceptors and morphometry of the
prostate transition zone could partly explain differences in
clinical outcome observed after transurethral needle ablation
of the prostate.
Histopathologic evaluation of the canine prostate
following electrovaporization
Benjamin DS; Oberg KC; Saukel GW; Ruckle HC; Stewart SC
Loma Linda University School of Medicine, Department of
Urology, California, USA.
J Urol (United States) Mar 1997, 157 (3) p1144-8
PURPOSE: Transurethral electrovaporization of the prostate
(TVP) for symptomatic benign prostatic hypertrophy (BPH) has
proven to be efficacious with minimal patient morbidity. When
compared to transurethral resection of the prostate (TURP),
TVP demonstrates comparable postoperative flow rates, American
Urologic Association (AUA) symptom score indices, and a
potential cost savings. However, in the human studies it has
not been possible to correlate these clinical parameters with
procedure-related histopathologic changes in the prostate
immediately postoperative or during wound healing. The
following study was done using a canine model in an effort to
evaluate these histopathologic changes.
METHODS AND MATERIALS: Fifteen hounds (25-35 kg.) underwent
antegrade electrovaporization of the prostate, via an open
cystotomy, using a Circon ACMI USA series resectoscope and
video equipment. The dogs were sacrificed and the prostates
harvested at various intervals postoperatively (0-11 weeks).
The prostates were evaluated grossly as well as histologically
for cavitary defects, depth of necrosis, and cellular
response.
RESULTS: Prostates examined immediately following the
procedure demonstrated superficial necrosis (less than 2 mm.)
in the region of vaporized tissue. One week postoperatively,
the vaporized regions demonstrated an intense acute
inflammation amidst superficial necrosis with focal hemorrhage
and dystrophic calcification. Transient glandular cystic
changes developed, but were resolving by seven weeks
postoperatively. Re-epithelialization was underway by the
third postoperative week and epithelial stratification
underway by the fifth week. There was no extension of the
initial two millimeter zone of necrosis at any time point
examined.
CONCLUSION: TVP in the canine model vaporizes prostatic
tissue at the site of contact. Only a shallow remnant of
necrosis remains at the site of vaporization, indicating the
highly localized effect of this technique. Healing at the site
of vaporization occurs in a rapid and expected manner. These
data provide a histopathologic rationale for the minimal
morbidity and the efficacious nature of this technique
demonstrated in clinical studies.
Transurethral vaporization of the prostate: a
promising new technique.
Thomas KJ; Cornaby AJ; Hammadeh M; Philp T; Matthews PN
Department of Urology, University Hospital of Wales, Cardiff,
UK.
Br J Urol (England) Feb 1997, 79 (2) p186-9
OBJECTIVE: To evaluate the efficacy and safety of
transurethral electrovaporization of the prostate (TUVP),
using a grooved roller electrode, for the surgical treatment
of symptomatic benign prostatic hypertrophy (BPH).
PATIENTS AND METHODS: TUVP was carried out using a grooved
roller electrode, pure-cutting diathermy and a standard
irrigating resectoscope to rapidly heat prostatic tissue to
> 100 degrees C, resulting in vaporization and cavitation
of the prostatic adenoma. Over a 10 month period, 116 patients
(mean age 69.8 years, range 51-93) with symptomatic BPH
(confirmed by a symptom score, urinary flow rate and an
ultrasonographic estimate of residual volume) were treated by
TUVP. Patients with carcinoma of the prostate, an elevated
level of prostate-specific antigen or those in chronic urinary
retention were excluded from the study. Each patient was
followed up every 4 months during the first post-operative
year, assessing their flow rate, residual volume and symptom
score.
RESULTS: Symptom scores improved by 67% and residual
volumes by 72%; the mean maximal flow rate increased from 8.5
mL/s (range 3.5-14) before treatment to 20.5 mL/s (range
4.5-39.0) at the same 4 month review. The procedure was simple
and safe, with a mean operative duration of 35 min (range
20-65), and no patients required a blood transfusion. Most
patients had their catheters removed within 24 h and were
discharged on the second day after treatment.
CONCLUSION: The effectiveness of TUVP in improving symptoms
and flow rates in patients with BPH was established. With
minimal capital expenditure and a reduced in-patient stay.
TUVP appears to have several advantages over other surgical
treatments for BPH, although continued follow-up is needed to
establish the long-term results.
Early experience with high-intensity focused
ultrasound for the treatment of benign prostatic
hypertrophy.
Sullivan LD; McLoughlin MG; Goldenberg LG; Gleave ME; Marich
KW
Department of Surgery, Vancouver Hospital.
Br J Urol (England) Feb 1997, 79 (2) p172-6
OBJECTIVE: To evaluate the safety and effectiveness of
high-intensity focused ultrasound (HIFU) in patients with
benign prostatic hypertrophy (BPH).
PATIENTS AND METHODS: The study comprised 25 patients (mean
age 67 years: range 47-84) with BPH treated using the
Sonoblate HIFU device. Patients were evaluated before and
after one treatment of HIFU using the American Urological
Association (AUA) symptom score, peak urinary flow rate (Qmax)
and a quality-of-life (QOL) score, and any complications were
noted.
RESULTS: Five patients with large glands were withdrawn
because the failure rate was high in these patients. The
remaining 20 patients showed a mean improvements in the AUA
symptom score (20.25 to 9.56), Qmax (9.2 to 13.7 mL/s) and QOL
score (4.75 to 2.50). There were no major complications.
CONCLUSIONS: HIFU is safe, produces minimal side-effects or
complications and relieves the symptoms of prostatism.
Detection of bladder tumor by urine cytology in
cases of prostatic hypertrophy.
Rammou-Kinia R; Anagnostopoulou I
Department of Cytology, Tzanio General Hospital, Piraeus,
Greece.
Diagn Cytopathol (United States) Dec 1996, 15 (5)
p409-11
Routine urine cytology has been performed for 809 male
patients presenting with symptoms due to prostatic
hypertrophy. In 6.42% of the cases, bladder tumor was revealed
incidentally diagnosed by urine cytology. Cystoscopy and
bladder biopsies were performed to confirm malignancy. The age
of these patients ranged from 48-84 years (mean 65.2) and they
complained mainly of irritative bladder symptoms. It is
therefore strongly indicated that all patients with prostatic
disease should have routine cytological examination of urine
sediments.
Quantification and distribution of alpha
1-adrenoceptor subtype mRNAs in human prostate: comparison of
benign hypertrophied tissue and non-hypertrophied
tissue.
Nasu K; Moriyama N; Kawabe K; Tsujimoto G; Murai M; Tanaka T;
Yano J
Molecular Biology Department, Nippon Shinyaku Co., Ltd.,
Kyoto, Japan.
Br J Pharmacol (England) Nov 1996, 119 (5)
p797-803
1. There are at least three alpha 1-adrenoceptor subtypes,
alpha 1a, alpha 1b and alpha 1d, in human tissues. Using an
RNase protection assay, we have now determined the amount of
each subtype mRNA in human prostatic tissue, for both benign
prostatic hypertrophy (BPH) and non-BPH. In all tissue samples
examined, the predominant subtype mRNA was alpha 1a. The total
abundance of alpha 1-adrenoceptor mRNA in BPH samples was over
six times that in non-BPH samples. This increase was mostly
accounted for by alpha 1a, which was almost nine times as
abundant in BPH samples as in non-BPH samples. The abundance
of alpha 1b was almost the same between BPH and non-BPH
samples, and the abundance of alpha 1d in BPH samples was
about three times that in non-BPH samples. The ratio of the
numbers of the subtype mRNAs, alpha 1a: alpha 1b: alpha 1d,
was 85:1:14 in BPH samples and 63:6:31 in non-BPH samples.
2. In situ hybridization studies showed no significant
differences in the tissue localization of alpha 1-adrenoceptor
subtype mRNAs between BPH and non-BPH samples. alpha 1a and
alpha 1d were clearly detected in the interstitium of the
prostate, where alpha 1a was stained more intensely than alpha
1d, and the positive sites were primarily smooth muscle cells.
In contrast, alpha 1b staining was very faint.
3. This increase in mRNA abundance may be directly related
to the contraction of prostatic tissue that leads to
obstruction of the urinary tract in BPH patients.
Specifically, our data suggest that increased expression of
the alpha 1a subtype may be primarily responsible for the
contraction of the prostate.
Prostate-specific antigen and age. Is there a
correlation? And why does it seem to vary?
Kirollos MM
Urology Department, South Devon Health Care Trust, Torquay,
UK.
Eur Urol (Switzerland) 1996, 30 (3) p296-300
OBJECTIVES: To determine whether there is a significant
correlation between age and prostate-specific antigen (PSA)
and to explain the wide literature variations in its
value.
METHODS: Two different groups were studied; the first (n =
403) consisted of patients undergoing prostatectomies for
symptomatic benign prostatic hypertrophy (BPH) and the second
(n = 192) of patients with no evidence of prostate cancer who
required no treatment.
RESULTS: The correlation coefficient found in the surgical
group was low (0.09) and was statistically insignificant while
in the second group it was much higher (0.36) and had a high
statistical significance (p < 0.001). This reflected the
age difference between the two groups rather than the
difference in clinical characteristics as proved by the
gradual decrease in the value of the coefficient by the
gradual exclusion of the younger age groups. The correlation
became statistically insignificant for those older than 60
years.
CONCLUSIONS: It is concluded that the correlation between
age and PSA is a variable one showing a gradual decline in its
coefficient with the gradual increase in the age of the
population studied. This implies a relatively orderly rise in
PSA with age up to a limit of 60 years. Beyond this age, the
relationship between age and PSA becomes disorderly. This
pattern of relationship can easily be explained by the known
rate of growth of BPH and would explain the literature
variations.
Colocalization of immunoglobulin binding factor and
prostate specific antigen in human prostate gland.
Maegawa M; Kamada M; Maeda N; Aono T; Izumi K; Kagawa S;
Koide SS
Department of Obstetrics and Gynecology, School of Medicine,
University of Tokushima, Japan.
Arch Androl (United States) Nov-Dec 1996, 37 (3)
p149-54
Immunoglobulin binding factor (IgBF) produced in the
prostate is a useful marker for the diagnosis of prostatic
tumor. IgBF was localized in the majority of epithelial cells
of benign prostatic hypertrophy by an immunohistochemical
technique. Prostate specific antigen (PSA), a known marker for
prostatic cancer, was localized to all epithelial cells.
Double immunolabeling of IgBF and PSA using fluorescent
methods revealed that all epithelial cells producing IgBF were
also immunopositive for PSA and some cells were positive only
for PSA. The present findings suggest that the prostatic
glands consist of two types of epithelial cells, one producing
both IgBF and PSA and the other producing PSA alone.
A study of the efficacy and safety of transurethral
needle ablation (TUNA) treatment for benign prostatic
hyperplasia.
Millard RJ; Harewood LM; Tamaddon K
New South Wales University, Sydney, Australia.
Neurourol Urodyn (United States) 1996, 15 (6)
p619-28
The objective of this early phase III study was to
determine the efficacy and safety of transurethral needle
ablation (TUNA) in patients presenting in acute urinary
retention due to benign prostatic hyperplasia (BPH). Between
September 1993 and August 1994, 20 patients of mean age 68.8
years were entered into a two-center study and treated with
TUNA after presenting in acute urinary retention and having
failed at least one trial of voiding. A mean of 5.4 lesions at
shield temperatures of 54.6 degrees C were produced. Patients
were reviewed at 1, 3, 6, and 12 months (mean, 6.2 months). In
17 of 20 patients, voiding was reestablished in a mean of 2.6
days. Three patients required TURP for persistent retention,
and 2 patients had delayed TURP for bothersome symptoms. Two
voiders died later of unrelated causes. Five patients were
lost to follow-up at 6 months but were voiding when last
reviewed. Symptom scores decreased from a mean of 19.0 (range
4-35) to 8.25 (range 1-20) at 12 months (p = 0.06). Mean peak
flow rate was 11.4 ml/sec (range 6.6-16.8) at 12 months (p =
0.001). Mean prostatic volume at baseline was 65.8 cc and
decreased to 56 cc at 12 months (p = 0.111). The treatment was
well tolerated by all patients, and side effects were mild,
including urinary tract infection and epididymo-orchitis. This
study demonstrates the safety and effectiveness of TUNA
procedure in patients with urinary retention due to benign
prostatic hypertrophy.
|