HoLEP Learning Curve-Resident Perspective: Survey of Senior Residents from High-Volume Tertiary Center.

Objective: We aim to report the learning curve and experience performing holmium laser enucleation of the prostate (HoLEP) from a resident standpoint trained at a tertiary high-volume center. Methods: An electronic survey was distributed to 10 surveyees that included recently graduated chief residents trained at Indiana University in the past 3 years i.e., between 2020 and 2022 with a 100% response rate. The questionnaire focused on HoLEP training experience based on a recently established mentorship curriculum in training the residents through each individual step of the surgery. Results: The average learning curve for performing HoLEP was reported to be greater than 25 cases with 50% of the residents reporting >50 cases to master the technique. The surgical difficulty of steps of the HoLEP were rated on a subjective scale of 1-5: 1 = very easy, 2 = easy, 3 = neutral, 4 = hard, and 5 = very hard. The common challenging steps in decreasing the order of difficulty as reported are performing apical enucleation, joining anterior and posterior planes, and dividing anterior commissure with a mean rating of 3.5, 3.1, and 3.1, respectively. The most difficult aspect of the surgery to master was performing apical dissection (60%). Comparing operative parameters for HoLEP with transurethral resection of the prostate in aspects of resection volume and times, 70% of candidates reported it better for HoLEP whereas 20% had similar times for both procedures. A total of 90% of the residents felt confident to offer HoLEP as part of their practice without the need for any further training. Regarding the initial challenge of including HoLEP surgery in practice, the majority (60%) reported difficulty with equipment set up in their practice while 20% reported difficulty maintaining efficient operating room (OR) times and turnover. Conclusion: We believe HoLEP can be performed immediately after residency training and incorporated into practice with high volume, repeated exposure to HoLEP surgery throughout residency based on study results. The average learning curve reported for performing HoLEP was greater than 25 cases.

Prostatic Artery Embolization as a Treatment Option for Symptomatic Benign Prostatic Hyperplasia: Results from the Prospective Follow-Up Study in Lithuania.

Background: The endovascular treatment of symptomatic benign prostate hypertrophy (BPH) by prostatic artery embolization (PAE) is one of the new treatments proposed. PAE is a minimally invasive alternative that has been shown to successfully treat lower urinary tract symptoms in BPH patients by causing infarction and necrosis of hyperplastic adenomatous tissue, which decompresses urethral impingement and improves obstructive symptoms. The aim of this study was to evaluate the effectiveness and efficacy of PAE in relieving symptoms in patients with symptomatic BPH. Materials and Methods: The material for the study was collected from 2019 to 2022. A total of 70 men with BPH and PAE were studied. Patients underwent an urological examination to measure the International Prostate Symptom Score (IPSS), Quality of Life score (QoL), International Index of Erectile Function short form (IIEF-5), uroflowmetry with Qmax, prostatic volume (PV), and post-void residual volume (PVR) measurements. Statistical analysis for dependent samples was applied. Measured parameters at 2 months and 6 months follow-up were compared to baseline. Results: At baseline, the age of the male (N = 70) subjects was 74 ± 9.6 years with a median of 73.8, but fluctuated from 53 to 90 years. The mean of PV was almost 111 mL and the Qmax was close to 7.7 mL/s. The average PVR was 107.6 mL. The IPSS score mean was 21.3 points and the QoL score was 4.53 points. The IIEF-5 questionnaire score was almost 1.8 points, which shows severe erectile dysfunction. The mean value of the PSA level was 5.8 ng/mL. After 2 and 6 months of PAE, all indicators and scores except erectile function significantly improved. Conclusions: The outcomes of our study show promising results for patients with benign prostatic hyperplasia after PAE. The main prostate-related parameters (PV, Qmax, PVR, IPSS) improved significantly 6 months after embolization.

Improving Whole Tomato Transformation for Prostate Health: Benign Prostate Hypertrophy as an Exploratory Model.

It is well-established that the beneficial properties of single phytonutrients can be better attained when they are taken with the complex of the molecules present in their natural milieu. Tomato, the fruit providing the most comprehensive complex of prostate-health-preserving micronutrients, has been shown to be superior to its single-nutrient counterparts in decreasing the incidence of age-related prostate diseases. Herein, we describe a novel tomato food supplement enriched with olive polyphenols, containing cis-lycopene concentrations far exceeding those present in industry-produced tomato commodities. The supplement, endowed with antioxidant activity comparable to that of N-acetylcysteine, significantly reduced, in experimental animals, the blood levels of prostate-cancer-promoting cytokines. In prospective, randomized, double-blinded, placebo-controlled studies performed on patients affected by benign prostatic hyperplasia, its uptake significantly improved urinary symptoms and quality of life. Therefore, this supplement can complement and, in some cases, be an alternative to current benign prostatic hyperplasia management. Furthermore, the product suppressed carcinogenesis in the TRAMP mouse model of human prostate cancer and interfered with prostate cancer molecular signaling. Thus, it may offer a step forward in exploring the potential of tomato consumption to delay or prevent the onset of age-related prostate diseases in high-risk individuals.

Water vapor therapy and polymyalgia rheumatica: Coincidental?

Polymyalgia rheumatica (PMR) is an inflammatory rheumatic condition characterized by pain and stiffness around the shoulders and hip girdles, an elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) and a dramatic response to corticosteroids. It is usually seen in adults aged over 50 years; about 30% also have giant cell arteritis. Its etiology is unknown. A 72-year-old male received water vapor therapy, a novel, minimally invasive therapy for benign prostate hypertrophy (BPH). On postoperative day 1, he developed severe shoulder pain and weakness, with difficulty with lifting his arms above his head, and hip pain and weakness, with difficulty getting out of a bed or chair. Laboratory results showed elevated ESR and CRP, but a normal creatine kinase level. The patient received low-dose prednisone and had prompt symptom relief. This case illustrates that a diagnosis of PMR after water vapor therapy can be easily overlooked.

Irrigation fluid absorption syndrome during HoLEP: A case study.

The classical transurethral resection syndrome as described with monopolar prostate resection has become rare since the switch to bipolar resection and even more so since the introduction of HoLEP. We report a case of a 74-year-old male patient who presented with an irrigation fluid absorption syndrome during a HoLEP for benign prostate hypertrophy. Biochemically this presented as metabolic acidosis and hyperchloremia instead of hyponatremia. He was treated with diuretics and had a swift recovery.

Índice de Salud Prostática (phi) / Prostate Health Index (phi)

El antígeno específico de próstata (PSA, del inglés, Prostate Specific Antigen) es una glicoproteína producida por la próstata, y es el marcador tumoral de mayor uso. Sin embargo, su baja especificidad para diferenciar entre cáncer de próstata y otras alteraciones no malignas, como la hipertrofia benigna de la próstata (HBP) y la prostatitis aguda, limitan su utilidad diagnóstica

Prostate Specific Antigen (PSA) is a glycoprotein produced by the prostate and is the most widely used tumor marker. However, its low specificity to differentiate between prostate cancer and other non-malignant conditions, such as benign prostate hypertrophy (BPH) and acute prostatitis, limits its diagnostic utility

The differential presence of human polyomaviruses, JCPyV and BKPyV, in prostate cancer and benign prostate hypertrophy tissues.

BACKGROUND: Studies have shown that human polyomavirus infection may be associated with various human cancers. We investigated the potential relationship between the prevalence of JCPyVor BKPyV and prostate cancer (PC) in patients from Taiwan. METHODS: Patients with PC and benign prostate hypertrophy (BPH; 76 and 30 patients, respectively) were recruited for this study. Paraffin-embedded tissues and clinical information of the patients were obtained. The tissue sections were used for viral DNA detection and immunohistochemistry analysis was performed for examining viral large T (LT) and VP1 proteins. Regression analysis was used to evaluate the relationship between the clinical characteristics of the patients and the risk of JCPyV/BKPyV infection. RESULTS: The prevalence of JCPyV/BKPyV DNA was different in PC and BPH tissues (27/76 [35.52%] and 2/30 [6.7%], respectively, p = 0.003)]. The LT and VP1 proteins were detected in 27 (35.52%) and 29 PC (38.2%) specimens, respectively, but neither protein was detected in BPH samples (p < 0.001). PC cells were more susceptible to JCPyV infection than BPH tissues [odds ratio (OR) 7.71, 95% CI: 1.71-34.09, p = 0.003). Patients with PC showing high levels of prostate-specific antigen and high Gleason scores were associated with a high risk of viral infection (ORs 1.1, 95% CI 1.000-1.003; p = 0.045 and ORs 6.18, 95% CI 1.26-30.33, p = 0.025, respectively). The expression of LT protein associated with the risk of PC increased 2923.39-fold (95% CI 51.19-166,963.62, p < 0.001). CONCLUSIONS: The findings indicate that JCPyV infection in PC cells may be associated with prostate cancer progression and prognosis.

Establishment and prospective validation of an SUVmax cutoff value to discriminate clinically significant prostate cancer from benign prostate diseases in patients with suspected prostate cancer by 68Ga-PSMA PET/CT: a real-world study.

Background and Aims: The aims of this study were to establish a maximum standardized uptake value (SUVmax) cutoff to discriminate clinically significant prostate cancer (csPCa) from benign prostate disease (BPD) by 68Ga-labeled prostate-specific membrane antigen (68Ga-PSMA-11) positron emission tomography/computed tomography (PET/CT) in patients with suspected prostate cancer (PCa), and to perform a prospective real-world validation of this cutoff value. Methods: The study included a training cohort to identify an SUVmax cutoff value and a prospective real-world cohort to validate it. A retrospective analysis assessed 135 patients with suspected PCa in a large tertiary care hospital in China who underwent 68Ga-PSMA-11 PET/CT. All patients were suspected of having PCa based on symptoms, digital rectal examination (DRE), total prostate-specific antigen (tPSA) level, and multiparameter magnetic resonance imaging (mpMRI). The 68Ga-PSMA PET/CT results were evaluated using histopathological results from transrectal ultrasound-guided 12-core biopsy with necessary targeted biopsy as references. Patients with Gleason scores (GS) ≥7 from the biopsy results were diagnosed with csPCa, and patients with negative biopsy and follow-up results were diagnosed with BPD. Receiver operating characteristic (ROC) curve analysis was used to identify the optimal SUVmax cutoff value. The cutoff value was prospectively validated in 58 patients with suspected PCa. The diagnostic benefits of the cutoff value for clinical decision making were also evaluated. Results: According to ROC curve analysis, the most appropriate SUVmax cutoff value for discriminating csPCa from BPD was 5.30 (sensitivity, 85.85%; specificity, 86.21%; area under the curve [AUC], 0.893). The cutoff achieved a sensitivity of 83.33%, a specificity of 81.25%, a positive predictive value (PPV) of 92.11%, a negative predictive value (NPV) of 65.00%, and an accuracy of 82.76% in the prospective validation cohort. Metastases were used as an indicator to reduce false negative results in patients with SUVmax ≤ 5.30. In patients without metastases, an SUVmax value of 5.30 was also the best cutoff to diagnose localized csPCa (sensitivity, 80.43%; specificity, 86.21%; AUC, 0.852). The cutoff discriminated localized csPCa from BPD with a sensitivity of 76.19%, a specificity of 81.25%, a PPV of 84.21%, an NPV of 72.22%, and an accuracy of 78.38% in the prospective validation cohort. The cutoff, combined with metastases, achieved an accuracy of 89.12% in all patients, increasing accuracy by 8.29% and reducing equivocal results compared with manual reading. There was a strong correlation between SUVmax and PSMA expression (rs = 0.831, P < 0.001) and a moderate correlation between SUVmax and GS (rs = 0.509, P < 0.001). The PSMA expression and SUVmax values of patients with csPCa were significantly higher than those of patients with BPD (P < 0.001). Conclusion: We established and prospectively validated the best SUVmax cutoff value (5.30) for discriminating csPCa from BPD with high accuracy in patients with suspected PCa. 5.30 is an effective cutoff to discriminate csPCa patients with or without metastases. The cutoff may provide a potential tool for the precise identification of csPCa by 68Ga-PSMA PET/CT, ensuring high accuracy and reducing equivocal results.

[Multicenter randomized study of bovhyalu-ronidase azoximer (Longidaza) in men after transuretral resection of the prostate].

INTRODUCTION: Transurethral resection of the prostate (TURP) is the gold standard of BPH surgical treatment. It is of current interest to search for medications that can reduce the incidence of complications after TURP. AIM: To evaluate the efficiency of Longidaza (rectal suppositories of 3000 IU) as part of combined therapy in order to prevent complications after TURP. MATERIALS AND METHODS: The study included 202 patients who underwent TURP in 3 hospitals. The patients were divided into 2 groups: main group - 96 men taking standard postoperative therapy with Longidaza rectal suppositories N 20; control group - 106 men - taking standard postoperative therapy (tamsulosin 30 days; fluoroquinolone 5 days). Follow-up included IPSS, urinalysis, urine culture, ultrasound examination of the prostate volume (PV), post void residual urine, uroflowmetry at 1,2,3,6 months after surgery. Average preoperative indices: IPSS 27 [23; 30], Qol 5 [4; 6], prostate volume (PV) 71+/-19cc (30-272 c), Qmax 7.5+/-2.5ml/s (1,3-18,7 ml/s). RESULTS: There was a significant improvement in IPSS, QoL, Qmax, PV, post void residual urine (PVR) compared to preoperative values during the entire observation period. There was no statistical difference between the main and control groups for these indexes in 6 months. In the main group had statistically lower incidence of bacteriuria at 3 (11% vs 17%) and 6 months (7% vs 17%), and leukocyturia at 3 (31% vs 46%) and 6 months of follow-up (20% vs 44%). Overall incidence of infectious complications and additional antibacterial drugs prescription was lower in the Longidaza group compared to the control group (17,7% vs 20,7%). Urethral strictures developed in 7 men in the main group, and 8 in the control group. CONCLUSION: Our results show that prescription of Longidaza significantly reduces the incidence of leukocyturia and bacteriuria postoperatively, decreasing the rate of infectious complications in men after TURP.

Analysis of risk factors of bladder neck contracture following transurethral surgery of prostate.

BACKGROUNDS: The aim of the present study was to investigate the perioperative parameters associated with bladder neck contracture (BNC) after transurethral surgery of the prostate and to compare the incidence of BNC after transurethral resection of the prostate (TURP) or Thulium vaporesection (resection group) versus Thulium vapoenucleation or enucleation of the prostate (enucleation group). METHODS: Between March 2008 and March 2020, 2363 patients received TURP and 1656 patients received transurethral surgery of the prostate with Thulium laser (ThuP) at Mackay Memorial Hospital. A total of 62 patients developed BNC. These BNC patients were age-and operation-matched to 124 randomly sampled TURP/ThuP controls without BNC. A 1:1 propensity score matching model was used to evaluate the difference in incidence of BNC. RESULTS: Our study demonstrated that a greater proportion of BNC patients had history of cerebrovascular accidents (11/62 vs. 7/124, p = 0.009), coronary artery disease (14/48 vs. 16/108, p = 0.03), chronic kidney disease (14/62 vs. 11/124, p = 0.01), and two or more comorbidities (29/62 vs. 27/124, p = 0.001) compared with NBNC patients. Multivariate analysis showed that smaller prostate volume (OR 0.96 (0.94-0.99), p = 0.008) and recatherization (OR 5.6 (1.02-30.6), p = 0.047) were significantly associated with BNC. A ROC curve predicted that a prostate volume < 42.9 cm3 was associated with a notably higher rate of BNC. The propensity score matching model reported there was no difference in incidence between resection and enucleation groups. CONCLUSION: This study demonstrated that incidence of BNC was the same in different surgical techniques and that low prostate volume, recatherization and ≥ 2 comorbidities were positively correlated with the development of BNC after TURP or ThuP.

The effect of vitamin D supplementation on the progression of benign prostatic hyperplasia: A randomized controlled trial.

BACKGROUND AND AIMS: Inflammation and proliferation are the cause of benign prostatic hyperplasia (BPH) and are the key components of its mechanism of action. In this study we sought to determine the role of 25-hydroxyvitamin D in BPH, because of its anti-inflammatory activities, and its effect on prostate volume and BPH symptoms. METHODS: This randomized clinical trial (RCT) was conducted on 108 participants >50 years of age who had either asymptomatic or mild BPH symptoms according to the International Prostate Symptom Score (IPSS) questionnaire. Patients were randomly divided into two groups, intervention and control. The intervention group received 50 000 units of vitamin D3 and the control group received a placebo every two weeks for six months. Prostate ultrasound, routine clinical examinations, toucher rectal (TR), and laboratory tests were performed for all patients. After six months, the patients underwent another ultrasound evaluation, measurement of prostate-specific antigen (PSA) levels and completed the IPSS. Results of the evaluations before and after the intervention were compared between the groups using the chi-square, t-test, and logistic regression analysis. Repeated measure analysis was used to evaluate the effect of vitamin D intervention on the changes in the IPSS score. RESULTS: The mean age of the participants was 56 ± 9 years. In the control group, the mean prostate volume was higher compared to the intervention group (p < 0.001). The control group had a higher mean PSA level than the intervention group (p < 0.001). Although the IPSS score decreased over time in both groups, analysis of variance showed that the amount of change or decrease in IPSS score in the intervention group was significantly more than the control group (p < 0.001). CONCLUSIONS: The results of our study support the effect of vitamin D in reducing prostate volume and PSA levels, and in improving BPH symptoms. Further studies are needed to confirm these findings to verify the use of vitamin D as a treatment for BPH.

[Benign prostatic hyperplasia surgery and patient's information: What do patients understand and remember?] / Chirurgie de l'hypertrophie bénigne de prostate et information des patients : qu'est ce que les patients comprennent et retiennent ?

INTRODUCTION: Preoperative information is a key to adherence to treatment for the patients, but may be misunderstood because of its density and complexity. The aim of this study was to assess comprehension and satisfaction of patients about preoperative information of benign prostatic hyperplasia (BPH) surgery. Factors influencing patient understanding were also studied. PATIENTS AND METHODS: It was a monocentric study on questionnaires including every patients planned for BPH surgery, whatever the surgical technique. A survey was sent at patient's home after the preoperative consultation. RESULTS: One hundred and six of 210 patients (50,5 %) returned the questionnaire. 38,68 % (n=41) found the quality of information excellent (9 or 10 out of 10), and 45,28 % (n=48) found the quality of information good (7 or 8 out of 10). The main recalled complications were retrograde ejaculation (39.6 %, n=42/106), and bleeding (29,2 %, n=31/106). 57.6 % of patients (n=61) remembered receiving the written information sheet of the French Association of Urology. 5.7 % (n=6) hesitated having the procedure. Only patient's age was significantly associated with difference of comprehension (p<0.005). CONCLUSION: Information given before a BPH surgery seems satisfactory although it was poorly understood, notably about complications. Providing complete oral information, insisting on complications, and giving the written information sheet are essential for a good doctor-patient relationship and a forensic serenity. LEVEL OF EVIDENCE: 3.

Multimodality approach to imaging giant multilocular cystadenoma of the prostate: A rare entity.

Giant multilocular cystadenomas of the prostate or seminal vesicles are rarely reported in literature. We present a case of a 76-year-old male presenting with lower urinary tract symptoms initially perceived as symptoms of benign prostatic hyperplasia. The patient was investigated by employing a multimodality imaging approach of the prostate that included ultrasound, computed tomography, and magnetic resonance imaging, which resulted in an incidental finding of large multiloculated benign cysts originating from the prostate, confirmed by pathological study. This case report highlights the multimodality imaging approach in the detection and diagnosis of this rare disease.

Possible clinical implications of peripheral zone changes depending on prostate size.

PURPOSE: Although numerous studies have observed an inverse relationship between the size of benign prostate hypertrophy (BPH) and the incidence of prostate cancer (PCa), few studies have explored specific mechanisms by which BPH and PCa may influence one another. In a recent study, one possibility has been brought up that growth in the transition zone due to BPH may cause pressure-induced fibrotic changes in the peripheral zone, an area where 80% of cancer occurs, leading to gland atrophy and the thickening of the prostatic capsule. To shed more light on this phenomenon, we conducted a pilot study examining the quantitative and qualitative histo-anatomical changes that occur in the peripheral zone associated with BPH. METHODS: Thirty-nine prostate specimens of various sizes were selected from patients who had undergone radical prostatectomies. Each prostate was evaluated in six different locations along the dorsal aspect of the peripheral zone by measuring the thickness of the peripheral fibrotic zone (prostate capsule) and its association with gland atrophy. Multiple regression analysis was performed to determine the relationship between prostate size and the average thickness of the prostate capsule. RESULTS: Multiple regression analysis revealed a strong, positive relationship between prostate size and average capsule thickness with a Pearson coefficient of 0.707 (p < 0.05). Fibrotic histo-anatomical changes were spatially associated with gland atrophy: glands found within the peripheral fibrotic zone appeared elongated and atrophic. CONCLUSION: The results suggest that BPH may be associated with the development of fibrotic material and atrophy of glands within the peripheral zone. Because this atrophy involves glands where 80% of prostate cancer originates, this potentially explains the inverse relationship between PCa and BPH.

Association between oral pathogens and prostate cancer: building the relationship.

BACKGROUND: Chronic inflammation and infections are associated with increased risk of prostate cancer development. There is considerable evidence that proves the interrelationship between bacterial/viral infections and carcinogenesis. Periodontitis is a chronic inflammatory disease triggered by gram-negative anaerobic bacteria. In this narrative review, we investigate the relationship between periodontal disease and prostate cancer by reviewing previous studies of the association and possible mechanisms that may explain this link. METHODS: A comprehensive search for articles published was performed using the key words, "periodontal disease", "prostate disease", "prostate cancer", "prostatic inflammation". Thorough reviews of each study were conducted and assessed for eligibility, and data was summarized. RESULTS: The role of inflammatory responses in the prostate as drivers of malignancy appears to be predisposed by periodontal pathogens and/or periodontitis inflammatory mediators. CONCLUSION: Periodontal diseases might be associated with prostate cancer. However, the mechanism(s) explaining this relationship remains unclear and requires further elucidation.

Use of 5α-reductase inhibitors for benign prostate hypertrophy and risk of high grade prostate cancer: a French population-based study.

OBJECTIVE: To assess the association between 5α-reductase inhibitor (5-ARI) use and high grade (Gleason score 8-10) prostate cancer. PATIENTS AND METHODS: We conducted a population-based nested matched case-control study using the French national health insurance database linked to data from all pathology laboratories in Brittany, France. Among 74 596 patients with ≥1 drug reimbursement for symptomatic benign prostate hypertrophy (BPH) between 1 January 2010 and 31 December 2011, 767 incident prostate cancer cases between 1 January 2012 and 31 December 2013 were matched according to age and delay between the first observed delivery of drug for BPH (5-ARIs, α-blockers or phytotherapy) and diagnostic date of the case to five control patients, using an incidence density sampling design. RESULTS: A total of 963 patients (153 cases, 810 controls) had been exposed to 5-ARIs. A significant heterogeneity (P = 0.005) was detected across cancer grades when estimating the association between prostate cancer and long-term (≥2 years) 5-ARI use vs no 5-ARI exposure: adjusted conditional odds ratio 1.76 (95% confidence interval [CI] 0.97-3.21) for Gleason score ≥8 and 0.64 (95% CI 0.44-0.93) for Gleason score < 8. CONCLUSION: Our results indicate an increased risk of high grade and a decreased risk of low grade prostate cancer associated with 5-ARI use. Patients treated for >2 years with 5-ARIs should be informed about the increased risk of development of high grade disease.

Caffeic acid phenethyl ester guards against benign prostate hypertrophy in rats: Role of IGF-1R/protein kinase-B (Akt)/ß-catenin signaling.

Benign prostate hypertrophy (BPH) is among the most common diseases with a huge impact on the quality of life of elderly men. There is a current need for the development of well-tolerated and effective preventive strategies to improve the clinical outcome. Caffeic acid phenethyl ester (CAPE) is an important active ingredient isolated from honey-bee propolis with potent anti-proliferative, anti-inflammatory and antioxidant effects. These properties promote CAPE as a promising candidate to be tested as an alternative therapy for BPH, which is still uninvestigated. Herein, we tested the ability of CAPE to guard against testosterone-induced BPH and investigated the involvement of IGF1-R/Akt/ß-catenin signaling as a protective mechanism in testosterone-induced BPH rat model. Treatment with CAPE reduced testosterone-induced increase in the prostate index and histopathological alterations. In addition, co-treatment with CAPE significantly suppressed insulin-like growth factor-1 receptor (IGF-1R)/Akt/ß-catenin/cyclinD1 axis as well as tumor necrosis factor-α level and nuclear factor (NF)-kB activity. Furthermore, the treatment with CAPE replenished the antioxidant defense systems, superoxide dismutase (SOD) and reduced glutathione (GSH) with subsequent reduction in prostate tissue lipid peroxides. This study highlights the potential merit of CAPE-enriched propolis formulations to protect elderly men against the development of BPH. © 2018 IUBMB Life, 70(6):519-528, 2018.

Clinical Usefulness of the Histoculture Drug Response Assay for Prostate Cancer and Benign Prostate Hypertrophy (BPH).

The histoculture drug response assay (HDRA) has been adapted to determine androgen sensitivity in Gelfoam histoculture of human benign prostatic tissue as well as prostate cancer. Gelfoam histoculture was used to measure androgen-independent and androgen-dependent growth of benign and malignant prostate tissue. The androgen-sensitivity index was significantly higher in 23 paired specimens of prostate cancer compared to benign prostate hypertrophy (BPH). Genistein decreased the androgen-sensitivity index of BPH and prostate cancer in Gelfoam® histoculture in a dose-dependent manner.

Impacto de la Prostatectomía en Síntomas Depresivos en pacientes con Hipertrofia Prostática Benigna / Impact of prostatectomy on depressive symptoms in patients with symptomatic Benign Prostatic Hypertrophy

Introducción: La hiperplasia prostática benigna (HPB) es una enfermedad caracterizada por síntomas del tracto urinario inferior (1). Estos síntomas suelen causar un impacto negativo en la calidad de vida del paciente llevándolo a padecer trastornos depresivos (7). Se han encontrado síntomas depresivos hasta en el 22.5% de los pacientes con HPB sin embargo, hay poca evidencia de que estos síntomas disminuyan luego de tratar la HPB (5). Una herramienta útil para medir los síntomas depresivos es la Escala de Medición de Depresión de Hamilton (3). Objetivos: Este estudio pretende evaluar la presencia de síntomas depresivos en pacientes con HPB y comprobar si estos síntomas disminuyen posteriormente al tratamiento quirúrgico para HPB. Métodos. Se utilizó un muestra de 30 pacientes, edad (promedio 67 ± 8 años), sometidos a tratamiento quirúrgico para HPB y quienes presentaran por lo menos un síntoma depresivo según la escala de medición de depresión de Hamilton. Resultados. Todos tuvieron resección transuretral de próstata (RTUP). Previo a la cirugía se encontraron síntomas depresivos en el 76%. Un mes posterior a la cirugía se encontraron síntomas depresivos en 28, sin embargo, se encontró depresión leve en el 23.3% (vs pre op 30%), depresión moderada en el 16.6% (vs pre op 30%) y depresión severa en el 13.3% (vs pre-op 16.6%). La Escala de Medición de Depresión de Hamilton tuvo una puntuación media preoperatoria de 13.93 puntos. Un mes posterior a la cirugía la puntuación media fue de 9.36 puntos. La diferencia fue de 4.56 puntos, lo cual es estadísticamente significativo (P=0.05). Hubo complicaciones quirúrgicas en 3 pacientes quienes tuvieron un aumento en el puntaje postoperatorio y hubo aumento del nivel de depresión. En el estudio 15 refirieron disfunción eréctil previo a la cirugía y únicamente 8 persistieron con disfunción luego de la cirugía. Conclusiones. Los pacientes con HBP constituyen una población en riesgo de padecer síntomas depresivos. Los síntomas depresivos están relacionados con padecer STUI y disfunción eréctil; ambas condiciones afectan la calidad de vida. El tratamiento quirúrgico para tratar la HPB es efectivo en disminuir los síntomas depresivos mejorando la calidad de vida causando mínimos efectos negativos.

Introduction: Benign Prostatic Hyperplasia (BPH) is a condition that leads to inferior urinary tract symptoms (1). These symptoms often cause a negative impact on the quality of life leading to depressive symptoms (7). Depressive symptoms are present in up to 22.5% of patients with BPH, however, there is limited evidence that these symptoms decrease with HPB treatment (5). A useful tool to measure depressive symptoms is the Hamilton Depression Rating Scale (HDRS) (3). Objective: Main purpose of the study is to assess the prevalence of depressive symptoms in patients with BPH and determine whether these symptoms decreased after a corrective surgery. Methods: A sample of 30 male patients, average age 67 ± 8 years old, with surgical treatment indication for BPH, with at least one depressive symptom according to the HDRS was obtained. Results: All patients in the study underwent transurethral resection of the prostate (TURP). Prior to surgery, depressive symptoms found in 76.6%. A month post-surgery depressive symptoms found in 28, however mild depression was present in 23.3% (vs pre-op 30%) moderate depression in 16.6% (vs pre-op 30.0%) and severe depression in 13.3% (vs pre-op 16.6%). Measurement with HDRS had a mean preoperative score 13.93 points; a post-surgery month the average score was 9.36. The difference was 4.56 points; which is statistically significant (P = 0.05). Three patients had surgical complications and they had an increase in postoperative score and also increased in the level of depression. In the study 15 patients reported erectile dysfunction prior to surgery; out of these patients only 8 persisted with dysfunction after surgery. Conclusions: BPH patients is a population at risk for developing depressive symptoms. Depressive symptoms are related to developing lower urinary tract symptoms and erectile dysfunction; both conditions affecting the quality of life. Surgery to treat BPH is effective in reducing depressive symptoms by improving the quality of life and with minimal adverse effects.

Analysis of serum insulin-like growth factor-1 and insulin-like growth factor binding protein-3 in patients with impaired glucose regulation and benign prostate hypertrophy / 实用医学杂志

Objective To study the relationship between IGF-1, IGFBP-3 and prostatic volume (PV) by examining the levels of insulin and insulin-like growth fator-1 (IGF-1) and insulin-like growth factor binding protein-3 ( IGFBP-3 ) and other indicators in patients with impaired glucose regulation and benign prostate hypertrophy. Methods According to 75 g oral glucose tolerance test (OGTT) results, 109 BPH patients aged over 50 years were divided into three groups: normal glucose tolerance (NGT) group (n = 56), impaired fasting glucose (IFG) group (n = 14), impaired glucose tolerance (IGT group, n = 39). The biochemical indicators and postatic hyperplasia related factors and IGF-1, GFBP-3 were measured. Results There were no statistical differences between the three groups in terms of blood lipids, homocysteine, urinary inhibition C, fasting insulin (FINS), glycosylated hemoglobin, IGF-1 and IGFBP-3 (P > 0.05). There were no significant differences between the groups in terms of PV, prostate specific antigen, the quality of life score and the international prostate symptom score (P > 0.05). Fasting plasma glucose and insulin resistance index (HOMA IR) were higher in IFG group than NGT group (P′ < 0.017) and IGT group (P′ < 0.017). 2-hour plasma glucose and 2-hour insulin were higher in IGT group than NGT group (P′ < 0.017) and IFG group (P′ < 0.017). PV was positively correlated with FINS but not correlated with IGF-1, IGFBP- 3 by multiple multiple step wise regression analysis. Conclusion Oyperinsulinemia is a risk factor in the development of BPH with IGR, and IGF-1 and IGFBP-3 are not associated with BPH risk. Further investigation is needed to elucidate the role of the IGF-1 and IGFBP-3 in BPH.