The thermal effect of lasers in urology: a review article.

Lasers as a technology have a leading role in the modern urological treatment armamentarium. In this article, the application of lasers in different areas of urology is described. The major uses are in urolithiasis, benign prostatic enlargement (BPE), and management of many urological malignancies and other benign pathologies. Lasers have become an established treatment modality in urolithiasis, an acceptable alternative with the least side effect profile in BPE patients, and a novel and promising therapy in many other fields of Urology.

COmparing Urolift and Standard Transurethral resection of prostate Ahead of Radiotherapy in men with urinary symptoms secondary to prostate enlargement in Southwest London and North Cumbria (CO-STAR): a study protocol for a randomised feasibility study.

INTRODUCTION: Patients undergoing prostate radiotherapy with an enlarged prostate can have short-term and long-term urinary complications. Currently, transurethral resection of the prostate (TURP) is the mainstay surgical intervention for men with urinary symptoms due to an enlarged prostate prior to radiotherapy. UroLift (NeoTract, Pleasanton, CA, USA) is a recent minimally invasive alternative, widely used in benign disease but is untested in men with prostate cancer. METHODS AND ANALYSIS: A multicentre, two-arm study designed in collaboration with a Patient Reference Group to assess the feasibility of randomising men with prostate cancer and coexisting urinary symptoms due to prostate enlargement to TURP or UroLift ahead of radiotherapy. 45 patients will be enrolled and randomised (1:1) using a computer-generated programme to TURP or UroLift. Recruitment and retention will be assessed over a 12 month period. Information on clinical outcomes, adverse events and costs will be collected. Clinical outcomes and patient reported outcome measures will be measured at baseline, 6 weeks postintervention and 3 months following radiotherapy. A further 12 in-depth interviews will be conducted with a subset of patients to assess acceptability using the Theoretical Framework of Acceptability. Descriptive analysis on all outcomes will be performed using Stata (StataCorp V.2021). ETHICS AND DISSEMINATION: The trial has been approved by the Research Ethics Committee (REC) NHS Health Research Authority (HRA) and Health and Care Research Wales (HCRW). The results will be published in peer-reviewed journals, presented at national meetings and disseminated to patients via social media, charity and hospital websites. TRIAL REGISTRATION NUMBER: NCT05840549.

Permanent interstitial brachytherapy for prostate cancer implementing neoadjuvant prostatic artery embolization.

PURPOSE: Indication for permanent interstitial brachytherapy (PIB) can be limited by prostate volume, commonly decreased using neoadjuvant hormonal therapy. Volume changes and initial clinical results focusing on patients treated with prostatic artery embolization (PAE) were evaluated in this study. METHODS AND MATERIALS: A group of 102 consecutive patients were treated with permanent interstitial brachytherapy (PIB), 13 patients received a neoadjuvant PAE (median 12 weeks before PIB) in case of large prostate volume >60 cm³, and moderate to severe urinary problems. RESULTS: Patients after PAE were treated with significantly larger prostate volumes (52 ± 11 cm³ vs. 39 ± 11 cm³; p < 0.01; 66 ± 17 cm³ before PAE), but larger volume reductions to 44 ± 10 cm³ versus 35 ± 10 cm³ was found at day 30 (p < 0.05). International Prostate Symptom Score (IPSS) decreased significantly from 13 ± 5 before PAE to 7 ± 4 after PAE; p < 0.01. Initial PSA and first PSA after PIB were similar for patients with versus without PAE (5.9 ± 2.9 ng/mL vs. 6.2 ± 2.8 ng/mL and 1.5 ± 0.8 ng/mL vs. 1.9 ± 1.5 ng/mL). However, PSA 12 months after PIB was significantly lower after PAE (0.4 ± 0.3 ng/mL vs. 0.8 ± 0.6 ng/mL; p = 0.03). Four patients without prior PAE needed an intervention after urinary retention - transurethral resection of the prostate (TURP) in three cases and PAE in a single case. Urinary incontinence resulted in two cases after TURP. CONCLUSIONS: PAE could be successfully applied to decrease prostate volume and reduce urinary symptoms before PIB or as a treatment for urinary retention after PIB. A significantly lower PSA is promising for improved long-term cancer control.

Prostate enucleation, better with low or high-power holmium laser? A systematic review / Enucleación prostática, de alta y baja potencia con laser holmium. Revisión sistemática

OBJECTIVE: To assess current efficacy and safety of low power HoLEP (Holmium Laser Enucleation of the Prostate) for the treatment of obstructing and symptomatic prostatic adenomas and to identify the mechanisms supporting the related clinical advantages. METHODS: A systematic review was conducted using relevant databases (Ovid Medline, PubMed, Scopus and Web of Sciences), employing ("low power" OR "high power") AND ("HoLEP" OR "holmium laser enucleation of the prostate") as search terms. Inherent publications were selected according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Additionally, the reference lists of the selected papers were checked manually. RESULTS: We included any kind of study (n=15) dealing with low power HoLEP because of the scarcity of the results obtained with the bibliographic search. Low power HoLEP seems to be fully comparable to the traditional high power HoLEP in terms of feasibility, efficacy and safety. An additional clinical advantage of the low power approach might be the reduced incidence of postoperative dysuria, with limited intensity and duration, possibly due to the decreased amount of energy delivered to the capsular plane with a less aggressive modality, conjugated with appropriate technical enucleative choices. The physical rationale of low power HoLEP is discussed. CONCLUSIONS: Low power HoLEP is feasible, safe and effective, and might play a not exclusive role in the reduction of incidence, intensity and duration of postoperative dysuria

OBJETIVO: Determinar la eficacia y seguridad de el holmium de baja potencia en el tratamiento de adenomas prostáticos obstructivos y identificar los mecanismos de soporte relacionados con las ventajas clínicas. MÉTODOS: Una revisión sistemática utilizando las bases de datos más relevantes fue conducida (Ovid Medline, PubMed, Scopus and Web of Sciences). Se utilizaron alta y baja potencia y HOLEP como palabras de búsqueda. Las publicaciones fueron seleccionadas según PRISMA. RESULTADOS: Se incluyó cualquier estudio (n=15) relacionado con baja potencia HOLEP dados los pocos resultados obtenidos con la búsqueda. HOLEP de baja potencia para ser totalmente comparable al HOLEP tradicional de alta potencia en términos de eficacia y seguridad. Una ventaja clínica adicional del de baja potencia es que parece reducir la disuria postoperatoria con intensidad limitada y de más corta duración, probablemente debido a la menor energía recibida por la capsula prostática, así como por el uso conjugado de las técnicas enucleación correctas. El racional para el HOLEP de baja potencia se discutirá en el manuscrito. CONCLUSIONES: El HOLEP de baja potencia es seguro y efectivo y parece reducir la incidencia, intensidad y duración de la disuria postoperatoria

RADIATION DOSES TO ANAESTHETISTS DURING PROSTATIC ARTERY EMBOLIZATION INTERVENTIONAL PROCEDURES.

The objective of this study was to assess the radiation doses received by anaesthetists from prostatic artery embolization (PAE) procedures. Ten PAE procedures conducted in a reference hospital in the city of Recife, Brazil were investigated. Occupational dosimetry was performed using thermoluminescent dosemeters which were located next to the eyes, close to the thyroid (over the shielding), on the thorax (under the apron), on the wrist and on the feet of the physician's body. The results showed that the anaesthetist's feet received the highest doses followed by the eyes and the hands. In some complex PAE procedures the doses received by anaesthetists on the lens of the eyes and the effective dose were higher than those received by the main operator due to the anaesthetist's close position to the patient's table and the use of oblique projections. The personal dose equivalent Hp(3) per procedure for the anaesthetist's right eyebrow ranged from 20.2 µSv to 568.3 µSv. This result shows that anaesthetists assisting PAE procedures can exceeds the annual eye lens dose limit of 20 mSv recommended by the ICRP with only one procedure per week if radiation protection measures are not implemented during procedures.

Safety and Effectiveness of Holmium Laser Enucleation of the Prostate Using a Low-power Laser.

OBJECTIVE: To assess the safety and effectiveness of holmium laser enucleation of the prostate (HoLEP) using a low-power 30-W holmium laser with an en bloc enucleation technique. MATERIALS AND METHODS: We retrospectively analyzed 74 patients with a diagnosis of benign prostatic hyperplasia treated with HoLEP using a 30-W laser set at 1.5 J with a frequency of 20 Hz, as a low-power setting. The enucleation process was performed using the en bloc technique. Forty-four patients were operated on by an experienced surgeon, whereas 30 patients were operated on by 2 less experienced surgeons. We evaluated the surgical parameters and practicality of the low-power laser. RESULTS: All patients underwent successful HoLEP with the low-power setting; it was not necessary to increase the output of the laser in any case. Mean preoperative estimated prostate volume was 94.5 mL (range 22-489 mL). Mean total operating time and enucleation time were 91.9 minutes (range 30-232 minutes) and 45.4 minutes (range 13-101 minutes), respectively. No patient required blood transfusion postoperatively. Other intraoperative complications, including capsular perforation and ureteral orifice injury, did not occur. In 55 patients without preoperative stress urinary incontinence (SUI), postoperative SUI was observed in 7 patients (12.7%) at 1 month postoperatively, and in 3 patients (5.5%) at 3 months postoperatively. CONCLUSION: HoLEP using a low-power 30-W holmium laser can be performed safely and without any technical problems; this low-power setting is thought to be sufficient for performing HoLEP. As the introduction costs can be reduced by using a low-power laser, HoLEP could become widespread.

Enucleación con láser de tulio (ThuLEP) frente a resección transuretral de la próstata en solución salina (TURis): un ensayo prospectivo aleatorizado para comparar resultados intra y postoperatorios tempranos / Thulium laser enucleation (ThuLEP) versus transurethral resection of the prostate in saline (TURis): A randomized prospective trial to compare intra and early postoperative outcomes

Objetivo: Comparar los resultados clínicos intra y postoperatorios tempranos entre la enucleación transuretral con láser de tulio de la próstata (ThuLEP) y la resección bipolar transuretral de la próstata (TURis) para el tratamiento de la hiperplasia prostática benigna (HBP) en un ensayo prospectivo aleatorizado. Métodos: El estudio aleatorizó a 208 pacientes consecutivos con HBP a ThuLEP (n = 102) o TURis (n = 106). Para todos los pacientes se evaluaron preoperatoriamente en cuanto a pérdida de sangre, tiempo de cateterización, volumen de irrigación, estancia hospitalaria y tiempo operatorio. A los 3 meses después de la cirugía también fueron evaluados por la International Prostate Symptom Score (IPSS) el flujo máximo (Qmáx) y el volumen de residuo posmiccional (RPM). Resultados: Los pacientes en cada brazo de estudio no mostraron diferencias significativas en los parámetros preoperatorios. En comparación con TURis, ThuLEP tuvo el mismo tiempo quirúrgico (53,69±31,44 vs 61,66±18,70min; p = 0,123), pero resultó en menos disminución de la hemoglobina (0,45 vs 2,83g/dl, p = 0,005). ThuLEP también necesitó menos tiempo de cateterización (1,3 vs 4,8 días, p = 0,011), volumen de irrigación (29,4 vs 69,2l; p = 0,002) y estancia hospitalaria (1,7 vs 5,2 días, p = 0,016). Durante los 3 meses de seguimiento, los procedimientos no demostraron una diferencia significativa en Qmáx, IPSS, RPM y ECDV. Conclusión: ThuLEP y TURis alivian los síntomas del tracto urinario inferior igualmente, con alta eficacia y seguridad. ThuLEP fue estadísticamente superior a TURis en la pérdida de sangre, el tiempo de cateterización, el volumen de irrigación y la estancia hospitalaria. Sin embargo, los procedimientos no difirieron significativamente en Qmáx, IPSS, RPM y ECDV a través de 3 meses de seguimiento

Objective: To compare clinical intra and early postoperative outcomes between thulium laser transurethral enucleation of the prostate (ThuLEP) and transurethral bipolar resection of the prostate (TURis) for treating benign prostatic hyperplasia (BPH) in a prospective randomized trial. Methods: The study randomized 208 consecutive patients with BPH to ThuLEP (n = 102) or TURis (n = 106). For all patients were evaluated preoperatively with regards to blood loss, catheterization time, irrigation volume, hospital stay and operative time. At 3 months after surgery they were also evaluated by International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), and postvoid residual urine volume (PVR). Results: The patients in each study arm each showed no significant difference in preoperative parameters. Compared with TURIS, ThuLEP had same operative time (53.69±31.44 vs 61.66±18.70 minutes, P = .123) but resulted in less hemoglobin decrease (0.45 vs 2.83g/dL, P = .005). ThuLEP also needed less catheterization time (1.3 vs 4.8 days, P = .011), irrigation volume (29.4 vs 69.2 L, P = .002), and hospital stay (1.7 vs 5.2 days, P = .016). During the 3 months of follow-up, the procedures did not demonstrate a significant difference in Qmax, IPSS, PVR, and QOLS. Conclusion: ThuLEP and TURis both relieve lower urinary tract symptoms equally, with high efficacy and safety. ThuLEP was statistically superior to TURis in blood loss, catheterization time, irrigation volume, and hospital stay. However, procedures did not differ significantly in Qmax, IPSS, PVR, and QOLS through 3 months of follow-up

UroLift in Place of Fiducial Markers for Patients With Benign Prostatic Hyperplasia Undergoing External Beam Radiation Therapy.

OBJECTIVE: To investigate if using a novel treatment for obstructive benign prostatic hyperplasia (UroLift) to relive lower urinary tract symptoms (LUTS) prior to external beam radiotherapy (EBRT) could also supplant the use of fiducial markers obviating the need for a second transrectal procedure while facilitating symptom-free voiding during and after EBRT a series of patients are reported on. METHODS: The medical records of 7 consecutive patients who underwent placement of UroLift for simultaneous treatment of obstructive LUTS due to benign prostatic hyperplasia and targeting of EBRT for treatment of prostate cancer between September and December of 2015 were reviewed. RESULTS: The UroLift clips were sufficiently radiopaque to make targeting possible for EBRT. All patients were able to complete a full course of radiotherapy without placement of fiducial markers. No patient experienced complications that could be attributed to the UroLift implants or procedure during their course of radiotherapy. None of the patients required additional alpha-blockers during radiation therapy. CONCLUSION: The UroLift system can serve as fiducial markers in patients undergoing EBRT. Although the current clip utilized in the UroLift system is generally radiopaque, it does not project well on the sagittal plane and would be significantly enhanced if a more strongly opaque substance was incorporated. It remains to be proven if the UroLift system can significantly reduce the symptoms of LUTS during and post EBRT.

[Pilot results of prostatic adenoma treatment with diode laser Medilas D UroBeam in the Ukraine].

Pilot results of prostatic adenoma treatment with diode laser (940 nm) in 94 patients showed high efficacy of laser vaporization of the prostate. The effect was achieved in all the patients in minimal number of complications and in satisfactory tolerance of the surgery. Laser vaporization has some advantages over standard treatment (TUR) and is a method of choice in small and middle-size adenomas. In large adenoma good results were obtained in combination of laser vaporization with bipolar TUR.

Effects of pulsed electromagnetic fields on benign prostate hyperplasia.

INTRODUCTION: Benign prostate hyperplasia (BPH) has been treated with various types of electromagnetic radiation methods such as transurethral needle ablation (TUNA), interstitial laser therapy (ILC), holmium laser resection (HoLRP). In the present study, the effects of a noninvasive method based on the exposure of patients with BPH to a pulsative EM Field at radiofrequencies have been investigated. MATERIALS AND METHODS: Twenty patients with BPH, aging 68-78 years old (y.o), were enrolled in the study. Patients were randomly divided into two groups: the treatment group (10 patients, 74.0 ± 5.7 y.o) treated with the α-blocker Alfusosin, 10 mg/24 h for at least 4 weeks, and the electromagnetic group (10 patients, 73.7 ± 6.3 y.o) exposed for 2 weeks in a very short wave duration, pulsed electromagnetic field at radiofrequencies generated by an ion magnetic inductor, for 30 min daily, 5 consecutive days per week. Patients of both groups were evaluated before and after drug and EMF treatment by values of total PSA and prostatic PSA fraction, acid phosphate, U/S estimation of prostate volume and urine residue, urodynamic estimation of urine flow rate, and International Prostate Symptom Score (IPSS). RESULTS: There was a statistically significant decrease before and after treatment of IPSS (P < 0.02), U/S prostate volume (P < 0.05), and urine residue (P < 0.05), as well as of mean urine flow rate (P < 0.05) in patients of the electromagnetic group, in contrast to the treatment group who had only improved IPSS (P < 0.05). There was also a significant improvement in clinical symptoms in patients of the electromagnetic group. Follow-up of the patients of this group for one year revealed that results obtained by EMFs treatment are still remaining. CONCLUSION: Pulsed electromagnetic field at radiofrequencies may benefit patients with benign prostate hyperplasia treated by a non-invasive method.

Three-dimensional conformal radiation therapy of spontaneous benign prostatic hyperplasia in canines.

The purpose of this study was to determine the effect and possible mechanism of three-dimensional conformal stereotactic radiation therapy (3D-CRT) for the treatment of spontaneous benign prostatic hyperplasia (BPH) in a canine model. Eight canines (7-15 years old) with spontaneous benign prostatic hyperplasia (prostate volume >18 cm3) were used as experimental models. The prostates were directly exposed to 3D-CRT at a total dose of 14 Gy. Serum prostate-specific antigen (PSA) and prostate acid phosphatase (PAP), prostate volume (measured by transrectal ultrasound), apoptosis index [AI, measured by terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL)], proliferation index [PI, measured by proliferating cell nuclear antigen (PCNA) expression], alpha-SMA, Bax, and bFGF were measured before and after radiation therapy. Histopathology of the prostate, rectum, and bladder tissue was also examined before and after irradiation. 3D-CRT treatment significantly decreased prostate volume, and the PI, PSA, and alpha-SMA, but significantly increased the AI, and had no effect on PAP. There was no evidence of Bax expression before or after irradiation. Irradiation led to no detectable symptoms of diarrhea or changes in stool, but did lead to minor bladder injury, based on light microscopy, scanning electron microscopy, and transmission electron microscopy. In our canine model, 3D-CRT is an effective, noninvasive treatment of BPH that is associated with minimal side effects. Our treatment appeared to reduce prostate size by treatment of the underlying pathological processes.

Láser de diodo-980 mm de alta potencia: resultados preliminares en el tratamiento de la hiperplasia benigna de próstata / High power 980 NM Diode Laser: preliminary results in the treatment of benign prostatic hyperplasia

OBJETIVO: Evaluar clínicamente la utilización de un láser de diodo de 980 nm en el tratamiento de la uropatía obstructiva infravesical secundaria a hiperplasia benigna de próstata (HBP), poniendo énfasis en la morbilidad perioperatoria y los resultados en un seguimiento a corto plazo.MÉTODOS: Quince pacientes fueron incluidos en el estudio. Todos fueron evaluados mediante los cuestionarios IPSS y de calidad de vida (CV), tacto rectal, PSA, ecografía y flujometría. Se procedió a la vaporización prostática con un láser de diodo de 980 nm (120 W; Intermedic; Barcelona, España) utilizando una fibra de disparo lateral de 600 micras. En el seguimiento se recogió cualquier incidencia, así como la puntuación en los cuestionarios IPSS y CV así como en el pico de flujo máximo.RESULTADOS: La edad media de los pacientes fue de 66,7 años (45-75). El rango del volumen prostático fue 20-76 cc (media 41,3 cc). La media de energía utilizada fue de 161,012 kJ (78,3-243). Ningún paciente presentó una pérdida hemática significativa ni síndrome de absorción líquida. En todos los casos se colocó un catéter uretral 22F que se retiró entre las 12-40 horas postoperatorias. Tras un seguimiento medio de 5,5 meses (2-9), la puntuación media en el cuestionario IPSS y en el de CV variaron, respectivamente, de una media de 22,4 (19-26) y de 3 (2-4) previa a la intervención, hasta una media de 6,8 (1-13) (p<0,01) en el cuestionario IPSS y de 1,4 (0-3) en el de CV al final del seguimiento (p<0,01). De igual modo, el flujo máximo se incrementó de 6,4 ml/s (5-11,9) en el preoperatorio a 19,7 ml/s (13,9-24) en el postoperatorio (p<0,01).Ningún paciente presenta incontinencia. No se ha requerido la repetición del procedimiento, si bien tres pacientes precisaron un sondaje transitorio en las primeras 48h (dos de los pacientes eran portadores de sonda vesical antes del tratamiento)(AU)

CONCLUSIONES: Nuestros resultados preliminares sugieren que la vaporización prostática con láser de diodo de 980 nm utilizando potencias de hasta 120 W es efectiva y asociada a escasa morbilidad(AU)

OBJECTIVES: A clinical evaluation of the use of a 980 nm diode laser in the treatment of bladder outlet obstruction secondary to benign prostatic hyperplasia (BPH), focused on perioperatory morbidity and results in a short-term follow-up.METHODS: Fifteen patients were included in the study. All of them were evaluated by IPSS and Quality of Life (QoL) questionnaires, digital rectal examination, PSA, ul-trasound scan and uroflowmetry. Prostate vaporization was performed with a laser of diode at 980 nm (Inter-medic; Barcelona, Spain) using a 600 microns side-fire fiber. In the follow-up any event was recorded, as well as the IPSS and QoL scores and Qmax.RESULTS: Mean age of the patients was 66.7 years(45-75). The range of prostate volume was 20-76 cc (median 41.3 cc). Mean delivered energy was 161,012 kJ (78,3-243). No patient showed either a significant hematic loss or fluid absorption syndrome. A 22F urethral three-way catheter was inserted and removed between 12-40 hours in the postoperatory period. After a mean follow-up of 5,5 months (2-9) the average IPSS and QOL questionnaires scores changed, respectively, from 22,4 (19-26) and from 3 (2 -4) to an average of 6,8 (1 – 13) (p<0,01) and 1,4 (0 – 3), respectively, at the end of follow-up (p <0,01). Qmax increased from 6,4 ml/s (5-11,9) baseline to 19,7 ml/s (13,9-24 (p <0,01). No patient showed urinary incontinence. Retreatment was not nee-ded though three patients needed a short-time catheterization (24 hours) after developing acute urinary retention in the first 48h hours.CONCLUSIONS: Our preliminary results suggest that prostate vaporization using 980 nm diode laser with output power up to 120 W, is effective and associated to minimal morbidity(AU)

Prostate stem cells and benign prostatic hyperplasia.

Pharmacological approaches are available to medically-managed patients with symptomatic BPH before surgical intervention is required. These include daily treatment with alpha-blockers and 5-alpha-reductase inhibitors alone or in combination. These medical approaches have two major problems. First, treatments are chronic and must be taken daily. Second, there are significant financial costs and quality of life issues for such chronic treatments. Is it possible to develop effective acute therapy for symptomatic BPH without the long-term androgen deprivation-induced side effects? Two seminal but rarely cited studies of Walsh [Peters, Walsh: N Engl J Med 317:599-604, 1987] and Coffey et al. [Sufrin et al.: Invest Urol 13:418-423, 1976], combined with the growing understanding of the stem cell organization of the prostate stromal (S) and epithelial (E) compartments and their reciprocal paracrine and autocrine interactions provides the rationale for an acute approach.The Walsh study documents that: (1) androgen deprivation disrupts the reciprocal interaction between the prostate S and E thereby decreasing the weight of both compartments and (2) once BPH develops, androgen deprivation does not decrease the number of stem cell units in either the S or E compartments since subsequent androgen restoration fully restores the enlarged gland. The Coffey study documents that acute androgen deprivation sensitizes S-E interactions to radiation induced disruptions so that following radiation, androgen restoration does not induce full gland regrowth. Therefore, effective therapy for symptomatic BPH should be achievable by acute treatment with reversible androgen deprivation for a limited period followed by a single dose of conformal external beam radiation before allowing the man to recovery his normal serum testosterone.

[Effect and safety of transrectal 137 CS gamma-rays in the treatment of benign prostatic hyperplasia].

OBJECTIVE: To evaluate the effect and safety of transrectal 137Cs gamma-ray therapy for benign prostatic hyperplasia. METHODS: Thirty cases of BPH were treated by transrectal 137Cs gamma-rays. RESULTS: After 6 months there was significant improvement in the maximum urine flow, IPSS and QOL (P < 0.05). But no significant changes were observed in the prostate volume and residual urine (P > 0.05). CONCLUSION: Transrectal 137Cs gamma-ray therapy is safe and effective in the treatment of BPH.

Cell death mechanisms associated with G2 radiosensitivity in patients with prostate cancer and benign prostatic hyperplasia.

Cells respond to genotoxic insults such as ionizing radiation by halting in the G2 phase of the cell cycle. Delayed cell death (mitotic death) can occur when the cell is released from G2, and specific spindle defects form endopolyploid cells (endoreduplication/tetraploidy). Enhanced G2 chromosomal radiosensitivity has been observed in many cancers and genomic instability syndromes, and it is manifested by radiation-induced chromatid aberrations observed in lymphocytes of patients. Here we compare the G2 chromosomal radiosensitivity in prostate patients with benign prostatic hyperplasia (BPH) or prostate cancer with disease-free controls. We also investigated whether there is a correlation between G2 chromosomal radiosensitivity and aneuploidy (tetraploidy and endoreduplication), which are indicative of mitotic cell death. The G2 assay was carried out on all human blood samples. Metaphase analysis was conducted on the harvested chromosomes by counting the number of aberrations and the mitotic errors (endoreduplication/tetraploidy) separately per 100 metaphases. A total of 1/14 of the controls were radiosensitive in G2 compared to 6/15 of the BPH patients and 15/17 of the prostate cancer patients. Radiation-induced mitotic inhibition was assessed to determine the efficacy of G2 checkpoint control in the prostate patients. There was no significant correlation of G2 radiosensitivity scores and mitotic inhibition in BPH patients (P = 0.057), in contrast to prostate cancer patients, who showed a small but significant positive correlation (P = 0.029). Furthermore, there was no significant correlation between G2 radiosensitivity scores of BPH patients and endoreduplication/ tetraploidy (P = 0.136), which contrasted with an extremely significant correlation observed in prostate cancer patients (P < 0.0001). In conclusion, cells from prostate cancer patients show increased sensitivity to the induction of G2 aberrations from ionizing radiation exposure but paradoxically show reduced mitotic indices and aneuploidy as a function of aberration frequency.

Effect of beta radiation on TGF-beta1 and bFGF expression in hyperplastic prostatic tissues.

AIM: To investigate the transforming growth factor beta1 (TGF-beta1) and basic fibroblast growth factor (bFGF) expressions in benign prostatic hyperplasia (BPH) and the effect of beta-radiation. METHODS: TGF-beta1 and bFGF expression was studied by means of an immunohistochemical method in nine normal prostatic (NP) tissues, 15 hyperplastic prostatic tissues and 35 hyperplastic prostatic tissues treated with 90Sr/90Y. RESULTS: The TGF-beta1 expression in the epithelium and stroma of normal prostatic tissues was 68.2 % +/- 10.5 % and 29.7 % +/- 4.6 %, respectively, while it was 64.8 % +/- 9.3 % and 28.6 % +/- 4.1 %, respectively, in hyperplastic prostatic tissues. Compared with the controls, TGF-beta1 expression in the epithelia and stroma of BPH treated with 90Sr/90Y increased significantly (P <0.01). The bFGF expression in epithelia and stroma of normal prostatic tissues was 17.4 % +/- 3.7 % and 42.5 % +/- 6.8 %, respectively, and was 46.3 % +/- 8.2 % and 73.2 % +/- 12.1 %, respectively, in hyperplastic prostatic tissues. Compared with the controls, expressions of bFGF in the epithelia and stroma of BPH treated with a 90Sr/90Y prostatic hyperplasia applicator decreased significantly (P <0.01). CONCLUSION: Exposure of beta-rays had noticeable effects on BPH tissues, enhancing TGF-beta1 expression and inhibiting bFGF expression.

[Changes in prostatic circulation in response to laser therapy and magnetic therapy in patients with benign prostatic hyperplasia].

The results of preoperative preparation were analysed in 59 patients with prostatic benign hyperplasia (PBH) subjected to TUR. Treatment outcomes were assessed by transrectal ultrasound (color Doppler mapping) in two groups of patients. Group 1 received combined therapy including transrectal laser radiation of the prostate, group 2--transrectal magnetotherapy. The analysis showed that laser radiation reduced insignificantly the size of the prostate and adenomatous node, improved microcirculation and circulation in the prostate. This resulted in relief of inflammation and reduction of the number of postoperative inflammatory complications. Transrectal magnetotherapy has a positive effect on vascularization and hemodynamics of the prostate, local immunity, contamination of the tissues with pathogenic flora.