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Prostatic Enlargement (prostatic + enlargement)
Selected AbstractsMonocyte chemotactic protein-1 (MCP-1/CCL2) is associated with prostatic growth dysregulation and benign prostatic hyperplasiaTHE PROSTATE, Issue 5 2010Kazutoshi Fujita Abstract BACKGROUND Chronic inflammation is commonly observed in benign prostate hyperplasia (BPH), and prostate tissue often contains increased inflammatory infiltrates, including T cells and macrophages. Cytokines are not only key mediators of inflammation but may also play important roles in the initiation and progression of BPH. METHODS In order to determine what cytokines might be involved in prostatic enlargement, expressed prostatic secretions (EPS) from ex vivo prostates were analyzed by human cytokine antibody microarray and ELISA. Prostate epithelial cells (PrEC) and prostate stromal cells (PrSC) were used for ELISA, proliferation, and Western blot assays. RESULTS Monocyte chemotactic protein-1 (MCP-1/CCL2) was one of the most elevated proteins in secretions from large prostate glands. PrSC were found to secrete MCP-1; Western blotting showed that both PrSC and PrEC express the MCP-1 receptor CCR2 which by RT-PCR was the CCR2b isoform. Proliferation assays showed that MCP-1 stimulates the proliferation of PrEC, but not PrSC, and that a specific MCP-1 antagonist (RS102895) suppressed this effect. Conditioned medium from PrSC stimulated the proliferation of PrEC as well, an effect completely inhibited by both RS102895 and a neutralizing anti-MCP-1 monoclonal antibody. The inflammatory cytokines interleukin (IL)-1,, interferon-,, and IL-2 enhanced the secretion of MCP-1 from PrEC and PrSC. In addition, MCP-1 levels in EPS correlated with mRNA levels of the macrophage marker CD68 in the same secretions. CONCLUSIONS The cytokine MCP-1, of apparent prostatic stromal cell origin, may play an important role in prostatic enlargement and BPH, and is a candidate biomarker for these pathologic processes. Prostate 70: 473,481, 2010. © 2009 Wiley-Liss, Inc. [source] The impact of targeted training, a dedicated protocol and on-site training material in reducing observer variability of prostate and transition zone dimensions measured by transrectal ultrasonography, in multicentre multinational clinical trials of men with symptomatic benign prostatic enlargementBJU INTERNATIONAL, Issue 1 2007Philip S. Murphy OBJECTIVE To assess the variability of a standardized protocol of transrectal ultrasonography (TRUS), with targeted training, and compare it to the variability in other multicentre clinical trials, as TRUS-estimated total prostate volume (TPV) and transition zone volume (TZV) are considered important efficacy endpoints in assessing new drug therapies for benign prostatic enlargement (BPE), but standardizing TRUS remains a challenge in such studies. PATIENTS AND METHODS In all, 174 patients with BPE in the placebo arm of a 30-centre clinical trial were analysed at baseline, 13 and 26 weeks with TRUS, to extract TPV and TZV values. All TRUS operators received training in the standardized methods, which was supplemented at the outset by a compact disc-based video. RESULTS The mean (sd) changes from baseline in TPV at 13 and 26 weeks were ,,2.9 (8.9) and ,1.9 (8.5) mL, respectively; the respective mean changes from baseline in TZV were ,1.2 (6.4) and +,0.7 (7.8) mL. For TPV, 80% of the measurements had differences of +,5.2 to ,13.4 mL at 13 weeks, and +,8.0 to ,,10.9 mL at 26 weeks. For TZV, 80% of the differences were +,5.8 to ,,7.4 at 13 weeks, and +,9.3 to ,6.5 mL at 26 weeks. CONCLUSION The performance of TRUS compared favourably with similar published multicentre studies, which we suggest relates in part to the careful implementation of the protocol. We showed that diligent implementation of a detailed protocol, supplemented by targeted training of investigators and provision of on-site training material, promoted consistent acquisition and successful derivation of key clinical trial endpoints. Quantifying the variability of such endpoints will enable us to track deployment quality for future clinical trials, and will ensure that trials are sufficiently powered to define small changes in prostate size. [source] The 24-h frequency-volume chart in adults reporting no voiding complaints: defining reference values and analysing variablesBJU INTERNATIONAL, Issue 9 2004E.P. Van Haarst OBJECTIVE To determine the variables (e.g. voiding frequency, voided volumes, urine production) and their mutual relationships and differences between age groups and genders, using a frequency-volume chart (FVC) in an adult population (representing all age groups) who denied having any voiding complaints. SUBJECTS AND METHODS In all, 1152 men and women aged >,20 years completed a 24-h FVC; registration started with the first voided volume in the morning and concluded with the first voided volume the next morning. The time of voiding and volume were both recorded, and bedtime hours noted. Each participant claimed to have no voiding complaints. The statistical analysis was aimed at discerning the relationships between the FVC variables, gender and age. RESULTS There was a linear increase in mean 24-h voiding frequency and nocturia in men, from 6.0 and 0.5 in the third decade to 8.5 and 1.6 in those aged >,70 years. Contrary to men, in women the mean 24-h frequency declined slightly in the older decades; it increased from 6.9 in the third to 8.2 in the sixth, declining to 7.8 in those aged >,70 years. Nocturia in women increased linearly, although slower than in men, from 0.7 in the third decade to 1.4 in those aged >,70 years. The mean volume/void decreased significantly in both genders, from 313 to 209 mL in men, and from 274 to 240 mL in women. The mean 24-h volume was 1718 and 1762 mL in men and women, respectively. For both genders there was a strong linear association between 24-h urine production and voided volumes. CONCLUSION The volume/void and maximum voided volume decreased significantly with age in both sexes, but more prominently in men. As a result, in men the frequency increased with age, probably reflecting subclinical changes associated with the development of prostatic enlargement. In contrast to men the frequency in women increased initially and decreased in the older groups. A higher 24-h urine production was associated with a higher mean volume/void. [source] Comparative efficacy of two ,1 -adrenoreceptor antagonists, doxazosin and alfuzosin, in patients with lower urinary tract symptoms from benign prostatic enlargementBJU INTERNATIONAL, Issue 6 2004T.M. De Reijke OBJECTIVES To compare doxazosin and alfuzosin in patients with moderate to severe lower urinary tract symptoms (LUTS) suggestive of bladder outlet obstruction. PATIENTS AND METHODS In all, 210 men with LUTS were randomized to receive doxazosin 1,8 mg once daily or alfuzosin 5,10 mg divided in two or three daily doses in a 14-week, multicentre, double-blind, baseline-controlled, dose-titration study. The International Prostate Symptom Score (IPSS) and maximum urinary flow rate were used to assess the efficacy of the treatment. RESULTS At study completion, the mean dose of doxazosin was 6.1 mg/day and alfuzosin 8.8 mg/day. The least squares mean (se) change from baseline in total IPSS was ,9.23 (0.6) for doxazosin and ,7.45 (0.6) (both P < 0.001) for alfuzosin. The respective mean change from baseline in irritative symptoms was ,3.5 (0.2) and ,2.8 (0.3) (both P < 0.001). The differences between the treatment groups were statistically significant in favour of doxazosin (total IPSS, P = 0.036; irritative symptoms, P = 0.049). The improvement between groups was also significantly different for postvoid residual urine volume, at ,29.19 (8.6) and +,9.59 (8.9) mL for doxazosin and alfuzosin, respectively (P = 0.002). Improvements in mean and maximum urinary flow rates were similar for both treatments, at +,1.5 and +,1.2, and +,2.8 and +,2.5 mL/s, respectively. Doxazosin and alfuzosin were both well tolerated, with most all-cause adverse events reported as mild or moderate. CONCLUSIONS The mean doses of doxazosin and alfuzosin used in this study were not equipotent. Doxazosin 6.1 mg/day produced significantly greater improvements than alfuzosin 8.8 mg/day in total and irritative urinary symptom scores and postvoid residual urine volume in men with moderate to severe LUTS. Changes in maximum and mean flow rates were comparable. Doxazosin and alfuzosin were both well tolerated. [source] Preoperative urodynamic and symptom evaluation of patients undergoing transurethral prostatectomy: analysis of variables relevant for outcomeBJU INTERNATIONAL, Issue 4 2003O.W. Hakenberg OBJECTIVE To assess the value of preoperative symptom score assessment and pressure-flow measurement in men undergoing transurethral prostatectomy (TURP). PATIENTS AND METHODS In a prospective study, 95 men (mean age 74.3 years) scheduled for TURP because of their lower urinary tract symptoms, flow rates and urinary residual volumes were assessed using the self-administered International Prostate Symptom Score (IPSS) and urodynamic pressure-flow studies. At 3 months after TURP the patients were reassessed with a flow rate measurement and the IPSS. The baseline IPSS and urodynamic values were analysed with respect to the endpoints of the study, flow rate and IPSS after TURP, and the improvements thereof, respectively. RESULTS There were significant improvements in mean IPSS (, 10.87 points) and peak flow rate (+ 7.06 mL/s) 3 months after TURP. Classifying the patients into subgroups with distinctly different initial values for IPSS, flow rate, residual urine volume and degree of obstruction (as expressed by Abrams-Griffiths number) showed that the flow rate and degree of obstruction influenced the improvement in flow rate but not in symptoms after TURP. Symptom improvement was only related to the initial level of symptoms. In a multivariate analysis, only age was an independent predictor of the outcome variables of flow rate and symptoms. CONCLUSIONS Clinical decision-making remains a valid instrument for selecting patients for TURP. Both the IPSS and pressure-flow assessment are useful to exclude patients who are unlikely to benefit from TURP. Age is an important predictor of the improvement in symptoms and flow rates after TURP for the lower urinary tract symptom complex associated with benign prostatic enlargement. [source] A prospective study of conservatively managed acute urinary retention: prostate size mattersBJU INTERNATIONAL, Issue 7 2000V. Kumar Objective To evaluate in a prospective study the medium- to long-term outcome of a policy of conservatively managing acute urinary retention (AUR), arising solely by bladder outlet obstruction caused by benign prostatic enlargement (BPE), and to identify the factors favouring a positive outcome of a trial without catheter (TWOC). Patients and methods All men admitted as an emergency with primary AUR caused by BPE (from August 1997 to March 2000) underwent a TWOC. The following variables were recorded; the nature and duration of any preceding lower urinary tract symptoms, previous episodes of retention, concomitant anticholinergic medication, coexisting constipation, alcohol as a precipitating cause of AUR, previous prostatectomy, confirmed urinary tract infection, residual urine drained on catheterization and prostate size, as determined by a digital rectal examination (DRE) carried out by one consultant urologist in all patients. Those voiding successfully were followed up prospectively using the International Prostate Symptom Score (IPSS), quality-of-life score, urinary flow rate measurement and ultrasonographic measurement of the postvoid residual (PVR). Results Of the 40 men with AUR, 22 (55%) voided spontaneously after removing the catheter and continued to do so with mean peak flow rates of 12.2 mL/s and mean PVRs of 69.6 mL over a follow-up of 8,24 months. These patients remained asymptomatic, with a mean IPSS of 5.2 and quality-of-life score of 0.9. These men had a mean prostatic size of 15.9 g and a mean catheterized residual volume of 814 mL, while in those who had an unsuccessful TWOC the mean prostate size was 27.5 g (P = 0.006) and a mean catheterized residual volume of 1062 mL (P = 0.09). Prostate size as assessed by the DRE was the most significant factor in predicting the outcome of a TWOC. Conclusion A TWOC is justified in the long-term for men presenting with AUR caused by BPE. Prostate size is the most important factor for predicting the outcome of such a trial. [source] | ||||||||||