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Benign Prostatic Hyperplasia

Posted by admin on July 11th, 2011 No Comments

Definition Benign prostatic hyperplasia, a nearly ubiquitous condition, is the most common benign neoplasm of American men and occurs as a result of hormone-driven prostate growth. Pathophysiology The prostate gland comprises three types of tissue: epithelial or glandular, stromal or smooth muscle, and capsule. Both stromal tissue and capsule are embedded with О±1-adrenergic receptors. The precise pathophysiologic mechanisms that cause Benign prostatic hyperplasia are not clear. However, both intraprostatic dihydrotestosterone and type II 5 О±-reductase are thought to be involved. Benign prostatic hyperplasia commonly results from both static (gradual enlargement of the prostate) and dynamic (agents or situations that increase О±-adrenergic tone and constrict the gland's smooth muscle) factors. Examples of drugs that can exacerbate symptoms include testosterone, О±-adrenergic agonists (e.g., decongestants), anticholinergics (e.g., antihistamines, phenothiazines, tricyclic antidepressants, anticholinergic antispasmodics, Read more [...]

Posted in Benign Prostatic Hyperplasia

Prostatitis: Advanced Therapy

Posted by admin on June 21st, 2011 No Comments

Prostatitis is one of the most perplexing disease entities with which the practicing urologist must contend. Also, the treatment of this disease is the least gratifying in that the patients often are labeled as "crazy" and have a poor response. In many ways, there are some significant similarities with interstitial cystitis, and perhaps some of the patients with complaints of prostatitis actually have interstitial cystitis, as has been suggested. Indeed, many of the symptoms and physical findings are similar and are outlined in Table 71-1. As in the case of interstitial cystitis, prostatitis has also been difficult to study, being a disease that lacked a formal and specific definition. Therefore, the National Institute for Diabetes, Digestive, and Kidney Diseases (NIDDKD) convened a consensus group to define prostatitis, expressly for the purpose of describing the different prostatitis syndromes in such a way that they could be investigated, and ultimately treated, in a more efficacious fashion. These new definitions, while not being radically different from the old criteria, serve the purpose of Read more [...]

Posted in Prostatitis

Prevention of the Progression and Long-Term Complications of Benign Prostatic Hyperplasia

Posted by admin on June 21st, 2011 No Comments

Benign prostatic hyperplasia is a common condition in men, second only to cataract surgery as the most common reason for a surgical procedure among elderly men. In 1995, over 5.5 million men in the United States above the age of 50 years were estimated to meet criteria proposed for discussing therapy for benign prostatic hyperplasia according to treatment and diagnostic guidelines. The lifetime risk for medical or surgical intervention for benign prostatic hyperplasia in a 50-year-old man has been estimated at 40%. Benign prostatic hyperplasia represents a significant burden on health care, particularly in light of the aging of the general population. The three components of benign prostatic hyperplasia, namely palpable enlargement of the prostate, lower urinary tract symptoms (lower urinary tract symptoms), and obstruction, overlap to varying degrees in individual patients. Despite the high prevalence of benign prostatic hyperplasia, standard clinical diagnostic criteria are yet to be developed. This limits the ability to characterize the natural history in untreated patients, and to identify Read more [...]

Posted in Benign Prostatic Hyperplasia

Findings from Community Studies and Clinical Trials

Posted by admin on June 21st, 2011 No Comments

Symptoms It is well known that the prevalence of urinary symptoms increases with age. Based on cross-sectional community-based studies, age-related increases in the prevalence of lower urinary tract symptoms have been consistently found in numerous countries in studies using similar questionnaires, despite cross-cultural differences in the prevalence of moderate to severe symptoms. Few longitudinal studies have explored the progression of lower urinary tract symptoms by following untreated men over time. Recent longitudinal findings from the community-based Olmsted County Study of Urinary Symptoms and Health Status Among Men suggest a measurable progression in symptom severity, on average, over 3.5 to 4 years accompanied by high intraindividual variability The age-related changes found in this study were consistent with autopsy prevalence studies relating prostate volume to age. Another community study has also documented symptom progression over 3 years. Continued follow-up of such community-based cohorts of men should better characterize the rate of progression of urinary symptoms over longer Read more [...]

Posted in Benign Prostatic Hyperplasia

Long-Term Complications

Posted by admin on June 21st, 2011 No Comments

Untreated, benign prostatic hyperplasia may lead to complications such as acute or chronic urinary retention, renal failure, serious or recurrent urinary tract infections, bladder decompensation, hydronephrosis, and calculi, particularly bladder calculi. Few studies, however, have quantified the long-term risk of these complications. Several authors have reviewed the available literature on the incidence and risk of such complications in detail. Acute Urinary Retention and Associated Risk Factors Bladder outlet obstruction may progress to acute urinary retention, a painful, sudden inability to urinate. Many patients consider this to be the most serious outcome of untreated benign prostatic hyperplasia, and it often requires emergency medical attention. Some clinicians considered acute urinary retention to be an absolute indication for surgical intervention while others have proposed catheterization and a voiding trial.' The recurrence of acute urinary retention within 1 week of catheterization is high, however. The etiology of acute urinary retention is not well understood. Based on previous studies, Read more [...]

Posted in Benign Prostatic Hyperplasia

Pharmacologic Strategies for Prevention

Posted by admin on June 21st, 2011 No Comments

Alpha-Blockers Alpha-adrenergic blockers have been shown to rapidly alleviate symptoms and improve urinary flow rates in men with lower urinary tract symptoms but do not appear to alter the disease process in such a way as to prevent progression. Alpha-blockers may induce apoptosis in the prostate gland but longitudinal data do not show a measurable effect on prostate volume. Alpha-blockers have not been typically studied in long-term controlled trials, and there are therefore only limited data available on long-term effects on outcomes. Only two controlled studies longer than 3 months have reported on outcomes such as acute urinary retention or benign prostatic hyperplasia-related surgery; only one of these, the 1-year placebo-controlled HYCAT study, had a predefined objective of evaluating resource utilization although the high proportion of patients who discontinued the study (42%) and had no follow-up information limits interpretation. In HYCAT, no significant difference was found in the number of patients who underwent prostatectomy during the 1-year trial (48 in the placebo and 41 in the Read more [...]

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Chemoprevention of Cancer of the Prostate

Posted by admin on June 21st, 2011 No Comments

With a dramatic increase in the number of prostate cancers detected as a result of prostate-specific antigen screening and the resulting public focus on the disease, a lot of attention has been placed on how to respond to this public health threat. While the focus of the 1970s and early 1980s was the optimal management of metastatic disease, the recognition that the most promising advances (e.g., combined androgen deprivation for newly diagnosed metastatic disease and suramin for hormone-refractory disease) made little, if any, impact on the survival and often worsened morbidity, more emphasis has been placed on early detection, especially using prostate-specific antigen, and therapy. While it has been anecdotally observed that with the increased focus on early detection, there has been a concomitant fall in the rate of metastatic disease as well as in prostate cancer mortality, that these events were due to screening and treatment remains a subject of considerable debate. One item of consensus, however, regarding early detection and treatment is that morbidity and cost accrue from this approach. Read more [...]

Posted in Prostate Cancer

Opportunities for Chemoprevention

Posted by admin on June 21st, 2011 No Comments

Vitamin E The term "vitamin E" is used to refer to a group of naturally occurring substances that have vitamin E activity including a-, β-, δ-, and y-tocopherols (that have saturated side chains) and tocotrienols (that have unsaturated side chains). These agents have some degree of difference in biopotency with the naturally occurring d-a-tocopherol approximately 30% more potent than the synthetic forms — d- or d, l-a-tocopherol alone, acetate, or succinate. The principal food sources of vitamin E are vegetable and seed oils as well as alfalfa and lettuce. A primary function of vitamin E is as an antioxidant, interacting with free radicals (e.g., singlet oxygen, superoxide anion, organic peroxide radicals, hydrogen peroxide, and others) that are generated as a normal part of cellular metabolism. These free radicals can interact with cellular structures, primarily membranes, and lead to cellular damage, generally through lipid peroxidation. Over time, the oxidative stress in humans increases and, similarly, with aging, the endogenous antioxidant capability (from glutathione, vitamins A, C, Read more [...]

Posted in Prostate Cancer

Management of Complications of Therapy

Posted by admin on June 21st, 2011 No Comments

Management of Complications of Therapy: Erectile Dysfunction Erectile dysfunction is the inability to attain or maintain penile erection sufficient for vaginal intromission. In determining the true incidence of erectile dysfunction as a consequence of prostate cancer therapy, one must consider the total prevalence of erectile dysfunction in the age-matched population. Estimates of all degrees of severity of erectile dysfunction range from 40% in men 40 years of age to 70% in men in their seventies, and are associated with vascular risk factors such as cardiovascular and peripheral vascular disease, hypertension, diabetes, and cigarette smoking. One of the difficulties in isolating the incidence of erectile dysfunction due solely to the complications of prostate cancer therapy, therefore, is the increased incidence of erectile dysfunction associated with aging or concomitant vascular disease. Further, the distinctions between the ability to attain and maintain an erection sufficient for penetration and the patient's observations that "my erection is not as hard as it used to be" complicate assessment Read more [...]

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Gonadotropin Modulators

Posted by admin on May 10th, 2011 No Comments

Overview Chlormadinone acetate (Teikoku's Prostal/Prostal L) is the only gonadotropin modulator available for treating benign prostatic hyperplasia. It is used only in Japan, where finasteride and dutasteride are not approved. Potentially serious side effects (e.g., diarrhea, sexual dysfunction, liver toxicity) make agents in this class less desirable than less-toxic therapies, such as the 5-ARIs. However, new agents in development may offer effective therapeutic relief and an improved side-effect profile. Because of their mechanism of action, these agents could have a greater effect on disease symptoms and progression. Mechanism Of Action Current understanding of the etiology of benign prostatic hyperplasia has established hormonal changes as a major contributor to the enlargement of prostate tissue around the urethra. The control of androgen production in the testes is directly mediated by hypothalamic/pituitary hormones. Gonadotropin-releasing hormone (Gonadotropin-releasing hormone), also known as luteinizing hormone-releasing hormone (luteinizing hormone-releasing hormone), is secreted Read more [...]

Posted in Benign Prostatic Hyperplasia

Posts Tagged ‘Finasteride’

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