PSA density is associated with BPH cellular composition

BACKGROUND

Current AUA guidelines recommend 5 alpha reductase inhibitor (5ARI) treatment for patients with obstructive benign prostatic hyperplasia (BPH) that display prostate volume ≥30 cc and total prostate specific antigen (PSA) ≥1.5 ng/ml. However, BPH is highly pleomorphic and response to 5ARIs is highly variable. An understanding of cellular composition based on a noninvasive PSA density test could lead to improved clinical decision making.

METHODS

The histological composition of 307 BPH specimens was scored by a pathologist for stromo-glandular content and associated with total PSA, prostate volume, PSA density and other clinical variables using univariate and multivariate linear regression.

RESULTS

The percentage of glandular composition in prostates of 5ARI-naïve men was positively and independently associated with PSA and PSA density. It was determined through statistical modeling that a PSA density ≤0.05 ng/ml2 associated with a glandular composition of ≤30% with 76% sensitivity.

CONCLUSIONS

PSA density could provide a decisive variable for estimating BPH cellular content and may eventually improve selection of patients for 5ARI treatment. Further work is needed to demonstrate that patients with higher glandular content are more responsive to 5ARI treatment.

5-Alpha Reductase Inhibitor Use and Prostate Cancer Prevention: A Victim of the Times?

Vaselkiv and colleagues present strong evidence of the long-term safety of 5-alpha reductase inhibitor (5-ARI) use. They demonstrated no association with developing advanced prostate cancer, nor dying of prostate cancer. This commentary covers the strengths and weaknesses of the article, and highlights the long and vacillating journey 5-ARIs and prostate cancer prevention have traveled. As 5-ARIs preferentially prevent low-grade prostate cancer, a fact confirmed in the study by Vaselkiv and colleagues, this commentary highlights how 5-ARI chemoprevention may be irrelevant now. With increasing use of active surveillance for low-grade prostate cancers found, and prebiopsy MRI and biomarkers shifting focus to only find those clinically significant cancers, it maybe that 5-ARIs are a victim of the times in their chemoprevention role. See related article by Vaselkiv et al., p. 1460.

[Chemoprevention for Prostate Cancer-The Potential of Angiotensin Ⅱ Receptor Blocker]

In Japan, the incidence of prostate cancer(Pca)has been increasing mainly due to the early detection system by PSA screening. Considering pharmacoepidemiology, the statins and metformin have been recognized to lower the risk of incidence of Pca. Excessive intake of calcium, multivitamin and vitamin E increased the Pca risk. The 5-alpha-reductase inhibitors( 5ARIs)are widely used in the treatment of benign prostatic hyperplasia(BPH)by biological function of inhibiting the conversion from testosterone to dihydrotestosterone. A systematic review and meta-analysis identified that 5ARIs had no impact on overall mortality and Pca-related mortality, nor on high-grade Pca diagnosis. The use of anti-hypertensive drugs was reportedly associated with an increasing risk of Pca. However, as an effect of post diagnostic use of anti-hypertensive drugs, angiotensin Ⅱ receptor blockers(ARBs)was associated with improved overall survival and cause specific survival, which means the second chemoprevention potential for Pca. Our previous investigation demonstrated ARBs can suppress the expression of androgen receptor and affect the proliferative signal transduction system in Pca cells. Based on additional data of our experiment, we confirmed the anti-tumor effect of ARBs for Pca, and further clinical trials to make sure the chemoprevention for pre-diagnostic Pca is needed in future.

Prostate cancer specific mortality after 5α-reductase inhibitors medication in benign prostatic hyperplasia patients: systematic review and meta-analysis

BACKGROUND

Our study was conducted to investigate the effect of 5-ARI on the death rate from prostate cancer by means of an updated meta-analysis using related data.

METHODS

We did comprehensive literature searches using the PubMed, Embase, and Cochrane databases through July 2019. We evaluated the risk of bias in such studies using the ROBINS-I tool and analyzed deaths from cancer and deaths from all causes using HR.

RESULTS

The meta-analysis included 11 studies. The pooled overall HRs for cancer-specific deaths between 5-ARI treatment versus non-exposed groups were 0.937 (95% CI: 0.730, 1.201). In the subgroup moderator analysis, the number of patients and additional medication variables were significantly associated with deaths from all causes (p = 0.022 and p = 0.005, respectively). For detecting the publication bias or small-study effect in the included studies, we performed Begg and Mazumdar's correlation test (0.851 and 0.573) and Egger's regression coefficient test (0.035 and 0.245) and ​suggested that there was no evidence of publication bias or small-study effect in this meta-analysis.

CONCLUSIONS

Our study indicated that exposure to 5-ARI had no close association between the overall death rate or cancer-specific deaths. To confirm these results, well-designed prospective studies with large samples are required.

Linh Phu Khang Tue Tinh inhibited prostate proliferation in rats induced benign prostatic hyperplasia by testosterone propionate

ETHNOPHARMACOLOGICAL RELEVANCE

Benign prostatic hyperplasia (BPH) is the hyperproliferation of the stromal and the epithelial cells within the prostatic transition zone. In recent years, phytotherapy have been studied with the concern for increasing quality of life, improving lower urinary tract symptoms (LUTS) as well as reducing prostate volume and the frequency of adverse events was similar to that of placebo. Linh Phu Khang Tue Tinh (LPKTT) capsules are formulated from 4 herbs widely used in traditional Vietnamese medicine - Panax notoginseng (Burkill) F.H.Chen - Tam thất (radix), Crinum asiaticum L. - Náng hoa trắng or giant crinum lily, Polygonum cuspidatum Willd. ex Spreng. (= Reynoutria japonica Houtt) - Cốt củ khí or Japanese knotweed (radix), Oldenlandia herbacea (L.) Roxb. (formerly known as Hedyotis diffusa Spreng.) - Bạch hoa xà thiẹ^t thảo or slender oldenlandia (herb). The preparation has been used in traditional Vietnamese medicine to treat nocturia, weak urine stream, urinary tract infection. According to modern studies, these herbs have anti-inflammation, antitumor, and antioxidant activities.

AIMS OF THE STUDY

Evaluating the effects of LPKTT capsules on the development of BPH using a rat model of BPH induced by testosterone propionate (TP).

MATERIALS AND METHODS

60 male Wistar rats, 10-12 weeks of age, weight 200-250 g were separated into six groups: (G1) a normal control group that was taken orally phosphate-buffered saline (p.o.; PBS.) with corn oil (subcutaneous injection- Sc); (G2) a BPH model group that received PBS (p.o) with TP (Sc); (G3) a positive control group that received dutasteride (25 μg/kg BW/24 h, p.o.) with TP (Sc); (G4) a positive control group that received alfuzosin HCl (1.8 mg/kg BW/24 h, p.o.) with TP (s.c.) and (G5 and G6) LPKTT groups that received LPKTT at 289.8 or 869.4 mg/kg(p.o.) respectively, with TP (s.c.). BPH model was induced by Sc of TP, 3 mg/kg for 4 weeks. After that, rats were received NaCl/Dutasteride/Alfuzosin/LPKTT for the next 28 days. On the 56th day, assessed the results were through the indicators: micturition frequency, voided volume, total voided volume, the prostate and body weights, the ratio of prostate weight to body weight, prostate histology.

RESULTS

LPKTT reduced micturition frequency and increased the voided volume when compared to the control group (p < 0.01). The results were equivalent to those of the alfuzosin ones (G4). LPKTT lowered prostate weight and the ratio of prostate weight to body weight when compared to the control group (p < 0.01). These reductions were the same in the dutasteride ones. Histomorphology in G5 and G6 also showed that LPKTT inhibited TP induced prostatic hyperplasia. The results were similar to that in the dutasteride group. Microscopic images of prostate in G5 and G6 were almost similar to that of G1.

CONCLUSION

LPKTT capsules work to inhibit prostate proliferation in rats induced BPH by TP.

The prostaglandin pathway is activated in patients who fail medical therapy for benign prostatic hyperplasia with lower urinary tract symptoms

BACKGROUND

Little is known about how benign prostatic hyperplasia (BPH) develops and why patients respond differently to medical therapy designed to reduce lower urinary tract symptoms (LUTS). The Medical Therapy of Prostatic Symptoms (MTOPS) trial randomized men with symptoms of BPH and followed response to medical therapy for up to 6 years. Treatment with a 5α-reductase inhibitor (5ARI) or an alpha-adrenergic receptor antagonist (α-blocker) reduced the risk of clinical progression, while men treated with combination therapy showed a 66% decrease in risk of progressive disease. However, medical therapies for BPH/LUTS are not effective in many patients. The reasons for nonresponse or loss of therapeutic response in the remaining patients over time are unknown. A better understanding of why patients fail to respond to medical therapy may have a major impact on developing new approaches for the medical treatment of BPH/LUTS. Prostaglandins (PG) act on G-protein-coupled receptors (GPCRs), where PGE₂ and PGF₂ elicit smooth muscle contraction. Therefore, we measured PG levels in the prostate tissue of BPH/LUTS patients to assess the possibility that this signaling pathway might explain the failure of medical therapy in BPH/LUTS patients.

METHOD

Surgical BPH (S-BPH) was defined as benign prostatic tissue collected from the transition zone (TZ) of patients who failed medical therapy and underwent surgical intervention to relieve LUTS. Control tissue was termed Incidental BPH (I-BPH). I-BPH was TZ obtained from men undergoing radical prostatectomy for low-volume, low-grade prostatic adenocarcinoma (PCa, Gleason score ≤ 7) confined to the peripheral zone. All TZ tissue was confirmed to be cancer-free. S-BPH patients divided into four subgroups: patients on α-blockers alone, 5ARI alone, combination therapy (α-blockers plus 5ARI), or no medical therapy (none) before surgical resection. I-BPH tissue was subgrouped by prior therapy (either on α-blockers or without prior medical therapy before prostatectomy). We measured prostatic tissue levels of prostaglandins (PGF_2α , PGI₂ , PGE₂ , PGD₂ , and TxA₂ ), quantitative polymerase chain reaction levels of mRNAs encoding enzymes within the PG synthesis pathway, cellular distribution of COX1 (PTGS1) and COX2 (PTGS2), and tested the ability of PGs to contract bladder smooth muscle in an in vitro assay.

RESULTS

All PGs were significantly elevated in TZ tissues from S-BPH patients (n = 36) compared to I-BPH patients (n = 15), regardless of the treatment subgroups. In S-BPH versus I-BPH, mRNA for PG synthetic enzymes COX1 and COX2 were significantly elevated. In addition, mRNA for enzymes that convert the precursor PGH₂ to metabolite PGs were variable: PTGIS (which generates PGI₂ ) and PTGDS (PGD₂ ) were significantly elevated; nonsignificant increases were observed for PTGES (PGE₂ ), AKR1C3 (PGF_2α ), and TBxAS1 (TxA₂ ). Within the I-BPH group, men responding to α-blockers for symptoms of BPH but requiring prostatectomy for PCa did not show elevated levels of COX1, COX2, or PGs. By immunohistochemistry, COX1 was predominantly observed in the prostatic stroma while COX2 was present in scattered luminal cells of isolated prostatic glands in S-BPH. PGE₂ and PGF_2α induced contraction of bladder smooth muscle in an in vitro assay. Furthermore, using the smooth muscle assay, we demonstrated that α-blockers that inhibit alpha-adrenergic receptors do not appear to inhibit PG stimulation of GPCRs in bladder muscle. Only patients who required surgery to relieve BPH/LUTS symptoms showed significantly increased tissue levels of PGs and the PG synthetic enzymes.

CONCLUSIONS

Treatment of BPH/LUTS by inhibition of alpha-adrenergic receptors with pharmaceutical α-blockers or inhibiting androgenesis with 5ARI may fail because of elevated paracrine signaling by prostatic PGs that can cause smooth muscle contraction. In contrast to patients who fail medical therapy for BPH/LUTS, control I-BPH patients do not show the same evidence of elevated PG pathway signaling. Elevation of the PG pathway may explain, in part, why the risk of clinical progression in the MTOPS study was only reduced by 34% with α-blocker treatment.

Postoperative medical treatment of lower urinary tract symptoms after benign prostatic hyperplasia surgery. Are we underestimating the problem?

PURPOSE OF REVIEW

The aim of this study was to determine whether well timed start of medical and surgical treatment of benign prostatic obstruction (BPO) influences the treatment's effectiveness and thus the patients' overall functional outcomes and quality of life.

RECENT FINDINGS

Pharmacological therapy even in high-volume (>80 cm3) BPH typically begins with α-blockers sole and only subsequently are 5ARI added. Several studies showed that acute urinary retention (AUR) developed more frequently in men who suffered severe lower urinary tract symptoms (LUTS) and who did not start combination therapy immediately. Moreover, there are no strict criteria which determine the right time for performing surgery in patients with mild and moderate LUTS, especially when pharmacological therapy fails. However, sometimes, the surgery does not eliminate all the symptoms, as it deals effectively with BPO, but does not treat an overactive bladder. Also, data show that surgery should be performed as soon as possible and be more radical after the first episode of AUR.

SUMMARY

A combination of α-blockers and 5ARI makes for a good starting point where the treatment of high volume BPH is concerned. Ideally, surgery should be performed immediately or as soon as possible in patients with the first episode of AUR and 'anatomic' BPH tissue removal is preferable (dissection of tissue along the prostate capsule to remove its maximum volume).

[Comparative analysis of the effectiveness of early and delayed initiation of combined DRUG therapy for bph]

INTRODUCTION

Currently, -blockers (-AB) and 5-alpha-reductase inhibitors (I-5-AR) are recommended as the drugs of choice for the treatment of patients with benign prostatic hyperplasia (BPH). However, despite the clear advantages of combination therapy, at the initial stages of treatment, I-5-AR is either not prescribed at all, or added to therapy after a few months. The aim of our study is to study the effectiveness of early and various options for delayed combined drug therapy of patients with BPH using -AB and I-5-AR.

MATERIALS AND METHODS

The study included 90 patients with BPH, who were divided into three groups of 30 people. In group 1, monotherapy with drugs from the -AB group was performed for 6 months, after which they were transferred to treatment with a combined drug. In group 2, monotherapy was performed for three months, after which they were also transferred to treatment with a combined drug. And in group 3, patients were prescribed combination therapy from day 1.

RESULTS

Early combination therapy with dutasteride was more effective than delayed Therapy for 6 months. There were no significant differences in the main parameters studied between patients who simultaneously started combination therapy and switched to it after 3 months, by the end of the 12th month of treatment. However, early therapy is a combined drug made it possible to achieve a more rapid effect in relation to LUTS.

CONCLUSION

Thus, the data obtained confirm the clinical recommendations regarding the expediency of early initiation of combined therapy with an -adrenoblocker and a 5-reductase inhibitor in patients with moderate and severe LUTS caused by BPH and the risk of disease progression. Postponing the transition to combination therapy for 6 months or more may lead to a decrease in the effectiveness of treatment of patients in this category.

The clinical applications of five-alpha reductase inhibitors

INTRODUCTION Five-alpha reductase (5-AR) deficiency was first identified by Imperato-McGinley and Walsh as the cause of pseudohermaphroditism in two separate studies. The discoveries led to the development of finasteride (inhibitor of type 2 isoenzyme of 5-AR) and dutasteride (inhibitor of type 1 and type 2 isoenzymes of 5-AR. Both drugs have been proven effective for the treatment of benign prostatic hyperplasia and improve voiding symptoms, reduce the risk of urinary retention and the need for prostate surgery. Five-alpha reductase inhibitors 5-ARIs have been demonstrated to be chemopreventive agents and reduce the risk of prostate cancer, although the risk of selecting out or mediating higher grade prostate cancer remains uncertain. A lower dose of finasteride has been shown to be effective in the treatment of male pattern baldness.

MATERIALS AND METHODS

A Medline search was performed using mesh terms, benign prostatic hypertrophy, prostate cancer, male pattern baldness, female and 5-AR.

RESULTS

The Prostate Long Term Efficacy and Safety Study (PLESS) was a randomized double-blind study that established that finasteride resulted in a 22% increase in maximum flow rate and a 19% decrease in prostate volume. Further studies demonstrated that finasteride caused a significant reduction in the risk of the need for surgery and urinary retention in a 4 year period. Additional studies showed similar beneficial results with dutasteride. The potential benefits of 5-ARIs as chemopreventive agents were examined in the Prostate Cancer Prevention Trial (PCPT) and the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) studies. In the 7 year PCPT trial, 18.4% of the finasteride group developed prostate cancer compared to 24.4% in the placebo group. In the 4 year REDUCE trial, there was a 22.8% reduction of prostate cancer at the conclusion of the study. Despite the reduction of prostate cancer in both the PCPT and REDUCE trials, each study showed an increased risk of prostate cancer in the treatment arms. The explanation for these observations remains an area of investigation. Low dose finasteride has also been used successfully for the treatment of male pattern baldness.

CONCLUSIONS

The use of 5-ARIs has been a major advance in urologic clinical practice. Urologists should be familiar with the underlying pharmacology of 5-ARIs as well as the clinical indications for their use.

The role of 5-reduction in physiology and metabolic disease: evidence from cellular, pre-clinical and human studies

The 5-reductases (5α-reductase types 1, 2 and 3 [5αR1-3], 5β-reductase [5βR]) are steroid hormone metabolising enzymes that hold fundamental roles in human physiology and pathology. They possess broad substrate specificity converting many steroid hormones to their 5α- and 5β-reduced metabolites, as well as catalysing crucial steps in bile acid synthesis. 5αRs are fundamentally important in urogenital development by converting testosterone to the more potent androgen 5α-dihydrotestosterone (5αDHT); inactivating mutations in 5αR2 lead to disorders of sexual development. Due to the ability of the 5αRs to generate 5αDHT, they are an established drug target, and 5αR inhibitors are widely used for the treatment of androgen-dependent benign or malignant prostatic diseases. There is an emerging body of evidence to suggest that the 5-reductases can impact upon aspects of health and disease (other than urogenital development); alterations in their expression and activity have been associated with metabolic disease, polycystic ovarian syndrome, inflammation and bone metabolism. This review will outline the evidence base for the extra-urogenital role of 5-reductases from in vitro cell systems, pre-clinical models and human studies, and highlight the potential adverse effects of 5αR inhibition in human health and disease.

Recent advances in hidradenitis suppurativa in pediatrics

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that can cause significant physical, mental, and socioeconomic burden. There remains a paucity of literature on HS in the pediatric population. This systematic review highlights recent advances in pediatric HS in epidemiology, presentation, comorbidities, and management. PubMed, Embase, Google Scholar, and Clinicaltrials.gov databases were used to identify trials and articles published on HS in pediatric patients between January 2015 and October 2019. A total of 39 articles were included. Current evidence suggests that pediatric onset HS may be associated with genetic factors along with endocrine and metabolic abnormalities. Delayed diagnosis in children with HS contributes to poor outcomes. Overall, children and adults with HS share similar lesion types and involved areas. Pediatric HS is associated with a number of comorbid conditions including acne, obesity, inflammatory joint disease, Down syndrome, inflammatory bowel disease, and diabetes. There are currently no pediatric treatment guidelines. Adalimumab is approved for the treatment of moderate-to-severe HS in children 12 and older. Other targeted immunomodulators and hormonal modulators are under investigation. Although the number of studies concerning HS are increasing, further investigation is warranted to better characterize HS, facilitate early diagnosis, and determine the best management for children.

Effects of dutasteride in a rat model of chemically induced prostatic inflammation-Potential role of estrogen receptor β

BACKGROUND

Dutasteride administration reportedly improves lower urinary tract symptoms in patient with chronic, histologically-identified prostatic inflammation, potentially through estrogen receptor β (ERβ), activation of which has anti-inflammatory effects in the prostate tissue. Therefore, we investigated the effect of dutasteride on intraprostatic inflammatory responses and bladder activity using a rat model of chemically induced prostatic inflammation.

METHODS

Male Sprague-Dawley rats at 10 weeks old were used. Prostatic inflammation was induced by 5% formalin injection into ventral lobes of the prostate and saline was injected in the control group (control, n = 5). Rats with prostatic inflammation were divided into dutasteride therapy (dutasteride, n = 5) and placebo groups (placebo, n = 5). Dutasteride was administrated at a dose of 0.5 mg/kg daily from 2 days before induction of prostatic inflammation whereas placebo rats received vehicle only. Twenty-eight days later, cystometry was performed in a conscious condition to measure non-voiding contractions (NVCs), intercontraction intervals (ICI) and postvoid residual volume (RV). After cystometry, the prostate was excised for analysis of messenger RNA (mRNA) expression levels of ERα, ERβ, interleukin-1β (IL-1β), and IL-18 by quantitative polymerase chain reaction.

RESULTS

The mean number of NVCs was significantly greater in placebo group than that of control group without prostatic inflammation (p < .05), and ICI were significantly decreased in placebo group compared with control group (p < .05). On the contrary, there was no significant change in NVCs or ICI between control and dutasteride groups. RV was not significantly different among three groups. Gene expression levels of ERα, IL-1β, and IL-18 was significantly increased in placebo rats compared with control rats (p < .05), but not significantly different between control and dutasteride rats. On the other hand, the mRNA expression level of ERβ was significantly decreased in placebo rats (p < .05), but not in dutasteride rats, compared with control rats.

CONCLUSION

Dutasteride treatment improved not only prostatic inflammation evident as increased gene expression levels in IL-1β and IL-18, but also bladder overactivity shown by increased NVCs during bladder filling. These therapeutic effects were associated with the restored expression of anti-inflammatory ERβ. Therefore, dutasteride might be effective via ERβ modulation for the treatment of prostatic inflammation in addition to its previously known, anti-androgenic effects on benign prostatic hyperplasia.

A Systematic Review on the Timing of Surgical Intervention for Benign Prostatic Enlargement (BPE)

PURPOSE OF REVIEW

Surgical intervention for benign prostatic enlargement (BPE) is typically reserved for those who fail medical therapy (i.e., α-blocker or 5-α reductase inhibitor treatment). We conducted a systematic review to determine whether timing of surgical intervention for BPE affects patient outcomes.

RECENT FINDINGS

The studies we reviewed suggested that patients who undergo surgical intervention for BPE after failing medical therapy may have worse outcomes. Increased age, worsened bladder function, and worse overall health may contribute to worsened outcomes. To date, there are few high-quality studies on the timing of surgical intervention for BPE in the literature. Further prospective trials are needed to determine ideal timing for intervention.

Disease mechanism, biomarker and therapeutics for spinal and bulbar muscular atrophy (SBMA)

Spinal and bulbar muscular atrophy (SBMA) is a hereditary neuromuscular disorder caused by CAG trinucleotide expansion in the gene encoding the androgen receptor (AR). In the central nervous system, lower motor neurons are selectively affected, whereas pathology of patients and animal models also indicates involvement of skeletal muscle including loss of fast-twitch type 2 fibres and increased slow-twitch type 1 fibres, together with a glycolytic-to-oxidative metabolic switch. Evaluation of muscle and fat using MRI, in addition to biochemical indices such as serum creatinine level, are promising biomarkers to track the disease progression. The serum level of creatinine starts to decrease before the onset of muscle weakness, followed by the emergence of hand tremor, a prodromal sign of the disease. Androgen-dependent nuclear accumulation of the polyglutamine-expanded AR is an essential step in the pathogenesis, providing therapeutic opportunities via hormonal manipulation and gene silencing with antisense oligonucleotides. Animal studies also suggest that hyperactivation of Src, alteration of autophagy and a mitochondrial deficit underlie the neuromuscular degeneration in SBMA and provide alternative therapeutic targets.

Influence of Postoperative Finasteride Therapy on Recurrence of Gynecomastia After Mastectomy in Men Taking Finasteride for Alopecia

Finasteride is commonly used for treatment of alopecia. Because finasteride is a cause of gynecomastia, there is concern regarding the continuation of finasteride therapy after mastectomy. No studies have been performed to determine whether finasteride should be continued after mastectomy when gynecomastia occurs in patients taking finasteride for the treatment of alopecia. The researchers studied the effects of finasteride on gynecomastia recurrence after mastectomy in men with gynecomastia taking finasteride for alopecia. The researchers retrospectively evaluated 1,673 patients with gynecomastia who underwent subcutaneous mastectomy with liposuction at Damsoyu Hospital from January 2014 to December 2016. In total, 52 of the patients were taking finasteride for alopecia before surgery and continued to use it in the same manner after mastectomy. Ultrasonography was performed 1 year after mastectomy. The patients’ median age was 26.5 (24.75–30) years. All 52 patients had bilateral gynecomastia. The median duration of finasteride therapy before and after surgery was 12 (5–25.75) and 33 (27.5–40.5) months, respectively. There were no statistically significant differences between the groups with and without the use of finasteride in relation to postoperative complications and recurrence rates. Taking finasteride seems to have little effect on recurrence in patients with alopecia who have undergone surgical treatment of gynecomastia. Surgeons may recommend continuous finasteride therapy in patients with alopecia who wish to take finasteride after mastectomy.

Effect of α-1-adrenolytic agent and 5-α-reductase inhibitor on renal function in an experimental model of hyperprolactinemia-induced benign prostatic hyperplasia

The standard pharmacotherapy of benign prostatic hyperplasia (BPH) may also alleviate potential kidney dysfunction resulting from the development of obstructive uropathy in the course of BPH.

AIM

The aim of study was to evaluate the effect of treatment with α-1- adrenolytic agent (tamsulosin) and 5-α-reductase inhibitor (finasteride) on renal function in rats.

MATERIALS AND METHODS

Four groups of rats were studied: 1 - controls, 2 - rats with metoclopramide-induced hyperprolactinemia BPH model, 3 - rats with BPH treated with tamsulosin, 4 - rats with BPH treated with finasteride. BPH presence was verified by histopathological examination. The renal function was assessed by histopathological examination, and the laboratory assessment of the classic nitrogen parameters and new kidney function markers (cystatin C; CysC, kidney injury molecule-1; KIM-1).

RESULTS

In group 2, BPH development was confirmed by histopathological examination, without simultaneous significant kidney disturbances. Compared to the controls, BPH animals exhibited significant proteinuria, and increased concentration and daily urinary excretion of CysC and KIM- 1. Treatment with tamsulosin significantly improved the histopathological image of the prostate without affecting renal structure and led to reduced blood urea and proteinuria. Treatment with finasteride also significantly reduced the histopathological signs of BPH without changing the image of the kidneys, and reduced CysC concentration and daily CysC excretion with urine compared to group 2 individuals.

CONCLUSIONS

In the course of experimental hyperprolactinemiainduced BPH, kidney tubulopathy developed, which was indicated by KIM-1 and CysC disturbances in urine. The administration of finasteride reduced renal dysfunction to a higher degree, bringing the concentration and daily excretion of CysC back to normal.

Methylation of SRD5A2 promoter predicts a better outcome for castration-resistant prostate cancer patients undergoing androgen deprivation therapy

PURPOSE

To determine whether SRD5A2 promoter methylation is associated with cancer progression during androgen deprivation therapy (ADT) in CRPC.

PATIENTS AND METHODS

In a Local CRPC cohort, 42 prostatic specimens were collected from patients who were diagnosed as CRPC and underwent transurethral resection of the prostate (TURP) at Massachusetts General Hospital (MGH). In a metastatic CRPC (Met CRPC) cohort, 12 metastatic biopsies were collected from CRPC patients who would be treated with abiraterone plus dutasteride (Clinical Trial NCT01393730). As controls, 36 benign prostatic specimens were collected from patients undergoing prostate reduction surgery for symptoms of bladder outlet obstruction secondary to benign prostatic hyperplasia (BPH). The methylation status of cytosine-phosphate-guanine (CpG) site(s) at SRD5A2 promoter regions was tested.

RESULTS

Compared with benign prostatic tissue, CRPC samples demonstrated higher SRD5A2 methylation in the whole promoter region (Local CRPC cohort: P < 0.001; Met CRPC cohort: P <0.05). In Local CRPC cohort, a higher ratio of methylation was correlated with better OS (R2 = 0.33, P = 0.013). Hypermethylation of specific regions (nucleotides -434 to -4 [CpG# -39 to CpG# -2]) was associated with a better OS (11.3±5.8 vs 6.4±4.4 years, P = 0.001) and PFS (8.4±5.4 vs 4.5±3.9 years, P = 0.003) with cutoff value of 37.9%. Multivariate analysis showed that SRD5A2 methylation was associated with OS independently (whole promoter region: P = 0.035; specific region: P = 0.02).

CONCLUSION

Our study demonstrate that SRD5A2 methylation in promoter regions, specifically at CpG# -39 to -2, is significantly associated with better survival for CRPC patients treated with ADT. Recognition of epigenetic modifications of SRD5A2 may affect the choices and sequence of available therapies for management of CRPC.

The role of 5α-reductase inhibitors in gastro-oesophageal cancer risk: A nested case-control study

PURPOSE

The strong male predominance of gastro-oesophageal cancer suggests that sex hormones play an important role. 5α-Reductase (5AR) inhibitors have antiandrogen effects and have been shown to decrease cancer cell proliferation and metastasis. We conducted the first epidemiologic investigation into the association between 5AR inhibitor use and gastro-oesophageal cancer risk.

METHODS

We conducted a nested case-control study within the Scottish Primary Care Clinical Information Unit Research database. Male cases diagnosed with oesophageal or gastric cancer between 1999 and 2011 were matched to up to five male controls based on birth year, diagnosis year, and general practice. We used electronic prescribing records to ascertain medication use. We used conditional logistic regression to calculate odds ratios (ORs) for the association between 5AR inhibitor use and cancer risk, after adjusting for comorbidities and aspirin, statin, or proton pump inhibitor use.

RESULTS

The study included 2003 gastro-oesophageal cancer cases and 9650 controls. There was some evidence of reduced gastro-oesophageal cancer risk among 5AR inhibitor users (adjusted OR = 0.75; 95% CI, 0.56-1.02), particularly for finasteride (adjusted OR = 0.68; 95% CI, 0.50-0.94). These decreases were more marked among those who received at least 3 years of 5AR inhibitors (adjusted OR = 0.54; 95% CI, 0.27-1.05; P value = .071) or finasteride (adjusted OR = 0.49; 95% CI, 0.24-0.99; P value = .046).

CONCLUSIONS

We found evidence of reduced gastro-oesophageal cancer risk among users of 5AR inhibitors, particularly finasteride. However, larger epidemiological studies are required before randomised controlled trials are considered.

[Economic aspects of treatment for lower urinary tract symptoms associated with benign prostatic hyperplasia]

A review of the literature dedicated to the economic aspects of drug and surgical treatment of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) is presented in the article. Currently, symptomatic therapy, which usually leads to an increase in the financial costs associated with the complications and surgical treatment, is most commonly used. The pathogenetic treatment of BPH (5-alpha reductase inhibitors), including combination therapy, requires an increase in costs, but it is also considered the most cost-effective approach. Despite the continuous growing of therapeutic armamentarium, the surgical treatment is still relevant and holds an important place. A lot of studies have shown that open procedures are inferior to endoscopic and minimally invasive interventions by both clinical and cost-effective results. At the same time, transurethral interventions on the prostate does not exclude economic losses due to the necessity of expensive laser technologies and the development of complications in the early postoperative period. Thus, currently, the best treatment option should be chosen not only on individual basis, but also depending on economic aspects based on a balanced medical and economic analysis of each treatment method.

Single-Nucleotide Polymorphism-Based Genetic Risk Score and Patient Age at Prostate Cancer Diagnosis

IMPORTANCE

Few studies have evaluated the association between a single-nucleotide polymorphism-based genetic risk score (GRS) and patient age at prostate cancer (PCa) diagnosis.

OBJECTIVES

To test the association between a GRS and patient age at PCa diagnosis and to compare the performance of a GRS with that of family history (FH) in PCa risk stratification.

DESIGN, SETTING, AND PARTICIPANTS

A cohort study of 3225 white men was conducted as a secondary analysis of the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) chemoprevention trial, a 4-year, randomized, double-blind, placebo-controlled multicenter study conducted from March 2003 to April 2009 to evaluate the safety and efficacy of dutasteride in reducing PCa events. Participants were confirmed to be cancer free by prostate biopsy (6-12 cores) within 6 months prior to the study and underwent 10 core biopsies every 2 years per protocol. The dates for performing data analysis were from July 2016 to October 2019.

INTERVENTIONS

A well-established, population-standardized GRS was calculated for each participant based on 110 known PCa risk-associated single-nucleotide polymorphisms, which is a relative risk compared with the general population. Men were classified into 3 GRS risk groups based on predetermined cutoff values: low (<0.50), average (0.50-1.49), and high (≥1.50).

MAIN OUTCOMES AND MEASURES

Prostate cancer diagnosis-free survival among men of different risk groups.

RESULTS

Among 3225 men (median age, 63 years [interquartile range, 58-67 years]) in the study, 683 (21%) were classified as low risk, 1937 (60%) as average risk, and 605 (19%) as high risk based on GRS alone. In comparison, 2789 (86%) were classified as low or average risk and 436 (14%) as high risk based on FH alone. Men in higher GRS risk groups had a PCa diagnosis-free survival rate that was worse than that of those in the lower GRS risk group (χ2 = 53.3; P < .001 for trend) and in participants with a negative FH of PCa (χ2 = 45.5; P < .001 for trend). Combining GRS and FH further stratified overall genetic risk, indicating that 957 men (30%) were at high genetic risk (either high GRS or positive FH), 1667 men (52%) were at average genetic risk (average GRS and negative FH), and 601 men (19%) were at low genetic risk (low GRS and negative FH). The median PCa diagnosis-free survival was 74 years (95% CI, 73-75 years) for men at high genetic risk, 77 years (95% CI, 75 to >80 years) for men at average genetic risk, and more than 80 years (95% CI, >80 to >80 years) for men at low genetic risk. In contrast, the median PCa diagnosis-free survival was 73 years (95% CI, 71-76 years) for men with a positive FH and 77 years (95% CI, 76-79 years) for men with a negative FH.

CONCLUSIONS AND RELEVANCE

This study suggests that a GRS is significantly associated with patient age at PCa diagnosis. Combining FH and GRS may better stratify inherited risk than FH alone for developing personalized PCa screening strategies.

Prostate Transition Zone Fibrosis is Associated with Clinical Progression in the MTOPS Study

PURPOSE

Medications targeting androgen receptor activity (eg finasteride) or smooth muscle contractility (eg doxazosin) do not resolve lower urinary tract symptoms indicative of lower urinary tract dysfunction in an important subgroup of men. Recently fibrosis has been implicated as another pathobiology contributing to male lower urinary tract symptoms but to our knowledge no systematic studies have been done to assess fibrosis in the context of medical treatment. We determine whether fibrotic changes in the prostate transition zone are associated with an increased risk of clinical progression in participants treated with doxazosin, finasteride or finasteride plus doxazosin in the MTOPS (Medical Therapy of Prostatic Symptoms) study.

MATERIALS AND METHODS

Transition zone biopsy tissues from men who did or did not experience clinical progression on placebo, doxazosin, finasteride or combination therapy were assessed for collagen content and architectural changes using picrosirius red birefringence and CT-FIRE (Curvelet Transform-Fiber Extraction) analysis. Correlations were made with annotated demographic and clinical data. Statistical analyses were done with the Pearson correlation coefficient, ANOVA and the t-test.

RESULTS

High levels of wavy, aligned prostate transition zone collagen significantly correlated with an increased risk of clinical progression among MTOPS trial participants treated with doxazosin plus finasteride, particularly those with a high body mass index.

CONCLUSIONS

Fibrotic changes in the prostate transition zone are associated with an increased risk of clinical progression in men treated with doxazosin plus finasteride. Antifibrotic therapeutics might provide a new treatment approach in men with lower urinary tract dysfunction who do not respond to current medical treatment approaches.

[Efficacy of 5-reductase inhibitors in the treatment of lower urinary tract symptoms in patients with benign prostatic hyperplasia]

In the treatment of lower urinary tract in combination with benign prostatic hyperplasia, alpha-blockers are most often prescribed, but in certain cases, the appointment of 5-reductase inhibitors is justified. This article analyzes relevant studies of recent years regarding the validity of the use of dutasteride (Gardium) 0.5 mg per day. Dutasteride can effectively reduce the total score of IPSS to 30%. It increases a volumetric urine flow rate 2-3 ml/sec, significantly reduces the chance of acute urinary retention in 70-88% in various studies, and reduces the frequency of hospitalization by 66%. Dutasteride also increases the likelihood of timely diagnosis of prostate cancer by 23%. Erectile dysfunction is a common side effect, serving as a reason for refusal of therapy is erectile dysfunction, which occurs in 16% of cases, and the probability of which is the highest in the first months during conservative therapy.

Association of Treatment With 5α-Reductase Inhibitors and Prostate Cancer Mortality Among Older Adults

This cohort study examines the association between use of 5α-reductase inhibitors and prostate cancer mortality among US Medicare beneficiaries.