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Can O, Otunctemur A. Impact of coronavirus disease on the management of lower urinary tract symptoms and voiding dysfunction. Curr Opin Urol 2022; 32:141-145. [PMID: 34930886 PMCID: PMC8815648 DOI: 10.1097/mou.0000000000000955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Coronavirus disease (COVID-19) has caused a crisis in the entire healthcare system since its emergence. The urgency and priority of various diseases have impacted the medical and surgical treatment in this period. We aim to review the impact of COVID-19 on lower urinary tract symptoms (LUTS) and management. RECENT FINDINGS There may be a relationship between COVID-19 and de novo or increased LUTS. Patients with LUTS should also be evaluated for COVID-19. Management of diseases has varied during the COVID-19 due to the density of the pandemic. Virtual consultations can mitigate patients who are postponed or cancelled, such as patients with LUTS. Patients suffering voiding dysfunction may manage with oral medications such as alpha blocker and 5-alpha reductase inhibitor via telemedicine. Minimally invasive procedures with a low risk of complications and a short hospitalization time should be considered in complicated cases such as the inability to catheterize. SUMMARY Telemedicine should be implemented on managements of noncomplicated LUTS and voiding dysfunction. Each centre can schedule its LUTS management approach according to the density of pandemic. Virtual consultations need to be developed to compete with face-to-face consultations.
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Affiliation(s)
- Osman Can
- Basaksehir Cam and Sakura City Hospital
| | - Alper Otunctemur
- Prof. Dr Cemil Tascioglu City Hospital, Department of Urology, Istanbul, Turkey
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Haghpanah A, Masjedi F, Salehipour M, Hosseinpour A, Roozbeh J, Dehghani A. Is COVID-19 a risk factor for progression of benign prostatic hyperplasia and exacerbation of its related symptoms?: a systematic review. Prostate Cancer Prostatic Dis 2022; 25:27-38. [PMID: 34007019 PMCID: PMC8129694 DOI: 10.1038/s41391-021-00388-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 04/28/2021] [Accepted: 04/30/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND To explore the potential mechanisms of SARS-CoV-2 in targeting the prostate gland, leading to exacerbation of benign prostatic hyperplasia (BPH) symptoms and greater risks of BPH complications such as acute urinary retention. METHODS A categorized and comprehensive search in the literature has been conducted by 10 April 2021 using international databases including PubMed, Embase, Web of Science, Scopus, and Cochrane Library in line with the PRISMA guidelines recommendations. PICO strategy was used to formulate the research question. The following terms were used: urology, COVID-19, coronavirus, BPH, inflammation, androgen receptors, LUTS, IPSS, PSA, and SARS-CoV-2 or a combination of them. Studies with irrelevant purposes and duplicates were excluded. The selected studies were performed on humans and published in English. RESULTS The research revealed 89 articles. After title screening and considering exclusion criteria, 52 papers were included for the systematic review. BPH is a common condition affecting older men. SARS-CoV-2 infects the host cell by binding to angiotensin converting enzyme 2 (ACE2). A hyperactivated RAS system during infection with SARS-CoV-2 may lead to activation of pro-inflammatory pathways and increased cytokine release. Thus, this virus can lead to exacerbation of lower urinary tract symptoms (LUTS) and trigger inflammatory processes in the prostate gland. Since androgen receptors (AR) play an important role in the BPH pathophysiology and infection with SARS-CoV-2 may be androgen-mediated, BPH progression and its related symptoms can be a complication of COVID-19 through AR involvement and metabolic disturbances. CONCLUSIONS Based on the current findings, SARS-CoV-2 can possibly damage the prostate and worsen BPH and its related LUTS through ACE2 signaling, AR-related mechanisms, inflammation, and metabolic derangement. We encourage future studies to investigate the possible role of COVID-19 in the progression of BPH-related LUTS and examine the prostatic status in susceptible patients with relevant available questionnaires (e.g., IPSS) and serum biomarkers (e.g., PSA).
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Affiliation(s)
- Abdolreza Haghpanah
- grid.412571.40000 0000 8819 4698Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran ,grid.412571.40000 0000 8819 4698Department of Urology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Masjedi
- grid.412571.40000 0000 8819 4698Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Salehipour
- grid.412571.40000 0000 8819 4698Department of Urology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Hosseinpour
- grid.412571.40000 0000 8819 4698Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran ,grid.412571.40000 0000 8819 4698Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Jamshid Roozbeh
- grid.412571.40000 0000 8819 4698Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Anahita Dehghani
- grid.412571.40000 0000 8819 4698Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Chauhan G, Mehta A, Gupta S. Stromal-AR influences the growth of epithelial cells in the development of benign prostate hyperplasia. Mol Cell Biochem 2020; 471:129-142. [PMID: 32504365 DOI: 10.1007/s11010-020-03773-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/31/2020] [Indexed: 11/24/2022]
Abstract
Activation of epithelial-AR signaling is identified as the major cause of hyperproliferation of the cells during benign and malignant prostate conditions. However, the contribution of stromal-AR is also precarious due to its secretory actions that contribute to the progression of benign and malignant tumors. The present study was aimed to understand the influence of stromal-AR mediated actions on epithelial cells during BPH condition. The secretome (conditioned media-CM) was collected from AR agonist (testosterone-propionate-TP) and antagonist (Nilutamide-Nil) treated BPH patient-derived stromal cells and exposed to BPH epithelial cells. Epithelial cells exhibited increased cell proliferation with the treatment of CM derived from TP-treated stromal cells (TP-CM) but did not support the clonogenic growth of BPH epithelial cells. However, CM derived from Nil-treated stromal cells (Nil-CM) depicted delayed and aggressive BPH epithelial cell proliferation with increased clonogenicity of BPH epithelial cells. Further, decreased AR levels with increased cMyc transcripts and pAkt levels also validated the clonogenic transformation under the paracrine influence of inhibition of stromal-AR. Moreover, the CM of stromal-AR activation imparted positive regulation of basal/progenitor pool through LGR4, β-Catenin, and ΔNP63α expression. Hence, the present study highlighted the restricted disease progression and retains the basal/progenitor state of BPH epithelial cells through the activation of stromal-AR. On the contrary, AR-independent aggressive BPH epithelial cell growth due to paracrine action of loss stromal-AR directs us to reform AR pertaining treatment regimes for better clinical outcomes.
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Affiliation(s)
- Gaurav Chauhan
- Department of Biochemistry, The M. S. University of Baroda, Vadodara, Gujarat, 390002, India
| | - Avani Mehta
- Department of Biochemistry, The M. S. University of Baroda, Vadodara, Gujarat, 390002, India.,Division of Biological Sciences, Department of Microbiology and Cell Biology, Indian Institute of Science, Bangalore, Karnataka, 560012, India
| | - Sarita Gupta
- Department of Biochemistry, The M. S. University of Baroda, Vadodara, Gujarat, 390002, India.
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Androgen receptor and immune inflammation in benign prostatic hyperplasia and prostate cancer. ACTA ACUST UNITED AC 2014; 4:935-950. [PMID: 26594314 DOI: 10.4155/cli.14.77] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Both benign prostatic hyperplasia (BPH) and prostate cancer (PCa) are frequent diseases in middle-aged to elderly men worldwide. While both diseases are linked to abnormal growth of the prostate, the epidemiological and pathological features of these two prostate diseases are different. BPH nodules typically arise from the transitional zone, and, in contrast, PCa arises from the peripheral zone. Androgen deprivation therapy alone may not be sufficient to cure these two prostatic diseases due to its undesirable side effects. The alteration of androgen receptor-mediated inflammatory signals from infiltrating immune cells and prostate stromal/epithelial cells may play key roles in those unwanted events. Herein, this review will focus on the roles of androgen/androgen receptor signals in the inflammation-induced progression of BPH and PCa.
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Izumi K, Mizokami A, Lin WJ, Lai KP, Chang C. Androgen receptor roles in the development of benign prostate hyperplasia. THE AMERICAN JOURNAL OF PATHOLOGY 2013; 182:1942-9. [PMID: 23570837 DOI: 10.1016/j.ajpath.2013.02.028] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 01/20/2013] [Accepted: 02/04/2013] [Indexed: 12/20/2022]
Abstract
Benign prostate hyperplasia (BPH) is a major cause of lower urinary tract symptoms, with an increased volume of transitional zone and associated with increased stromal cells. It is known that androgen/androgen receptor (AR) signaling plays a key role in development of BPH, and that blockade of this signaling decreases BPH volume and can relieve lower urinary tract symptoms, but the mechanisms of androgen/AR signaling in BPH development remain unclear, and the effectiveness of current drugs for treating BPH is still limited. The detailed mechanisms of androgen/AR signaling need to be clarified, and new therapies are needed for better treatment of BPH patients. This review focuses on roles of AR in epithelial and stromal cells in BPH development. In epithelial cells, AR may contribute to BPH development via epithelial cell-stromal cell interaction with alterations of epithelial-mesenchymal transition, leading to proliferation of stromal cells. Data from several mouse models with selective knockout of AR in stromal smooth-muscle cells and/or fibroblasts indicate that the AR in stromal cells can also promote BPH development. In prostatic inflammation, AR roles in infiltrating macrophages and epithelial and stromal cells have been linked to BPH development, which has led to discovery of new therapeutic targets. For example, targeting AR with the novel AR degradation enhancer, ASC-J9 offers a potential therapeutic approach against BPH development.
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Affiliation(s)
- Kouji Izumi
- George H. Whipple Laboratory for Cancer Research, University of Rochester Medical Center, Rochester, New York 14642, USA
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Zucchetto A, Tavani A, Dal Maso L, Gallus S, Negri E, Talamini R, Franceschi S, Montella M, La Vecchia C. History of weight and obesity through life and risk of benign prostatic hyperplasia. Int J Obes (Lond) 2005; 29:798-803. [PMID: 15917855 DOI: 10.1038/sj.ijo.0802979] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The relation of anthropometric measures, diabetes, hypertension and hyperlipidemia with benign prostatic hyperplasia (BPH) risk was investigated. DESIGN Hospital-based case-control study. SUBJECTS Cases were 1369 men with histologically confirmed BPH, and controls were 1451 men below 75 y, admitted to hospital for acute non-neoplastic diseases. MEASUREMENTS Using a structured questionnaire, trained interviewers collected information on self-reported height and weight, and measured waist and hip circumference of patients. The odds ratios (OR) and 95% confidence intervals (CI) were estimated using unconditional multiple logistic regression models. RESULTS Compared to the corresponding lowest quartile, the OR for the highest one were 0.76 (95% CI 0.59-0.98) for body weight, 0.71 (95% CI 0.54-0.94) for waist-to-hip ratio and 0.87 (95% CI 0.70-1.09) for body mass index (BMI, kg/m(2)). Compared to a lowest lifelong BMI <20.7 kg/m(2), the OR was 1.56 (95% CI 1.25-1.95) for a lowest lifelong BMI > or =23.7 kg/m(2). The OR was 0.74 (95% CI 0.60-0.93) for a lifelong increase of BMI > or =6.1 kg/m(2), compared to <1.6 kg/m(2). No association emerged for history of diabetes, hypertension and hyperlipidemia. CONCLUSIONS Overweight was modestly, inversely related to BPH. The hypothesis of reduced testosterone levels in obese individuals may explain the different BPH risk and need to be tested.
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Affiliation(s)
- A Zucchetto
- Unita di Epidemiologia e Biostatistica, Centro di Riferimento Oncologico, Aviano (PN), Italy
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Abstract
The lipid composition and concentration in human benign prostatic hyper-plasia (BPH) were investigated. The reason was to shed some light onto the lipid environment of cellular membranes, in which the epithelial and stromal 5 alpha-reductase of the human prostate have apparently to be embedded in order to gain an active state. The phospholipids were found to be the major portion (67% +/- 1.1) of total lipids in whole BPH homogenate, followed by cholesterol (29% +/- 1.1) and glyceride glycerols (4% +/- 0.9). In BPH epithelium, the lipid concentration related to wet weight and to protein was two to three-fold higher than in stroma. Assigning the lipid concentration on a per-cell basis (i.e., related to DNA), a significantly lower lipid concentration was found in the epithelium as compared to the stroma. In the stroma, a significantly higher phospholipid and lower cholesterol portion were found than in the epithelium. Moreover, sphingomyelin was found to comprise a higher portion in stromal than in epithelial phospholipids, whereas the percentage of phosphatidylserine was higher in the epithelial phospholipids. We discuss whether the significant differences in lipid concentration and composition between the epithelium and stroma of human BPH could have an impact on the activity of the membrane-bound 5 alpha-reductase, or whether such differences in the lipid environment are due to a different hormonal milieu in the epithelium and stroma of BPH.
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Affiliation(s)
- H Weisser
- Institute of Clinical Chemistry, Transfusion and Laboratory Medicine, University Clinic Bergmannsheil, Bochum, Germany
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8
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Sánchez-Visconti G, Herrero L, Rabadán M, Pereira I, Ruiz-Torres A. Ageing and prostate: age-related changes in androgen receptors of epithelial cells from benign hypertrophic glands compared with cancer. Mech Ageing Dev 1995; 82:19-29. [PMID: 7475354 DOI: 10.1016/0047-6374(95)01593-o] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Total and nuclear androgen receptors (AR) were studied from epithelial cells in internal and external prostatic zones in 51- to 86-year-old individuals with benign prostatic hyperplasia (BPH) (n = 68) and prostatic cancer (n = 9). We focussed on the role played by androgens on those processes, despite the fact that at these ages, its secretion has normally decreased. In BPH, the nuclear AR do not change, but total measured androgen receptors rise with age (r = 0.5, P < 0.01). Total or nuclear AR do not correlate with gland volume, despite its increase with age (r = 0.8, P < 0.05). In prostates less than 180 cc in volume, there is a significant correlation between size, serum total testosterone level (r = 0.53, P < 0.05) and prostatic specific antigen (PSA) (r = 0.63, P < 0.05). The amount of nuclear AR in cells from the external zone (infiltrated by cancer or healthy) is two times greater than in those from the internal region. Total receptor content of the external zone cells is also high, but the sample is too small to demonstrate an age dependence. The results suggest that ageing is accompanied by an accumulation of non-nuclear AR in the cytosol, that does not play a role in the development of BPH because the amount of nuclear receptors remains unaltered. The enrichment in nuclear receptors of the external zone cells, independently of the presence of cancer, points to a greater androgen dependence in these cells than in cells of the internal region.
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Affiliation(s)
- G Sánchez-Visconti
- Instituto Universitario de Investigación, Gerontológica y Metabólica, Universidad Autónoma de Madrid, Spain
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9
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Chodak GW, Kranc DM, Puy LA, Takeda H, Johnson K, Chang C. Nuclear localization of androgen receptor in heterogeneous samples of normal, hyperplastic and neoplastic human prostate. J Urol 1992; 147:798-803. [PMID: 1371552 DOI: 10.1016/s0022-5347(17)37389-5] [Citation(s) in RCA: 104] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To facilitate an understanding of how androgens participate in the genesis of human benign hyperplasia and carcinoma we assayed androgen receptor in the epithelium and stroma of human prostatic tissue from 57 patients. Immunohistochemical staining of human androgen receptor was performed on 106 sections of normal prostate, benign prostatic hyperplasia (BPH) and prostate cancer. To determine variability of androgen receptor staining sections taken from different portions of the gland were studied. Frozen tissue sections were incubated with monoclonal antiandrogen receptor antibodies and staining was completed by the indirect avidin-biotin peroxidase method. Antibody staining was found mainly in the nucleus of prostatic epithelial cells, although some stromal cells also showed positive staining. Unlike normal prostate, there was a heterogeneous distribution of androgen receptor in BPH and prostate cancer. The androgen receptor content in well differentiated adenocarcinoma epithelium was significantly higher compared to moderately (p less than 0.05) and poorly (p less than 0.05) differentiated adenocarcinoma. Regardless of the origin of stromal tissue, some staining was observed. In each specimen studied the androgen receptor staining was consistent qualitatively and quantitatively for each pathological component throughout the specimen. These data confirm that androgen receptor is a nuclear receptor protein. Furthermore, they show the ability of monoclonal antibodies to reveal cellular/subcellular distribution of androgen receptor, and demonstrate a correlation between the degree of tumor differentiation and androgen receptor content in epithelial but not in stromal cells. These observations may have important implications for understanding the variable tumor response to hormone therapy.
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Affiliation(s)
- G W Chodak
- Department of Surgery/Urology, University of Chicago, Illinois 60637
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Das H, Bhattacharyya AK. Changes in biochemical markers of hyperplastic and malignant prostatic tissues. ARCHIVES OF ANDROLOGY 1991; 26:185-8. [PMID: 1714708 DOI: 10.3109/01485019108987641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Some biochemical markers were evaluated in human prostatic tissue obtained from patients with benign hyperplasia. There was an almost threefold increase in the activity of acid phosphatase of these patients as compared to that of normal men. The changes in the acid phosphatase activity were directly correlated with citric acid concentration. Significant (p less than 0.001) increases in the content of citric acid, zinc, and calcium in benign hyperplastic prostates was found. There was no change in the activity of aminopeptidase. The activities of both enzymes were lower in malignant prostatic tissues.
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Affiliation(s)
- H Das
- Department of Biochemistry, Calcutta University College of Science, India
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11
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Wernert N, Seitz G. Prostatic cancer--immunohistochemistry of steroid hormone receptors. CURRENT TOPICS IN PATHOLOGY. ERGEBNISSE DER PATHOLOGIE 1991; 83:475-94. [PMID: 2007339 DOI: 10.1007/978-3-642-75515-6_14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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12
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Masai M, Sumiya H, Akimoto S, Yatani R, Chang CS, Liao SS, Shimazaki J. Immunohistochemical study of androgen receptor in benign hyperplastic and cancerous human prostates. Prostate 1990; 17:293-300. [PMID: 1701248 DOI: 10.1002/pros.2990170405] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Androgen receptor was detected immunohistochemically in benign as well as malignant prostatic tissues by using a monoclonal rat anti-human androgen receptor antibody (AN 1-15). In both benign and malignant cells, the androgen receptor was exclusively localized in nuclei. In hyperplastic prostate, the androgen receptor was stained in the glandular and the stromal cells. In the gland, cells facing the lumen were stained more intensively than those adjacent to the basal membrane. In cancer tissue, receptor-positive and -negative cancer cells were intermingled. The percent of strongly positive cancer cells was correlated inversely with grade. Relapsed cells showed a low population of strongly positive cells irrespective of grade.
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Affiliation(s)
- M Masai
- Department of Urology, School of Medicine, Chiba University, Japan
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Abstract
Saturable binding sites for radioiodinated epidermal growth factor (EGF) have been quantified in surgical specimens of benign prostate hypertrophy (BPH), histologically normal (HN) prostate, and prostate cancer. Values for EGF binding did not differ significantly between HN prostate and prostate cancer, although dedifferentiated samples tended to higher levels. These were coincident with lower comparative levels of androgen receptors. Unfractionated BPH tissue contained lower levels of EGF binding than either HN or carcinomatous prostate, but in separated epithelial cells EGF binding fell into the same range. Saturation analyses showed two affinity classes of binding in all except dedifferentiated tissues.
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Affiliation(s)
- P Davies
- Tenovus Institute for Cancer Research, University of Wales College of Medicine, Cardiff, United Kingdom
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Peters CA, Barrack ER. Androgen receptor localization in the human prostate: demonstration of heterogeneity using a new method of steroid receptor autoradiography. JOURNAL OF STEROID BIOCHEMISTRY 1987; 27:533-41. [PMID: 2447390 DOI: 10.1016/0022-4731(87)90351-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We have used a novel receptor labeling and autoradiographic technique to identify the cell types in human benign prostatic hyperplasia (BPH) that contain androgen receptors, and we have found that androgen receptor localization is heterogeneous. Prostatic androgen receptors were labeled by incubating slide-mounted frozen tissue sections (10 micron thickness) with [3H]R1881 in vitro. Tissue sections labeled in this way were subjected to concurrent biochemical and autoradiographic analysis. Some of the sections were wiped from the slides for scintillation counting to validate that the procedure indeed measures total cellular androgen receptors of appropriate high affinity and androgen steroid specificity. Replicate labeled slide-mounted tissue sections were dried rapidly, apposed to dry emulsion-coated coverslips, and exposed in the dark for autoradiography. Autoradiograms were developed, fixed, and stained; silver grains were counted over nuclei or cytoplasm of epithelium or stroma to evaluate specific androgen receptor location. Autoradiographic analysis of human glandular BPH demonstrated androgen receptor localization almost exclusively in the epithelial nuclei, with little or none in the stroma. We anticipate that data obtained using this new method of steroid receptor autoradiography may provide fresh insight into the mechanism of hormonal regulation of the prostate.
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Affiliation(s)
- C A Peters
- James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD 21205
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