Medikamentöse Therapie der benignen Prostatahyperplasie

Inhibition of Human Prostate and Bladder Smooth Muscle Contraction, Vasoconstriction of Porcine Renal and Coronary Arteries, and Growth-Related Functions of Prostate Stromal Cells by Presumed Small Molecule Gαq/11 Inhibitor, YM-254890

Introduction: Lower urinary tract symptoms (LUTS) involve benign prostatic hyperplasia (BPH) and overactive bladder (OAB). Standard-of-care medical treatment includes α1-blockers and antimuscarinics for reduction of prostate and detrusor smooth muscle tone, respectively, and 5α-reductase inhibitors (5-ARI) to prevent prostate growth. Current medications are marked by high discontinuation rates due to unfavourable balance between efficacy and treatment-limiting side effects, ranging from dry mouth for antimuscarinics to cardiovascular dysregulation and a tendency to fall for α1-blockers, which results from hypotension, due to vasorelaxation. Agonist-induced smooth muscle contractions are caused by activation of receptor-coupled G-proteins. However, little is known about receptor- and organ-specific differences in coupling to G-proteins. With YM-254890, a small molecule inhibitor with presumed specificity for Gαq/11 became recently available. Here, we investigated effects of YM-254890 on prostate, bladder and vascular smooth muscle contraction, and on growth-related functions in prostate stromal cells.

Methods: Contractions of human prostate and detrusor tissues, porcine renal and coronary arteries were induced in an organ bath. Proliferation (EdU assay), growth (colony formation), apoptosis and cell death (flow cytometry), viability (CCK-8) and actin organization (phalloidin staining) were studied in cultured human prostate stromal cells (WPMY-1).

Results: Contractions by α1-adrenergic agonists, U46619, endothelin-1, and neurogenic contractions were nearly completely inhibited by YM-254890 (30 nM) in prostate tissues. Contractions by cholinergic agonists, U46619, endothelin-1, and neurogenic contractions were only partly inhibited in detrusor tissues. Contractions by α1-adrenergic agonists, U46619, endothelin-1, and neurogenic contractions were strongly, but not fully inhibited in renal arteries. Contractions by cholinergic agonists were completely, but by U46619 and endothelin-1 only strongly inhibited, and neurogenic contractions reduced by half in coronary arteries. YM-254890 had no effect on agonist-independent contractions induced by highmolar (80 mM) potassium chloride (KCl). Neurogenic detrusor contractions were fully sensitive to tetrodotoxin. In WPMY-1 cells, YM-254890 caused breakdown of actin polymerization and organization, and obvious, but clearly limited decreases of proliferation rate, colony formation and viability, and slightly increased apoptosis.

Conclusion: Intracellular post-receptor signaling pathways are shared by Gαq-coupled contractile receptors in multiple smooth muscle-rich organs, but to different extent. While inhibition of Gαq/11 causes actin breakdown, anti-proliferative effects were detectable but clearly limited. Together this may aid in developing future pharmaceutical targets for LUTS and antihypertensive medication.

[Contemporary surgical management of benign prostatic obstruction in Germany : A population-wide study based on German hospital quality report data from 2006 to 2019]

Hintergrund

Die operative Therapie des benignen Prostatatsyndroms (BPS) hat in den letzten Jahren an Diversität gewonnen.

Ziel der Arbeit

Ziel dieser Studie ist die Darstellung aktueller Therapietrends sowie der Versorgungssituation in Deutschland.

Material und Methoden

Auf Basis der Qualitätsberichte der Krankenhäuser wurden mithilfe der Onlineplattform reimbursement.INFO Diagnose- wie Eingriffszahlen erhoben. Für die benigne Prostatahyperplasie (BPH) wurden die ICD-Codes N40 und D29.1 ausgewertet. Die Prozeduren wurden mittels der OPS-Codes 5‑600.0, 5‑601, 5‑603, 5‑609.4 und 5‑609.8 inklusive Subcodierungen extrahiert. Es erfolgten eine deskriptive Darstellung, Trend- und Korrelationsanalysen.

Ergebnisse

Insgesamt wurden 2019 83.687 BPS-Operationen in 473 urologischen Fachabteilungen durchgeführt. Am häufigsten wurde die transurethrale Prostataresektion (TURP; 71,7 %) angewendet. Die Holmiumlaserenukleation (HoLEP; 9,5 %) bzw. die chirurgische Adenomektomie (5,6 %) waren das zweit- bzw. dritthäufigste Verfahren. Seltener wurden Thuliumlaserenukleation (ThuLEP; 3,1 %), Laservaporisation (2,9 %) und elektrische Vaporisation (2,8 %) durchgeführt. Alle weiteren Verfahren machten jeweils < 1 % aus. HoLEP, ThuLEP und elektrische Vaporisation erlebten seit 2006 eine stetige Zunahme der Eingriffszahlen (HoLEP: +42,42 %/Jahr; p < 0,001, ThuLEP: +20,6 %/Jahr, p = 0,99; elektrische Vaporisation: +43,42 %/Jahr, p < 0,001), während die chirurgische Adenomektomie abnahm (−1,66 %/Jahr, p < 0,001). Die Krankenhausverweildauer lag 2019 bei mittleren 5,1 ± 0,1 Tagen.

Schlussfolgerung

Die TURP bleibt das am häufigsten durchgeführte Operationsverfahren. Während, insbesondere in Zentren, die Lasertherapien zunehmen, geht die chirurgische Adenomektomie zurück.

Zusatzmaterial online

Die Online Version dieses Artikels (10.1007/s00120-022-01777-9) enthält weitere Tabellen und Abbildungen zur Entwicklung der Eingriffszahlen für die chirurgische Adenomresektion, Urologische Fachabteilungen mit den höchsten Eingriffszahlen, Entwicklung der Eingriffe TURP, chirurgische Adenomektomie, HoLEP und ThuLEP in den 5 Häusern mit den meisten BPS-Eingriffen und zur Deutschlandweiten Verteilung der BPH-Diagnosen.

Randomized double-blind controlled clinical trials with herbal preparations of Serenoa repens fruits in treatment of lower urinary tract symptoms : An overview

In this review, results of randomized double-blind controlled clinical trials (RCTs) with extracts of Serenoa repens fruits at a dose of 320 mg/d for the treatment of lower urinary tract symptoms (LUTS) are assessed. Of the RTCs conducted for up to 6 months, a benefit was seen in three of three RTCs with ethanolic, in eight of nine RTCs with hexane, and in one of two RTCs with CO₂ extracts. Of the RTCs conducted for more than 6 months, a benefit was seen in two RTCs with hexane and in one RTC with CO₂ extracts, whereas one RTC with an ethanolic, two RTCs with hexane, and one RTC with CO₂ extracts did not show positive results. As LUTS are dynamic conditions with strong spontaneous fluctuation over time, the majority of patients might expect improvement of single symptoms and thus of quality of life, particularly as the extracts are well tolerated even in long-term treatment.

Effect of fractions of kolaviron on some indices of benign prostatic hyperplasia in rats: identification of the constituents of the bioactive fraction using GC-MS

This study investigated the effect of fractions of kolaviron on some biochemical parameters in benign prostatic hyperplasia (BPH) rats and also characterized the most active fraction (F1) using GC-MS.

Multiple readout assay for hormonal (androgenic and antiandrogenic) and cytotoxic activity of plant and fungal extracts based on differential prostate cancer cell line behavior

ETHNOPHARMACOLOGICAL RELEVANCE

Prostate cancer is one of the most diagnosed forms of cancer among men in western regions. Many traditional applications or phytotherapeutic concepts propose to inhibit the proliferation of prostate cancer cells. In order to detect influences of plant or fungal extracts and derived fractions on androgen receptor signaling pathways, a differentiating cell proliferation assay was established, which enables the simultaneous detection of hormonal and cytotoxic effects.

MATERIAL AND METHODS

The well characterized prostate cancer cell lines LNCaP and PC-3 were used in a multiple readout assay. In all, 186 fractions of 23 traditionally used organisms were screened regarding their effects on proliferation of the two prostate cancer cell lines. The fractions were prepared by accelerated solvent extraction followed by gradient extrography. Extracts of the potential hormonally active plants Cibotium barometz, Heteropterys chrysophylla, and Sideroxylon obtusifolium (= Bumelia sartorum) were phytochemically investigated.

RESULTS

Fractions from Cibotium barometz, Cortinarius rubellus, Cyrtomium falcatum, Heteropterys chrysophylla, Nephrolepis exaltata, Salvia miltiorrhiza, Sideroxylon obtusifolium, Trichilia emetica, and Trimeria grandifolia exhibited hormonal influences on prostate cancer cells. Cytotoxic activity towards human cell lines was detected for the first time for fractions from Aglaia spectabilis (A. gigantea), Nephrolepis exaltata and Cortinarius brunneus.

CONCLUSIONS

The differential behavior of the two prostate cancer cell lines allows the discrimination between potential androgenic or antiandrogenic activities and effects on the estrogen or glucocorticoid receptor as well as cytotoxic activities. The combined cell lines assay can help to assess the biological activities of material used in traditional medicine.