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Ren J, Li Y, Zhang X, Xiong M, Zhang H, An L, Cao Y, Xia S, Luo G, Tian Y. Correlation between metabolic syndrome and periurethral prostatic fibrosis: results of a prospective study. BMC Urol 2024; 24:38. [PMID: 38347470 PMCID: PMC10863095 DOI: 10.1186/s12894-024-01413-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/22/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Prostatic fibrosis, characterized by the accumulation of myofibroblasts and collagen deposition, is closely associated with LUTS and may lead to mechanical obstruction of the urethra. Additionally, Metabolic Syndrome (MetS), characterized by central obesity, high blood sugar, lipid metabolism disorders, and hypertension, is increasingly recognized as a proinflammatory condition linked to prostate inflammation. METHODS Clinical data from 108 subjects who underwent transurethral resection of the prostate or bipolar plasmakinetic enucleation of the prostate were prospectively collected between June 2021 and August 2022. Patients were divided in two groups according to whether or not they had a diagnosis of MetS. Specimens were stained with Masson trichrome and the periurethral prostatic fibrosis extent was evaluated using quantitative morphometry. RESULTS Forty-three patients (39.8%) were diagnosed with MetS. Patients with MetS showed a significantly greater extent of prostatic fibrosis than the others (68.1 ± 17.1% vs. 42.5 ± 18.2%, P < 0.001), and there was a positive correlation between the number of positive MetS parameters and the extent of prostatic fibrosis (R2 = 0.4436, P < 0.001). Multivariate regression analysis revealed that central obesity (B = 2.941, 95% confidence interval, 1.700-3.283), elevated fasting glucose (B = 1.036, 95% confidence interval, 0.293-1.780), reduced HDL cholesterol (B = 0.910, 95% confidence interval, 0.183-1.636) and elevated triglycerides (B = 1.666, 95% confidence interval, 0.824-2.508) were positively correlated to prostatic fibrosis. Elevated blood pressure, however, was unrelated to prostatic fibrosis (B = 0.009, 95% confidence interval, -0.664-0.683). CONCLUSIONS The present findings suggest that prostatic fibrosis is positively correlated with MetS and its components including central obesity, elevated fasting glucose, reduced high density lipoprotein cholesterol and elevated triglycerides.
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Affiliation(s)
- Jingwen Ren
- Department of Urology, Guizhou Provincial People's Hospital, Guiyang, China
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuanyuan Li
- Department of Urology, Guizhou Provincial People's Hospital, Guiyang, China
- Guizhou University School of Medicine, Guiyang, China
| | | | - Min Xiong
- Department of Urology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Heng Zhang
- Department of Urology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Lingyue An
- Department of Urology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Ying Cao
- Guizhou University School of Medicine, Guiyang, China
| | - Shujie Xia
- Department of Urology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Guangheng Luo
- Department of Urology, Guizhou Provincial People's Hospital, Guiyang, China
- Guizhou University School of Medicine, Guiyang, China
| | - Ye Tian
- Department of Urology, Guizhou Provincial People's Hospital, Guiyang, China.
- Guizhou University School of Medicine, Guiyang, China.
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Tallman JE, Wallis CJD, Zhao Z, Huang LC, Penson DF, Koyama T, Goodman M, Hamilton AS, Wu XC, Paddock LE, Stroup A, Cooperberg MR, Hashibe M, O'Neil BB, Kaplan SH, Greenfield S, Hoffman KE, Barocas DA. Prostate volume, baseline urinary function, and their association with treatment choice and post-treatment urinary function in men treated for localized prostate cancer. Prostate Cancer Prostatic Dis 2023; 26:787-794. [PMID: 36482081 PMCID: PMC11229171 DOI: 10.1038/s41391-022-00627-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/21/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Benign prostatic hyperplasia, lower urinary tract symptoms, and prostate cancer often co-occur. Their effect on urinary function is an important consideration regarding prostate cancer treatment choices. While prostate volume (PV) and urinary symptoms are commonly used in treatment choice decision making, their association with post-treatment urinary function is unknown. We evaluated the associations between PV and baseline urinary function with treatment choice and post-treatment urinary function among men with localized prostate cancer. METHODS We identified 1647 patients from CEASAR, a multicenter population-based, prospective cohort study of men with localized prostate cancer, for analysis. Primary outcomes were treatment choice and health-related quality of life (HRQOL) assessed by the 26-item Expanded Prostate Index Composite (EPIC-26) at pre-specified intervals up to 5 years. Multivariable analysis was performed, controlling for demographic and clinicopathologic features. RESULTS Median baseline PV was 36 mL (IQR 27-48), and baseline urinary irritative/obstructive domain score was 87 (IQR 75-100). There was no observed clinically meaningful association between PV and treatment choice or post-treatment urinary function. Among patients with poor baseline urinary function, treatment with radiation or surgery was associated with statistically and clinically significant improvement in urinary function at 6 months which was durable through 5 years (improvement from baseline at 5 years: radiation 20.4 points, surgery 24.5 points). CONCLUSIONS PV was not found to be associated with treatment modality or post-treatment urinary irritative/obstructive function among men treated for localized prostate cancer. Men with poor baseline urinary irritative/obstructive function improve after treatment with surgery or radiation therapy.
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Affiliation(s)
- Jacob E Tallman
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA.
| | | | - Zhiguo Zhao
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Li-Ching Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David F Penson
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tatsuki Koyama
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael Goodman
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Ann S Hamilton
- Department of Preventive Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Xiao-Cheng Wu
- Department of Epidemiology, Louisiana State University New Orleans School of Public Health, New Orleans, LA, USA
| | - Lisa E Paddock
- Department of Epidemiology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Antoinette Stroup
- Department of Epidemiology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | | | - Mia Hashibe
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Brock B O'Neil
- Department of Urology, University of Utah Health, Salt Lake City, UT, USA
| | - Sherrie H Kaplan
- Department of Medicine, University of California Irvine, Irvine, CA, USA
| | - Sheldon Greenfield
- Department of Medicine, University of California Irvine, Irvine, CA, USA
| | - Karen E Hoffman
- Department of Radiation Oncology, University of Texas M. D. Anderson Center, Houston, TX, USA
| | - Daniel A Barocas
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
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3
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Rostambeigi N, Golzarian J, Little MW. Updates on Preprocedural Evaluation and Patient Selection for Prostatic Artery Embolization. Semin Intervent Radiol 2022; 39:547-554. [PMID: 36561799 PMCID: PMC9767769 DOI: 10.1055/s-0042-1760274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Prostatic artery embolization (PAE) is a safe and effective treatment for benign prostatic hyperplasia. Patient evaluation is a critical and important part of this growing practice. History taking should include symptoms score evaluations for lower urinary tract symptoms, erectile function, and prostatitis symptoms score. The objective evaluations commonly include measurement of prostate specific antigen, postvoid residual volume, and uroflowmetry as well as urodynamic studies in selective patients. Imaging evaluation may include computed tomography angiography or magnetic resonance angiography, elucidating prostate volume, prostate gland morphology, vasculature, and prostate cancer. With evolving knowledge on PAE, we aim to discuss patient evaluation and selection based on updated evidence and discuss specific scenarios.
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Affiliation(s)
- Nassir Rostambeigi
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri
| | - Jafar Golzarian
- University of Minnesota Medical Center, Minneapolis, Minnesota
| | - Mark W. Little
- Royal Berkshire NHS Foundation Trust, Reading, United Kingdom
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4
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Tian Y, Zhang H, Cao Y, Yang L, Luo G. The P.R.OS.T.A.T.E Nomogram for the Preoperative Prediction of Clinical Efficacy of Transurethral Resection of the Prostate in Benign Prostatic Hyperplasia Patients. Clin Interv Aging 2022; 17:845-855. [PMID: 35634569 PMCID: PMC9138692 DOI: 10.2147/cia.s365282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/14/2022] [Indexed: 12/01/2022] Open
Abstract
Purpose Transurethral resection of the prostate (TURP) is often indicated for benign prostatic hyperplasia (BPH). Some patients, however, fail to adequately respond to these interventions. Accordingly, a powerful prediction model for TURP efficacy is warranted. This study aimed to create a nomogram with preoperative parameters for the prediction of individual TURP efficacy. Methods Clinical data from 356 BPH subjects who underwent TURP were retrospectively collected between November 2015 and June 2021 for nomogram development. The prediction model was developed using multivariable logistic regression analysis and presented as a nomogram. Nomogram performance was assessed through calibration curves and the concordance index (C-index). An independent validation cohort containing 177 consecutive patients in the corresponding period was used for external validation. The optimal cutoff value was determined through receiver operating characteristic curve (ROC) analysis by maximizing the Youden index, and its accuracy was assessed through sensitivity, specificity and predictive values. Results In multivariate analysis of the primary cohort, the independent factors for TURP efficacy were age, International Prostate Symptom Score (IPSS), intravesical prostatic protrusion (IPP), bladder wall thickness (BWT), peripheral zone thickness (PT) and transitional zone thickness (TT), all of which were included in the nomogram. The calibration curve for survival probability showed good agreement between the nomogram predictions and actual observations. The C-index for predicting TURP efficacy was 0.860 (95% confidence interval [CI], 0.808–0.911). The optimal cutoff total nomogram score was 177, with a maximum Youden index of 0.643. The sensitivity, specificity, positive predictive value, and negative predictive value for predicting TURP efficacy were 70.6%, 75.6%, 90.6%, and 43.7% in the validation cohort, respectively. Logistic regression analysis in the validation cohort demonstrated that the area under the curve (AUC) was 0.806 (95% CI, 0.733–0.879). Conclusion The P.R.OS.T.A.T.E nomogram objectively and accurately predicted TURP efficacy, thereby facilitating the clinical decision-making process.
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Affiliation(s)
- Ye Tian
- Department of Urology, Guizhou Provincial People’s Hospital, Guiyang, People’s Republic of China
- Guizhou University School of Medicine, Guiyang, People’s Republic of China
| | - Heng Zhang
- Department of Urology, Guizhou Provincial People’s Hospital, Guiyang, People’s Republic of China
- Guizhou University School of Medicine, Guiyang, People’s Republic of China
| | - Ying Cao
- Guizhou University School of Medicine, Guiyang, People’s Republic of China
| | - Lu Yang
- Department of Urology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Guangheng Luo
- Department of Urology, Guizhou Provincial People’s Hospital, Guiyang, People’s Republic of China
- Correspondence: Guangheng Luo, Tel +86-173-8501-5539, Fax +86-851-8562 1836, Email
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5
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Cao Y, Tian Y, Zhang H, Luo GH, Sun ZL, Xia SJ. Imbalance in the estrogen/androgen ratio may affect prostate fibrosis through the TGF-β/Smad signaling pathway. Int Urol Nephrol 2022; 54:499-508. [DOI: 10.1007/s11255-021-03079-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
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Liu G, Zhu Y, Yao Z, Jiang Y, Wu B, Bai S. Development and validation of a predictive model for determining clinically significant prostate cancer in men with negative magnetic resonance imaging after transrectal ultrasound-guided prostate biopsy. Prostate 2021; 81:983-991. [PMID: 34254330 DOI: 10.1002/pros.24193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/12/2021] [Accepted: 06/29/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND The interpretation of negative magnetic resonance imaging (MRI) screening results for clinically significant prostate cancer (csPCa) (International Society of Urological Pathology grade ≥group 2) is debatable and poses a clinical dilemma for urologists. No nomograms have been developed to predict csPCa in such populations. In this study, we aimed to develop and validate a model for predicting the probability of csPCa in men with negative MRI (PI-RADS score 1-2) results after transrectal ultrasound-guided systematic prostate biopsy. METHODS The development cohort consisted of 728 patients with negative MRI results who underwent subsequent prostate biopsy at our center between January 1, 2014 and December 31, 2017. The patients' clinicopathologic data were recorded. The Lasso regression was used for data dimension reduction and feature selection, then multivariable binary logistic regression was used to build a predictive model with regression coefficients. The model was validated in an independent cohort of 334 consecutive patients from January 1, 2018 and June 30, 2020. The performance of the predictive model was assessed with respect to discrimination, calibration, and decision curve analysis. RESULTS The predictors incorporated in this model included age, history of previous negative prostate biopsy, prostate specific antigen density (PSAD), and lower urinary tract symptoms, with PSAD being the strongest predictor. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.875 (95% confidence interval, 0.816-0.933) and good calibration (unreliability test, p = .540). Decision curve analysis demonstrated that the model was clinically useful. CONCLUSION This study presents a good nomogram that can aid pre-biopsy risk stratification for the detection of csPCa, and that may help inform biopsy decisions in patients with negative MRI results.
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Affiliation(s)
- Gang Liu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yuze Zhu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zichuan Yao
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yunzhong Jiang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Bin Wu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Song Bai
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
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7
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Tamalunas A, Westhofen T, Schott M, Keller P, Atzler M, Stief CG, Magistro G. Holmium laser enucleation of the prostate: A truly size-independent method? Low Urin Tract Symptoms 2021; 14:17-26. [PMID: 34323002 DOI: 10.1111/luts.12404] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/13/2021] [Accepted: 07/07/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To evaluate the impact of prostate size on functional outcomes and perioperative morbidity, we analyzed patients undergoing holmium laser enucleation of the prostate (HoLEP) for lower urinary tract symptoms (LUTS). As LUTS secondary to benign prostatic obstruction (BPO) are a chronic progressive disease, prevalence and prostate size increase with age. HoLEP is a size-independent method for surgical treatment of LUTS/BPO and can be offered in medication-refractory patients with durable long-term results and reduced perioperative morbidity. METHODS We retrospectively collected data of 852 patients who underwent HoLEP for LUTS secondary to BPO between 2014-2018. Patients were divided into group 1 (≤60 cc), group 2 (>60 < 120 cc), group 3 (≥120 cc). Perioperative parameters, safety and short-term functional outcomes were assessed and analyzed. RESULTS Patients in group 3 were significantly older and showed a significantly higher median prostate-specific antigen level. Perioperative parameters, such as enucleation time and morcellation time significantly differed in favor of smaller prostate sizes, while enucleation and morcellation speed showed favorable results for larger prostate sizes. Larger prostates ≥120 cc showed a significantly higher postoperative drop in hemoglobin. However, patients did not differ in postoperative functional outcomes or Clavien-Dindo grade ≥II complications (4.8% of all patients [41/852]). There was no difference in perioperative complications between all groups (P = 0.760). CONCLUSION While larger prostates take significantly longer to operate on, postoperative functional outcomes show no difference between all sizes. In conclusion, HoLEP is a size-independent and effective method for surgical treatment of LUTS/BPO in prostates ≥30 cc.
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Affiliation(s)
| | - Thilo Westhofen
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Melanie Schott
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Patrick Keller
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Michael Atzler
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Christian G Stief
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Giuseppe Magistro
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
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MRI Evaluation of Patients Before and After Interventions for Benign Prostatic Hyperplasia: An Update. AJR Am J Roentgenol 2021; 218:88-99. [PMID: 34259037 DOI: 10.2214/ajr.21.26278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Transurethral resection of the prostate is the most commonly performed procedure for the management of patients with lower urinary tract symptoms attributed to benign prostatic hyperplasia (BPH). However, in recent years, various minimally invasive surgical therapies have been introduced to treat BPH. These include laser-based procedures such as holmium laser enucleation of the prostate and photoselective vaporization of the prostate as well as thermal ablation procedures such as water vapor thermal therapy (Rezūm), all of which result in volume reduction of periurethral prostatic tissue. In comparison, a permanent metallic device (UroLift) can be implanted to pull open the prostatic urethra without an associated decrease in prostate size, and selective catheter-directed prostate artery embolization results in a global decrease in prostate size. The goal of this article is to familiarize radiologists with the underlying anatomic changes that occur in BPH as visualized on MRI and to describe the appearance of the prostate on MRI performed after these procedures. Complications encountered on imaging after these procedures are also discussed. Although MRI is not currently used in the routine preprocedural evaluation of BPH, emerging data support a role for MRI in predicting postprocedure outcomes.
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Sanford TH, Harmon SA, Kesani D, Gurram S, Gupta N, Mehralivand S, Sackett J, Wiener S, Wood BJ, Xu S, Pinto PA, Choyke PL, Turkbey B. Quantitative Characterization of the Prostatic Urethra Using MRI: Implications for Lower Urinary Tract Symptoms in Patients with Benign Prostatic Hyperplasia. Acad Radiol 2021; 28:664-670. [PMID: 32307270 PMCID: PMC8456710 DOI: 10.1016/j.acra.2020.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/11/2020] [Accepted: 03/14/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The aim of this study was to perform a quantitative assessment of the prostate anatomy with a focus on the relation of prostatic urethral anatomic variation to urinary symptoms. METHODS This retrospective study involved patients undergoing magnetic resonance imaging for prostate cancer who were also assessed for lower urinary tract symptoms. Volumetric segmentations were utilized to derive the in vivo prostatic urethral length and urethral trajectory in coronal and sagittal planes using a piece-wise cubic spline function to derive the angle of the urethra within the prostate. Association of anatomical factors with urinary symptoms was evaluated using ordinal univariable and multivariable logistic regression with IPSS score cutoffs of ≤7, 8-19, and >20 to define mild, moderate, and severe symptoms, respectively. RESULTS A total of 423 patients were included. On univariable analysis, whole prostate volume, transition zone volume, prostatic urethral length, urethral angle, and retrourethral volume were all significantly associated with worse urinary symptoms. On multivariable analysis prostatic urethral length was associated with urinary symptoms with a normalized odds ratio of 1.5 (95% confidence interval 1.0-2.2, p = 0.04). In a subset analysis of patients on alpha blockers, maximal urethral angle, transition zone volume as well as urethral length were all associated with worse urinary symptoms. CONCLUSION Multiple parameters were associated with worse urinary symptoms on univariable analysis, but only prostatic urethral length was associated with worse urinary symptoms on multivariable analysis. This study demonstrates the ability of quantitative assessment of prostatic urethral anatomy to predict lower urinary tract symptoms.
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Affiliation(s)
- Thomas H Sanford
- Molecular Imaging Program, National Cancer Institute, 10 Center Drive, Room B3B85, Bethesda 20892, MD
| | - Stephanie A Harmon
- Molecular Imaging Program, National Cancer Institute, 10 Center Drive, Room B3B85, Bethesda 20892, MD; Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, MD
| | - Deepak Kesani
- Molecular Imaging Program, National Cancer Institute, 10 Center Drive, Room B3B85, Bethesda 20892, MD
| | - Sandeep Gurram
- Urologic Oncology Branch, National Cancer Institute, Bethesda MD
| | - Nikhil Gupta
- Urologic Oncology Branch, National Cancer Institute, Bethesda MD
| | - Sherif Mehralivand
- Molecular Imaging Program, National Cancer Institute, 10 Center Drive, Room B3B85, Bethesda 20892, MD
| | - Jonathan Sackett
- Molecular Imaging Program, National Cancer Institute, 10 Center Drive, Room B3B85, Bethesda 20892, MD
| | | | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute, Bethesda, MD
| | - Sheng Xu
- Center for Interventional Oncology, National Cancer Institute, Bethesda, MD
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, Bethesda MD
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, 10 Center Drive, Room B3B85, Bethesda 20892, MD
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, 10 Center Drive, Room B3B85, Bethesda 20892, MD.
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Nordström T, Engel JC, Bergman M, Egevad L, Aly M, Eklund M, Palsdottir T, Grönberg H. Identifying Prostate Cancer Among Men with Lower Urinary Tract Symptoms. EUR UROL SUPPL 2021; 24:11-16. [PMID: 34337490 PMCID: PMC8317798 DOI: 10.1016/j.euros.2020.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 11/23/2022] Open
Abstract
Background In men aged above 50 yr, lower urinary tract symptoms (LUTS), benign prostate hyperplasia, and prostate cancer are common urological conditions. Current guidelines for general practitioners frequently recommend prostate-specific antigen (PSA) testing in patients with LUTS for the detection of prostate cancer. Objective To assess the performance of PSA, PSA density, and the Stockholm3 blood test for identification of prostate cancer among men with LUTS. Design, setting, and participants In this post hoc analysis of a population-based diagnostic trial (STHLM3, n = 58 588), 4588 men aged 50–69 yr, without previous prostate cancer, with International Prostate Symptom Score (IPSS) data, and having PSA ≥ 3 ng/mL were identified. Men with at least moderate LUTS, defined as an IPSS score of ≥8, were included. PSA density and Stockholm3 scores were calculated. Intervention Participants underwent 10–12-core systematic prostate biopsies. Outcome measurements and statistical analysis The primary outcome was significant prostate cancer (sPCa) defined as International Society of Urological Pathology (ISUP) grade ≥2. Logistic regression analysis adjusted for age and previous biopsy status was performed. The area under the receiver operating characteristic curve (AUC) was calculated, and decision curve analysis was performed. Results and limitations Out of 4588 men, 1544 (34%) reported at least moderate LUTS. The median age was 64 yr, and 11% had undergone a previous prostate biopsy. The Stockholm3 test showed superior discrimination for sPCa to PSA density, which in turn showed superior discrimination to PSA (AUC 0.77 vs 0.70 vs 0.61, p < 0.02). Calibration of the Stockholm3 test was adequate. Performing biopsy only in men with PSA ≥5 ng/mL saved 64% of biopsies, but resulted in missing 52% of detectable sPCa. Recommending biopsy for men with PSA density ≥0.07 resulted in sparing 26% of biopsy procedures and delaying the diagnosis of 12% of sPCa cases, with a 6.1% risk of sPCa among unbiopsied men. Recommending men with Stockholm3 ≥ 0.11 for biopsy resulted in sparing 53% of biopsy procedures and delaying the diagnosis of 20% of sPCa cases, with a 5.1% risk of finding sPCa in unbiopsied men. Conclusions PSA density and the Stockholm3 blood test were superior to PSA for the identification of prostate cancer among men with LUTS. Patient summary In this analysis of a large Swedish study, we find that the use of prostate-specific antigen (PSA) density or the Stockholm3 blood test instead of only PSA might improve the detection of prostate cancer among men with lower urinary tract symptoms.
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Affiliation(s)
- Tobias Nordström
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jan Chandra Engel
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Martin Bergman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lars Egevad
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Markus Aly
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Martin Eklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Thorgerdur Palsdottir
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Grönberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Pascal LE, Mizoguchi S, Chen W, Rigatti LH, Igarashi T, Dhir R, Tyagi P, Wu Z, Yang Z, de Groat WC, DeFranco DB, Yoshimura N, Wang Z. Prostate-Specific Deletion of Cdh1 Induces Murine Prostatic Inflammation and Bladder Overactivity. Endocrinology 2021; 162:5992231. [PMID: 33211830 PMCID: PMC7745638 DOI: 10.1210/endocr/bqaa212] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Indexed: 12/25/2022]
Abstract
Benign prostatic hyperplasia (BPH) is an age-related debilitating prostatic disease that is frequently associated with prostatic inflammation and bothersome lower urinary tract symptoms (LUTS). Animal models have shown that formalin- and bacterial-induced prostatic inflammation can induce bladder dysfunction; however, the underlying mechanisms contributing to prostatic inflammation in BPH and bladder dysfunction are not clear. We previously reported that E-cadherin expression in BPH is downregulated in hyperplastic nodules compared with expression in adjacent normal tissues. Here, we explored the potential consequences of prostatic E-cadherin downregulation on the prostate and bladder in vivo using an inducible murine model of prostate luminal epithelial-specific deletion of Cdh1. The prostate-specific antigen (PSA)-CreERT2 transgenic mouse strain expressing tamoxifen-inducible CreERT2 recombinase driven by a 6-kb human PSA promoter/enhancer was crossed with the B6.129-Cdh1tm2Kem/J mouse to generate bigenic PSA-CreERT2/Cdh1-/- mice. Deletion of E-cadherin was induced by transient administration of tamoxifen when mice reached sexual maturity (7 weeks of age). At 21 to 23 weeks of age, the prostate, bladder, and prostatic urethra were examined histologically, and bladder function was assessed using void spot assays and cystometry. Mice with Cdh1 deletion had increased prostatic inflammation, prostatic epithelial hyperplasia, and stromal changes at 21 to 23 weeks of age, as well as changes in bladder voiding function compared with age-matched controls. Thus, loss of E-cadherin in the murine prostate could result in prostatic defects that are characteristic of BPH and LUTS, suggesting that E-cadherin downregulation could be a driving force in human BPH development and progression.
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Affiliation(s)
- Laura E Pascal
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Correspondence: Zhou Wang, PhD, Department of Urology, University of Pittsburgh Medical Center, 5200 Centre Ave, Suite G40, Pittsburgh, PA 15232, USA. ; or Laura E. Pascal, PhD, Department of Urology, University of Pittsburgh Medical Center, 5200 Centre Ave, Suite G34, Pittsburgh, PA 15232, USA.
| | - Shinsuke Mizoguchi
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Wei Chen
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lora H Rigatti
- Division of Laboratory Animal Resources, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Taro Igarashi
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Rajiv Dhir
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Pradeep Tyagi
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Zeyu Wu
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Zhenyu Yang
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - William C de Groat
- Department of Pharmacology and Chemical Biology, and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Donald B DeFranco
- Department of Pharmacology and Chemical Biology, and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Naoki Yoshimura
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Zhou Wang
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Pharmacology and Chemical Biology, and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Correspondence: Zhou Wang, PhD, Department of Urology, University of Pittsburgh Medical Center, 5200 Centre Ave, Suite G40, Pittsburgh, PA 15232, USA. ; or Laura E. Pascal, PhD, Department of Urology, University of Pittsburgh Medical Center, 5200 Centre Ave, Suite G34, Pittsburgh, PA 15232, USA.
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12
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Chandra Engel J, Palsdottir T, Aly M, Egevad L, Grönberg H, Eklund M, Nordström T. Lower urinary tract symptoms (LUTS) are not associated with an increased risk of prostate cancer in men 50-69 years with PSA ≥3 ng/ml. Scand J Urol 2019; 54:1-6. [PMID: 31876229 DOI: 10.1080/21681805.2019.1703806] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: There is conflicting evidence about the association between prostate cancer and Lower Urinary Tract Symptoms (LUTS). We aimed to describe the prevalence of LUTS and its association with prostate cancer risk.Methods: We studied the association between International Prostate Symptom Score (IPSS) and prostate cancer in a population-based sample of men (n = 45,595) aged 50-69 years from the Stockholm3 study. Men with PSA ≥3 ng/ml (n = 4579) underwent systematic prostate biopsies. We used the International Society of Urological Pathology Gleason Grading (ISUP grade) and performed regression analysis for risk of any cancer (n = 1797), ISUP grade ≥2 (n = 840) and advanced cancer, defined as ISUP grade ≥3 or cT ≥3 (n = 353).Results: 74.6% of all men had no or mild LUTS (IPSS ≤7) and 3.2% had severe LUTS (IPSS >19). Men with any, ISUP grade ≥2 or advanced cancer had lower median IPSS compared to men with benign biopsy (any cancer: 4 (IQR 2-9); ISUP grade ≥2: 4 (2-8); advanced cancer: 4 (2-8); benign biopsy: 6 (3-11); p < 0.05). IPSS was not associated with increased risk of cancer in multivariate analyses (OR (any cancer) 0.97; 95% CI 0.96-0.98; OR (ISUP grade ≥2) 0.97; 95% CI 0.96-0.99; OR (advanced cancer) 0.99; 95% CI 0.99-1.01).Conclusions: Three-quarters of men aged 50-69 years report no or mild LUTS. Our data do not support any clinically meaningful association between LUTS and prostate cancer. Specifically, men with advanced prostate cancer did not exhibit more urinary symptoms than men without cancer.
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Affiliation(s)
- Jan Chandra Engel
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Thorgerdur Palsdottir
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Markus Aly
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Patient Area Pelvic Cancer, Prostate Cancer Patient Flow, Karolinska University Hospital Solna, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Lars Egevad
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Grönberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Martin Eklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Tobias Nordström
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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13
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Abstract
Benign prostatic hyperplasia (BPH) is a common condition in aging men that is frequently associated with troublesome lower urinary tract symptoms (LUTS). The American Urologic Association Symptom Index is a validated, self-administered tool that is used to diagnose LUTS, guide initial treatment, and assess treatment response. Watchful waiting is an option for men with mild symptoms. Pharmacologic treatment includes alpha-adrenergic blockers and 5-alpha reductase inhibitors. There is no evidence to support the use of herbal supplements in the treatment of LUTS. Surgical therapy is effective and indicated for men with complications from BPH or who fail medical therapy.
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14
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Deebajah M, Bazzi M, Walton E, Pantelic M, Park H, Dabaja A, Alanee S. Prostate volume measured by magnetic resonance imaging is not a predictor of lower urinary tract symptoms. J Family Med Prim Care 2019; 8:1370-1373. [PMID: 31143723 PMCID: PMC6510102 DOI: 10.4103/jfmpc.jfmpc_94_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Purpose: Prostate volume is frequently utilized to counsel patients presenting to family medicine physicians with voiding complaints. We evaluated the relation between International Prostate Symptom Score (IPSS) and prostate volume measured by phased-array surface coil magnetic resonance imaging (MRI). Methods: We performed an institutional review board (IRB)–approved retrospective study of all patients who received a prostate MRI between 2015 and 2017. Correlation between the overall IPSS, IPSS components, prostate volume stratified by prostate specific antigen (PSA) (<1.4 vs. ≥1.4 g/dL), and race (black vs. white) was examined. Results: In all, 592 patients had prostate MRIs performed between 2015 and 2017. Two hundred and twenty-nine of these patients had IPSS and prostate volume information available in their medical records. The mean age of the cohort was 64.67 (SD = ±7.82) and mean PSA was 7.75 (SD = ±8.3). The mean IPSS was 9.77 (SD ± 7.2), and mean prostate volume was 55.88 cubic cm (SD = ±38.9). The correlation coefficient between prostate volume and IPSS was 0.12789 (P = 0.05). The correlation between prostate volume and IPSS was also not significant in 128 men with prostate volume above 40 cubic cm. Stratifying analysis by race and PSA showed no significant correlation between volume and IPSS. Analysis of the correlation between the different dimension of prostate volume and IPSS revealed significant but weak associations. Conclusions: Even with more precise estimation with MRI, prostate volume does not predict obstruction complaints. This finding is of importance when treating males presenting with voiding dysfunction to primary care.
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Affiliation(s)
| | - Mahdi Bazzi
- Vattikuti Urology Institute, Detroit, Michigan, USA
| | - Eric Walton
- Vattikuti Urology Institute, Detroit, Michigan, USA
| | | | - Hakmin Park
- Department of Radiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Ali Dabaja
- Vattikuti Urology Institute, Detroit, Michigan, USA
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15
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Pushkar D, Vinarov A, Spivak L, Kolontarev K, Putilovskiy M, Andrianova E, Epstein O. Efficacy and safety of Afalaza in men with symptomatic benign prostatic hyperplasia at risk of progression: a multicenter, double-blind, placebo-controlled, randomized clinical trial. Cent European J Urol 2018; 71:427-435. [PMID: 30680237 PMCID: PMC6338808 DOI: 10.5173/ceju.2018.1803] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/18/2018] [Accepted: 12/04/2018] [Indexed: 01/27/2023] Open
Abstract
Introduction In order to investigate the efficacy and safety of Afalaza in men with benign prostatic hyperplasia (BPH) at risk of progression, this multicenter, double-blind, placebo-controlled, randomized clinical trial was performed. Derived by technological treatment of antibodies to prostate-specific antigen (PSA) and endothelial nitric oxide synthase (eNOs), Afalaza was previously proved to modulate its molecular targets. The mechanism of action of the drug is associated with the modulating effect of the antibiodies (RA-Abs) on the molecular targets (PSA and eNOS) by way of conformational changes. Material and methods A total of 249 patients aged 45–60 years with BPH and moderate lower urinary tract symptoms (LUTS), total prostate volume (TPV) ≥30 cm3, Qmax 10–15 ml/s, and serum PSA<4 ng/ml were randomly assigned to receive either Afalaza (n = 125) or placebo (n = 124) for 12 months. Changes in BPH/LUTS symptoms (according to the International Prostate Symptom Score), Qmax, TPV, PSA, BPH clinical progression, occurrence of acure urinary retention (AUR) events or BPH-related surgery were estimated as the study endpoints. Results IPSS mean change was -3.7 ±3.0 (95% CI -4.3 to -3.2) after 12 months of Afalaza (vs. -2.9 ±2.4; 95% CI -3.3 to -2.4 in placebo; р = 0.02). Qmax growth was 2.5 ±4.3 ml/s (vs. 1.4 ±3.3 in placebo; p = 0.049), TPV reduced by 11.8 ±16.0% (vs. 6.5 ±14.7%; p = 0.01, and PSA remained unchanged. Afalaza therapy resulted in a significant decrease in the total sum of BPH progression symptoms (p = 0.01). The maximum effect of Afalaza was registered after 12 months without a tendency to form a ‘plateau’. During the study, no patients experienced AUR or BPH-related surgery. Conclusions A 12-month course of Afalaza therapy is effective and safe for patients with BPH. The results of end points measurements revealed asignificant advantage of Afalaza compared to placebo in the overall symptoms benefit and a decline in the risk of BPH progression. ClinicalTrials.gov: NCT01716104.
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Affiliation(s)
- Dmitry Pushkar
- Moscow State University of Medicine and Dentistry, Department of Urology, Moscow, Russian Federation
| | | | | | - Konstantin Kolontarev
- Moscow State University of Medicine and Dentistry, Department of Urology, Moscow, Russian Federation
| | | | | | - Oleg Epstein
- The Institute of General Pathology and Pathophysiology, Moscow, Russian Federation
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16
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Lifestyle and Progression of Lower Urinary Tract Symptoms in German Men—Results From the EPIC-Heidelberg Cohort. Urology 2018; 120:192-196. [DOI: 10.1016/j.urology.2018.06.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 06/06/2018] [Accepted: 06/07/2018] [Indexed: 11/19/2022]
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17
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Patel DN, Feng T, Simon RM, Howard LE, Vidal AC, Moreira DM, Castro-Santamaria R, Roehrborn C, Andriole GL, Freedland SJ. PSA predicts development of incident lower urinary tract symptoms: results from the REDUCE study. Prostate Cancer Prostatic Dis 2018; 21:238-244. [PMID: 29795141 DOI: 10.1038/s41391-018-0044-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 02/06/2018] [Accepted: 02/17/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND The relationship between baseline prostate-specific antigen (PSA) and development of lower urinary tract symptoms (LUTS) in asymptomatic and mildly symptomatic men is unclear. We sought to determine if PSA predicts incident LUTS in these men. METHODS A post-hoc analysis of the 4-year REDUCE study was performed to assess for incident LUTS in 1534 men with mild to no LUTS at baseline. The primary aim was to determine whether PSA independently predicted incident LUTS after adjusting for the key clinical variables of age, prostate size, and baseline International prostate symptom score (IPSS). Incident LUTS was defined as the first report of medical treatment, surgery, or sustained clinically significant symptoms (two IPSS >14). Cox proportional hazards, cumulative incidence curves, and the log-rank test were used to test our hypothesis. RESULTS A total of 1534 men with baseline IPSS <8 were included in the study cohort. At baseline, there were 335 men with PSA 2.5-4 ng/mL, 589 with PSA 4.1-6 ng/mL, and 610 with PSA 6-10 ng/mL. During the 4-year study, 196 men progressed to incident LUTS (50.5% medical treatment, 9% surgery, and 40.5% new symptoms). As a continuous variable, higher PSA was associated with increased incident LUTS on univariable (HR 1.09, p = 0.019) and multivariable (HR 1.08, p = 0.040) analysis. Likewise, baseline PSA 6-10 ng/mL was associated with increased incident LUTS vs. PSA 2.5-4 ng/mL in adjusted models (HR 1.68, p = 0.016). This association was also observed in men with PSA 4.1-6 ng/mL vs. PSA 2.5-4 ng/mL (HR 1.60, p = 0.032). CONCLUSIONS Men with mild to no LUTS but increased baseline PSA are at increased risk of developing incident LUTS presumed due to benign prostatic hyperplasia.
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Affiliation(s)
- Devin N Patel
- Department of Surgery, Division of Urology, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Tom Feng
- Department of Surgery, Division of Urology, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ross M Simon
- Department of Urology, University of South Florida, Tampa, FL, USA
| | - Lauren E Howard
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Adriana C Vidal
- Department of Surgery, Division of Urology, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel M Moreira
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Claus Roehrborn
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Gerald L Andriole
- Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Stephen J Freedland
- Department of Surgery, Division of Urology, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Urology Section, Veterans Affairs Medical Center, Durham, NC, USA
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18
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Branche BL, Howard LE, Moreira DM, Roehrborn C, Castro-Santamaria R, Andriole GL, Hopp ML, Freedland SJ. Sleep Problems are Associated with Development and Progression of Lower Urinary Tract Symptoms: Results from REDUCE. J Urol 2017; 199:536-542. [PMID: 28870861 DOI: 10.1016/j.juro.2017.08.108] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2017] [Indexed: 11/17/2022]
Abstract
PURPOSE Although lower urinary tract symptoms and sleep problems often develop together, to our knowledge it is unknown whether sleep disturbances are linked to lower urinary tract symptoms development and progression. As measured by the 6-item MOS-Sleep (Medical Outcomes Study Sleep Scale) survey we examined the relationship between sleep problems, and the development and progression of lower urinary tract symptoms in the REDUCE (Reduction by Dutasteride of Prostate Cancer Events) study. MATERIALS AND METHODS REDUCE was a randomized trial testing prostate cancer chemoprevention with dutasteride in men with prostate specific antigen 2.5 to 10 ng/ml and a negative biopsy. At baseline men completed MOS-Sleep and a scaled average was used to calculate the sleep score. Men were followed for 4 years and I-PSS (International Prostate Symptom Score) was completed at baseline and every 6 months. Asymptomatic men had I-PSS less than 8 while symptomatic men had I-PSS 8 or greater. In the placebo arm of 2,588 men not receiving α-blockers or 5α-reductase inhibitors at baseline we tested the association between sleep problems and lower urinary tract symptom development and progression using Cox models. RESULTS During followup lower urinary tract symptoms developed in 209 of 1,452 asymptomatic men (14%) and 580 of 1,136 (51%) with lower urinary tract symptoms demonstrated progression. On multivariable analysis higher sleep scores were suggestively associated with increased lower urinary tract symptoms in asymptomatic men (quartile 4 vs 1 HR 1.41, 95% CI 0.92-2.17, p = 0.12) and with lower urinary tract symptom progression in symptomatic men (per 10 points of sleep score HR 1.06, 95% CI 1.01-1.12, p = 0.029). CONCLUSIONS Among men with lower urinary tract symptoms worse sleep scores were associated with the progression of lower urinary tract symptoms and among asymptomatic men worse sleep scores were suggestively associated with the development of lower urinary tract symptoms. If confirmed, these data suggest that sleep problems may precede such symptoms. Whether treating sleep problems would improve lower urinary tract symptoms requires further testing.
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Affiliation(s)
- Brandee L Branche
- Surgery Section, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Lauren E Howard
- Surgery Section, Durham Veterans Affairs Medical Center, Durham, North Carolina; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | | | - Claus Roehrborn
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ramiro Castro-Santamaria
- Metabolic Pathways and Cardiovascular R&D Unit, GlaxoSmithKline, Inc., King of Prussia, Pennsylvania
| | - Gerald L Andriole
- Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Martin L Hopp
- Cedars-Sinai Medical Center, Los Angeles, California
| | - Stephen J Freedland
- Surgery Section, Durham Veterans Affairs Medical Center, Durham, North Carolina; Cedars-Sinai Medical Center, Los Angeles, California.
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19
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Accurate Estimation of Prostate Size in the Evaluation of Nocturia. CURRENT BLADDER DYSFUNCTION REPORTS 2017. [DOI: 10.1007/s11884-017-0420-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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20
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Does Peak Urine Flow Rate Predict the Development of Incident Lower Urinary Tract Symptoms in Men with Mild to No Current Symptoms? Results from REDUCE. J Urol 2017; 198:650-656. [PMID: 28428110 DOI: 10.1016/j.juro.2017.04.075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE We determined whether decreased peak urine flow is associated with future incident lower urinary tract symptoms in men with mild to no lower urinary tract symptoms. MATERIALS AND METHODS Our population consisted of 3,140 men from the REDUCE (Reduction by Dutasteride of Prostate Cancer Events) trial with mild to no lower urinary tract symptoms, defined as I-PSS (International Prostate Symptom Score) less than 8. REDUCE was a randomized trial of dutasteride vs placebo for prostate cancer prevention in men with elevated prostate specific antigen and negative biopsy. I-PSS measures were obtained every 6 months throughout the 4-year study. The association between peak urine flow rate and progression to incident lower urinary tract symptoms, defined as the first of medical treatment, surgery or sustained and clinically significant lower urinary tract symptoms, was tested by multivariable Cox models, adjusting for various baseline characteristics and treatment arm. RESULTS On multivariable analysis as a continuous variable, decreased peak urine flow rate was significantly associated with an increased risk of incident lower urinary tract symptoms (p = 0.002). Results were similar in the dutasteride and placebo arms. On univariable analysis when peak flow was categorized as 15 or greater, 10 to 14.9 and less than 10 ml per second, flow rates of 10 to 14.9 and less than 10 ml per second were associated with a significantly increased risk of incident lower urinary tract symptoms (HR 1.39, p = 0.011 and 1.67, p <0.001, respectively). Results were similar on multivariable analysis, although in the 10 to 14.9 ml per second group findings were no longer statistically significant (HR 1.26, p = 0.071). CONCLUSIONS In men with mild to no lower urinary tract symptoms a decreased peak urine flow rate is independently associated with incident lower urinary tract symptoms. If confirmed, these men should be followed closer for incident lower urinary tract symptoms.
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21
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Prostate Volume as a Risk Factor for Lower Urinary Tract Symptoms: The Quest Continues. Eur Urol 2016; 69:892-3. [PMID: 26755339 DOI: 10.1016/j.eururo.2015.12.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 12/19/2015] [Indexed: 11/23/2022]
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