Benign Prostatic Hyperplasia: A Review and Ultrasound Classification

Peripheral zone thickness in preoperative MRI is predictive of Trifecta achievement after Holmium laser enucleation of the prostate (HoLEP)

PURPOSE

To investigate various anatomical features of the prostate using preoperative MRI and patients' clinical factors to identify predictors of successful Holmium:YAG laser enucleation of the prostate (HoLEP).

METHODS

71 patients who had received HoLEP and undergone a 3.0-T prostate MRI scan within 6 months before surgery were retrospectively enrolled. MRI features (e.g., total prostate and transitional zone volume, peripheral zone thickness [PZT], BPH patterns, prostatic urethral angle, intravesical prostatic protrusion, etc.) and clinical data (e.g., age, body mass index, surgical technique, etc.) were analyzed using univariable and multivariable logistic regression to identify predictors of successful HoLEP. Successful HoLEP was defined as achieving the Trifecta, characterized by the contemporary absence of postoperative complications within 3 months, a 3-month postoperative maximum flow rate (Qmax) > 15 mL/s, and no urinary incontinence at 3 months postoperatively.

RESULTS

Trifecta achievement at 3 months post-surgery was observed in 37 (52%) patients. Patients with Trifecta achievement exhibited a lower preoperative IPSS-quality of life score (QoL) (4.1 vs. 4.5, P = 0.016) and a thinner preoperative peripheral zone thickness (PZT) on MRI (7.9 vs.10.3 mm, P < 0.001). In the multivariable regression analysis, a preoperative IPSS-QoL score < 5 (OR 3.98; 95% CI, 1.21-13.07; P = 0.017) and PZT < 9 mm (OR 11.51; 95% CI, 3.51-37.74; P < 0.001) were significant predictors of Trifecta achievement after HoLEP.

CONCLUSIONS

Alongside the preoperative QoL score, PZT measurement in prostate MRI can serve as an objective predictor of successful HoLEP. Our results underscore an additional utility of prostate MRI beyond its role in excluding concurrent prostate cancer.

The prostatic middle lobe: clinical significance, presentation and management

The role of the prostatic middle lobe in the presentation and management of benign prostatic hyperplasia (BPH) is under-appreciated. Middle lobe enlargement is associated with intravesical prostatic protrusion (IPP), which causes a unique type of bladder outlet obstruction (BOO) via a 'ball-valve' mechanism. IPP is a reliable predictor of BOO and the strongest independent factor for failure of medical therapy necessitating conversion to surgical intervention. Men with middle lobe enlargement tend to exhibit mixed symptoms of both the storage and the voiding types, but symptomatology will vary depending on the degree of IPP present. Initial assessments such as uroflowmetry and post-void residual volumes are inadequate to detect IPP and could confound the clinical picture. Radiological evaluation of prostate morphology is key to assessment as it provides important prognostic information and can help with operative planning. Treatment strategies employed for BPH should consider the shape and morphology of prostate adenomata, specifically the presence of middle lobe enlargement and the degree of associated IPP.

Diagnostic efficacy of systemic immune-inflammation biomarkers in benign prostatic hyperplasia using receiver operating characteristic and artificial neural network

Benign prostatic hyperplasia (BPH) is a chronic, progressive disease characterized by mesenchymal cell-predominance and stromal and glandular cell-hyperproliferation. Although, the precise cause of BPH is unknown, it is believed to be associated with hormonal changes in aging men. Despite androgens and ageing are likely to play a role in the development of BPH, the pathophysiology of BPH remains uncertain. This paper aims to evaluate the diagnostic efficacy of platelet-to-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR) and systemic immune-inflammation index in in diagnosing BPH. A single-center-randomized-retrospective study was carried out at Alzahraa university hospital between January 2022 and November 2022 on 80 participants (40 non-BPH subjects and 40 patients with symptomatic enlarged prostate) who visited the outpatient clinic or admitted to the urology department. The BPH cases were evaluated by digital rectal examination (DRE), International Prostate Symptom Score (IPSS), prostate size, prostate specific antigen (PSA), TRUS biopsy in elevated PSA > 4 ng/ml, PLR, NLR and systemic immune inflammatory (SII). The diagnosing efficiency of the selected parameters was evaluated using Receiver Operating Characteristic (ROC) and Artificial Neural Network (ANN) showing excellent discrimination with 100% accuracy and AUC = 1 in the ROC curves. Moreover, the accuracy rate of the ANN exceeds 99%. Conclusion: PLR, NLR and SII can be significantly employed for diagnosing BPH.

More Than Detection of Adenocarcinoma - Indications and Findings in Prostate MRI in Benign Prostatic Disorders

BACKGROUND

 Multiparametric MRI of the prostate has become a fundamental tool in the diagnostic pathway for prostate cancer and is recommended before (or after negative) biopsy to guide biopsy and increase accuracy, as a staging examination (high-risk setting), and prior to inclusion into active surveillance. Despite this main field of application, prostate MRI can be utilized to obtain information in a variety of benign disorders of the prostate.

METHODS

 Systematic bibliographical research with extraction of studies, national (German) as well as international guidelines (EAU, AUA), and consensus reports on MRI of benign disorders of the prostate was performed. Indications and imaging findings of prostate MRI were identified for a) imaging the enlarged prostate, b) prostate MRI in prostatic artery embolization, c) imaging in prostatitis and d) imaging in congenital anomalies.

RESULTS AND CONCLUSIONS

 Different phenotypes of the enlarged prostate that partly correlate with severity of symptoms are discussed. We provide an overview of the different types of prostatitis and possible imaging findings, highlighting abscesses as a severe complication. The most common congenital anomalies of the prostate are utricular cysts, whereas anomalies like aplasia, hypoplasia, and ectopia are rare disorders. Knowledge of indications for imaging and imaging appearance of these conditions may improve patient care and enhance differential diagnosis.

KEY POINTS

  · Current guidelines do not implement indications for mpMRI apart from prostate carcinoma.. · MRI can distinguish different anatomical phenotypes of prostatic enlargement.. · Prostatic artery embolization represents a valuable treatment option in cases of symptomatic benign prostatic enlargement.. · Different forms of prostatitis exist and may mimic prostate carcinoma in MRI.. · MRI can be used to evaluate anatomical prostate anomalies..

CITATION FORMAT

· Oerther B, Sigle A, Franiel T et al. More Than Detection of Adenocarcinoma - Indications and Findings in Prostate MRI in Benign Prostatic Disorders. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1719-1463.

Tissue stiffness in BPH patients from magnetic resonance elastography

Background

BPH is commonly found in older men which can lead to lower urinary tract symptoms. Magnetic resonance elastography (MRE) is an innovative, noninvasive imaging technique used to evaluate tissue stiffness. There has not been any study, however, that assessed the tissue stiffness in patients with BPH. A prospective descriptive study was performed to demonstrated MRI and MRE techniques of the prostate gland in ten patients with BPH to assess tissue stiffness, features of BPH on MRI and components of BPH in the area of increased stiffness.

Results

MRI and MRE examinations in all patients were successful without any complications. The mean tissue stiffness of the whole prostate gland was 4.40 ± 0.71 kPa with good reproducibility (ICC 0.82). Stromal components and mixed glandular-stromal components tended to be associated with the areas of increased stiffness on stiffness images, 50.6% for stromal components and 37.9% for mixed glandular-stromal components. Some MRI findings were seen on the patients with high mean stiffness values such as prostatic calcification, type-5 BPH pattern and large prostate volumes.

Conclusions

Prostate MRE is a useful noninvasive reproducible diagnostic tool for evaluating prostate tissue stiffness by both qualitative and quantitative assessments. The mean prostate tissue stiffness from MRE in patients with BPH in this study was 4.40 ± 0.71 kPa. Some MRI features might be associated with increased tissue stiffness.

Trial registration: PID 229. Registered 4 October 2019. http://md.redcap.kku.ac.th

Evaluation of prostate volume in mpMRI: comparison of the recommendations of PI-RADS v2 and PI-RADS v2.1

PURPOSE

We aimed to evaluate the prostate volumes calculated as recommended in the PI-RADS v2 and PI-RADS v2.1 guidelines, intraobserver and interobserver variability, and the agreement between the two measurement methods.

METHODS

Prostate mpMRI examinations of 114 patients were evaluated retrospectively. T2-weighted sequences in the axial and sagittal planes were used for the measurement of the prostate volume. The measurements were performed by two independent observers as recommended in the PI-RADS v2 and PI-RADS v2.1 guidelines. Both observers conducted the measurements twice and the average values were obtained. In order to prevent bias, the observers carried out measurements at one-week intervals. In order to assess intraobserver variability, observers repeated the measurements again at one-week intervals. The prostate volume was calculated using the ellipsoid formula (W×H×L×0.52).

RESULTS

Intraclass correlation coefficient (ICC) revealed almost perfect agreement between the first and second observers for the measurements according to both PI-RADS v2 (0.93) and PI-RADS v2.1 (0.96) guidelines. The measurements were repeated by both observers. According to the ICC values, there was excellent agreement between the first and second measurements with respect to both PI-RADS v2 and PI-RADS v2.1 for first (0.94 and 0.96, respectively) and second observer (0.94 and 0.97, respectively). For both observers, the differences had a random, homogeneous distribution, and there was no clear relationship between the differences and mean values.

CONCLUSION

The ellipsoid formula is a reliable method for rapid assessment of prostate volume, with excellent intra- and interobserver agreement and no need for expert training. For the height measurement, the recommendations of the PIRADS v2.1 guideline seem to provide more consistently reproducible results.

Evaluation of the Ginsburg Scheme: Where Is Significant Prostate Cancer Missed?

Simple Summary

Systematic biopsy according to the Ginsburg scheme is widely used to complement MRI-targeted biopsy for the diagnosis of prostate cancer. This is the first study to evaluate the distribution of cancerous lesions that were missed by the Ginsburg scheme. We found that significant prostate cancer lesions were missed in 3.6% of patients. The majority of the missed lesions (17/39, 43.6%) were localized within the anterior region of the prostate. Complementing the Ginsburg scheme by adding biopsy cores to this region may be considered in certain patients who were extensively pre-biopsied without a conclusive diagnosis or when targeted biopsy was not possible. Moreover, based on Ginsburg scheme sectors and newly defined blind sectors, we developed a new sector map of the prostate that can be applied to focal therapy planning and for the follow-up management of patients under active surveillance.

Abstract

Background: Systematic biopsy (SB) according to the Ginsburg scheme (GBS) is widely used to complement MRI-targeted biopsy (MR-TB) for optimizing the diagnosis of clinically significant prostate cancer (sPCa). Knowledge of the GBS’s blind sectors where sPCa is missed is crucial to improve biopsy strategies. Methods: We analyzed cancer detection rates in 1084 patients that underwent MR-TB and SB. Cancerous lesions that were missed or underestimated by GBS were re-localized onto a prostate map encompassing Ginsburg sectors and blind-sectors (anterior, central, basodorsal and basoventral). Logistic regression analysis (LRA) and prostatic configuration analysis were applied to identify predictors for missing sPCa with the GBS. Results: GBS missed sPCa in 39 patients (39/1084, 3.6%). In 27 cases (27/39, 69.2%), sPCa was missed within a blind sector, with 17/39 lesions localized in the anterior region (43.6%). Neither LRA nor prostatic configuration analysis identified predictors for missing sPCa with the GBS. Conclusions: This is the first study to analyze the distribution of sPCa missed by the GBS. GBS misses sPCa in few men only, with the majority localized in the anterior region. Adding blind sectors to GBS defined a new sector map of the prostate suited for reporting histopathological biopsy results.

Quantitative Characterization of the Prostatic Urethra Using MRI: Implications for Lower Urinary Tract Symptoms in Patients with Benign Prostatic Hyperplasia

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.

Prostatic peripheral zone thickness: what is normal on magnetic resonance imaging?

PURPOSE

To report the precision of a technique of measuring the PZ thickness on T2-weighted MRI and report normal parameters in patients with normal-sized prostates. We also wanted to establish the mean and second standard deviations (2SD) above and below the mean as criteria for abnormally narrow or expanded PZ thickness.

METHODS

Of the initial 1566 consecutive cohort referred for evaluation for carcinoma based on elevated PSA (prostate specific antibody) or DRE (digital rectal examination), 132 separate subjects with normal-sized prostates were selected for this study. Mean age was 58.2 years (15-82). Median serum PSA was 6.2 ng/mL (range 0.3-145). Most were asymptomatic for lower urinary tract symptoms (LUTS). Inclusion criteria in this study required technically adequate T2-weighted MRI and total prostatic volume (TPV) ≤ 25 cc. Exclusion criteria included post-prostatic surgical and radiation patients, patients having had medical management or minimally invasive therapy for BPH, those being treated for prostatitis. Patients with suspected tumor expanding or obscuring measurement boundaries were also not considered. Transition zone (TZ) and peripheral zone (PZ) volumes were determined using the prolate ellipsoid model. Posterolateral measurement of the PZ was obtained at the axial level of maximal transverse diameter of the prostate on a line drawn from the outer boundary of the TZ to the inner boundary of the external prostatic capsule (EPC). The data were normally distributed. Therefore, it was analyzed using the 2-sided student t-test and Pearson product correlation statistic.

RESULTS

Mean pooled (composite) measurement for the posterolateral PZ (PLPZ) was 10 mm (CI 9.5-10.5 mm) with SD of 2.87 mm. Means were statistically the same for the 2 observers (p = 0.75). Pearson correlation between the two observers was 0.63.

CONCLUSIONS

In a prostate ≤ 25 cc volume , the posterolateral PZ should be no thicker than 15.8 mm and averages 10.0 mm when measured in the maximal axial plane on MRI. These norms were independent of age or use of endorectal coil. The technique measurement demonstrated clinically useful precision.

Prostatic stromal proliferations: a review

Prostatic stromal proliferations account for the majority of benign tumour-like lesions in the prostate. The most common is nodular hyperplasia, seen in a majority of elderly men. Diagnostic difficulty is encountered with some variants, including stromal hyperplasia with atypia, characterised by degenerative changes of myofibroblasts. In contrast with benign stromal tumours, malignant stromal tumours of the prostate are rare, accounting for less than 0.1% of all prostatic malignancies. The most common are rhabdomyosarcoma (paediatric) and leiomyosarcoma (adults); others include phyllodes tumour and stromal sarcoma. Some authors lump malignant tumours with poor outcome (e.g., phyllodes tumour and stromal sarcoma) with benign stromal tumours (e.g., stromal hyperplasia with atypia, leiomyoma), considering them collectively to be of uncertain malignant potential, but this approach is discouraged. This review presents a contemporary approach to classification and diagnosis of prostatic stromal tumours.

Morphological Changes of Meibomian Glands in Men With Benign Prostate Hyperplasia

PURPOSE

Meibomian glands are subject to regulation by sex hormones. We have now investigated the possible relation between benign prostate hyperplasia (BPH) and meibomian gland dysfunction (MGD).

METHODS

Men diagnosed with BPH and receiving treatment with tamsulosin and age-matched male control subjects who attended Itoh Clinic, Saitama, Japan, were enrolled. An ocular symptom score, lid margin abnormality score, and superficial punctate keratopathy score as well as the meiboscore (0-6), meibum grade, breakup time of the tear film, and Schirmer test values were evaluated. Male pattern baldness was also graded according to the Hamilton-Norwood scale.

RESULTS

Forty-four eyes of 44 men with BPH (mean age ± SD, 76.1 ± 2.2 years) and 46 eyes of 46 control subjects (mean age ± SD, 75.3 ± 6.2 years) were enrolled. The meiboscore in the BPH group (4.5 ± 1.4) was significantly higher than that in the control group (1.8 ± 1.5, P < 0.0001). Breakup time of the tear film was significantly shorter (3.6 ± 1.7 vs. 5.6 ± 2.5 seconds, P < 0.0001), and Schirmer test value was significantly smaller (9.8 ± 4.8 vs. 13.3 ± 8.0 mm, P = 0.048) in the BPH group than that in the control group. Other ocular parameters did not differ significantly between the 2 groups. The proportion of men with androgenic alopecia was also higher in the BPH group than that in the control group.

CONCLUSIONS

BPH was associated with meibomian gland loss and instability of the tear film as well as with the presence of androgenic alopecia.

Prostate Benign Diseases

Magnetic resonance imaging (MRI) has been increasingly used in the detection, localization, and staging of prostate cancer. Because of its excellent soft tissue contrast and multiplane imaging, it can be also very useful in the evaluation of benign prostate diseases. Prostatic benign disorders have a high prevalence, vastly represented by benign prostatic hyperplasia and prostatitis. On the contrary, benign prostatic neoplasms are extremely rare, represented by multilocular cystadenoma, leiomyomas, hemangioma, and granular cell tumor, although these uncommon tumors have been most encountered due to widespread use of MRI. Congenital prostatic anomalies are associated with defects in the development of the prostate embryology, including hypoplasia, ectopia, and vascular malformations, abnormalities rarely seen on cross-sectional imaging. Prostatic cysts are the most common development abnormalities and occasionally are related to clinical symptoms, mainly due to infection and hemorrhage. As with prostate cancer, multiparametric MRI is a reliable tool for the diagnosis and management of benign prostatic diseases as well, providing additional information such morphological changes of the prostate, more accurate prostatic measurements, and functional characteristics of nonmalignant prostatic lesions. In this review, we discuss MRI findings of these benign prostatic diseases.

Measurement of Prostate Volume with MRI (A Guide for the Perplexed): Biproximate Method with Analysis of Precision and Accuracy

To review the anatomic basis of prostate boundary selection on T2-weighted magnetic resonance imaging (MRI). To introduce an alternative 3D ellipsoid measuring technique that maximizes precision, report the intra- and inter-observer reliability, and to advocate it's use for research involving multiple observers. We demonstrate prostate boundary anatomy using gross pathology and MRI examples. This provides background for selecting key boundary marks when measuring prostate volume. An alternative ellipsoid volume method is then proposed using these boundaries in an attempt to improve inter-observer precision. An IRB approved retrospective study of 140 patients with elevated serum prostate specific antigen levels and/or abnormal digital rectal examinations was done with T2-weighted MRI applying a new (Biproximate) technique. Measurements were made by 2 examiners, correlated with each other for inter-observer precision and correlated with an expert observer for accuracy. Correlation statistics, linear regression analysis, and tests of means were applied using p ≤ 0.05 as the threshold for significance. Inter-observer correlation (precision) was 0.95 between observers. Correlation between these observers and the expert (accuracy) was 0.94 and 0.97 respectively. Intra-observer correlation for the expert was 0.98. Means for inter-rater reliability and accuracy were all the same (p = 0.001). We conclude that using more precise reproducible landmarks with biproximate technique, precision and accuracy of total prostate volume is found to be demonstrated.

Does Prostate Artery Embolization (PAE) Improve Voiding Symptoms, Storage Symptoms, or Both?

INTRODUCTION

Many studies have looked at global changes in the International Prostate Symptom Score (IPSS) following PAE; however, no studies have examined the breakdown between storage and voiding symptoms. We aimed to explore the extent to which PAE improves storage symptoms in relation to voiding symptoms.

METHOD

This single-center, prospective cohort study recruited consecutive patients undergoing PAE from June 2012 to June 2016. The IPSS breakdown was recorded pre-PAE, at 3 months and 12 months post-PAE. Planned statistical analysis included the paired t test.

RESULTS

A total of 43 patients were recruited (mean age 64.72 ± 6.27, prostate volume 88.65 ± 37.23 cm³, IPSS 23.02 ± 5.84, QoL 4.98 ± 1.01, PSA 4.2 ± 2.8). Storage symptoms were more frequently the most severe symptom (58.1%). Voiding score (13.35-5.39, p < 0.001) and storage score (9.67-5.08, p < 0.001) both improved; however, voiding improved to a greater extent (1.9 vs. 1.5 mean per question, p = 0.023). PAE was most consistent when improving storage symptoms ('Urgency' improved in 86% patients, 'Frequency' and 'Nocturia' 77%).

CONCLUSION

Storage symptoms are a significant problem for patients with benign prostatic obstruction. PAE is an effective treatment for both storage and voiding symptoms. More research is needed to evaluate how this compares with surgical techniques.

Precision and accuracy of magnetic resonance imaging for lobar classification of benign prostatic hyperplasia

PURPOSE

To validate the application of a magnetic resonance imaging (MRI)-based lobar classification of benign prostatic hyperplasia (BPH) for use in research and clinical management.

METHODS

Two radiologists with 5 and 11 years post-fellowship experience were trained in the lobar classification of BPH using an internally developed atlas of prostate anatomy with example MRI images edited by a third senior radiologist designated as the "administrator" of the study. A study population of 140 patients referred to a tertiary academic medical center with known or suspected prostate cancer was selected by the administrator to test the interrater reliability (IRR; precision) of the classification as well as accuracy of the two readers compared to the administrator as the "gold" standard. The intrarater reliability of repeat readings of the administrator was also examined. Percentage of agreement, proportion of agreement, and Cohen's κ were applied. This was a retrospective IRB-approved study.

RESULTS

IRR (precision) between the two interpreting radiologists was 64% agreement, corresponding to unweighted κ of 0.52. Composite proportion of agreement across all BPH types (categories) for interpreting radiologists was 0.67. Observer accuracy was 62% agreement, unweighted κ 0.49, for observer 1 and 67%, unweighted κ 0.58, for observer 2. Intrarater reliability for the administrator was 87% agreement, unweighted κ 0.81 with composite proportion of agreement across all categories of 0.87.

CONCLUSIONS

MRI lobar classification of BPH is a reproducible and reliable tool for research and clinical applications.

Deformable phantoms of the prostatic urinary tract for urodynamic investigations

PURPOSE

Assessment of urethral dynamics is clinically regarded to be important in analyzing the functional impact of pathological features like urethral obstruction, albeit it is difficult to perform directly in vivo. To facilitate such an assessment, urethra phantoms may serve well as investigative tools by reconstructing urethral dynamics based on anthropomorphic factors. Here, our aim is to design a new class of anatomically realistic, deformable urethra phantoms that can simulate the geometric, mechanical, and hydrodynamic characteristics of the male prostatic urethra.

METHODS

A new lost-core tube casting protocol was devised. It first involved the drafting of urethra geometry in computer-aided design software. Next, 3D printing was used to fabricate the urethra geometry and an outer mold. These parts were then used to cast a urinary tract using a polyvinyl alcohol (PVA)-based material (with 26.6 ± 4.0 kPa Young's elastic modulus). After forming a surrounding tissue-mimicking slab using an agar-gelatin mixture (with 17.4 ± 3.4 kPa Young's modulus), the completed urethra phantom was connected to a flow circuit that simulates voiding. To assess the fabricated phantoms' morphology, ultrasound imaging was performed over different planes. Also, color Doppler imaging was performed to visualize the flow profile within the urinary tract.

RESULTS

Deformable phantoms were devised for the normal urethra and a diseased urethra with obstruction due to benign prostatic hyperplasia (BPH). During voiding, the short-axis lumen diameter at the verumontanum of the BPH-featured phantom (0.91 ± 0.08 mm) was significantly smaller than that for the normal phantom (2.49 ± 0.20 mm). Also, the maximum flow velocity of the BPH-featured phantom (59.3 ± 5.8 cm/s; without Doppler angle correction) was found to be higher than that of the normal phantom (22.7 ± 9.0 cm/s).

CONCLUSION

The fabricated phantoms were effective in simulating urethra deformation resulting from urine passage during voiding. They can be used for mechanistic studies of urethral dynamics and for the testing of urodynamic diagnostic techniques in urology.

Programmable prostate palpation simulator using property-changing pneumatic bladder

The currently available prostate palpation simulators are based on either a physical mock-up or pure virtual simulation. Both cases have their inherent limitations. The former lacks flexibility in presenting abnormalities and scenarios because of the static nature of the mock-up and has usability issues because the prostate model must be replaced in different scenarios. The latter has realism issues, particularly in haptic feedback, because of the very limited performance of haptic hardware and inaccurate haptic simulation. This paper presents a highly flexible and programmable simulator with high haptic fidelity. Our new approach is based on a pneumatic-driven, property-changing, silicone prostate mock-up that can be embedded in a human torso mannequin. The mock-up has seven pneumatically controlled, multi-layered bladder cells to mimic the stiffness, size, and location changes of nodules in the prostate. The size is controlled by inflating the bladder with positive pressure in the chamber, and a hard nodule can be generated using the particle jamming technique; the fine sand in the bladder becomes stiff when it is vacuumed. The programmable valves and system identification process enable us to precisely control the size and stiffness, which results in a simulator that can realistically generate many different diseases without replacing anything. The three most common abnormalities in a prostate are selected for demonstration, and multiple progressive stages of each abnormality are carefully designed based on medical data. A human perception experiment is performed by actual medical professionals and confirms that our simulator exhibits higher realism and usability than do the conventional simulators.

Characterization of adenoviral transduction profile in prostate cancer cells and normal prostate tissue

BACKGROUND

Prostate diseases are common in males worldwide with high morbidity. Gene therapy is an attractive therapeutic strategy for prostate diseases, however, it is currently underdeveloped. As well known, adeno virus (Ad) is the most widely used gene therapy vector. The aims of this study are to explore transduction efficiency of Ad in prostate cancer cells and normal prostate tissue, thus further providing guidance for future prostate pathophysiological studies and therapeutic development of prostate diseases.

METHODS

We produced Ad expressing enhanced green fluorescence protein (EGFP), and characterized the transduction efficiency of Ad in both human and mouse prostate cancer cell lines in vitro, as well as prostate tumor xenograft, and wild-type mouse prostate tissue in vivo. Ad transduction efficiency was determined by EGFP fluorescence using microscopy and flow cytometry. Cell type-specific transduction was examined by immunofluorescence staining of cell markers.

RESULTS

Our data showed that Ad efficiently transduced human and mouse prostate cancer cells in vitro in a dose dependent manner. Following intratumoral and intraprostate injection, Ad could efficiently transduce prostate tumor xenograft and the major prostatic cell types in vivo, respectively.

CONCLUSIONS

Our findings suggest that Ad can efficiently transduce prostate tumor cells in vitro as well as xenograft and normal prostate tissue in vivo, and further indicate that Ad could be a potentially powerful toolbox for future gene therapy of prostate diseases.

Targeting phenotypic heterogeneity in benign prostatic hyperplasia

Benign prostatic hyperplasia and associated lower urinary tract symptoms remain difficult to treat medically, resulting in hundreds of thousands of surgeries performed annually in elderly males. New therapies have not improved clinical outcomes since alpha blockers and 5 alpha reductase inhibitors were introduced in the 1990s. An underappreciated confounder to identifying novel targets is pathological heterogeneity. Individual patients display unique phenotypes, composed of distinct cell types. We have yet to develop a cellular or molecular understanding of these unique phenotypes, which has led to failure in developing targeted therapies for personalized medicine. This review covers the strategic experimental approach to unraveling the cellular pathogenesis of discrete BPH phenotypes and discusses how to incorporate these findings into the clinic to improve outcomes.

Magnetic resonance imaging of benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) is a common condition in middle-aged and older men and negatively affects the quality of life. An ultrasound classification for BPH based on a previous pathologic classification was reported, and the types of BPH were classified according to different enlargement locations in the prostate. Afterwards, this classification was demonstrated using magnetic resonance imaging (MRI). The classification of BPH is important, as patients with different types of BPH can have different symptoms and treatment options. BPH types on MRI are as follows: type 0, an equal to or less than 25 cm3 prostate showing little or no zonal enlargements; type 1, bilateral transition zone (TZ) enlargement; type 2, retrourethral enlargement; type 3, bilateral TZ and retrourethral enlargement; type 4, pedunculated enlargement; type 5, pedunculated with bilateral TZ and/or retrourethral enlargement; type 6, subtrigonal or ectopic enlargement; type 7, other combinations of enlargements. We retrospectively evaluated MRI images of BPH patients who were histologically diagnosed and presented the different types of BPH on MRI. MRI, with its advantage of multiplanar imaging and superior soft tissue contrast resolution, can be used in BPH patients for differentiation of BPH from prostate cancer, estimation of zonal and entire prostatic volumes, determination of the stromal/glandular ratio, detection of the enlargement locations, and classification of BPH types which may be potentially helpful in choosing the optimal treatment.

Characterization of degradation products of silodosin under stress conditions by liquid chromatography/Fourier transform mass spectrometry

RATIONALE

Silodosin (SDN) is a novel α₁ -adrenoceptor antagonist in the treatment of benign prostatic hyperplasia (BPH). The presence of degradation products in a drug affects not only the quality, but also the safety and efficacy of drug formulation. Thus, it is essential to develop an efficient analytical method which could be useful to selectively separate, identify and characterise of all possible degradation products of SDN which is mandatory in drug development processes.

METHODS

SDN was subjected to forced degradation under hydrolytic (acid, base and neutral), oxidative, photolytic and thermal stress conditions. Separation of the drug and degradation products was achieved by a liquid chromatography (LC) method using an Acquity UPLC® BEH C18 (2.1 × 100 mm, 1.7 μm; Waters) column with mobile phase consisting of 0.1% formic acid (FA) in water (A) and 0.1% FA in acetonitrile (ACN) and methanol (MeOH) (1:1) (B) as organic modifier at a flow rate of 0.15 mL min^-1 in gradient elution mode. Identification and characterization of the degradation products was performed by mass spectrometry methods using an LTQ-Orbitrap mass spectrometer.

RESULTS

A total of five degradation products (DP1 to DP5) were formed under various stress conditions and their structures were proposed with the help of tandem mass spectrometry (MS/MS) experiments and high-resolution mass spectral data. A common degradation product (DP1) was observed under acidic and basic degradation conditions. DP2 was observed under acidic, DP4 and DP5 were observed under basic hydrolytic conditions, whereas DP3 was observed under oxidative conditions.

CONCLUSIONS

SDN was found to be labile under hydrolytic and oxidative conditions. The structures of all the degradation products were proposed. The most rational mechanisms for the formation of the degradation products under different stress conditions have been established. The proposed method can be effectively used to carry out the determination and detection of SDN and its degradation products. Copyright © 2017 John Wiley & Sons, Ltd.

Treatment of Benign Prostatic Hyperplasia by Ultrasound-Guided Botulinum Toxin Type A Injection

The objective of the study was to determine the efficacy of ultrasound-guided botulinum toxin type A (BTX-A) injection in the treatment of benign prostatic hyperplasia (BPH). In the 32 patients clinically diagnosed with BPH, 200 IU BTX-A was injected into five points at the lateral and middle lobes of the prostate under the guidance of ultrasound using a balloon dilatational device. The international prostate symptom score, quality of life score, maximum flow rate, post-void residual urine volume, prostate-specific antigen, and prostate volume were determined before treatment and at 1, 3, 6, and 12 months after treatment. All clinical symptoms and indicators were remarkably improved 1 month after the treatment and reached the optimal levels at 6 months post-treatment. This improvement of clinical parameters was maintained for a period of at least 1 year. Ultrasound-guided BTX-A injection was found to be safe and effective in the management of BPH.

In vivo metabolic investigation of silodosin using UHPLC-QTOF-MS/MS and in silico toxicological screening of its metabolites

Silodosin (SLD) is a novel α1-adrenoceptor antagonist which has shown promising clinical efficacy and safety in patients with benign prostatic hyperplasia (BPH). However, lack of information about metabolism of SLD prompted us to investigate metabolic fate of SLD in rats. To identify in vivo metabolites of SLD, urine, feces and plasma were collected from Sprague-Dawley rats after its oral administration. The samples were prepared using an optimized sample preparation approach involving protein precipitation followed by solid-phase extraction and then subjected to LC/HR-MS/MS analysis. A total of 13 phase I and six phase II metabolites of SLD have been identified in rat urine which includes hydroxylated, N-dealkylated, dehydrogenated, oxidative, glucosylated, glucuronide and N-sulphated metabolites, which are also observed in feces. In plasma, only dehydrogenated, N-dealkylated and unchanged SLD are observed. The structure elucidation of metabolites was done by fragmentation in MS/MS in combination with HRMS data. The potential toxicity profile of SLD and its metabolites were predicted using TOPKAT software and most of the metabolites were proposed to show a certain degree of skin sensitization and occular irritancy. Copyright © 2016 John Wiley & Sons, Ltd.

MRI evaluation of benign prostatic hyperplasia: Correlation with international prostate symptom score

PURPOSE

To investigate the correlation between magnetic resonance imaging (MRI)-derived prostate parameters and benign prostatic hyperplasia (BPH) type with the International Prostate Symptom Score (IPSS).

MATERIALS AND METHODS

In all, 61 patients (median age, 60; range, 41-81 years) who underwent preoperative MRI and prostatectomy were included in this retrospective study. The MRI-based parameters including total prostate volume (TPV), transition zone (TZ) volume (TZV), TZ index, intravesical prostatic protrusion (IPP), the anterior fibromuscular stroma (AFMS) distance, prostatic urethral angle, bladder wall thickness, urethral wall thickness, urethral compression, urethral wall changes, and BPH type were correlated with total IPSS, IPSS-storage symptom (IPSS-ss), IPSS-voiding symptom (IPSS-vs), and responses to the individual IPSS questions using Spearman (ρ) or Pearson (r) correlation coefficients, one-way analysis of variance (ANOVA), and multiple linear regression.

RESULTS

TPV (r = 0.414, P = 0.001), TZV (r = 0.405, P = 0.001), IPP (r = 0.270, P = 0.04), and AFMS distance (r = 0.363, P = 0.004) correlated with total IPSS. In multiple linear regression analysis, TZV was the only predictor for total IPSS (P = 0.001), IPSS-ss (P < 0.001), IPSS-vs (P = 0.03), and the scores for the IPSS questions 1 (P = 0.03) and 4 (P = 0.001). TPV was a predictor of the scores for questions 2 (P = 0.003), 3 (P = 0.009), and 7 (P < 0.001).

CONCLUSION

Several MRI-derived prostate measurements (TPV, TZV, IPP, AFMS distance) correlated with total IPSS. TZV was the only predictor for total IPSS based on multiple regression analysis.

LEVEL OF EVIDENCE

3 J. Magn. Reson. Imaging 2017;45:917-925.

Inhibitory Effect of Yongdamsagan-Tang Water Extract, a Traditional Herbal Formula, on Testosterone-Induced Benign Prostatic Hyperplasia in Rats

Yongdamsagan-tang, a traditional herbal formula, is used widely for the treatment of inflammation and viral diseases. In this study, we investigated whether Yongdamsagan-tang water extract (YSTE) affects testosterone propionate- (TP-) induced benign prostatic hyperplasia (BPH) in a rat model. To induce BPH, rats were injected subcutaneously with 10 mg/kg of TP every day. YSTE was administrated daily by oral gavage at doses of 200 and 500 mg/kg along with the TP injection. After 4 weeks, prostates were collected, weighed, and analyzed. The relative prostrate weight was significantly lower in both YSTE groups (200 and 500 mg/kg/day) compared with the TP-induced BPH group. YSTE administration reduced the expression of proliferation markers PCNA, cyclin D1, and Ki-67 and the histological abnormalities observed in the prostate in TP-induced BPH rats. YSTE attenuated the increase in the TP-induced androgen concentration in the prostate. The YSTE groups also showed decreased lipid peroxidation and increased glutathione reductase activity in the prostate. These findings suggest that YSTE effectively prevented the development of TP-induced BPH in rats through antiproliferative and antioxidative activities and might be useful in the clinical treatment of BPH.

Multiparametric prostate MRI: focus on T2-weighted imaging and role in staging of prostate cancer

Multiparametric MRI (mpMRI) represents a growing modality for the non-invasive evaluation of prostate cancer (PCa) and is increasingly being used for patients with persistently elevated PSA and prior negative biopsies, for monitoring patients in active surveillance protocols, for preoperative characterization of cancer for surgical planning, and in planning for MRI-targeted biopsy. The focus of this work is twofold. First, we review the key role of T2-weighted imaging (T2WI) in mpMRI, specifically outlining how it is used for anatomic evaluation of the prostate, detection of clinically significant PCa, assessment of extraprostatic extension (EPE), and mimics of PCa on this sequence. We will also discuss optimal technical acquisition parameters for this sequence and recent technical advancements in T2WI. Second, we will delineate the role that mpMRI plays in the staging of PCa and describe the implications of the information that mpMRI can provide in determining the most appropriate management plan for the patient with PCa.

Use of MRI for Lobar Classification of Benign Prostatic Hyperplasia: Potential Phenotypic Biomarkers for Research on Treatment Strategies

OBJECTIVE

We present an MRI classification of benign prostatic hyperplasia (BPH) for use as a phenotype biomarker in the study of proposed therapeutic interventions.

CONCLUSION

Six patterns of BPH distribution were identified. Illustrations are provided for each classification type.

Clinical value of prostate segmentation and volume determination on MRI in benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) is a nonmalignant pathological enlargement of the prostate, which occurs primarily in the transitional zone. BPH is highly prevalent and is a major cause of lower urinary tract symptoms in aging males, although there is no direct relationship between prostate volume and symptom severity. The progression of BPH can be quantified by measuring the volumes of the whole prostate and its zones, based on image segmentation on magnetic resonance imaging. Prostate volume determination via segmentation is a useful measure for patients undergoing therapy for BPH. However, prostate segmentation is not widely used due to the excessive time required for even experts to manually map the margins of the prostate. Here, we review and compare new methods of prostate volume segmentation using both manual and automated methods, including the ellipsoid formula, manual planimetry, and semiautomated and fully automated segmentation approaches. We highlight the utility of prostate segmentation in the clinical context of assessing BPH.

The utility and limitations of contrast-enhanced ultrasound for the diagnosis and treatment of prostate cancer

In association with the widespread use of prostate specific antigen (PSA) screening, the numbers of men identified with early-stage prostate cancer (PCa) are increasing in the developed countries, including Japan. However, the accurate localization of PCa lesions in diagnostic imaging is still difficult because PCa has a tendency to be multifocal in the prostate gland. Contrast-enhanced ultrasound (CEUS) improves the detection of PCa by visualizing cancerous lesions in order to target a needle biopsy. CEUS has the potential to enable not only accurate diagnoses but also novel treatments such as focal therapy. The combination of CEUS and other modalities is expected to improve the diagnosis of PCa and its treatment.

Efficacy and Safety of the Selective α1A-Adrenoceptor Blocker Silodosin for Severe Lower Urinary Tract Symptoms Associated With Benign Prostatic Hyperplasia: A Prospective, Single-Open-Label, Multicenter Study in Korea

Purpose

To evaluate the efficacy and safety of silodosin 8 mg once daily in a 12-week treatment of subjects with severe lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH).

Materials and Methods

A total of 100 subjects from 10 urology centers in Korea were included in this study. The inclusion criteria were as follows: age ≥50 years, International Prostate Symptom Score (IPSS) ≥20, quality of life (QoL) score ≥3, urine volume ≥120 mL and maximal urinary flow rate (Qmax) <15 mL/s, and postvoid residual volume (PVR) <100 mL. We assessed the improvement of LUTS with change in IPSS, QoL score, Qmax, PVR, and adverse events at baseline and 4 and 12 weeks after treatment with silodosin 8 mg once daily.

Results

The IPSS values were 23.27±3.34, 15.89±6.26, and 13.80±6.31 at baseline, 4, and 12 weeks, respectively, with significant improvements (p<0.0001, p=0.0214, respectively). QoL scores were 4.44±0.85, 3.38±1.20, and 3.04±1.20 at baseline, 4, and 12 weeks, respectively, and the differences were statistically significant (p<0.0001). There was a significant difference in Qmax between baseline and 12 weeks (p<0.0001) but not in PVR (p=0.9404) during the clinical trial. The most frequent adverse event in this study was ejaculation failure with 13 cases. However, no subject dropped out because of ejaculation failure, and in 12 of the 13 cases it was fully resolved without further treatment.

Conclusions

Silodosin 8 mg once daily may be effective and safe in Korean patients with severe LUTS associated with BPH.

[Evolution of lower urinary tract symptoms under silodosin: factors influencing patients' satisfaction]

The objective of this study was to analyze the efficacy and safety of silodosin in patients with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) in current urologic practice.

METHOD

This was a prospective observational study conducted by 272 urologists on patients treated by silodosin for BPH. The parameters evaluated were the weighted IPSS score, the IPSS question 8 related to quality of life, the USP score and the Athens Insomnia Scale (AIS) measured at treatment initiation and after 3 months.

RESULTS

Nine hundred and fourteen patients whose average age was 66 years with LUTS for 3.3 years were analyzed. After 3 months of treatment, a significant decrease in IPSS (from 16.2 ± 6.1 to 9.7 ± 5.5, P<0.0001) and USP score (from 10.6 ± 5.1 to 6 0 ± 4.6, P<0.0001) were observed, quality of life (from 67.1% to 14.4% of unsatisfied patients, P<0.0001) and sleep were significantly improved (from 49.2% to 28.9% patients with insomnia, P<0.0001). Among the patients, 21.2% experienced at least one adverse event. The most frequent were abnormal ejaculation (17.2%). And 7.1% discontinued the treatment for this reason. After 3 months of treatment silodosin was continued in 86.9% of patients.

CONCLUSION

This large study confirmed the efficacy of silodosin in LUTS associated with BPH with a safety profile that does not affect patient satisfaction.

Twelve-month medication persistence in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia

AIMS

This study aimed to assess patients' baseline characteristics and provider factors influencing the continuation of medication for 12 months in patients who were newly diagnosed with benign prostatic hyperplasia (BPH).

METHODS

This study was conducted in patients with newly diagnosed lower urinary tract symptoms (LUTS)/BPH (age ≥ 40) who received either one or a combination of the two pharmacological classes of drugs (alpha-blockers or 5-alpha-reductase inhibitors) from January 2008 to January 2010. Patient demographics and clinical data were assessed from the electronic patient records and telephone surveys. Persistence was defined as continuation of all BPH medications prescribed at the start of the first treatment. Logistic regression analysis was used to evaluate the association between 12-month persistence and patient or provider factors.

RESULTS

Of the 789 newly diagnosed LUTS/BPH patients, 670 (84.9%) were included in the study. Twelve-month persistence for LUTS/BPH medication was 36.6%. Independent predictors of 12-month medication persistence included larger prostate volume, higher prostate specific antigen, having an adequate income and a good patient-doctor relationship. Important reasons for discontinuation were resolved symptoms (31.1%), no improvement in symptoms (23.7%) and adverse events (20.0%).

CONCLUSIONS

About two-thirds of newly diagnosed LUTS/BPH patients discontinued medications within 1 year of starting treatment. We found several potential patient and provider factors associated with persistence, which could be exploited to increase continuation of treatment in future clinical settings.

Applicators for magnetic resonance-guided ultrasonic ablation of benign prostatic hyperplasia

OBJECTIVES

The aims of this study were to evaluate in a canine model applicators designed for ablation of human benign prostatic hyperplasia (BPH) in vivo under magnetic resonance imaging (MRI) guidance, including magnetic resonance thermal imaging (MRTI), determine the ability of MRI techniques to visualize ablative changes in prostate, and evaluate the acute and longer term histologic appearances of prostate tissue ablated during these studies.

MATERIALS AND METHODS

An MRI-compatible transurethral device incorporating a tubular transducer array with dual 120° sectors was used to ablate canine prostate tissue in vivo, in zones similar to regions of human BPH (enlarged transition zones). Magnetic resonance thermal imaging was used for monitoring of ablation in a 3-T environment, and postablation MRIs were performed to determine the visibility of ablated regions. Three canine prostates were ablated in acute studies, and 2 animals were rescanned before killing at 31 days postablation. Acute and chronic appearances of ablated prostate tissue were evaluated histologically and were correlated with the MRTI and postablation MRI scans.

RESULTS

It was possible to ablate regions similar in size to enlarged transition zone in human BPH in 6 to 18 minutes. Regions of acute ablation showed a central "heat-fixed" region surrounded by a region of more obvious necrosis with complete disruption of tissue architecture. After 31 days, ablated regions demonstrated complete apparent resorption of ablated tissue with formation of cystic regions containing fluid. The inherent cooling of the urethra using the technique resulted in complete urethral preservation in all cases.

CONCLUSIONS

Prostatic ablation of zones of size and shape corresponding to human BPH is possible using appropriate transurethral applicators using MRTI, and ablated tissue may be depicted clearly in contrast-enhanced magnetic resonance images. The ability accurately to monitor prostate tissue heating, the apparent resorption of ablated regions over 1 month, and the inherent urethral preservation suggest that the magnetic resonance-guided techniques described are highly promising for the in vivo ablation of symptomatic human BPH.

Fertility and developmental toxicity assessment in rats and rabbits with LY500307, a selective estrogen receptor beta (ERβ) agonist

LY500307 is a selective estrogen receptor beta (ERβ) agonist that was developed for the treatment of benign prostatic hyperplasia. The in vitro functional selectivity of LY500307 for ERβ agonist activity is 32-fold above the activity at the alpha receptor (ERα). LY500307 was evaluated in a series of male (M) and female (F) rat fertility and rat and rabbit embryo-fetal development (EFD) studies, using 20 or 25 animals/group. LY500307 was administered daily by oral gavage starting 2 weeks (F) or 10 weeks (M) before mating, during cohabitation, until necropsy (M) or through gestation day (GD) 6 (F) in the fertility studies and from GD 6 to 17 (rats) or GD 7 to 19 (rabbits) in the EFD studies. Dosage levels of LY500307 ranged from 0.03 to 10 mg/kg/day for rats and from 1 to 25 mg/kg/day for rabbits. Fertility, estrous, maternal reproductive endpoints, conceptus viability, sperm parameters, organ weights, and histopathology were evaluated in the fertility studies. Maternal reproductive endpoints and fetal viability, weight, and morphology were evaluated in the EFD studies. Toxicokinetics were assessed in satellite animals. At 10 mg/kg/day in the male fertility study, findings included decreased body weight (BW); food consumption (FC); fertility, mating, and conception indices; sperm concentration; and reproductive tissue weight (associated with atrophic histologic changes). In the female fertility study, effects included decreased BW and FC at ≥0.3 mg/kg/day and persistent diestrus, delayed mating, and reduced fertility/conception indices at 3 mg/kg/day. In the rat EFD study, findings included decreased maternal BW and FC and increased incidences of adverse clinical signs, abortion, maternal mortality/moribundity, postimplantation loss, and fetal skeletal variations at 3 mg/kg/day. Effects in the rabbit EFD study were limited to decreases in maternal BW and FC at 25 mg/kg/day. In general, systemic maternal exposure increased proportionally with dosage in rats, but less than proportionally in rabbits. In conclusion, the no-observed adverse effect levels following LY500307 administration were 1 mg/kg/day for male rat fertility, 0.3 mg/kg/day for female rat fertility and EFD, and 25 mg/kg/day for rabbit EFD. Adverse reproductive and developmental effects only occurred at or above parentally toxic dosage levels and were considered predominantly due to off-target ERα effects.

An introduction to acinar pressures in BPH and prostate cancer

Intra-acinar and peri-acinar pressures in the prostate might be key factors in the evolution of its zonal morphology and the pathogenesis of BPH and cancer. Herein, I hypothesize that intra-acinar pressures lead to a decrease in apoptosis by distending or stretching acinar epithelium and its surrounding stroma. Increased prostatic smooth muscle content and tone might generate peri-acinar pressures, which could, in the long-term, counteract intra-acinar pressures and decrease epithelial stretch. Thus, it is proposed that BPH (characterized by increased prostatic smooth muscle and, therefore, raised peri-acinar pressures) might decrease the risk of prostate cancer progression by counteracting intra-acinar pressures. In the context of this theory, the transition zone might have evolved as a specialized region within the prostate that can mount a concerted stromal-epithelial response to increased urethral and intra-acinar pressures (BPH), and the urethral angulation, anterior stroma and the prostatic capsule have an adjunctive evolutionary role in this phenomenon.

Effect of Transurethral Resection of the Prostate on Storage Symptoms in Patients with Benign Prostatic Hyperplasia of Less than 30 ml

Purpose

Many patients with benign prostatic hyperplasia (BPH) have not only voiding symptoms but also storage symptoms. Despite the many types of treatment that have been developed for BPH, storage symptoms persist. We conducted an assessment of the efficacy of transurethral resection of the prostate (TURP) and the change in the International Prostate Symptoms Score (IPSS) storage sub-score after the procedure according to prostate size in patients with BPH.

Materials and Methods

Men aged 50 years or older who had BPH were enrolled in this study. 186 patients were divided into two groups according to prostate size measuring using transrectal ultrasonography: In group 1, prostate size was less than 30 ml (51 patients), and in group 2, prostate size was greater than 30 ml (135 patients). All of the patients underwent TURP. We examined whether the degree of change in the IPSS, voiding symptoms, storage symptoms, and quality of life (QoL) differed before and after TURP and according to prostate size.

Results

After three months of TURP, the subjects in both groups showed significant improvement in the IPSS, voiding symptoms, storage symptoms, QoL, and maximum flow rate (p<0.05). The scores for the IPSS, voiding symptoms, storage symptoms, and QoL of group 1 and 2 after three months of TURP were 16.36, 14.25 (p=0.233), 8.21, 8.24 (p=0.980), 8.11, 5.16 (p=0.014), 2.89, and 2.10 (p=0.030), respectively.

Conclusions

TURP is an effective treatment for patients with BPH, regardless of prostate size. However, while the improvement in the storage symptoms of patients with a prostate size of less than 30 ml was not significant, it was in patients with a prostate size greater than 30 ml.

Impact of bent distortion on accuracy of measurement during transrectal ultrasonography for prostatic imaging: a preliminary study

OBJECTIVE

To evaluate the effect of bent distortion of the image of the prostate on the accuracy of 3-dimensional measurements during transrectal ultrasonography (TRUS).

METHODS

TRUS images were obtained prospectively from 60 patients with prostate cancer. The degree of rectal compression on the probe was varied in each case to obtain a typical bent distortion image (BDI) and a minimally bent image (MBI). Magnetic resonance imaging (MRI) served as the reference. Axial and midsagittal BDI, MDI, and MRI were selected. Three-dimensional prostate diameters (height, width, and length) and volume were obtained from all images by 2 independent observers. The data were analyzed by using a paired t test, intraclass correlation coefficients (ICCs), and Bland-Altman plots.

RESULTS

The MBI and BDI diameters differed significantly (P <.001). All ICCs for the MBI diameters and volume and the ICCs for BDI length and volume exceeded 0.9, which indicates high measurement reliability. However, the ICCs for BDI height and width were below 0.9. When the difference in MBI or BDI relative to MRI was calculated for each variable, the MBI differences were all significantly smaller than the BDI differences (P <.001).

CONCLUSION

Bent distortion during TRUS affects the accuracy of measurements. MBI is also morphologically more realistic than BDI. Therefore, to minimize prostatic image distortion, the rectal probe should be placed so that the posterior wall of the prostate is as flat as possible.

Silodosin is effective for treatment of LUTS in men with BPH: a systematic review

The aim of this study was to systematically review the evidence on the efficacy and safety of silodosin treatments on lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH) from randomized controlled trials. We searched PubMed (1966-December 2011), Embase (1974-December 2011) and the Cochrane Library Database (2011, Issue 12). The assessed outcome measures were the change from baseline for the International Prostate Symptom Score (IPSS), quality of life (QoL) score, peak urine maximum flow rate (Q(max)), QoL related to urinary symptoms and adverse effects. Two authors independently assessed the study quality and extracted data. All data were analysed using RevMan 5.1. The meta-analysis included four randomized controlled trials with a total of 2504 patients. The study durations were each 12 weeks. At the follow-up end points, the pooled results showed that the change from baseline for the silodosin group was significantly higher than the placebo group for the IPSS, QoL score and Q(max)(mean difference (MD)=-2.78, P<0.00001; MD=-0.42, P=0.004; MD=1.17, P<0.00001,respectively) and patients felt more satisfied with QoL related to urinary symptoms in the silodosin group than the placebo group. Ejaculation disorder was the most commonly reported adverse effect. The pooled results also showed that the silodosin group was superior to the 0.2 mg tamsulosin group with respect to the IPSS and QoL score (IPSS: MD=-1.14, P=0.02; QoL score: MD=-0.26, P=0.02) and inferior to the 0.2 mg tamsulosin group with respect to Q(max) (MD=-0.85, P=0.01). In contrast, there was no significant difference in the incidence of ejaculation disorder and dizziness between the silodosin and 0.2 mg tamsulosin groups. The current meta-analysis suggested that silodosin is an effective therapy for LUTS in men with BPH and is not inferior to 0.2 mg tamsulosin.

α-Blockers for benign prostatic hyperplasia: the new era

PURPOSE OF REVIEW

α1-Adrenoceptor blockers are the most frequently prescribed medical therapy in the treatment of lower urinary tract symptom suggestive of benign prostatic hyperplasia (LUTS/BPH). The purpose of this review is to highlight the evolution of adrenoceptor blockers with emphasis on newly approved drugs.

RECENT FINDINGS

Over the past years new formulations of several α1-adrenoceptor blockers were introduced to the market. Five long-acting α1-blockers are currently approved by the Food and Drug Administration for treatment of symptomatic LUTS/BPH: terazosin, doxazosin, tamsulosin, alfuzosin and silodosin. Silodosin is the only adrenoceptor blocker that exhibits true selectivity for the α1-adrenoceptor subtypes. This unique adrenoceptor selectivity profile likely accounts for the very favorable cardiovascular safety profile.

SUMMARY

Tamsulosin, alfuzosin slow release and silodosin do not require dose titration. Alfuzosin, terazosin, doxazosin and silodosin have all been shown to be effective in relieving LUTS/BPH independent of prostate size. Low incidence of orthostatic hypotension has been reported for silodosin, but abnormal ejaculation is the most commonly reported adverse effect.

Safety and efficacy of silodosin for the treatment of benign prostatic hyperplasia

Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) are highly prevalent in older men. Medical therapy is the first-line treatment for LUTS associated with BPH. Mainstays in the treatment of male LUTS and clinical BPH are the α(1)-adrenergic receptor antagonists. Silodosin is a new α(1)-adrenergic receptor antagonist that is selective for the α(1A)-adrenergic receptor. By antagonizing α(1A)-adrenergic receptors in the prostate and urethra, silodosin causes smooth muscle relaxation in the lower urinary tract. Since silodosin has greater affinity for the α(1A)-adrenergic receptor than for the α(1B)-adrenergic receptor, it minimizes the propensity for blood pressure-related adverse effects caused by α(1B)-adrenergic receptor blockade. In the clinical studies, patients receiving silodosin at a total daily dose of 8 mg exhibited significant improvements in the International Prostate Symptom Score and maximum urinary flow rate compared with those receiving placebo. Silodosin showed early onset of efficacy for both voiding and storage symptoms. Furthermore, long-term safety of silodosin was also demonstrated. Retrograde or abnormal ejaculation was the most commonly reported adverse effect. The incidence of orthostatic hypotension was low. In conclusion, silodosin, a novel selective α(1A)-adrenergic receptor antagonist, was effective in general and without obtrusive side effects. This review provides clear evidence in support of the clinical usefulness of silodosin in the treatment of LUTS associated with BPH.