Benign prostatic hyperplasia: does lifestyle play a role?

Evaluation of the Therapeutic Effect of the Traditional Herbal Medicine Atrifil and Oshagh Gum on Testosterone-Induced Benign Prostatic Hyperplasia in Wistar Rats

Benign prostatic hyperplasia (BPH) is a common disease that affects elderly men with various complications. This study evaluates the effects of an Iranian traditional herbal medicine “Atrifil and Oshagh gum” on BPH in male Wistar rats. Atrifil is a combination of three medicinal plants: Emblica officinalis Gaertn, Terminalia chebula Retz, and Terminalia bellerica Retz” extracts, and Oshagh gum is Dorema ammoniacum D. Dono gum. In this study, 30 male Wistar rats were divided into five groups: normal control, disease, finasteride, and extract with 300 and 600 mg/kg groups. The extract is a combination of hydroalcoholic Atrifil extract and Oshagh gum. All groups received intramuscular testosterone enanthate to induce BPH except the normal control group. On the twenty-eighth day, prostate glands were separated. Histopathological changes were observed. Furthermore, the prostate-specific antigen (PSA) and prostate weights were measured. The binding propensities of finasteride, equol, and flavonoids present in this extract such as quercetin, rutin, and kaempferol for 5α-reductase, estrogen receptor alpha and beta, and estrogen-related receptor gamma were assessed using in silico docking approach. Histopathological evaluation, biochemical parameter, and PSA level results indicated significant inhibition of accruing and progression of BPH in groups treated with 600 mg/kg extract (p < 0.01). Furthermore, molecular docking showed that rutin had a high affinity to bind the receptors 5α-reductase, estrogen receptor beta, and estrogen-related receptor gamma even more than finasteride, and on average, quercetin had a higher affinity to all these receptors. In the end, it can be concluded that Atrifil and Oshagh gum is effective in preventing BPH.

Lower urinary tract symptoms in patients with small prostates: Smooth muscle proliferation and calcification might be causative factors

OBJECTIVES

The current study is designed to evaluate and compare the histological changes in the surgical samples of prostate taken from patients undergoing transurethral resection of prostate (TURP) for benign prostate hyperplasia (BPH) with different sizes.

METHODS

Prostate surgical tissue samples were obtained from BPH patients undergoing TURP after taking informed consent. Ultrasound measure of prostatic weight and prostate-specific antigen (PSA) levels were obtained from the patients along with other clinical and demographic details. Tissue samples were fixed, processed, sectioned and stained with hematoxylin and eosin and Masson's trichrome to look for histological features, specifically smooth muscle proliferation. Immunohistochemical expression of bone morphogenetic protein (BMP)-2 was recorded to assess the calcification potential.

RESULTS

Fifty-nine surgical samples were obtained from the patients of age range 50-90 years and body mass index (BMI) 15.6-33.3 kg/m² . The range of ultrasound measures of prostate weight was 20-137 g with PSA ranged 1.03-93.3 ng/mL. Patients with small-sized prostate had significant severe smooth muscle proliferation (P < .001). Prostate size/weight had significant positive association with BMI (P < 0.001, r = 0.543) and negative association with BMP-2 (P < 0.001, r = -0.654). Samples with severe smooth muscle proliferation were with increased BMP-2 expression (P < .001) and higher levels of PSA levels (P = 0.004). BMP-2 expression revealed positive significant association with PSA (P < .001, r = 0.432).

CONCLUSION

From this study we conclude that BPH patients with small-sized glands and high PSA levels have increased smooth muscle proliferation and calcification potential causing the symptoms of lower urinary tract symptoms in these patients.

[How to prevent LUTS due to BPH development and progression]

OBJECTIVE

Our objective was to define potential risk factors for lower urinary tract symptoms (LUTS) related with benign prostatic hyperplasia (BPH).

METHOD

A non-systematic review of the scientific literature was conducted from the PubMed database to extract the most relevant scientific publications between 2000 and July 2018 and cross them with the recommendations of the AFU and the EA by combining the keywords HBP with diet, diet, physical activity, spa treatments, tobacco, alcohol, cardiovascular risk factors, testosterone or inflammation. A synthesis has been proposed in order to identify the important elements to proscribe or modify in order to limit the development and progression of LUTS/BPH.

RESULTS

LUTS due to BPH are clearly associated with erectile dysfunction, cardiovascular diseases and metabolic syndrome. Some reversible risk factors have been identified such as low physical activity, overweight and hypercaloric nutrition. Interventions such as increased physical activity, weight-loss, and a diet including vegetables, tomatoes, carrots, vitamin E, lycopene, selenium, carotene, correction of the metabolic syndrome, stress reduction, and a suitable urinary behavior may impact progression of the disease.

CONCLUSION

Education of the patients on reversible risk factors for LUTS due to BPH is crucial and should be included in everyday practice. Physical activity and weight-loss are the most important factors to take into account.

LEVEL OF EVIDENCE

5 consensus d'experts.

Specific expression pattern of tissue cytokines analyzed through the Surface Acoustic Wave technique is associated with age-related spontaneous benign prostatic hyperplasia in rats

The aim of the study reported herein was to evaluate the suitability of the Surface Acoustic Wave (SAW) technique as a possible diagnostic tool in benign prostatic hyperplasia (BPH). Moreover, for the first time, the BPH model was a totally physiological using naturally aged rats with spontaneous, age-related BPH instead of the pharmacologically induced models usually used. Eighteen male Wistar rats were distributed according to their age: 6 weeks (young), 12 weeks (adult) and 12 months (old) old. Prostate gland was removed and analyzed by mini-arrays, Western blotting (WB) and SAW techniques. Mini-arrays indicated that there were significant differences in the expression of 29/34 inflammation-related cytokines. WB was carried out to confirm the results after selection of 4 cytokines from which one showed no changes, namely PDGF-AA, and the other three, which significantly increase in older animals, were CD86, β-NGF and VEGF. Notwithstanding, WB of old rats yielded confusing results due to an anomalous migration of proteins, dismissing this technique as an useful tool in these animals. Accurate results in old rats were uniquely obtained by using the SAW technique. Thus, SAW analysis showed that there were not differences among groups in the amount of PDGF-AA. On the contrary, SAW analysis showed that amounts of CD86, β-NGF and VEGF in old rats were 2.0, 1.9 and 5.7-fold higher than that from young ones, respectively. These results indicate that SAW is a highly accurate technique for determining changes in the cytokines expression in BPH.

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Diagnosis of prostate alterations can be improved by using the SAW technique.

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Study of prostate alterations can be optimized by using an age-related animal model.

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VEGF is a sensitive marker of bening prostatic hyperplasia.

A possible relationship between serum sex hormones and benign prostatic hyperplasia/lower urinary tract symptoms in men who underwent transurethral prostate resection

In this study, we examined the relationship between sex hormone levels and lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH) who underwent transurethral surgery. The study was conducted in 158 patients who came to our hospital for surgery. Clinical conditions were assessed by body mass index (BMI), digital rectal examination, International Prostate Symptom Score (IPSS) and transrectal ultrasound (TRUS). The levels of sex hormones (including total testosterone (TT), estradiol (E₂), progesterone (P), luteinizing hormone (LH), follicle-stimulating hormone (FSH) and prolactin (PRL)) and prostate-specific antigen (PSA) were reviewed. Correlations were determined through statistical analysis. The mean age was 72.06 ± 8.68 years. The total IPSS was significantly associated with the TT level (r = −0.21, P= 0.01). Other sex hormone levels were not correlated with total IPSS. However, some ratios such as E₂/TT (r = 0.23, P= 0.00) and FSH/LH (r = −0.17, P = 0.04) were associated with total IPSS. Further analysis showed that the nocturia was associated with age (r = 0.16, P= 0.04), BMI (r = 0.21, P = 0.01), and TT (r = −0.19, P= 0.02). Moreover, we divided the patients into two subgroups based on IPSS severity (<20 or ≥20). The mean TT level was in the normal range, but it was significantly related to the presence of severe LUTS. In summary, our study has shown that the severity of LUTS is associated with TT, E₂/TT and FSH/LH in men who underwent prostate surgery. Increasing nocturia was observed in lower testosterone patients. Additional larger studies are needed to elucidate the potential mechanisms.

Effect of Silodosin, an Alpha1A-Adrenoceptor Antagonist, on Ventral Prostatic Hyperplasia in the Spontaneously Hypertensive Rat

Background

A decreased prostatic blood flow could be one of the risk factors for benign prostatic hyperplasia/benign prostatic enlargement. The spontaneously hypertensive rat (SHR) shows a chronic prostatic ischemia and hyperplastic morphological abnormalities in the ventral prostate. The effect of silodosin, a selective alpha_1A-adrenoceptor antagonist, was investigated in the SHR prostate as a prostatic hyperplasia model focusing on prostatic blood flow.

Methods

Twelve-week-old male SHRs were administered perorally with silodosin (100 μg/kg/day) or vehicle once daily for 6 weeks. Wistar Kyoto (WKY) rats were used as normotensive controls and were treated with the vehicle. The effect of silodosin on blood pressure and prostatic blood flow were estimated and then the prostates were removed and weighed. The tissue levels of malondialdehyde (MDA), interleukin-6 (IL-6), chemokine (C-X-C motif) ligand 1/cytokine-induced neutrophil chemoattractant 1 (CXCL1/CINC1), tumor necrosis factor-alpha (TNF-α), transforming growth factor beta 1 (TGF-β1), basic fibroblast growth factor (bFGF) and alpha-smooth muscle actin (α-SMA) were measured. The histological evaluation was also performed by hematoxylin and eosin staining.

Results

There was a significant increase in blood pressure, prostate weight, prostate body weight ratio (PBR), tissue levels of MDA, IL-6, CXCL1/CINC1, TNF-α, TGF-β1, bFGF and α-SMA in the SHR compared to the WKY rat. The ventral prostate in the SHR showed the morphological abnormalities compared to the WKY rat. Prostatic blood flow was decreased in the SHR. However, treatment with silodosin significantly restored the decreased prostatic blood flow in the SHR. Moreover, silodosin normalized tissue levels of MDA, IL-6, CXCL1/CINC1, TNF-α, TGF-β1, bFGF and α-SMA, and it ameliorated ventral prostatic hyperplasia in the SHR excluding blood pressure. Silodosin decreased PBR but not prostate weight in the SHR.

Conclusions

Silodosin can inhibit the progression of prostatic hyperplasia through a recovery of prostatic blood flow.

Relationship between metabolic syndrome and prostate volume in Korean men under 50 years of age

Purpose

The metabolic syndrome (MS) has been accepted as an important cause of benign prostatic hyperplasia (BPH) in old age. However, there are no studies of the influence of MS on prostate volume in relatively young adults. We evaluated the relationship between parameters of MS and prostate volume in men under 50 years of age who visited our health promotion center.

Materials and Methods

A total of 968 men aged 30 to 49 years were enrolled from March 2009 to June 2010. Prostate volume by transrectal ultrasonography of the prostate, serum prostate-specific antigen, digital rectal examination, urinalysis, and MS-related parameters were investigated. We evaluated the correlations of prostate volume with MS and MS-related parameters.

Results

Prostate volume was not significantly larger in the MS group (18.4 cc; range: 14.3-23.1 cc) than in the non-MS group (17.8 cc; range, 13.6-21.6 cc). The prostate volumes in subjects with abnormal fasting plasma glucose (FPG) (18.9 cc; range, 14.3-22.7 cc) and abnormal waist circumference (WC) (19.5 cc; range, 15.6-23.7 cc) were significantly larger than those of subjects with normal parameters (16.9 [range, 12.7-20.4] cc and 17.5 [range, 13.3-21.2] cc, respectively; p=0.001). The logistic regression analysis showed the FPG level and WC to have a significantly positive correlation with the prostate volume (odds ratios: 1.441 [95% CI: 1.303-1.643] and 2.305 [95% CI: 1.470-3.614], respectively).

Conclusions

Groups with abnormal FPG and WC had larger prostate volumes than did normal groups. The abnormal FPG and WC could be more important factors than MS in prostate volume enlargement in relatively young adults.

High-fat diet increases NF-κB signaling in the prostate of reporter mice

BACKGROUND

High-fat diet (HFD) is considered as a major risk factor for benign prostatic diseases and cancer in the Western world. Studies have shown an association between oxidative stress and prostatic diseases. NF-κB has been implicated in stress response and is deregulated in prostrate disorders; therefore, we sought to determine whether HFD could induce oxidative stress in the prostate which could contribute to prostatic diseases.

METHODS

Transgenic NF-κB-Luc-Tag mice were either fed with regular diet (RD) or HFD for 12 weeks. Serial, non-invasive molecular imaging was performed to study NF-κB activation in the whole body, and in various organs including thymus, spleen, and prostate. Western blotting was used to determine the expression of NF-κB, its upstream and downstream targets in the prostate.

RESULTS

Twofold increase in whole body NF-κB activity in vivo and two to threefold upregulated prostate NF-κB activity ex vivo were observed after HFD intake compared with RD controls. HFD-induced NF-κB activity was elevated remarkably in the abdominal cavity, thymus, spleen, and prostate with increase in prostrate weight. In the prostrate, an increase in the protein expression of gp91(phox) , p22(phox) , and p47(phox) NADPH oxidase subunits was observed suggesting the involvement of HFD in causing oxidative stress. Nuclear extracts from the prostrate tissue showed an increased expression of p65/RelA that corresponded with elevated cytosolic levels of p-IκBα, along with increased expression of downstream targets of NF-κB, nitric oxide synthase, and cyclooxygenase-2.

CONCLUSIONS

Our findings suggest that HFD-mediated oxidative stress and deregulation of NADPH oxidase leads to NF-κB activation in the prostrate.