Effect of Gloriosa superba linn (EEGS) on mPT and monosodium glutamate-induced proliferative disorder using rat model

ETHNOPHARMACOLOGICAL RELEVANCE

Hyperplasia, Tumors and cancers are various forms of proliferative disorders affecting humans. Surgery is the main treatment approach while other options are also associated with adverse effects. There is therefore a need for the development of better alternative therapy that is cost effective and readily available with little or no adverse effect. Some bioactive agents in medicinal plants exhibit their anti-proliferative potential by induction of mitochondrial permeability transition pore (mPT) opening. Gloriosa superba, a medicinal plant, is folklorically used in the treatment of tumors and cancers.

AIM OF THE STUDY

This study therefore aimed at investigating the effect of ethanol leaf extract of Gloriosa superba (EEGS) on mPT and monosodium glutamate-induced proliferative disorder in some specific tissues using rat model.

MATERIALS AND METHODS

Isolated rat liver mitochondria were exposed to different concentrations (10, 30, 50, 70 and 90 μg/ml) of EEGS. The mPT pore opening, cytochrome c release, mitochondrial ATPase activity and lipid peroxidation were assessed spectrophotometrically. Caspases 9 and 3 activities were carried out using ELISA technique. Histological assessment of the liver, prostate and uterus of normal and monosodium glutamate (MSG)-treated rats were carried out.

RESULTS

The results showed significant induction of mPT pore opening, release of cytochrome c, enhancement of mitochondrial ATPase activity, inhibition of lipid peroxidation and activation of caspases 9 and 3 activities by EEGS. The histological assessment revealed the presence of MSG-induced hepato-cellular damage, benign prostate hyperplasia and uterine hyperplasia which were ameliorated by EEGS co-administration.

CONCLUSIONS

These findings suggest that EEGS contains putative agents that can induce apoptosis via induction of mPT pore opening and as well protect against MSG-induced hepato-cellular damage and proliferative disorder in prostate and uterus.

The Polyphenols as Potential Agents in Prevention and Therapy of Prostate Diseases

In recent years, the progress of science and medicine greatly has influenced human life span and health. However, lifestyle habits, like physical activity, smoking cessation, moderate alcohol consumption, diet, and maintaining a normal body weight represent measures that greatly reduce the risk of various diseases. The type of diet is very important for disease development. Numerous epidemiological clinical data confirm that longevity is linked to predominantly plant-based diets and it is related to a long life; whereas the western diet, rich in red meat and fats, increases the risk of oxidative stress and thus the risk of developing various diseases and pre-aging. This review is focused on the bioavailability of polyphenols and the use of polyphenols for the prevention of prostate diseases. Special focus in this paper is placed on the isoflavonoids and flavan-3-ols, subgroups of polyphenols, and their protective effects against the development of prostate diseases.

[Calculus formation in the prostatic cavity after transurethral resection of the prostate: causes, treatment and prevention]

OBJECTIVE

To study the causes, clinical manifestations, treatment and prevention of calculus that develops in the prostatic cavity after transurethral resection of the prostate.

METHODS

We reported 11 cases of calculus that developed in the prostatic cavity after transurethral resection or transurethral plasmakinetic resection of prostate. The patients complained of repeated symptoms of frequent micturition, urgent micturition and urodynia after operation, accompanied with urinary tract infection and some with urinary obstruction, which failed to respond to anti-infective therapies. Cystoscopy revealed calculi in the prostatic cavity, with eschar, sphacelus, uneven wound surface and small diverticula in some cases. After diagnosis, 1 case was treated by holmium laser lithotripsy and a second transurethral resection of the prostate, while the other 10 had the calculi removed under the cystoscope, followed by 1 -2 weeks of anti-infective therapy.

RESULTS

After treatment, all the 11 cases showed normal results of routine urinalysis, and no more symptoms of frequent micturition, urgent micturition and urodynia. Three- to six-month follow-up found no bladder irritation symptoms and urinary tract infection.

CONCLUSION

Repeated symptoms of frequent micturition, urgent micturition, urodynia and urinary tract infection after transurethral resection of the prostate should be considered as the indicators of calculus in the prostatic cavity, which can be confirmed by cystoscopy. It can be treated by lithotripsy or removal of the calculus under the cystoscope, or even a second transurethral resection of the prostate. For its prevention, excessive electric coagulation and uneven wound surface should be avoided and anti-infection treatment is needed.

Dietary patterns and prostatic diseases

Dietary patterns play a role on prostatic diseases in association with genetic, behavioral, occupational and environmental ones. Data from reviewed literature provide evidences of a possible relationship between dietary habits and the incidence of prostate disorders, even if it is not enough to justify a widespread adoption of new dietary habits. In this review the role of dietary patterns, including the use of supplements, in the prevention and treatment of the most frequent and known prostatic diseases, benign prostatic hyperplasia (BPH) and prostate cancer (PC) was analyzed. A limited number of well designed trials were identified in which diet and dietary supplement intervention appeared to slow disease progression. Although conclusive evidences are limited, the current data suggest that a diet low in total calories and fat, high in vegetables and fruits and that body weight control could be possibly effective in preventing prostatic diseases. On the other hand care must be taken to ensure that over-consumption of dietary supplements does not occur because it may be harmful.

Activity of Serenoa repens, lycopene and selenium on prostatic disease: evidences and hypotheses

An increasing number of preclinical data, epidemiological evidences and clinical trials point to a potential role of natural compounds like herbal extracts, carotenoids and specific metals in the prevention and/or treatment of different prostate conditions, like hyperplasia, inflammation, cancer. The present article reviews some of the major and most recent findings on the therapeutic properties of three of the most widely used compounds, i.e. Serenoa repens, lycopene and selenium. Although the mechanism of action of these compounds ought to be further characterized by focused investigation, it appears that a common feature of these agents may be a dual activity on proliferative disorders as well as on inflammatory conditions at the level of the prostate gland.

Is there a role for Helicobacter pylori infection in urological diseases?

INTRODUCTION

Helicobacter pylori (H pylori) infection is a focus of attention nowadays. It has been found to cause gastrointestinal disorders and also extra-intestinal disorders. The aim of this paper is to explore the role of H pylori in urological diseases and to keep urologists up to date in this subject.

MATERIALS AND METHODS

Medline and PubMed were searched from 1950 to December 2007 for the following combined terms: Helicobacter pylori together with urology, urological diseases, kidney, kidney cancer, ureter, bladder, bladder cancer, prostate, prostate cancer, benign prostatic hyperplasia, urethra, seminal vesicle, testis, and testicular cancer.

RESULTS

Accumulating evidence is appearing in the literature relating H pylori infection to urological diseases. The most obvious is the implication of H pylori in inducing chronic cystitis leading to bladder lymphoma. In addition, some epidemiological studies have shown significant associations between infective chronic prostatitis and prostatic carcinoma.

CONCLUSION

A simple hypothetical model relating H pylori infection to prostate and bladder diseases is proposed to stimulate the collaborative work between the urologists and scientists to explore this field which is underinvestigated to date. If H pylori is found to have a significant role in urological diseases, prevention of bladder and prostate cancers by eradication of H pylori infection may become a reality like what happened in the treatment of peptic ulcer disease and gastric cancer.

[Curcumin in the treatment of prostatic diseases]

The use of turmeric, derived from the root of the plant curcuma longa, for the treatment of various diseases has been described in Ayurveda and in Traditional Chinese Medicine for thousands of years. The active component of turmeric responsible for this activity, curcumin, was identified almost two centuries ago. Extensive research over the last decade has indicated that this polyphenol can both prevent and treat prostatic diseases.

Surgical management of common canine prostatic conditions

Prostatic diseases commonly warrant surgical intervention. Early castration may prevent the development of benign prostatic hyperplasia, prostatitis, and cavitary lesions (prostatic abscesses or cysts). In intact dogs that present with these disorders, castration should always be part of the specific surgical treatment because it enhances treatment success and may prevent recurrence. The current treatment of choice for cavitary lesions is prostatic omentalization, which results in lower postoperative mortality, faster recovery, and fewer incidences of recurrence than other prostatic drainage techniques. Prostatic neoplasia without evidence of metastasis may be managed with total prostatectomy, subtotal prostatectomy in conjunction with intraoperative radiotherapy, or postoperative chemotherapy. Understanding the neurovascular supply of the prostate and surrounding tissues is essential to decrease the risk for urinary incontinence, severe hemorrhage, and avascular necrosis. Postoperative management includes analgesia, appropriate antibiotic therapy, and in cases of subtotal or total prostatectomy, temporary urinary catheterization.

Dietary supplements and nutraceuticals in the management of andrologic disorders

Dietary supplements and nutraceuticals are commonly used by men with erectile dysfunction, decreased libido, BPH, and concerns about developing prostate cancer. Many preparations do not contain the advertised dosages of the active ingredient or are contaminated. Dietary supplements and nutraceuticals, particularly those addressing erectile dysfunction and libido, need to undergo rigorous testing before they can be wholeheartedly recommended.

Mesure de l’effet de la prévention à l’hôpital

INTRODUCTION

Prevention policy is a legal obligation for French hospitals. As such, preventive clinical practices should therefore be assessed.

OBJECTIVE

Assess the results of the hospital prevention policy.

METHOD

A cross-sectional, stratified epidemiological survey, took place in 10 hospital wards of the university hospital of Clermont-Ferrand. The patients included had to be aged over 60 and leaving the hospital. The criteria for prevention assessment were surveillance of blood pressure and glycaemia, screening of viral serologies for people having had blood transfusion or major surgery, surveillance of weight, check of tetanus vaccination, check of influenza vaccination for people aged 65 and over, detection of prostatic disorders for men aged 70 and over, and detection of dementia in people aged 60 and over.

RESULTS

315 patients were examined during the 33 weeks study. The probable malnutrition rate was twice the obesity rate (10.7 vs 5.9%) but detection of obesity was better in the hospital. Tetanus vaccination rate decreased with age and was lower than influenza vaccination rate (59.5 vs 73.0%). Detection of prostatic disorders was only biological.

DISCUSSION

The hospital prevention policy could be improved in terms of data collection and transmission of information to the GP's. We dispose of a tool for the measure of secondary prevention, independent of the treatment context, in the hospital. Measurements reveal wide gaps between norms and reality and would help to increase awareness among the health care providers.

[Prophylaxis of prostate diseases]

According to the WHO, what second man after fortieth year of life, which, suffers on disorder of prostate gland fifth can hear once "my the mister of cancer of prostate". The cancer of prostate gland is this second, after cancer of skin, the most often recognizable tumor at men, and second, after cancer of lungs the most often bringing to death. It is the purpose of article the performance of preventive workings inhibitory the excess of prostate gland, as well as reducing the risk of falling ill on neoplasm disease of prostate gland.

Isoflavones and the prevention and treatment of prostate disease: is there a role?

Epidemiologic and experimental data suggest that isoflavones have benefits for preventing and treating some prostate disease. Isoflavone supplements may therefore be an important tool for men concerned about prostate disease, such as those with benign prostatic hypertrophy undergoing watchful waiting or those concerned about the potential for prostate cancer. Conclusive proof of a relationship between isoflavones and the prevention and treatment of prostate disease can only come from prospective, randomized, controlled clinical trials.

Dietary supplements of soya flour lower serum testosterone concentrations and improve markers of oxidative stress in men

OBJECTIVE

We examined the effects on serum sex steroids, lipids and markers of oxidative stress of supplementing the diets of healthy male volunteers with scones made with soya flour.

DESIGN

A randomized placebo controlled cross-over trial.

SETTING

University Hospital of Wales.

SUBJECTS

Twenty volunteers recruited by advertisement.

INTERVENTIONS

Male volunteers ate three scones a day in addition to their normal diet for a period of 6 weeks. The scones were made with either wheat or soya flour (containing 120 mg/day of isoflavones). Blood was analysed for sex steroids (testosterone, dihydro-testosterone, oestradiol, oestrone, sex hormone binding globulin, albumin and the concentration of non-protein bound sex steroids were calculated), lipid profile (total cholesterol, high density lipoprotein cholesterol and triglycerides) and measures of oxidative stress (hydroperoxides, susceptibility of LDL to oxidation with copper and myeloperoxidase).

RESULTS

The volunteers' mean age was 35.6 (s.d. 11.2) y. Total serum testosterone fell in volunteers taking the soya scones (19.3-18.2 nmol/l; 95% CI 1.01, 1.12; P=0.03). No significant changes were seen in the concentrations of the other serum sex steroids, albumin or sex hormone binding globulin throughout the study. Significant improvements in two of the three markers of oxidative stress were seen in volunteers taking soya scones. Lag time for myeloperoxidase rose from 55.0 to 68.0 min (95% CI -16.0, -3.5; P=0.009) and the presence of hydroperoxides decreased from 2.69 to 2.34 micro mol/l (95% CI 0.12, 0.71; P=0.009). There were no changes seen in serum triglycerides or cholesterol.

CONCLUSIONS

We have shown that soya supplements reduce serum testosterone and improve markers of oxidative stress. These findings provide a putative mechanism by which soya supplements could protect against prostatic disease and atherosclerosis. Further dietary studies with clinical end points are warranted.

Decreased suburethral prostatic microvessel density in finasteride treated prostates: a possible mechanism for reduced bleeding in benign prostatic hyperplasia

PURPOSE

We evaluated the influence of finasteride on prostatic microvessel density to elucidate a mechanism of decreased bleeding in finasteride treated patients with hematuria secondary to benign prostatic hyperplasia (BPH).

MATERIALS AND METHODS

A total of 22 patients with clinical BPH and gross hematuria who underwent prostate reductive surgery between 1998 and 2000 were prospectively evaluated. The prostate from 10 finasteride treated and 12 untreated patients was immunohistochemically stained for CD-34. Microvessel density analysis was performed by quantifying positive stained blood vessels located within the stroma of hyperplastic nodules as well as in the suburethral portion of the prostate.

RESULTS

Mean microvessel density plus or minus standard deviation in finasteride treated patients was significantly lower in the suburethral portion of the prostate versus untreated controls (14.0 +/- 2.8 versus 20.2 +/- 5.3 vessels per high power field, p <0.05). In the nodular hyperplasia there was no statistically significant difference in the treatment and control groups (mean 17.5 +/- 2.8 and 16.7 +/- 4.6 vessels per high power field, respectively).

CONCLUSIONS

Finasteride significantly decreases suburethral prostatic microvessel density in patients with BPH, which may explain its efficacy for decreasing BPH associated bleeding.

Evaluation of a preparatory community-based prostate health education program

BACKGROUND

Medical organizations are divided on the issue of screening for prostate cancer, yet there is agreement that men should be educated about prostate health. Shared decision making involves patients and practitioners in this process, yet some men need preparatory education prior to the physician encounter. This study assessed the effectiveness of a community prostate health awareness program, focusing on men at risk for prostate cancer.

METHODS

Participants were given a pretest and a posttest to assess knowledge gains and impact on short-term intentions to address their prostate health.

RESULTS

There was a statistically significant increase in knowledge. Short-term intentions increased for those participants meeting the inclusion criteria.

DISCUSSION

Community outreach programs remain an excellent vehicle to educate the public and complement the efforts of health care providers.

Pain after transrectal ultrasonography-guided prostate biopsy: the advantages of periprostatic local anaesthesia

OBJECTIVE

To prospectively evaluate the efficacy and safety of periprostatic local anaesthesia (LA) during prostatic biopsy guided by transrectal ultrasonography (TRUS), as 20-65% of men report moderate to severe pain, and there is anecdotal and published evidence that periprostatic anaesthesia improves patients' tolerance.

PATIENTS AND METHODS

In all, 157 patients were prospectively recruited and sequentially randomized to receive either LA or no anaesthesia. Sextant biopsies were taken in all men but some had more than six biopsies. All were asked to complete questionnaires immediately after TRUS-guided biopsy and for the subsequent week, giving pain scores and recording any morbidity, including symptoms of infection; analgesic use was also surveyed.

RESULTS

Patients given LA had significantly lower pain scores at the time of biopsy than those given no anaesthesia, with median (sd) pain scores of 1.53 (0.7) and 1.95 (0.65) (P < 0.001), respectively. In addition, there was a trend towards less analgesic use by those given LA, although this was not statistically significant. There was no difference in the amount of haematuria, haematochezia or haematospermia, or infection rate, between the groups. The additional cost and time of the procedure was minimal ( pound3.00 and 3 min/per patient, respectively).

CONCLUSION

Periprostatic LA infiltration is a quick and simple procedure which significantly improves immediate pain with no added morbidity; we strongly advocate its use to improve patient tolerance of TRUS-guided prostate biopsy.

Diet and its preventive role in prostatic disease

Asian men have much lower incidences of prostate cancer and possibly of benign prostatic hyperplasia (BPH) than their Western counterparts. Vegetarian men also have a lower incidence of prostate cancer than omnivorous males. Both Asian and vegetarian men consume low-fat, high-fibre diets which provide a rich supply of weak dietary oestrogens. These plant or phyto-oestrogens have been proposed as chemopreventive agents, particularly for Asian men and to a lesser extent, for vegetarian men also. The three principal classes of phyto-oestrogens are the isoflavonoids, flavonoids and lignans. Many foods of plant origin contain varying amounts of these compounds and hundreds of plants manifest some degree of oestrogenic activity. Soya, a dietary staple in many parts of Asia, is a major source of the isoflavonoids, daidzein and genistein. Flavonoids are present in high concentration in many fruits, vegetables and crop species. In particular, apigenin and kaempferol are regarded as major flavonoids because of their common occurrence in plants, and their significant concentrations when present. Apples, onions and tea-leaves are excellent sources of flavonoids. Plant lignans are present in many cereals, grains, fruits and vegetables, and give rise to the mammalian lignans, enterodiol and enterolactone; however, the richest source is linseed (flaxseed) and other oilseeds. In addition to their oestrogenic activity, many of these plant compounds can interfere with steroid metabolism and bioavailability, and also inhibit enzymes, such as tyrosine kinase and topoisomerase, which are crucial to cellular proliferation.

Planning a prostate awareness week

There are low consultation rates among men with prostate disease. Prostate disease can affect the quality of life of both patients and their families. Health promotional activities, such as a prostate awareness week, can empower men to seek professional advice and treatment.

Phytoestrogens and diseases of the prostate gland

Both benign hyperplasia (BPH) and cancer of the prostate are manifest in men beyond the age of 50. Approximately 50% of men greater than 50 years of age will suffer from the symptoms associated with BPH, especially from bladder outlet obstruction. With the ever-increasing proportion of the population over 65 years of age worldwide, BPH is becoming an important medical problem as the world moves into the next millennium. Cancer of the prostate is the second most commonly diagnosed cancer after skin cancer in the male population of the United States, and the second most common cause of death from cancer after that of the lung. Overall, around the world the incidence of carcinoma of the prostate is increasing annually by 2-3%. Both race and geographical location have a profound influence of the prevalence of prostate cancer worldwide. Black men in the USA have the highest incidence, while the incidence is much lower in Asian men from China, Japan and Thailand. Although the prostate gland is androgen-dependent, it is now recognized that the biological actions of endocrine-related factors, such as androgens, oestrogens, glucocorticoids and certain dietary and environmental factors, are mediated within the gland by various growth regulatory factors. The growth regulatory factors such as epidermal growth factor (EGF), keratinocyte growth factors (KGF), fibroblast growth factors (FGFs) and insulin-like growth factors II and I are mitogenic and directly stimulate cell proliferation under the modulating influence of steroid hormones. Steroids are therefore essential but not directly responsible for cell proliferation. Certain plant compounds such as isoflavonoids, flavonoids and lignans have been proposed as cancer protective compounds in populations with low incidences of prostate diseases. In particular, soya contains the isoflavone genistein, a compound with many properties which could influence both endocrine and growth factor signalling pathways.

Prostatodynia in United Nations peacekeeping forces in Haiti

Prostatodynia is a clinical entity associated with voiding symptoms and pelvic pain suggestive of prostatitis but with a normal prostate examination and without evidence of inflammation or infection in expressed prostatic secretions. The problem tends to be chronic and is vexing in its management. Although thought to be a common condition, prevalence data are generally lacking. From June to October 1995, the U.S. Army's 86th Combat Support Hospital provided medical support to a multinational United Nations peacekeeping force in Haiti. Patients diagnosed with prostatodynia were more common (13 cases) than men with other urologic problems (urolithiasis, 6 cases; urinary tract infection, 6 cases; scrotal abscess/mass, 2 cases; epididymitis, 1 case). Patients tended to be young (mean age 29.8), had multiple visits, failed to respond to multiple courses of antibiotics for presumed "prostatitis," and denied recent sexual relations. Some patients reported having had similar symptoms on prolonged separation from their spouses in the past that resolved with resumption of normal intercourse. Masturbation, however, had no impact on symptoms and was painful in some individuals. Terazosin, an alpha-antagonist, and stress-reduction therapy led to improvement in some patients' symptoms. A discussion of these retrospective findings in light of what is known about the possible etiologies and treatment of prostatodynia is presented. Prostatodynia appears to be a common problem in deployed troops and can lead to frequent use of medical services. Physicians supporting long deployments need to be aware of this entity.

Prostate-specific antigen levels from a mass screening program using highly sensitive RIA kits

BACKGROUND

This study was designed to evaluate the distribution of prostate-specific antigen (PSA) levels of men in a mass screening program for prostatic disease.

METHODS

A total of 763 men over 40 years of age underwent mass screening for prostatic disease in a Japanese prefecture using the highly sensitive Eiken kit and the Hybritech (Tandem-R) kit. The screening tests consisted of serum PSA determination, digital rectal examination, a questionnaire on symptoms, evaluation of prostate volume, and determination of the obesity rate.

RESULTS

Serum PSA levels of all subjects were measured with both kits. The correlation between the values obtained by the Eiken kit and those of the Tandem-R kit was high (r = 0.990), but the values of the former were slightly higher than those of the latter. Serum PSA weakly correlated with age, however, when estimated within decade age brackets, the levels of PSA showed significant differences among only 1 pair of groups stratified by age. In contrast, the levels of PSA showed significant differences among 9 pairs of groups stratified by prostate volume.

CONCLUSION

A highly sensitive assay kit is useful to evaluate both the distribution of PSA levels and the relationship of PSA values to age and prostate volume of men in mass screening programs for prostatic disease, since approximately 40% of the subjects who underwent the present mass screening showed PSA values under 1.0 ng/mL, which have been the the lower limit of detection of many PSA kits.

Urologic 'nuisances': how to work up and relieve men's symptoms

Common urologic complaints in the midlife man include bladder outlet obstruction, bladder hyperactivity, and large urinary output. Obstruction can result from benign prostate hypertrophy or some other problem distal to the bladder neck, such as urethral stricture. Hyperactivity can be induced by stress and caffeine or can suggest neurologic disease or bladder neoplasia. Large urinary output suggests excessive fluid intake, diabetes insipidus or mellitus, or mobilization of fluid from the use of diuretics or reclining at night. Sexual dysfunction may be caused by stress, but it is more often linked to peripheral vascular disease. Screening for prostate cancer is controversial; the benefit of PSA testing is most clear in patients at elevated risk (eg, due to race or family history).

[Potential role for family physicians in pushing back age-related impairment: hearing and vision disorders, incontinence and arthrosis]

OBJECTIVE

To determine which age-related disorders lend themselves for screening followed by intervention in general practice.

SETTING

Department of General Practice Medicine, University of Leiden.

DESIGN

Descriptive.

METHODS

This study concerned eight frequent age-related disorders: auditory and visual disorders, cognitive limitations, vertigo, incontinence, prostate symptoms, osteoarthritis and depressive symptoms. Four criteria (diagnostic possibilities, therapeutic possibilities, suitability of general practice for screening and intervention, the benefit of the programme to the elderly) were applied to selected literature (from Medicine and the electronic article files of the Nederlands Tijdschrift voor Geneeskunde (Dutch Journal of Medicine) and of Huisarts en Wetenschap (GP and Science) to find out whether screening followed by intervention appeared useful.

RESULTS

With regard to three disorders (auditory and visual disorders and incontinence) it appeared possible to reduce the impairments caused by them, while in osteoarthritis, screening and intervention might lead to better mobility.

CONCLUSION

With reference to recent literature, it appears theoretically possible to reduce the impairments caused by auditory and visual disorders, incontinence and osteoarthritis.

[Changes in the voiding condition with aging in elderly males--results of a field survey for prostatic diseases]

We investigated changes in the voiding condition with aging in 1476 males 50 years and older, who participated in a field survey for prostatic diseases conducted from 1982 to 1991 in Hokkaido. Voiding conditions were evaluated subjectively with a symptom index (weak stream, intermittency, nocturia, urge incontinence), and objectively with maximum flow rate. Digital rectal examination (DRE) revealed 10.3% (572 participants) of total evaluable participants to have moderate or marked enlargement of the prostate. The incidence of enlargement of the prostate apparently increased with aging. Subjective urinary symptoms, both obstructive and irritative, increased in the incidence and degree with aging. The maximum flow rate and maximum flow rate-nomogram also became worse with aging the incidences participants having urinary symptoms or decreased maximum flow rate increased in parallel with the size of the prostate on DRE. For each size of the prostate on DRE, the incidence of participants having urinary symptoms increased with aging. The maximum flow rate showed a similar tendency, decreasing with aging, irrespective of the size of the prostate. These results indicate that aging as well as the size of the prostate may affect the voiding condition in males aged 50 years and older.

[The volume of the seminal vesicles in general senior population]

The volume of the seminal vesicles in 413 males, who were submitted to a mass screening program for prostatic diseases by transrectal sonography, was measured by tracing ultrasonograms using a multi-planimeter. Ages of the subjects ranged from 46 to 88 years (mean age 67.0 years). The mean volume of the seminal vesicles for all cases was 14.55 +/- 5.11 cm3. The volume of the seminal vesicles was not related statistically to the height, body weight and body mass index of the subject. The volume of the seminal vesicles in cases of no prostatic diseases decreased with age, while that of cases of benign prostatic hypertrophy increased with the progress of the disease. These facts suggested that the seminal vesicles were androgen dependent, similar to the prostate.

[Simultaneous enucleo-resection of synchronous bilateral renal carcinoma, incidentally discovered during prostate disease screening]

Bilateral synchronous renal cell carcinoma is rare, incidental discovery is exceptional. We report a case of asymptomatic bilateral simultaneous renal tumor discovered during screening for prostatic disease. Two year previously the patient underwent sonography and IVP for right ureteral stone, spontaneously ejected, with no evidence of renal masses. Ultrasound, CT and selective digital angiography demonstrated two renal tumors < 3 cm in size. Bilateral simultaneous enucleoresection was the therapeutic choice, that we consider to be elective in such a case.

[A study on the mass screening system for prostatic diseases]

Between 1984 and 1990, a mass screening for prostatic diseases was carried out on men over 55 years old in cities, towns and villages in Toyama Prefecture, Japan. The total number of subjects examined in the primary study was 1,232, which was 17.7% of the males over 55 years old in these areas. The primary study consisted of inquiry concerning urination, digital examination of the prostate, transabdominal ultrasonography, and determination of tumor markers. A secondary study was indicated for 100 subjects (8.9%) suspected to have prostatic cancer and 169 (15%) suspected to have benign prostatic hypertrophy, but only 92 (35%) of them were actually examined. Prostatic cancer was histologically diagnosed in 3 subjects (0.3%), and benign prostatic hypertrophy was established in 56 subjects (4.5%), who were referred to urologists. Though a high percentage of the population was covered by the primary study the percentage of subjects who received the secondary study among those in whom it was indicated was low. This probably was a reason for the low detection rate of prostatic cancer. An improved system is considered to be needed to increase the efficiency of mass screening for prostatic diseases.

[Diagnostic imaging of the prostate]

Modalities for the diagnostic imaging of the prostate are surveyed. Transrectal sonography is thought to be the best method for the purpose, because of its non-invasive nature, fine picture quality, sufficient reproductivity and less expensive cost. Up-to-date utilizations of the method are described, such as diagnostic capability, staging, monitoring, screening and intervention. CT is less effective but MRI is promising to visualize internal structure inside the prostate. Two very new techniques, namely, ultrasonic Doppler color flow mapping and positron emission CT (PET), of which application to the prostate is being investigated originally in our laboratory, are introduced.

[Studies on prostatism of males fifty years of age and older--analysis on results of a second mass screening for prostatic diseases in Tanno town]

We conducted a second mass screening for prostatism on males 50 years of age and older in the Tanno town area, to determine the incidence of benign prostatic hypertrophy (BPH) and prostatic carcinoma. We also studied how often elderly males had symptoms related to prostatism according to their age. The incidence of BPH was 10.0% in these males who were received the first and/or second mass screening as well as those treated previously, when BPH was defined as the prostate with a moderately or greater enlarged size upon digital palpation. The incidence of BPH was 8.9% in males fifty years of age and older who lived in Tanno town. The figures tended to elevate with the advance of age. Two new patients with prostatic carcinoma were discovered during this second mass screening, which resulted in a total of 8 patients discovered in this area. Of these 8 patients, 6 had been found in the first screening. The incidence of prostatic carcinoma was 1.4% in those males who received the first or second mass screening as well as those treated previously, and that in all the males who lived in the town was 1.0%. Further efforts will be necessary to establish a more convenient system that can provide less costly screening procedures and more effective diagnostic procedures to detect localized prostatic carcinoma. With advance in age the male tended to have a higher incidence of prostate with a moderately or markedly enlarged size, and symptoms related to prostatism. In addition, the urinary flow rate tended to decrease, irrespective of the prostate size. The results supported the significance of mass screening for prostatism.

[Cost-benefit effect of mass screening for prostatic disease on national economy]

A survey was made to determine how much mass screening for prostatic cancer (PC) and benign prostatic hypertrophy (BPH) would benefit the nation economically. Presently in Japan, approximately 20,000 people are suffering from PC, approximately 0.2% of the male population over the age of 55. Approximately 37 billion yen is spent annually to treat them with current medical care. This amounts to approximately 0.3% of the annual national medical fee for all diseases and approximately 4% for malignant neoplasms. However, if all adult males participated in a mass screening program for prostatic cancer once every two years, a program already established by us, eradication of PC may be theoretically possible at the cost of approximately 31 billion yen per year. Mass screening for prostatic cancer will thus contribute highly to both the reduction of the national medical costs and the decrease of deaths from cancer. The nation also spends heavily on BPH. There is an urgent need to recognize that BPH is a heavy burden on the national economy, and to consider a proper counterplan.

Prostatic biopsy guided by transrectal ultrasonography using real-time linear scanner

Prostatic needle biopsy guided by transrectal ultrasonography using a real-time linear scanner was performed on 257 cases in our outpatient clinic and mass screening program for prostatic diseases. The success rate was 99.2 per cent, and complications occurred in only 2 cases (0.8%) after biopsy. This newly developed method is recommended as being safer and more accurate than conventional ones.

A mobile mass screening unit for prostatic disease

A mobile unit for mass screening of prostatic disease using transrectal ultrasonotomography was developed in December 1980. In the following years we screened 1,396 males over 55 years of age. We have detected 463 cases [33.2%] of benign prostatic hypertrophy [BPH] and eight cases [0.6%] of prostatic cancer. The detection rate of BPH and malignancy of the prostate was shown to be very high. Thus, the unit promises to be of value in preventative medicine projects for prostatic disease in Japan.