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Differentiation; Research in Biological... 2011The origins of benign prostatic diseases, such as benign prostatic hyperplasia (BPH) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), are poorly... (Review)
Review
The origins of benign prostatic diseases, such as benign prostatic hyperplasia (BPH) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), are poorly understood. Patients suffering from benign prostatic symptoms report a substantially reduced quality of life, and the relationship between benign prostate conditions and prostate cancer is uncertain. Epidemiologic data for BPH and CP/CPPS are limited, however an apparent association between BPH symptoms and cardiovascular disease (CVD) has been consistently reported. The prostate synthesizes and stores large amounts of cholesterol and prostate tissues may be particularly sensitive to perturbations in cholesterol metabolism. Hypercholesterolemia, a major risk factor for CVD, is also a risk factor for BPH. Animal model and clinical trial findings suggest that agents that inhibit cholesterol absorption from the intestine, such as the class of compounds known as polyene macrolides, can reduce prostate gland size and improve lower urinary tract symptoms (LUTS). Observational studies indicate that cholesterol-lowering drugs reduce the risk of aggressive prostate cancer, while prostate cancer cell growth and survival pathways depend in part on cholesterol-sensitive biochemical mechanisms. Here we review the evidence that cholesterol metabolism plays a role in the incidence of benign prostate disease and we highlight possible therapeutic approaches based on this concept.
Topics: Acyl Coenzyme A; Anticholesteremic Agents; Cardiovascular Diseases; Cholesterol; Clinical Trials as Topic; Gene Expression; Humans; Hypercholesterolemia; Macrolides; Male; Prostate; Prostatic Hyperplasia; Prostatic Neoplasms; Prostatitis; Signal Transduction
PubMed: 21862201
DOI: 10.1016/j.diff.2011.04.005 -
American Family Physician Feb 2016Chronic prostatitis is relatively common, with a lifetime prevalence of 1.8% to 8.2%. Risk factors include conditions that facilitate introduction of bacteria into the... (Review)
Review
Chronic prostatitis is relatively common, with a lifetime prevalence of 1.8% to 8.2%. Risk factors include conditions that facilitate introduction of bacteria into the urethra and prostate (which also predispose the patient to urinary tract infections) and conditions that can lead to chronic neuropathic pain. Chronic prostatitis must be differentiated from other causes of chronic pelvic pain, such as interstitial cystitis/bladder pain syndrome and pelvic floor dysfunction; prostate and bladder cancers; benign prostatic hyperplasia; urolithiasis; and other causes of dysuria, urinary frequency, and nocturia. The National Institutes of Health divides prostatitis into four syndromes: acute bacterial prostatitis, chronic bacterial prostatitis (CBP), chronic nonbacterial prostatitis (CNP)/chronic pelvic pain syndrome (CPPS), and asymptomatic inflammatory prostatitis. CBP and CNP/CPPS both lead to pelvic pain and lower urinary tract symptoms. CBP presents as recurrent urinary tract infections with the same organism identified on repeated cultures; it responds to a prolonged course of an antibiotic that adequately penetrates the prostate, if the urine culture suggests sensitivity. If four to six weeks of antibiotic therapy is effective but symptoms recur, another course may be prescribed, perhaps in combination with alpha blockers or nonopioid analgesics. CNP/CPPS, accounting for more than 90% of chronic prostatitis cases, presents as prostatic pain lasting at least three months without consistent culture results. Weak evidence supports the use of alpha blockers, pain medications, and a four- to six-week course of antibiotics for the treatment of CNP/CPPS. Patients may also be referred to a psychologist experienced in managing chronic pain. Experts on this condition recommend a combination of treatments tailored to the patient's phenotypic presentation. Urology referral should be considered when appropriate treatment is ineffective. Additional treatments include pelvic floor physical therapy, phytotherapy, and pain management techniques. The UPOINT (urinary, psychosocial, organ-specific, infection, neurologic/systemic, tenderness) approach summarizes the various factors that may contribute to presentation and can guide treatment.
Topics: Adrenergic alpha-Antagonists; Anti-Bacterial Agents; Chronic Disease; Diagnostic Imaging; Humans; Male; Pain Measurement; Pelvic Pain; Physical Therapy Modalities; Prostatitis; Risk Factors
PubMed: 26926816
DOI: No ID Found -
The British Journal of Radiology May 2014One in six males will develop prostate cancer during their lifetime. Prostate cancer is the second leading cause of cancer death in American males, behind only lung... (Review)
Review
One in six males will develop prostate cancer during their lifetime. Prostate cancer is the second leading cause of cancer death in American males, behind only lung cancer. Unfortunately, even though this disease is so common, clinical screening methods such as prostate-specific antigen test and transrectal ultrasound-guided prostate biopsy lack sensitivity and specificity in diagnosing prostate cancer. In recent years, multiparametric prostate MRI has emerged as a very important tool in the diagnosis of prostate carcinoma with a high accuracy. However, diagnostic difficulty is often encountered even with an experienced abdominal radiologist. That is mainly because many normal and abnormal entities can mimic prostate carcinoma at multiparametric MRI. Therefore, the purpose of this pictorial review is to discuss the usefulness of multiparametric prostate MRI in the diagnosis of prostate carcinoma, emphasizing the key MRI features that help to make a distinction of prostate carcinoma from its mimics.
Topics: Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Male; Neoplasm Recurrence, Local; Prostate; Prostatectomy; Prostatic Hyperplasia; Prostatic Neoplasms; Prostatitis; Risk Factors; Sensitivity and Specificity
PubMed: 24646125
DOI: 10.1259/bjr.20130659 -
The Canadian Journal of Urology Aug 2019Invasive procedures, such as transurethral resection of the prostate (TURP), have long been the gold standard therapy for the treatment of lower urinary tract symptoms... (Review)
Review
INTRODUCTION
Invasive procedures, such as transurethral resection of the prostate (TURP), have long been the gold standard therapy for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). In recent years, newer treatment modalities have arisen, such as Aquablation, with similar efficacy and improved adverse event profiles, with particular emphasis on postoperative sexual function.
MATERIALS AND METHODS
Aquablation is a new technology that utilizes machine-controlled water jets to ablate the soft tissue of the prostate as determined by the doctor. In this review, we will discuss the techniques currently being used to complete this procedure, the outcomes and safety, and finally, the long term data as well as the adverse events associated with Aquablation.
RESULTS
Aquablation is rapidly effective in treating patients with LUTS due to BPH. Critically, in head to head comparison with TURP, Aquablation has equivalent objective results with much shorter resections times, and significantly less sexual side effects. Currently, the literature only reports results extending to 12 months post-procedure, and therefore long term durability of results beyond this time point remains unknown.
CONCLUSIONS
Aquablation is a safe and effective option for treating LUTS secondary to BPH. Aquablation is a new surgical option that shows very promising short term results, in particular, due to its short resection time regardless of gland size and low rate of sexual side effects. This technology still requires further investigation to confirm durability and efficacy over time.
Topics: Ablation Techniques; Humans; Male; Prostatic Hyperplasia; Prostatism; Treatment Outcome; Water
PubMed: 31481145
DOI: No ID Found -
Archives of Pathology & Laboratory... Jul 2012Specimens from the prostate and bladder are commonly encountered by the general surgical pathologist. Emphasis is usually placed on neoplasms of the bladder and... (Review)
Review
CONTEXT
Specimens from the prostate and bladder are commonly encountered by the general surgical pathologist. Emphasis is usually placed on neoplasms of the bladder and prostate, particularly if malignant, owing to their therapeutic consequences. A good command of benign lesions occurring in the bladder and prostate, and knowledge of their preneoplastic potential will help pathologists confidently diagnose malignancy versus its benign mimickers and guide the urologists in choosing the appropriate therapy and follow-up for the patient.
OBJECTIVE
To present a mixture of benign entities, and discuss their histologic and clinical characteristics, hoping to provide a practical review for the general surgical pathologist.
DATA SOURCES
An extensive review of the literature on the entities discussed was performed.
CONCLUSIONS
A wide variety of benign entities are present in the prostate and bladder. Benign lesions in the prostate can be age related, such as prostatic atrophy and benign prostatic hyperplasia; transition zone associated, such as basal cell hyperplasia, adenosis, and sclerosing adenosis; or prostatic urethra associated. Benign lesions of the bladder encompass a wide variety of reactive changes that can occur in the urothelium, as well as hyperplastic lesions or reactive proliferations that could be misdiagnosed as malignant. The bladder responds to chronic irritation through several reactive/metaplastic lesions such as cystitis cystica/glandularis, keratinizing squamous metaplasia, or nephrogenic metaplasia. The urothelium can also give rise to hyperplastic/proliferative lesions, in particular von Brunn nest hyperplasia, papillary polypoid cystitis, and pseudocarcinomatous proliferation, which should be distinguished from malignant processes. Ectopic tissue, such as prostatic or mullerian, can also be seen.
Topics: Atrophy; Humans; Male; Prostate; Prostatitis; Urinary Bladder; Urinary Bladder Diseases
PubMed: 22742546
DOI: 10.5858/arpa.2011-0584-RA -
Differentiation; Research in Biological... 2011A wealth of published studies indicate that a variety of chemokines are actively secreted by the prostatic microenvironment consequent to disruptions in normal tissue... (Review)
Review
A wealth of published studies indicate that a variety of chemokines are actively secreted by the prostatic microenvironment consequent to disruptions in normal tissue homeostasis due to the aging process or inflammatory responses. The accumulation of senescent stromal fibroblasts, and, possibly, epithelial cells, may serve as potential driving forces behind chemokine secretion in the aging and enlarged human prostate. Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and histological inflammation may also potentially serve as rich sources of chemokine secretion in the prostate. Once bound to their cognate receptors, chemokines can stimulate powerful pro-proliferation signal transduction pathways and thus function as potent growth factors in the development and progression of Benign Prostatic Hyperplasia (BPH) and lower urinary tract symptoms (LUTS). These functions have been amply demonstrated experimentally and particularly point to robust Mitogen Activated Protein Kinase (MAPK) and phosphoinositide 3-kinase (PI3K) signaling, as well as global transcriptional responses, which mediate chemokine-stimulated cellular proliferative responses. A small body of literature also suggests that chemokine-mediated angiogenesis may comprise a contributing factor to BPH/LUTS development and progression. Thus, the observed low-level secretion of multiple chemokines within the aging prostatic microenvironment may promote a concomitant low-level, but cumulative, over-proliferation of both stromal fibroblastic and epithelial cell types associated with increased prostatic volume. Though the accumulated evidence is far from complete and suffers from some rather extensive gaps in knowledge, it argues favorably for the conclusion that chemokines can, and likely do, promote prostatic enlargement and the associated lower urinary tract symptoms, and justifies further investigations examining chemokines as potential therapeutic targets to delay or ablate BPH/LUTS initiation and progression.
Topics: Aging; Angiogenesis Inducing Agents; Cell Proliferation; Chemokines; Humans; Inflammation; Lower Urinary Tract Symptoms; Male; Prostate; Prostatic Hyperplasia; Prostatitis; Signal Transduction
PubMed: 21600689
DOI: 10.1016/j.diff.2011.04.003 -
Histopathology Jan 2012Chronic inflammation is now known to contribute to several forms of human cancer, with an estimated 20% of adult cancers attributable to chronic inflammatory conditions... (Review)
Review
Chronic inflammation is now known to contribute to several forms of human cancer, with an estimated 20% of adult cancers attributable to chronic inflammatory conditions caused by infectious agents, chronic non-infectious inflammatory diseases and/or other environmental factors. Indeed, chronic inflammation is now regarded as an 'enabling characteristic' of human cancer. The aim of this review is to summarize the current literature on the evidence for a role for chronic inflammation in prostate cancer aetiology, with a specific focus on recent advances regarding the following: (i) potential stimuli for prostatic inflammation; (ii) prostate cancer immunobiology; (iii) inflammatory pathways and cytokines in prostate cancer risk and development; (iv) proliferative inflammatory atrophy (PIA) as a risk factor lesion to prostate cancer development; and (v) the role of nutritional or other anti-inflammatory compounds in reducing prostate cancer risk.
Topics: Chronic Disease; Cytokines; Humans; Inflammation; Male; Prostate; Prostatic Neoplasms; Prostatitis; Th17 Cells
PubMed: 22212087
DOI: 10.1111/j.1365-2559.2011.04033.x -
Clinical Microbiology Reviews Oct 1998The laboratory diagnosis of acute bacterial prostatitis is straightforward and easily accomplished in clinical laboratories. Chronic bacterial prostatitis, and... (Review)
Review
The laboratory diagnosis of acute bacterial prostatitis is straightforward and easily accomplished in clinical laboratories. Chronic bacterial prostatitis, and especially chronic idiopathic prostatitis (most often referred to as abacterial prostatitis), presents a real challenge to the clinician and clinical microbiologist. Clinically, the diagnosis of chronic idiopathic prostatitis is differentiated from that of acute prostatitis by a lack of prostatic inflammation and no "significant" (controversial) leukocytes or bacteria in the expressed prostatic secretions. Despite these diagnostic criteria, the etiology of chronic idiopathic prostatitis is unknown. While this review covers the entire spectrum of microbially caused acute prostatitis (including common and uncommon bacteria, viruses, fungi, and parasites) and microbially associated chronic prostatitis, a special focus has been given to chronic idiopathic prostatitis. The idiopathic syndrome is commonly diagnosed in men but is poorly treated. Recent data convincingly suggests a possible bacterial etiology for the condition. Provocative molecular studies have been published reporting the presence of 16S rRNA bacterial sequences in prostate biopsy tissue that is negative for ordinary bacteria by routine culture in men with chronic idiopathic prostatitis. Additionally, special culture methods have indicated that difficult-to-culture coryneforms and coagulase-negative staphylococci are present in expressed prostatic secretions found to be negative by routine culture techniques. Treatment failures are not uncommon in chronic prostatitis. Literature reports suggest that antimicrobial treatment failures in chronic idiopathic prostatitis caused by organisms producing extracellular slime might result from the virulent properties of coagulase-negative staphylococci or other bacteria. While it is difficult to definitively extrapolate from animal models, antibiotic pharmokinetic studies with a murine model have suggested that treatment failures in chronic prostatitis are probably a result of the local microenvironment surrounding the persistent focal and well-protected small bacterial biofilms buried within the prostate gland. These conclusions support the molecular and culture data implicating bacteria as a cause of chronic idiopathic prostatitis.
Topics: Humans; Male; Prostatitis
PubMed: 9767058
DOI: 10.1128/CMR.11.4.604 -
International Journal of Antimicrobial... Feb 2008Prostatitis describes a combination of infectious diseases (acute and chronic bacterial prostatitis), chronic pelvic pain syndrome, and asymptomatic inflammation. (Review)
Review
BACKGROUND
Prostatitis describes a combination of infectious diseases (acute and chronic bacterial prostatitis), chronic pelvic pain syndrome, and asymptomatic inflammation.
MATERIALS AND METHODS
We employed evidence-based methods to review the epidemiology of prostatitis syndromes.
RESULTS
The prevalence of prostatitis symptoms could be compared in five studies surveying 10,617 men. Overall, 873 participants met various criteria for prostatitis, representing an overall rate of 8.2%, with prevalence ranging from 2.2 to 9.7%. A history of sexually transmitted diseases was associated with an increased risk for prostatitis symptoms. Men reporting a history of prostatitis symptoms had a substantially increased rate of benign prostatic hyperplasia, lower urinary tract symptoms and prostate cancer. In one study, the incidence of physician-diagnosed prostatitis was 4.9 cases per 1000 person-years. Two studies suggest that about one-third of men reporting prostatitis symptoms had resolution after 1 year. Patients with previous episodes and more severe symptoms are at higher risk for chronic pelvic pain.
DISCUSSION
The prevalence of prostatitis symptoms is high, comparable to rates of ischaemic heart disease and diabetes. Clinical evaluation appears necessary to verify that prostatitis is responsible for patients' symptoms. Prostatitis symptoms may increase a man's risk for benign prostate hypertrophy, lower urinary tract symptoms and prostate cancer. We need to define natural history and consequences of prostatitis, develop better algorithms for diagnosis and treatment, and develop strategies for prevention.
Topics: Adult; Aged; Aged, 80 and over; Humans; Male; Middle Aged; Prevalence; Prostatitis; Risk Factors
PubMed: 18164907
DOI: 10.1016/j.ijantimicag.2007.08.028 -
Nature Reviews. Cancer Apr 2007About 20% of all human cancers are caused by chronic infection or chronic inflammatory states. Recently, a new hypothesis has been proposed for prostate carcinogenesis.... (Review)
Review
About 20% of all human cancers are caused by chronic infection or chronic inflammatory states. Recently, a new hypothesis has been proposed for prostate carcinogenesis. It proposes that exposure to environmental factors such as infectious agents and dietary carcinogens, and hormonal imbalances lead to injury of the prostate and to the development of chronic inflammation and regenerative 'risk factor' lesions, referred to as proliferative inflammatory atrophy (PIA). By developing new experimental animal models coupled with classical epidemiological studies, genetic epidemiological studies and molecular pathological approaches, we should be able to determine whether prostate cancer is driven by inflammation, and if so, to develop new strategies to prevent the disease.
Topics: Carcinogens; Chromosome Aberrations; Chronic Disease; Diet; Epigenesis, Genetic; Humans; Infections; Inflammation; Male; Models, Biological; Mutation; Prostatic Neoplasms; Prostatitis; Risk Factors
PubMed: 17384581
DOI: 10.1038/nrc2090