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Archivio Italiano Di Urologia,... Oct 2019During the last years, pharmaceutical innovations in primary care are dramatically less frequent and will be even more rare in the next future. In this context,... (Review)
Review
During the last years, pharmaceutical innovations in primary care are dramatically less frequent and will be even more rare in the next future. In this context, preclinical and clinical research oriented their interest toward natural compounds efficacy and safety, supporting the development of a new "nutraceutical" science. Medicinal plants, in the form of plant parts or extracts of them, are commonly used for the treatment of prostate diseases such as benign hypertrophy, prostatitis and chronic pelvic pain syndrome. The pharmacological properties searched for the treatment of prostatic diseases are anti-androgenic, anti-estrogenic, antiproliferative, antioxidant and anti-inflammatory. The most studied and used medicinal plants are Serenoa repens, Pygeum africanum and Urtica dioica. Other promising plants are Cucurbita pepo, Epilobium spp, Lycopersum esculentum, Secale cereale, Roystonea regia, Vaccinium macrocarpon. In parallel, epidemiological studies demonstrated that diet may play an important role on incidence and development of prostatic diseases. The Mediterranean diet is rich of elements with anti-oxidant properties that act as a protective factor for prostatic cancer. Similarly, low intake of animal protein, high intake of fruits and vegetable, lycopene and zinc are a protective factor for benign prostatic hyperplasia (BPH). Serenoa repens in the treatment of symptoms of BPH has been tested either alone or, more frequently, in combination with other medicinal plants, alpha-blockers and inhibitors of 5- alpha reductase (5-ARI). Recent meta-analyses found the effectiveness of Serenoa repens similar or inferior of that of finasteride and tamsulosin but clearly higher than that of placebo in the treatment of mild and moderate low urinary tract symptoms (LUTS), nocturia and discomfort. Clinical trials showed potential synergistic effect of Serenoa repens with other medicinal plants and drugs. In addition to Serenoa repens, there are many other medicinal plants for which clinical evidence is still controversial. Urtica dioica, Pygeum africanum and Curcubita pepo can be considered as an adjunct to the common therapies and their use is supported by studies showing improvement of symptoms and flowmetric indices. Lycopene and selenium are natural products with antioxidant and anti-inflammatory action. The combination of lycopene and selenium with Serenoa repens was able to reduce inflammation in histological prostate sections and to further improve symptom scores and urinary flow in patients with BPH on tamsulosin treatment. Similar effects could be obtained with the use of other carotenoids, such as astaxanthin, and/or zinc. Efficacy on symptoms of patients with BPH of some polyphenols such as quercitin, equol and curcumin have been demonstrated by clinical studies. Pollen extract is a mixture of natural components able to inhibit several cytokines and prostaglandin and leukotriene synthesis resulting in a potent anti-inflammatory effect. Pollen extracts significantly improve symptoms, pain, and quality of life in patients affected by chronic pelvic pain syndrome and chronic prostatitis. Beta-sitosterol is a sterol able to improve urinary symptoms and flow measures, but not to reduce the size of the prostate gland. Palmitoylethanolamide (PEA) is an endogenous fatty acid amide-signaling molecule with anti-inflammatory and neuroprotective effects that can have an interesting role in the management of chronic pelvic pain syndrome and chronic urological pain. Finally, several plant-based products have been subjected to preclinical, in vitro and in vivo, investigations for their potential pharmacological activity against prostate cancer. Some epidemiological studies or clinical trials evaluated the effects of beverages, extracts or food preparations on the risk of prostate cancer. Some plant species deserved more intense investigation, such as Camelia sinensis (green or black tea), Solanum lycopersicum (common tomato), Punica granatum (pomegranate), Glycine max (common soy) and Linum usitatissimum (linen).
Topics: Dietary Supplements; Humans; Male; Phytotherapy; Plant Extracts; Plants, Medicinal; Prostatic Hyperplasia; Prostatic Neoplasms
PubMed: 31577095
DOI: 10.4081/aiua.2019.3.139 -
Physiological Reviews Jul 2017Estrogens have historically been associated with female reproduction, but work over the last two decades established that estrogens and their main nuclear receptors... (Review)
Review
Estrogens have historically been associated with female reproduction, but work over the last two decades established that estrogens and their main nuclear receptors (ESR1 and ESR2) and G protein-coupled estrogen receptor (GPER) also regulate male reproductive and nonreproductive organs. 17β-Estradiol (E2) is measureable in blood of men and males of other species, but in rete testis fluids, E2 reaches concentrations normally found only in females and in some species nanomolar concentrations of estrone sulfate are found in semen. Aromatase, which converts androgens to estrogens, is expressed in Leydig cells, seminiferous epithelium, and other male organs. Early studies showed E2 binding in numerous male tissues, and ESR1 and ESR2 each show unique distributions and actions in males. Exogenous estrogen treatment produced male reproductive pathologies in laboratory animals and men, especially during development, and studies with transgenic mice with compromised estrogen signaling demonstrated an E2 role in normal male physiology. Efferent ductules and epididymal functions are dependent on estrogen signaling through ESR1, whose loss impaired ion transport and water reabsorption, resulting in abnormal sperm. Loss of ESR1 or aromatase also produces effects on nonreproductive targets such as brain, adipose, skeletal muscle, bone, cardiovascular, and immune tissues. Expression of GPER is extensive in male tracts, suggesting a possible role for E2 signaling through this receptor in male reproduction. Recent evidence also indicates that membrane ESR1 has critical roles in male reproduction. Thus estrogens are important physiological regulators in males, and future studies may reveal additional roles for estrogen signaling in various target tissues.
Topics: Animals; Aromatase; Estrogens; Genitalia, Male; Genotype; Humans; Male; Mice, Knockout; Mutation; Phenotype; Prostate; Prostatic Diseases; Receptors, Estrogen; Reproduction; Signal Transduction
PubMed: 28539434
DOI: 10.1152/physrev.00018.2016 -
International Journal of Molecular... Apr 2019Prostate cancer is the most prevalent non-skin cancer in men and is the leading cause of cancer-related death. Early detection of prostate cancer is largely determined... (Review)
Review
Prostate cancer is the most prevalent non-skin cancer in men and is the leading cause of cancer-related death. Early detection of prostate cancer is largely determined by a widely used prostate specific antigen (PSA) blood test and biopsy is performed for definitive diagnosis. Prostate cancer is asymptomatic in the early stage of the disease, comprises of diverse clinico-pathologic and progression features, and is characterized by a large subset of the indolent cancer type. Therefore, it is critical to develop an individualized approach for early detection, disease stratification (indolent vs. aggressive), and prediction of treatment response for prostate cancer. There has been remarkable progress in prostate cancer biomarker discovery, largely through advancements in genomic technologies. A rich array of prostate cancer diagnostic and prognostic tests has emerged for serum (4K, phi), urine (Progensa, , ExoDx, SelectMDx), and tumor tissue (ConfirmMDx, Prolaris, Oncoytype DX, Decipher). The development of these assays has created new opportunities for improving prostate cancer diagnosis, prognosis, and treatment decisions. While opening exciting opportunities, these developments also pose unique challenges in terms of selecting and incorporating these assays into the continuum of prostate cancer patient care.
Topics: Biomarkers; Biomarkers, Tumor; Disease Management; Humans; Male; Microarray Analysis; Molecular Diagnostic Techniques; Prognosis; Prostatic Neoplasms
PubMed: 31013716
DOI: 10.3390/ijms20081813 -
Frontiers in Bioscience (Elite Edition) Jan 2013The prevalence of semen hyperviscosity (SHV) is estimated to be between 12-29% and can lead to male factor infertility both in vivo and in vitro. Semen is composed of... (Review)
Review
The prevalence of semen hyperviscosity (SHV) is estimated to be between 12-29% and can lead to male factor infertility both in vivo and in vitro. Semen is composed of fluids secreted by the male accessory glands, which contain proteins essential to the coagulation and liquefaction of semen. Hypofunction of the prostate or seminal vesicles causes abnormal viscosity of seminal fluid. Infection and high levels of seminal leukocytes may also result in the development of SHV. Oxidative stress and biochemical and genetic factors can furthermore contribute to this condition. Hyperviscosity can impair normal sperm movement in the female reproductive tract, and can lead to decreased sperm count. SHV is treated with a hypodermic needle, mucolytic enzymes, antibiotics and anti-inflammatory agents in certain cases. Further research is needed to better understand the contributors to SHV and the treatments that can be used for infertile males with hyperviscous semen.
Topics: Humans; Infertility, Male; Male; Prostatic Diseases; Semen; Seminal Vesicles; Viscosity
PubMed: 23276984
DOI: 10.2741/e610 -
BJU International Jun 2021To describe the trend in the impact of lower urinary tract symptoms attributed to benign prostatic hyperplasia (LUTS/BPH) on a global scale using the Global Burden of...
OBJECTIVES
To describe the trend in the impact of lower urinary tract symptoms attributed to benign prostatic hyperplasia (LUTS/BPH) on a global scale using the Global Burden of Disease (GBD) database.
MATERIALS AND METHODS
Using the GBD database, worldwide data aggregated from registries and health systems from 1990 to 2017 were filtered for LUTS/BPH diagnoses. Calculation of years lived with disability (YLD) were compared with other urological diseases. YLD were calculated by a standardized method using assigned disability weights. The GBD-defined sociodemographic index (SDI) was used to assess impact of LUTS/BPH by global SDI quintile.
RESULTS
Global Burden of Disease data over the 1990-2017 study period were summarized and global numbers and trends noted with other urological diseases for comparison. A total of 2 427 334 YLD were attributed to BPH in 2017 alone, almost three times more than those attributed to the next highest urological disease, prostate cancer (843 227 YLD). When stratified by SDI quintile, a much lower impact of BPH was found in the bottom three quintiles, despite this subset representing 66.9% of the 2017 world population.
CONCLUSIONS
Lower urinary tract symptoms attributed to benign prostatic hyperplasia exert a rapidly rising human burden far exceeding other urological diseases. As the population ages and men in a lower SDI enjoy increased life expectancy and decreased competing mortalities, a continually accelerating wave of LUTS/BPH can be forecast. These epidemiological trends have serious implications for the future allocation of resources and the global urological workforce.
Topics: Global Burden of Disease; Humans; Lower Urinary Tract Symptoms; Male; Prostatic Hyperplasia
PubMed: 33124118
DOI: 10.1111/bju.15286 -
Asian Journal of Andrology 2019Prostate cancer is among the most common malignancies in Western countries, and its incidence is rapidly rising in Asia where it was traditionally considered an uncommon...
Prostate cancer is among the most common malignancies in Western countries, and its incidence is rapidly rising in Asia where it was traditionally considered an uncommon tumor. Our understanding of the disease and management strategies continue to evolve. The first revolution of its treatment was in the 1940s when hormonal therapy was used to treat patients. The discovery of prostate-specific antigen (PSA) and the subsequent adoption of widespread PSA screening have made it possible to diagnose the disease early, but it was not until recently that the field realized that we had been overdiagnosing and overtreating a large number of men with indolent diseases that will not impact their quality of life or life expectancy. Distinguishing indolent tumors from aggressive ones remains a challenge, although recent advances in multiparametric MRI have given clinicians more confidence in choosing men for active surveillance. However, more need to be done to fundamentally understand the molecular and cellular bases that determine the biologic behavior of each of the tumors.
Topics: Androgen Antagonists; Disease Progression; Humans; Male; Prostatic Neoplasms
PubMed: 30971530
DOI: 10.4103/aja.aja_31_19 -
Asian Journal of Andrology 2015The International Prostate Forum (IPF) originally started with three urology departments in Japan, Turkey, and the United States. The forum emphasized discussions and...
The International Prostate Forum (IPF) originally started with three urology departments in Japan, Turkey, and the United States. The forum emphasized discussions and presentations of new knowledge in all areas of prostate diseases with an early emphasis on ultrasound and diagnostics. The meeting has generally run every 2 years and rotated through the three sites with new leaders joining the effort. Over the years, the meeting has enjoyed a diverse locale and points of emphasis. The latter agendas now cover all aspects of the benign prostate disease, prostate cancer screening, prostate cancer diagnosis and staging, and therapies. summarizes the dates of the meetings, locations, and chairman.
Topics: Congresses as Topic; Humans; Japan; Male; Prostatic Diseases; Societies, Medical; Turkey; United States; Urology
PubMed: 26112490
DOI: 10.4103/1008-682X.156860 -
Asian Journal of Andrology 2014A growing body of literature has established the anabolic benefi ts of testosterone (T) therapy in hypogonadal men. However, there remains a paucity of data regarding... (Review)
Review
A growing body of literature has established the anabolic benefi ts of testosterone (T) therapy in hypogonadal men. However, there remains a paucity of data regarding the risks of exogenous androgen use in older men and the potential for adverse effects on the prostate gland. Whether T therapy in older, hypogonadal men might worsen lower urinary tract symptoms or exacerbate, unmask, or even incite prostate cancer development has tempered enthusiasm for T therapy, while known prostatic disease has served as a relative contraindication to T therapy. Androgens are necessary for the development and maintenance of the prostate gland. However, epidemiologic studies do not consistently fi nd a positive relationship between endogenous serum androgen concentrations and the risk of prostate disease. Recent data demonstrate that 5α-reductase inhibitors decrease the risk of low-grade prostate cancer, suggesting that modifying androgen metabolism may have beneficial effects on prostate health, yet similar reductions in high-grade disease have not been observed, thereby questioning the true clinical benefits of these agents for chemoprevention. Knowing how to best investigate the relationship between androgens and the development of prostate disease given the lack of large, randomized trials is difficult. Accumulating data challenges the assumption that alterations in serum androgens have parallel effects within the prostate hormonal environment or change androgen-regulated processes within the gland. Long-term intervention studies are needed to truly ascertain the effects of androgen manipulation on prostate tissue and disease risk. However, available data do not support the notion that restoring serum androgens to normal physiologic ranges drives prostate disease.
Topics: Androgens; Humans; Male; Prostatic Diseases; Prostatic Neoplasms
PubMed: 24407178
DOI: 10.4103/1008-682X.122361 -
Prostate Cancer and Prostatic Diseases Mar 2022
Topics: Humans; Male; Prostate; Prostatic Diseases; Prostatic Hyperplasia; Prostatic Neoplasms
PubMed: 35046556
DOI: 10.1038/s41391-022-00499-5 -
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