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Prostate Cancer and Prostatic Diseases 2009Early detection is the key to effective treatment of prostate cancer, and to the prevention of deaths due to progression to untreatable advanced stage cancer. Because of... (Review)
Review
Early detection is the key to effective treatment of prostate cancer, and to the prevention of deaths due to progression to untreatable advanced stage cancer. Because of mitigating factors, especially benign prostatic hyperplasia (BPH), that result in a low accuracy (about 60%) of prostate-specific antigen (PSA) testing, there is an urgent need for a more reliable biomarker for the identification of early stage through advanced stage prostate cancer and 'at-risk' individuals. To address this issue we propose that changes in prostatic fluid composition could provide accurate and reliable biomarkers for the screening of prostate cancer. Most notable is the consistent and significant decrease in citrate and zinc that is associated with the development and progression of prostate cancer. In this review we provide the clinical and physiological basis and the evidence in support of the utility of prostatic fluid analysis as an effective approach for screening/detection of prostate cancer, especially early stage and 'at-risk' subjects. The problem of BPH interference that plagues PSA testing is eliminated in the potential prostatic fluid biomarkers. The potential development of rapid, simple, direct, accurate clinical tests provides additional advantageous conditions. Further exploration and development of citrate, zinc and other electrolytes as prostatic fluid biomarkers are urgently needed to address this critical prostate cancer issue.
Topics: Biomarkers, Tumor; Body Fluids; Citric Acid; Early Detection of Cancer; Electrolytes; Humans; Male; Mass Screening; Prostatic Neoplasms; Zinc
PubMed: 18591961
DOI: 10.1038/pcan.2008.19 -
Journal of Proteomics Aug 2009The prostate gland secretes many proteins in a prostatic fluid that combines with seminal vesicle derived fluids to promote sperm activation and function. Proximal... (Review)
Review
The prostate gland secretes many proteins in a prostatic fluid that combines with seminal vesicle derived fluids to promote sperm activation and function. Proximal fluids of the prostate that can be collected clinically are seminal plasma and expressed-prostatic secretion (EPS) fluids. EPS represents the fluid being secreted by the prostate following a digital rectal prostate massage, which in turn can be collected in voided urine post-exam. This collection is not disruptive to a standard urological exam, and it can be repeatedly collected from men across all prostatic disease states. A direct EPS fluid can also be collected under anesthesia prior to prostatectomy. While multiple genetic assays for prostate cancer detection are being developed for the shed epithelial cell fraction of EPS urines, the remaining fluid that contains many prostate-derived proteins has been minimally characterized. Approaches to optimization and standardization of EPS collection consistent with current urological exam and surgical practices are described, and initial proteomic and glycomic evaluations of the of EPS fluid are summarized for prostate specific antigen and prostatic acid phosphatase. Continued characterization of the prostate specific protein components of EPS urine combined with optimization of clinical collection procedures should facilitate discovery of new biomarkers for prostate cancer.
Topics: Acid Phosphatase; Biomarkers; Body Fluids; Electrophoresis, Gel, Two-Dimensional; Epithelial Cells; Gene Expression Regulation, Neoplastic; Glycomics; Humans; Male; Prostate; Prostatic Diseases; Prostatic Neoplasms; Protein Tyrosine Phosphatases; Proteomics; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; Time Factors
PubMed: 19457353
DOI: 10.1016/j.jprot.2009.01.007 -
The Cochrane Database of Systematic... 2001Chronic abacterial prostatitis is a common disabling but enigmatic condition with a symptom complex of pelvic area pain and lower urinary tract symptoms. The scope of... (Review)
Review
BACKGROUND
Chronic abacterial prostatitis is a common disabling but enigmatic condition with a symptom complex of pelvic area pain and lower urinary tract symptoms. The scope of treatments recommended for chronic abacterial prostatitis is a testament to how little is known about what causes the condition and how to treat it. As a result, chronic abacterial prostatitis often causes physician frustration, patient confusion and dissatisfaction, variable thresholds for referral, and potentially inappropriate antibiotic use.
OBJECTIVES
Examine the evidence regarding the effectiveness of therapies for chronic abacterial prostatitis.
SEARCH STRATEGY
Studies were identified through a search of MEDLINE (1966-2000), the Cochrane Library, bibliographies of identified articles and reviews, and contact with an expert.
SELECTION CRITERIA
Studies were eligible if they: (1) are randomized controlled trials (RCTs) or controlled clinical trials (CCTs) (2) involve men with chronic abacterial prostatitis (3) control group receives placebo, sham intervention, active pharmacologic or device therapy for chronic abacterial prostatitis and (4) outcomes data are provided. Eligibility was assessed by at least two independent observers.
DATA COLLECTION AND ANALYSIS
Study information on patients, interventions, and outcomes was extracted independently by 2 reviewers. The main outcome was the efficacy of treatment for chronic abacterial prostatitis vs. control in improving urologic symptom scale scores or global report of urinary tract symptoms. Secondary outcomes included changes in the prostate examination, uroflowmetry, urodynamics, analysis of urine, expressed prostatic secretions and seminal fluid, and prostate ultrasonography.
MAIN RESULTS
The 15 treatment trials involved: medications used to treat benign prostatic hyperplasia (n=4 trials); anti-inflammatory medications (n=2 trials); antibiotics (n=1 trial); thermotherapy (n=5 trials); and miscellaneous medications (n=3 trials). The disparity between studies did not permit quantitative analysis. There were a total of 600 enrollees (age range 38-45). All but one of the trials were done outside the United States.
REVIEWER'S CONCLUSIONS
The treatment trials are few, weak methodologically, and involve small sample sizes. The routine use of antibiotics and alpha blockers for chronic abacterial prostatitis is not supported by the existing evidence. The small studies examining thermal therapy appear to demonstrate benefit of clinical significance and merit further evaluation. Additional treatment trials are required and they should report important patient characteristics (e.g., race), study design details and utilize clinically relevant and validated assessment measures.
Topics: Chronic Disease; Clinical Trials as Topic; Humans; Male; Pelvic Pain; Prostatic Hyperplasia; Prostatitis; Treatment Outcome
PubMed: 11279750
DOI: 10.1002/14651858.CD002080 -
The Journal of Experimental Medicine Dec 1942Certain specimens of human semen shorten the coagulation time of whole blood because of the presence of active thromboplastic agents, while other samples prolong its...
Certain specimens of human semen shorten the coagulation time of whole blood because of the presence of active thromboplastic agents, while other samples prolong its coagulation time. Human prostatic fluid in large amounts always delays or abolishes blood coagulation. The delay or absence of clotting is counteracted by adding calcium ions and is due to the large concentration of citrate in prostatic fluid and in some semens. While most specimens of dog semen shorten the coagulation time of blood because of their thromboplastic activity, certain specimens render blood incoagulable or delay coagulation; in contrast to human semen, this adverse effect on coagulation is not overcome with calcium ions and is due to a different mechanism, the lysis of fibrinogen. The citrate content of dog prostatic fluid is small. Human semen which has become liquefied does not contain thrombin or prothrombin, but fibrinogen and thromboplastic substances are present. Beef fibrinogen added to semen is destroyed by incubation for 18 hours, but added prothrombin and thromboplastic substances are still present after this treatment. Dog semen, in some instances, contains small amounts of thrombin. The semens of man and dog contain a fibrinolysin for human blood which seems not to differ greatly from the fibrinolysin associated with hemolytic streptococci. The blood of the donor of prostatic fluid is susceptible to fibrinolysis by this fluid. However, the blood of persons with some diseases, is absolutely resistant to the action of seminal fibrinolysin. In how many diseases this happens has not yet been determined. The semens of man and dog both contain an agent capable of inactivating fibrinogen, but in different amounts. This activity may be called fibrinogenase. Human semen is rich in fibrinolysin, poor in fibrinogenase; dog semen is rich in fibrinogenase, poor in fibrinolysin. These species differences, together with the fact that it is easy by appropriate dilution to retain the stronger proteolytic agent and eliminate the weaker one, imply that fibrinolysin and fibrinogenase are different entities. Dog semen, and less constantly human semen, contain very small amounts of trypsin. All of these proteolytic agents derive from the prostate gland; their secretion in prostatic fluid constitutes a hitherto undescribed function for the prostate gland.
PubMed: 19871256
DOI: 10.1084/jem.76.6.527 -
Topics in Companion Animal Medicine Dec 2018In last years, following the increased canine life expectancy and the rising attention pet-owners devote to their animals, several authors have carried on investigations... (Review)
Review
In last years, following the increased canine life expectancy and the rising attention pet-owners devote to their animals, several authors have carried on investigations concerning new techniques to early identify canine prostatic disorders that might affect the dog's quality of life. Prostatic disorders often have an asymptomatic onset and their early diagnosis is difficult: hence, they are usually identified at an advanced stage, only. Traditionally, the diagnosis of prostatic disorders is based on noninvasive tools, such as transrectal and abdominal palpation, seminal or prostatic fluid evaluation, and urinalysis and imaging. On the other hand, a definite diagnosis of prostatic abnormalities could be achieved through prostatic parenchyma Fine Needle Aspiration (FNA) or biopsy. However, these investigations are performed rarely because of their invasiveness. Thus, several authors investigated canine serum biomarkers in order to achieve an earlier diagnostic timing and to apply therapeutic strategies for better outcomes. The Canine Prostatic Specific Esterase (CPSE) has been identified as a suitable biomarker to be included in a prostate health screening program, following the model of prostate-specific antigen (PSA) in human medicine. A higher CPSE in dogs suffering from several prostatic diseases, such as benign prostatic hyperplasia, bacterial prostatitis, or prostatic carcinoma, was reported in literature. Thanks to the potential usefulness in clinical practice, further studies should investigate the potential role of CPSE in monitoring the medical treatment success in the male reproductive system. Moreover, the spreading availability of serum biomarkers, easily carried out on blood samples in clinical practice, could assure a more accurate evaluation of the actual prevalence of prostatic disorders. The CPSE is actually recognized as a promising diagnostic tool for the detection of prostatic disorders in a "prostate health screening program," in order to properly select those patients requiring further more accurate and expensive diagnostic investigations.
Topics: Animals; Biomarkers; Dog Diseases; Dogs; Early Diagnosis; Esterases; Male; Prostate; Prostatic Diseases
PubMed: 30502858
DOI: 10.1053/j.tcam.2018.09.002 -
The Prostate Nov 2020Age-dependent increase in the incidence of benign prostatic hyperplasia (BPH) and prostate cancer (PCa) are both related to cell proliferation and survival controlled by... (Review)
Review
BACKGROUND
Age-dependent increase in the incidence of benign prostatic hyperplasia (BPH) and prostate cancer (PCa) are both related to cell proliferation and survival controlled by intraprostatic free testosterone (FT) concentration. Paradoxically, BPH and PCa occur as circulating testosterone levels decrease, so any possible relationship between testosterone levels and development of BPH and PCa remains obscure.
RESULTS
In BPH the enlarging prostate is exposed to high testosterone levels arriving directly from the testes at concentrations about hundredfold higher than systemic FT. This occurs because venous blood from the testes is diverted into the prostate due to the elevated hydrostatic pressure of blood in the internal spermatic veins (ISVs). Elevated pressure is caused by the destruction of one-way valves (clinically detected as varicocele), a unique phenomenon related to human erect posture. While standing, human males are ISVs vertically oriented, resulting in high intraluminal hydrostatic pressures-a phenomenon not found in quadrupeds. In this communication, we demonstrate the fluid mechanics' phenomena at the basis of varicocele leading to prostate pathology.
CONCLUSIONS
So far, varicocele has been studied mostly for its etiologic role in male infertility and, thus, for its effects on the testes. It is becoming clear that varicocele is a major etiologic factor in BPH and likely also in PCa. Restoring normal testicular venous pressure by treatment of the abnormal ISV's in varicocele has been shown to avert the flow from the prostate with the effect of reducing prostate volume, alleviating symptoms of BPH, and increasing concentrations of circulating FT.
Topics: Humans; Hydrodynamics; Hydrostatic Pressure; Male; Posture; Prostate; Prostatic Hyperplasia; Testis; Testosterone; Varicocele
PubMed: 32833288
DOI: 10.1002/pros.24051 -
Critical Reviews in Oncology/hematology Sep 2019Liquid biopsy can quantify and qualify cell-free (cfDNA) and tumour-derived (ctDNA) DNA fragments in the bloodstream. CfDNA quantification and mutation analysis can be... (Review)
Review
Liquid biopsy can quantify and qualify cell-free (cfDNA) and tumour-derived (ctDNA) DNA fragments in the bloodstream. CfDNA quantification and mutation analysis can be applied to diagnosis, follow-up and therapeutic management as novel oncologic biomarkers. However, some tumor-types release a low amount of DNA into the bloodstream, hampering diagnosis through standard liquid biopsy procedures. Several tumors, as such as brain, kidney, prostate, and thyroid cancer, are in direct contact with other body fluids and may be alternative sources for cfDNA and ctDNA. Non-blood sources of cfDNA/ctDNA useful as novel oncologic biomarkers include cerebrospinal fluids, urine, sputum, saliva, pleural effusion, stool and seminal fluid. Seminal plasma cfDNA, which can be analyzed with cost-effective procedures, may provide powerful information capable to revolutionize prostate cancer (PCa) patient diagnosis and management. In the near future, cfDNA analysis from non-blood biological liquids will become routine clinical practice for cancer patient diagnosis and management.
Topics: Biomarkers, Tumor; Cell-Free Nucleic Acids; Circulating Tumor DNA; DNA Mutational Analysis; Feces; Female; Gene Expression Profiling; Humans; Liquid Biopsy; Male; Medical Oncology; Neoplasms; Pathology, Clinical; Prostatic Neoplasms; Urinalysis
PubMed: 31212145
DOI: 10.1016/j.critrevonc.2019.06.005 -
Nature Reviews. Urology Apr 2013The healthy human prostate accumulates the highest level of zinc of any soft tissue in the body. This unique property is retained in BPH, but is lost in prostatic... (Review)
Review
The healthy human prostate accumulates the highest level of zinc of any soft tissue in the body. This unique property is retained in BPH, but is lost in prostatic malignancy, which implicates changes in zinc and its transporters in carcinogenesis. Indeed, zinc concentrations diminish early in the course of prostate carcinogenesis, preceding histopathological changes, and continue to decline during progression toward castration-resistant disease. Numerous studies suggest that increased zinc intake might protect against progression of prostatic malignancy. In spite of increased dietary intake, zinc accumulation might be limited by the diminished expression of zinc uptake transporters, resulting in decreased intratumoural zinc levels. This finding can explain the conflicting results of various epidemiological studies evaluating the role of zinc supplementation on primary and secondary prostate cancer prevention. Overall, more research into the mechanisms of zinc homeostasis are needed to fully understand its impact on prostate carcinogenesis. Only then can the potential of zinc and zinc transport proteins be harnessed in the diagnosis and treatment of men with prostate cancer.
Topics: Animals; Carrier Proteins; Homeostasis; Humans; Intracellular Fluid; Male; Prostatic Neoplasms; Zinc
PubMed: 23478540
DOI: 10.1038/nrurol.2013.43 -
Urology Case Reports Sep 2023A 25 year old male presented with several weeks of fevers and testicular pain. Workup demonstrated scrotal and prostatic abscesses. Fluid from these following surgical...
A 25 year old male presented with several weeks of fevers and testicular pain. Workup demonstrated scrotal and prostatic abscesses. Fluid from these following surgical drainage revealed Blastomyces dermatitidis. He was treated with 12 months of oral anti-fungal therapy and repeat Blastomyces urine antigen was negative at follow up. While disseminated blastomycosis most commonly presents with pulmonary and cutaneous manifestations, genitourinary symptoms are rarely seen, but important to consider.
PubMed: 37455778
DOI: 10.1016/j.eucr.2023.102489 -
International Journal of Nanomedicine 2015Prostate cancer is one of the leading causes of cancer-related deaths among the Caucasian adult males in Europe and the USA. Currently available diagnostic strategies... (Review)
Review
Prostate cancer is one of the leading causes of cancer-related deaths among the Caucasian adult males in Europe and the USA. Currently available diagnostic strategies for patients with prostate cancer are invasive and unpleasant and have poor accuracy. Many patients have been overly or underly treated resulting in a controversy regarding the reliability of current conventional diagnostic approaches. This review discusses the state-of-the-art research in the development of novel noninvasive prostate cancer diagnostics using nanotechnology coupled with suggested diagnostic strategies for their clinical implication.
Topics: Biological Assay; Body Fluids; Humans; Male; Nanomedicine; Prostate-Specific Antigen; Prostatic Neoplasms
PubMed: 26527873
DOI: 10.2147/IJN.S91908