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Archive for the ‘Prostate’ Category

Experts predict that one out of every two men will eventually develop lower urinary tract symptoms that require medical treatment during their lifetime. Given these numbers, finding the best treatment for the cause of these symptoms— benign prostate hyperplasia (BPH)—is an important goal.

Prostate resection, an operation in which part of the prostate is removed, has been the standard therapy for benign prostate hyperplasia for decades. In recent years, treatments based on removing prostate tissue using heat have been developed. These include microwave therapy, ultrasound, and needle ablation.

A recent study in the” Journal of Urology” compared the success of prostate resection and transurethral needle ablation in 121 men with benign prostate hyperplasia. The men were randomly assigned to receive one of the procedures, and their progress was followed for six months. In addition to several measures of symptoms, the researchers evaluated objective measures of free urinary flow and pressure flow. The study took place at seven centers around the United States.

Measured after treatment and again six months later, both procedures produced significant improvements in symptoms, quality-of-life, and free urine and pressure flow. Resection, however, produced significantly more improvement in urine flow than ablation. There were no other differences between the two groups at six months after treatment.

The researchers also wanted to know if objective measures of urinary flow can predict how well patients will respond to treatment. These measures, however, did not predict response either right after treatment or at the six-month follow-up. The researchers concluded that these tests do not help doctors decide which treatment is best for each individual patient.

Even though there was no difference in how much patient symptoms improved, resection did decrease urinary obstruction more than ablation. On the other hand, the degree of obstruction did not predict how well patients would respond to treatment. The researchers concluded that more research is needed in this area before conclusions about the “best” treatment can be made.

Until recently, there was little data about risk factors for acute urinary retention (AUR). Men with enlarged prostates seem to get it more, but that’s about all that was certain about this problem. Now, a new study published in the “Journal of Urology” sheds light on who’s most at risk for this painful condition.

Over 6,000 men from a long-term health study completed questionnaires about AUR and lower urinary tract symptoms. These men also filled out general health questionnaires every other year.

Overall, four to five men per 1,000 had acute urinary retention episodes each year during this two-year study. Chances of AUR increased with age, severity of urinary symptoms, and diagnosis of benign prostatic hyperplasia (BPH). Men with BPH who also had high symptom scores were nine times more likely to have an AUR episode than men without severe symptoms or benign prostatic hyperplasia.

About two-thirds of the men with AUR episodes had either high symptom scores or BPH, but about 20 percent of episodes occurred in “low-risk” men with no urinary problems or benign prostatic hyperplasia.

The urinary tract symptoms that made up the scale are:

Sensation of incomplete bladder emptying,
Having to void again after less than two hours,
Stopping and starting several times during voiding,
Difficulty postponing voiding,
Weak urinary stream,
Having to push or strain to begin voiding, and
Typically got up three times/night or more to void during the past month.

Having one of these symptoms more than 25 percent of the time doubled or tripled the risk for acute urinary retention, as did worsening of symptoms over a two-year period. Symptoms of urinary irritation or obstruction (incomplete emptying, urinary frequency, weak urine stream) particularly increased risk for AUR. Men taking calcium blockers, beta-blockers, or antiarrhythmic drugs were also at increased risk.

This research confirms that lower urinary tract symptoms are an important risk factor for AUR, whether measured by severity or increased frequency — a fact that has been inconclusively studied in the past. The study also confirms that acute urinary retention risk increases with age and presence of benign prostatic hyperplasia.

Results from a Phase I human study of a new treatment option for benign prostatic hyerplasia (BPH) helps men overcome problems associated with an enlarged prostate gland without the need for surgery.

BPH accounts for a variety of urinary difficulties in men over the age of 50. These symptoms typically include a need to pass urine more frequently (especially at night), an urgent need to urinate, weak or interrupted urine flow, a feeling that the bladder is not completely empty, and a delay or hesitation at the onset of urination. It is estimated that 50 percent of men over age 50 suffer from BPH.

Produced by Celsion Corporation, this exciting new therapy uses two mechanisms to overcome the problem of an enlarged prostate. First, a microwave balloon catheter system shrinks the prostate through the delivery of microwave heating. Second, simultaneous expansion of the balloon catheter compresses the walls of the urethra, enlarging the urinary opening.

Since the system is designed to relieve obstruction, it concomitantly relieves uncomfortable urinary symptoms. The procedure can be performed on a one-time, outpatient basis.

The results of the Phase I trial, conducted by researchers at the Montefiore Medical Center in New York, are reportedly encouraging. Principal investigator Dr. Arnold Melman stated that “(The) preliminary results suggest that the system, when fully tested and approved, could provide immediate symptomatic relief.” He added, “If Phase II studies are successful, I believe Celsion’s system should encourage a greater number of men with BPH to seek treatment, particularly those who suffer from milder forms of the condition.”

The company is in the midst of seeking approval from the U.S. Food and Drug Administration (FDA) for multi-site Phase II clinical studies. The studies are required to determine the safety and effectiveness of the system in benign prostatic hyperplasia patients. Pending FDA approval, Celsion plans to start Phase II studies in the summer of 1999. If the results obtained are positive, the company will then apply for premarket approval from the FDA to market the system in the United States.

Several studies in the past year have reported racial variations in the incidence of benign prostatic hyperplasia (BPH). Some have suggested that African-American men are more likely to get this condition than white Americans. Others report no differences. A new study looked at different definitions of race and BPH to try to sort it all out.

Researchers from the Harvard Medical School and Brigham and Women’s Hospital, both in Boston, examined data from the Health Professionals Follow-Up Study, a long-term study of more than 50,000 male healthcare professionals. The men were aged 40 to 70 when the study began in 1986, and have completed questionnaires and physical examinations every other year since.

Of the 31,775 men in this study, 3345 were defined as having benign prostatic hyperplasia, based on symptom reports, surgery for the condition, or diagnosis from a rectal exam.

After accounting for age, alcohol intake, smoking, weight, and other factors that affect BPH, the researchers found that black and Asian men were no more or less likely to develop benign prostatic hyperplasia than white men. They were, however, less likely to have surgery for it. The researchers also measured a number of hormones related to prostate symptoms, and again found no racial differences.

When Caucasians were split into groups, those of southern European origin were slightly more likely to have a variety of prostate problems, including BPH, than other white men, and those of Scandinavian origin were slightly less likely.

In the February issue of the Journal of Urology, the researchers explain that they used three different ways of classifying race and ethnicity to analyze the data, and the results were similar each time. They also used different combinations of benign prostatic hyperplasia symptoms, and again the results were the same.

The men in this study were well-educated professionals, the researchers point out, so they may not represent the general population of American men in health behaviors — diet, lifestyle and other factors that influence BPH. On the other hand, none of the factors measured in the study, including diet, obesity, lifestyle, vasectomy, blood pressure, or heart disease, accounted for the racial differences.

The researchers conclude that the “common contention” that black men are at higher risk, and Asian men at lower risk, than whites was not supported. They recommend further study of differences among different Caucasian groups.