Natural Ways to Treat Enlarged Prostate

The 21 Day Prostate Fix

21 Day Prostate Fix written by Radu Belasco is a healthier alternative to drugs and invasive medical procedures. Radu Belasco is an early prostate problem sufferer, with a family history of prostate pain, problems and cancer. Using a unique system of natural remedies, he fixed his prostate problems and wrote them in his smash hit eBook The 21 Day Prostate Fix. It is about miraculous herbs and fruits from all over the world. These unique foods have the power to cure your prostates inflammation in record time and shrink it to a healthier size. Also, you will learn how to concoct the miracle elixir that will not just cleanse your prostate, but also burn body fat. Aside from these, youll get topnotch information on nutrition, so you can keep your prostate healthy and your sex drive at its peak. Plus, youll learn other health conditions that might be contributing to your prostate issues, so you can also remedy them and get your body in its best shape ever.

The 21 Day Prostate Fix Overview

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Inhibition of Dendritic Cell Generation and Function by Serum from Prostate Cancer Patients Correlation with Serum Free

Tumor produces a number of immunosuppressive factors that block maturation of dendritic cells (DCs). Here, we demonstrated that endogenous factors presented in the serum of patients with prostate cancer (CaP) inhibited the generation of functionally active DCs from CD14+ monocytes in vitro. We have shown a significant inhibitory potential of serum obtained from patients with CaP and benign prostate hyperplasia benign prostatic hyperplasia (BPH) when compared with serum from healthy volunteers. As assessed by flow cytometry, expression of CD83, CD86, and CD40 molecules was strongly inhibited by CaP and BPH serum. In addition, these DCs were weak stimulators of allogeneic T cell proliferation when compared with DCs produced in the presence of healthy volunteer serum. Statistical analysis of the results revealed a positive relationship between the inhibition of expression of DC markers CD83 and CD80 and the levels of serum-free prostate-specific antigen (PSA). These data...

Modulating Tolerance of Tumor Specific T cells in a Murine Model of Prostate Cancer

The development of genetically modified murine models of cancer has profoundly aided in understanding T cell responses to tumor antigens. To study T cell tolerance and tumor immunity, we utilize the TRAMP model, an autochthonous model of prostate cancer that highly resembles the pathogenesis and progression of prostate cancer in humans. TRAMP mice carry the -426 +28 fragment of the androgen-driven, prostate-specific rat Probasin (PB) regulatory element fused to the SV40 T t antigen gene (TAg) (Greenberg et al. 1995). The TRAMP model system has been proven by us and others to be a valid model to study immunological tolerance and potential immunotherapeutics aimed at overcoming T cell tolerance to tumors (Granziero et al. 1999 Hurwitz et al. 2000 Tourkova et al. 2004). Traditionally, generating an effective antitumor immune response has primarily focused on priming CD8+ T cells to tumor antigens. CD8+ T cells have been strategically targeted because the majority of tumors express MHC I,...

Suprapubic Transvesical Prostatectomy

Transvesical Suprapubic Prostatectomy

Used to score the fascia in the midline aspect of the established wound. The fascial incisions are generally extended to the lateral border of each rectus abdominis muscle. At this point, it is necessary to raise the superior and inferior fascial flaps. This is done easily using three Kocher clamps applied equidistantly at each edge. The assistant provides gentle uplift, and the surgeon provides counter traction on the underlying rec-tus muscles. Using the Bovie, the superior flap is raised to a point halfway to the umbilicus. The inferior flap is raised to the pubic symphysis. The exposed rectus abdominis muscles are then separated one from the other in the midline aspect. Careful sharp and blunt dissection permits mobilization of the rectus muscle bellies and good exposure to the underlying umbilicoprevesical fascia. The latter is gently uplifted and incised. At this point, the peritoneal reflection is identified and gently reflected from the dome of the nicely distended bladder....

Indications For Open Prostatectomy

There are a number of factors that should prompt the serious consideration of suprapubic transvesical prostatectomy. These include the following (1) adenomas > 75 g (2) transition zone hyperplasia associated with a large, prominent subtrigonal component (3) presence of a physiologically relevant diverticulum (4) multiple large bladder calculi (5) confounding orthopedic problems such as severe spinal stenosis and fusion ankylosis of the hip joints (6) large scrotal hernia or massive hydrocele (7) rigid or semirigid penile prosthesis (8) multiple urethral strictures (9) trigonal distortion resulting from trauma or previous surgery that places the ureteral orifices in close proximity to the bladder neck (10) expectations prejudices of the patient and (11) skill experience of the surgeon (1). Ideally, simple perineal prostatectomy warrants consideration in those patients with large, low-lying prostates who are capable of withstanding prolonged exaggerated lithotomy. Preferably, patients...

Simple Perineal Prostatectomy

Prostate Adenoma Enucleation

Currently, adenomectomy for the treatment of BPH is rarely performed by means of the perineal route. Previously, this approach was associated with significantly lower mortality than the abdominal route. However, this latter advantage has disappeared in the modern era as the mortality from all forms of prostatectomy has decreased to exceedingly low levels (18). Resurgence of interest in the radical perineal prostatectomy has resulted in an increasing number of urologists becoming familiar with the perineal approach. This, in addition to a more precise understanding of anatomic relationships of the prostate (sphincter mechanism, neu-rovascular bundles), may encourage reevaluation of the perineal approach for the management of BPH in selected cases. In any event, knowledge that a perineal adenomectomy is a feasible procedure that has been performed with satisfactory results is important to maintain (1). tuberosities is placed just above the mucocutaneous junction. The incised skin and...

Androgen And Prostate Growth

Pseudohermaphrodites

The prostate gland is dependent on androgens that are produced exogenously by the testicles to facilitate normal development and to maintain normal structure and function (1). Briefly, the testes are stimulated to produce and secrete testosterone and other steroids by an exogenous protein, luteinizing hormone, which is made in the pituitary gland. Testosterone (T) is converted to its reduced form, dihydrotestosterone (DHT), by the enzyme 5a-reductase in the prostate. Both T and DHT bind to and activate the androgen receptor, causing a cascade of events that results in stimulation and maintenance of prostatic epithelial and stromal growth and secretion. DHT has a greater affinity for the androgen receptor than T and is normally the major prostate growth stimulant. Currently, attempts to interrupt or alter the stimulatory effects of exogenous factors that control prostate growth target aspects of the pituitary-testis-prostate axis. One approach is to alter the production and secretion...

Benign Prostatic Hyperplasia

Prevalence Bph 2012

Urinary obstruction resulting from benign prostatic disease was described in the earliest days of medicine. Initially formalized by Riolan in the 17th century, the relationship between BPH and urinary obstruction was further elucidated by Morgani in the mid-18th century he provided one of the earliest descriptions of BPH and its sequelae (23). More specific recognition of the pathologic process has been credited to Virchow in the last quarter of the 19th century. Despite a greater understanding of benign prostate growth, however, identification of its cause remains elusive. Autopsy studies have repeatedly demonstrated an association between BPH and aging based on histologic criteria, prostate weight, and prostate volume. Randall found histologic evidence that the incidence of BPH exceeded 50 in men over 50 yr of age and rose to 75 as men entered their 80s (24). The age-related prevalence of histologic BPH found at autopsy is similar in several countries despite population diversity...

Normal Growth And Development Of Human Prostate

The human prostate increases in size and develops histologic evidence of stimulated growth during three periods of life before and at birth, during puberty, and with achievement of advancing age (20). The evidence for prostatic stimulation during gestation and at birth is based on histologic studies. During development, the prostatic tubules progress from solid cellular buds at the ends of ducts to bud acinar combinations and then to acinar tubular clusters arranged in lobules. The tubules gradually regress after the first month of life (21). The secretions stain with variable intensity with periodic acid Schiff stain but stain only weakly for prostate-specific antigen (11). At puberty, the prostate demonstrates marked histologic evidence of stimulation, progressing from enlargement of the end buds of the pro-static ducts to development of somewhat distended alveoli and tall columnar epithelium. Although stromal cells are the predominant prostate tissue, the relative smooth muscle...

Transurethral Waterinduced Thermotherapy Wit Of The Prostate

A variety of techniques have been introduced over the last 15 years using heat to destroy prostate tissue to relieve obstruction and other symptoms of BPH. The latest of these is transurethral WIT (ArgoMed Inc., Cary NC). This technique was conceived, designed, and a com WIT is performed using the Thermoflex (ArgoMed Inc, Cary NC) system. The system consists of a console that heats and pumps the water into a treatment balloon inflated to 50 Fr within the prostatic fossa, which receives 60 C water for 45 min. There is also a balloon inflated with 16 mL of air located in the bladder. The catheter is insulated except for the balloon in the prostatic urethra. Treatment balloons are available in lengths of 20-60 mm in 5-mm increments, allowing balloon length to be matched to prostate length. The treatment is not effective for median lobe prostatic hypertrophy. The depth of necrosis from WIT therapy was around 10 mm in prostate specimens studied by Corica and co-workers (7). In the European...

Prostate Cancer

The prostate was originally thought to be an immunologically privileged site. However, there is now good evidence that the prostate has a lymphatic system, can mount inflammatory immune responses and these responses as evidenced by density of tumor infiltrating lymphocyes may be associated with prognosis in PC (reviewed in ref. 118). The immune system may therefore play a role in the pathogenesis of PC, via regulation of tumor growth, while evasion of the immune response may play a role in disease progression. In addition, due to the critical role of angiogenesis in PC development,93 and based on our findings in CMM, we elected to determine whether polymorphisms in pro- and anti-inflammatory and pro-angiogenic cytokine genes were associated with susceptibility to and or markers of prognosis in a case-control study of British Caucasian PC patients and population controls. Results indicated that the IL-10 -1082 AA 'low expression' genotype was significantly increased in incidence in the...

The Prostate

The effects of exogenous androgen therapy on the prostate are not well defined. Because severe androgen deficiency prevents prostate development and disease, exposure to adult male testosterone concentrations for decades must establish the origins of prostate disease (11). Yet the effects of androgen deficiency and administration during midlife on risk of late-life prostate disease is unclear. Although men who are androgen deficient have reduced prostate volume (112,113), testosterone administration for androgen replacement therapy restores prostate volume, either in part (113) or fully (112) however, even massive androgen doses don't cause significant prostatic hyperplasia at least during midlife (114). Although the effects of androgen therapy on prostate size or cancer risk are not reported in men with chronic renal failure, prolonged pharmacological androgen therapy (nandrolone decanoate 200 mg wk for up to 24 mo) had no significant effects on blood levels of prostate markers...

Prostate Disease

Normal prostate growth and development requires the presence of androgens from childhood to adolescence and adulthood. In younger hypogonadal men in whom prostate diseases are uncommon, androgen replacement increases the size of the prostate from the smaller volumes at baseline to the expected range for eugonadal men (66). However, progressive increases in prostate volume do not occur with continued testosterone replacement (66,67). Serum PSA levels may increase significantly with testosterone replacement but generally remain within the normal range (15,18,55,67). In middle-aged and older men, androgen replacement has resulted, in a few instances, in lower urinary tract obstructive symptoms and increased serum PSA levels, resulting in urological referral and ultrasound-guided prostate biopsy (17,20). In most reports, prostate-related adverse events have occurred rather early in the course of androgen replacement, suggesting that such treatment may have unmasked existing latent or...

Trapped Prostate

Turner-Warwick introduced the term trapped prostate to describe the small obstructing prostate trapped between the bladder neck and the external sphincter (12). Today, this poorly understood cause of LUTS in men is termed primary bladder neck obstruction, Marion's disease, (13) dysfunctional bladder neck, (14) or bladder neck dyssynergia (15,16). Often, these men are young (age 20-50 yr), with long-standing obstructive and irritative voiding symptoms, and often they have been misdiagnosed with chronic nonbacterial prostatitis, neurogenic bladder dysfunction, or psychogenic voiding dysfunction (8-10,14). Video

Prostate and Testes

Prolactin normally stimulates cell growth in the prostate gland (probably through direct as well as through androgen-mediated mechanisms), although it is unclear what impact hyperprolactinemia may have on the prostate gland in humans. In animal studies high prolactin results in prostate gland inflammation and abnormal cell growth (Reiter et al. 1999). In men benign prostatic hypertrophy is associated with increased prolactin in some but not all studies (Saroff et al. 1980). Prolactin levels normally increase with age, potentially confounding the results of these studies. Prolactin levels may be increased in men with prostate cancer, but the prostate itself may produce prolactin, making cause and effect difficult to determine (Goffin et al. 2002 Harper et al. 1976). One case-control study found no increased risk of prostate cancer in antipsychotic-treated patients (Mortensen 1992), but there are no studies of risk of prostate cancer in patients with sustained antipsychotic-induced...

Preface to the First Edition

In the UK, the interest in transsphenoidal surgery was rekindled after the World War II and hypophysectomy was used as endocrine control of the spread of hormone-sensitive secondary cancers, such as breast and prostate. As neurosurgery was developing in other directions at that time, otolaryngologists such as Angel-James in Bristol, Richards in Cardiff, and Williams in London developed the transethmoidal technique, gaining enormous experience at a time when endocrinologists were able to measure accurately and to a certain extent control pituitary diseases medically. It was only on the continent and in Canada, through the legacy of Cushing's trainees (Norman Dott, who taught Guiot in Paris, who taught Jules Hardy in Montreal), that transsphenoidal surgery remained in the neurosurgical domain.

Why Proteomics Has Not Succeeded In The Past Cancer As An Example

The inability of these protein biomarkers to detect all cancers (false negatives) reflects both the progressive nature of cancer and its heterogeneity. Cancer is not a single disease but rather an accumulation of several events, genetic and epigenetic, arising in a single cell over a long period of time. Proteins overexpressed in late stage cancers may not be overexpressed in earlier stages and, therefore, are not useful for early cancer detection. For example, the CA125 antigen is not highly expressed in many Stage I ovarian cancers. Also, because tumors are heterogeneous, the same sets of proteins are not necessarily overexpressed in each individual tumor. For example, while most patients with high-grade prostate cancers have increased levels of PSA, approximately 15 of these patients do not have an elevated PSA level. The reciprocal problem of biomarkers indicating the presence of cancer when none is present (false positives) results because these proteins are not uniquely produced...

How Have Proteomic Approaches Changed Over The Years

Currently investigators are pursuing three different approaches to develop biomarkers with increased sensitivity and specificity. The first is to improve on a currently used biomarker. For instance, specificity and sensitivity of PSA may be improved by measurement of its complex with alpha(1)-antichymotrypsin patients with benign prostate conditions have more free PSA than bound, while patients with cancer have more bound PSA than free.29 This difference is thought to result from differences in the type of PSA released into the circulation by benign and malignant prostatic cells. Researchers are also trying to improve the specificity and sensitivity of PSA by incorporating age- and race-specific cut points and by adjusting serum PSA concentration by prostatic volume (PSA density). The second approach is to discover and validate new biomarkers that have improved sensitivity and specificity. Many investigators are actively pursuing new biomarkers using a variety of new and old...

Current Clinical Urology

McAninch, 2005 Management of Prostate Cancer, Second Edition, edited by Eric A. Klein, 2004 Essential Urology A Guide to Clinical Practice, edited by Jeannette M. Potts, 2004 Management of Benign Prostatic Hypertrophy, edited by Kevin T. McVary, 2004 Pediatric Urology, edited by John P. Gearhart, 2003 Laparoscopic Urologic Oncology, edited by Jeffrey A. Cadeddu, 2004 Essential Urologic Laparoscope The Complete Clinical Guide, edited by Stephen Y. Nakada, 2003 Prostate Cancer Screening, edited by Ian M. Thompson, Martin I. Resnick, and Eric A. Klein, 2001 Voiding Dysfunction Diagnosis and Treatment, edited by Rodney A. Appell, 2000 Management of Prostate Cancer, edited by Eric A. Klein, 2000

Natural Causes of Death in Patients With Schizophrenia

Two incidence studies on cancer in patients with schizophrenia further demonstrate varying results between geographic locations for different types of cancer. The results varied between cohorts in the World Health Organization's three-cohort study (Gulbinat et al. 1992). The Danish cohort showed decreased rates of cancer (standardized incidence ratio SIR 0.67, 95 CI 0.60-0.75), the Nagasaki cohort revealed increased risk of cancer (male SIR 1.43, not significant, with 95 CI 0.85-2.26 female SIR 1.67, 95 CI 1.17-2.44), and the Honolulu cohort overall demonstrated no unusual cancer incidence (females of Japanese origin did have elevated risk, with an SIR of 1.73, 95 CI 1.03-2.74). Different patterns of risk were seen between cohorts when the data were analyzed by site of malignancy. The Danish group had low rates of lung, prostate, cervical, and ovarian cancers, whereas breast cancer was increased in the Nagasaki and Honolulu Japanese females and cervical cancer in the Nagasaki females....

Lymphatic Mapping In Genitourinary Cancer

Some early experience in patients with vulva cancer has been encouraging and suggests that this technique can be successfully applied to patients with this malignancy 77,78 . There have also been promising descriptions of the application of lymphatic mapping techniques in the abdominal cavity in patients with high-risk endometrial cancer which have shown that the sentinel nodes in the pelvis, common iliac, and para-aortic area can be identified 79 . Other studies are proceeding to confirm the accuracy of this method in uterine cancer. It is hoped that sentinel lymphadenectomy can in this way replace the current approach of random node sampling. It might also be possible in the future to map the lymphatic drainage pathways from malignancies in other intra-abdominal sites such as the bladder and prostate, and even the large bowel.

Conventional Msbased Proteomics Technologies

Of the TOF MS enables protein profiles to be generated from as little as a single microliter of serum, and have been generated from as few as 25-50 cells 17 . SELDI-TOF MS has proved to be useful in the discovery of potential diagnostic markers and patterns for prostate 18 , bladder 19 , breast 20 , and ovarian cancers 21 . While SELDI-TOF MS has been used primarily for the analysis of crude biological fluids, and its greatest potential is within the field of diagnostic medicine, it can also be used for more targeted studies, such as the characterization of phosphoproteins 22 , glycoproteins 23 , and protein-DNA interactions 24 .

Highresolution Seldi Proteomic Patterns

Since this original study, several laboratories have validated the use of serum proteomic pattern analysis for the diagnosis of breast 20 and prostate cancer 18 . The most common analytical platform used to acquire the proteomic patterns is the PBS-II, a low-resolution TOF MS as described previously. Many of these studies have been able to correctly diagnose serum samples with sensitivities and specificities in the high 90 range. Even with this high PPV, this technology as it exists would not be useful as a clinical screening

Initial Evaluation And Selection Of Therapy

The Agency for Healthcare Policy and Research clinical guidelines for the diagnosis and treatment of BPH provide an approach to the evaluation and therapy for this disease (15). On initial evaluation, taking a medical history and performing a physical examination, including a digital rectal exam, are recommended. Laboratory evaluation includes a urinalysis, creatinine measurement, and optional prostate-specific antigen test. Surgical intervention should be considered primary therapy for those patients with refractory retention, recurrent urinary tract infection, recurrent or persistent gross hematuria, bladder stones, or renal insufficiency secondary to bladder outlet obstruction. For the remaining patients, quantitative symptom assessment with instruments such as the International Prostate Symptom Score (I-PSS) provide a standardized measurement of symptoms (16). The I-PSS includes a quality of life scale to determine the degree of bother experienced by the patient. The symptom score...

Extradural Spinal Masses

Spinal Hemangioma Mri Images

These lesions are found outside the dural sac involving the epidural space, paravertebral soft tissues, and spinal skeleton. The most common extradural masses are metastases from primary breast, lung, prostate, myeloma, and lymphoma. MRI is the preferred imaging modality to detect these lesions. Primary bone tumors rarely involve the lumbar spine. Nerve sheath tumors may present as extradural lesions but this is less common than their presentation in the intradural compartment. Chordomas classically occur in the sacrum and coccyx. Metastatic disease frequently affects the spine primarily involving the vertebral body, usually followed by neoplastic infiltration of the posterior elements and epi-dural compartment (Fig. 16). The vast majority of these lesions arise from hematogenous spread to vertebral bodies. The usual MRI appearance is neoplastic replacement of the normal fatty marrow with hypointense T1 signal and hyperintense T2 signal relative to bone marrow. Well defined oval or...

Materials And Methods

Total RNA is isolated from normal and prostate cancer specimens by the single-step, acid guani-dinium thiocyanate-phenol-chloroform extraction method10 or by TRIZOL reagent (GIBCO BRL, Gaithersburg, MD) following manufacturer's directions. RNA (10 jig) from each tissue is treated

Intervention by Physical Means Radiation Hyperthermia Electrochemical Therapy

Data from pre-clinical studies provide the proof of principle that different immunotherapeutic strategies can be combined with RT to enhance antitumor effects. An adenovector expressing TNF-a under the control of an irradiation-inducible promoter was developed. A recently published phase I study in patients with solid tumors demonstrated safety and a greater response in lesions treated with a viral vector and RT compared with RT alone 104 . Another clinical trial was designed to examine whether vaccination with Pox-virus encoding prostate specific antigen could be combined with standard external beam RT in patients with prostate cancer. The trial suggests that this combination can generate an antigen cascade with development of T cells directed against other TAAs then those present in the vaccine 105 , a phenomenon recently proposed to play a crucial role in determining the therapeutic efficacy of immunotherapy 106, 107 .

Development Of 5aReductase Inhibitors

As discussed, although other approaches to androgen ablation and androgen inhibition (antiandrogens) have been evaluated in the past, these methods produced only a moderate desired impact and had many side effects, thus limiting their use (14). Typical antiandrogen (e.g., flutamide) side effects include onset of erectile dysfunction, impairment in libido and ejaculation, gastrointestinal distress, nausea, flatulence, gynecomastia, breast pain, diminished energy levels, impairment in spermatogenesis, and decreased muscle mass. In contrast, because mature (postpubertal) patients with 5 a-reductase deficiency did not appear to have impaired sexual function or diminished external mascu-linization, the 5 a-reductase enzyme was a logical target for treating men with clinically significant BPH. The potential blockade of 5a-reductase seemed to provide hope for decreasing prostate growth and minimizing side effects. Investigators began to work to create an effective 5 a-reductase inhibitor to...

Use Of Finasteride In The Treatment Of

BPH is an extremely common condition that affects most men age 55 yr and older. BPH develops almost exclusively in the periurethral and transition zone tissues within the prostate gland. The cause of BPH is not known androgens are necessary but not sufficient to initiate and maintain subsequent growth. Histologically, hyperplastic nodules develop in part as a result of prolonged exposure of prostatic tissue to androgens (1,21). Clinical symptoms compatible with BPH are present in most men over 60 yr of age. These lower urinary tract symptoms often include obstructive symptoms such as diminished force of stream, hesitancy, and postvoid dribbling (22). Over time, these obstructive changes can lead to bladder dysfunction, with related symptoms such as urgency, straining, and urgency incontinence. In severe cases, hydronephrosis and chronic renal impairment may develop. Urinary tract symptoms and urinary flow rates tend to worsen over time, although there is not a direct correlation...

Additional Clinical Trials

Three other double-blind, placebo-controlled, randomized, multicenter studies were conducted to evaluate finasteride vs placebo in terms of onset of urinary retention, need for catheterization, and need for surgical procedure. These studies included the Scandinavian Study on Reduction of the Prostate by Andersen et al. (32), Proscar Safety Plus Efficacy Canadian 2-Year Study by Nickel (33), and the Proscar Worldwide Efficacy and Safety Study (33a). Tempany and associates performed a 1-yr study evaluating the impact of finasteride on prostate volume as measured by magnetic resonance imaging (MRI) (36). Patients given 1- and 5-mg doses of finasteride were grouped together because there was not a significant difference in their results. After 12 mo of treatment, patients receiving finasteride had a significant decline in their total prostate volume (11.5 3.2 mL p < 0.02). Additionally, the change in periurethral zone volume (6.2 3.0 mL p < 0.03) was statistically significant. This...

Finasteride Treatment And Psa Concentration

The decrease in serum PSA levels are generally predictable over the entire range of PSA values, even in those patients with prostate cancer (19). In numerous clinical trials where elevated PSA was closely monitored with serial repeat testing and prostate biopsies, finasteride did not appear to affect the rate of detection of prostate cancer. In fact, in these studies, there was no significant difference in the detection of prostate cancer for patients taking finasteride vs those taking placebo. The PLESS study group, which included 3000 patients, confirmed that

Future Directions In Finasteride Therapy

The National Institutes of Health-funded Medical Therapy of Prostate Symptoms trial, which recently concluded, compared treatment with doxazosin, finasteride, and combination therapy (46). Both doxazosin-treated and finasteride-treated individuals had equivalent reductions in risk of BPH progression. Combination treatment with doxazosin and finasteride was more effective than monotherapy with either agent in preventing progression of clinical BPH. All treatments reduced the risk of acute urinary retention, with doxazosin yielding a short-term risk reduction and finasteride and combination therapy resulting in long-term risk reduction. Regarding AUA symptom score and maximal urinary flow rate, combination therapy was more effective than either agent alone. In summary, combination treatment with doxazosin and finasteride was more effective than either alone in producing improvements in AUA symptom score and maximal voiding pressure, whereas finasteride monotherapy and combination...

IL10 Gene Polymorphisms and Cancer

In the following consideration of the studies summarised in Table 2, cutaneous malignant melanoma (CMM), prostate (PC) and breast cancer (BC) are considered first, since angiogen-esis is crucial for the development of these tumors89 and indeed the extent of angiogenesis correlates with the probability of metastasis and or prognosis in these malignancies.90-96

Determine Whether Exposure Prevalence Varies as Expected Among the Controls

An empirical application of this strategy comes from a study of serum lycopene (an antioxidant form of carotenoid found in fruits and vegetables) in relation to the risk of prostate cancer (Vogt et al., 2002). A multicenter case-control study was conducted in the late 1980s in Atlanta, Detroit, and 10 counties in New Jersey. Controls were chosen through random-digit dialing for men under age 65 and through the Health Care Financing Administration records for men age 65 and older. Among a much larger pool of participants, 209 cases and 228 controls had blood specimens analyzed for lycopenes. Serum lycopene was inversely associated with risk of prostate cancer and found to be lower among African-American controls as compared to white controls (Table 5.4). To corroborate the plausibility of lower levels among African Americans (who experience a markedly higher risk of prostate cancer generally), the authors examined pertinent data from the National Health and Nutrition Examination...

Tuna Principles And Background

The TUNA system requires the use of a specially designed cysto-scope that contains two independent energy delivery needles and a low-level RF generator. TUNA uses low-level RF waves (490 kHz) that allow a deeper and more uniform penetration than microwave thermo-therapy. The RF energy is delivered by two independent 22-mm needles placed at the end of the specially designed 22-Fr rigid cystoscope. The needles and protective sheaths advance and retract by controls on the catheter handle and are put into the prostate tissue at an acute angle to the catheter and at 40 to each other. The sheaths can be placed over the needles to protect the urethral lining. Thermocouples at the tip of each protective sheath and at the side of the catheter tip monitor the temperature at the intra-adenoma region and prostatic urothelium, respectively. The catheter tip can be rotated manually to direct the needles into either lateral lobe of the prostate. The RF energy can only be delivered to the tissues by...

Mechanism Of Action

Normal prostate cells undergo necrosis when exposed to temperatures of 44-45 C for 30 min (6). Microwaves, which fall within 3003000-MHz wavelengths, are absorbed as they propagate through tissue, causing local changes that produce heat. TUMT is performed by the transurethral route, using an external power source to create microwaves at a frequency of 900-1100 MHz. Tissue penetration leads to electromagnetic oscillations of free charges and the polarization of small molecules such as water, resulting in the release of kinetic energy and increasing the temperature of the tissue. Finally, cell necrosis, vascular injury, and apoptosis ensue.

Preoperative Considerations Patient Selection

The physical examination should be systematic and meticulous, focusing on the presence or absence of distended bladder, urethral stenosis, meatal stenosis, and anal area and rectal tone. The prostate is evaluated for size and presence or absence of nodularity, laterality, consistency, and landmarks.

Critical Thinking Exercises

Salinas is prescribed a cholinergic blocking drug for a gastric ulcer. You note in the admission interview that he states that he has a history of enlarged prostate. Discuss how Mr. Salinas' history of enlarged prostate relates to the drug therapy for a gastric ulcer.

Defects in Tumor Suppressor Genes Remove Normal Restraints on Cell Division

Retinoblastoma is a cancer of the retina that occurs in children who have two defective Rb alleles. Very young children who develop retinoblastoma commonly have multiple tumors in both eyes. Each tumor is derived from a single retinal cell that has undergone a mutation in its one good copy of the Rb gene. (A fetus with two mutant alleles in every cell is nonviable.) Retinoblastoma patients also have a high incidence of cancers of the lung, prostate, and breast.

Dietary lipids and cancer

As reviewed above, the evidence is strong for a link between adiposity and breast cancer and for endometrial cancer, both in post-menopausal women. The most consistent theory implicates the production of oestrogens by the excess adipose tissue. Adipose tissue is an important site for the conversion of androgens (particularly androstene-dione, secreted from the adrenal cortex) to oestrogens, oestradiol and oestrone. The development of some forms of breast and endometrial cancer is stimulated by oestrogens, and hence the association with dietary fat or obesity. The intake of some antioxidants, including tocopherols and lycopene (the red carotenoid pigment of tomatoes), has been linked to protection against certain cancers, including prostate. Even if these findings should be confirmed, it should be emphasized that cancer prevention may not be as simple as supplementation with the antioxidant vitamins at high doses. A number of supplementation studies has been carried out, none so far...

Direct Outcome Measures

Group, and the urethral pressure profile was shorter after the operation (6,30). Urodynamic improvements remained at a mean follow-up of 53 mo. At that time, the reported mean detrusor pressure at peak flow had decreased from 85 to 44 cm H2O, the maximum detrusor pressure had decreased from 114 to 55 cm H2O, and the mean maximum flow rate increased from 10.3 to 15.3 mL s (23). The average urethral resistance factor value decreased from 41 cm H2O to the unobstructed range (16 cm H2O) (53). The size of the prostate was an important selection criterion in these studies (prostate volume < 30 cm) (23,30,54,55). Of note, although urodynamic testing is helpful in many men pre-operatively, postoperative urodynamic data do not correlate with patient reported improvement. A reported 80 of all patients participating in urodynamic studies of transurethral resection, transurethral incision, and laser prostatectomy had obstruction before treatment, but the number of men who did not have...

Incidence and Distribution of Cancers

Deaths are attributable to four malignancies. For females they are lung (25 ), breast (17 ), and colon (10 ), while for males the distribution is lung (32 ), prostate (14 ), and colon (9 ). The incidence of specific cancers varies significantly across the world, possibly due to different environmental factors. For example, the incidence of melanoma is 150-fold greater in Australia than in Japan, prostate cancer occurs 70 times more frequently in the U.S. than in China, and liver cancer is 50 times more prevalent in China than in Canada. At the same time, the incidences of certain malignancies such as leukemia, ovarian cancer, and breast cancer are similar in most countries. Even within these general differences, the use of cancer maps has, in certain instances, disclosed some dramatic variations that are likely to be related to local socioeconomic or environmental factors. The lifetime probability of developing a malignancy is 1 in 2 for males and 1 in 3 for females. These numbers...

Reactive arthropathy

The spectrum of reactive arthropathy or spondyloarthropathy is impressive. Findings range from frank synovitis to enthesitis and axial skeleton involvement. Extraarticular manifestations include dermal (psoriasiform, keratoderma blennorrhagicum, circinate balanitis), ocular (conjunctivitis, uveitis), mucosal (palatine and buccal ulcerations), genital (urethritis, cervicitis, prostatitis), and intestinal involvement. Any combination of findings may coexist. In the HIV-infected patient, two categories are frequently found the post-infectious and psoriasis-related reactive type of arthritides.

Abnormal findings

Ihe female E and the prostate in the male d . Ihe female E and the prostate in the male d . there may be tethering of the rcctal mucosa. The prostate is abnormally small in hypogonadism. Tenderness accompanied by a change in the consistency of the gland may be due to prostatitis or a prostatic abscess.

Fatty acids and cell signaling 31 Overview

NEFAs have many cellular actions which could impact cardiovascular pathobiology. Although this review focuses principally on the cardiovascular system, NEFAs also have cellular actions implicated in cancer (57-59). Because obese patients are not only at a greater risk for cardiovascular disease but also for cancers of the colon, breast, uterus, and prostate (60-62), NEFAs may be one of the factors contributing to these seemingly disparate observations.

Caveolin1 Expression Confers a New Level of Regulation

Caveolin-1 association with a number of proteins can be inhibitory. Likewise, caveolin expression in tissues in which its expression is normally low results in the formation of caveolae. The presence of caveolin then causes docking of signaling proteins, inhibition where proteins were previously constitutively active, and induction of regulatory pathways where they were absent, as a result. For example, expression of caveolin in hepatocytes causes down-regulation of lipid uptake in the liver 35 , a tissue that is normally active in the uptake of high-density lipoprotein (HDL), leading to higher circulating levels of lipoproteins as a result. Loss of cav-eolin in cancer removes a regulatory structure, and the inhibitory activity that caveolin-1 confers to a number of signaling proteins, resulting in overactivation of growth signaling. Dysregulation of caveolin-1 is associated with an overactivation of growth signals in breast 36,37 , and prostate cancers 38-40 . Several of the...

Representative other applications

An important group of relevant biomarkers are DNA adducts which originate from the chemical modification of bases in DNA or amino acids in proteins by toxic chemicals. Advantages of LC-ESI-MS methods, compared to 35P-postlabeling (the gold standard) and GC-MS (with negative CI), include detection of highly polar compounds without derivatization, direct analyte identification, and accurate quantification using internal standards (preferably stable isotope labeling) current detection limit is 1 108 nucleotides. Relevant applications include aflatoxin B1 and hepatocellular carcinoma, oxidative DNA adducts of prostate carcinoma, and M1G adducts in a variety of malignancies and in the predisposition to gastric adenocar-cinoma resulting from infection by H. pylori 155 .

Associated soft tissue injuries

Urethral injury, more common in males, occurs in 15 and bladder rupture occurs in 5 of pelvic fractures. Injuries to the ureter are rare. Urethral injuries manifest as blood at the meatus, penile bruising, a high riding prostate on PR examination, or haematuria. Urological advice is required before attempted catheterization. Suprapubic catheterization is often preferable and further investigation includes a retrograde urethrogram, cystogram, intravenous pyelogram (IVP) or CT scan.

Evaluate Known Predictors of Exposure

In a study of the potential association between serum selenium and the risk of lung and prostate cancer among cigarette smokers, Goodman et al. (2001) provided a rather detailed analysis of predictors of serum selenium concentrations (Table 8.5). In addition to addressing concerns with the comparability of collection and storage methods across study sites, they were able to corroborate the expected reduction in serum selenium levels associated with intensity and recency of cigarette smoking. Even though the background knowledge is limited to help anticipate what patterns to expect, confirming the inverse association with smoking adds confidence that the measurements were done properly and are more likely to be capturing the desired exposure.

Spermatogenesis After Single Dose Irradiation

Animal data suggest that fractionation of radiotherapy increases its gonadal toxicity, and the evidence suggests that this is also the case in humans. Speiser et al. (36) studied 10 patients who received a testicular dose of radiation of 1.2 to 3 Gy in 14 to 26 fractions during inverted Y-inguinal field irradiation for Hodgkin's disease. All patients were azoospermic after treatment, and recovery was not seen in a single patient, despite follow-up of more than 15 mo in 4 patients and up to 40 mo in 1 patient. An update of these data published in 1994 (37) revealed no recovery of spermatogenesis in patients receiving doses of 1.4 to 2.6 Gy after 17 to 43 mo follow-up, but a return of fertility in the 2 patients with testicular radiation doses of 1.2 Gy, suggesting that this may represent a threshold for permanent testicular damage. Hahn et al. (38) carried out serial semen analysis on 11 patients with cancer who had received large pelvic field irradiation or interstitial 125I seeds...

Types of Immune Response

As a malignant tumor develops, the host is interacting with tumor-associated antigens (TAAs), the nature of which may change continuously. Examples of antigens associated with human malignancies include (a) oncofetal antigens, e.g., carcinoembryonic antigen (CEA) in colorectal and pancreatic carcinoma, and a-fetoprotein in primary liver and some testicular and ovarian cancers (b) viral antigens, e.g., hepatitis B in primary liver cancer, Epstein-Barr in Burkitt's lymphoma, and human papilloma viruses in cervical carcinoma and (c) other antigens, e.g., prostate-specific antigen and prostatic acid phosphatase in prostatic cancer, and certain glycopro-teins in solid tumors. Mass spectrometric aspects of relevant antigens are discussed in Chapter 6.

Indicationcontraindications

Indications for TUVP are same as those for TURP. Primarily, they include moderate-to-severe symptoms on the International Prostate Symptom Score (I-PSS) or the American Urologic Association Symptom Index (AUA SI), and or prostatism refractory to medical therapy. Other absolute indications for surgery are acute refractory urinary retention, recurrent infection, recurrent hematuria, cystolithiasis, and postrenal azotemia. There are no absolute size requirements. The literature generally recommends TUIP for prostatic glands < 30 g without a median lobe because of reported low morbidity. For the same reason, an open prostatectomy is recommended for glands > 80 g. The median lobe is not a contraindication for TUVP, unlike for some of the other new minimally invasive procedures. Although there have been reports of performing transurethral surgery of prostate with the patient under local anesthesia, we generally recommend using a general or spinal anesthesia. There are no differences in...

Differential diagnosis

Prostate and breast carcinoma in bone may resemble Paget's disease, but bony expansion is lacking and cortical destruction is more frequent. In any site, if destruction of bone, extracortical extension, or a possible soft-tissue mass is present, neoplasia must be ruled out, especially if pain is increasing.

Introduction Instruments

While standard transurethral resection of the prostate (TUR-P) remains the gold standard for surgical treatment of BPH in selected patients with significant comorbidity and subsequently elevated operative risk factors, the questions of a minimal invasive alternative to standard TUR-P may arise.

Epidemiological Evidence

One of the early population cohort studies of note was the American Cancer Society 'One Million Study', in which the risk of cancer in relation to body weight was studied prospectively. This study showed (1) that there was an association between overweight and cancer of the colon, pancreas, stomach, kidney, gallbladder and prostate for men

T Cell Tolerance to Tumors and Cancer Immunotherapy

It is widely recognized that the immune system plays a role in cancer progression and that some tumors are inherently immunogenic. The identification of tumor-associated antigens (TAAs) has stimulated research focused on immunotherapies to mediate the regression of established tumors. Cancer-specific immunity has traditionally been aimed at activating CD8+ cytotoxic T lymphocytes (CTLs) directed against major histocompatibility complex (MHC) class I-binding peptide epitopes. Other approaches utilize T cell adoptive therapy where autologous, tumor-specific T cells propagated in vitro are transferred back into recipients. However, these strategies have met with limited success in part due to the regulatory mechanisms of T cell tolerance, which poses a considerable challenge to cancer immunother-apy. Our laboratory utilizes the TRansgenic Adenocarcinoma of the Mouse Prostate (TRAMP) model, a murine model of prostate cancer, to study mechanisms of T cell tolerization to tumor...

To identifying tumorpromoting mutations

A recent study of prostate cancer surveyed LOH in 11 patients, using approximately 1500 SNPs across the genome that could be detected by differential hybridization on DNA oligonucleotide chips (SNP-chips). The idea of this approach is to identify heterozygous SNPs in normal cells from these patients (only a subset of patients will be heterozygous for a given SNP) and then see if both variants of these SNPs are present in the prostate tumor cells. If only one SNP variant is present, then LOH has occurred. Figure 17-21 shows the distribution of 32 sites in the genome that exhibited LOH, superimposed on the human cytogenetic map. Each of these regions could then be subjected to more intensive screening for SNPs or other heterozygous polymorphic markers in the vicinity of the detected LOH sites to determine the size of the lost region. After the sizes of these regions have been determined, they can be compared with the known genes on the sequence map that fall into these regions. The...

Restrict Inference to Disease Outcome That Can Be Ascertained Accurately

Many, perhaps most, diseases have a spectrum of severity, with the probability of manifesting symptoms and being detected increasing as the severity of the condition increases. Prostate cancer in older men, for example, is extremely common and usually asymptomatic, but the form of the disease that is more aggressive and metastasizes to bone results in clinical symptoms that more often lead The most informative approach to the study of diseases with a spectrum of severity is to comprehensively identify all cases across the spectrum of disease, even the least severe, in order to determine empirically whether risk factors differ for more versus less severe variants of the condition. When comprehensive diagnosis is infeasible due to the invasiveness or expense of the methods for definitive diagnosis, e.g., laparoscopic surgery to diagnose endometriosis, compromise in the study design is required. Shifting interest to the study of severe endometriosis or aggressive prostate cancer is one...

Overcoming Tolerance Leads to Tumor Immunity

Initially, it was demonstrated by many groups that conferring costimulatory ligands to T cells makes tumors more immunogenic (Townsend and Allison 1993 Zheng et al. 2006). Subsequently, it was shown that blocking negative signals favors more efficient T cell activation and can result in a potent antitumor response. Cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) binds to B7.1 2 on APC with higher affinity than CD28 (Linsley et al. 1994) and delivers an inhibitory signal to T cells that serves to block IL-2 expression and cell cycle progression (Krummel and Allison 1996). Transient in vivo blockade of CTLA-4 at the time of tumor vaccination can enhance vaccine potency and antitumor immunity against melanoma and prostate cancer (van Elsas et al. 1999 Hurwitz et al. 2000). We and others previously reported that treatment of a mouse model of prostate cancer (TRansgenic Adenocarcinoma of the Mouse Prostate TRAMP model) with a GM-CSF-expressing cell-based...

Hormone Receptors Determine Whether a Cell Will Respond to a Hormone

A certain degree of specificity is ensured by the restricted distribution of some hormones. For example, several hormones produced by the hypothalamus regulate hormone secretion by the anterior pituitary. These hormones are carried via small blood vessels directly from the hypothalamus to the anterior pituitary, prior to entering the general systemic circulation. The anterior pituitary is, therefore, exposed to considerably higher concentrations of these hypothalamic hormones than the rest of the body, as a result, the actions of these hormones focus on cells of the anterior pituitary. Another mechanism that restricts the distribution of active hormone is the local transformation of a hormone within its target tissue from a less active to a more active form. An example is the formation of di-hydrotestosterone from testosterone, occurring in such androgen target tissues as the prostate gland. Dihydrotestos-terone is a much more potent androgen than testosterone. Because the enzyme that...

Miscellaneous Drugs

That sometimes occur due to disorders such as cystitis, prostatitis, or other affected structures such as the kidney or the urethra. Overactive bladder is estimated to affect more than 16 million individuals in the United States. Symptoms of an overactive bladder include urinary urgency, frequent urination day and night, and urge incontinence, accidental loss of urine caused by a sudden and unstoppable need to urinate. These drugs also help control the discomfort associated with irritation of the lower urinary tract mucosa caused by infection, trauma, surgery, and endoscopic procedures. Other miscellaneous drugs are used to relieve the pain associated with irritation of the lower genitourinary tract (eg, phenazopyridine) caused by infection, trauma, surgery, and endoscopic procedures.

Preoperative and perioperative assessment of the prostatic urethra

When the urethral involvement is the determining factor in the decision to perform a prophylactic urethrectomy or to leave the urethra behind (to be used for a bladder replacement), the assessment of the prostatic urethra before surgery is of great importance. The need for accurate sampling of the prostatic urethra was first suggested by prostate mapping studies, which showed malignant changes in the prostatic urethra in 50-70 of patients.14,15 In another extensive study, 4-mm step sections were performed in 84 cystoprostatectomy specimens.16,17 Thirty-six patients (43 ) were found to have transitional cell carcinoma of the prostate. Of this group, 94 had prostatic urethra involvement and 6 had a normal prostatic urethra, but transitional cell carcinoma was present in the periurethral structures. This high incidence of involvement suggests that increasing the intensity of the search for prostate invasion results in an increased incidence of this diagnosis. Not all patterns of...

Computer Aided Interventions

The use of intraoperative ultrasound has been found valuable due to its relatively low cost and the possibility to generate 3D anatomical visual information within seconds, especially in neurosurgery 9 10 11 12 54 . In other areas such as prostate brachytherapy, 3D ultrasound has been used for visual guidance when positioning seed implants 4 42 .

The Epididymus and Vas Deferens

From their site of production in the testes, sperm pass through the epididymis, the vas deferens, the ejaculatory duct, then finally the urethra to the outside of the body. As sperm are expelled from the body along this route, they are mixed with seminal fluid to produce semen. Seminal fluid is secreted into the tubes by three sets of glands the seminal vesicles, the prostate, and the bulbourethral (Cowper's) glands. The sperm never enter these glands fluid is squeezed out of them into the tubes where the sperm are located.

Results and Discussion

Total 308 patients have been recruited for cancer vaccine trial in N.N. Petrov Institute of Oncology during 1998-2006. The following tumor types were included melanoma 196, kidney cancer 108, colorectal cancer 3 and prostate cancer 1. Mean age of the patients was 53.7 years (time interval 21-79 years). Total 117 patients received non-modified vaccine (48 patients 2-6 intracutaneous BCG injections 54 patients 4-6 intracutaneous IL-1P injections and 15 patients up to 6 injections of IL-1P + low doses of cyclophosphamide. Clinical trial of genetically modified vaccine included 59 patients 54 patients received 2-10 injections of the tag7 PGRP-S gene modified autologous tumor cells and 5 patients received 18-35 injections of this vaccine (Table 1). Prostate cancer

Laser Microbeams for Genomics and Proteomics

Genetic changes manifested in multistep progression of cancer can involve gain of mutation in dominant oncogenes, or loss of a function by delection, mutation, or methylation in repressive tumor suppressor genes. This loss of supressor gene function in a tumor is called loss of heterozygosity (LOH) (Gillespie et al., 2000). Laser microdissection has made a significant contribution to applications of LOH analysis to cancer studies because virtually pure populations of tumor cells or preneoplastic foci necessary for LOH analysis can be isolated without contamination even by a few unwanted cells. The LOH analysis has proved valuable in the mapping of tumor suppressor genes, localization of putative chromosomal hot spots, and the study of sequential genetic changes in preneoplastic lesions. LCM in conjunction with fluorescence in situ hybridization (FISH, discussed in Chapter 8) demonstrated LOH on chromosome sp21 in prostate cancer. Loss of the dematin gene was observed, leading to...

The Function of Prolactin

Further research will likely reveal other roles for prolactin, because pro-lactin is produced by multiple tissues and interacts with multiple other neurotransmitter, peptide, and hormonal systems. In addition to the anterior pituitary gland, numerous other brain areas produce prolactin, as do breast tissue, placenta, uterus, prostate, and lymphocytes (Bole-Feysot et al. 1998 Goffin et al. 2002). Other peptides are known to be affected by or to affect prolactin levels examples include estrogen, testosterone, lep-tin, galanin, somatostatin, calcitonin, bombesin-like peptides, neurotensin, endothelins, neuropeptide Y, and cholecystokinin. In addition, neu-rotransmitter systems other than dopamine are affected by and or affect prolactin, including glutamate, aspartate, glycine, gamma-aminobutyric acid (GABA), and nitric oxide. Although prolactin's role in reproductive function is relatively well understood, prolactin's other homeostatic functions are less understood nevertheless, the...

Purposeful Changes that Affect Emulsion Stability

There are two primary factors that can be manipulated to effect emulsion stability, liposome concentration, and percentage of oil in the emulsion. Emulsions made with 25-mM liposomal phospholipids are very unstable, breaking within a few hours. By increasing the phospholipid concentration of the liposomes, emulsions can be made to break in a few hours or a few days to being stable for long periods of times (Fig. 6). The volume of the liposomes can also be changed. Similarly, the stability of emulsion can be varied by changing the percentage of light mineral oil. Emulsions with low percentages of oil are unstable breaking within two days, while emulsions with high percentage of oil (42.5 ) are stable for long periods of time (Fig. 7). In addition, a combination of these factors can be varied to change the stability of the emulsion. The emulsion that we used in clinical trials with prostate cancer patients contained 1 mL of PSA liposomes and 0.1 mL of light mineral oil (2,20). This...

Expected Immune Responses from Immunization with Liposomal Emulsions

We have used liposomal emulsions in studies with both mice and in humans. PSA, KSA, kallikrein, anthrax protective antigen, and HIV gp140 have been used as antigen in mice (28,30). High titers of antibodies and potent cellular immunity were induced in mice. The antibody responses tended to be reduced below those obtained with liposomes alone. Cellular immune responses were similar to those obtained with liposomes alone. In contrast, immunization of prostate cancer patients with liposomes containing PSA and lipid A induced minimal to no antibody or cellular immune responses (2,20). This was quite surprising because immunization with Walter Reed liposomes induced very strong immune responses in clinical trials for malaria and HIV vaccine (24,25,61). Vaccine research in prostate cancer patient represented a very challenging context for research. The patients were at the final stage, having failed all other conventional therapies, immu-nosuppressed, and had high levels of circulating PSA....

Androgens Have Effects on Reproductive and Nonreproductive Tissues

Between 8 and 18 weeks of fetal life, androgens mediate differentiation of the male genitalia. The organogenesis of the wolffian (mesonephric) ducts into the epididymis, vas deferens, and seminal vesicles is directly influenced by testosterone, which reaches these target tissues by diffusion rather than by a systemic route. The differentiation of the urogenital sinus and the genital tubercle into the penis, scrotum, and prostate gland depends on testosterone being converted to DHT. Toward the end of fetal life, the descent of the testes into the scrotum is promoted by testosterone and insulin-like hormones from Leydig cells (see Chapter 39).

Clinical Focus Box 371

Prostate Cancer Some prostate cancers are highly dependent upon androgens for cellular proliferation therefore, physicians attempt to totally ablate the secretion of androgens by the testes. Generally, two options for those patients are surgical castration and chemical castration. Surgical castration is irreversible and requires the removal of the testes, while chemical castration is reversible. antiandrogens, such as flutamide, bind to the androgen receptor and prevent binding of endogenous androgen. Some prostate cancers are androgen-independent, and the treatment requires nonhormonal therapies, including chemotherapy and radiation.

Survival Promoting Activity of Caveolin1

Several studies using either overexpression or antisense suppression techniques demonstrated that caveolin-1 may act as a positive regulator of cell survival in certain cancer cells. This was first shown in mouse and human prostate cancer cells, where expression of caveolin-1 protects the cells from androgen deprivation-induced apoptosis and c-Myc-induced apoptosis, respectively 7,10 . In the former case, caveolin-1 was secreted from the cells, upon testosterone treatment, acting as an autocrine or paracrine pro-survival factor 9 . Similarly, overexpression of caveolin-1 in LNCaP human prostate cancer cells significantly reduced thapsigargin-induced apoptosis 12 . The pro-survival action of caveolin-1 in prostate cancer cells was recently confirmed in the TRAMP mouse model, where caveolin-1 gene knockout attenuated tumor progression and metastasis in vivo and stimulated apoptosis of tumor-derived cells both in vitro and in vivo 84 . We have recently shown that caveolin-1 expression in...

In Vivo Antitumour Activity

Testing of drug candidate TK inhibitors for in vivo anti-tumour activity was carried out with KB cell-derived human squamous tumour xenografts grown in nude mice. Structural chemistry necessary for in vivo anti-tumour activity, and the importance of sustaining concentrations of drug in the blood sufficient to inhibit EGFR-TK activity throughout each 24-h period following once-daily, oral dosing, were defined using this model. Iressa was chosen as a drug development candidate because it achieves high and sustained blood levels, in vivo, over a 24-h period (Barker et al. 2001). The potential spectrum of anti-tumour activity for Iressa in patients was assessed in xenografts of major solid human tumours representing a wide range of tissues of origin (Wakeling et al. 2002). The anti-tumour efficacy of Iressa varied widely between tumours. Dose-dependent growth inhibition was noted for A431 (human vulval squamous), A549 (lung), Du145 (prostate), HCT15, HT29 and LoVo (colon), and KB (oral...

Affected Organs And Cell Types In Polyomavirusassociated Disease And Persistent Virus Infection

Analysis of prostate biopsy specimens for BKV revealed virus DNA in 58 of asymptomatic tissue and in 87 of prostate hyperplasias sampled from prostate carcinoma patients. This was comparable to the rate in bladder tissue. In addition, 70 of cervix and vulvar tissue exhibited viral DNA, and analysis of sperm gave an incidence of 95 for the presence of BKV DNA. In contrast, DNA of the second polyomavirus JC was found in only 5 of cervical and vulvar tissue specimens. Glandular tissue yielded no JCV DNA, whereas 21 of sperm samples were positive for JCV DNA. The high rate of BKV DNA present in asymptomatic tissue and semen suggests that these sites should be considered as locations of polyomavirus persistence (Monini et al., 1995, 1996 Shinohara et al., 1993).

Diseases of the genitourinary system N00N99

Of prostate Hyperplasia of prostate Median bar (prostate) Prostatic obstruction NOS Excludes benign neoplasms, except adenoma, fibroma and myoma of prostate ( D29.1 ) _ Inflammatory diseases of prostate Use additional code (B95-B97), if desired, to identify infectious agent. N41.0 Acute prostatitis N41.1 Chronic prostatitis N41.2 Abscess of prostate N41.3 Prostatocystitis N41.8 Other inflammatory diseases of prostate N41.9 Inflammatory disease of prostate, unspecified Prostatitis NOS __Other disorders of prostate N42.0 Calculus of prostate N42.1 Congestion and haemorrhage of prostate N42.2 Atrophy of prostate N42.8 Other specified disorders of prostate N42.9 Disorder of prostate, unspecified

Technical considerations for salvage cystectomy

Handling Cystectomy

Figure 2 Dissection of the bladder and prostate off the anterior rectal wall. will find the posterior bladder wall densely adherent to the rectum, as illustrated in Figure 2b. To minimize the risk of injury to the rectal wall, use a sponge-stick to depress the rectal wall at the same time the bladder is lifted up, and then use scissors to cut immediately adjacent to the posterior bladder wall then push gently, if possible, to reveal the next point that should be cut. The proper technique requires the surgeon to visualize to the fullest extent possible the juncture of posterior bladder wall and rectum, cut and gently push to see if the dissection proceeds easily, and then repeat the cycle as many times as is necessary. As you approach the prostate itself, it is often easier to complete the dissection following incision of the endopelvic fascia. This may enable you to get down behind the prostate and work in a retrograde manner. It may be optimal to alternate these two approaches cut...

Functional Neuroanatomy Of Penile Function

Ischiocavernosus Erection

Dendrites also project to areas containing descending axons from supraspinal centers that integrate and coordinate the autonomic nervous system, such as the hypothalamus, reticular formation, and midbrain (7). The preganglionic fibers from the sacral roots form the pelvic nerves (pelvic splanchnic nerves or nervi erigentes) and are joined by fibers from the inferior hypogastric nerves (sympathetic) to form the pelvic plexus (31). Alternatively known as the inferior hypogastric plexus, these nerves run in the pelvic fascia on the lateral side of the rectum, seminal vesicles, prostate, and posterior bladder. Additional sympathetic contribution arises from the sacral sympathetic chain ganglia via the gray rami. cavernous nerve (parasympathetic and sympathetic postganglionic fibers) leaves the pelvis between the transverse perineal muscles and the membranous urethra, passing between the arch of the pubic bone to supply each corpus cavernosum. The cavernous nerve divides into two branches....

Erection and Ejaculation Are Neurally Regulated

The secretions of the accessory glands promote sperm survival and fertility. The accessory glands that contribute to the secretions are the seminal vesicles, prostate gland, and bulbourethral glands. The semen contains only 10 sperm by volume, with the remainder consisting of the combined secretions of the accessory glands. The normal volume of semen is 3 mL with 20 to 50 million sperm per milliliter, normal is considered more than 20 million sperm per milliliter. The seminal vesicles contribute about 75 of the semen volume. Their secretion contains fructose (the principal substrate for glycolysis of ejaculated sperm), ascorbic acid, and prostaglandins. In fact, prostaglandin concentrations are high and were first discovered in semen but were mistakenly considered the product of the prostate. Seminal vesicle secretions are also responsible for coagulation of the semen seconds after ejaculation. Prostate gland secretions ( 0.5 mL) include fibrinolysin, which is responsible for...

Development of Accessory Sex Organs and External Genitalia

Labia Majora And Labia Minora Disease

The external genitalia of males and females are essentially identical during the first 6 weeks of development, sharing in common a urogenital sinus, genital tubercle, urethral folds, and a pair of labioscrotal swellings. The secretions of the testes masculinize these structures to form the penis and spongy (penile) urethra, prostate, and scrotum. In the absence of secreted testosterone, the genital tubercle that forms the penis in a male will become the clitoris in a female. The penis and clitoris are thus said to be homologous structures. Similarly, the labioscrotal swellings form the scrotum in a male or the labia majora in a female these structures are therefore homologous also (fig. 20.6). for the development and maintenance of the penis, spongy urethra, scrotum, and prostate. Evidence suggests that testosterone itself directly stimulates the wolffian duct derivatives epididymis, ductus deferens, ejaculatory duct, and seminal vesicles.

Case 29 Increased Bony Densities Due To Osteosclerotic Metastases

Paget Disease Breast

The bones show patchy increased density due to metastases from carcinoma of the prostate. The differential diagnoses are Paget's disease and Fluorosis. Cancer of breast or lymphoma may also cause the same appearance. The CXR also shows right lower lobe infiltrates, suggesting aspiration pneumonia, common in the last stages of patients debilitated with cancer.

Neisseria gonorrheae Gonorrhea

Neisseria Meningitidis And Gonorrhea

Gonorrhea is a sexually transmitted disease. The pathogens penetrate into the urogenital mucosa, causing a local purulent infection. In men, the prostate and epididymis can also become infected. In women, the gonococci can also cause salpingitis, oophoritis, or even peritonitis. Gonococci reaching the conjunctival membrane may cause a purulent conjunctivitis, seen mainly in newborn children. Gonococci can also infect the rectal or pharyngeal mucosa. Hematogenously disseminated gonococci may also cause arthritis or even endocarditis.

Temporary Bioresorbable Prostatic Stents

Were polymers of organic acids with a molecular weight of up to 1,000,000 D. The properties of these polymers depend on the basic molecules and the degree of polymerization. The degradation depends on the structure and strength of the individual materials. The use of these polymers in temporary bioresorbable prostatic stents in 11 men was reported by Isotalo and associates (30). They used a temporary bioresorbable self-reinforced poly-L-lactic acid prostatic urethral stent plus finasteride. The strength of the stent is retained for 35 wk in vitro and the total degradation time is 1 yr. The stent expands 45 to hold itself in place. All patients were able to void spontaneously, and their bladders emptied properly. In this trial, there were three cases of incorrect positioning of the stent and three urinary tract infections. The stents held the prostatic urethra open until finasteride could shrink the prostate. Laaksovirta and associates reported their results in 39 men treated with a...

Two kinds of genes are changed in many cancers

Two Hit Hypothesis

The isolation of various tumor suppressor genes has confirmed Knudson's two-hit hypothesis. Some of these genes are involved in inherited forms of rare childhood cancers such as retinoblastoma (a tumor of the eye) and Wilms' tumor of the kidney as well as in inherited breast and prostate cancers.

Molecular Mechanisms Implicated in the Pro Survival Action of Caveolin1

Cell Prosurvivial Image

The phosphoinositide 3-kinase (PI3K) Akt cell survival pathway has recently emerged as a major target for regulation by caveolin-1 in a variety of cancer cells 12,13,86 . A possible role of caveolin-1 in PI3K Akt pathway activation was shown in multiple myeloma cells which, unlike most other hematopoietic-derived cells, express high levels of caveolin-1 86 . Caveolin-1 was found to co-localize in lipid rafts fractions, and to co-exist in an immunoprecipitable complex, with receptors for insulin-like growth factor-I (IGF-I) and interleukin-6 (IL-6). These cell survival-inducing factors stimulated c-Src-mediated phosphorylation of caveolin-1 on Tyr14 and its association with PI3K subunits. The disruption of lipid raft organization by cholesterol depletion resulted in a redistribution of caveolin-1 and PI3K, an inhibition of Tyr14 phosphorylation of caveolin-1, and an abrogated IGF-I- and IL-6-induced activation of Akt and survival, thus confirming that both caveolin-1 and intact...

Leptomeningeal Spread Sclc

The incidence of LM from melanoma is about 23 .4 The exact incidence in genitourinary (GU) cancers (renal, bladder and prostate) is not reported but 6 of all LM patients have GU malignancies, and the incidence rate may be increasing.12'32'74'115'134 Gastrointestinal (GI) cancers were once believed to be a major cause of LM but are now rarely encountered.38 LM from gynecological cancers (ovarian, cervical, and fallopian tube adenocarcinoma) and head and neck cancers are also seen.1'7'95'128 Rare solid tumors that metastasize to the leptomeninges include thyroid cancer,10 retinoblastoma,55 neuroblastoma,65 neuroendocrine tumors,36 carcinoid,79 sarcoma,62'134 and squamous cell of the skin or larynx.11,120'140

Primary Sex Organtestis

At the posterior surface of the prostate gland, the ductus deferens is joined by another duct called the seminal vesicle. The seminal vesicle is also a long tubular structure, but it is coiled up into a small mass at the back of the prostate gland. The seminal vesicle produces a nutrient fluid that helps to maintain the spermatozoa. d. Ejaculatory Duct. On each side, as the ductus deferens and seminal vesicle join, they form a single tube on the same side, called the ejaculatory duct. Each ejaculatory duct, left and right, carries the seminal vesicle secretion and spermatozoa through the substance of the prostate gland. Each ejaculatory duct empties into the prostatic urethra. e. Prostate Gland. The prostate gland is located in the pelvic cavity immediately under the urinary bladder. The urethra of the urinary system passes through the substance of the prostate gland, where it is known as the prostatic urethra. The prostate gland also adds a secretion. Altogether,...

Diseases Characterized By Vaginal Discharge

Trichomoniasis is caused by the protozoan Trichomonas vaginalis. Classically, infection is associated with a thin, greenish-yellow vaginal discharge, dysparenia, vaginal irritation, and sometimes dysuria (54). On examination, a thin vaginal discharge along with punctate cervical hemorrhages (strawberry cervix) is characteristic. Men are frequently asymptomatic although trichomoniasis may cause prostatitis and epididymi-tis (54).

Testosterone Shbg And Obesity

The relationship between low testosterone and obesity is bidirectional. Bjorntorp (43) has proposed that hypogonadism predisposes to central obesity and insulin resistance in men. In support of this idea, Becker et al. (45) reviewed the clinical records of 50 hypogonadal men with Klinefelter syndrome seen at the Mayo Clinic, and reported in 1966 that 50 were obese as adults. Furthermore, men with prostate cancer who were receiving androgen deprivation therapy with GnRH analogs had a higher fat mass by dual energy x-ray absorptiometry (DEXA) scan than did age-matched men with nonmetastatic prostate cancer who were postprostatectomy and or radiotherapy or age-matched normal men (46). In a longitudinal study, fat mass increased 5 (from 20.2 + 9.4 to 21.9 + 9.6 kg) after 3 mo of androgen-deprivation therapy (47). In a study of healthy Japanese American men, lower baseline total testosterone predicted an increase in intraabdominal fat (48). Finally, testosterone replacement of middle-aged...

Clinical Aspects of the Male Reproductive System

Transurethral Incision The Prostate

Another common STD is herpes infection, caused by a virus. Other STDs are discussed in Chapter 15. Mumps is a non-sexually transmitted viral disease that can infect the testes and lead to sterility. Other microorganisms can infect the reproductive tract as well, causing urethritis, prostatitis, orchitis, or epididymitis. Benign Prostatic Hyperplasia As men age, the prostate gland commonly enlarges, a condition known as benign prostatic hyperplasia (BPH). Although not cancerous, this overgrown tissue can press on the urethra near the bladder and interfere with urination. Urinary retention, infection, and other complications may follow if an obstruction is not corrected. Medications for increasing urinary flow rate by relaxing smooth muscle in the prostate and bladder neck are used to treat the symptoms of BPH. Drugs that interfere with testosterone activity in the prostate may slow In advanced cases of BPH, removal of the prostate, or prostatectomy, may be required. When this is...

Patients With Minimal Structural Heart Disease or With LVH

In patients with minimal or no significant structural heart disease, any antifibrillatory agent can be employed. A specific agent should be selected by its side-effect profile. Class IC agents such as propafenone and flecainide have an extremely low incidence of ventricular proarrhythmia in normal hearts, and are generally well-tolerated. Sotalol and class IA agents such as disopyramide and procainamide can be used safely in this setting if careful attention is given to the dose-dependent QT-prolonging effects of these drugs. Quinidine is the exception, because it has both a dose-dependent and an idiosyncratic QT-prolonging effect in certain individuals. Periodic complete blood counts should be performed on patients who are taking either procainamide or quinidine because of the rare occurrence of blood dyscrasias. Disopyramide is well-tolerated in younger patients, but because of its significant anticholinegic effects, caution should be used in men with symptoms of an enlarged...

Intraoperative Complications

Excessive bleeding can occur for a variety of reasons. A frequent cause is failure to control early bleeding, particularly from arteries, which subsequently impairs visualization to the extent that identification of bleeding vessels becomes increasingly difficult. Perforation of the surgical capsule, especially early in the procedure, is another common culprit. Although generally venous and not arterial, this type of bleeding can be particularly difficult to control with cauterization because of the size of the vessels. When this occurs early, especially in large prostates, some surgeons advocate completing the resection on the side of the perforation and aborting the rest of the procedure. If necessary, TURP can be completed at a later date. Late perforation of the capsule generally allows completion of the procedure however, this complication must be recognized, thereby prompting the surgeon to finish the procedure expeditiously. In all situations, aggressive attempts at hemostasis...

Physiology Of Cortisol Metabolism

Cortisol Metabolism Hsd

Role in bile acid metabolism (41). 5a-reductase activity is catalysed by two isozymes from different genes (Table 18.2) (42). 5a-reductase type 1 is expressed in liver, non-genital skin, brain and to a lesser extent in stromal cells of adipose tissue (43). In addition to metabolizing cortisol, it also converts testosterone to the more potent androgen receptor agonist 5a-dihydrotestosterone. 5a-reductase type 2 is expressed in human liver, specific areas of the developing central nervous system (CNS) involved in reproductive behaviour, prostate and genital skin. In the latter tissues it is essential to enhance local androgen receptor activation and development of the

An Oblique Surgical Incision Follows What Direction

Case Study 14-2 Benign Prostatic Hyperplasia with TURP C.S., a 62-year-old businessman, saw a urologist with complaints of decreased force of urine stream and ejaculation, hesitancy, and sensation of incomplete bladder emptying. He claimed he had taken prostate-health herbal supplements without any real benefit for 2 years before making the appointment. He denied dysuria, hematuria, or flank pain. He has no history of UTI, epididymitis, prostatitis, renal disease, or renal calculi. Rectal examination revealed a 50-g prostate with slight firmness in the right prostatic lobe. Bladder ultrasound showed no intravesical lesions or prostate protrusion into the bladder base. C.S. was diagnosed with benign prostatic hyperplasia with bladder neck obstruction and was scheduled for a TURP. d. lateral to the prostate 10. inflammation of the prostate gland _

Staging Past present and future

T2a Tumour invades superficial muscle (inner half) T2b Tumour invades deep muscle (outer half) T3 Tumour invades perivesical tissue T3a microscopically T3b macroscopically (extravesical mass) T4 Tumour invades any of the following prostate, uterus, vagina, pelvic wall, abdominal wall T4a Tumour invades prostate or uterus or vagina T4b Tumour invades pelvic wall or abdominal wall T2a Inner half T2b Outer half T3 Beyond muscularis T3a Microscopically T3b Extravesical mass T4a Prostate, uterus, vagina T4b Pelvic wall, abdominal wall N1 Single < 2cm T2 Tumour invades muscle (superficial) T3a Tumour invades muscle (deep) T3b Tumour invades through bladder wall T4a Tumour invades prostate, uterus or vagina T4b Tumour invades pelvic or abdominal wall The role and significance of bimanual palpation is controversial. At the 4th International Consensus Meeting on Bladder Cancer, some investigators indicated that ultrasound or CT-scan was more accurate than bimanual palpation under...

Prostatic Stents For Treatment Of

Prostatic stents are divided into three categories prostate springs, which include Urospiral, Prostacath, Prostacoil stents self-expandable stents such as the Urolume and balloon-expandable stents such as the Titan and the newer Memotherm, including intraurethral catheters and the new biodegradable ones. The available literature concerning the various types of stents consist of small series with short follow-up and no controls. There are, however, excellent recent reviews (9,10). The first described use of intraprostatic stents in the treatment of prostatic obstruction dates to 1980 when Fabian described placing a temporary stent through the prostate for high-risk patients (the urospiral) (12,13). The urospiral reportedly had problems with migration, encrustation, and recurrent infections, and did not allow cystoscopy. The second permanent prostatic stent system was reported by Chapple et al. in 1990 (14). This group had previous experience with stents for managing strictures in the...

Metastatic Tumors To The Sellar Region

Metastatic deposits from any systemic and hemopoietic malignancies occasionally involve the sellar region (1). A favored anatomic target for such deposits is the posterior lobe of the pituitary. The predilection of metastatic tumors for the posterior lobe of the pituitary relates to its blood supply. In contrast to the anterior pituitary, which has a somewhat tenuous and indirect supply from the portal circulation, the posterior lobe derives its circulation directly from the carotid arterial system. Although the majority of metastatic tumors in this region occur in the context of advanced malignancy, occasional posterior lobe metastases may be the first sign of an unrecognized neoplastic process (150,151). Of the metastatic cancers, breast is the most common primary, followed by lung and prostate (150,151). Hemopoietic malignancies that may present with a posterior lobe deposit include the solitary plasmacytomas (which usually evolve into multiple myelomas) as well as various...

Operative Technique

Rectal Eversion

When the colon has been full mobilised and the mesentery has been divided, the patient is placed in a steep Trendelenburg position. The presacral space is entered by dividing the left and right pararectal peritoneum. The plane is developed posteriorly and laterally. Anteriorly in male patients, care is taken to identify seminal vesicles, fascia and prostate. The rectum is circumferentially dissected down to the pelvic floor and transected with an articulate linear stapler positioned 1-2 cm above the dentate line. Although various reservoir designs have been described, it was not until 1978 when Parks et al. 61 , from St. Mark's Hospital of London, reported their experience with the triple-folded S-shaped reservoir that the modern era of the IPAA began. Several other reservoir designs were later proposed, including the double-folded J-shaped reservoir, the four-folded W-shaped reservoir, the later lateral reservoir of Fonkalsrud, and the U-shaped reservoir. The...

Finasteride Phase Iii Clinical Trials

Two separate phase III clinical trials studying symptomatic patients with palpably enlarged prostates were conducted to evaluate the safety and efficacy of finasteride in treating symptomatic BPH. These 12-mo studies of men receiving either 5 mg of finasteride or placebo daily were performed in a randomized, double-blind, placebo-controlled fashion. In the first trial, the North American Study, men who received finasteride 5 mg d (n 297 patients) had a decrease in prostate volume of 19 vs a 3 drop noted in men taking placebo (n 300 patients) (25). In the International Study, also known as the Finasteride Study Group, men receiving 5 mg d of finasteride experienced a 22 drop in prostate volume, compared to a 5 drop in the placebo group (26). Regarding maximum urinary flow rate, men in the North American Study group treated with 5 mg d of finasteride had a statistically significant but clinically limited increase in maximum flow rate of 1.6 mL s men receiving placebo were found to have...

Primary And Metastatic Spinal Tumors

Multiple myeloma and lymphoma represent the more aggressive lesions of the spine and are permeative in presentation. Multiple myeloma and lymphoma can grow through the vertebrae in a diffuse manner and cause marrow replacement. The weakened bone is prone to form compression fractures that can narrow the central canal and recesses, and be the source of radicular symptoms or focal or referred pain. Multiple myeloma is one of the most common primary bone tumors and most often involves the spine. Lymphoma is often found in the spine as a metastasis in up to 30 of patients with primary systemic disease. Although in fewer than 5 of cases, lymphoma presents as a primary bone lesion. Metastases to the spine occur in 10-40 of cancer patients and the most common primary sites are lung, breast, prostate, and kidney neoplasms.

Proscar Longterm Efficacy And Safety Study

After the phase III studies, finasteride was further evaluated in a 4-yr, multicenter, double-blind, placebo-controlled, randomized study called PLESS or Proscar Long-Term Efficacy and Safety Study (29). The goals of this study were to compare long-term (4-yr) treatment with finasteride 5 mg vs placebo in the following parameters urinary symptoms, urinary flow rates, incidence of surgery for BPH, and acute urinary retention. There were 3040 men enrolled, with a mean age of 64 yr. To be eligible for randomization, subjects had to exhibit moderate-to-severe urinary symptoms, enlarged prostate gland on digital rectal exam (DRE), serum prostate specific antigen (PSA) concentration < 10 ng mL, and peak urinary flow rate < 15 mL s. Furthermore, men with PSA concentrations greater than or equal to 4 mg mL and < 10 mg mL had to undergo screening prostate biopsies to rule out the presence of prostate cancer before undergoing randomization. Throughout PLESS, the prostate volume for the...

How Do We Monitor Androgen Replacement Therapy

Because administration of testosterone may unmask histological prostate cancers by increasing serum PSA levels, measuring PSA early after beginning treatment, e.g., 1 to 3 mo is recommended. Thereafter, PSA should be checked yearly according to the uro-logical practice applicable to each man. Hemoglobin and hematocrit should be checked at 3 mo and after each dose adjustment, followed by yearly intervals. Subjects whose hemoglobin level is high before treatment should be monitored more carefully. As with other patients on replacement therapy, a yearly liver function test and lipid profile should be done.