Rozprawy doktorskie na temat „Benign prostatic hyperplasia”

[Truncated abstract] This thesis examines the potential role of dietary intake in the development of two common conditions affecting the prostate gland; prostate cancer and benign prostatic hyperplasia (BPH). Diet is of interest as a potential risk factor for prostate cancer because of geographical variations in prostate cancer incidence and increased prostate cancer risks associated with migration from Asian to western countries. Some geographical variation has been suggested for BPH, but this is less certain. However, both prostate cancer and BPH have potential links with diet through their positive associations with sex hormone levels, metabolic syndrome, increased insulin levels and chronic inflammation. In addition, zinc is an essential dietary micronutrient required for semen production in the prostate gland. The original work for this thesis is presented in six manuscripts of which, four have been published in peer-reviewed journals (at the time of thesis completion). BPH investigated in this thesis is defined as surgically-treated BPH. The following hypotheses were investigated. Regarding foods, nutrients and the risk of prostate cancer and BPH: 1. Increasing intakes of fruits, vegetables and zinc are inversely associated with the risk of prostate cancer and BPH 2. Increasing intakes of total fat and calcium are positively associated with the risk of prostate cancer and BPH. 3. Dietary patterns characterised by high meat, processed meat, calcium and fat content are positively associated with the risk of prostate cancer and BPH. 4. Dietary patterns characterised by high fruit and vegetable and low meat content are inversely associated with the risk of prostate cancer and BPH. v Regarding methodological issues related to the study of diet-disease relationships: 5. Dietary patterns (overall diet) elicited from principal components analysis yield stronger diet-disease associations than when studying isolated nutrients. 6. Remotely recalled dietary intake is reliable enough to be used in studies of chronic disease with long latency periods, such as prostate cancer and BPH. Methods: Data from two studies was used to address the hypotheses above. ... Based on the literature reviewed and the original work for this thesis, the most important dietary risk factors for prostate cancer and BPH appear to be those common to western style diets, i.e. diets high in red meat, processed meat, refined grains, dairy products, and low in fruit and vegetables. This type of diet is likely to result in marginal intakes of antioxidants and fibre, excess intakes of fat and possibly, moderate intakes of carcinogens associated with processed meat and meat cooked at high temperatures. These dietary factors have been linked with biomarkers of inflammation, and they support the hypotheses that chronic inflammation is involved in the development of both prostate cancer and BPH. In addition, this work builds on evidence that zinc is an important factor in prostate health. There is scope for more investigation into the reliability of dietary patterns and the use of nutrient patterns as an alternative to focussing on single food components. Further studies on the reliability of remote dietary intake would also be useful. Because of the latency of chronic disease, it can be theorised that remote dietary recall may uncover more robust diet-disease relationships.

Transurethral resection of the prostate (TURP) has been the established surgical gold standard for the treatment of prostatic obstruction due to benign prostatic hyperplasia(BPH). Prior to TURP, the mainstay of surgical treatment was open suprapubic prostatectomy (SPP), which carried a high risk of morbidity and mortality. TURP did not go through rigorous assessment of outcomes or comparison with SPP in order to become labeled as the gold standard. TURP is still a procedure with potential significant morbidity, particular with regard to hemorrhage and surgical misadventure. In the mid to late 1990’s, there began efforts to find less morbid alternatives to TURP. Most of these early attempts fell out of favour due to clinical outcomes failing to meet both surgeon and patient expectations. In the 2000’s newer alternative treatment options such as photoselective vaporization of the prostate (PVP) and the prostatic urethral lift (PUL) have emerged and have progressively been introduced into clinical practice. Studies of these technologies form the basis of this DMedSci thesis. The use of the green wave length laser (532nm) to perform PVP is shown in a series of manuscripts to demonstrate it’s effectiveness and morbidity in treating various populations of men with lower urinary tract symptoms due to BPH. PUL is a minimally invasive treatment that has been shown in this series of manuscripts to relieve urinary symptoms rapidly and without any deleterious effect on sexual function. Readers are taken through the journey of how this technology has progressed from first-in-man studies through to entry into mainstream clinical practice.

The prostate epithelial stem cell has been proposed as the primary origin of neoplastic change in prostate cancer. However, due to a lack of specific markers, such cells have been profoundly difficult to isolate. We propose that the Hoechst 33342 dye efflux assay 'Side Population' originally developed to isolate a stem cell enriched haemopoietic stem cell population from bone marrow provides a method for identifying the cancer stem cell origin in prostatic adenocarcinoma.

Thesis (M.S.)--West Virginia University, 2000.
Title from document title page. Document formatted into pages; contains ix, 154 p. : ill. Includes abstract. Includes bibliographical references (p. 137-143).

The primary aim of this study is to assess the predictive value of six molecular markers in determining PRCa risk in patients with BPH. These molecular markers are: (A)- Two polymorphic repeats, (CAG)_n and (GGN)_n, in the androgen receptor (AR) gene; (B)- A single nucleotide polymorphism (SNP) in the (-290 A to G) 5' regulatory region of the CYP3A4 gene; (C)- Two SNPs (TaqI and FokI) in vitamin D receptor (VDR) gene; (D)- A SNP (Val655Ile) in the transmembrane domain coding region of HER2 gene. The study evaluated 28 patients who presented with PRCa at least 3 years and up to 15 years after the diagnosis of BPH and 56 matched patients with BPH who did not progress to PRCa over a comparable period. The results of this study showed that CYP3A4 variant genotype identified men with BPH who are at increased risk of developing PRCa (odds ratio 5.2, 95% CI = 1.8-14.3). Similar finding was also seen for VDR TaqI SNP, where TT genotype was associated with a significant 5 fold increase in the risk of developing PRCa in patients previously diagnosed with BPH. Tentative evidence of association between risk of developing PRCa and the variant genotype of HER2 and VDR FokI SNPs was also demonstrated, although the results were not statistically significant. The odds ratio of developing PRCa was 1.88, and 2.33 in BPH patients having HER2 Ile/Ile genotype and VDR FokI FF genotype respectively. This study also showed no evidence for association between the size of AR CAG and GGN repeats and the risk of the development of PRCa in patients with BPH. However, data of this study suggest that BPH patients with AR CAG instability have a 12 fold increase risk in development PRCa. These results provide a potential tool to assist prediction strategies for this important disease.

β-NGF was measured in human benign prostatic hyperplastic (BPH), adenocarcinomatous and normal tissues using an enzyme-linked immunosorbent assay. Concentrations were 1992pg/g wet weight in BPH tissue (SD = 684pg/g), 3100pg/g in adenocarcinomatous tissue (SD = 1503pg/g), and 2690pg/g in normal tissue. mRNA transcripts for β-NGF were demonstrated in prostate tissues by reverse transcription-polymerase chain reaction showing that the β-NGF measured in prostate tissue was endogenously produced. Western blotting allowed the demonstration that immunoreactive β-NGF in the prostate represented dimeric β-NGF and not behaviour β-NGF-like proteins which have been described elsewhere. Immunohistochemistry for β-NGF localised the hormone to the prostate epithelium in BPH, cancer and normal tissue. This epithelial localisation was confirmed by video-assisted tissue morphometric studies. Thereby it was shown that specimen β-NGF concentrations correlated well and statistically significantly with specimen prostatic glandular content. Morphometric studies also allowed the expression of β-NGF concentrations in terms of each specimen's contained, β-NGF secreting, glandular tissue. Thereby it was demonstrated that BPH glandular tissue produced greater concentrations of β-NGF (1597pg/100mg glandular tissue, SD = 788pg/100mg) than did malignant glandular tissue (1058pg/100mg glandular tissue, SD = 559pg/100mg), in spite of the higher concentrations of β-NGF found grossly in adenocarcinomatous tissue. β-NGF concentrations did not correlate with differential of adenocarcinomas or with the degree of neurodocrine differentiation therein. The thesis suggests that human prostatic β-NGF has a role similar to that described in other tissues. That is the maintenance and stimulation of adrenergic nerves. This may be relevant to the widespread use of sympatholytic drugs in the treatment of BPH.

The aim of this thesis was to synthesize multipotent drugs for the treatment of Alzheimer’s disease (AD) and for benign prostatic hyperplasia (BPH), two diseases that affect the elderly. AD is a neurodegenerative disorder that is characterized, among other factors, by loss of cholinergic neurons. Selective activation of M1 receptors through an allosteric site could restore the cholinergic hypofunction, improving the cognition in AD patients. We describe here the discovery and SAR of a novel series of quinone derivatives. Among them, 1 was the most interesting, being a high M1 selective positive allosteric modulator. At 100 nM, 1 triplicated the production of cAMP induced by oxotremorine. Moreover, it inhibited AChE and it displayed antioxidant properties. Site-directed mutagenesis experiments indicated that 1 acts at an allosteric site involving residue F77. Thus, 1 is a promising drug because the M1 activation may offer disease-modifying properties that could address and reduce most of AD hallmarks. BPH is an enlargement of the prostate caused by increased cellular growth. Blockade of α1-ARs is the predominant form of medical therapy for the treatment of the symptoms associated with BPH. α1-ARs are classified into three subtypes. The α1A- and α1D-AR subtypes are predominant in the prostate, while α1B-ARs regulate the blood pressure. Herein, we report the synthesis of quinazoline-derivatives obtained replacing the piperazine ring of doxazosin and prazosin with (S)- or (R)-3-aminopiperidine. The presence of a chiral center in the 3-C position of the piperidine ring allowed us to exploit the importance of stereochemistry in the binding at α1-ARs. It turned out that the S configuration at the 3-C position of the piperidine increases the affinity of the compounds at all three α1-AR subtypes, whereas the configuration at the benzodioxole ring of doxazosin derivatives is not critical for the interaction with α1-ARs.

The aim of this thesis was to synthesize multipotent drugs for the treatment of Alzheimer’s disease (AD) and for benign prostatic hyperplasia (BPH), two diseases that affect the elderly. AD is a neurodegenerative disorder that is characterized, among other factors, by loss of cholinergic neurons. Selective activation of M1 receptors through an allosteric site could restore the cholinergic hypofunction, improving the cognition in AD patients. We describe here the discovery and SAR of a novel series of quinone derivatives. Among them, 1 was the most interesting, being a high M1 selective positive allosteric modulator. At 100 nM, 1 triplicated the production of cAMP induced by oxotremorine. Moreover, it inhibited AChE and it displayed antioxidant properties. Site-directed mutagenesis experiments indicated that 1 acts at an allosteric site involving residue F77. Thus, 1 is a promising drug because the M1 activation may offer disease-modifying properties that could address and reduce most of AD hallmarks. BPH is an enlargement of the prostate caused by increased cellular growth. Blockade of α1-ARs is the predominant form of medical therapy for the treatment of the symptoms associated with BPH. α1-ARs are classified into three subtypes. The α1A- and α1D-AR subtypes are predominant in the prostate, while α1B-ARs regulate the blood pressure. Herein, we report the synthesis of quinazoline-derivatives obtained replacing the piperazine ring of doxazosin and prazosin with (S)- or (R)-3-aminopiperidine. The presence of a chiral center in the 3-C position of the piperidine ring allowed us to exploit the importance of stereochemistry in the binding at α1-ARs. It turned out that the S configuration at the 3-C position of the piperidine increases the affinity of the compounds at all three α1-AR subtypes, whereas the configuration at the benzodioxole ring of doxazosin derivatives is not critical for the interaction with α1-ARs.

Orientadores: Hernandes Faustino de Carvalho, Paulo Roberto Eleutério de Souza
Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Biologia
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Resumo: A próstata é alvo de afecções severas que comprometem a função urinária, a qualidade de vida e que consistem em risco de vida aos indivíduos do sexo masculino, particularmente com o avançar da idade. Interações dinâmicas entre o epitélio prostático e o estroma, regulam vários aspectos do desenvolvimento, da função e das patologias prostáticas. O gene WFDC1 é expresso pelas células musculares lisas do estroma prostático normal e tem função na regulação do comportamento do epitélio, na organização da matriz extracelular e na regulação da angiogênese. Dois transcritos principais são oriundos de splicing alternativo do transcrito primário: um com todos os éxons (WFDC1) e outro sem o éxon 3 (Delta 3). Neste trabalho, investigamos as relações quantitativas entre estas duas variantes, com emprego de qRT-PCR (Taqman) e sondas para as junções dos éxons 2-3 e 2-4, em amostras de hiperplasia prostática benigna (BPH) e de câncer de próstata (PCA) provenientes de bancos de tecidos. A expressão do gene marcador MYH11 foi utilizada como estimativa do conteúdo de células musculares lisas nas amostras. Os resultados demonstraram que as amostras puderam ser dividas em dois grupos com expressão diferencial da MYH11(um com baixa expressão e outro com alta miosina, sendo o primeiro correspondente ao quartil inferior da distribuição dos valores de expressão). Foi demonstrada correlação entre a expressão de WFDC1 e MYH11 em BPH, mas não em PCA, enquanto não houve correlação entre Delta 3 e WFDC1 e nem com MYH11. O conteúdo de Delta 3 variou em cinco ordens de magnitude em comparação ao de WFDC1. A razão entre as duas variantes apresentou variação exponencial, distribuições discretas e intercaladas das amostras de BPH e de PCA, que se distribuíram em populações que preservaram as relações 10:1; 1:1 e 1:3. Poucas amostras estiveram livres de cada uma destas variantes. Em conclusão, a expressão do gene WFDC1 e de sua variante WFDC1 correlaciona-se com a diferenciação das células musculares lisas, mas não está condicionada a ela, enquanto a expressão de Delta 3 é completamente independente deste parâmetro e tem correlação positiva com o progressão do PCA, quando o sistema de classificação de Gleason (Gleason 1 + Gleason 2) foi considerado. Adicionalmente, fatores independentes da idade, incidência de BPH ou PCA, são mais influentes na determinação da quantidade total e da proporção entre as duas variantes
Abstract: The prostate gland is intimately related with reproductive and urinary functions, commonly disturbed by a series of diseases. Besides reducing the quality of life, they consist in serious life risk particularly to the aging men. Dynamic interactions between the epithelium and stroma in the gland regulate various aspects of development, function and pathologies. The WFDC1 gene is expressed by smooth muscle cells in the prostate stroma and its product ps20 was shown to control epithelial cell behavior, extracellular matrix organization and angiogenesis. It is supposed to function as a serine protease inhibitor, as other members of its family do. Two transcripts are produced as a result of alternative splicing. The first (WFDC1) retains all exons and the second (Delta 3) lacks the exon 3. In this work, we investigated the quantitative relationship among these two splicing variants, using qRT-PCR (Taqman) probing the junctions between exons 2-3 and 2-4, in benign prostatic hyperplasia (BPH) and prostate cancer (PCA) samples from tissue banks. The expression of the MYH11 gene was used to estimate the content of smooth muscle cells in the samples. The results demonstrate that the samples could be divided in two groups with low or high expression of MYH11, the first corresponding to the lower quartile of expression values). WFDC1 and MYH11 expression were correlated in the BPH samples. Delta 3 expression was independent of both WFDC1 and from WFDC1. The ratio between the variants WFDC1 and Delta 3 varied exponentially in five orders of magnitude. The the ratio between the two variants also varied exponentially, with BPH and PCA samples arranged in discrete and intercalated subgroups. The distribution of populations with different expression levels preserved the ratios 10:1, 1:1 and 1:3. Either variant was absent in only a few samples. In conclusion, the expression of WFDC1 and it WFDC1 variant correlates with but is not conditioned to the differentiation of smooth muscle cells, while Delta 3 is completely independent and is positively correlated with PCA grade (as assessed by the summed Gleason score). Unknown factors independent of age, BPH or PCA incidence are likely influencing Delta 3 expression
Doutorado
Biologia Celular
Doutor em Biologia Celular e Estrutural

Objective: To assess in a prospective trial the influence of the amount of tissue resected at transurethral resection of the prostate (TURP) for benign prostatic enlargement on the symptom improvement as assessed by symptom scores. Methods: Between December 1996 and August 1998 a total of 138 men (mean age 68.2, range 53–89) with symptomatic benign prostatic enlargement who underwent TURP participated in this prospective study. Patients were assessed preoperatively with the International Prostate Symptom Score (IPSS), the American Urological Association Bother Score (AUA–BS) and the Benign Prostatic Hyperplasia Impact Index (BPH–II) as well as urinary flow rate measurements (Qmax) and prostate volume (PV) and residual urine determination by ultrasound. The amount of tissue resected was weighed. Patients were followed with reevaluation of Qmax, residual urine and the symptom and bother scores at 3 and 6 months. Results: A close correlation between preoperative PV (mean 49.0 ml, SD 22.0, range 13–140) and the resected tissue weight (RTW, mean 24.7 g, SD 18.0, range 6–128) was seen (r = 0.75, p<0.001). Age was correlated with preoperative PV (r = 0.23, p<0.05). While significant mean improvements in Qmax, residual volume and IPSS, AUA–BS and BPH–II were found 3 and 6 months postoperatively, a negative correlation was seen between the RTW and the IPSS, the AUA–BS and the BPH–II 3 months after TURP (r = –0.23, p<0.024; r = –0.23, p<0.025; r = –0.20, p = 0.05). No statistically significant correlation was seen between symptom change and the percentage of PV removed or the residual prostatic weight. Classification of the patients into groups depending on preoperative PV (<30, 31–50, 51–70 and >70 ml) showed a tendency for patients with larger PV to gain more symptom improvement postoperatively. Conclusions: Early symptom improvement after TURP will depend on the amount of tissue removed but the relationship is weak and affected by several other confounding factors. Apparently, the symptomatic improvement after TURP is not primarily dependent on the relative completeness of the resection. Patients with larger prostates and larger RTW tend to gain more symptomatic benefit from TURP than do patients with smaller prostates
Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich

Background: To compare the clinical value of the measurement of complex and total PSA in the discrimination between benign prostatic hyperplasia (BPH) and prostate cancer. Methods: In serum samples collected from 166 men with histopathologically proven clinically localized prostate cancer and of 97 men with BPH, total prostate-specific antigen (PSA), complexed PSA and the free to total PSA ratio were determined. The statistical analysis was done by the comparison of the receiver operator characteristic (ROC) curves. Results: The areas under the ROC curves were 0.776 for total PSA, 0.799 for complexed PSA (total PSA vs. cPSA: p < 0.0001) and 0.812 for the free to total PSA ratio. With a cut-off of 3.0 ng/ml for complexed PSA, the sensitivity was 90%, the specificity 58%, the positive and the negative predictive values 79 and 78%, respectively. With a cut-off of 4.0 ng/ml for total PSA, the sensitivity was 87%, the specificity 59%, the positive and the negative predictive values were 78 and 72%, respectively. Conclusions: There was a statistically significant advantage for complexed PSA compared to total PSA in the discrimination between BPH and prostate cancer. The difference was, however, small and its clinical relevance is questionable
Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich

ABSTRACT Prostasin is expressed in normal prostate epithelial cells but down-regulated in prostate cancers, while prostasin re-expression in invasive prostate cancer cells reduced invasion. We examined prostasin expression and function in benign prostatic hyperplasia (BPH). We evaluated prostasin expression in 12 BPH specimens by immunohistochemistry, and evaluated the impact of prostasin silencing by siRNA on the expression of the inducible nitric oxide synthase (iNOS), intercellular adhesion molecule-1 (ICAM-1), and cyclin D1, as well as on cell proliferation and invasion, using the BPH-1 human prostate epithelial cell line model. Prostasin expression was localized in the glands of BPH tissues by immunohistochemistry, in either the tall columnar-shaped or the flattened epithelial cells. We silenced prostasin expression by >50% at both the mRNA and protein levels using siRNA in the BPH-1 human prostate epithelial cell line, and this silencing of prostasin expression was associated with an induction of iNOS and ICAM-1 expression and a down-regulation of cyclin D1 expression. The protein expression of EGFR, a putative prostasin substrate, was not affected by prostasin silencing in this cell line. The prostasin-silenced cells displayed a reduced cell proliferation rate and reduced invasiveness, cell behaviors regulated by cyclin D1, iNOS, and ICAM-1 in the BPH-1 cells. We believe that this down-regulation of cyclin D1 is due to prostasin's augmentative effect on iNOS. We also believe that the decrease in cell motility is due to an increase in iNOS and ICAM-1 as well as a decrease in cyclin D1, since all of these molecules can play a role in cell motility. In conclusion, Prostasin is somehow involved in the regulation of inflammatory gene expression (iNOS and ICAM-1) in prostate epithelial cells, as well as cyclin D1 expression, cell proliferation and invasion, involving molecular mechanisms different than those in the prostate cancer cells. These studies suggest that prostasin is a player in the glandular components of benign prostatic hyperplasia.
M.S.
Department of Molecular Biology and Microbiology
Burnett College of Biomedical Sciences
Molecular and Microbiology MS

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Câncer é um conjunto de alterações celulares, que leva a uma divisão celular sem controle, podendo invadir tecidos adjacentes através da circulação sanguínea e do sistema linfático. O Câncer de Próstata (CP) é o segundo tumor mais comum entre a população masculina, e é considerado o câncer da terceira idade. A carcinogênese é um mecanismo complexo no qual ocorre mudanças na expressão de proteínas e glicoconjugados. Glicosilação é mediada por glicosiltransferases, enzimas que tem função de inserir resíduos de carboidratos específicos, e é um dos mais importantes processos biológicos pós-tradução de modificações na estrutura final e função de lipídios e proteínas. As fucosiltransferases (FUT) participam da transferência de resíduos de L-fucose, um sacarídeo associado ao câncer e a processos inflamatórios, da GDP-L-fucose. Neste estudo objetivou-se avaliar a expressão dos genes FUT3 e FUT6 através da Imunohistoquímica em Adenocarcinoma Prostático e Hiperplasia Prostática Benigna correlacionando com o padrão de expressão de L-fucose empregando a histoquímica com as lectinas UEA-I (Ulex europaeus) e LTA (Lotus tetragonolobus). As enzimas FUT3 e FUT6 apresentaram-se com uma alta expressão tanto no Adenocarcinoma Prostático como na Hiperplasia Benigna Prostática, principalmente a FUT 6. Os resultados da histoquímica com lectinas mostraram uma baixa distribuição/accessibilidade de L-fucose. Sugere-se que, as enzimas FUT3 e FUT6 possam representar potenciais biomarcadores para avaliar alterações benignas e malignas prostáticas refletindo uma variação no perfil de L-fucose nestes tumores que podem estar associados às suas características biológicas.
Cancer is a set of cellular changes, leading to uncontrolled cell division that may invade surrounding tissues via bloodstream and lymphatic system. Prostate Cancer (PC) is the second most common tumor in men and is considered the cancer of the elderly. Carcinogenesis is a complex mechanism in which changes occur in the expression of proteins and glycoconjugates where glycosylation plays key roles since modulates the carbohydrate moieties in glycoconjugates being one of the most important biological processes of posttranslational modifications in the final structure and function of lipids and proteins. Fucosyltransferases (FUTs) are enzymes that catalyze the transfer of the L-fucose residues, a saccharide which has been linked to cancer and inflammation features, from GDP-Fuc. This study the objective to evaluate the expression of genes FUT 3 and FUT 6 by immunohistochemistry in Prostatic Adenocarcinoma and Benign Prostatic Hyperplasia and to correlates with the expression pattern of L-fucose using lectin histochemistry with UEA-I (Ulex europaeus) and LTA (Lotus tetragonolobus). FUT3 and FUT6 showed a high expression in both prostatic tissues, especially FUT6. The results of lectin histochemistry showed a low distribution/accessibility of L-fucose residues. It is suggested that FUT3 and FUT6 may represent potential biomarkers to evaluate benign and malignant alterations in prostate reflecting a variation in the profile of L-fucose residues in these tumors which can be associated to their biological features.

Objective: To assess in a prospective trial the influence of the amount of tissue resected at transurethral resection of the prostate (TURP) for benign prostatic enlargement on the symptom improvement as assessed by symptom scores. Methods: Between December 1996 and August 1998 a total of 138 men (mean age 68.2, range 53–89) with symptomatic benign prostatic enlargement who underwent TURP participated in this prospective study. Patients were assessed preoperatively with the International Prostate Symptom Score (IPSS), the American Urological Association Bother Score (AUA–BS) and the Benign Prostatic Hyperplasia Impact Index (BPH–II) as well as urinary flow rate measurements (Qmax) and prostate volume (PV) and residual urine determination by ultrasound. The amount of tissue resected was weighed. Patients were followed with reevaluation of Qmax, residual urine and the symptom and bother scores at 3 and 6 months. Results: A close correlation between preoperative PV (mean 49.0 ml, SD 22.0, range 13–140) and the resected tissue weight (RTW, mean 24.7 g, SD 18.0, range 6–128) was seen (r = 0.75, p<0.001). Age was correlated with preoperative PV (r = 0.23, p<0.05). While significant mean improvements in Qmax, residual volume and IPSS, AUA–BS and BPH–II were found 3 and 6 months postoperatively, a negative correlation was seen between the RTW and the IPSS, the AUA–BS and the BPH–II 3 months after TURP (r = –0.23, p<0.024; r = –0.23, p<0.025; r = –0.20, p = 0.05). No statistically significant correlation was seen between symptom change and the percentage of PV removed or the residual prostatic weight. Classification of the patients into groups depending on preoperative PV (<30, 31–50, 51–70 and >70 ml) showed a tendency for patients with larger PV to gain more symptom improvement postoperatively. Conclusions: Early symptom improvement after TURP will depend on the amount of tissue removed but the relationship is weak and affected by several other confounding factors. Apparently, the symptomatic improvement after TURP is not primarily dependent on the relative completeness of the resection. Patients with larger prostates and larger RTW tend to gain more symptomatic benefit from TURP than do patients with smaller prostates.
Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Background: To compare the clinical value of the measurement of complex and total PSA in the discrimination between benign prostatic hyperplasia (BPH) and prostate cancer. Methods: In serum samples collected from 166 men with histopathologically proven clinically localized prostate cancer and of 97 men with BPH, total prostate-specific antigen (PSA), complexed PSA and the free to total PSA ratio were determined. The statistical analysis was done by the comparison of the receiver operator characteristic (ROC) curves. Results: The areas under the ROC curves were 0.776 for total PSA, 0.799 for complexed PSA (total PSA vs. cPSA: p < 0.0001) and 0.812 for the free to total PSA ratio. With a cut-off of 3.0 ng/ml for complexed PSA, the sensitivity was 90%, the specificity 58%, the positive and the negative predictive values 79 and 78%, respectively. With a cut-off of 4.0 ng/ml for total PSA, the sensitivity was 87%, the specificity 59%, the positive and the negative predictive values were 78 and 72%, respectively. Conclusions: There was a statistically significant advantage for complexed PSA compared to total PSA in the discrimination between BPH and prostate cancer. The difference was, however, small and its clinical relevance is questionable.
Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

The feasibility of Fourier transform infrared (FTIR)-imaging spectroscopy as a tool to discriminate samples from patients suffering from benign prostatic hyperplasia (BPH) and prostate cancer (CaP) samples in blood serum was investigated. Prostate cancer is known to be an age related disease, with the risk of developing the disease dramatically increasing in men past forty years old. Currently the PSA blood test is notoriously unreliable and is non specific for CaP thus leading to overtreatment of the disease. It is important therefore to develop diagnostic method that is non-invasive, reliable, and specific for CaP.In order to achieve the objective of establishing a robust protocol, which could be applied to a clinical study, obtaining optimal sample preparation for the FTIR analysis of serum smears, had to be achieved. A protocol was developed to prepare the serum samples prior to their FTIR analysis. First, the samples were centrifuged with ultrafiltration devices of different sizes to obtain several fractions which were then smeared to obtain thin films of serum. The spectra from the larger (>100 kDa components) and medium (containing the 10–100 kDa components) fractions were utilised for both a pilot and a clinical study, while the spectra from the smaller fractions (containing the 3–10 and <3 kDa components) were affected by fringing and could therefore not be used. A major novelty of this project involved the application of FTIR-imaging to the analysis of serum smears. The use of the Focal Plane Array detector system enabled the collection of a spectral image containing 16,384 spectra, on which a Quality Testing and pre-processing techniques were applied to select the “good spectra” and reject the spectra that failed the Quality Test. Several types of substrates were assessed to determine the most appropriate for the analysis of the smears and it was established that the spectra obtained from the serum smeared on CaF2 windows gave the most reproducible results. 5 BPH and 5 CaP samples were analysed for the pilot study following the developed protocol. While no clear separation was observed in the Principal Component Analysis (PCA) plots between the BPH and the cancerous samples, a trend emerged throughout the results, with the CaP samples clustering together and the BPH samples scattered around them. A larger clinical study was conducted with 60 BPH samples and 60 CaP samples. PCA was applied on the “good spectra” and while the over 100 kDa fraction did not show a clear separation between the two types of samples, the 10–100 kDa fraction showed a distinct classification between the BPH and CaP samples. An artificial neural network was then applied to create a model using patients from the database used for the PCA analysis to determine whether the discrimination between the two types of samples could be increased or highlight different classification trends. For the >100 kDa fraction, the sensitivity value was calculated to be 97.8% and the specificity value was calculated to be 44.3% while the sensitivity and the specificity value for the 10 to 100 kDa fraction were calculated to be 78.9% and 60% respectively. A complementary study using mass spectrometry was carried out on healthy and diseased samples to identify the components contained within the different fractions and determine whether they could be correlated with the components identified from the spectral features of the FTIR data. While no quantitative information was obtained from this study, the components found in the different fractions were identified, confirming the results of the FTIR studies.

5α-reductases (5αRs) catalyse reduction of 4-pregnene steroids, most notably the androgen testosterone to its more potent metabolite dihydrotestosterone (DHT). Well-characterised isozymes of 5αR are designated 5αR1 and 5αR2. Inhibitors of 5αR, finasteride (a 5αR2 inhibitor) and dutasteride (a dual 5αR1 and 5αR2 inhibitor), are utilised in conditions where a reduction in androgen action is desired, including benign prostatic hyperplasia. Although 5αR2 is predominantly expressed in reproductive tissues, both isozymes, but particularly 5αR1, are expressed in metabolic tissues including liver and adipose and both metabolise glucocorticoids as well as androgens; therefore inhibition of 5αR may have consequences for metabolic health. This thesis addresses the hypotheses that 5αR1 inhibition with dutasteride decreases insulin sensitivity and causes dysregulation of the HPA axis in humans. Metabolism and the HPA axis were studied in men prior to and following 3 months of dutasteride (0.5 mg daily; n=16), finasteride (5 mg daily; n=16) or control (tamsulosin MR; 0.4 mg daily; n=14). Glucose disposal during hyperinsulinaemia was the primary endpoint, measured during a hyperinsulinaemic euglycaemic clamp, with d2-glucose and d5-glycerol tracers. Peripheral insulin sensitivity for both glucose uptake and NEFA suppression decreased with dutasteride versus both finasteride and control, while hepatic insulin sensitivity was preserved. Body fat increased with dutasteride, though was not accompanied by changes in metabolic or inflammatory gene transcript abundance in subcutaneous adipose biopsies, nor any differences in abdominal adipose depots on post-treatment MRI. Subtle dysregulation of the HPA axis was evident with both 5αR inhibitors, though to a greater degree with dutasteride and changes were largely compensated for. In support of this study, this thesis also describes the development, validation and application of two novel liquid chromatography tandem mass spectrometry assays; establishing compliance by measuring serum drug levels, and demonstrating effects of 5αR inhibitors on androgen metabolism and adrenal steroidogenesis by measurement of testosterone, DHT and androstenedione. In conclusion, 5αR1 inhibition with dutasteride, but not finasteride, induces peripheral insulin resistance and increases body fat. Findings presented may have important implications for patients prescribed dutasteride for benign prostatic hyperplasia.

Thesis (Ph. D.)--West Virginia University, 1999.
Title from document title page. Document formatted into pages; contains vi, 125 p. : ill. Vita. Includes abstract. Includes bibliographical references (p. 107-122).

Benign prostatahyperplasi (BPH) är ett tillstånd som drabbar nästintill samtliga män över 80 år och vilket medför urologiska besvär som kan ha inverkan på livs¬kvaliteten och det dagliga livet. Syftet med denna litteraturstudie var att redogöra för hur män med benign prostatahyperplasi upplever sitt dagliga liv samt hur deras livskvalitet påverkas. En litteraturstudie gjordes utifrån ett systematiskt tillväga¬gångssätt. Litteratursökningen utfördes i databaserna Cinahl, PsycInfo, PubMed samt The Cochrane Library. Både kvantitativa och kvalitativa studier inkluderades vilka kvalitetsgranskades av båda författarna oberoende av varandra med hjälp av ett modifierat granskningsprotokoll. Resultatet visar på att män med BPH har en störd sömn på grund av nykturi, begränsar sitt sociala liv och upplever genans över de urologiska symtomen och en negativ påverkan på det sexuella samlivet. Män med BPH tycks också utveckla copingstrategier för att bemästra sin vardag som att t ex reducera vätskeintaget, prata om besvären och acceptera tillståndet. Det verkar också vara vanligt förekommande att livskvaliteten hos män med BPH är sämre än hos män utan BPH. Fler studier med både kvalitativ och kvantitativ metodansats behövs för att finna en djupare förståelse för män med BPH och för att stärka evidensen avseende livskvalitet och dagligt liv.
Benign prostatic hyperplasia (BPH) is a condition which causes urology bother that might have an impact on quality of life and daily living in almost all men over the age 80. The aim of this study was to report on how men with benign prostatic hyperplasia experiencing their daily lives and how their quality of life is affected. A systematic review was made in accordance to a systematic procedure. The literature searching was made in the databases CINAHL, PsycInfo, PubMed and The Cochrane Library. Both quantitative and qualitative studies were included and the quality was assessed by both authors independently of each other using a modified audit protocol. The results show that men with BPH have disturbed sleep due to nocturia, limiting their social lives and experiencing embarrassment over the urological symptoms and a negative impact on the sexual life. Men with BPH also seems to develop coping strategies to overcome their daily lives such as reducing fluid intake, talk about the complaint and accept the condition. It also seems that it is more common for men with BPH to rank their quality of life lower than men without BPH. More studies using both qualitative and quantitative approach are needed to find a deeper understanding of men with BPH and to strengthen evidences about quality of life and daily life.

Bakgrund   Icke-maligna prostataförändringar är ett utbrett samhällsproblem och en vanlig anledning till att människor söker sjukvård. Prostatit och benign prostatahyperplasi är två icke-maligna förändringar som kan te sig på olika sätt och kan orsaka lidande hos de drabbade, ofta genom ”lower urinary tract symptoms” och smärta som är vanliga symtom. Att lindra lidande är vårdens uppgift och en sjuksköterskas ansvar.     Syfte Syftet med denna litteraturöversikt var att belysa hur det är att leva med en icke-malign prostataförändring.    Metod  Metoden som användes var icke-systematisk litteraturöversikt där 18 artiklar analyserades.    Resultat Resultatet efter att ha analyserat de inkluderad studierna visade att icke-maligna prostataförändringar kan ha inverkan på samliv och relationer, ge upphov till känslor av skam, rädsla och oro, att det finns faktorer som kan vara mer eller mindre gynnsamma vid dessa tillstånd samt att det finns rum för förbättring vid mötet med sjukvården.   Slutsats Resultatet i denna litteraturöversikt visar på att leva med icke-maligna prostataförändringar och symtomen de ger upphov till kan ha en tydlig inverkan på drabbade personers liv och livskvalitet i ett flertal aspekter
Background Non-malignant prostatic conditions are a prevalent problem in society and a common reason as to why people seek medical care. Prostatitis and benign prostatic hyperplasia are two examples of non-malignant conditions that can appear in different ways and that could cause the afflicted person suffering, oftentimes through symptoms like pain and lower urinary tract symptoms. Alleviating suffering is an undertaking of health-care professionals’ and a nurse’s responsibility.     Aim The aim of this literature review was to illuminate what it is like to live with a non-malignant prostatic condition.    Method Non-systematic literature review where 18 articles were analyzed.     Results The results of the included and analyzed studies show that non-malignant prostatic conditions can influence intimate relationships, cause feelings of shame, fear and worry, that there are factors that can be more or less favourable in relation to these conditions and that there is room for improvement in the meeting with healthcare professionals.    Conclusions The results in this non-systematic literature review show that living with non-malignant prostatic conditions, and the symptoms they cause, can have a significant influence on the affected persons’ lives and quality of life in several aspects.

A hiperplasia prostática benigna (HPB) e o câncer de próstata (CaP) são duas condições crônicas muito comuns em homens com idade avançada e têm sido relacionadas a processos inflamatórios. As quimiocinas são reconhecidas como mediadores críticos da resposta inflamatória por regular a migração das células imunológicas através da ativação de receptores de quimiocinas na superfície destas células. As quimiocinas estão relacionadas à patogênese tumoral, embora não seja claro de que modo afetam a progressão tumoral humana. O objetivo desse estudo foi investigar a associação de dois polimorfismos de receptores de quimiocinas, CCR2-64I e CCR5-delta32, com HPB e CaP. Neste trabalho foram genotipadas 385 amostras de DNA genômico de homens do sul do Brasil, predominantemente euro-descendentes, incluindo 130 casos de HPB, 136 casos de CaP e 119 indivíduos controle saudáveis. Para o polimorfismo CCR2-64I a genotipagem foi realizada por PCR-RFLP e para o CCR5-delta32 foi por PCR convencional. As frequências alélicas do CCR2-64I foram 14,0%; 15,8% e 11,1% nos grupos controle, HPB e CaP, respectivamente; enquanto as do CCR5-delta32 foram 5,1%; 7,1% e 6,2%, respectivamente. A mediana referente aos níveis de PSA foi de 0,79; 1,45 e 6,91 ng/mL nos grupos controle, HPB e CaP, respectivamente; diferindo significativamente entre estes (todos p<0,001). A mediana do volume da próstata foi 20,00 cm3 no grupo controle, portanto, menor que dos grupos HPB (35,35 cm3) e CaP (35,80 cm3) (ambos p<0,001); no entanto, não foi observada diferença entre pacientes com HPB e CaP (p=0,172). Algo interessante observado foi CCR2-64I como um fator protetor para CaP quando comparado com HPB (OR=0,550; IC95%=0,311–0,975), mas não quando comparado com o grupo controle (p=0,448). Não foi observada associação do CCR2-64I com os estados clinicopatológicos do CaP (estadiamento tumoral e escore de Gleason) (todos p≥0,308). Não foi observada associação significativa da variante CCR5-delta32 com HPB ou CaP (todos p≥0,072), ou com os estados clinicopatológicos do CaP (todos p≥0,253). Assim, nossos dados sugerem a influência da variante CCR2-64I, observada como fator protetor para CaP quando comparada com HPB, no desenvolvimento do câncer de próstata.
Benign prostatic hyperplasia (BPH) and prostate cancer (PCa) are two chronic conditions very common in aged men and have been related to inflammatory process. Chemokines are recognized as critical mediators of inflammatory responses by regulating the migration of immune cells through the activation of chemokine receptors on the surface of these cells. Chemokines are implicated in tumor pathogenesis, although it is not clear how it affects human tumor progression. The aim of this study was to investigate the association of two chemokine receptor gene polymorphisms, CCR2-64I and CCR5-delta32, with BPH and PCa. In this study were genotyped 385 genomic DNA samples from southernmost Brazilian men, predominantly euro-descendants, including 130 BPH, 136 PCa and 119 healthy control subjects. To CCR2-64I polymorphism the genotyping was performed by PCR-RFLP and to CCR5-delta32 by conventional PCR. The allele frequencies of CCR2-64I were 14.0%, 15.8% and 11.1% in control, BPH and PCa, respectively; while of CCR5-delta32 were 5.1%, 7.1% and 6.2%, respectively. Median of serum PSA levels were 0.79, 1.45 and 6.91 ng/mL in control, BPH and PCa group, respectively (all p<0.001). The prostate volume median was 20.00 cm3 in the control group, thus, lower than BPH (35.35 cm3) and PCa (35.80 cm3) group (both p<0.001), nevertheless no difference was observed between BPH and PCa patients (p=0.172). Interestingly, CCR2-64I was detected as a protective factor to PCa when compared with BPH (OR=0.550; 95%CI=0.311–0.975), but not when compared with control group (p=0.448). No significant associations of the CCR2-64I were observed with PCa clinicopathologic states (tumor stage and Gleason score) (all p≥0.308). No significant associations of the CCR5-delta32 variant were observed with BPH or PCa (all p≥0.072), or with PCa clinicopathologic status (all p≥0.253). Thus, our data suggest a influence of the CCR2-64I variant, that was observed as a protective factor in PCa when compared with BPH, in prostate cancer development.

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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
A hiperplasia prostática benigna (HPB) tem início no animal com um a dois anos de idade, sendo que 80% dos cães com cinco anos apresentam evidências histológicas de sua presença. A fisiopatologia da doença não está totalmente compreendida, no entanto, a diidrotestosterona é o principal hormônio envolvido. Recentemente, o efeito da toxina botulínica A (TB-A) foi investigado na próstata, mostrando que esta induz atrofia do parênquima e redução do volume. Como o cão é o único animal doméstico que apresenta esta alteração, este se apresenta como modelo experimental para novos estudos da HPB humana. Com base nisso, este estudo objetivou fornecer informações acerca dos efeitos da TB-A sobre a próstata, libido e qualidade do sêmen, comparando os dados com animais orquiectomizados. Para tanto, 18 cães adultos, com evidências ultra-sonográficas de HPB foram submetidos à castração ou administração de 250 ou 500 U de TB-A, e avaliados durante 16 semanas. A orquiectomia mostrou-se um excelente tratamento para a HPB, promovendo redução de 80% do volume prostático. Aplicação da TB-A não ocasionou alterações significativas na libido, ereção ou qualidade e características seminais. Efeitos locais e sistêmicos também não foram observados. Administração de 250 U da TB-A promoveu redução máxima de 9,4% do volume prostático, entretanto, tal redução não foi significativa. Por outro lado, a administração de 500 U de TB-A reduziu significamente as variáveis comprimento, altura e volume da próstata. Desta forma, o presente ensaio contribui de forma singular e inovadora para o conhecimento dos efeitos desta nova modalidade de tratamento na HPB canina.
Benign prostatic hyperplasia (BPH) starts the development in animals aging about 1 – 2 years. 80% of 5 years-old dogs have histologic evidences of BPH. Despite the little knowledge concerning about this disease, dihydrotestosterone is the main involved hormone. Recently, the effect of botulinum toxin A (BT-A) on rat and human prostate was investigated, and prostatic parenchyma atrophy and decrease in glandular volume were observed. The dog is one of a few animals that can develop BPH spontaneously and is frequently used as an animal model for human prostatic hyperplasia. Based on that, this study aimed to provide information on BT-A effects on prostate, libido and semen quality, in comparison to orchiectomized dogs. For that, 18 adults dogs, with Ultrasonographic evidences of BPH were submitted to orchiectomy or administration of 250 or 500 U of BT-A, and evaluated along 16 weeks. Orchiectomy presented excellent results on BPH, reducing the prostate volume up to 80%. Administration of BT-A did not significantly interfered on libido, erection or semen characteristics. Local and systemic effects also were not observed. Administration of 250 U of BT-A has promoved a maximum decrease of 9,4% on prostatic volume. However, this reduction was not statistically significant. On the other hand, 500 U of BTA administration has shown to significantly reduce the length, height and volume of prostate. This way, the present study is an innovative and singular contribution for the knowledge of the effects of BT-A on canine prostate.

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Universidade Federal Fluminense. Centro de Ciências Médicas. Instituto Biomédico. Departamento de Morfologia. Anatomia Humana
A uretra masculina humana possui uma macro estrutura uniforme. Apesar disso apresenta evidências clínicas, morfológicas e moleculares ao longo de seus segmentos, que indicam haver diferenças estruturais e patológicas entre os mesmos. A maioria das alterações da uretra prostática (UP), em homens acima dos 50 anos, são consideradas como sendo secundárias à compressão devido ao crescimento de nódulos fibromatosos hiperplásicos do tecido prostático. Os sinais obstrutivos consequentes a Hiperplasia Prostática Benigna (HPB) incluem hesitação para iniciar a micção, redução da força e calibre do jato urinário, bem como, tardiamente, retenção urinária. Para tentar explicar as alterações que ocorreram na estrutura histológica da UP, no processo da HPB, estudamos as variações qualitativas e quantitativas que ocorreram na densidade volumétrica (Vv) do componente fibroso da matriz extracelular (MEC) e do músculo liso da UP de pacientes com HPB submetidos a tratamento cirúrgico. Foram estudadas amostras obtidas da UP de 10 pacientes com HPB sintomática, submetidos à prostatectomia aberta. Os pacientes não tinham história de tratamento prévio, para HPB. A idade dos pacientes selecionados para o presente estudo variou entre 63 a 79 anos. Para fins de comparação, foram usadas amostras controle obtidas durante a necropsia de 10 indivíduos adultos jovens com idades variando de 18 a 25 anos, vítimas de morte violenta sem comprometimento do sistema urogenital e/ou manipulação uretral. Todas as Próstatas do grupo controle apresentavam peso entre 20-25g, sendo consideradas adultas e dentro dos limites da normalidade. As amostras foram fixadas em solução de formol 10% e processadas para inclusão em parafina. Para análise da Vv, foram usadas as técnicas de coloração de tricrômico de Masson e, de Weigert. Também foram submetidas a análise imunohistoquímica. A Vv do componente fibroso da MEC e do músculo liso foi determinada pela análise de 25 campos aleatórios de cada fragmento de UP usando um sistema teste M-42. Os dados quantitativos foram analisados por meio do teste de Kolmogorov-Smirnov e Mann-Whitney. A Vv (%médio±SD) nos grupos controle e HPB foram respectivamente: 20,3±0,3 e 17,12±1,1 para as fibras do sistema elástico (p <0,007); 29,7 ± 1,9 e 25,1 ± 2,4 para colágeno (p <0,03). A Vv do músculo liso apresentou aumento, não significativo, no grupo HPB, 49,9 ± 0,4 e 52,3 ± 2,3. Por outro lado, 21,9±1,5 e 29,1±1,2 para a fibronectina (P < 0. 0001).
The human male urethra has a uniform structure. Despite this, presents morphological, molecular and clinical evidence throughout their segments that indicates pathological and structural differences between them. Most of changes in prostatic urethra (PU) in men over 50 years, are considered to be secondary to compression due to the growth of fibrous hyperplastic prostate tissue nodules. The signs of obstructive Benign Prostatic Hyperplasia (BPH) reflect the decreased distendibility of the prostatic urethra; that includes hesitation to begin urination, reduced force and caliber of the urinary stream, as well as (late) retention. To explain the histological, structural changes that occurred in the prostatic urethra, studies were made to analyse the changes in quality and quantity that occurred in the volumetric density of the fibrous component of the extracellular matrix (ECM) and smooth muscle of the urethra of patients with BPH submitted to surgical treatment. Samples were obtained from the urethra of 10 patients with symptomatic BPH who had undergone open prostatectomy. No patient had a history of previous treatment for BPH. The age ranged from 63-79 years. To compare we used control samples obtained during autopsy of 10 young adults subjects aged 18-25 that died from violent death without involvement of the urogenital system or uretral manipulation. The samples were fixed in formalin 10% and processed for paraffin embedding. For analysis of Vv, were used staining techniques tricomic Masson and Weigert. Were also submitted to immunohistochemical analysis. The Vv fibrous component of MEC and smooth muscle was determined by the analysis of 25 random fields of each fragment of a test system using M-42. Quantitative data were analyzed using the olmogorov-Smirnov and Mann-Whitney test. The Vv (mean ± SD) in the control and BPH groups respectively were: 20.3±0.3 and 17.12±1.1 in the elastic fiber system (p<0.007); and 29.7±1.9 and 25.1±2.4 in the collagen compartment (p<0.03). Smooth muscle cell volume was increased in BPH cases, 49.9±0.4 and 52.3±2.3 (not statistically significant). On other hand was 21.9±1.5 and 29.1±1.2 in the fibronectin (P < 0. 0001).

Orientador: Wilter Ricardo Russiano Vicente
Banca: Maria Denise Lopes
Banca: Maria Isabel de Mello Martins
Resumo: A hiperplasia prostática benigna (HPB) tem início no animal com um a dois anos de idade, sendo que 80% dos cães com cinco anos apresentam evidências histológicas de sua presença. A fisiopatologia da doença não está totalmente compreendida, no entanto, a diidrotestosterona é o principal hormônio envolvido. Recentemente, o efeito da toxina botulínica A (TB-A) foi investigado na próstata, mostrando que esta induz atrofia do parênquima e redução do volume. Como o cão é o único animal doméstico que apresenta esta alteração, este se apresenta como modelo experimental para novos estudos da HPB humana. Com base nisso, este estudo objetivou fornecer informações acerca dos efeitos da TB-A sobre a próstata, libido e qualidade do sêmen, comparando os dados com animais orquiectomizados. Para tanto, 18 cães adultos, com evidências ultra-sonográficas de HPB foram submetidos à castração ou administração de 250 ou 500 U de TB-A, e avaliados durante 16 semanas. A orquiectomia mostrou-se um excelente tratamento para a HPB, promovendo redução de 80% do volume prostático. Aplicação da TB-A não ocasionou alterações significativas na libido, ereção ou qualidade e características seminais. Efeitos locais e sistêmicos também não foram observados. Administração de 250 U da TB-A promoveu redução máxima de 9,4% do volume prostático, entretanto, tal redução não foi significativa. Por outro lado, a administração de 500 U de TB-A reduziu significamente as variáveis comprimento, altura e volume da próstata. Desta forma, o presente ensaio contribui de forma singular e inovadora para o conhecimento dos efeitos desta nova modalidade de tratamento na HPB canina.
Abstract: Benign prostatic hyperplasia (BPH) starts the development in animals aging about 1 - 2 years. 80% of 5 years-old dogs have histologic evidences of BPH. Despite the little knowledge concerning about this disease, dihydrotestosterone is the main involved hormone. Recently, the effect of botulinum toxin A (BT-A) on rat and human prostate was investigated, and prostatic parenchyma atrophy and decrease in glandular volume were observed. The dog is one of a few animals that can develop BPH spontaneously and is frequently used as an animal model for human prostatic hyperplasia. Based on that, this study aimed to provide information on BT-A effects on prostate, libido and semen quality, in comparison to orchiectomized dogs. For that, 18 adults dogs, with Ultrasonographic evidences of BPH were submitted to orchiectomy or administration of 250 or 500 U of BT-A, and evaluated along 16 weeks. Orchiectomy presented excellent results on BPH, reducing the prostate volume up to 80%. Administration of BT-A did not significantly interfered on libido, erection or semen characteristics. Local and systemic effects also were not observed. Administration of 250 U of BT-A has promoved a maximum decrease of 9,4% on prostatic volume. However, this reduction was not statistically significant. On the other hand, 500 U of BTA administration has shown to significantly reduce the length, height and volume of prostate. This way, the present study is an innovative and singular contribution for the knowledge of the effects of BT-A on canine prostate.
Mestre

Doctor of Philosophy
Department of Human Nutrition
Brian L. Lindshield
The growth-inhibitory effect of saw palmetto supplements (SPS) with high long-chain fatty acids (FA)-low phytosterols (HLLP), high long-chain FA-high phytosterols (HLHP), and high medium-chain FA-low phytosterols (HMLP) was determined using androgen-sensitive LNCaP prostate cancer (PCa) cells and Syrian hamster flank organs. In vitro, all three SPS at high concentrations significantly decreased dihydrotestosterone-stimulated LNCaP cell number. HMLP and HLLP at high concentrations significantly decreased, but HLHP which significantly increased testosterone-stimulated LNCaP cell number. In Syrian hamsters, all three SPS treatments caused notable, but nonsignificant reduction in the difference between the left and right flank organ growth in the testosterone-, but not dihydrotestosterone-treated SPS groups. Results suggest SPS might be a mild 5-alpha-reductase (5-alpha-R) inhibitor. The pharmaceuticals finasteride inhibits 5-alpha-R2, and dutasteride inhibits 5-alpha-R1 and 5-alpha-R2 isoenzymes. Because finasteride inhibits only 5-alpha-R2, we hypothesized that it would not be as efficacious in preventing PCa development and/or progression in TRAMP mice as dutasteride. Six-week-old C57BL/6 TRAMP x FVB male mice were randomized to control, pre- and post- finasteride and dutasteride diet groups that began at 6 and 12 weeks of age, respectively, and terminated at 20 weeks of age. Pre and post groups received drugs before and after mice were expected to develop PCa, respectively. Post-Dutasteride treatment was significantly more effective than Pre-Dutasteride; and dutasteride treatments significantly more effective than finasteride treatments in decreasing prostatic intraepithelial neoplasia progression and PCa development. The finasteride groups and the Pre-Dutasteride group had significantly increased incidence of poorly differentiated PCa versus control. Androgen receptor and Ki-67 protein, DNA fragmentation from apoptosis, 5-alpha-R1 and 5-alpha-R2 mRNA levels were determined in mice with genitourinary weight less than 1 gram and greater than 1 gram to elucidate the discordant response in Pre-Dutasteride and finasteride groups, and Post-Dutasteride’s efficacy. Results suggest the difference in genitourinary weights is influenced more by proliferation, rather than androgen receptor and apoptosis in tumor. Mice age may not be significantly important in regulating proliferation, androgen receptor and apoptosis to promote tumor growth. In conclusion, the results with 5-alpha-reductase inhibitors may support the therapeutic use of dutasteride, but not finasteride, or saw palmetto supplements.

INTRODUCTION Benign prostatic hyperplasia (BPH) is the most common pathological condition of aged men which significantly impairs the quality of life status. Though pharmacotherapy with adrenoblockers and 5-alpha reductase inhibitors markedly decreased the rate of surgical interventions, BPH surgery still constitutes the main workload (around ¼ of total) of urologists in the department. The results of the observational study performed by Barry et al. show that the probability of surgical treatment of BPH during the period of 4 years for subjects with mild symptoms equals to 10%, and in case of moderate and severe symptoms - 24% and 39%, respectively. According to the data of large multicenter study performed with 7,588 men in Asia and Australia, moderate and severe symptoms are present in 29%, 40%, and 56% of men in their fifth, sixth, and seventh decade of life, respectively. Symptoms are the main driving force of BPH treatment, but their correlation with residual urine, objective findings of uroflowmetry and invasive urodynamics is only poor. The association of various parameters with the outcomes of surgical treatment is complicated and still not completely investigated. Therefore finding parameters that predict the outcome of surgical BPH treatment is important. According to the literature, unfavorable outcomes of transurethral resection are present in around 15-30% of men with symptomatic BPH. This is mostly associated with inadequate preoperative evaluation, not fully... [to full text]

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado.
Objetivo El antígeno prostático específico es utilizado en el diagnóstico de patologías prostáticas. No existe un estudio en Perú que proponga un punto de corte de PSA index para discriminar entre cáncer de próstata e hiperplasia prostática benigna para la indicación de biopsia prostática. Actualmente, se emplean diferentes puntos de corte basados en estudios internacionales. Material y métodos Se realizó un estudio de validación diagnóstica de PSA index para discriminar entre ambas entidades en pacientes con un PSA total entre 4,0 ng/ml y 9,9 ng/ml. Fueron incluidos 356 pacientes con diagnóstico de hiperplasia prostática benigna o cáncer de próstata mediante biopsia prostática. Se evaluó la sensibilidad, especificidad, los valores predictivos y los cocientes de probabilidad de los valores de PSA index de 15 hasta 25%. Se graficó la curva ROC. Resultados Un PSA index de 17% posee mejores valores de sensibilidad (87,8%), especificidad (62,2%) y valores predictivos (valor predictivo positivo de 62,4% y valor predictivo negativo de 87,4%) respecto a otros para disminuir el número de biopsias negativas. El cociente de probabilidad positivo fue 2,3 y el cociente de probabilidad negativo fue 0,1. El área bajo la curva fue 0,75 [IC 95%, 0,71 a 0,79]. Conclusión Se sugiere un PSA index de 17% como punto de corte para discriminar entre hiperplasia prostática benigna y cáncer de próstata en pacientes que acuden a consulta ambulatoria con un PSA total entre 4,0 ng/ml y 9,9 ng/ml. Se recomienda este valor si se desea reducir el número de biopsias prostáticas negativas.
Revisión por pares

Patologias prostáticas como a Hiperplasia Prostática Benigna (HPB) e o Câncer de próstata (CaP) apresentam alta incidência, morbidade e mortalidade em indivíduos a partir de 40-50 anos. Fatores ambientais e nutricionais são possíveis fatores envolvidos no desenvolvimento destas doenças. Este trabalho tem por objetivo avaliar o padrão alimentar, perfil antropométrico e perfil lipídico em homens com e sem HPB e CaP e verificar se existe associação entre as variáveis consideradas e a presença de HPB ou CaP na amostra estudada. Foram entrevistados pacientes provenientes do ambulatório de Urologia do Hospital de Clínicas de Porto Alegre (pelo médico da equipe) e preenchida ficha para coleta de dados pessoais e demográficos, história médica e familiar, idade, estágio e grau do tumor, volume da próstata e valor do PSA na época do diagnóstico. Após, os pacientes foram encaminhados à nutricionista para avaliação nutricional (peso, altura, dobras cutâneas, relação cintura/quadril e Recordatório de 24h). O consumo alimentar foi avaliado pelo Recordatório de 24h e analisado pelo programa de apoio à nutrição da Escola Paulista de Medicina – EPM (DIS-EPM, versão 1.5, 2002, UNIFESP). Os pacientes foram orientados a procurar o laboratório de análises clínicas do mesmo hospital para coletar uma amostra sangüínea para dosagem sérica de testosterona total, colesterol total, colesterol HDL e triglicerídeos. O IMC e a circunferência da cintura não apresentaram diferença estatística entre os grupos avaliados. O grupo HPB apresentou consumo menor (p<0,05) de calorias e carboidrato (1875 ± 635 Kcal/dia e 253 ± 105 g/dia) quando comparado ao grupo CaP (2017 ± 476 e 283 ± 75) e ao grupo controle(2179 ± 565 e 302 ± 91). O consumo de fibra alimentar (g/dia) foi significativamente menor (p=0,01) nos grupos HPB (27 ± 12) e CaP (28 ± 10) em relação ao grupo controle (34 ± 15). O consumo aumentado de fibras parece estar relacionado a menor incidência de HPB e CaP. O consumo de calorias e demais nutrientes, o perfil antropométrico e o perfil lipídico não demonstraram relação com estas doenças.
Prostatic pathologies such as Benign Prostatic Hyperplasia (BPH) and Prostate Cancer (PCa) present high incidence, morbidity and mortality among individuals at the age of 40-50 years. Environmental and nutritional factors seem to be involved in the development of these diseases. The objective of the present study is to assess the alimentary pattern, anthropometric and lipid profiles in men with and without BPH and PCa and to verify whether there exists an association among the considered variables and the presence of BPH or PCa in the studied individuals. Urology outpatients from Hospital de Clínicas de Porto Alegre were interviewed by a physician who collected personal and demographic data, medical and familiar history, age, stage and degree of tumor, prostate volume and PSA value at diagnosis. Patients were directed to a nutritionist for nutritional evaluation (weight, height, skin folds, waist/hip ratio and 24-hours recall). Alimentary intake was assessed by 24-hours recall and analyzed by the nutrition support program of Escola Paulista de Medicina – EPM (DIS-EPM, version 1.5, 2002, UNIFESP). Patients were asked to return to the clinical analysis laboratory at the same hospital the following week, in order to collect another blood sample to dose serum total testosterone, total cholesterol, HDL cholesterol and triglycerides. Body Mass Index and waist circumference did not show statistical difference among the assessed groups. The BPH group presented with lower intake (p<0.05) of calories and carbohydrate (1875 ± 635 Kcal/day and 253 ± 105 g/day) when compared tothe PCa group (2017 ± 476 and 283 ± 75) and the control group (2179 ± 565 and 302 ± 91). Fiber intake (g/day) was significantly lower (p=0.01) on BPH (27 ± 12) and PCa groups (28 ± 10) when compared to control group (34 ± 15). Higher intake of fibers seems to be related to lower BPH and PCa incidence. Calories and other nutrients intake, anthropometric profile and lipid profile did not show relation to these diseases.

A Hiperplasia Prostática Benigna (HPB) é a doença benigna mais freqüente na terceira idade. A Ressecção Transuretral (RTU) de próstata constitui-se na técnica operatória mais empregada atualmente para o tratamento da HPB. A anestesia para este procedimento possui características próprias, tornando-se um desafio para o anestesiologista o manejo de suas particularidades. Com o objetivo de avaliar a conduta anestésica, comparando técnicas empregadas, drogas e doses, eventuais complicações e respectivos tratamentos, revisou-se 300 prontuários de pacientes submetidos a RTU de próstata no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto (HC-FMRP-USP). Optou-se por dois períodos de quatro anos com intervalo de dez anos entre eles (1989-1992 (período 1) e 1999-2002 (período 2)) para tentar estabelecer uma suposta relação entre a evolução das técnicas anestésicas e a possível redução na incidência de complicações. Foram incluídos no estudo apenas os pacientes portadores de neoplasias benignas da próstata. Algumas características dos pacientes (média de idade e estado físico ASA) foram semelhantes entre os grupos. A média de peso foi superior no período 2. Foram pedidos menos exames pré-operatórios para os pacientes do período 1. Quanto ao tipo de anestesia houve um predomínio absoluto, nos dois períodos, da anestesia regional (sendo que o bloqueio raquidiano foi o mais utilizado). O anestésico local mais empregado foi a bupivacaína nos dois períodos. Observou-se uma maior incidência de falhas nos bloqueios realizados no período 1, com maior índice de conversão para anestesia geral. O fato pode em parte ser atribuído ao não uso de agentes opióides nas punções nessa época, que sabidamente melhoram a qualidade do bloqueio. A duração média do procedimento foi maior no período 2 (considerando 45 minutos como tempo padrão). A incidência de eventos adversos intra-operatórios, como como hipotensão, arritmias cardíacas e hipotermia foi semelhante entre os períodos. No entanto, houve um maior número de pacientes com diagnóstico de infarto agudo do miocárdio no pós-operatório de até 24 horas no período1. Provavelmente esse fato aconteceu pela falta de exames complementares e avaliação cardiológica prévia nos pacientes submetidos à cirurgia nesse período. No tocante as transfusões sangüíneas, a proporção entre os períodos foi semelhante, embora fosse prática costumeira no período 1 que os pacientes realizassem autotransfusão prévia. A autotransfusão não se mostrou eficaz, na população estudada, como fator redutor do número de transfusões sangüíneas. Na sala de recuperação anestésica o tempo de permanência foi semelhante entre os períodos, no entanto, observou-se uma maior incidência de eventos adversos no período 1. A mortalidade foi maior no período 2 mas essa diferença não foi estatisticamente significante. Palavras- chave: 1. Anestesia 2. Hiperplasia Benigna da Próstata 3. Ressecção Transuretral de Próstata 4. Síndrome da Intoxicação Hídrica
Benign Prostatic Hyperplasia (BPH) is the most common disease in the third ages. Transurethral Resection of the Prostate (TRP) is the surgery technique most frequently used for the treatment of BPH. Anaesthesia for this procedure has its own features becoming a challenge for the anaesthesiologist to manage with its peculiarities. In order to evaluate the anaesthetic behavior, to compare the techniques used, drugs and doses, possible complications and their treatments, three hundreds of medical records of patients submitted to TRP in the University Hospital, Faculty of Medicine of Ribeirão Preto (FM-USP). Two periods of four years were chosen (1989-1992 (period 1) and 1999-2002 (period 2)) in order to establish some evolution between the anaesthetics techniques used and possible reduction in the incidence of complications. Only patients who had benign prostatic hyperplasia were included in this study. Some patients characteristics were similar between the two groups (mean ages and physical status ASA). Mean weight were higher in the period 2. Less preoperative exams were applied in the period 1. In both periods, the regional anaesthesia was predominant (the spinal anaesthesia was the most used). Hyperbaric bupivacaine was the most commonly used agent for regional anaesthesia in both periods. More failed blocks were seen in the period 1 with an increased number of conversion to general anaesthesia. This fact may be attached with the lack of use of opioids agents in that period, which are known to complement and improve the quality of the block. Mean duration of the procedure were higher in period 2 (taking 45 minutes as standard time). The incidence of intra-operative adverse events like hypotension, cardiac arrhythmias and hypothermia were similar in both periods. However more patients had acute heart infarct in the 24 hours of postoperative period 1. Probably this happens because of the lack of preoperative exams and cardiology evaluation in patients submitted to surgery in this period. The proportion of blood transfusions were similar in two periods although it was usual to make an autotransfusion in the patients of the first period. Autotransfusion previous to the surgery were not an effective method to reduce the number of transfusions. In postanaesthesia care unit the length of stay was similar between the periods but the incidence of adverse events was higher in the period 1. The mortality was bigger in the period 2 but this difference were not significant. Key-words: 1. Anaesthesia 2. Benign Prostatic Hyperplasia 3. Transurethral Resection of the Prostate 4. The TURP Syndrome

Solanum cernuum Vell. (Solanaceae), popularmente conhecida como \"panacéia\", é uma planta nativa do sul e sudeste do Brasil. Seu nome \"panacéia\" provavelmente é devido à grande amplitude de aplicações que possui na medicina popular: tratamento de úlceras, lesões hepáticas, infecções de pele, como antitumoral, diurético, depurativo, anti-hemorrágico, bem como para o tratamento da gonorreia e da hiperplasia benigna da prostática (HBP). Considerando os usos de S. cernuum na medicina popular brasileira e a escassez de estudos que os corroborrem, propomos neste trabalho, a partir da obtenção de diferentes extratos, frações e compostos isolados, testar as atividades biológicas gastroprotetora, citotóxica e antimicrobiana relatadas na medicina popular. Para tanto, folhas da espécie Solanum cernuum Vell. (Solanaceae) foram coletadas no município de Teresópolis/ RJ. O extrato hidroetanólico (ESC) e em acetato de etila foram obtidos a partir de folhas secas e trituradas. Frações em hexano (FHex), diclorometano (FDCM), acetato de etila (FAcOEt), n-butanol (FBuOH) e água (FAq) foram obtidas a partir do extrato ESC. A partir dos diversos fracionamentos do extrato ESC isolaram-se e identificaram-se quatro compostos: ácido trans-isoferulico, cernumidina, quercitrina e afzelina, sendo encontrados no extrato nas concentrações de 1,5%, 4,8%, 1,3% e 1,6%, respectivamente. Da fração em heptano, obtida da partição do extrato em acetato, isolaram-se ?-sitsterol e friedelina. No ensaio antimicrobiano, apenas as frações FHex, FDCM e FAq, oriundas da partição do extrato ESC, apresentaram atividade, em diferentes concentrações, frente a determinadas linhagens de bactérias e fungos testadas. Quanto aos compostos voláteis, na extração por hidrodestilação, não houve rendimento suficiente, mas a partir do hidrolato, por partição com diclorometano, foi possível determinar a composição dos voláteis por CG/EM. Os tricomas de S. cernuum são majoritariamente estrelados, do tipo tectores. No ensaio do XTT apenas a FDCM e o composto friedelina foram seletivos para células MCF-7 (carcinoma mamário) na concentração de 16,6 ?g/mL e 124,9 ?g/mL, respectivamente. O extrato ESC apresentou atividade gastroprotetora nos ensaios de indução de úlcera por etanol/HCl e por anti-inflamatório não esteroidal (AINE), bem como foi curativo no ensaio de úlcera crônica induzida por ácido acético na dose de 250 mg/kg. Os compostos isolados, exceto o alcaloide cernumidina, apresentaram atividade gastroprotetora pelo ensaio de indução de úlcera por etanol/HCl na dose de 30 mg/kg. Ainda sobre a gastroproteção, na avaliação de pH utilizando o ensaio de ligadura de piloro, todos os grupos de animais tratados com extrato ESC não apresentaram diminuição da acidez estomacal. Porém, houve diminuição da concentração de íons hidrogênio ([H+] mEq.g-1/L) na secreção gástrica nos grupos tratados. A produção de muco na mucosa gástrica também não foi aumentada nos grupos tratados com o extrato ESC. A avaliação da ação gastroprotetora por inibição da enzima iNOS e alquilação de grupos sulfidrilas evidenciou que a produção de óxido nítrico e de grupos sulfidrilas podem estar envolvidos na atividade gastroprotetora do ESC. Diferentes concentrações de ii extrato ESC e alcaloide cernumidina foram testadas nos tempos de 48, 72 e 96 h em cultura primária de células de músculo liso relacionadas a hiperplasia benigna da próstata (HPB), sendo possível observar inibição do crescimento celular de 60% na concentração de 3 mg/mL para o extrato e de 62% para o alcaloide na concentração de 1 mg/mL (3,3 x 10-6 M) no tempo de exposição de 96 h. Com o intuito de avaliar o potencial efeito indutor de apoptose, foi realizado o ensaio de anexina V Cy5 por citometria de fluxo. Tanto para o extrato ESC como para o acaloide cernumidina observou-se que a morte celular ocorreu mais por apoptose. Apenas para o alcaloide, na concentração de 1 mg/mL, houve significativa morte por necrose. Na atividade de inibição da angiogenese, avaliada em células HUVEC, a FBuOH (50 ?g/mL) e o alcaloide cernumidina (160 nM) inibiram a formação de vasos endoteliais em 62,75% e 77,73%. Na secagem do extrato por spray dryer o rendimento, a densidade aparente, a densidade compacta, o tamanho das partículas (D50) e o teor de cernumidina foram influenciados por alguns dos fatores avaliados: temperatura, vazão e porcentagem de adjuvante, linearmente ou na forma quadrática. Na otimização da secagem por spray dryer, utilizando a função desejabilidade, observou-se a proximidade dos valores preditos para rendimento do pó e teor de cernumidina com os valores reais, evidenciando a confiabilidade desse método matemático. Assim, os resultados obtidos corroboram alguns dos usos populares abrindo novas possibilidades para o desenvolvimento de fitoterápico a partir S. cernuum.
Solanum cernuum Vell. (Solanaceae), popularly known as \"panacéia\", is a native tree from Southern and Southeastern Brazil. Its traditional name is due to the wide range of uses in folk medicine including the treatment of ulcers, liver damage, skin infections, as diuretic, antitumor, depurative, anti-hemorrhagic, as well as to treat gonorrhoea and benign prostatic hyperplasia (BPH). Considering the importance of S. cernuum in folk medicine and the lack of research supporting its use, the aims of this project were to obtain different extracts, fractions and isolated compounds this plant to be tested for gastroprotective, cytotoxicity and antimicrobial activities. Leaves S. cernuum were collected in Teresópolis/RJ. The hydroethanolic (ESC) and ethyl acetate extracts were obtained from the dried and grinded leaves. Fractions in hexane (FHex), dichloromethane (FDCM), ethyl acetate (FAcOEt), n-butanol (FBuOH) and water (FAQ) were obtained from the ESC extract. The ESC extract was fractionated using different chromatographic techniques furnishing four isolated compounds: trans-isoferulic acid, cernumidine, quercitrin and afzelin. The content of these four compounds were quantified to be 1.5%, 4.8%, 1.3% and 1.6%, respectively, in the extract. ?-sitosterol and the friedelin were isolated by partitioning the ethyl acetate extract with heptane. In the antimicrobial assay, only FHex, FDCM and FAq fractions showed activity at different concentrations against the tested strains of bacteria and fungi. The hydrodistillation of the leaves of S. cernuum did not fusrnish essential oils, but the partition of the hydrolate with dichloromethane allowed the determination of its composition by GC/MS. The trichomes of S. cernuum are majority kind of stellate tector. Only FDCM fraction and friedelin compound showed activity in XTT assay against MCF-7 cells (breast carcinoma) at the concentration of 16.6 ?g/mL and 124.9 ?g/mL, respectively. The ESC extract showed gastroprotective effects in the acute gastric ulcer assay, which is induced by HCl/EtOH and nonsteroidal anti-inflammatory drugs (NSAIDs). Also, in the chronic ulcer assay, induced by acetic acid, the oral administration of ESC extract (250 mg/kg) reduced the ulcerated area, suggesting that it has a curative potential. The isolated compounds (30 mg/kg) exhibited gastroprotective activity in acute gastric ulcer assay, except cernumidine. The results indicated that the ESC extract was able to reduce the concentration of H+ ions in comparison with the control group. However, ESC extract did not modify the pH of the gastric juice acid and there was no significant increment in the amount of gastric adherent mucus in pretreated group. Further, it was evaluated the role of nitric oxide (NO) and sulfhydryl (SH) groups on the gastroprotective effect elicited by ESC extract. The results showed that gastroprotection induced by the ESC extract is correlated with the presence of endogenous NO and SH groups which were responsible for gastroprotective activity. In the anti-angiogenic activity assay evaluated in HUVEC cells, the FBuOH fraction (50 ?g/mL) and the cernumidine alkaloid (160 nM) inhibited the the formation of endothelial vessels by 62.75% and 77.73%, respectively. Different concentrations of the ESC extract and cernumidine alkaloid were further tested in primary culture of iv smooth muscle HPB for 48, 72 and 96 h. ESC extract (3 mg/mL) and the alkaloid (1 mg/mL; 3.3 x 10-6 M) treatment for 96 h inhibited the cell growth by 60% and 62%, respectively. In addition, it was assessed the potential effect of extract and its constituents to induce apoptosis by performing the annexin Cy5 assay by flow cytometry. Treatment with ESC extract and cernumidine alkaloid led to cell death by apoptosis. Only cernumidine at 1 mg/mL showed significant cells death by necrosis compared to control. Considering the spray dryer technique to dry the extract, the yield, bulk and tapped densities, particle size (D50) and the content of the cernumidine are influenced by some of the evaluated factors: temperature, flow and excipient percentage, linearly or quadratic form. To optimize the drying by spray dryer, it was used the desirability function. It was observed that the proximity of the predicted values of the yield and cernumidine content with the real values were found, showing the reliability of this mathematical method. Therefore, the obtained results corroborate the folk use and open new opportunities for the development of a phytotherapic from S. cernuum.

Saw palmetto berries (Sereona repens) are used today for symptoms of benign prostatic hyperplasia (BPH) which is an age dependent disease leading to lower urinary tract symptoms (LUTS) and impacts negatively sexual functions (SDys). I carried out the first clinical pilot trial to assess if a saw palmetto treatment in patients with BPH symptoms and concomitant SDys is efficacious and safe on both groups of symptons. After 8 weeks of treatment with 320mg saw palmetto extract daily, the BPH symptoms assessed with the International Prostate Symptome Score IPSS were reduced from 14.4 ± 4.7 to 6.9 ± 5.2 (P < 0.0001) . At the same time SDys measured with the brief Sexual Function Inventory bSFI improved from 22.4 ± 7.2 to 31.4 ± 9.2 (P < 0.0001), and with the Urolife BPH QoL-9 questionnaire from 162.7 ± 47.9 to 105.0 ± 56.3 (P < 0.0001). The treatment was very well tolerated and accepted by the patients. Another subject of the thesis was to investigate the quality of products from 8 countries which contained saw palmetto and are sold as treatments of BPH symptoms. For each of the 46 analyzed products the amount of the main active constituent, the fatty acids was determined using gas chromatography. The quantity of fatty acids per daily dosage varied widely between the commodities and also the composition of the samples was very heterogenous. A last aspect of this thesis was to investigate how saw palmetto was historically introduced into the German speaking medical practice. The first recorded mention of saw palmetto in a German medicinal publication was in 1892. From then on saw palmetto grew more and more popular among German homeopathic doctors and was often mentioned in their publications. The homeopathic doctors were ones in the end having made saw palmetto popular as a medicinal treatment in Germany. In conclusion, this thesis shows how saw palmetto made its way into medical practice in Germany, that saw palmetto preparations on the markets differ widely in their content of active constituents and thus higher quality demands from regulatory authorities are warranted, and for the first time that saw palmetto is not only an efficacious and safe treatment for BPH symptoms but also for concomitant SDys.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
CHAPTER I - Prostate cancer is a common disease in the world and in some countries it is one of the main causes of male population mortality. Some molecular markers have been associated with prostate carcinogenesis. To observe changes in transcript levels of the AR, SRD5A2, KLK2, PSMA and PCA3 genes, the mRNA was analyzed in tissues with prostatic adenocarcinoma (PCa, N= 48) and benign prostatic hyperplasia (BPH, N= 25), performed through a differential multiplex RT-PCR assay. Significant differences were observed in the relative expression of these genes between cancerous and non-cancerous tissues. The optical density ratio of the cDNA amplicons between PCa and BPH for the AR gene was 1.6-fold higher for the prostatic adenocarcinoma. On the other hand, the SRD5A2 mRNA levels were associated with BPH and were 1.4-fold higher than that of PCa. For KLK2, PSMA and PCA3, the transcriptional levels were respectively, 1.9-, 1.9- and 5-fold higher in PCa than those in BPH tissues. Of the diagnostics tests carried through individually, the PCA3 gene was that presented higher sensitivity and accuracy, and the inclusion of the serum PSA improved the sensitivity (of 76 to 92%), positive preditive value (of 85 to 94%), negative preditive value (of 60 to 62%) and accuracy (of 74 to 78%). The results suggest that the higher AR, KLK2, PSMA, and PCA3 and/or reduced SRD5A2 genes expression in prostatic tissues may indicate the occurrence of prostate adenocarcinoma; however the PCA3 and serum PSA analysis together are highly promising as auxiliary method in the diagnosis of this cancer. CHAPTER II - Purpose: Prostate cancer (PCa) is the most commonly diagnosed malignancy in men, and it consists of multifactorial and multifocal events. Due to the complexity of the disease process, which includes genome alterations, local invasion, micrometastatic cell extravasations to circulation, invasion of secondary organ tissues, and resistance to hormonal blockage, many markers must be used to represent the multiple and variable events that lead to cancer development. The low specificity of the unique serum marker for prostate cancer diagnostics, PSA, has leaded us to investigate four potential markers in the peripheral blood of patients by detecting their mRNA levels and associating them to clinical parameters. Methods: The expression levels of the KLK2, KLK3, PCA3 and PSMA transcripts were determined by Nested RT-PCR. Patients with PCa (99) and with benign prostatic hyperplasia (BPH, 36), and healthy volunteers (104) were investigated. Results: Significant differences for the RNA relative levels have been found for the KLK2, PCA3 and PSMA transcripts between PCa and BPH patients or healthy volunteers. The KLK2 and PSMA levels also presented a positive association (P<0.05) with extra-prostatic disease (pT3). The combined positive RT-PCR Nested for the KLK2, PCA3, PSMA genes with serum PSA higher than 4ng/mL presented a 10-fold higher chance of cancer occurrence than healthy controls, with sensitivity, specificity and positive predictive value of 57%, 89% and 93%, respectively. Conclusions: The combined analysis of KLK2, PCA3 and PSMA transcripts may become a useful tool for the discrimination of PCa patients from those with benign disease or healthy individuals. Additionally, the KLK2 and PSMA transcripts may also be used as prognostic markers for the presence of extra-capsular disease and assisting in the prediction of the post-operative outcome. CHAPTER III - Purpose: Transcripts of PCA3/DD3 gene are at the moment the most specific molecule found in prostate cancer specimens. This mRNA can be detected in important sample targets for clinical analyses, such as prostatic tissues, urine after prostatic massage, and the peripheral blood. Methods: The present study evaluated the PCA3 gene expression in prostatic tissues and in peripheral blood of BPH and PCa patients, by RT-PCR assays, and based on its detection together with other clinical parameters, we proposed a model for molecular monitoring in order to improve diagnosis as an auxiliary technology. Results: The concomitant use of PCA3 transcript detection in the peripheral blood and in prostate tissues has improved diagnosis, with sensitivity and an accuracy of 77%. For the molecular staging, patients have been classified as: localized disease (PBL-; negative PCA3) and circulating tumors cells disease (PBL+; positive PCA3). The higher frequencies of PBL- had been observed in T1-T2 stages (75%); on the other hand, the higher PCA3 positivity was observed for the T3-T4 staging (43%), while the T1-T2 stages presented 25% positivity. A correlation was found between the molecular staging and serum PSA < 10ng/mL before surgery, and approximately 60% of patients with T3-T4 stages that presented biochemical failure after radical prostatectomy presented a positive PCA3 result (P= 0.05), with an odds ratio of 16-fold higher for the possibility of disease recurrence in relation to the T1-T2 patients, and an accuracy of 82%. Conclusion: These data demonstrated the importance of the PCA3 gene as an auxiliary method in prostate cancer diagnosis, by distinguishing PCa from BPH patients, and also demonstrated its prognostic value in recurrent disease for post-operative patients. CHAPTER IV - Approximately 98% of all the products transcribed in the human genome correspond to non coding RNAs (ncRNA). Many ncRNA functions are attributed to this structural particularity given mainly for the secondary structures formed from its linear sequence of bases. Among the ncRNA types are tRNA, rRNA, small nuclear RNA, small nucleolar RNA, small interference RNA (siRNA), microRNA (miRNA) and catalytic RNAs (ribozymes). The bioinformatics has supplied useful tools in the prediction of optimal or suboptimal secondary structures allowing the design of interference RNA as miRNAs or siRNAs. In human, miRNAs have been associated with the development of diverse complex diseases as cancer. The PCA3 (DD3) gene was molecularly characterized as cancer and prostate specific, and its transcripts are non-coding, once no peptide products have been found. Due to its structural characteristics, the PCA3 gene belongs thus to the increasing family of ncRNA. In the present work, four new variant molecules of the PCA3 gene have been sequence characterized and their frequencies demonstrated in prostate cancer and in benign prostatic hyperplasia patients, as well as in healthy individuals. We have also investigated and predicted the putative secondary structures formed in order to elucidate its role in prostate cancer biology. No association has been found between the frequency of these molecules and prostate pathologies (PCa or BPH). On the other hand, PCA3 variants were found in 10% (12/115) of cases in the general population. Similar analyses of the possible polypeptides of these molecules demonstrated that it remains as a non-coding RNA, and introns presents in the first, second and fourth variants suggesting a possible role as a miRNA with intracellular activity to these molecules to the PCA3 gene. In prostatic tissues, 100% of the prostate cancer cases presented the RNA molecule with an exon 2 splicing. However, further investigation must be carried out to demonstrate the true role of these splicing variants in prostate tumors and in other pathologies, once these molecules have been preferentially found in the peripheral blood.
CAPÍTULO I - O câncer de próstata é uma doença comum no mundo e já assumiu em alguns países uma das principais causas de mortalidade da população masculina. Vários marcadores moleculares têm sido associados à gênese do câncer de próstata. A fim de demonstrar a expressão diferencial dos níveis transcricionais dos genes AR, SRD5A2, KLK2, PSMA e PCA3 em doenças prostáticas, o RNAm foi analisado em tecidos com adenocarcinoma prostático (CaP, N= 48) e hiperplasia prostática benigna (HPB, N= 25) por meio da técnica RT-PCR multiplex semi-quantitativa. Foram observadas diferenças significativas na expressão relativa desses genes entre os tecidos cancerosos e nãocancerosos. A taxa de densidade ótica entre os amplicons para cDNA provenientes do gene AR foi 1.6 vezes maior no adenocarcinoma prostático. Por outro lado, os níveis de RNAm do gene SRD5A2 foi associado com a HPB e foi 1.4 vezes maior do que no CaP. Para os genes KLK2, PSMA e PCA3, os níveis transcricionais foram respectivamente, 1.9, 1.9 e 5 vezes maior no câncer comparado a tecidos benignos. Dos testes diagnósticos realizados, o gene PCA3 individualmente foi o que apresentou as melhores sensibilidade e acurácia, sendo que a inclusão das medidas de PSA sérico melhorou a sensibilidade (de 76 para 92%), o valor preditivo positivo (de 85 para 94%), o valor preditivo negativo (de 60 para 62%) e a acurácia (de 74 para 78%). Os dados sugerem que a maior expressão dos genes AR, KLK2, PSMA e PCA3 ou expressão reduzida do gene SRD5A2 em tecidos prostáticos podem indicar a ocorrência do adenocarcinoma da próstata, sendo que as análises do gene PCA3 juntamente aos do PSA sérico são altamente promissores como método auxiliar no diagnóstico desse tipo de câncer. CAPÍTULO II - O câncer de próstata (CaP) e o mais comumente diagnosticado na população masculina e consiste de eventos multifatoriais e multifocais. Devido a complexidade da doença, a qual inclui alterações genômicas, invasão local, liberação de células micrometastáticas para a circulação, invasão secundaria de tecidos de outros órgãos, e resistência ao bloqueio hormonal, muitos marcadores podem ser usados para representar os eventos múltiplos e variáveis que levam ao desenvolvimento do câncer. A baixa especificidade do único marcador para diagnostico do câncer de próstata, PSA, tem nos levado a investigar quatro potenciais marcadores no sangue periférico de pacientes pela detecção de seus níveis de RNAm e associá-los a parâmetros clínicos. Os níveis de expressão dos transcritos do KLK2, KLK3, PCA3 e PSMA foram avaliados pela RT-PCR Nested, em pacientes com CaP (99), com hiperplasia prostática benigna (HPB, 36) e voluntários saudáveis (104). Diferenças significativas foram encontradas para a expressão dos genes KLK2, PSMA e PCA3 entre os pacientes com CaP e os pacientes com HPB ou voluntários saudáveis. Os níveis do KLK2 e PSMA também apresentaram associação positiva (P<0.05) com doença extra-prostática (pT3). A RT-PCR Nested positiva combinada para os genes KLK2, PCA3 e PSMA com PSA sérico maior que 4ng/mL apresentou uma chance 10 vezes maior de ocorrência do câncer comparado aos controles saudáveis, com sensibilidade, especificidade e acurácia de 57%, 89% e 93%, respectivamente. A análise combinada dos genes KLK2, PCA3 e PSMA pode ser uma ferramenta útil na distinção de pacientes com CaP daqueles com doença benigna ou de indivíduos saudáveis. Ainda, a analise dos transcritos KLK2 e PSMA podem ser usados como marcadores prognósticos para a presença de doença extra-capsular e auxiliando na predição de recidiva da doença no pós-operatório. CAPÍTULO III - Os transcritos do gene PCA3/DD3 são até o momento as moléculas mais específicas encontradas em espécimes de câncer de próstata. Esses RNAm podem ser detectados em importantes alvos para a análise clínica como tecidos prostáticos, na urina após massagem prostática e em sangue periférico. O presente estudo avaliou a expressão do gene PCA3 em tecidos prostáticos e em sangue periférico de pacientes com HPB e CaP, por técnicas de RT-PCR, e baseado na sua detecção juntamente com os parâmetros clínicos, foi proposto um modelo de estadiamento molecular como técnica assessória para melhor o diagnóstico da doença. O uso concomitante da detecção dos transcritos do gene PCA3 no sangue periférico e no tecido prostático melhorou o diagnóstico, com sensibilidade e acurácia de 77%. Para o estadiamento molecular, os pacientes foram classificados como contendo a doença localizada (PBL-) e em doença com células tumorais circulantes (PBL +). Maiores freqüências de tumor localizado pelo estadiamento molecular foram observadas nos estadios T1-T2 (75%), enquanto que 25 e 43% dos cânceres T1-T2 e T3-T4, respectivamente, apresentaram PCA3 positivo (células circulantes). Uma correlação foi encontrada para o estadiamento molecular para doença localizada e PSA sérico pré-cirúrgico < 10ng/mL, e aproximadamente 60% dos pacientes TNM T3-T4 que apresentaram falha bioquímica após a cirurgia radical apresentaram RTPCR positiva do PCA3 (P= 0.05), com um Odds Ratio 16 vezes maior para a possibilidade de recorrência da doença em relação aos pacientes T1-T2 e uma acurácia de 82%. Esses dados demonstram a importância da detecção do gene PCA3 como método no diagnóstico do câncer de próstata, por distinguir pacientes com CaP daqueles com HPB, e também demonstrando seu valor prognóstico na doença recorrente no pósoperatório dos pacientes. CAPÍTULO IV - Aproximadamente 98% de todos os produtos transcritos do genoma humano correspondem a RNAs não codificantes (RNAnc). Muitas funções dos RNAnc são atribuídas a suas particularidades estruturais dadas principalmente pelas estruturas secundárias formadas a partir da sua sequência linear de bases. Dentre os tipos de RNAnc estão os RNAt, RNAr, small nuclear RNA, small nucleolar RNA, small interference RNA (siRNA), microRNA (miRNA) e RNAs catalíticos (ribozimas). A bioinformática tem fornecido ferramentas úteis na predição de estruturas secundárias ótimas ou subótimas permitindo o design de RNAs de interferência como os miRNAs ou siRNAs. Em humanos, os miRNAs tem sido associados ao desenvolvimento de diversas doenças complexas como o câncer. O gene PCA3 (DD3) foi molecularmente caracterizado como câncer- e próstata- específico e os seus RNAs são os responsáveis por essa característica, isso porque nenhum produto protéico tem sido encontrado para esse gene. Devido às suas características estruturais, o gene PCA3, pertence assim à crescente família de RNAnc. No presente trabalho foi analisado as freqüências de quatro moléculas variantes do gene PCA3, além das anteriormente reportadas, como também foram preditas as suas estruturas secundárias na tentativa de elucidar o seu papel na biologia do câncer de próstata. Nenhuma associação foi encontrada entre a freqüência dessas moléculas e as patologias da próstata como hiperplasia benigna ou câncer, sendo que na população geral analisada essas variantes foram encontradas em apenas 10% (12/115) dos casos. As análises de homologia de possíveis polipeptídeos para essas moléculas demonstram que permanece o papel de RNA não-codificante para o gene PCA3. Ainda, a presença de introns nas variantes 1, 2 e 4 podem sugerir um papel intracelular de miRNA para essas moléculas do gene PCA3. Nos tecidos prostáticos, 100% dos casos de câncer foi representando pela molécula com splicing do exon 2. Contudo, para as variantes de splicing, novas pesquisas deverão ser realizadas incluindo outras patologias além das doenças prostáticas e outros tipos tumorais para verificar o real impacto dessas moléculas, uma vez que foram encontradas preferencialmente no sangue periférico.
Doutor em Genética e Bioquímica

Aims: The overall aim was to determine how lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction (BPO) affect sleep, health related quality of life and disease specific quality of life, and how the men’s urinary symptoms affect their partners. Subjects and methods: In papers I–II, a descriptive design with a pre-test and post-test was used and in papers III-IV the design was descriptive and comparative. The method was self-administered questionnaires. In papers I- II: The questionnaires were translated in the ethnographic mode. In paper I the reliability of the questionnaire was tested in 122 patients with LUTS/ BPO. The disease specific quality of life was studied before and after intervention in 572 consecutive patients with BPO, aged 45-94 yrs. In paper II, the partner specific quality of life was studied in partners to men with BPO before and after TURP. The reliability and the responsiveness of the questionnaire were tested in two groups with 51 partners each. Papers III-IV: A study of 239 men with LUTS, aged 45-80 yrs, and their partners (n=126) who were compared to randomly selected men from the population (n=213) and their partners (n=131). The men had an extra control group, men with inguinal hernia (n=200). Sleep and health related quality of life was studied in both men and their partners. The partners’ specific quality of life was also studied and the men with LUTS answered questions about urinary symptoms and disease specific quality of life. Results: Papers I-II: All the tested questionnaires showed an acceptable reliability and responsiveness. I: Before and after intervention the prevalence of urinary incontinence was 46 % and 16 % respectively. II: Partners were affected by the patients’ BPO symptoms before and improved after the patients TURPs. III: Most sleep variables were significantly impaired in men with LUTS compared to one or both of the control groups. The men with LUTS had a significantly higher prevalence of insomnia (40 %) than both control groups and significantly lower sleep efficiency (49 %) than men with hernia. The men with LUTS were significantly impaired in most domains of the health related quality of life compared to men in the population. IV: There were no significant differences between the two partner groups regarding the quantity and quality of sleep or the health related quality of life. Conclusions: All tested questionnaires showed an acceptable reliability and responsiveness. The prevalence of urinary incontinence before and after intervention was higher than earlier reported. Men with LUTS had significantly poorer sleep quality, reduced sleep efficiency and a higher prevalence of insomnia than men in the population and men with inguinal hernia. The HRQOL is impaired in men with LUTS compared to men in the population and men with inguinal hernia. Partners are affected by the patients’ symptoms, and it is emotional rather than practical aspects that affect them most. Partners of men with LUTS did not differ significantly from partners in the population with regard to sleep and health related quality of life.

Serial prostate-specific antigen (PSA) measurements (PSA velocity) as an additional instrument to detect prostatic cancer was introduced in 1992. It has previously been reported that PSA increase per year differed in the last 5 years prior to diagnosis in patients with benign prostatic hyperplasia (0.18 ng/ml/year), locally confined (0.75 ng/ml/year) and metastasized (4.4 ng/ml/year) cancer of the prostate (CaP) in contrast to healthy men (0.04 ng/ml/year). The ability of PSA velocity to detect organ-confined CaP in patients with intermediate PSA serum values depends therefore on a reliable and reproducible PSA result. The present study comprised 85 men with PSA values between 3 and 8 ng/ml (Abbott IMx). PSA measurements were repeated with Abbott IMx (n = 85 patients) and Hybritech Tandem-E (n = 59 patients) assays. The PSA serum values differed from one examination to the other from 0.02 to 2.74 ng/ml with the Abbott IMx. Standard deviation amounted to 0.35 ng/ml with the Abbott IMx PSA assay. Using the Hybritech Tandem-E assay, mean standard deviation was 1.15 ng/ml and therefore higher than with the Abbott IMx assay. The difference from one test to the other ranged from 0.05 to 4.05 ng/ml with the Hybritech Tandem-E. Using the Abbott IMx assay, 10.6% of all repeat measurements exceeded 1 ng/ml whereas in the Hybritech Tandem-E assay 62.7% of the second measurements differed >1 ng/ml from the first PSA result. An increase in PSA serum values may therefore be due to intratest variation, physiological day-to-day variation as well as prostatic disease. It is important to notice that the intra-assay variation may be greater than the PSA increase per year in a patient with CaP. Therefore, PSA velocity seems to be of limited value
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A indicação de biópsia para o diagnóstico precoce do câncer prostático baseia-se na dosagem sérica do PSA e nos achados do toque retal. O PSA é uma kalecreina estando seus genes reguladores ligados aos andrógenos. Drogas que afetam o metabolismo dos andrógenos podem afetar a produção de PSA. A finasterida é uma droga sintética que inibe a conversão de testosterona em DHT pela enzima 5 AR. O uso da finasterida na dose de 5mg/dia para o tratamento da HPB causa redução do volume prostático de 20 a 30% e diminuição dos valores dos PSA em aproximadamente 50% do seu valor inicial após 6 meses. O uso da finasterida na dose de 1mg/dia para o tratamento da AAM foi aprovado pelo FDA em 1997. Um estudo realizado em 2007 avaliou a alteração do nível do PSA em homens com mais de 40 anos fazendo uso de finasterida 1mg/dia para tratamento da AAM. Os resultados revelaram redução dos valores do PSA semelhante à verificada nos pacientes portadores de HPB. Não existem estudos prospectivos sobre o tema incluindo pacientes mais jovens. O objetivo do nosso trabalho foi verificar as alterações da dosagem do PSA, da testosterona sérica total e do volume prostático em indivíduos com menos de 40 anos de idade com em uso de finasterida 1mg/dia. Selecionamos 52 pacientes que após avaliação inicial preenchiam os critérios de inclusão. Foram dosados os níveis séricos do PSA e da testosterona, e mensurado o volume prostático através da ultrassonografia transabdominal, no início do estudo (T0) e um ano após o uso da finasterida (T2). No intervalo, 6 meses após o início da droga, foi solicitada apenas nova dosagem de PSA (T1). O valor médio na avaliação inicial (T0) da dosagem do PSA, da testosterona total plasmática e do volume prostático mensurado pela ultrassonografia transabdominal foi de 0,398 ng/ml (0,14- 0,78); 735,77 ng/dl (548-927) e 21,35 ml (15-31ml) respectivamente. Foi observada uma redução do valor médio do PSA de 9,21% após 6 meses do uso da droga (p=0,001). Após 12 meses do uso da finasterida verificamos uma redução de 10,51% do valor do PSA em relação à dosagem inicial (p<0,001) e uma diminuição do valor médio do volume prostático 21,37 ml para 20,03 ml (p<0,001). Não foi detectada alterações nos níveis de testosterona. Diferentemente de estudos anteriores em que, em homens fazendo uso de finasterida 1mg/dia, houve redução de 40% e 50% dos valores do PSA nas faixas etárias de 40 a 49 anos e 50 a 59 anos, nosso trabalho revelou reduções inferiores. Nosso estudo traz importantes questionamentos em relação a como deve ser feita a correção dos valores do PSA nos pacientes que começaram a utilizar finansterida 1mg antes dos 40 anos de idade e que se apresentam para avaliação prostática. Outro ponto de interesse é se a hiperplasia do componente epitelial observada durante envelhecimento masculino poderia ser inibida pelo uso da finasterida desde a juventude, pois sabemos que indivíduos portadores de deficiência congênita de 5AR não apresentam alopecia e nem tão pouco desenvolvem HPB.
The indication of biopsy for early diagnosis of prostate cancer is based on serum PSA levels and digital rectal examination findings. PSA is a kalecreine and its regulatory genes are modulating by androgens. Drugs affecting the androgens metabolism can affect the production of PSA. Finasteride is a synthetic drug, which inhibits the conversion of testosterone to DHT by the enzyme 5 AR. There are two subtypes of 5AR enzymes, Type 1 that predominates in non-prostatic tissues such as liver and skin, and Type 2, which predominates in the prostate and scalp but is also expressed in other tissues. The use of Finasteride 5mg / day for the treatment of BPH is well known. After six months we observe a decrease in prostate volume by 20 to 30% and also a decrease in total serum PSA concentration of approximately 50%. The use of Finasteride at 1mg / day for the treatment of MAA has been approved by the FDA in 1997. In 2007 a study evaluated the change in total serum PSA concentration in men over 40 years taking Finasteride 1 mg / day to treat MAA. The results showed a reduction in PSA values similar to that observed in patients treated of BPH. There are no prospective studies including younger patients. The aim of our study was to assess the changes in total serum PSA concentration, total serum testosterone concentration and prostate volume in patients younger than 40 years of age in use of Finasteride 1mg / day for MAA. We prospectively selected 52 patients with MAA and indication for treatment with Finasteride who met the inclusion criteria. Serum levels of total PSA and total testosterone and prostate volume, measured by transabdominal ultrasound, were obtained at baseline (T0) and one year after started the drug (T2). In the interval, 6 months after started drug, only serum total PSA concentration was measured (T1). The median value at baseline (T0), for total PSA, total testosterone and prostate volume was 0.398 ng / ml (0.14 to 0.78); 735.77 ng / dl (548-927) and 21.35 ml (15-31ml) respectively. A reduction of 9.21% on total PSA concentration was detected 6 months after started the drug (p = 0.001). After 12 months we observed a 10.51% decrease in total serum PSA concentration, when compared with the baseline value, (p <0.001). A reduction in the median value of prostate volume from 21.37 ml to 20.03 ml (p < 0.001) was also detected at the same period. There were no detectable changes in testosterone levels. They reported a decrease of 40% and 50% in total PSA concentration for groups between 40-49 and 50-59 of age respectively. In our study we observed lower reductions. Our finding may be explained by the fact that the epithelial component of the prostate gland has not yet started the hyperplasia process, so the conversion of testosterone into DHT by blocking 5AR by Finasteride would cause less impact. The fact that the values of plasma testosterone not have changed is not surprising since Finasteride is not considered an anti androgenic drug, it means that the synthesis of the testosterone is not affected by its use. Our study highlights important questions about how the adjustment of PSA values should be done in patients who began taking Finasteride 1mg / day before 40 years of age and present for prostate evaluation. Another point of interest is whether the hyperplasia of the epithelial component, observed during the aging process, could be inhibited by the use of Finasteride. This hypothesis can be corroborate by the fact that individuals with congenital deficiency of 5AR do not present alopecia or develop BPH. In conclusion the use of Finasteride 1mg /day reduces the total serum PSA value by 10,51% after one year. Prostate volume is also reduced by 6,3% in the same period.