This fourth edition of the Japanese Clinical Practice Guidelines for Prostate Cancer 2023 is compiled. It was revised under the leadership of the Japanese Urological Association, with members selected from multiple academic societies and related organizations (Japan Radiological Society, Japanese Society for Radiation Oncology, the Department of EBM and guidelines, Japan Council for Quality Health Care (Minds), Japanese Society of Pathology, and the patient group (NPO Prostate Cancer Patients Association)), in accordance with the Minds Manual for Guideline Development (2020 ver. 3.0). The most important feature of this revision is the adoption of systematic reviews (SRs) in determining recommendations for 14 clinical questions (CQs). Qualitative SRs for these questions were conducted, and the final recommendations were made based on the results through the votes of 24 members of the guideline development group. Five algorithms based on these results were also created. Contents not covered by the SRs, which are considered textbook material, have been described in the general statement. In the general statement, a literature search for 14 areas was conducted; then, based on the general statement and CQs of the Japanese Clinical Practice Guidelines for Prostate Cancer 2016, the findings revealed after the 2016 guidelines were mainly described. This article provides an overview of these guidelines.
日本 2023 年前列腺癌临床实践指南》(Japanese Clinical Practice Guidelines for Prostate Cancer 2023)已编纂完成第四版。该指南是在日本泌尿外科协会的领导下,由多个学术团体和相关组织(日本放射学会、日本放射肿瘤学会、EBM和指南部、日本医疗质量委员会(Minds)、日本病理学会和患者团体(NPO前列腺癌患者协会))根据《指南制定Minds手册》(2020年3.0版)选出的成员共同修订的。本次修订的最大特点是采用系统回顾(SR)来确定 14 个临床问题(CQ)的建议。对这些问题进行了定性 SR,并根据结果通过指南制定小组 24 名成员的投票提出了最终建议。此外,还根据这些结果创建了五种算法。一般性声明中描述了性报告未涵盖的内容,这些内容被视为教科书材料。在一般性声明中,对 14 个领域进行了文献检索;然后,根据一般性声明和《2016 年日本前列腺癌临床实践指南》的 CQ,主要介绍了 2016 年指南之后的研究结果。本文对这些指南进行了概述。
{"title":"Japanese clinical practice guidelines for prostate cancer 2023.","authors":"Yasuo Kohjimoto, Hiroji Uemura, Masahiro Yoshida, Shiro Hinotsu, Satoru Takahashi, Tsutomu Takeuchi, Kazuhiro Suzuki, Hiroshi Shinmoto, Tsutomu Tamada, Takahiro Inoue, Mikio Sugimoto, Atsushi Takenaka, Tomonori Habuchi, Hitoshi Ishikawa, Takashi Mizowaki, Shiro Saito, Hideaki Miyake, Nobuaki Matsubara, Norio Nonomura, Hideki Sakai, Akihiro Ito, Osamu Ukimura, Hideyasu Matsuyama, Isao Hara","doi":"10.1111/iju.15545","DOIUrl":"https://doi.org/10.1111/iju.15545","url":null,"abstract":"<p><p>This fourth edition of the Japanese Clinical Practice Guidelines for Prostate Cancer 2023 is compiled. It was revised under the leadership of the Japanese Urological Association, with members selected from multiple academic societies and related organizations (Japan Radiological Society, Japanese Society for Radiation Oncology, the Department of EBM and guidelines, Japan Council for Quality Health Care (Minds), Japanese Society of Pathology, and the patient group (NPO Prostate Cancer Patients Association)), in accordance with the Minds Manual for Guideline Development (2020 ver. 3.0). The most important feature of this revision is the adoption of systematic reviews (SRs) in determining recommendations for 14 clinical questions (CQs). Qualitative SRs for these questions were conducted, and the final recommendations were made based on the results through the votes of 24 members of the guideline development group. Five algorithms based on these results were also created. Contents not covered by the SRs, which are considered textbook material, have been described in the general statement. In the general statement, a literature search for 14 areas was conducted; then, based on the general statement and CQs of the Japanese Clinical Practice Guidelines for Prostate Cancer 2016, the findings revealed after the 2016 guidelines were mainly described. This article provides an overview of these guidelines.</p>","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Comparison of the efficacy of a pulsed thulium YAG laser versus a holmium YAG laser on dusting lithotripsy: In vitro analysis using an optical motion capture system.","authors":"Kazuyoshi Nakao, Takashi Yoshida, Kenta Takayasu, Keiki Chuman, Tadao Matsunaga, Hidefumi Kinoshita","doi":"10.1111/iju.15548","DOIUrl":"https://doi.org/10.1111/iju.15548","url":null,"abstract":"","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141758625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mohamed Zouari, Manel Belhajmansour, Najoua Ben Kraiem, Hana Ben Ameur, Mahdi Ben Dhaou, Riadh Mhiri
{"title":"Risk factors for 30-day complications following ureteral reimplantation for vesicoureteral reflux in children.","authors":"Mohamed Zouari, Manel Belhajmansour, Najoua Ben Kraiem, Hana Ben Ameur, Mahdi Ben Dhaou, Riadh Mhiri","doi":"10.1111/iju.15549","DOIUrl":"https://doi.org/10.1111/iju.15549","url":null,"abstract":"","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141751677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: A multicenter database was utilized to examine the current treatment landscape and clinical outcomes among patients with metastatic hormone-sensitive prostate cancer (mHSPC) following approval of upfront androgen receptor signaling inhibitors (ARSIs).
Methods: We retrospectively analyzed patients with mHSPC who commenced treatment between February 2018 and June 2023. The Kaplan-Meier method was used to assess oncological outcomes, including time to castration-resistant prostate cancer (CRPC), progression-free survival 2 (PFS2, duration from initial treatment to tumor progression during second-line treatment), cancer-specific survival (CSS), and overall survival (OS). Cox regression analyses were performed to determine the impact of treatment choices on oncological outcomes. In addition, the incidence rate of adverse events was assessed.
Results: In total, 829 patients were analyzed; 42.5% received ARSIs with androgen deprivation therapy (ADT), 44.0% received combined androgen blockade (CAB), and 13.5% received ADT alone. Kaplan-Meier curves and multivariate Cox regression analyses indicated higher rates of CRPC and shorter PFS2 in patients treated with CAB versus ARSIs with ADT. By contrast, CSS and OS were not significantly different between the ARSI with ADT group and the CAB group. Grades 3-4 adverse events occurred in 1.9% of patients receiving CAB and 6.0% of those receiving ARSIs with ADT.
Conclusions: Initial treatment with ARSIs in combination with ADT resulted in a longer time to CRPC and longer PFS2 compared to CAB. Although CAB and ADT alone were associated with fewer adverse events, ARSIs with ADT should be considered a first-line treatment option given its superior oncological outcomes.
{"title":"Changes in the treatment landscape of metastatic hormone-sensitive prostate cancer following approval of upfront androgen receptor signaling inhibitors: A multicenter study.","authors":"Fumihiko Urabe, Katsuki Muramoto, Takafumi Yanagisawa, Wataru Fukuokaya, Keiichiro Mori, Kojiro Tashiro, Kota Katsumi, Hidetsugu Takahashi, Kentaro Yoshihara, Keiichiro Miyajima, Yu Imai, Kosuke Iwatani, Sotaro Kayano, Taro Igarashi, Masaya Murakami, Shunsuke Tsuzuki, Tatsuya Shimomura, Hiroki Yamada, Jun Miki, Takahiro Kimura","doi":"10.1111/iju.15546","DOIUrl":"https://doi.org/10.1111/iju.15546","url":null,"abstract":"<p><strong>Background: </strong>A multicenter database was utilized to examine the current treatment landscape and clinical outcomes among patients with metastatic hormone-sensitive prostate cancer (mHSPC) following approval of upfront androgen receptor signaling inhibitors (ARSIs).</p><p><strong>Methods: </strong>We retrospectively analyzed patients with mHSPC who commenced treatment between February 2018 and June 2023. The Kaplan-Meier method was used to assess oncological outcomes, including time to castration-resistant prostate cancer (CRPC), progression-free survival 2 (PFS2, duration from initial treatment to tumor progression during second-line treatment), cancer-specific survival (CSS), and overall survival (OS). Cox regression analyses were performed to determine the impact of treatment choices on oncological outcomes. In addition, the incidence rate of adverse events was assessed.</p><p><strong>Results: </strong>In total, 829 patients were analyzed; 42.5% received ARSIs with androgen deprivation therapy (ADT), 44.0% received combined androgen blockade (CAB), and 13.5% received ADT alone. Kaplan-Meier curves and multivariate Cox regression analyses indicated higher rates of CRPC and shorter PFS2 in patients treated with CAB versus ARSIs with ADT. By contrast, CSS and OS were not significantly different between the ARSI with ADT group and the CAB group. Grades 3-4 adverse events occurred in 1.9% of patients receiving CAB and 6.0% of those receiving ARSIs with ADT.</p><p><strong>Conclusions: </strong>Initial treatment with ARSIs in combination with ADT resulted in a longer time to CRPC and longer PFS2 compared to CAB. Although CAB and ADT alone were associated with fewer adverse events, ARSIs with ADT should be considered a first-line treatment option given its superior oncological outcomes.</p>","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141731198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Qihao Sun, Kun Du, Shulei Sun, Yuxin Liu, Houtao Long, Daofeng Zhang, Junhao Zheng, Xiaoliang Sun, Yong Zhao, Haiyang Zhang
Objectives: This study aims to evaluate the efficacy of local treatment (LT), including radiotherapy (RT) and cytoreductive prostatectomy (CRP), in improving outcomes for patients with oligometastatic prostate cancer (OmPCa).
Methods: A systematic review and meta-analysis of articles from PubMed, Embase, and Web of Science published between 2010 and November 2023 were conducted. The study included 11 articles, comprising three randomized controlled trials (RCTs) and eight retrospective analyses. The study assessed overall survival (OS), radiographic progression-free survival (rPFS), prostate-specific antigen (PSA) PFS, cancer-specific survival (CSS), and complication rate (CR).
Results: OS was significantly improved in the LT group, with both RCTs and non-RCTs showing statistical significance [hazard ratios (HR) = 0.64; 95% confidence intervals (95% CIs), 0.51-0.80; p < 0.0001; HR = 0.55; 95% CIs, 0.40-0.77; p = 0.0004]. For rPFS, RCTs did not show statistically significant outcomes (HR = 0.60; 95% CIs, 0.34-1.07; p = 0.09), whereas non-RCTs demonstrated significant results (HR = 0.42; 95% CIs, 0.24-0.72; p = 0.002). Both RCTs and non-RCTs showed a significant improvement in PSA-PFS (HR = 0.44; 95%CI, 0.29-0.67; p = 0.0001; HR = 0.51; 95% CIs, 0.32-0.81; p = 0.004). For CSS, RCTs demonstrated statistical differences (HR = 0.65; 95% CIs, 0.47-0.90; p = 0.009), whereas non-RCTs did not (HR = 0.61; 95% CIs, 0.29-1.27; p = 0.19). Regarding CR, the risk difference was -0.22 (95% CIs, -0.32 to -0.12; p < 0.00001).
Conclusion: LT significantly improved OS and PFS in patients with OmPCa. Further RCTs are necessary to confirm these results.
研究目的本研究旨在评估局部治疗(LT),包括放射治疗(RT)和细胞修复性前列腺切除术(CRP)在改善寡转移性前列腺癌(OmPCa)患者预后方面的疗效:对2010年至2023年11月期间发表在PubMed、Embase和Web of Science上的文章进行了系统综述和荟萃分析。研究共纳入11篇文章,包括3项随机对照试验(RCT)和8项回顾性分析。研究评估了总生存期(OS)、放射学无进展生存期(rPFS)、前列腺特异性抗原(PSA)无进展生存期、癌症特异性生存期(CSS)和并发症发生率(CR):结果:LT组的OS明显改善,RCTs和非RCTs均显示出统计学意义[危险比(HR)=0.64;95%置信区间(95% CIs),0.51-0.80;P 结论:LT能明显改善前列腺癌患者的OS和PFS:LT能明显改善OmPCa患者的OS和PFS。有必要进行更多的 RCT 研究来证实这些结果。
{"title":"Local treatment benefits patients with oligometastatic prostate cancer: A systematic review and meta-analysis.","authors":"Qihao Sun, Kun Du, Shulei Sun, Yuxin Liu, Houtao Long, Daofeng Zhang, Junhao Zheng, Xiaoliang Sun, Yong Zhao, Haiyang Zhang","doi":"10.1111/iju.15540","DOIUrl":"https://doi.org/10.1111/iju.15540","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to evaluate the efficacy of local treatment (LT), including radiotherapy (RT) and cytoreductive prostatectomy (CRP), in improving outcomes for patients with oligometastatic prostate cancer (OmPCa).</p><p><strong>Methods: </strong>A systematic review and meta-analysis of articles from PubMed, Embase, and Web of Science published between 2010 and November 2023 were conducted. The study included 11 articles, comprising three randomized controlled trials (RCTs) and eight retrospective analyses. The study assessed overall survival (OS), radiographic progression-free survival (rPFS), prostate-specific antigen (PSA) PFS, cancer-specific survival (CSS), and complication rate (CR).</p><p><strong>Results: </strong>OS was significantly improved in the LT group, with both RCTs and non-RCTs showing statistical significance [hazard ratios (HR) = 0.64; 95% confidence intervals (95% CIs), 0.51-0.80; p < 0.0001; HR = 0.55; 95% CIs, 0.40-0.77; p = 0.0004]. For rPFS, RCTs did not show statistically significant outcomes (HR = 0.60; 95% CIs, 0.34-1.07; p = 0.09), whereas non-RCTs demonstrated significant results (HR = 0.42; 95% CIs, 0.24-0.72; p = 0.002). Both RCTs and non-RCTs showed a significant improvement in PSA-PFS (HR = 0.44; 95%CI, 0.29-0.67; p = 0.0001; HR = 0.51; 95% CIs, 0.32-0.81; p = 0.004). For CSS, RCTs demonstrated statistical differences (HR = 0.65; 95% CIs, 0.47-0.90; p = 0.009), whereas non-RCTs did not (HR = 0.61; 95% CIs, 0.29-1.27; p = 0.19). Regarding CR, the risk difference was -0.22 (95% CIs, -0.32 to -0.12; p < 0.00001).</p><p><strong>Conclusion: </strong>LT significantly improved OS and PFS in patients with OmPCa. Further RCTs are necessary to confirm these results.</p>","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: To evaluate the clinical characteristics of oligometastatic disease (OMD) in metastatic urothelial carcinoma (mUC) with visceral metastases when classified into synchronous and metachronous metastases.
Methods: Of 957 cases of de novo mUC treated between 2008 and 2023, 374 with visceral metastases were analyzed. Cases were classified into OMD with up to three metastatic lesions and polymetastatic disease (PMD), and into synchronous and metachronous metastases. The clinical characteristics and overall survival (OS) for each group were analyzed.
Results: Overall, 196 (52.4%) had synchronous metastasis and 178 (47.6%) had metachronous metastasis. Median OS for synchronous metastases was significantly shorter than for metachronous metastases (12.1 months vs. 15.3 months, p = 0.011). Among the synchronous metastases, 48 (24.5%) were OMD and 148 (75.6%) were PMD. There was no significant difference in OS between the OMDs and PMDs (median 14.9 months vs. 11.7 months, p = 0.32), and only decreased albumin level was identified as a significant predictor of poor OS. Among the metachronous metastases, 64 (36.0%) were OMD and 114 (64.0%) were PMD. There was no significant difference in OS between the OMD and PMD (median 21.2 months vs. 15.0 months, p = 0.35), and no significant predictors of poor OS were identified.
Conclusions: For mUC with visceral metastases, the timing of metastasis appearance was associated with prognosis, with synchronous metastases being a poorer prognostic factor compared to metachronous metastases. There was no prognostic difference between OMD and PMD with visceral metastases when classified into synchronous or metachronous metastases.
{"title":"Outcomes and prognostic factors in patients with synchronous and metachronous oligometastatic urothelial carcinoma with visceral metastases.","authors":"Soichiro Yoshida, Yuya Maezawa, Kensaku Ishihara, Naoki Inoue, Kenji Tanabe, Keita Izumi, Motohiro Fujiwara, Masahiro Toide, Takanobu Yamamoto, Sho Uehara, Saori Araki, Masaharu Inoue, Ryoji Takazawa, Noboru Numao, Yukihiro Ohtsuka, Hajime Tanaka, Yasuhisa Fujii","doi":"10.1111/iju.15542","DOIUrl":"https://doi.org/10.1111/iju.15542","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the clinical characteristics of oligometastatic disease (OMD) in metastatic urothelial carcinoma (mUC) with visceral metastases when classified into synchronous and metachronous metastases.</p><p><strong>Methods: </strong>Of 957 cases of de novo mUC treated between 2008 and 2023, 374 with visceral metastases were analyzed. Cases were classified into OMD with up to three metastatic lesions and polymetastatic disease (PMD), and into synchronous and metachronous metastases. The clinical characteristics and overall survival (OS) for each group were analyzed.</p><p><strong>Results: </strong>Overall, 196 (52.4%) had synchronous metastasis and 178 (47.6%) had metachronous metastasis. Median OS for synchronous metastases was significantly shorter than for metachronous metastases (12.1 months vs. 15.3 months, p = 0.011). Among the synchronous metastases, 48 (24.5%) were OMD and 148 (75.6%) were PMD. There was no significant difference in OS between the OMDs and PMDs (median 14.9 months vs. 11.7 months, p = 0.32), and only decreased albumin level was identified as a significant predictor of poor OS. Among the metachronous metastases, 64 (36.0%) were OMD and 114 (64.0%) were PMD. There was no significant difference in OS between the OMD and PMD (median 21.2 months vs. 15.0 months, p = 0.35), and no significant predictors of poor OS were identified.</p><p><strong>Conclusions: </strong>For mUC with visceral metastases, the timing of metastasis appearance was associated with prognosis, with synchronous metastases being a poorer prognostic factor compared to metachronous metastases. There was no prognostic difference between OMD and PMD with visceral metastases when classified into synchronous or metachronous metastases.</p>","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Editorial Comment to Clinical characteristics and survival outcomes of elderly patients with de novo metastatic germ cell tumors","authors":"Takeshi Kishida MD","doi":"10.1111/iju.15525","DOIUrl":"10.1111/iju.15525","url":null,"abstract":"","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141467944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Benign prostatic hyperplasia, a prevalent condition in aging men, is characterized by the proliferation of prostatic epithelial and stromal cells, which leads to bladder outlet obstruction and the exacerbation of lower urinary tract symptoms. There is increasing evidence that chronic prostatic inflammation contributes to the pathogenesis and progression of benign prostatic hyperplasia. This review explores the complex relationship between chronic inflammation and benign prostatic hyperplasia, focusing on the underlying mechanisms, clinical implications, and current therapeutic approaches. The pathophysiology of benign prostatic hyperplasia is multifaceted, involving factors such as hormonal changes, hypoxia, urine reflux into prostatic ducts and stroma, autoimmune responses, and infection-induced inflammation. Inflammatory cytokines, particularly interleukin-17 and interleukin-8, may play key roles in tissue remodeling and smooth muscle contraction within the prostate, thereby influencing benign prostatic hyperplasia progression. Current therapies for benign prostatic hyperplasia include α1-blockers, phosphodiesterase 5 inhibitors, 5α-reductase inhibitors, and plant-based treatments (e.g., pollen extract). These therapies aim to alleviate symptoms by reducing prostatic inflammation, improving blood flow, and inhibiting hormonal pathways involved in prostatic enlargement. However, patients with chronic prostatic inflammation often experience more severe lower urinary tract symptoms and may be resistant to conventional treatments. This resistance has prompted the exploration of alternative therapies targeting inflammation. Chronic prostatic inflammation plays a central role in the pathogenesis and severity of benign prostatic hyperplasia. An understanding of its mechanisms will enable the development of more effective treatments to improve the quality of life among patients with benign prostatic hyperplasia.
{"title":"Chronic inflammation in benign prostatic hyperplasia: Pathophysiology and treatment options","authors":"So Inamura, Naoki Terada","doi":"10.1111/iju.15518","DOIUrl":"10.1111/iju.15518","url":null,"abstract":"<p>Benign prostatic hyperplasia, a prevalent condition in aging men, is characterized by the proliferation of prostatic epithelial and stromal cells, which leads to bladder outlet obstruction and the exacerbation of lower urinary tract symptoms. There is increasing evidence that chronic prostatic inflammation contributes to the pathogenesis and progression of benign prostatic hyperplasia. This review explores the complex relationship between chronic inflammation and benign prostatic hyperplasia, focusing on the underlying mechanisms, clinical implications, and current therapeutic approaches. The pathophysiology of benign prostatic hyperplasia is multifaceted, involving factors such as hormonal changes, hypoxia, urine reflux into prostatic ducts and stroma, autoimmune responses, and infection-induced inflammation. Inflammatory cytokines, particularly interleukin-17 and interleukin-8, may play key roles in tissue remodeling and smooth muscle contraction within the prostate, thereby influencing benign prostatic hyperplasia progression. Current therapies for benign prostatic hyperplasia include α1-blockers, phosphodiesterase 5 inhibitors, 5α-reductase inhibitors, and plant-based treatments (e.g., pollen extract). These therapies aim to alleviate symptoms by reducing prostatic inflammation, improving blood flow, and inhibiting hormonal pathways involved in prostatic enlargement. However, patients with chronic prostatic inflammation often experience more severe lower urinary tract symptoms and may be resistant to conventional treatments. This resistance has prompted the exploration of alternative therapies targeting inflammation. Chronic prostatic inflammation plays a central role in the pathogenesis and severity of benign prostatic hyperplasia. An understanding of its mechanisms will enable the development of more effective treatments to improve the quality of life among patients with benign prostatic hyperplasia.</p>","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/iju.15518","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141456832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}