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Neoplasms of the Prostate Gland. IN: Tanagho, E.; McAninch, J., eds. Smith’s General Urology. 17th ed. Columbus, OH: McGraw Hill. 2008. pp 348-374.

This chapter about neoplasms of the prostate gland is from an updated edition of a comprehensive textbook about urology that offers an overview of the diagnosis and treatment of diseases and disorders common to the genitourinary tract. The authors note that the prostate gland is the male organ most commonly afflicted with either benign or malignant neoplasms. Topics include the incidence and epidemiology, etiology, pathology, pathophysiology, clinical findings, differential diagnosis, and treatment of benign prostatic hyperplasia (BPH); the incidence and epidemiology, molecular genetics and pathobiology, and treatment of prostate cancer; and prostate cancer chemoprevention. Treatment options for prostate cancer include watchful waiting and active surveillance, radical prostatectomy, external beam radiation therapy, brachytherapy radiation therapy, and cryosurgery and high-intensity focused ultrasound (HIFU). One section discusses therapy for recurrent disease. The chapter is illustrated with numerous black-and-white drawings and photographs. The chapter concludes with an extensive list of references, categorized by topic. 4 figures. 6 tables. 92 references.

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NIDDK Prostate Research Strategic Plan. Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse. 2008. 88 p.

Benign diseases of the prostate are among the most common urologic diseases seen by health care professionals. Two of the most significant prostate disorders, based on a variety of troubling symptoms and resulting in diminished quality of life (QOL) of affected males are benign prostate hyperplasia (BPH) and prostatitis. This document presents a blueprint that investigators and the Federal Government can use to identify where the research in this field has been, where the field is now and, most important, where future research efforts should be directed. Not surprisingly, there is overlap in the major sections comprising this document with respect to some topics and recommendations. The document categorizes research efforts into four areas: basic science; epidemiology and population-based studies; translational opportunities; and clinical sciences. BPH, which is often associated with a collection of lower urinary tract symptoms (LUTS), affects men of all races and ethnic groups and can progress in severity over time. If untreated, BPH can lead to significant consequences, such as acute urinary retention, incontinence, and urinary tract infection. Prostatitis affects men of all ages and leads to significant bother and diminished QOL. Prostatitis comprises four categories of acute or chronic disease, including chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Despite its relatively high prevalence—estimates have ranged from 2.7 to 9.7 percent in men 18 years and older—prostatitis remains a poorly understood disorder and is very challenging to treat. Moreover, prostatitis, specifically in its chronic form CP/CPPS, can be physically and psychologically devastating for many patients. Specific research topics considered in this report include: vascular biology, metabolism, inflammation and reactive stroma, stem cells, hormonal effects, animal models, aging, neurobiology, proteomics and new technologies, quality of care, quality of life, costs, serum and tissue biorepositories for prostatic disease, database studies and informatics, histopathology, genetics, measuring disease severity and outcome, drug therapies, phytotherapies, and behavioral and lifestyle interventions. Each section includes figures and tables and numerous references. 14 figures. 6 tables. 151 references.

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What I Need to Know About Prostate Problems. Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse. 2008. 20 p.

This booklet familiarizes readers with the anatomy and physiology of the prostate, as well as prostate problems that men may experience. The booklet reviews the anatomy and function of the prostate and notes that for men younger than 50, the most common prostate problem is prostatitis. For men older than 50, the most common prostate problem is benign prostatic hyperplasia (BPH), a noncancerous enlargement of the prostate gland. The booklet focuses on BPH, describing the symptoms of the condition, the diagnostic tests that may be used to confirm BPH, treatment options, transurethral resection of the prostate (TURP), other transurethral treatment options, surgery, the potential side effects of prostate treatments, and current research efforts in this area. The booklet concludes with a pronunciation guide for some of the medical terms and contact information for three resource organizations that can provide additional information to readers: American Urological Association Foundation (1–866–746–4282 or www.UrologyHealth.org), the Prostatitis Foundation (1–888–891–4200 or www.prostatitis.org), and the National Cancer Institute (1–800–422–6237 or www.cancer.gov). Readers are referred to the National Kidney and Urologic Diseases Information Clearinghouse at 1–800–891–5390 or www.kidney.niddk.nih.gov for additional publications and more information. The booklet is written in nontechnical language, with medical terms explained, and illustrated with line drawings of patients and health care providers. 9 figures.

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Benign Prostatic Hyperplasia, Bladder Neck Obstruction, and Prostatitis. IN: Atlas of Urodynamics. 2nd ed. Williston, VT: Blackwell Publishing Inc. 2007. pp 96-119.

The purpose of urodynamic testing is to measure and record various physiological variables while the patient is experiencing those symptoms which make up the presenting complaint. This chapter on benign prostatic hyperplasia (BPH), bladder neck obstruction, and prostatitis is from an atlas of urodynamics that provides a comprehensive, detailed look at the indications, technology, and use of urodynamics in modern urologic practice. The chapter begins with a section defining the terminology currently in use, then goes on to cover mechanical obstruction, smooth muscle obstruction, differential diagnosis, urodynamic evaluation, primary bladder neck obstruction, acquired voiding dysfunction, bladder diverticula, the neurogenic bladder and BPH, and chronic pelvic pain syndrome and prostatitis. The authors then present case illustrations, accompanied by figures and black-and-white photographs of actual urodynamic tests. The authors note that, even in patients with documented prostatic obstruction, factors other than the mechanical effects of prostatic bulk play an important role. These include detrusor muscle strength and tone, bladder wall compliance, smooth muscle function of the bladder neck and prostatic urethra, striated muscle function of the prostate-membranous urethra, and interstitial factors such as elastin and collagen type. 18 figures. 1 table. 15 references.

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Benign Prostatic Hyperplasia. IN: Litwin, M.S.; Saigal, C.S., eds. Urologic Diseases in America. Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse. pp. 43-70.

Benign prostatic hyperplasia (BPH) is a common benign neoplasm, a chronic condition that increases in both incidence and prevalence with age. BPH is associated with progressive lower urinary tract symptoms and affects nearly three out of four men during the seventh decade of life. This chapter on BPH is from a lengthy text that offers a comprehensive portrait of the illness burden and resource use associated with the major urologic diseases in the United States. In this chapter, the authors discuss definition and diagnosis; prevalence and incidence; natural history; risk factors; clinical evaluation; trends in health care resource utilization for this condition, including inpatient and outpatient care, pharmaceutical management, surgical management, and nursing home care; and economic impact. They conclude by noting that BPH therapy trends are moving away from the gold-standard surgical options toward less-invasive drug therapy. However, complementary and alternative therapies for BPH remain poorly characterized and their efficacy largely undetermined. 5 figures. 26 tables. 19 references.

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Prostate Problems: What Men Need to Know. Los Problemas de Prostata: Lo Que Los Hombres Deben Saber. Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse. 2007. 4 p.

This fact sheet answers common questions that men may have about prostate problems and their possible impact on urination. Topics include the anatomy and physiology of the prostate, the different types of prostate problems, the symptoms of prostatitis, the causes of prostatitis, treatment options, the symptoms of benign prostatic hyperplasia (BPH), the causes of BPH, other problems that can cause the same symptoms as prostatitis and BPH, and treatment strategies. Readers are referred to the National Kidney and Urologic Diseases Information Clearinghouse (NIKUDIC) for more information. Two pages of the fact sheet are in English; the other two pages present the same information in Spanish.

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Benign Prostatic Hyperplasia. IN: Kellogg Parsons, J.; James Wright, E., eds. Brady Urology Manual. New York, NY: Informa Healthcare USA. 2006. pp 71-84.

This chapter about benign prostatic hyperplasia (BPH) is from a reference handbook that offers a comprehensive overview of urology, presented in outline and bulleted formats for ease of access in the busy health care world of hospital emergency rooms and outpatient clinics. The author defines BPH as uncontrolled, nonmalignant growth of the prostate characterized by hyperplasia of epithelial and stromal cells within the transition zone. The chapter covers prostate anatomy, presentation and epidemiology, etiology, pathophysiology, diagnosis, initial patient evaluation, general principles of treatment, watchful waiting, medical therapy, and minimally invasive therapies, including transurethral microwave therapy (TUMT), transurethral needle ablation (TUNA), prostatic urethral stents, transurethral resection of the prostate (TURP), transurethral electrovaporization of the prostate (TUVP), transurethral incision of the prostate (TUIP), laser ablation, and open prostatectomy. Clinically, BPH typically presents with lower urinary tract symptoms (LUTS). The American Urological Association (AUA) Symptom Index can be used as a measure for grading symptom severity, determining need for therapy, and assessing response to therapy. The authors stress that, due to the variability of the impact of LUTS on quality of life among men with BPH, the patient’s perception of the severity of the condition remains a primary determinant in the selection of management options. The chapter concludes with a list of references for additional reading and an appendix that reprints the AUA symptom index for BPH. 2 appendices. 2 figures. 44 references.

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Bladder Outflow Obstruction. IN: Dawson, C.; Whitfield, H.N., eds. ABC of Urology. Williston, VT: Blackwell Publishing Inc. 2006. pp. 6-9.

Bladder outflow obstruction is most commonly the result of benign prostatic hyperplasia (BPH). This chapter on bladder outflow obstruction is from an atlas of basic urologic problems that is designed to help general practitioners address the ever-increasing number of patients presenting to their offices with urological problems. In this chapter, the author focuses on bladder outflow obstruction that is secondary to BPH. Topics include the patient history, examination, and investigations, which culminate in diagnosis; and treatment, which can include watchful waiting, drug therapy, and surgical intervention. The author concludes that transurethral resection of the prostate (TURP) remains the gold standard treatment for bladder outflow obstruction as a result of BPH. Other, more minimally invasive techniques, still need to be compared with TURP through research studies to provide better data on durability, cost-effectiveness, and long-term benefits. Two final brief sections consider urethral stricture and bladder neck dysfunction as other potential causes of bladder outflow obstruction. The chapter features a few pages of text, summaries of information in charts and tables, and full-color photographs and illustrations. 4 figures. 6 tables.

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Evaluation of the Economic Costs and Patient-Related Consequences of Treatments for Benign Prostatic Hyperplasia. BJU International. 97(5): 1007-1016. May 2006.

This article reports on a study undertaken to compare the costs and effectiveness of treatments for benign prostatic hyperplasia (BPH), including watchful waiting, drug therapy, transurethral microwave thermotherapy (TUMT), and transurethral resection of the prostate (TURP). The study used a Markov model over a 20-year period and the societal perspective to evaluate the costs of treatment alternatives for BPH. The authors note that considering something the “best” treatment depends on the value that an individual and society place on costs and consequences. Alpha-blockers are less expensive than the alternatives and are effective at relieving patient-reported symptoms. Unfortunately, they have little effect on clinical outcomes and have the highest BPH progression rate. Other treatments have lower disease progression and better clinical outcomes, but are more expensive and entail more invasive treatments. TURP remains the gold standard for surgical procedures. The desire to avoid TURP or the 2 weeks of catheterization associated with TUMT might affect a patient’s treatment decision when symptoms are severe. More information about patient preferences and risk aversion is needed to inform treatment decision-making for BPH. 4 figures. 5 tables. 54 references.

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Medical Tests for Prostate Problems. Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse. 2006. 6 p.

The prostate is a walnut-sized gland in men that produces fluid that is a component of semen. The most common prostate problems are prostatitis, defined as inflammation or infection of the prostate, and prostatic enlargement, also known as benign prostatic hyperplasia (BPH). Different prostate problems sometimes have similar symptoms. This brochure describes the medical tests used to diagnose prostate problems. Topics include the importance of talking openly with one’s health care provider; preparing for the diagnostic tests; procedures, including the digital rectal exam (DRE), the prostate-specific antigen (PSA) blood test, urinalysis, transrectal ultrasound and prostate biopsy, magnetic resonance imaging (MRI) and computerized tomography scans (CT), urodynamic tests, abdominal ultrasound, and cystoscopy; what to expect after the procedures; and getting the results. The brochure concludes with the contact information for three resource organizations, American Urological Association Foundation (1–866–746–4282 or www.UrologyHealth.org), the Prostatitis Foundation (1–888–891–4200 or www.prostatitis.org), and the Cancer Information Service (1–800–422–6237 or www.cancer.gov). Readers are referred to the National Kidney and Urologic Diseases Information Clearinghouse at 1–800–891–5390 or www.kidney.niddk.nih.gov for additional publications and more information. The booklet is written in nontechnical language, with medical terms explained, and illustrated with line drawings. 3 figures.

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