Objective. —To define the characteristics of serum prostate-specific antigen (PSA) in a population of healthy men without clinically evident prostate cancer, but who are at risk for developing the malignancy. The influence of patient age and prostatic size on the serum PSA concentration was assessed in order to use PSA more appropriately to detect clinically significant prostate cancer at an early, potentially curable stage. Design. —Prospective, community-based study. Participants. —Between December 1989 and March 1991, 2119 healthy men aged 40 to 79 years from Olmsted County, Minnesota, were entered into a prospective study to assess the natural history of benign prostatic hyperplasia. Of these, 537 (25%) were randomly chosen to participate in a detailed clinical examination that included a serum PSA determination (Tandem-R PSA assay), digital rectal examination, and transrectal ultrasonography. Four hundred seventy-one (88%) completed the prostatic evaluation and had no evidence of prostate cancer by any of these three diagnostic tests; these men formed the study population on which all analyses were performed. Main Outcome Measure. —Serum PSA concentration, prostatic volume, and PSA density (serum PSA level/prostatic volume) as a function of patient age. Results. —The serum PSA concentration is correlated with patient age (r=.43;P Conclusions. —The serum PSA concentration is directly correlated with patient age and prostatic volume, the latter of which also is directly related to age. Thus, rather than rely on a single reference range for men of all age groups, it is more appropriate to have age-specific reference ranges. These age-specific reference ranges have the potential to make serum PSA a more discriminating tumor marker for detecting clinically significant cancers in older men (increasing specificity) and to find more potentially curable cancers in younger men (increasing sensitivity). (JAMA. 1993;270:860-864)

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=jama&articleId=407988&pdfFileName=jama_270_7_041.pdf

Serum prostate-specific antigen in a community-based population of healthy men. Establishment of age-specific reference ranges.

Prostate specific antigen: a critical assessment of the most useful tumor marker for adenocarcinoma of the prostate.

Objective. ——To evaluate longitudinal changes in prostate-specific antigen (PSA) levels in men with and without prostate disease. Design. —Case-control study of men with and without prostate disease who were participants in a prospective aging study. Setting. —Gerontology Research Center of the National Institute on Aging; the Baltimore (Md) Longitudinal Study of Aging. Patients. —Sixteen men with no prostate disease (control group), 20 men with a histologic diagnosis of benign prostatic hyperplasia (BPH), and 18 men with a histologic diagnosis of prostate cancer. Outcome Measures. —Multiple PSA and androgen determinations on serum samples obtained from 7 to 25 years prior to histologic diagnosis or exclusion of prostate disease. Results. —Changes in androgen levels with age did not differ between groups. Control subjects did not show a significant change in PSA levels with age. There was a significant difference in the age-adjusted rate of change in PSA levels between groups (prostate cancer>BPH>control; P Conclusions. —The most significant factor affecting serum PSA levels with age is the development of prostate disease. Rate of change in PSA levels may be a sensitive and specific early clinical marker for the development of prostate cancer. ( JAMA . 1992;267:2215-2220)

Longitudinal evaluation of prostate-specific antigen levels in men with and without prostate disease.

Background Benign prostatic hyperplasia is a progressive, androgen-dependent disease resulting in enlargement of the prostate gland and urinary obstruction. Preventing the conversion of testosterone to its tissue-active form, dihydrotestosterone, by inhibiting the enzyme 5 alpha-reductase could decrease the action of androgens in their target tissues; in the prostate the result might be a decrease in prostatic hyperplasia and therefore in symptoms of urinary obstruction. Methods In a double-blind study, we evaluated the effect of two doses of finasteride (1 mg and 5 mg) and placebo, each given once daily for 12 months, in 895 men with prostatic hyperplasia. Urinary symptoms, urinary flow, prostatic volume, and serum concentrations of dihydrotestosterone and prostate-specific antigen were determined periodically during the treatment period. Results As compared with the men in the placebo group, the men treated with 5 mg of finasteride per day had a significant decrease in total urinary-symptom scores (P less than 0.001), an increase of 1.6 ml per second (22 percent, P less than 0.001) in the maximal urinary-flow rate, and a 19 percent decrease in prostatic volume (P less than 0.001). The men treated with 1 mg of finasteride per day did not have a significant decrease in total urinary-symptom scores, but had an increase of 1.4 ml per second (23 percent) in the maximal urinary-flow rate, and an 18 percent decrease in prostatic volume. The men given placebo had no changes in total urinary-symptom scores, an increase of 0.2 ml per second (8 percent) in the maximal urinary-flow rate, and a 3 percent decrease in prostatic volume. The frequency of adverse effects in the three groups was similar, except for a higher incidence of decreased libido, impotence, and ejaculatory disorders in the finasteride-treated groups. Conclusions The treatment of benign prostatic hyperplasia with 5 mg of finasteride per day results in a significant decrease in symptoms of obstruction, an increase in urinary flow, and a decrease in prostatic volume, but at a slightly increased risk of sexual dysfunction.

https://www.nejm.org/doi/pdf/10.1056/NEJM199210223271701

The effect of finasteride in men with benign prostatic hyperplasia. The Finasteride Study Group.

A decline in testicular function is recognized as a common occurrence in older men However data are sparse regarding the effects of hypogonadism on age-associated physical and cognitive declines This study was undertaken to examine the year-long effects of testosterone administration in this patient population Fifteen hypogonadal men (mean age 68 ± 6 yr) were randomly assigned to receive a placebo, and 17 hypogonadal men (mean age 65± 7 yr) were randomly assigned to receive testosterone Hypogonadism was defined as a bioavailable testosterone <60 ng/dL The men received injections of placebo or 200 mg testosterone cypionate biweekly for 12 months The main outcomes measured included grip strength, hemoglobin, prostate-specific antigen, leptin, and memory Testosterone improved bilateral grip strength (P < 005 by ANOVA) and increased hemoglobin (P < 0001 by ANOVA) The men assigned to testosterone had greater decreases in leptin than those assigned to the control group (mean ± sem: −20 ± 09 ng/dL vs

Testosterone Replacement in Older Hypogonadal Men: A 12-Month Randomized Controlled Trial

We examined the influence of androgens on benign prostatic hyperplasia, using nafarelin acetate, a potent luteinizing-hormone-releasing hormone agonist, to achieve reversible androgen deprivation in men with benign prostatic hyperplasia. Nine patients with bladder-outlet obstruction due to benign prostatic hyperplasia were treated with subcutaneous nafarelin acetate (400 micrograms per day) in an open trial for six months. In all patients, serum testosterone decreased to castrate levels. Objective observations included uroflowmetry, measurement of residual urine volume, determination of prostatic size by ultrasonography, and prostatic biopsy. In all patients, the prostate regressed to a mean (+/- SEM) of 75.8 +/- 3 percent of the initial size (range, 52 to 86; P less than 0.005); the regression reached a plateau after four months. Morphologic analysis of biopsy specimens showed regression of glandular epithelium. Three of nine patients had clinical improvement with treatment. Six months after the cessation of treatment, plasma testosterone levels had returned to normal and the size of the prostate had increased to 99 +/- 5.5 percent of the initial size. These findings suggest that androgens have an important supportive role in established benign prostatic hyperplasia and that testicular suppression will benefit some patients. However, this form of treatment could be applicable only in carefully selected patients who were not surgical candidates, and it would need to be maintained indefinitely.

The effect of nafarelin acetate, a luteinizing-hormone-releasing hormone agonist, on benign prostatic hyperplasia

The influence of reversible androgen deprivation on serum prostate-specific antigen levels in men with benign prostatic hyperplasia

To examine the role of testosterone in the maintenance of hemoglobin levels, we studied the effect of reversible androgen deprivation on hemoglobin, serum immunoreactive erythropoietin, and serum testosterone in seven men treated with a luteinizing hormone-releasing factor (LHRH) agonist for 6 months and then followed for an additional 6 months. The mean serum testosterone level was 4.35 +/- 1.05 ng/ml initially and it decreased to castrate levels in all patients by 6 months. After stopping therapy, there was a rapid increase in serum testosterone such that by 12 months the mean concentration was normal. The pretreatment hemoglobin was 15.2 +/- 0.9 g/dl (mean +/- SD); after 6 months of androgen deprivation it had fallen to 14.1 +/- 0.4 g/dl (P less than 0.05). Six months after stopping therapy, the hemoglobin rose to pre-treatment levels. Before treatment, serum immunoreactive erythropoietin was 9.5 +/- 4.6 mu/ml (mean +/- SD) and did not change significantly during or after the 6 month period of androgen deprivation. No significant inhibition of burst-forming unit-erythroid (BFU-E) or colony-forming unit-granulocyte macrophage (CFU-GM) was observed at the serum level of nafarelin acetate obtainable in vivo. These data suggest that, within the normal range of hemoglobin in men, androgens are a determinant of the red cell mass.

Effect of reversible androgen deprivation on hemoglobin and serum immunoreactive erythropoietin in men

Campbell-Walsh Urology 10th Edition Review, 10th Edition - Libros de Medicina - Urologia General - 71,99

Campbell-Walsh Urology 10th Edition Review, 10th Edition

Tienda online donde Comprar Campbell-Walsh Urology. 4 Vol., 10th Edition al precio 466,20 € de Craig A. Peters | Alan W. Partin | Andrew C. Novick | Louis R. Kavoussi | Alan J. Wein, tienda de Libros de Medicina, Libros de Urologia - Urologia General

Craig A. Peters

Papers

The effect of nafarelin acetate, a luteinizing-hormone-releasing hormone agonist, on benign prostatic hyperplasia

The influence of reversible androgen deprivation on serum prostate-specific antigen levels in men with benign prostatic hyperplasia

Effect of reversible androgen deprivation on hemoglobin and serum immunoreactive erythropoietin in men

Campbell-Walsh Urology 10th Edition Review, 10th Edition

Comprar Campbell-Walsh Urology. 4 Vol., 10th Edition | Craig A. Peters | 9781416069119 | Saunders