Talk:Benign prostatic hyperplasia/Archive 1

Archive 1

BPH Discussion

I have created this discussion for people who have BPH to share their experiences with this condition. For those who contribute, there is a template for your history with BPH -- see Personal History Template below. Contributors to this discussion may enhance the layout and scope of the discussion and/or contribute his personal experience with BPH. I have started the discussion with my own experience using "BPH#1" as my identifier. 68.192.215.132 17:12, 10 September 2005

• Above comment by 68.192.215.132; rest of comment was such a personal experience, removed as superfluous per WP:REFACTOR. --Kinu ^t/_c 19:21, 9 June 2006 (UTC)
• You seem to be mistaking Wikipedia for a discussion board. Please start a blog, but don't use this page for discussions, unless they pertain directly to the article. Thank you. JFW | T@lk 00:20, 11 September 2005 (UTC)

DRE does not increase PSA

There is no evidence to suggest that digital rectal examination increases levels of prostate specific antigen (PSA). Urologists agree on this fact. Please research claims before posting so-called "facts". Unfounded knowledge such as this may dissuade men from receiving a digital rectal examination for fear of an accidental labeling of prostate cancer. This is NOT true. ^ Kumar and Clark, Sixth Edition, Elsevier Saunders, 2005, p. 685 74.129.180.149 (talk) 01:02, 11 April 2007 (UTC).

I concur, to a point. Technically speaking, DRE can increase PSA, but not by a clinically significant amount. We are probably talking about tenths of nanograms per mL. Jfbcubed 18:52, 16 April 2007 (UTC)

I agree with Jfcubed, increases are clinically insignificant. See for example:

1.Lechevallier E, Eghazarian C, Ortega J, Roux F, Coulange C (1999). "Effect of digital rectal examination on serum complexed and free prostate-specific antigen and percentage of free prostate-specific antigen". Urology. 54 (5): 857–61. PMID 10565747.{{cite journal}}: CS1 maint: multiple names: authors list (link)

2.Collins G, Martin P, Wynn-Davies A, Brooman P, O'Reilly P (1997). "The effect of digital rectal examination, flexible cystoscopy and prostatic biopsy on free and total prostate specific antigen, and the free-to-total prostate specific antigen ratio in clinical practice". J. Urol. 157 (5): 1744–7. PMID 9112518.{{cite journal}}: CS1 maint: multiple names: authors list (link)

Derwig 19:21, 16 April 2007 (UTC)

Age and occurance

Can BPH occur in younger males? This article claims that it never does. Peoplesunionpro 01:03, 14 November 2005 (UTC)

It doesn't say that, it just refers to the enlargement in middle-aged and elderly men. It *can* occur in younger men, but it is rare. In younger men, the same symptoms can occur, but they tend to be due to dysfunction of the bladder neck rather than obstruction from prostatic hypertrophy. Jfbcubed 23:07, 29 January 2006 (UTC)

Typically, the symptoms of BPH do not manifest until the 40's or 50's. A younger man exhibiting these symptoms should be carefully evaluated for other causes (i.e. prostatitis). The prostate growth occurs in response to hormonal changes within the prostate, which increase with age. User:Lasermama 05:43, 12 June 2007 (UTC) Lasermama

Symptoms

I have re-written the symptoms section. Any comments are welcomed. I intend to edit the entire article, and will appreciate any help.--Derwig 18:22, 3 March 2007 (UTC)

Slight change to the statement that BPH is necessarily progressive. It isn't. This was pretty well demonstrated by the Ball, et al.'s findings (British Journal of Urology 1981; 53:613-6). The study is not without weaknesses, but they found that there was very little evidence of symptomatic or urodynamic deterioration in untreated men over 5 years. Jfbcubed 17:05, 8 March 2007 (UTC)

The concept of BPH progression has changed significantly since the 1981 study, as was demonstrated in studies like the MTOPS (added to the references, currently #3). Nevertheless, as BPH is not always progressive in all patients, I agree with your edit. --Derwig 17:50, 8 March 2007 (UTC)

I agree that is a compelling point. Technically there is a difference between BPH and lower urinary tract symptoms, however (Hald's rings and all that); also "progression" was defined differently in the two studies we are talking about. Most of those that progressed in MTOPS were deterioration in AUA scores – the AUA didn't publish their scoring system until 11 years after Bristol group (Ball, et al). Progression in the Bristol paper was surgical intervention (there was no accepted medical treatment in those days), acute retention, or a "significant" deterioration in urodynamic variables. I accept these are cruder tests and may explain the different "progression" rates seen in the two studies. My point remains though that both studies did have cohorts that did not progress. In fact, the Bristol paper showed a sizeable number improved with no treatment (I believe – I have neither paper to hand – about 30% improved with conservative management).

To slightly contradict myself however, and for completeness, the Olmsted County paper (Jacobsen, et al., Journal of Urology 1996: 155; 595-600) did show widespread symptomatic progression before patient presentation to a physician. The evidence that this progression continues in the post-presentation period is less strong, although it is difficult to explain why it wouldn't. (Sorry for being so verbose) Jfbcubed 18:35, 8 March 2007 (UTC)

On another topic, while Wilt's paper suggested equivalence of Saw Palmetto it was not a prospective trial. A reasonable attempt to achieve a prospective randomised study was reported in either NEJM or JAMA (can't immediately recall) last year and showed that, at the doses studied (which were commonly available doses), there was no effect above placebo. I'll dig out the paper when I get a chance. It's changed my practice (as I used to cautiously recommend enthusiasts to use Saw Palmetto, now I don't!). Jfbcubed 20:25, 8 March 2007 (UTC)

The NEJM paper is : N Engl J Med. 2006 Feb 9;354(6):557-66. I never recommended phytotherapy, because I thought a true EBM was not availabe. The paragraph dealing with phytotherapy should be edited, it does not reflect current scientific knowledge or clinical practice. Hopefuly I will get to it soon.Derwig 20:36, 8 March 2007 (UTC)

I commend your dedication! Jfbcubed 12:06, 9 March 2007 (UTC)

Is it possible for anesthesia to cause BPH or at least make manifest a condition that might have been latent? 198.45.19.48 (talk) 16:24, 12 March 2008 (UTC)

Causes

What about mentioning the causes? Especially in younger males (even though it's rare). 24.26.101.71 12:47, 18 January 2007

The causeology is not exactly known. There are factors important in the causation, and factors important in its prevention, but this is not like heart disease... Jfbcubed 00:06, 19 January 2007 (UTC)

I was searching the web about this, because my father is now dealing with this problem, but it seems that causes are frequently not a concern. Why is medicine always so concerned with symptomatology, concerned with lowering symptoms instead of searching for the root of the problem? Isn't this like poisoning rats instead of searching where and why are they entering our houses? You may kill them but they will keep coming again and more. 217.129.73.208 (talk) 16:48, 7 April 2008 (UTC)

Diagnosis section

"THIS IS NOT A FACT." probably should be investigated dirther/ tidied up. Not really a good phrase to remain in an encylopedia... 217.155.82.154 12:52, 20 April 2007 (UTC)oaf

No mention of the PCA3 test, which is now used clinically to distinguish between benign prostate enlargement and prostate cancer. Seems like it belongs here. Jedwards01 (talk) 23:55, 3 August 2008 (UTC)

diagnosis of LUTS due to investigation for BPH – perhaps a mention? (LUTS = Lower Urinary Tract Symptoms) URL ref http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowEachType&ProduktNr=227234 Ferbish (talk) 09:45, 17 October 2008 (UTC)

Treatment

There are many different laser wavelengths now being employed, including Thullium and a 980nm wavelength. GreenLight has now added a 120W laser to the 532nm offering, in addition to the 30W. Ethanol (absolute alcohol) is still experimental (in fact, they have also experimented with injecting botox) Most urologists no longer use VLAP, as was described in the 1990's due to long catheterization time, prolonged irritative symptoms, and disappointing outcomes. Lasermama 05:52, 12 June 2007 (UTC)lasermama 1:49, 12 June, 2007

"Thullium" - Thulium? Thallium? --Hugh7 (talk) 00:55, 15 January 2008 (UTC)

PVP description is given by this quote:

---

A similar technology called Photoselective Vaporization of the Prostate (PVP) with the GreenLight (KTP) laser have emerged very recently. This procedure involves a high powered 80 Watt KTP laser with a 550 micrometre laser fiber inserted into the prostate.

---

My interest is that I underwent this procedure. I spent most of my professional life working on lasers. As a consequence, I find this quote to be confusing even though I admit to not being up-to-date.

In spite of it being called a KTP laser, most likely it is a Nd laser using a YAG crystal. The KTP is a frequency doubler. It converts 1.064 micron radiation to 0.532 micron radiation. The 550 micron wavelength is too far off for any common Nd laser. PEBill (talk • contribs) 23:58, 23 May 2009 (UTC)

2nd opening paragraph: "adenomatous prostatic growth"

Is "adenomatous prostatic growth" supposed to be a synonym for BPH, or does it refer to a different condition, e.g., a prostate tumor (as suggested by the "adenoma" article)? If it's the former, then the linking of the word "adenomatous" to "adenoma" (tumor) is somewhat misleading, isn't it? According to the dictionary, the suffix "-ous" may mean "full of, abounding in, having" or merely "possessing the qualities of". --Keith111 (talk) 16:36, 14 December 2009 (UTC)

Evidence that estrogens play a role in the etiology of BPH ??

This is my first edit on WP please be patient. I am interested in developing the statement that "There is growing evidence that estrogens play a role in the etiology of BPH", but I cannot find any reference about this. This is a very hot hopic. Flame wars abound on the web between friends and foes of anti-aromatizers. Who can provide any medical evidence? 213.166.17.19 (talk) 17:41, 30 November 2009 (UTC)

The claim is repeated in the finasteride article, where it is attributed to bodybuilder and steroid-inventor Patrick Arnold, who spent time in prison for his role in a steroid scandal. --Keith111 (talk) 16:49, 14 December 2009 (UTC)

footnote to 1990 study found unpersuasive in Cochrane review

Moved here from main article:

Citation of the following study, which is among those of low quality finding some benefit to proprietary name-brand patent product mentioned here. Cochrane review mentioning such studies but finding them wanting left in main article.

Buck AC, Cox R, Rees RW, Ebeling L, John A (1990). "Treatment of outflow tract obstruction due to benign prostatic hyperplasia with the pollen extract, cernilton. A double-blind, placebo-controlled study". Br J Urol. 66 (4): 398–404. doi:10.1111/j.1464-410X.1990.tb14962.x. PMID 1699628.{{cite journal}}: CS1 maint: multiple names: authors list (link)

Cochrane Review PMID 10792162 :

BJU Int. 2000 May;85(7):836-41. A systematic review of Cernilton for the treatment of benign prostatic hyperplasia.

MacDonald R, Ishani A, Rutks I, Wilt TJ.

The DVA Coordinating Center of the Cochrane Collaborative Review Group in Prostatic Diseases and Urologic Malignancies. Minneapolis VA Center for Chronic Diseases Outcomes Research, Minneapolis 55417, USA. macdonald.roderick@minneapolis.va.gov

OBJECTIVE: To systematically review the evidence for the clinical effects and safety of the rye-grass pollen extract (Cernilton) in men with symptomatic benign prostatic hyperplasia (BPH). METHODS: Trials were identified by searching Medline, specialized databases (EMBASE, Cochrane Library, Phytodok), bibliographies, and contacting relevant trialists and manufacturers. Randomized or controlled clinical trials were included if: men with symptomatic BPH were treated with Cernilton; a control group received either placebo or pharmacological therapy; the treatment duration was >/= 30 days; and clinical outcomes were reported. RESULTS: In all, 444 men were enrolled in two placebo-controlled and two comparative trials lasting 12-24 weeks. Three studies used a double-blind method although the concealment of treatment allocation was unclear in all. Cernilton improved 'self-rated urinary symptoms' (the proportion reporting satisfactory or improving symptoms) vs placebo and another plant product, Tadenan. The weighted mean (95% confidence interval) risk ratio (RR) for self-rated improvement vs placebo was 2.40 (1. 21-4.75) and the weighted RR vs Tadenan was 1.42 (1.21-4.75). Cernilton reduced nocturia compared with placebo or Paraprost (a mixture of amino acids); against placebo, the weighted RR was 2.05 (1.41-3.00), and against Paraprost the weighted mean difference for nocturia was – 0.40 times per evening (- 0.73 to 0.07). Cernilton did not improve urinary flow rates, residual volume or prostate size compared with placebo or the comparative study agents. Adverse events were rare and mild; the withdrawal rate for Cernilton was 4. 8%, compared with 2.7% for placebo and 5.2% for Paraprost. CONCLUSIONS: The Cernilton trials analysed were limited by their short duration, limited number of enrolees, omissions in reported outcomes, and the unknown quality of the preparations used. The comparative trials had no confirmed active control. The available evidence suggests that Cernilton is well tolerated and modestly improves overall urological symptoms, including nocturia. Additional randomized placebo and active-controlled trials are needed to evaluate the long-term clinical effectiveness and safety of Cernilton.

PMID 10792162 [PubMed – indexed for MEDLINE]

Ocdcntx (talk) 23:53, 21 February 2010 (UTC)

Too many abbrvs.

There are too many abbreviations.

Result is jargon -- not very accessible to a reader newly diagnosed, who may be needlessly bewildered trying to figure out what "PSA" or "DHT" means.

Such abbreviations should be extensively replaced with click-throughs where wikipedia articles exist. Ocdcntx (talk) 00:07, 22 February 2010 (UTC)

Needs section on prevention

Finasteride may reverse or slow progression so that treatment is never needed, while also reducing risks of prostate cancer.

Are there other preventive strategies backed by good evidence?

Ocdcntx (talk) 00:02, 22 February 2010 (UTC)

joke: problem – gravitational force on the venous drainage of the reproductive system solution1 – elevate the pelvis above the heart often solution2 – replant the left testicular vein into the inferior vena cava similar to the right one Puldis (talk • contribs) 20:23, 20 May 2010 (UTC)

THERE IS NO FACT THAT TESTOSTERONE ACT ON BENIGN PROSTATIC HYPERPLASIA

This is only by the fact that:

People who don't have Dihydrotestosterone (DHT) don't have BPH (benign prostatic hyperplasia).... This people are all deficients

But the reality is else

People who have Dihydrotestosterone (DHT), have NO ALWAYS PBH. Dihydrotestosterone (DHT) is known as protect of the effect of the âge, usualy for the skin and muscles and organs... Men who have a good level of DHT have a good protection about mostly cancer There is physician who said that Dihydrotestosterone (DHT) can protect of BPH.... and arrive to have good results in their patients. he said less hormon destroy the possibility of the body to prevent the illness

But Dihydrotestosterone (DHT) is a natural hormon, necessary for the normal man

In fact, they suppose that : " DHT give cancer " , because castras do not develop PBH, but we have no study about the origin of the BPH, and castras are people with no sex and they are not normal.

Until recently male gonads were considered to function adequately many years beyond the age of female gonadal failure of menopause. That this seems not to be the case in many men has been recently deocumented by Dr. Bebled (Paris) and confirmed by the authors and other physicians. On the contrary, in many men, and even from the 35th year of life, testosterone production and peripheral tissue utilization decrease steadily, causing sexual and overall systemic aging. Further anabolic steroid failure is aggravated in several of these men by diminished adrenal androgen production as shown by severe decrease of 17-Ketosteroid fractions in 24- hr urine.

Deficiency of the male hormone has pronounced damaging effects in men. Clinical and biochemical evaluation of androgen condition in men deserves great consideration as early replacement therapy inverses the catabolic condition created by the lack of sufficient anabolic androgen hormones and helps to restore maletonic activit 93.25.203.240 (talk) 06:03, 30 July 2010 (UTC)

Western vs. Rural Lifestyle

Anonymous, 06:24, 10 November, 2006 (UTC)

Please explain and cite this quote located under the Etiology heading, "This is confirmed by research in China showing that men in rural areas have very low rates of clinical BPH, while men living in cities adopting a western lifestyle have a skyrocketing incidence of this condition, though it is still below rates seen in the West.".

What exactly are the differences of western and rural lifestyles pertaining to this article? This implies that BPH can be prevented through a lifestyle change but no explanation of exactly which changes are needed. If true, it is interesting and should be expanded.

I'd never heard the urban / rural distinction before. It is without doubt true that some Eastern races have a lower incidence of BPH. There is a good chart depicting rates by age and geography in Campbells Urology. If you need it, I'll dig out the references. Jfbcubed 20:27, 12 November 2006 (UTC)

__________________________________

I, too, would like a citation for this statement (in quotes above). Hf006 (talk) 02:15, 8 October 2011 (UTC)

In reply to the above hypothesis about lifestyle change prevention and urban/rural distinction: I believe this may have to do with western lifestyle involving learning bad ideas from pro-n videos such as abnormally long length edited sex. I have yet to confirm this but previously I've always had very short masturbation. I now have a condition (unconfirmed) which closely resembles the signs of this. This was preceded by trying to see how long I could masturbate without ejaculation (holding them of when I shouldn't have caused repeat high pressures). I have roughly half of the symptoms in the article, but there's also few additional symptoms that come and go and may suggest other damage/injury as well – current theory is that the urine or semen mixes with the hormones or blood and travels up easier when lying down. Even with a bed with head 20 cm higher, enough still travels up to slowly lead to hard breathing and feel of black out. 213.243.177.76 (talk) 04:29, 29 February 2012 (UTC)

Differentiating signs and symptoms

I think the section on "symptoms" needs some attention to differentiate between signs and symptoms. There is a tiny irony in the fact that someone has carefully linked to symptoms and then proceeded to ignore the difference. Richard Avery (talk) 14:14, 31 August 2012 (UTC)

BPH – Hyperplasia or Hypertrophy

It is, technically speaking, a hyperplastic process rather than hypertrophic, so I have amended it as such. Even as a urologist, though, I often call it "Benign Prostatic Hypertrophy". Old habits die hard... Jfbcubed 21:12, 29 January 2006 (UTC)

Interesting point, but I've still seen the term used in authoritative sources like NEJM:

Book Review: Management of Benign Prostatic Hypertrophy, January 13, 2005, Abrams P., N Engl J Med 2005; 352:211-212 http://www.nejm.org/doi/full/10.1056/NEJM200501133520227

…Chicago urologists, 12 other U.S. urologists, and an eminent urologist from Ireland — reviews the anatomy, pathophysiology, and causes of benign prostatic hypertrophy, or hyperplasia (BPH), and discusses the assessment and treatment of the condition...

Given a review like that in NEJM, I'd be more comfortable if we had more than one source saying that it's wrong.

It's not the Wikipedia style to say that something is right or wrong, but rather to give a WP:RS and let the reader decide for him/herself.

I also don't think that the issue is simple or important enough to give it so much discussion in the introduction. WP is written for the non-specialist. When you're trying to explain to a non-specialist what BPH is in the first place, you don't start by telling him the difference between hyperplasia and hypertrophy.

It probably belongs in the body, but I'm moving it to the bottom of the introduction. Maybe somebody else can finesse it.

There is also this argument that BPH is a marketing term.

BMJ. 2008 February 23; 336(7641): 405. doi: 10.1136/bmj.39493.447361.1F PMC 2249638 Benign Prostatic Hyperplasia: The term BPH is misused, Paul Abrams, professor of urology http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2249638/ --Nbauman (talk) 20:44, 24 September 2012 (UTC)

Voiding position mystery

As written, the subsection on "Voiding position" seems meaningless. It says that using the right position gives better results, but gives no guidance as to what that position might be. This needs fixing by an expert on Voiding Positions.Megapod (talk) 23:09, 3 September 2014 (UTC)

Revisions to last paragraph in causes

Some of the comments in previous version are not supported by the medical literature (from previous version: "However, rates of clinically significant, symptomatic BPH vary dramatically depending on lifestyle. Men who lead a western lifestyle^{(need definition of "western lifestyle")} have a much higher incidence of symptomatic BPH than men who lead a traditional or rural lifestyle^{(Need definition of "rural lifestyle")}. ). In reviewing the literature, the characterization "vary dramatically" seems to be based on a single study in China where details of the BPH diagnosis are not provided in the abstract. The comment about western lifestyle is not supported in the reference cited. That study verifies that BPH prevalence assessed in living men corresponds with that found on autopsy (ie, techniques for diagnosing are valid). The first sentence is just another statement about the epidemiology that is covered elsewhere in the article. Working on this and planning to add more about risk factors under epidemioogy. juanTamad 09:44, 1 March 2015 (UTC) Jtamad (talk • contribs)

References

Nominated for good article status

I've been working on this one to bring it up to good article status and recently nominated it. Please critique. Happy to work on it more, if needed. juanTamad 02:20, 18 June 2015 (UTC) Jtamad (talk • contribs)

prostatic urethral lift

Not covered at present: http://www.sciencedirect.com/science/article/pii/S2287888215000033 juanTamad (talk) 22:24, 11 August 2015 (UTC)

Placebo effects from medications and surgeries

A recently published secondary source describes the significant changes in both subjective and objective outcomes in the placebo arms of trials of medication and surgery for BPH [1]. I noted that the 'alternative medicine' section under 'management' mentions that placebo is a probable mechanism for these treatment options, so I assume this new source can be used to discuss the role of placebo in the sections on medication and surgeries? 108.181.201.237 (talk) 00:38, 27 August 2015 (UTC)

I would say so. Looks like a good addition, if you want to work in. ~ juanTamad (talk) 07:35, 27 August 2015 (UTC)

I will, if you don't want to or can't (no certain how to do it). ~ juanTamad (talk) 07:38, 27 August 2015 (UTC)

GA Review

This review is transcluded from Talk:Benign prostatic hyperplasia/GA1. The edit link for this section can be used to add comments to the review.

Reviewer: Delldot (talk · contribs) 05:08, 20 October 2015 (UTC)

An interesting and important topic and a valuable contribution to improve the article. I'm just starting this review but I think I'll put what I have so far and work in pieces. Here's what I have so far:

• Needs less technical language. Think of writing this for someone with no special medical vocabulary. Try to find synonyms for, or define inline, terms like hyperplasia, patent, lumen, hypertrophy, clinically significant, Supra-pubic, stasis, etc. There are a lot of sentences that should be rephrased in a less jargony way.

• In signs and symptoms I think the bulleted list should be converted into sentences and explained better. This will allow the info to be merged into the paras below and cut out redundancy. Explain what each of the items means. e.g. hesitancy, Intermittent stream, Overflow incontinence, etc. What is this chronic retention? I think it needs to be spelled out.

• Also, does the one citation at the end of the paragraph cover everything prior? If not, citations needed. I will go through and tag where they're needed.

Looking good so far! I will keep reading and add to this as I go. Looking forward to working with you! delldot ∇. 05:08, 20 October 2015 (UTC)

Here is my next slew of comments.

• The lead should be a summary of the whole article, so sections like signs and symptoms, causes, diagnosis, and management should each get a sentence or two.

• The causes section is very technical and hard to follow. e.g. this language needs to be simplified: In both of these cell types, DHT binds to nuclear androgen receptors and signals the transcription of growth factors that are mitogenic to the epithelial and stromal cells.

• I might recommend a reorganization of the causes section to put the testosterone para before the castration one. Is there a reason it's organized this way?

• In the pathophys section, if there's going to be info like the median lobe is usually enlarged, it is necessary to first explain that there are lobes, how many and where.

• explain PUG and TZ.

• The diagnosis section repeats signs and symptoms from the s/s section and ads one or two not mentioned above. This should be merged into s/s.

• This sentence needs to be clarified and simplified: They reported statistically significant declines in prostate volume and nocturia using an interventional radiological technique that involves percutaneous venography and sclerotherapy of the internal spermatic vein network, including associated venous bypasses and retroperitoneal collaterals.

More to follow. Great work so far Jtamad, I'm excited to see how this improves! I hope this is not overwhelming. Take your time with this, I know it's a lot. If you think this is too much to take on during the course of a review like this, that's fine. We can take it down for now, work on it, and renominate when it's ready. Up to you. delldot ∇. 06:02, 20 October 2015 (UTC)

I'll see what I can do now. May take more than 7 days. If it's going to take too long, will think about denominating and trying again later. ~ juanTamad (talk) 06:23, 20 October 2015 (UTC)

That's totally fine, I have no problem with taking it down or leaving it up and letting you take your time with it. I think as long as progress is being made on it no one will object to it staying listed at GAN. On the other hand if it would be less stressful to take it down, cool. Thanks for putting in the work! delldot ∇. 14:41, 20 October 2015 (UTC)

@Jtamad: How's it going with the work? I haven't seen any progress lately, any objection to taking this down for now and improving it over time? delldot ∇. 21:37, 5 November 2015 (UTC)

Let's take it down for now until there's energy to do a push. delldot ∇. 07:17, 10 November 2015 (UTC)

I'm working on it. Busy with other things for now, so ETA 3 months. ~ juanTamad (talk) 02:23, 11 November 2015 (UTC)

Sounds good, take your time. delldot ∇. 05:34, 11 November 2015 (UTC)

Causes and pathophysiology vs risk factors in epidemiology

Seems to me that several paragraphs in causes may be more appropriate in pathophysiology (testosterone, estrogen, all the hormonal description), or maybe merge the sections (etiopathogenesis), and then epidemiology can include discussion or risk factors (factors that predispose or are protective in terms of relative risk from observational studies). I see that some featured articles have three separate sections. Will have to think it over. ~ juanTamad (talk) 05:51, 14 November 2015 (UTC)

Gat and Goren

Bondi1975 has been writing on a few different articles about this Gat and Goren. He recently added these links [2] [3]. I looked at the links and felt it seemed dubious, and Bondi seems like it may be a single purpose accountSpecial:Contributions/Bondi1975. The whole things seems very commercial. I think it should probably be scrubbed from all the articles it was added to, but I would like to see some commentary first on the best way to handle this.

A study published in 2008 in the journal of andrology "Andrologia"[4] reports on a newly discovered venous route by which free (active) testosterone reaches the prostate in extremely high concentrations, promoting the accelerated proliferation of prostate cells, leading to the gland's enlargement. The study (conducted by two Israeli doctors: Dr. Yigal Gat and Dr. Menachem Goren) suggests that BPH is caused by malfunction of the valves in the internal spermatic veins manifesting as varicocele, a phenomenon which has been shown to increase rapidly with age,[5][6] roughly equal to 10-15% each decade of life. The 6- to 8-fold elevated hydrostatic pressure then leads to retrograde venous drainage, allowing free communication with the prostatic circulation. Having measured a concentration of free testosterone of some 130-fold above serum level in the internal spermatic vein (the testes being the main source and the blood being undiluted in systemic circulation), the authors conclude that the elevated venous pressure causes hypertrophy and exposure to high concentrations of free testosterone causes hyperplasia in the prostate. The study also proposes a treatment method (Gat–Goren Technique) similar to that used in treating varicocele, which restores normal pressure in the venous drainage system, effectively reducing the volume of the prostate and clinical manifestation of BPH.

Benign prostatic hyperplasia#Cause

In the Gat-Goren nonsurgical method for treating varicoceles, performed under local anesthesia, a catheter is inserted through a vein in the upper thigh. Fluid injected through the catheter selectively closes off the malfunctioning veins, thus enabling the testicular tissues to recover and begin to produce normal sperm in normal amounts. The procedure lasts one to two hours and causes almost no discomfort. The patient can return to his regular routine in about 5 days.[11]

Varicocele#Possible treatment

--Taylornate (talk) 20:54, 5 November 2011 (UTC)

I am a doctor specializing in Urology (I have no connection to this research group). From what I read here, the quotes and articles that are attached indeed confirm the existence of this method and it's results. I think that the text may be relevant to the readers 79.181.208.117 (talk) 10:35, 17 December 2011 (UTC)

There are zero hits for this "Gat Goren" method on pubmed. Doc James (talk · contribs · email) 08:49, 4 January 2016 (UTC)

Doc James, you are absolutely wrong. Y. Gat & M. Goren (Gornish) are mentioned many times in Pubmed.

Here is one link which is relevant in this caes:

http://www.ncbi.nlm.nih.gov/pubmed/18811916

One should be careful before erasing data which people worked hard to find and write. Specialy an information that exists here for long time and backed up with peer reviewed medical articles Bondi1975 (talk · contribs · email) 15:50, 4 January 2016 (UTC)

Bondi, please do read and follow WP:MEDRS – we base content about health on reviews – the most recent we can find. Please do not add content about health supported by primary sources. Happy to explain more if you like. Jytdog (talk) 15:37, 4 January 2016 (UTC)

Bondi appears to be promoting the business of these two physicians. Here [4] they add a link to their website[5]

No pubmed source uses the term "Gat Goren method" just them Doc James (talk · contribs · email) 22:45, 4 January 2016 (UTC)

The IP above that claims to have no connection comes from Tel Aviv.[6] And so does the business in question [7]. I am thinking we have some conflict of interest here. Doc James (talk · contribs · email) 23:08, 4 January 2016 (UTC)

Should add prostate artery embolisation somewhere

Maybe under Minimally invasive therapies (since it's offered by UK NHS)? - but maybe also in an Experimental section if that is the status in USA ? - Rod57 (talk) 12:36, 7 January 2016 (UTC)

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Obviously wrong

"About 105 million people are affected globally... Half of males age 50 and over are affected."

Obviously these both can't be true. 194.230.214.119 (talk) 13:17, 25 March 2018 (UTC)

Relevant personal recognition about cause (reason) and prevention

(In german I am blocked, so I can not put it to the article-discussion there in german. Sorry. But even in english language it is important.)

(In the german article - Prostatavergrößerung, ´Cause and Development´ (´Ursache und Entstehung´) is said, that for the development the testosterone is essential, substantial; (quote "bekannt, dass für die Entstehung einer BPH das männliche Geschlechtshormon Testosteron wesentlich ist. Männer, die kein Testosteron bilden, entwickeln auch keine BPH.".)

At ´Prevention´ - ´Vorbeugung und Vorsorge´ - is said, "sufficient movement (exercise) regular sporting activity are important positiv influencing factors"; (quote "Ausreichende Bewegung und regelmäßige sportliche Betätigung sind wichtige positive Einflussfaktoren").)

This both lets me recognize:
Excitement, indignation OR (overstrain oneself) enthusiasm: makes testosterone. To solve, convert, dismantle - (this) testosterone - is possible with (substitute, interchange) talk OR movement. (Sorry. THAT´s IT.)

(In german I would write it as follows:

Aufregung, Empörung oder (sich selbst überanspruchende) Begeisterung: macht Testostoron. Bewegung ODER Austausch (Gespräch) löst es auf, setzt es um, baut es ab: das Testoron.

For the info to me from the german site about the testosterone I am very greatful, because this - with (the note of) the movement - could help me fast to this very recognition. Which is so ´easy´ as cause to now to understand at all, and not so easy, but not impossible, reduce the excitement(s) and do more movement from now on.) --Visionhelp (talk) 12:51, 24 August 2019 (UTC)

Cause and prepare. And Plants-medicine.

(I put it here to the talk, because I come from the german article, which is very different to the english version.)

Here is a source, sadnessly only german but the link is the google-translated web-site to english. A sub-point with some sources there. Sorry, for not having a better source, http://translate.google.com/translate?sl=de&tl=en&u=https%3A%2F%2Fwww.phytodoc.de%2Fheilpflanzen%2Fsaegepalme — Preceding unsigned comment added by Visionhelp (talk • contribs) 15:07, 4 September 2019 (UTC)

A druggist, a pharmacist, says: "Testosterone does not have a causal - I say: direct - correlation, as in the german wikipedia at "Cause and prepare" is said. (Without source. This statement ´screams´ for naming a source ... ?)
Despite that the statements of for movement and sports as prepare are correctly, as she says.

´Spontaneously´ this to me appears as a contradiction, as ´opposition´. But other hormons from with testoron coming with do not really interesst me, when testosteron is the cause of the enlargement of the prostate. — Preceding unsigned comment added by Visionhelp (talk • contribs) 15:26, 4 September 2019 (UTC)

Help and (little, but) reduce possible, but stop a further enlargement: There are more things from - and - plants, that help. But the most told is: saw palmetto, as capsules, plus the roots of stinging nettle, as tee, or as capsules, too. A combination of both in one capsule - in Germany - are well known as a reliable help, proved, classical. http://translate.google.com/translate?sl=de&tl=en&u=https%3A%2F%2Fwww.brennessel-tee.com%2Fbrennesselwurzel

The use - not ´only´ in ADDITION - of tea of leaves of stinging nettle helps, too. (In the time of the increasing moon may be not so good accommodating, if.)

A further good link (source) with very good infos about some (blind) studys and more, http://translate.google.com/translate?sl=de&tl=en&u=https%3A%2F%2Fwww.brennessel-tee.com%2F--Visionhelp (talk) 00:48, 5 September 2019 (UTC)

Some infos about the prostate enlargement

(Please, let me wright it here temporary in german, until I able to realize a good manual translation. Thanks. But already just a www.DeepL.com/Translator, following after the german text, please.)

In der Prostata passieren Flüssigkeits-Prozesse. Das kann zu schnellen Vergößerungen, und aber AUCH wieder zu schnellen Verkleinerungen kommen, wenn auch - ´vorüber-gehend´- nur mit Medikament, Pflanzlich oder Anderes.

Vergrößerung, Verkrampfung, Entzündung durch Vergrößerung, andere Entzündungen, sind wohl möglich für Trink-Blockade oder/und Schwierigkeit - bis Schmerzen - beim Wasser-Lassen. Die möglichen Entzündungen, außer durch eine mögliche Entzündung durch die Vergrößerung selbst, sind nicht bekannt, also: die (möglichen) Ursachen dafür.

Ob eine aktuelle Prostata-Vergrößerung von Entzündung oder nur alleinig eine Vergrößerung - von was - ist, selbst das KANN schon nicht unterschieden - ist nicht unterscheidbar auf Ultra-Schall-Bild - werden.
Emotionale Beanspruchung kann Ursache: als Auslöser sein.

(www.DeepL.com/Translator):
Fluid processes happen in the prostate. This can lead to rapid enlargements, but also to rapid reductions, even if - ´temporary´- only with medication, herbal or other.

Enlargement, cramping, inflammation due to enlargement, other inflammations, are probably possible for drinking blockade or/and difficulty - to pain - in letting water. The possible inflammations, except by a possible inflammation by the magnification itself, are not known, therefore: the (possible) causes for it.

Whether a current prostate enlargement is from inflammation or just a magnification - of what - even that CANNOT be distinguished - is indistinguishable from ultra-sound image - will be.

Emotional encroachment may be cause: as release, trigger, elicitor, catalyst; sorry, can not determine ... not decide, which is the easiest for all the fastest and best understanding of these translations. --Visionhelp (talk) 18:01, 11 September 2019 (UTC)

Trivia?

This is simple based on primary sources. We should use secondary sources. Also basically trivia. Doc James (talk · contribs · email) 10:56, 30 April 2020 (UTC)

"BPH can be a progressive growth that in rare instances leads to exceptional enlargement. Prostates weighing more than 100 grams have been recorded in only 4% of men over the age of 70 years. In some males, the prostate enlargement exceeds 500 grams. This condition has been defined as giant prostatic hyperplasia(GPH). Less than thirty cases of GPH have been reported in the literature to date, the largest surgical specimen of 2410 grams. An even larger specimen measured only by MRI without surgical removal was reportedly 3987 ml."

With all due respect, the use of the word "trivia" comes across as derogatory. And in deciding to expand the subject of GIANT PROSTATIC HYPERPLASIA(GPH) within the existing BENIGN PROSTATIC HYPERPLASIA page, it was a genuine recognition of GPH being a pathophysiologic extreme. As more articles on this subject were published (each of them essentially a primary source) they have referenced previous literature, to de facto be considered secondary sources. I chose NOT to list 25-30 references. This could be easily done in a TABLE format.

If you feel that a completely NEW Wikipedia page with the titling GIANT PROSTATIC HYPERPLASIA is appropriate to give this subject its proper forum, then please advise

JamesRichardFishman (talk) 18:09, 30 April 2020 (UTC)

With a little more investigation, a 2020 article has now published that appears to satisfy criteria as a secondary source on the subject of GIANT PROSTATIC HYPERPLASIA:

JamesRichardFishman (talk) 19:57, 30 April 2020 (UTC)

Source #5 is still essentially a case report, and I don't think there is enough for another article. That being said, I can support the inclusion of this part: "BPH can be a progressive growth that in rare instances leads to exceptional enlargement. Prostates weighing more than 100 grams have been recorded in only 4% of men over the age of 70 years. In some males, the prostate enlargement exceeds 500 grams. This condition has been defined as giant prostatic hyperplasia(GPH)" without the aggrandizing weights. That should be a simple citation on the 500 gm sentence imho. MartinezMD (talk) 02:32, 1 May 2020 (UTC)

How to proceed? An abbreviated sentencing as suggested by MartinezMD is incorporated into the body of the PATHOPHYSIOLOGY section with just references 1 and 2 ? And the decision to elaborate in another article titled 'GIANT PROSTATIC HYPERPLASIA' rests on my efforts. I promise you there is more than enough information to warrant another article.

JamesRichardFishman (talk) 13:49, 1 May 2020 (UTC)

Updated based on a review article to "In some males, the prostate enlargement exceeds 200 to 500 grams. This condition has been defined as giant prostatic hyperplasia (GPH) and is rare." Doc James (talk · contribs · email) 06:34, 4 May 2020 (UTC)

References

UroLift

There is no mention of a minimally invasive procedure to install a device called a UroLift. It is a kind of stapling of the prostate to draw the prostate away from the urethra. There is lots of data out there about the Erolift. I just don't know if My editing skills are up to creating such a whole new section of the page, which I think it should have. Plus, since I had one done I might be more susceptible to confirmation bias and shouldn't be the one to write it urolift and here is a list of the peer review studies urolift publications Jackhammer111 (talk) 06:29, 19 July 2020 (UTC)

• Added This is correct, it should be included as a major non-invasive technique. I added just a short description, I don't think it needs an entire section here but I found a high quality source (My goto urology textbook). There is a separate page on surgical procedures where this could be expanded upon further. PainProf (talk) 18:02, 19 July 2020 (UTC)

Minimally invasive procedures update

To further the Cochrane-Wikipedia project, I updated the section of this page regarding prostatic arterial embolization to include the latest results from a 2020 Cochrane review. The section previously only held information from 2017.

Added: A Cochrane review from 2020 that looked at men in their 40s with enlarged prostates found that this treatment and surgery may work similarly to relieve symptoms and improve quality of life for up to 12 months' follow up, but may increase the need for being treated again.[81] This review is very uncertain about the adverse effects of this treatment and longer term (13-24 months) comparison of this alternative and surgical treatments.

--Gsom12812 (talk) 21:54, 10 February 2021 (UTC)

I added information about water vapor treatment therapy from a Cochrane review about the potential outcomes of this therapy in comparison with a sham procedure. --Gsom12812 (talk) 17:51, 15 February 2021 (UTC)

Surgery

Added information from a Cochrane review comparing monopolar and bipolar TURP surgical options --Gsom12812 (talk) 03:04, 17 February 2021 (UTC)

Lifestyle

Added information about the impact of physical activity as an intervention for lower urinary tract symptoms from a Cochrane review--Gsom12812 (talk) 16:22, 17 February 2021 (UTC)

Phosphodiesterase inhibitors

Changed the title of the section to increase the clarity of information. Added comparisons between phosphodiesterase inhibitors and other medications for BPH using information from a Cochrane review --Gsom12812 (talk) 17:28, 18 February 2021 (UTC)

Aquablation therapy

Added additional information about the effectiveness of aquablation therapy in comparison with TURP surgery from a Cochrane review --Gsom12812 (talk) 17:49, 18 February 2021 (UTC)

Prevalence

There seems to be a contradiction between the following statements in the article:
1. "While the prevalence rate is 2.7% for men aged 45–49, it increases to 24% by the age of 80 years."
2. "For a symptom-free man of 46 years, the risk of developing BPH over the next 30 years is 45%. ".
The latter implies that by the age of 76, 45% of men will have developed this illness - therefore how can the prevalence at the age of 80 be 24%? --Savig (talk) 11:22, 27 November 2021 (UTC)

Because men have a life expectancy of less than 80. At any given time there's only 24% with it because the other 21% have died before reaching 80. MartinezMD (talk) 17:13, 27 November 2021 (UTC)