Could more than one type of benign prostatic hyperplasia (BPH) exist? Can a simple blood test help determine the best treatment for BPH? Can a drug used to treat erectile dysfunction (ED) help alleviate the troubling symptoms of an enlarged prostate? The answer to all of these questions is -- perhaps. In this Special Report, Johns Hopkins discusses key studies that identify new form of BPH and reveal links between BPH and ED.
Although it's too early to give a definitive yes or no to these questions, research on several fronts is changing the way urologists view BPH. Recent findings suggest that the condition is more complex than originally thought, and these insights are pointing the way to promising new strategies for diagnosis and treatment.
Severe Form of BPH Identified -- Until recently, BPH was considered to be a single disease responsible for a variety of lower urinary tract symptoms, ranging from discomfort while urinating to the inability to urinate at all. But a new discovery by Johns Hopkins researchers challenges that view. Their findings suggest that there may be at least two forms of BPH: one type with mild symptoms that are unlikely to cause urinary tract complications and another, more severe form that can lead to irreversible bladder damage. Knowing which form of BPH a man has at diagnosis could help guide treatment choices.
Reporting in The Journal of Urology, the researchers described a protein known as JM-27 that can help determine which men have the severe form of BPH. In the study, blood samples were obtained from 68 men (39 with severe BPH symptoms; 29 with BPH but no or mild symptoms) who participated in the Medical Therapy of Prostatic Symptoms (MTOPS) study. Using an experimental blood test for the JM-27 protein, the investigators identified with about 90% accuracy which men had the more severe form of BPH. Interestingly, those with the lowest amounts of the JM-27 protein in their blood had the most severe symptoms.
To validate their findings, the researchers are evaluating the test in a larger number of blood samples from men in the MTOPS study. The goal is to develop a blood test that doctors can use in their offices to measure blood levels of the JM-27 protein. Such a test would allow doctors to identify and treat the severe form of BPH early -- perhaps before significant symptoms develop -- which could prevent damage to the bladder. A JM-27 test might also help doctors tailor BPH therapy more precisely to each patient and to monitor each man's response to treatment.
The Link Between ED and BPH -- In separate research, investigators are exploring the link between BPH symptoms and ED. Accumulating evidence suggests that men with significant lower urinary tract symptoms due to BPH are at increased risk of having ED. The reverse also is true: Men who experience ED are more likely to have lower urinary tract symptoms related to BPH. Several studies show that treatment for one disorder often helps the other.
In a study published last year in The Journal of Urology, men with lower urinary tract symptoms were given the ED drug tadalafil (Cialis) or a placebo. The men who took Cialis daily for 12 weeks experienced significant improvements in their International Prostate Symptom Score (IPSS), a standard questionnaire used to help diagnose BPH and monitor its symptoms.
In another study also reported in The Journal of Urology, sildenafil (Viagra) relieved BPH-related lower urinary tract symptoms and ED among men who had both conditions. After 12 weeks of daily Viagra, the men's scores improved significantly on both the International Index of Erectile Function and the IPSS. The men who took Viagra also had better scores on questionnaires that assessed the impact of BPH on daily living, quality of life, relationships, and self-esteem.
Better BPH Therapies Ahead? The results of these and similar studies suggest that advances in BPH diagnosis and treatment can be expected in the next several years. Future studies will likely evaluate different drug combinations to find the most effective treatments for men with BPH and ED, hopefully leading to a more individualized approach to therapy for both conditions.
