European Urology Supplements RSS feed: Current Issue. Supplements to European Urology are published under the title European Urology Supplements (ISSN 1569-9056). All subscribers to European Urology automatically receive this publication. European Urology Supplements is the perfect publication vehicle for the proceedings of a scientific symposium, commissioned thematic issues, or for disseminating a selection of invited articles. What makes European Urology Supplements unique is the fact that it has impact factor of 1.711 (2008)* and sits within the widely respected European Urology family of urology publications published by Elsevier on behalf of the EAU and EBU. Publication History: Incorporating EAU-EBU Update Series. You can also visit the European Urology (ISSN 0302-2838) and EAU-EBU Update Series (ISSN 1570-9124).http://www.europeanurology-supplement.com/?rss=yesElsevier Inc.en © 2009 Published by Elsevier Inc. All rights reserved. European Urology Supplements1569-9056813December 2009 © 2009 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.europeanurology-supplement.com/article/PIIS1569905609001407/abstract?rss=yesEditorial Board10.1016/S1569-9056(09)00140-7European Urology Supplements 8, 13 (2009)2009-12-01European Urology Supplements2009-12-01813S1569-9056(09)X0011-4iihttp://www.europeanurology-supplement.com/article/PIIS1569905609001328/abstract?rss=yesTake Home Message: This supplement will focus on the most recent findings with respect to inflammation as a major pathway in the development and progression of benign prostatic hyperplasia and prostate cancer, as well as on findings suggesting a clinical impact from targeting the inflammatory process with Serenoa repens.The Correlation between Inflammation, BPH and Prostate CancerBob Djavan10.1016/j.eursup.2009.11.001European Urology Supplements 8, 13 (2009)2009-11-26European Urology Supplements2009-11-26813S1569-9056(09)X0011-4863864http://www.europeanurology-supplement.com/article/PIIS156990560900133X/abstract?rss=yesAbstract: Context: Benign prostatic hyperplasia (BPH) is a well-known condition characterised by prostate growth accompanied by lower urinary tract symptoms. Several mechanisms seem to be involved in the development and progression of BPH.Objective: To review the most important findings regarding the key mechanisms involved in the pathophysiology of BPH.Evidence acquisition: During the 2009 annual meeting of the European Association of Urology in Stockholm, Sweden, a satellite symposium was held on BPH and its treatment. This paper is based on one of the presentations at the symposium. A structured, comprehensive literature review was performed using data retrieved from recent review articles, original articles, and abstracts.Evidence synthesis: Several mechanisms seem to be implicated in the pathophysiology of BPH. These represent age-related tissue modifications, hormonal alterations, and metabolic syndrome as well as inflammation. Although androgens do not cause BPH, the development of BPH requires the presence of androgens. Moreover, several studies support the association between noninsulin-dependent diabetes mellitus, hypertension, obesity, and low high-density lipoprotein cholesterol and the development of BPH. Finally, recent increasing evidence seems to support the idea that BPH consists of an inflammatory-based disorder. Inflammation would be initiated by an unknown stimulus that would create a proinflammatory milieu within the gland. This theory is confirmed by several basic research and clinical studies that showed a statistically significant association between inflammation and BPH severity and progression.Conclusions: Although the pathogenesis of BPH is not yet fully understood, several mechanisms seem to be involved in the development and progression of the disease. These mainly include systemic and local hormonal and vascular alterations as well as prostatic inflammation that would stimulate cellular proliferation. Inflammation would be initiated by an unknown stimulus that would create a proinflammatory environment within the prostate. Therefore, from the recent clinical and basic research studies, a novel approach in the clinical management of BPH might focus on the inflammatory process involved in the development and progression of the disease.Take Home Message: Although the pathogenesis of benign prostatic hyperplasia (BPH) is not yet fully understood, several mechanisms seem to be involved in the development and progression of the disease. In this context, the most recent results from clinical and basic research papers support the hypothesis that BPH predominantly consists of an immune inflammatory response of prostatic tissue to an unknown stimulus that would create a proinflammatory milieu within the gland.Benign Prostatic Hyperplasia and Its AetiologiesAlberto Briganti, Umberto Capitanio, Nazareno Suardi, Andrea Gallina, Andrea Salonia, Marco Bianchi, Manuela Tutolo, Valerio Di Girolamo, Giorgio Guazzoni, Patrizio Rigatti, Francesco Montorsi10.1016/j.eursup.2009.11.002European Urology Supplements 8, 13 (2009)2009-11-27European Urology Supplements2009-11-27813S1569-9056(09)X0011-4865871http://www.europeanurology-supplement.com/article/PIIS1569905609001341/abstract?rss=yesAbstract: Context: The immunology of the prostate has developed into a new field of research in urology. The leukocyte population increases are not yet fully understood, but it has been demonstrated that most resected prostate tissue shows signs of inflammatory response.Objective: This article reviews recent findings and discusses the complex mechanisms involved in the prostatic inflammatory response and the immunologic functions of the prostate, and the roles the prostatic inflammatory response in the cause of prostate disease such as benign prostatic hyperplasia (BPH).Evidence acquisition: We performed a search of the medical literature with PubMed, using keywords such as prostate cancer, inflammation of the prostate, leukocytes, estrogen, and cytokine and genetic expression of inflammation. Articles and data were reviewed as to their relevance, and inclusion and exclusion criteria were determined prospectively.Evidence synthesis: Evidence showing that inflammation of the prostate plays a role in prostate cancer (PCa) is mounting. Different types of inflammation exist and are distinguished according to the distribution and location of leukocytes and the histology of the surrounding tissue. Most resected prostate tissue shows signs of inflammatory response, and a relationship between T-cell infiltration and stromal proliferation can be found. Evidence for the importance of estrogen and proinflammatory cytokine interleukin (IL; IL-6, IL-8, IL-15, IL-17) also can be found. Early stages of investigation of the immunologic function of the prostate show that both prostatic epithelial and stromal cells express members of the toll-like receptor family and are therefore capable of recognizing foreign incoming antigens.Conclusions: Although this area of study is new, the immunology and inflammatory responses of the prostate are seen as important components of further study of prostate diseases such as PCa and BPH. Data supporting the role of immunology and activated leukocytes in malignant cells are also an important finding and can possibly lead to new knowledge about malignant cells.Take Home Message: Most resected prostate tissue shows signs of an inflammation, and a relationship between T-cell infiltration and stromal proliferation has been demonstrated. Estrogen and proinflammatory cytokine interleukin (IL; IL-6, IL-8, IL-15, IL-17) also play important roles in inflammatory responses of the prostate.Complex Mechanisms in Prostatic Inflammatory ResponseBob Djavan, Elisabeth Eckersberger, Geovanni Espinosa, Gero Kramer, Alessandra Handisurya, Chung Lee, Michael Marberger, Herbert Lepor, Georg E. Steiner10.1016/j.eursup.2009.11.003European Urology Supplements 8, 13 (2009)2009-11-27European Urology Supplements2009-11-27813S1569-9056(09)X0011-4872878http://www.europeanurology-supplement.com/article/PIIS1569905609001353/abstract?rss=yesAbstract: Context: Although benign prostatic hyperplasia (BPH) is the most frequent disease in elderly men, only a few predictive factors have been identified. Recently, prostatic inflammation has emerged as one of them.Objective: This review describes the relationship between inflammation and BPH prognosis that emerges from the literature.Evidence acquisition: Publications relating to the role of inflammation in BPH were identified by searching PubMed Medline database. Basic science and clinical studies were reviewed.Evidence synthesis: At 12-wk gestation, few inflammatory cells can be observed in the prostatic gland. This amount progressively increases and is more frequent in surgery-derived specimens than in young normal prostates. In fact, almost 80% of surgery-derived specimens show signs of inflammation. Microscopic and immunohistochemical analysis of the inflammatory infiltrate has shown a vast majority of antigen-presenting cells; these immune cells could ensure the sterility of the genitourinary tract. However, immune cells are also releasing numerous cytokines and growth factors that recruit other cells that promote the growth of epithelial and stromal prostatic cells. This process finally results in prostate enlargement. Because of the relationship between BPH and inflammation, anti-inflammatory treatments have been tested in BPH and have been shown to improve urinary symptoms. They could therefore be proposed to treat BPH patients with prostatic inflammation. Although inflammation can be diagnosed on prostate biopsy, noninvasive biomarkers that could be used to monitor BPH treatment are still needed.Conclusions: Chronic prostatic inflammation is a risk factor for prostate enlargement, BPH symptoms, or acute urinary retention. For BPH patients with inflammation, close surveillance and therapies that exert anti-inflammatory effects could therefore be proposed. However, reliable biomarkers have not yet been validated to detect prostatic inflammation in routine clinical practice.Take Home Message: Chronic prostatic inflammation is observed in >50% of patients with symptomatic benign prostatic hyperplasia (BPH) and has been shown to be a prognostic factor in disease progression. Noninvasive biomarkers still have to be investigated, as do effects of specific anti-inflammatory treatments on BPH progression.Should We Investigate Prostatic Inflammation for the Management of Benign Prostatic Hyperplasia?Grégoire Robert, Aurélien Descazeaud, Yves Allory, Francis Vacherot, Alexandre de la Taille10.1016/j.eursup.2009.11.004European Urology Supplements 8, 13 (2009)2009-11-27European Urology Supplements2009-11-27813S1569-9056(09)X0011-4879886http://www.europeanurology-supplement.com/article/PIIS1569905609001365/abstract?rss=yesAbstract: Context: Medical therapies derived from natural sources have been used for centuries. Many are as effective as synthetic medications. The use of plant-derived medications for benign prostatic hyperplasia (BPH) is no exception. In particular, extracts of Serenoa repens (SrE), the fruit of the American dwarf palm, are widely available, and their use is rising throughout the world.Objective: The underlying basis for SrE popularity stems from its safety and tolerability profile. However, despite its extensive use, its mechanism of action has not been definitely clarified. In this paper, we analyse the scientific basis for SrE efficacy in the treatment of BPH and explore the mechanisms by which its effects are induced.Evidence acquisition: This literature review focuses on the actions of the lipidosterolic SrE on a host of targets. Several cellular and molecular techniques have been used to characterise the biologic pathways that may mediate these actions. Morphologic studies have been carried out to identify the changes of prostate ultrastructure and to determine modifications that may shed light on the mechanisms underlying SrE efficacy.Evidence synthesis: Selectivity of the action of SrE for the prostate has been demonstrated. There are several morphologic changes, and these are accompanied by an increase in the apoptotic index of the gland, along with inhibition of the activity of the 5α-reductase isoenzymes. The drug also acts on a number of other biologic systems and shows a capacity to moderate the androgenic, apoptotic, and inflammatory pathways of the cell. These pathways have been implicated in the hyperplastic process.Conclusions: The interaction between prostate cells and SrE is manifest at several levels of the gland's biological spectrum and results in antiandrogenic, anti-inflammatory, and proapoptotic effects. These effects may account for the beneficial response triggered in some patients with BPH treated with SrE.Take Home Message: Serenoa repens (saw palmetto) extracts are complex mixtures of compounds that act simultaneously on several biologic pathways known to be associated with the development of benign prostatic hyperplasia (BPH) in man. Reversal of the prohyperplastic pathways by the drug accounts for its clinical efficacy in the treatment of BPH.Serenoa repens: The Scientific Basis for the Treatment of Benign Prostatic HyperplasiaFouad K. Habib10.1016/j.eursup.2009.11.005European Urology Supplements 8, 13 (2009)2009-11-27European Urology Supplements2009-11-27813S1569-9056(09)X0011-4887893http://www.europeanurology-supplement.com/article/PIIS1569905609001377/abstract?rss=yesAbstract: Context: Lower urinary tract symptoms (LUTS) are almost universal in men aged >50 yr. As men become more symptomatic, they frequently want to take either supplements or medications to improve their condition or to prevent it from worsening.Objective: To examine and to assess the efficacy and the role of Serenoa repens products in the clinical management of LUTS due to benign prostatic hyperplasia (BPH; BPH/LUTS).Evidence acquisition: Review was undertaken of all articles published on phytotherapies in the urologic literature from 1990 to the present.Evidence synthesis: Only randomized trials were included in this analysis. Special attention was given to the three major meta-analyses on this topic, and the large randomized comparative and placebo-controlled trials were highlighted.Conclusions: Serenoa repens products are a first-line intervention, usually patient initiated, in the management of BPH/LUTS. These products are generally considered very safe and have minimal side effects. The magnitude of their efficacy is still to be determined.Take Home Message: Phytotherapies are frequently patients’ first choice for managing lower urinary tract symptoms due to benign prostatic hyperplasia. Serenoa repens is a safe product that may provide a benefit for this condition without many of the side effects of standard pharmaceutical medications.The Role of Serenoa repens in the Clinical Management of Lower Urinary Tract Symptoms Due to Benign Prostatic HyperplasiaFranklin C. Lowe10.1016/j.eursup.2009.11.006European Urology Supplements 8, 13 (2009)2009-11-27European Urology Supplements2009-11-27813S1569-9056(09)X0011-4894897