In Benign Prostatic Hyperplasia, Decrease in Oxygen to Tissues Is Linked to Urinary Retention

In Benign Prostatic Hyperplasia, Decrease in Oxygen to Tissues Is Linked to Urinary Retention

High expression of hypoxia-inducible factor (HIF) is a marker of proliferating prostate tissues and may predict a risk for acute urinary retention in benign prostatic hyperplasia (BPH) patients, according to a study, “Elevated expression of HIF-lα in actively growing prostate tissues is associated with clinical features of benign prostatic hyperplasia,” published in the journal Oncotarget.

Benign prostatic hyperplasia is one of the most common diseases in middle-age or older men, and is characterized by lower urinary tract problems and bladder outlet obstruction. An increasing number of studies report that benign prostatic hyperplasia is associated with hypoxia, a condition where there is a significant decrease in the amount of oxygen reaching the tissues.

HIF is a DNA-binding transcription factor (with a hypoxia response factor called HIF-1α) and its levels have been reported upregulated in prostate cancer, inducing transcription of genes involved in hypoxia-adaptive conditions. Benign prostatic hyperplasia samples from patients submitted to prostate surgery were also positive for HIF-1α. Despite this association, there is no clinical evidence of how HIF-1α affects the prognosis of benign prostatic hyperplasia.

Researchers performed a retrospective collection of patients’ data and tissue samples from fetal prostates, normal prostates, intra-acinar of benign prostatic hyperplasia, peri-acinar of benign prostatic hyperplasia (acinar refers to any cluster of cells that resembles a many-lobed “berry”), prostate cancers, and sarcomas of the prostate. Levels of HIF-1α in all samples, together with vascular endothelial growth factor (VEGF), a gene whose induction is regulated through HIF-1α binding, were analyzed.

While normal prostate and peri-acinar of benign prostatic hyperplasia samples were negative for HIF-1α expression, the transcription factor was expressed in intra-acinar of BPH (69.5 percent), prostate cancer (85.7 percent) and all fetal prostates. The levels of HIF-1α expression were higher in both fetal prostates samples and malignant tumors when compared to benign prostatic hyperplasia samples.

When correlating HIF-1α expression levels with patients’ clinical information, authors found that HIF-1α in intra-acinar benign prostatic hyperplasia was significantly correlated with the intra-acinar weight of hyperplastic prostate. Importantly, they noted that HIF-lα moderate-positive patients had a significant increased incidence of acute urinary retention, a severe symptom of BPH patients.

These results reveal that HIF-1α expression is increased in highly proliferative prostate tissues, such as fetal prostates, intra-acinar of hyperplasia tissues of benign prostatic hyperplasia and prostate malignant tumors, and its expression correlates with the weight of intra-acinar prostate.

Expression of HIF-1α is also a potential marker for predicting a patient’s likelihood of developing acute urinary retention.

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