Novel Cause of BPH, PCa Proposed

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VIENNA—Benign prostatic hyperplasia (BPH) and prostate cancer could be the result a previously unrecognized route of free testosterone flow from the testes to the prostate, according to investigators.

The underlying cause, they say, is varicocele, which in turn is the result of a malfunction of one-way valves in the testicular venous drainage system, a phenomenon that exists only in humans.

“The evolution of prostate diseases is a long-standing enigma in medicine,” said lead investigator Yigal Gat, MSc, MD, PhD, Head of Andrology & Interventional Radiology at the Maayanei Hayeshua Medical Center in Bnei Brak, Israel, and a research consultant in Condensed Matter Physics, Sub-Micron Research, Weizmann Institute of Science in Rehovot, Israel.

“Our research group has been working together for several years and via physical understanding we have come to the  conclusion that did not surprise us - prostatic enlargement  is actually a secondary symptom of a hitherto disregarded clinical problem—varicocele – namely, malfunction of those valves.”

Dr. Gat and his colleagues demonstrated that testosterone at a concentration of about 130 times that of physiologic levels reaches the prostate via the testicular and prostate venous drainage systems, causing accelerated proliferation of prostate cells.

At the 26th Annual Congress of the European Association of Urology, Dr. Gat reported on a study of 63 BPH patients with prostatic symptoms and bilateral varicocele who underwent super-selective venography and sclerotherapy of the network of impaired testicular  venous  system, thereby eliminating the flow of free testosterone from the testes to the prostate.

The mean follow-up was about two years. The treatment resulted in a significant reduction of some 50% of the pathologic volume (the enlargement beyond the normal prostate volume) over six to nine months and a parallel decrease in prostate symptoms, although 5% of men experienced recurrent varicocele.

The researchers concluded that their findings may explain the mechanism underlying development of BPH and possibly prostate cancer and may resolve several mysteries associated with these diseases during the last 70 years.

The researchers used a multidisciplinary approach involving medicine, engineering, hydraulic physics, molecular biology, and molecular biochemistry, which Dr. Gat said “succeeded in showing that varicocele and the problems of hydrostatic pressure that it produces leads to ‘illegal' flow of extremely high concentrations of free testosterone in the wrong direction from the testes directly to the prostate. The result is prostatic enlargement due to accelerated cell proliferation.”

By discovering the actual cause of the evolution of BPH , he said, their group was able to develop a non-surgical, targeted interventional radiologic procedure (known as the “Gat Goren Method”) that occludes the dysfunctional venous bypasses and many accompanying retroperitoneal collateral vessels that cause the problem. Dr. Gat developed the procedure with Menachem Goren, MD, an American board-certified radiologist who is an interventional radiologist at Maayanei Hayeshua Medical Center. 

“Our research team has faith that we face the beginning of a new era in understanding the pathophysiologic mechanism of prostate diseases,” Dr. Gat said. “We expect more good medical news on this field in the near future.”

Details on the Gat-Goren procedure were published in a chapter in the textbook Andrology for the Clinician (pp. 447-453) Springer edition 2006, and in Andrologia (2008;40:273-281).

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