Breakthrough in prostate research.

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.