madman
Super Moderator
Abstract
Background: Age‐dependent increase in the incidence of benign prostatic hyperplasia (BPH) and prostate cancer (PCa) are both related to cell proliferation and survival controlled by intraprostatic free testosterone (FT) concentration. Paradoxically, BPH and PCa occur as circulating testosterone levels decrease, so any possible relationship between testosterone levels and development of BPH and PCa remains obscure.
Results: In BPH the enlarging prostate is exposed to high testosterone levels arriving directly from the testes at concentrations about a hundredfold higher than systemic FT. This occurs because venous blood from the testes is diverted into the prostate due to the elevated hydrostatic pressure of blood in the internal spermatic veins (ISVs). Elevated pressure is caused by the destruction of one‐way valves (clinically detected as varicocele), a unique phenomenon related to human erect posture. While standing, human males are ISVs vertically oriented, resulting in high intraluminal hydrostatic pressures—a phenomenon not found in quadrupeds. In this communication, we demonstrate the fluid mechanics' phenomena at the basis of varicocele leading to prostate pathology.
Conclusions: So far, varicocele has been studied mostly for its etiologic role in male infertility and, thus, for its effects on the testes. It is becoming clear that varicocele is a major etiologic factor in BPH and likely also in PCa. Restoring normal testicular venous pressure by treatment of the abnormal ISV's in varicocele has been shown to avert the flow from the prostate with the effect of reducing prostate volume, alleviating symptoms of BPH, and increasing concentrations of circulating FT.
9 | CONCLUSIONS
1. The reasons for the age‐dependent increase in the levels of testosterone in the prostate can be understood from the fluid mechanic's analysis of the reversal of blood flow from testicles to the prostate.
2. Failure of the OWVs in ISVs, the major conduit of venous blood from the testes, increases hydrostatic pressure in the testicular drainage system, reduces the supply of oxygenated blood to testicular tissue, and leads to male infertility and decreased testosterone production. The same hydrostatic feature diverts venous blood from the testes directly to the prostate. As this blood takes to the prostate undiluted testosterone (rather than a hundredfold lower concentration normally supplied by arterial blood), it stimulates prostate cell proliferation leading to prostate enlargement and possibly cancer.
3. Testosterone levels in peripheral blood do not reflect testosterone levels in the prostate and are not related to prostate pathology.
4. Preventing the flow of undiluted FT from the testes directly to the prostate can arrest and reverse, if performed early, the development of BPH, and, possibly, localized PCa. This is accomplished by occluding all vertically oriented malfunctioning veins of the testicular venous drainage bilaterally.
Background: Age‐dependent increase in the incidence of benign prostatic hyperplasia (BPH) and prostate cancer (PCa) are both related to cell proliferation and survival controlled by intraprostatic free testosterone (FT) concentration. Paradoxically, BPH and PCa occur as circulating testosterone levels decrease, so any possible relationship between testosterone levels and development of BPH and PCa remains obscure.
Results: In BPH the enlarging prostate is exposed to high testosterone levels arriving directly from the testes at concentrations about a hundredfold higher than systemic FT. This occurs because venous blood from the testes is diverted into the prostate due to the elevated hydrostatic pressure of blood in the internal spermatic veins (ISVs). Elevated pressure is caused by the destruction of one‐way valves (clinically detected as varicocele), a unique phenomenon related to human erect posture. While standing, human males are ISVs vertically oriented, resulting in high intraluminal hydrostatic pressures—a phenomenon not found in quadrupeds. In this communication, we demonstrate the fluid mechanics' phenomena at the basis of varicocele leading to prostate pathology.
Conclusions: So far, varicocele has been studied mostly for its etiologic role in male infertility and, thus, for its effects on the testes. It is becoming clear that varicocele is a major etiologic factor in BPH and likely also in PCa. Restoring normal testicular venous pressure by treatment of the abnormal ISV's in varicocele has been shown to avert the flow from the prostate with the effect of reducing prostate volume, alleviating symptoms of BPH, and increasing concentrations of circulating FT.
9 | CONCLUSIONS
1. The reasons for the age‐dependent increase in the levels of testosterone in the prostate can be understood from the fluid mechanic's analysis of the reversal of blood flow from testicles to the prostate.
2. Failure of the OWVs in ISVs, the major conduit of venous blood from the testes, increases hydrostatic pressure in the testicular drainage system, reduces the supply of oxygenated blood to testicular tissue, and leads to male infertility and decreased testosterone production. The same hydrostatic feature diverts venous blood from the testes directly to the prostate. As this blood takes to the prostate undiluted testosterone (rather than a hundredfold lower concentration normally supplied by arterial blood), it stimulates prostate cell proliferation leading to prostate enlargement and possibly cancer.
3. Testosterone levels in peripheral blood do not reflect testosterone levels in the prostate and are not related to prostate pathology.
4. Preventing the flow of undiluted FT from the testes directly to the prostate can arrest and reverse, if performed early, the development of BPH, and, possibly, localized PCa. This is accomplished by occluding all vertically oriented malfunctioning veins of the testicular venous drainage bilaterally.
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