[Is a single prostatic biopsy sufficient for selection of medical treatment in benign prostatic hypertrophy?]

Medical treatments in BPH (5-alpha reductase inhibitors and alpha-blockers) have been extensively studied in the last years, but their clinical outcome is unpredictible. Therefore, a better selection of the patients before prescribing these medical treatment of BPH is certainly needed. The variability in tissue composition in BPH may partially explain the differences observed in clinical outcome after medical therapy. In the present study, we have quantified the percentage of the different tissue components (smooth muscle, epithelial cells) in a prostatic biopsy and in the corresponding whole-adenoma in 14 patients operated on of a retropubic adenomectomy. Immunostaining with actin anti-actin was used to stain the smooth muscle cells and with anti-PSA for the epithelial cells components. Quantification was made using a computerized image analysis system. Our results indicates that a statistically significative difference in the percentage of smooth muscle cells (p < 0.02) exists when comparing a single biopsy and the corresponding adenomas. In contrast, no difference was found in the percentage of epithelial cells, nor for the glandular acini between a single biopsy and the entire adenoma (paired t-test). Using a multivariate matrix, a statistically significative correlation was found between the percentage of smooth muscle cells in the biopsies and the prostatic adenomas in toto. In conclusion, our study demonstrates that major differences in the percentage of the different tissue components exist between different prostatic adenomas. A single prostatic biopsy could help in selecting patients prior to medical therapy for BPH.