Prostate cancer metastases to bone: observational study for the evaluation of clinical presentation, course and treatment patterns. Presentation of the METAURO protocol and of patient baseline features.

AIM: The aim of the present study is to describe the research protocol and preliminary results of an observational survey on presentation patterns of prostate cancer metastasis to bone (METAURO), involving urology departments in several Italian hospitals. MATERIALS AND METHODS: The study design was observational and inclusion criteria required subjects with prostate cancer patients who were first diagnosed with metastatic bone disease not more than 18 months before. For each patient recruited to the study, a retrospective evaluation and a prospective surveillance were undertaken. RESULTS: One hundred and ninety-nine patients were enrolled at 32 urological centers in Italy. The median age of participants at first visit was 72.7 years (SD = 7.8). Mean PSA at onset was 323.6 (SD = 1058.3) and these values strongly correlated with Gleason score (Spearman r = 0.228; p = 0.003). The main cause for suspicion of bone metastasis was routine follow up (53%), followed by pathological fracture (31%). Main metastasis sites were located at femur (43.2%), lumbar sacral spine (39.7%), cervical spine (38.2%) and ribs (33.7%). With regard to the main types of bone metastases identified, 27.6% were sclerotic, 5% were lytic and 21.1% were mixed. The specialist who most frequently suspected bone metastasis and referred patients for diagnostic assessment was an urologist (84.9%). CONCLUSIONS: The present survey is a multicentric study with the main aim to identify features of prostate cancer patients with bone metastases. This survey confirmed that suspicion of bone metastasis is motivated by pain symptoms only in a small percentage of patients with prostate cancer, which testifies to both the difficulty of diagnosis and the need and usefulness of accurate regular follow up.

Prognostic role of cell apoptotic rate in prostate cancer: outcome of a long-time follow-up study.

The tumour apoptotic pattern is described as a good predictor of outcome in patients with prostate cancer (PCa). So far no authors have evaluated the role of apoptotic characteristics in patients who have undergone radical prostatectomy (RRP) alone. The aim of the present study is to estimate the prognostic role of the apoptotic index (AI) in a group of patients with prostatic adenocarcinoma subjected to RRP with no adjuvant therapy. Fifty patients underwent RRP according to standardised techniques and the surgical specimens were analysed histologically. In order to evaluate the AI and correlate these results with the follow-up data, we used a standardised apoptotic regulatory terminal deoxynucleotidyl transferase-mediated biotinylated deoxyuridine-triphosphate-biotin nick end-labelling technique (Becton Dickinson Immunocytometry Systems, San Jose, CA, USA). The mean follow-up period was 66 months. Significant correlations were found between the AI and pathological features, such as stage (p<0.001) and grade (p<0.001). Out of 50 patients, 13 (26%) had biochemical recurrence and clinical disease progression, with an AI of 1.93 (range, 0.76-5.22), while 37 patients (74%) who did not report any disease progression, had an AI of 0.58 (range, 0.1-3.12). Furthermore, the AI significantly correlated with status at the end of follow-up (r=0.75, p=0.002), these data being confirmed by Kaplan-Meier curve analysis (p<0.001). On multivariate analysis, the AI proved to be an independent prognostic factor of progression-free probability (p<0.001). Our results highlight the utility of AI analysis in assessing the probability risk of clinical progression in PCa patients who are treated with RRP.

Penile Doppler ultrasound assessment of the cavernous arteries.

OBJECTIVE: To evaluate the possible relationship between the basal and dynamic diameter of the cavernous arteries and altered peak diastolic (PDV) and systolic values (PSV) in patients undergoing penile Doppler ultrasound for differential diagnosis of erectile dysfunction (ED). MATERIALS AND METHODS: From December 2003 to December 2004 we examined 132 consecutive patients suffering from erectile dysfunction and 30 controls. All patients underwent penile Doppler ultrasound in basal and dynamic conditions and all the examinations were performed by measurements of the cavernous arteries diameters in basal and dynamic conditions. RESULTS: In the 30 healthy controls the mean cavernous arteries diameter was 0.82 mm (range 0.6-1.3 mm) on the right and 0.8 mm (range 0.5-1.25 mm) in basal conditions vs 1.30 mm (range 0.9-1.6 mm) on the right and 1.25 on the left (range 0.9 -1.60 mm) in dynamic conditions after injection of 10 microg. In the 132 patients with a diagnosis of organic ED, the mean diameter was 0.70 mm (range 0.3-1.3 mm) on the right and 0.76 mm (range 0.3-1.24) on the left in basal conditions vs 1.21 mm (range 0.8-1.93 mm) on the right and 1.24 mm (range 0.9-1.66 mm) on the left in dynamic conditions after injection of 10 microg. CONCLUSION: In our experience, assessment of the cavernous arteries in basal and dynamic conditions provides important additional data. Altered basal and dynamic values are predictive of anomalous PDV and PSV findings.