Normal anatomic relationships in prepubescent female external genitalia.

OBJECTIVE: Female congenital abnormalities and concomitant ambiguous genitalia constitute the primary reason for female genital reconstruction, however, objective data describing normal female anatomy is lacking. The aim of this study is to describe the normal anatomical relationships and size of the external genital structures in prepubescent females. MATERIALS AND METHODS: Data were collected prospectively from consecutive Tanner stage 1 females undergoing surgery unrelated to the genitalia. Recorded measurements included: clitoris length and width, length from clitoris to anus, clitoris to urethra, clitoris to posterior labia majora, mucosa behind vagina or posterior fourchette, and radius to labia minora at vagina. Patients were stratified by age into four age groups: <2 years, 2-5 years, 5-11 years and >11 years. RESULTS: Fifty-six patients met inclusion criteria. Clitoral width was similar in all age groups. The regression plots for the remaining measurements modeled on age all show a significant linear growth distribution. CONCLUSIONS: The average clitoral width was 3.8 mm, which remained constant between age groups. Clitoral length, length from clitoris to anus, clitoris to posterior labia majora, clitoris to urethra and posterior fourchette length increased across age groups. This study provides insight into the dimensions of normal external genitalia in tanner stage 1 females.

The effect of short-term dutasteride intake in early-stage prostate cancer: analysis of 148 patients who underwent three-dimensional prostate mapping biopsy.

OBJECTIVES: The effect of dutasteride on existing prostate cancer volume is largely unknown. In this study, we assessed the impact of dutasteride on tumor burden and Gleason score. METHODS: A retrospective review of patients from our institution was performed, examining men interested in surveillance for prostate cancer, who underwent transperineal three-dimensional mapping (TP-3DM) biopsy within 3-6 months after their initial cancer diagnosis. The criteria to qualify for TP-3DM biopsy included prostate-specific antigen < 10 ng/mL, Gleason score ≤ 7, ≤ 2 positive cores out of 12. There were 2 cohorts of men--those who took dutasteride daily before the TP-3DM biopsy and those who did not receive any 5ARIs. Upstaging of prostate cancer diagnosis was defined as an increase in one or more positive cores or a change from unilateral to bilateral disease. RESULTS: From 2006-2008, a cohort of 148 men underwent TP-3DM biopsy of the prostate. Ninety-one men received a treatment regime of dutasteride at least 3 months before TP-3DM biopsy. Fifty-seven men did not receive dutasteride or any other 5ARI. Approximately 74% of men who did not take dutasteride were upstaged and/or upgraded compared with 49.4% of men who received dutasteride (P = .0038). CONCLUSIONS: We observed a 24.3% decrease in the proportion of upstaging and/or upgrading of prostate cancer in men who received dutasteride at least 3 months before 3D prostate TP-3DM biopsy. Thus, the effect of dutasteride on prostate cancer may have implications for its potential use as a secondary chemoprevention agent.

The role of LHRH antagonists in the treatment of prostate cancer.

For patients with advanced prostate cancer, luteinizing hormone-releasing hormone (LHRH) agonists have provided successful androgen deprivation therapy (ADT) for some 25 years. However, the benefits of LHRH agonists are limited in that these agents are agonists, not antagonists. The search for and development of an effective LHRH antagonist have proven difficult. Nevertheless, antagonists offer subtle advantages, including more rapid reduction in testosterone levels, reduction in testosterone-induced flare, and maintenance of castrate levels of testosterone. Accordingly, LHRH antagonists appear to provide a viable alternative to LHRH agonist therapy. Degarelix, a recently approved LHRH antagonist, has been shown to work more quickly in lowering serum testosterone levels, with an acceptable safety profile and a mechanism of action that obviates the testosterone surges associated with LHRH agonist use. Presently, degarelix is the only LHRH antagonist approved for the treatment of advanced prostate cancer.

Targeted focal therapy for prostate cancer: a review.

PURPOSE OF REVIEW: Prostate cancer screening has shifted the diagnosis of prostate cancer to lower grade, organ confined disease. Radical prostatectomy or radiation therapy has been shown to be overtreatment in 30% of patients. In this review, we will discuss targeted focal therapy (TFT) using the modalities of cryotherapy or high intensity focused ultrasound as an alternate treatment for low-risk prostate cancers. RECENT FINDINGS: TFT uses 3-D mapping biopsies to guide treatment so lesions of interest are ablated whereas sparing surrounding healthy tissues, avoiding the side-effects associated with more invasive treatments. In recent years, improvements in cryotherapy and HIFU have increased efficacy whereas decreasing complications. Prostate cancer control reported following TFT is promising. SUMMARY: With data demonstrating effective treatment in select patients, physicians can better inform their patients of the options available to eradicate their prostate cancer. TFT provides an alternative to active surveillance and more aggressive treatments for patients with low-risk tumors. As studies mature, more information regarding long-term survival and benefit will become more evident.