Microbiome and Prostate Cancer: Emerging Diagnostic and Therapeutic Opportunities.

This review systematically addresses the correlation between the microbiome and prostate cancer and explores its diagnostic and therapeutic implications. Recent research has indicated an association between the urinary and gut microbiome composition and prostate cancer incidence and progression. Specifically, the urinary microbiome is a potential non-invasive biomarker for early detection and risk evaluation, with altered microbial profiles in prostate cancer patients. This represents an advancement in non-invasive diagnostic approaches to prostate cancer. The role of the gut microbiome in the efficacy of various cancer therapies has recently gained attention. Gut microbiota variations can affect the metabolism and effectiveness of standard treatment modalities, including chemotherapy, immunotherapy, and hormone therapy. This review explores the potential of gut microbiome modification through dietary interventions, prebiotics, probiotics, and fecal microbiota transplantation for improving the treatment response and mitigating adverse effects. Moreover, this review discusses the potential of microbiome profiling for patient stratification and personalized treatment strategies. While the current research identifies the pivotal role of the microbiome in prostate cancer, it also highlights the necessity for further investigations to fully understand these complex interactions and their practical applications in improving patient outcomes in prostate cancer management.

HER2 positivity predicts BCG unresponsiveness and adaptive immune cell exhaustion in EORTC risk-stratified cohort of bladder cancer.

Introduction: Predicting the response to Bacillus Calmette-Guérin (BCG) therapy in high-risk patients with non-muscle invasive bladder cancer (NMIBC) is crucial, as failure may necessitate interventions, such as radical cystectomy or salvage therapy. With the recent classification of genetic class 2a (which has HER2 protein abundance as its signature mutation of ERBB2), evaluating its prognostic role and relationship with BCG response could yield important results. Methods: This retrospective study included 160 patients with NMIBC who underwent transurethral resection of bladder tumors at Gangneung Asan Hospital between 2000 and 2013 and were stratified based on the European Organization for Research and Treatment of Cancer (EORTC) risk criteria. In addition, we analyzed a subset of 67 patients who had received BCG induction therapy to identify factors predictive of BCG treatment response. Univariate and multivariate analyses were used to assess the impact of clinicopathological factors, HER2 positivity, and EORTC risk on recurrence, progression, survival, and BCG response. Each variable's prognostic significance was determined using the Kaplan-Meier analysis. The tumor microenvironments (TMEs) were evaluated in relation to HER2 and EORTC risk. Results: Patients with HER2+ had a higher median age, a greater prevalence of high-grade tumors, and more frequent recurrences. The univariate analysis demonstrated that the HER2+, intermediate (vs. low-risk) high (vs. low-risk), and EORTC recurrence risk groups were significantly associated with recurrence. In patients treated with BCG, only the HER2+ status predicted recurrence. In the univariate analysis for progression, age, high EORTC progression risk (vs. low-to-intermediate), HER2+, and programmed death-ligand 1 positive (PD-L1+) were significant factors. In multivariate analyses for progression, age, high EORTC progression risk, and PD-L1+ were significant factors for progression. HER2 expression was associated with the TME, influencing the proportion of PD-L1+ cells, as well as other markers of PD-1, CD8, and Ki67. Conclusion: The HER2+ status may be related to genetic characteristics that appear more frequently in older age, which suggests a potential for predicting the recurrence and response to BCG treatment. Additionally, analyzing TME trends of aggressive adaptive immune response characterized by HER2 expression provides insight into recurrence and BCG response mechanisms.

Efficacy and tolerability of mirabegron compared with solifenacin for children with idiopathic overactive bladder: A preliminary study.

PURPOSE: To compare the efficacy and tolerability of mirabegron and solifenacin in pediatric patients with idiopathic overactive bladder (OAB) and to identify factors affecting OAB symptom improvement after treatment. MATERIALS AND METHODS: We retrospectively reviewed 103 patients (5-15 years old) who visited our hospital with OAB symptoms between July 2017 and March 2019. All participants had received solifenacin or mirabegron. Those who had secondary OAB or who did not complete the frequency-volume chart either before or after treatment were excluded. The age-adjusted bladder capacity ratio was used to evaluate bladder capacity. Efficacy was assessed on the basis of patient reports and changes in the frequency-volume chart, and ≥90% reduction was regarded as "responding to medication." Tolerability was assessed by obtaining reports from patients about the adverse effects of the drug. RESULTS: After the exclusion of 58 patients, 45 patients (29 in solifenacin-group and 16 in mirabegron-group) were included in the primary analysis. The age-adjusted bladder capacity ratio increased from 0.71 to 0.96 (p<0.001) and from 0.57 to 0.97 (p=0.002) after solifenacin and mirabegron use, respectively. Decreased bladder capacity before medication was associated with responding to medication (odds ratio, 7.41; p=0.044). There was no significant difference in efficacy between the two drugs. Drug-induced adverse effects were reported in only 3 (10.3%) of the solifenacin-treated patients. CONCLUSIONS: Mirabegron showed comparable efficacy to solifenacin in pediatric patients with idiopathic OAB. Additionally, only few adverse effects were reported, suggesting that mirabegron can be a safe alternative for the treatment of idiopathic pediatric OAB.

Factors affecting the response rate of frequency volume chart: A prospective nonrandomized controlled study.

AIMS: To evaluate if compliance with frequency volume charts can be improved if a physician explains its importance and to identify factors affecting compliance and accurate responses to frequency volume chart (FVC). METHODS: We identified patients ≥18 years of age with voiding dysfunction reported from July 2013 to February 2014. Patients were explained the importance of frequency volume charts by a doctor and then a nurse explained how to fill it (group A). Others were only explained how to fill it (group B). RESULTS: A total of 137 patients were enrolled. The response rate to frequency volume charts was higher in group A than in group B (94.3% vs 82.9%, P = .038). Patients ≥70 years of age, without a private health insurance, with high school education or higher, and without past medical history had a higher response rate in group A than in group B. In the multivariate binary logistic regression analysis, group A (odds ratio [OR], 4.87; 95% confidence interval [95% CI], 1.04-22.89; P = .045) and QoL (OR, 2.28; 95% CI, 1.16-4.46; P = .017) were factors associated with the response rate. In addition, group A (OR, 3.46; 95% CI, 1.03-11.70; P = .045) and being 60's years old (vs 50's years, OR, 7.01; 95% CI, 1.36-36.23; P = .020) were related to FVC complete response rate. CONCLUSIONS: Frequency volume chart compliance can be improved if physicians explain its importance for lower urinary tract symptoms diagnosis and management. The explanation and severe lower urinary tract symptoms are factors affecting compliance and the explanation and being 60's years old are related to accurate response.

Surgical managements of pseudoepitheliomatous keratotic and micaceous balanitis: A case report.

INTRODUCTION: Pseudoepitheliomatous keratotic and micaceous balanitis (PKMB) is an extremely rare disease. Herein, we report a case of PKMB in a patient who underwent two surgical procedures, since the 5-FU cream was not available. PRESENTATION OF CASE: A 50 year-old Korean man undergoing circumcision in a local clinic presented with a tumor-like lesion on the glans penis. Peeling the mass was performed to remove the entire mass after an excisional biopsy. A pathologic finding of mass showed hyperkeratotic and papillomatous squamous epithelium without obvious cytologic atypia. Considering that the lesion recurred after 4 weeks, the patient underwent glansectomy with split-thickness skin graft (STSG). There had been no evidence of recurrence at the surgical site during the follow-up at 6 years postoperatively. DISCUSSION: If the 5-FU cream is not available, two surgical procedures can be performed for treatment and biopsy. Peeling the mass has the advantage of confirming the characteristics of the whole lesion, but it cannot confirm tumor invasion because it is unable to obtain the subepithelial layer. Glansectomy is able to accurately identify the tumor stage because it removes the tumor and total glans penis and has excellent outcome. CONCLUSION: PKMB is very rare and has a characteristic appearance, which is mica-like crusts and keratotic horny mass on the glans penis. Glansectomy with STSG is a good procedure when the 5-FU cream was not available.

Integrity of the Urethral Sphincter Complex, Nerve-sparing, and Long-term Continence Status after Robotic-assisted Radical Prostatectomy.

BACKGROUND: The applicability of the sphincter complex integral theory to robotic-assisted radical prostatectomy (RARP) is unclear, with little known about the long-term effect of sphincter complex integrity on continence. OBJECTIVE: To determine whether the preoperative anatomical and functional features of the sphincter complex and the degree of nerve-sparing affect long-term continence after RARP. DESIGN, SETTING, AND PARTICIPANTS: Prospective study of 529 patients who underwent RARP at a single tertiary center. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Anatomical factors, including membranous urethral length (MUL) and pelvic diaphragm length (PDL), were assessed using sagittal views of preoperative magnetic resonance imaging. MUL was defined as the distance from the posterior prostate apex to the urethra level at the penile bulb, and PDL was defined as the length of the urethra that met the planes created by the pelvic floor muscles. Functional parameters including maximum urethral closure pressure (MUCP) and functional urethral length were evaluated using preoperative measurements of the urethral pressure profiles. The degree of nerve-sparing was stratified as bilateral, unilateral, or none. Continence (pad-free status) was assessed according to anatomical and functional factors and nerve-sparing. We used binary logistic regression to assess factors predicting continence return 12 mo after RARP. RESULTS AND LIMITATIONS: Continence return rates 1, 3, 6, and 12 mo after RARP were 39.7%, 66.0%, 80.2%, and 87.0%, respectively. Continence return rates at 12 mo differed significantly in patients with MUL ≥11.7mm (91.9%) and <11.7mm (79.9%), PDL ≥9.9mm (96.7%) and <9.9mm (74.5%), and MUCP ≥66 cmH2O (89.7%) and <66 cmH2O (79.4%). The continence return rate was significantly higher in patients with bilateral (93.0%) than in patients with unilateral (78.1%) or no (76.7%) nerve-sparing. Multivariate analysis showed that PDL (odds ratio [OR]=2.187 per mm), MUCP (OR=1.037 per cmH2O), and bilateral nerve-sparing (OR=3.671) were independently associated with continence return 12 mo after RALP. CONCLUSIONS: The anatomical length and static pressure of the sphincter complex affected continence after RARP. Bilateral nerve-sparing was independently associated with long-term continence. PATIENT SUMMARY: Predisposing length and static pressure of the urinary sphincter affect continence after robotic-assisted radical prostatectomy. Nerve bundle preservation during surgery enhances postoperative return of continence.

Androgen deprivation therapy during and after post-prostatectomy radiotherapy in patients with prostate cancer: a case control study.

BACKGROUND: Here we assessed the influence of androgen deprivation therapy (ADT) during and/or after post-prostatectomy radiotherapy (RT) on biochemical recurrence (BCR) and radiographic progression in patients with prostate cancer. METHODS: Patients with prostate cancer who underwent post-prostatectomy RT were analyzed. BCR and radiographic progression after RT were compared according to the concurrent or salvage ADT. Cox regression analyses were used to identify risk factors for BCR and radiographic progression. RESULTS: Of the 227 patients who underwent post-prostatectomy RT, 95 (41.9%) received concurrent ADT for a median of 17.0 months. Despite more aggressive disease characteristics in the concurrent ADT group than in the RT-only group, the former had a better 5-year BCR-free survival rate than the latter (66.1 vs. 53.9%; p = 0.016), whereas the radiographic progression rate was not significantly different between two groups. On the other hand, salvage ADT after post-RT BCR significantly delayed radiographic progression (5-year radiographic progression-free survival; 75.2 vs. 44.5%; p = 0.002). CONCLUSIONS: Concurrent ADT improved BCR-free survival, and salvage ADT after post-RT BCR improved radiographic progression-free survival. To maximize the oncological benefit, ADT of sufficient duration should be implemented.

Heterogeneous oncologic outcomes according to surgical pathology in high-risk prostate cancer: implications for better risk stratification and preoperative prediction of oncologic outcomes.

PURPOSE: To evaluate the better risk stratification based on surgical pathology, and to predict oncologic outcomes after radical prostatectomy (RP) with a better scoring system in high-risk prostate cancer (PCa) patients. METHODS: We evaluated high-risk PCa patients (PSA >20 ng/ml, ≥cT3a, or Gleason score 8-10) who underwent RP between 2007 and 2013 at our institute. We classified patients into three groups according to their pathologic outcomes: favorable (pT2, Gleason score ≤7, and node negative), intermediate (specimen-confined disease (pT2-3a, node negative PCa with negative surgical margins) but not in the favorable group), and unfavorable (the remaining patients). We developed a risk stratification scoring system to predict prognostic outcomes after RP and validated our scoring system to estimate its predictive accuracy. RESULTS: Among a total of 356 patients, 95 (26.7%), 115 (32.3%), and 146 (41%) were in the favorable, intermediate, and unfavorable prognostic groups, respectively. The 5-year biochemical recurrence-free survival rates of the patients in each group were 87.8, 64.6, and 41.4%, respectively. We developed a scoring system based on preoperative PSA, clinical stage, percentage of tumor positive core, and percentage of cores with a Gleason score 8-10. This demonstrated internally and externally validated concordance indices of 0.733 and 0.772, respectively. CONCLUSIONS: Using our scoring system, we can predict which patients with high-risk PCa would benefit more from RP. Thus, this system can be used in patient counseling to determine an optimal treatment strategy for high-risk PCa.

Prognostic heterogeneity in T3aN0M0 renal cell carcinoma according to the site of invasion.

PURPOSE: We investigated the influence of the site of invasion on recurrence and survival in patients with pT3aN0M0 renal cell carcinoma (RCC). MATERIALS AND METHODS: We reviewed the data of 266 patients with pT3aN0M0 RCC who underwent nephrectomy and divided them into the following 5 groups according to the site of invasion: perinephric invasion (PNI), sinus fat invasion (SFI), PNI and SFI without renal vein invasion (RVI) (i.e., PNI+SFI), RVI, and RVI with PNI and/or SFI (RVI+PNI±SFI). Subgroup analysis was performed to verify the differences in prognosis according to the extent of renal vein invasion using Cox regression models. RESULTS: A total of 111 patients (41.7%) experienced recurrence and 59 patients (22.2%) died of disease during follow-up (median = 58.1mo; interquartile range: 37.2-86.5). Patients with RVI showed significantly poorer outcomes than those with fat invasion in terms of 5-year recurrence-free survival (34.3% vs. 62.2%, P<0.001) and cancer-specific survival (62.8% vs. 84.1%; P<0.001). In multivariate analysis, RVI was an independent prognostic factor for recurrence and survival. In 94 patients with RVI, the 5-year recurrence-free survival rates were 50.0%, 33.9%, and 8.9% for the thrombus-only, the vascular wall invasion with negative surgical margin, and the vascular wall invasion with positive surgical margin groups, respectively (P<0.001), and the cancer-specific survival rates were 82.3%, 56.6%, and 20.0%, respectively (P<0.001). Wall invasion was the only independent prognostic factor for cancer-specific survival in these patients. CONCLUSIONS: Patients with pT3aN0M0 RCC with RVI have a significantly poorer prognosis than those with fat invasion. The prognosis differs according to the extent of RVI. Wall invasion should be considered a negative prognostic indicator in patients with T3a RCC.

The efficacy of performing shockwave lithotripsy before retrograde intrarenal surgery in the treatment of multiple or large (≥1.5 cm) nephrolithiasis: A propensity score matched analysis.

PURPOSE: To investigate the effect of performing shockwave lithotripsy (SWL) before retrograde intrarenal surgery (RIRS) on the treatment outcomes of patients with nephrolithiasis. MATERIALS AND METHODS: The data of 189 patients with renal stones who underwent RIRS from July 2007 to July 2014 was reviewed retrospectively. Patients with stones larger than 1.5 cm were recommended to undergo SWL before RIRS. Patients were divided into 2 groups based on whether the preoperative SWL was performed (group 1, n=68) or not (group 2, n=121). The cohorts of the 2 groups cohorts were matched 1:1 using propensity score analysis. Patient, stone characteristics, operative parameters, and stone-free rates were compared. RESULTS: Patients in groups 1 and 2 were matched with respect to stone size, number, and location, leaving 57 patients in each group. After matching, no differences were identified between the 2 groups regarding age, body mass index, sex, stone composition, density and multiplicity. Compared to group 2 patients, patients in group 1 had fewer number of procedures performed (1.10 vs. 1.26, p=0.045) and higher stone-free rate (89.4% vs.73.6%, p=0.039). In multivariate analysis, Non lower calyceal location (odd ratio [OR], 8.215; 95% confidence interval [CI], 1.782-21.982; p=0.041), stone size (OR, 6.932; 95% CI, 1.022-18.283; p<0.001), and preoperative SWL (OR, 2.210; 95% CI, 1.058-7.157; p=0.019) were independent factors predicting a stone-free state after RIRS. CONCLUSIONS: Performing SWL before RIRS may favor stone eliminations during surgery and increase the stone-free rate in selected patients.

Prognostic value of vascular endothelial growth factor (VEGF), VEGF receptor 2, platelet-derived growth factor-ß (PDGF-ß), and PDGF-ß receptor expression in papillary renal cell carcinoma.

The prognostic value of the expression of vascular endothelial growth factor (VEGF), VEGF receptor 2 (VEGFR2), platelet-derived growth factor (PDGF)-ß, and PDGF receptor (PDGFR)-ß in papillary renal cell carcinoma (pRCC) is unknown. A total of 145 patients, who were confirmed to have pRCC, were analyzed. Expression levels of molecular markers were assessed via immunohistochemistry. The median follow-up period for all patients was 52.0 (interquartile range, 34.5-90.5) months. Among the cohort of 145 patients, high VEGF expression was observed in 100 (69.0%) patients, whereas high expression of VEGFR2, PDGF-ß, and PDGFR-ß was observed in 64 (44.1%), 42 (29.0%), and 30 (20.7%) patients, respectively. Only patients with high VEGFR2 expression exhibited improved 10-year recurrence-free survival (85.3% versus 58.1%; P=.005) and cancer-specific survival (86.4% versus 70.1%; P=.014) rates compared with individuals who exhibited low expression. Multivariate analysis revealed that high VEGFR2 expression was an independent prognostic factor for recurrence (hazard ratio, 0.326; P=.006) and cancer-specific mortality (hazard ratio, 0.334; P=.046). During follow-up, 17 patients received targeted drug therapy. Patients with high VEGFR2 expression showed a better initial response (partial response, 40%; stable disease, 20%; progressive disease, 40%) than patients with low expression did (partial response, 0%; stable disease, 58.3%; progressive disease, 41.7%; P=.052). pRCC with high VEGFR2 expression seems to be associated with a better initial response to targeted drug therapy and a better prognostic outcome.

Simultaneous robotic low anterior resection and prostatectomy for adenocarcinoma of rectum and prostate: initial case report.

BACKGROUND: We report a case of synchronous rectal and prostate cancer treated successfully with simultaneous da Vinci robotic-assisted low anterior resection of the rectum and robotic-assisted laparoscopic radical prostatectomy to address both cancers. CASE PRESENTATION: Recently, minimally invasive surgical techniques using da Vinci robot® system (Intuitive Surgical, Sunnyvale, USA) were introduced as curative surgical modality of prostate and rectal malignancies. Herein, we report an initial case of simultaneous robotic low anterior resection and robotic prostatectomy for adenocarcinoma of rectum and prostate sharing a considerable number of port sites. CONCLUSION: Simultaneous robotic-assisted low anterior resection could be performed with robotic-assisted radical prostatectomy safely and effectively in synchronous rectal and prostate cancer.

Characteristics of Anteriorly Located Prostate Cancer and the Usefulness of Multiparametric Magnetic Resonance Imaging for Diagnosis.

PURPOSE: We analyzed the pathological and oncologic characteristics of anteriorly located prostate cancer and assessed the usefulness of magnetic resonance imaging to detect anterior prostate cancer. MATERIALS AND METHODS: We analyzed the records of 728 consecutive patients treated with radical prostatectomy. Patients were categorized with anterior or prostate cancer or tumors involving the anterior and posterior prostate according to the dominant tumor location on whole mount section. RESULTS: The anterior and posterior prostate cancer groups and the group with cancer at both locations represented 31.0%, 46.7% and 22.3% of the total number of patients, respectively. Anterior prostate cancer was less commonly palpable (p <0.001) and needed more frequent repeat biopsy (p = 0.012) than posterior prostate cancer. Moreover, the anterior group had fewer positive cores than the posterior group (p <0.001) despite comparable tumor volumes. Gleason score upgrading was more frequently observed in anterior than in posterior prostate cancer (p = 0.003). However, final pathological features did not significantly differ. Only the seminal vesicle involvement rate was lower in anterior than in posterior prostate cancer (p <0.001). Estimated 5-year biochemical recurrence-free survival in patients with anterior prostate cancer was 87.5%, significantly higher than in patients with posterior prostate cancer (77.4%, p = 0.001) and patients with anterior plus posterior involvement (74.4%, p <0.001). Multivariate analysis revealed that anterior location was an independent prognostic factor for biochemical recurrence (HR 0.403) along with other well-known prognostic factors. To detect anterior prostate tumors the sensitivity and specificity of magnetic resonance imaging were 78.1% and 58.2%, respectively. CONCLUSIONS: Anterior prostate cancer had pathological features and favorable oncologic outcomes comparable to those of posterior prostate cancer but also more frequent Gleason score upgrading. Magnetic resonance imaging had moderate diagnostic performance for detecting lesions in the anterior prostate.

Effects of Continuous Peritubal Local Anesthetic Instillation on Postoperative Pain After Percutaneous Nephrolithotomy: A Prospective, Randomized Three-Arm Study.

OBJECTIVE: We evaluated the effects of continuous instillation of a local anesthetic at the nephrostomy site on postoperative pain following percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS: Sixty patients who underwent PCNL between August 2013 and March 2015 were enrolled in this randomized prospective study. The following three groups comprising 20 patients each were analyzed: Group A, continuous infiltration of local anesthetic at the nephrostomy site; Group B, local anesthetic injected only once; and Group C, 0.9% saline injected as a control at the end of the procedure. Postoperative patients reported pain scores, and amount of analgesic use was recorded at 2, 6, 12, 24, and 48 hours after the surgery. RESULTS: The mean pain scores of patients in Group A and B were significantly lower compared with Group C patients as much as 12 hours postoperatively (p = 0.001). However, at 24 hours postoperatively, the mean pain scores of Group B and C patients became comparable, while those of Group A patients remained significantly lower until 48 hours after the surgery (p < 0.001). Patients in Group A and C demanded the least and greatest amounts of analgesics, respectively, at all-time intervals (all p < 0.05). CONCLUSIONS: Continuous infiltration of a local anesthetic is effective for both managing pain immediately after surgery and in dealing with pain that occurs late in the recovery period.

Effect of preoperative urodynamic detrusor overactivity on post-prostatectomy incontinence: a systematic review and meta-analysis.

PURPOSE: To investigate whether preoperative urodynamic detrusor overactivity (DO) contributes to post-prostatectomy incontinence (PPI). METHODS: We systematically searched the online PubMed, Embase, and Cochrane Library databases spanning the period of January 1989 to December 2014. RESULTS: A total of nine articles met the eligibility criteria for this systematic review. The eligible studies included a total of 457 patients with a median number of 58 patients per study (range 17-92). Of the nine studies, five conducted open retropubic radical prostatectomy (RRP), two performed robot-assisted laparoscopic prostatectomy (RALP), and two others utilized multiple modalities. PPI was more likely to occur in patients with preoperative DO [pooled odds ratio (OR) 2.30; 95 % confidence interval (CI) 1.39-3.82; studies 9; participants 419], as compared to patients who were DO negative. Sensitivity analysis using the subgroups of RRP (OR 2.32; 95 % CI 1.11-4.85), RALP (OR 3.41; 95 % CI 1.55-7.47), DO defined as any amplitude of involuntary contraction (OR 2.32; 95 % CI 1.11-4.85), no postoperative intervention (OR 2.32; 95 % CI 1.11-4.85), and outcome evaluation after 6 months (OR 2.32; 95 % CI 1.11-4.85) demonstrated consistent results. Although some comparisons showed inter-study heterogeneity, there was no clear evidence of publication bias in this meta-analysis. CONCLUSIONS: Our meta-analysis results suggest that preoperative DO is another possible underlying mechanism for PPI.

Bone mineral density in prostate cancer: a comparative study of patients with prostate cancer and healthy controls using propensity score matching.

OBJECTIVE: To determine whether the prevalence of prostate cancer is associated with a decrease in bone mineral density (BMD) compared to a healthy control group and to identify the factors associated with osteoporosis in patients diagnosed with prostate cancer before the initiation of any kind of treatment. MATERIALS AND METHODS: A retrospective study was conducted in 582 patients with prostate cancer and 2536 healthy men. Confounding variables affecting BMD, including age, serum testosterone, body mass index (BMI), diabetes mellitus, hypertension, and smoking were matched in the 2 study groups using propensity score analysis. RESULTS: The propensity score model included 6 variables, and matching by propensity score yielded 502 patients in the prostate cancer group matched to 502 men in the healthy control group. On the basis of the lowest T-score available, a high prevalence of osteoporosis was found in the prostate cancer group (P = .0001). Prostate cancer was the factor correlating significantly with osteoporosis before propensity score matching (odds ratio [OR] 2.96, P <.001) and after propensity score matching (OR 3.22, P <.001). By multivariate analysis, conducted to assess the significance of each variable affecting the development of osteoporosis in patients with prostate cancer, bone metastasis was found to be an independent predictor of osteoporosis (OR 3.45, P = .002), along with BMI (continuous, OR 0.75, P <.001). CONCLUSION: After controlling for variables affecting BMD, prostate cancer was a risk factor for osteoporosis. Measurement of BMD is a logical first step in the clinical strategy to avoid or minimize potential bone-related complications in men with prostate cancer, especially if they have bone metastasis and a slender stature.

Does repeat biopsy affect the prognosis of patients with prostate cancer treated with radical prostatectomy? Analysis by the number of cores taken at initial biopsy.

UNLABELLED: Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? To date, studies to evaluate clinical significance of prostate cancer detected on repeat biopsy in patients who underwent radical prostatectomy have yielded inconsistent results. The present study confirms that prostate cancer diagnosed after repeat biopsies is related to better pathological outcomes after radical prostatectomy, but not predictive of biochemical recurrence. Additionally, we find that the number of cores taken at initial biopsy do not affect the association between the number of previous biopsies and the prognosis. OBJECTIVE: To determine whether repeat prostate biopsies are associated with more favourable prognoses compared with diagnosis at initial biopsy in patients who undergo radical prostatectomy for prostate cancer and to determine if this association is affected by the number of cores taken at initial biopsy. PATIENTS AND METHODS: We reviewed 1147 patients with prostate cancer from 1991 to 2008. Patients were stratified into two groups by the number of biopsies before diagnosis (initial biopsy vs repeat biopsy: at least two biopsies). The effects of several variables on pathological outcomes and biochemical recurrence-free and systemic progression-free survivals were assessed. RESULTS: Of the 1147 patients, 1064 (92.8%) were diagnosed with cancer at first biopsy and 83 (7.2%) at repeat biopsy. Compared with patients diagnosed at initial biopsy, those diagnosed at repeat biopsies were more likely to have a lower clinical stage (cT1c: 79.5% vs 55.5%, P < 0.001) and organ-confined tumours (78.3% vs 61.3%, P= 0.003), but there was no significant difference in initial biopsy core number (8.3 vs 8.7, P= 0.373). Five-year biochemical recurrence-free and progression-free survival rates did not show significant differences between the two groups (88.8% vs 82.2%, P= 0.078; 100.0% vs 96.5%, P= 0.105, respectively), and these results were not affected by the number of cores taken at initial biopsy. CONCLUSIONS: Although prostate cancer diagnosed after repeat biopsies was related to better pathological outcomes after radical prostatectomy, the number of previous biopsies did not predict disease recurrence. Moreover, the number of cores taken at initial biopsy did not affect these associations.

Predictive characteristics of malignant pheochromocytoma.

PURPOSE: The prognosis of patients with malignant pheochromocytoma is poor, but the predictive factors are not well understood. We aimed to identify the clinical characteristics predictive of malignancy after initial surgical removal in patients with pheochromocytoma. MATERIALS AND METHODS: We retrospectively reviewed the records of 152 patients diagnosed with pheochromocytoma, including 5 (3.3%) with metastasis at the time of the initial surgical excision and 12 (7.9%) who developed metastasis during follow-up. To determine the factors predictive of malignancy, we compared clinical, radiographical, and urinary chemical findings between patients with benign and malignant disease. Mean follow-up was 41.5 months (range, 0.9-298 months) after surgery. RESULTS: Malignant tumors were significantly larger than benign tumors (11.1±4.0 cm vs. 6.2±3.4 cm, p<0.001), and postoperative persistence of arterial hypertension was more frequent after removal of malignant than benign tumors (p=0.001). Among the 147 patients without metastatic disease at diagnosis, those who developed metastasis had significantly lower concentrations of urinary catecholamine metabolites per unit of tumor, including vanillylmandelic acid (1.2 vs. 3.7 mg/day/cm, p=0.049), epinephrine (4.5 vs. 168.9 µg/day/cm, p=0.008), and norepinephrine (13.1 vs. 121.8 mg/day/cm, p<0.001). The overall 5-year metastasis-free survival rate was 84.4% and was significantly higher in patients with smaller tumors (≤5.5 vs. >5.5 cm; 90.6% vs. 81.2%, p=0.025) and higher 24-hour secretion of vanillylmandelic acid (>2.1 vs. ≤2.1 mg/day/cm; 94.9% vs. 70.9%, p=0.019). CONCLUSIONS: Large tumor size (>5.5 cm) and minimally elevated 24-hour urinary vanillylmandelic acid (≤2.1 mg/day/cm) were significantly associated with a higher probability of a malignant pheochromocytoma portending a lower metastasis-free survival and mandating more rigorous follow-up after surgery.

Effect of prostate size on pathological outcome and biochemical recurrence after radical prostatectomy for prostate cancer: is it correlated with serum testosterone level?

OBJECTIVE: To examine whether prostate size is associated with pathological outcome and biochemical recurrence (BCR) after radical prostatectomy (RP) in patients with prostate cancer, and to evaluate whether it is correlated with serum testosterone level. PATIENTS AND METHODS: The study comprised 579 men treated with RP for prostate cancer between June 1991 and March 2008, with a prostate-specific antigen level of <20 ng/mL. We assessed the associations of prostate size (volume), measured using magnetic resonance imaging, and serum testosterone concentration, with adverse pathological outcomes and BCR. RESULTS: There was a positive correlation between preoperative prostate volume and prostate weight (r= 0.685, P < 0.001). On multivariate analysis, prostate volume was inversely associated with the outcomes of high-grade prostate cancer (P= 0.044), extracapsular extension (P= 0.011) and BCR (P= 0.016). There was also a positive correlation between serum testosterone level and prostate volume (r= 0.136, P= 0.043). Multivariate analysis showed that lower serum testosterone levels correlated with adverse pathological stage and a pathological Gleason score of ≥ 8 (P= 0.042). However, there was no relationship between serum testosterone level and BCR after adjusting for covariates. CONCLUSIONS: Men with smaller prostates had unfavourable pathological findings and were at greater risk of progression after RP. Low serum testosterone levels were not associated with tumour progression. Therefore, another mechanism, aside from hormonal factors, might be involved in unfavourable outcomes in patients with a small prostate.