Randomized clinical trial evaluating the effects of administering acidogenic boluses at dry-off on udder health, milk yield, and herd removal.

Acidogenic boluses can mitigate potential negative effects of high milk yield at dry-off on udder health. This randomized controlled trial aimed to investigate the effect of administering acidogenic boluses at dry-off on dry period intramammary infection (IMI) dynamics and on milk production parameters, somatic cell count linear score (LSCC), clinical mastitis (CM), and herd removal in the next lactation. A total of 901 cows from 3 dairy farms were randomly allocated to a control (CON, n = 458; no administration of acidogenic boluses at dry-off) or treatment group (TRT, n = 443; administration of 2 acidogenic boluses at dry-off). Quarter milk samples were collected at dry-off and after calving and submitted for bacteriological milk culture. The effects of treatment on the presence of quarter-level postpartum IMI, cure of existing IMI, and acquisition of new IMI, and on the prevalence of cow-level high LSCC (LSCC ≥4) in the first 30 days in milk (DIM) were analyzed using mixed effects logistic regression. Mixed linear regression was used to analyze cow-level milk production parameters (i.e., milk yield, fat corrected milk, fat and protein yield, and LSCC) in the first 90 DIM and until 300 DIM. For CM and herd removal, Cox proportional hazard regression models were used. In addition to treatment group, lactation group at dry-off, presence of high LSCC in the last test-day, average milk yield in the week before dry-off, presence of CM in the lactation of enrollment, and biologically relevant interactions were offered in all models. There was no evidence of a difference in IMI dynamics or in milk, fat corrected milk, protein or fat yields in the subsequent lactation between groups. The TRT group had a lower LSCC in the first 2 mo postpartum compared with the CON group (2.58 ± 0.3 vs. 2.92 ± 0.3 and 2.42 ± 0.3 vs. 2.81 ± 0.3, for first and second month postpartum). The prevalence of high LSCC in the first 30 DIM was 9.1% lower in the TRT compared with the CON group (16.3% vs. 25.5%; risk difference: -9.2; 95% confidence interval [CI]: -15.8, -2.5). Cows in the TRT group exhibited reduced hazards of CM in the subsequent lactation compared with cows in the CON group (hazard ratio: 0.75; 95% CI: 0.63, 0.89) as well as a reduced hazard of herd removal (hazard ratio: 0.82, 95% CI: 0.77, 0.88). The administration of acidogenic boluses as a component of dry-off management is a promising approach to maintain good udder health and reduce the hazard of CM and herd removal during the subsequent lactation.

Prostate cancer risk in men with prostate and breast cancer family history: results from the REDUCE study (R1).

BACKGROUND: To what degree the associations between PCa risk and family history of prostate cancer (PCa) and/or breast cancer (BCa) are attributable to screening biases is unclear. We examined these questions within the REDUCE study, where biopsies were largely independent of prostate specific antigen (PSA) minimizing screening biases. METHODS: Data were from REDUCE, which tested dutasteride 0.5 mg daily for PCa risk reduction in men with PSA 2.5-10.0 ng mL(-1) and a negative prestudy biopsy. Among men undergoing at least one on-study biopsy with complete data (n = 6415; 78.1%), the association between family history and PCa risk was tested using multivariate logistic regression adjusting for clinicodemographic characteristics. RESULTS: A family history of PCa alone was associated with increased PCa diagnosis (OR: 1.47, 95%CI: 1.22-1.77). In North America, PCa family history was not related to PCa diagnosis (OR: 1.02, 95%CI: 0.73-1.44), whereas outside North America, PCa family history was significantly related to diagnosis (OR: 1.72, 95%CI: 1.38-2.15) (P-interaction = 0.01). A family history of both PCa and BCa (OR: 2.54, 95%CI: 1.72-3.75) but not BCa alone (OR: 1.04, 95%CI: 0.84-1.29) was associated with increased PCa risk versus no family history and irrespective of geographical region. CONCLUSIONS: In REDUCE, PCa family history was significantly related to PCa diagnosis, although only for men outside North America. The presence of both PCa and BCa family history significantly increased risk versus PCa family history alone, irrespective of geographical region. Ultimately, our observations may support the need for changes in how we address family history in terms of both risk of PCa diagnosis and general risk stratification.

Baseline Basal Cell Hyperplasia Is not Associated With Baseline Lower Urinary Tract Symptoms, Baseline Clinical Prostatitis or Prostate Cancer in Repeat Biopsies.

OBJECTIVES: To evaluate whether the presence of basal cell hyperplasia (BCH) in negative biopsies is associated with concurrent lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH), clinical prostatitis, and future prostate cancer (PCa) in repeat prostate biopsy. METHODS: We performed a retrospective analysis of 6471 men, 50-75 years old with prostate-specific antigen between 2.5 and 10 ng/ml and prior negative biopsy who were enrolled in the Reduction by Dutasteride of PCa Events trial and underwent a 2-year repeat biopsy. The association between baseline BCH and risk of PCa, BPH/LUTS and clinical prostatitis measured at baseline were evaluated with logistic regression in uni/multivariable analysis, controlling for baseline patient characteristics. RESULTS: Among 6471 men enrolled, 84 (1.3%) had BCH in the baseline prostate biopsy. BCH was associated less chronic inflammation and more prostate atrophy (P < 0.05) and was unrelated to baseline patient characteristics. In both uni/multivariable analyses, BCH was not associated with PCa in repeat biopsy (univariable odds ratio [OR] = 0.98, 95% confidence interval [CI] = 0.53-1.82, P > 0.05; multivariable OR=1.15, 95% CI = 0.61-2.16, P > 0.05), BPH/LUTS (univariable OR = 1.13, 95% CI = 0.71-1.81, P > 0.05; multivariable OR = 1.20, 95% CI = 0.74-1.94, P > 0.05), or clinical prostatitis (univariable OR = 0.56, 95% CI = 0.18-1.81, P > 0.05; multivariable OR = 0.57, 95% CI = 0.18-1.83, P > 0.05). CONCLUSION: Among men undergoing repeat prostate biopsy with a baseline negative biopsy, BCH was associated with more histological atrophy and less chronic prostatitis, but was unrelated to LUTS/BPH, clinical prostatitis or future PCa risk.

Short-term wind speed forecasting in Uruguay using computational intelligence.

Short-term wind speed forecasting for Colonia Eulacio, Soriano Department, Uruguay, is performed by applying an artificial neural network (ANN) technique to the hourly time series representative of the site. To train the ANN and validate the technique, data for one year are collected by one tower, with anemometers installed at heights of 101.8, 81.8, 25.7, and 10.0 m. Different ANN configurations are applied for each site and height; then, a quantitative analysis is conducted, and the statistical results are evaluated to select the configuration that best predicts the real data. This method has lower computational costs than other techniques, such as numerical modelling. For integrating wind power into existing grid systems, accurate short-term wind speed forecasting is fundamental. Therefore, the proposed short-term wind speed forecasting method is an important scientific contribution for reliable large-scale wind power forecasting and integration in Uruguay. The results of the short-term wind speed forecasting showed good accuracy at all the anemometer heights tested, suggesting that the method is a powerful tool that can help the Administración Nacional de Usinas y Transmissiones Eléctricas manage the national energy supply.

Analysis of the feeding habits of the swallow-tailed hummingbird, Eupetomena macroura (Gmelin, 1788), in an urban park in southeastern Brazil.

The aim of this work was to observe and describe the feeding habits and available food resources of the swallow-tailed hummingbird, Eupetomena macroura. The study was carried out in a municipal park located in the city of Taubaté, in the state of São Paulo. The observations took place between December 2003 and October 2004, recording the following variables: 1) the plant species visited for feeding and territorial defense; 2) the kinds of food resources; and 3) the kinds of flight to procure and obtain food. E. macroura visited 12 plant species. For territorial defense, Mangifera indica was the most visited, whereas Malvaviscus arboreus was most visited for feeding. The foliage was the plant part that received the most frequent visits. In order to obtain nectar, the only species visited was M. arboreus; to obtain arthropods, the species most visited were Mangifera indica and Hymenaea stilbocarpa. In the dry season, the hummingbirds visited flowers, whereas in the rainy season they visited leaves to acquire food. The arthropod groups most frequently found on leafy branches were Homoptera and Psocoptera. Finally, the results of the type of flight analysis showed that flight used to capture food was more often observed than were flights to search for food. In conclusion, these observations suggest that E. macroura shows plasticity in feeding behavior, which can help it to persist in urban areas.

The association of atrophy in baseline prostate biopsy and lower prostate cancer grade in radical prostatectomy specimens.

INTRODUCTION: To evaluate whether the presence of prostate atrophy (P.A.) in negative prostate biopsy is associated with prostate cancer (P.C.a) grade at surgical pathology among men who are ultimately diagnosed with P.C.a and undergo radical prostatectomy (R.P.). METHODS: A retrospective analysis was performed of 136 men from the placebo arm of the Reduction by Dutasteride of P.C.a Events (R.E.D.U.C.E.) trial who had a baseline prostate biopsy negative for P.C.a, and were later diagnosed with P.C.a on biopsy and underwent radical prostatectomy over the 4-year study period. The association of baseline P.A. (present/absent) with P.C.a grade (W.H.O./I.S.U.P. grade group 1 or ≥2) at surgical pathology was evaluated with logistic regression in uni- and multivariable analyses, controlling for baseline patient characteristics. RESULTS: P.A. was observed in 74 prostate biopsies (54%). P.A. was not associated with baseline characteristics (age, body mass index, prostate-specific antigen level, prostate volume, race, family history of P.C.a, and digital rectal exam), except for chronic inflammation (p = 0.001). The presence of P.A. in baseline prostate biopsies was associated with lower risk of W.H.O./I.S.U.P. grade group ≥2 P.C.a in R.P. specimens on both univariable (O.R. = 0.39, 95% C.I. = 0.19-0.78, p = 0.008) and multivariable (O.R. = 0.43, 95% C.I. = 0.20-0.92, p = 0.029) analyses. CONCLUSIONS: Among men with a baseline prostate biopsy negative for P.C.a who were later found to have P.C.a and underwent R.P., baseline P.A. is independently associated with lower risk of W.H.O./I.S.U.P. grade group ≥2 P.C.a on surgical pathology. P.A. may be used to identify subjects at lower risk for W.H.O./I.S.U.P. ≥ 2 P.C.a and select optimal candidates for active surveillance.

The combination of histological prostate atrophy and inflammation is associated with lower risk of prostate cancer in biopsy specimens.

BACKGROUND: To evaluate whether the presence of both prostate atrophy (PA) and chronic prostate inflammation (CPI) in the same biopsy and in the same biopsy core are associated with prostate cancer (PCa) risk and grade in repeat biopsies. METHODS: Retrospective analyses of 6132 men who were 50-75 years old undergoing 2-year repeat prostate biopsy after a negative baseline biopsy for PCa in the REduction by DUtasteride of prostate Cancer Events (REDUCE) study. PA, CPI and PCa were determined by central pathology. The association of baseline PA and CPI with 2-year repeat biopsy cancer status and grade was evaluated with χ2 test and logistic regression controlling clinicopathological features. RESULTS: PA, CPI and both were detected in 583 (9.5%), 1063 (17.4%) and 3675 (59.9%) baseline biopsies, respectively. Compared with biopsies with neither PA nor CPI, the presence of PA (odds ratio (OR)=0.73, 95% confidence interval (CI)=0.57-0.93), CPI (OR=0.72, 95% CI=0.58-0.88) and both (OR=0.54, 95% CI=0.45-0.64) were associated with lower PCa risk in the 2-year repeat prostate biopsy. Results were similar in multivariable analysis. Among subjects with both PA and CPI, those with both findings in the same core had even lower PCa risk compared with PA and CPI in different cores (univariable OR=0.68, 95% CI=0.51-0.91; multivariable OR=0.73, 95% CI=0.54-0.99). Combination of PA and CPI was associated with lower risk of high-grade PCa. CONCLUSIONS: The presence of both PA and CPI in baseline biopsies, especially in the same core, was associated with lower PCa risk and grade. The presence and topographical distribution of PA and CPI may be used in PCa risk stratification.

Greater extent of prostate inflammation in negative biopsies is associated with lower risk of prostate cancer on repeat biopsy: results from the REDUCE study.

BACKGROUND: To evaluate whether the extent of baseline acute prostate inflammation (API) and chronic prostate inflammation (CPI) was associated with risk of prostate cancer (PCa) at 2-year repeat prostate biopsy in a clinical trial with systematic biopsies independent of PSA. METHODS: A retrospective analysis of 6065 men with a negative baseline biopsy in the reduction by dutasteride of PCa events (REDUCE) trial undergoing 2-year biopsy. API and CPI extent (percentage of cores involved) and PCa (present or absent) were assessed by central pathology. The association of baseline API and CPI with PCa at the 2-year biopsy was evaluated with logistic regression in uni- and multivariable analyses. RESULTS: API extent was classified as absent or involving 1-25%, 26-50%, 51-75% and >75% cores in 5140 (85%), 742 (12%), 151 (2%), 17 (<1%) and 15 (<1%) cases, respectively. CPI extent was classified as absent or involving 1-25%, 26-50%, 51-75% and >75% cores in 1367 (22%), 2532 (42%), 1474 (24%), 397 (7%) and 295 (5%) cases, respectively. More extensive API was associated with younger age, lower PSA and lower prostate volume, while more extensive CPI was associated with older age, lower PSA and higher prostate volume (all P<0.01). In both uni- and multivariable analyses, API and CPI extent were associated with lower risk of PCa at the 2-year biopsy (both P<0.01). CONCLUSIONS: In a cohort of men undergoing repeat prostate biopsy 2 years after a negative baseline biopsy, a greater extent of baseline API and CPI was independently associated with lower PCa risk.

Baseline subject characteristics predictive of compliance with study-mandated prostate biopsy in men at risk of prostate cancer: results from REDUCE.

BACKGROUND: Study compliance is crucial when the study outcome is determined by an invasive procedure, such as prostate biopsy. To investigate predictors of compliance in study-mandated prostate biopsies, we analyzed demographic, clinical and reported lifestyle data from the REDUCE trial. METHODS: We retrospectively identified 8025 men from REDUCE with at least 2 years of follow-up, and used multivariable logistic regression to test the association between baseline demographic and clinical characteristics and undergoing the study-mandated prostate biopsy at 2 years. We then examined whether missing any of these data was associated with undergoing a biopsy. RESULTS: In REDUCE, 22% of men did not undergo a 2-year biopsy. On multivariable analysis, the non-North American region was predictive of 42-44% increased likelihood of undergoing a 2-year biopsy (P⩽0.001). Being enrolled at a center that enrolled >10 subjects (2nd and 3rd tertile) was associated with a 42-48% increased likelihood of undergoing a 2-year biopsy (P<0.001). In addition, black race predicted 44% lower rate of on-study 2-year biopsy (odds ratio (OR)=0.56; P=0.001). Finally, missing one or more baseline variables was associated with a 32% decreased likelihood of undergoing a 2-year biopsy (OR=0.68; P<0.001). CONCLUSIONS: In REDUCE, men outside North America, those at higher volume centers and those with complete baseline data were more likely to undergo study-mandated 2-year biopsies. Given prostate biopsy is becoming increasingly utilized as an endpoint in trials that are often multi-national, regional differences in compliance should be considered when designing future trials. Likewise, efforts are needed to ensure compliance in low-volume centers or among subjects missing baseline data.

Predicting bone scan positivity in non-metastatic castration-resistant prostate cancer.

BACKGROUND: To evaluate PSA levels and kinetic cutoffs to predict positive bone scans for men with non-metastatic castration-resistant prostate cancer (CRPC) from the Shared Equal Access Regional Cancer Hospital (SEARCH) cohort. METHODS: Retrospective analysis of 531 bone scans of 312 clinically CRPC patients with no known metastases at baseline treated with a variety of primary treatment types in the SEARCH database. The association of patients' demographics, pathological features, PSA levels and kinetics with risk of a positive scan was tested using generalized estimating equations. RESULTS: A total of 149 (28%) scans were positive. Positive scans were associated with younger age (odds ratio (OR)=0.98; P=0.014), higher Gleason scores (relative to Gleason 2-6, Gleason 3+4: OR=2.03, P=0.035; Gleason 4+3 and 8-10: OR=1.76, P=0.059), higher prescan PSA (OR=2.11; P<0.001), shorter prescan PSA doubling time (PSADT; OR=0.53; P<0.001), higher PSA velocity (OR=1.74; P<0.001) and more remote scan year (OR=0.92; P=0.004). Scan positivity was 6, 14, 29 and 57% for men with PSA<5, 5-14.9, 15-49.9 and ⩾ 50 ng ml(-1), respectively (P-trend <0.001). Men with PSADT ⩾ 15, 9-14.9, 3-8.9 and <3 months had a scan positivity of 11, 22, 34 and 47%, correspondingly (P-trend <0.001). Tables were constructed using PSA and PSADT to predict the likelihood of a positive bone scan. CONCLUSIONS: PSA levels and kinetics were associated with positive bone scans. We developed tables to predict the risk of positive bone scans by PSA and PSADT. Combining PSA levels and kinetics may help select patients with CRPC for bone scans.

[Global aphasia without hemiparesis: case report]. / Afasia global sem hemiparesia: relato de caso.

Symptoms and signs of a stroke indicate which areas of the brain are affected and may also suggest the pathophysiology. We report herein a case of global aphasia without hemiparesis due to embolic infarct. Our case suggests that this situation may be an important sign for embolic cerebral infarction, as reported in literature.

[Neuroradiological features of the brain in subacute combined spinal cord degeneration: case report]. / Alterações neurorradiológicas cerebrais na degeneração combinada de medula: relato de caso.

Deficiency of vitamin B12 may produce neuropsychiatric disturbances. In the CNS the disease affects mainly myelin sheaths, and the spongy degeneration and diffuse demyelination of the posterior and lateral columns of the spinal cord are the classical pathological changes in patients with subacute combined degeneration. Similar changes also occur in cerebral hemispheres and MRI abnormalities in brain of such patients could be expected, but have received little attention. We report a case of pernicious anemia with neurological manifestations and brain MRI abnormalities. We discuss the neuropathological aspects and we suggest that pernicious anemia is a differential diagnosis to consider in central demyelinating lesions at MRI.

[Alzheimer's disease and magnetic resonance spectroscopy of the hippocampus]. / Doença de Alzheimer e espectroscopia por ressonância magnética do hipocampo.

OBJECTIVE: Acquisition of data of magnetic resonance metabolite spectrum of the hippocampal formation (hippocampus-hc) in the elderly, normal and with Alzheimer's disease (AD). METHOD: Subjects matched for age: a. normal sample (n=20), CDR=0, and b. AD sample (n=40), CDR 1 and 2. TECHNIQUE: Signa Horizon LX-GE, 1.5T, 1H-MRS with automated software PROBE/SV, VOI: hc (right and left); single voxel (2x2x2cm); TR 1500ms/TE 50ms; PRESS; metabolites: N-acetylaspartate (Naa), choline (Cho), creatine (Cr), myo-inositol (mI). RESULTS: The present data relate to the ratios of Naa, Cho and mI, with Cr taken as reference, and the mI/Naa ratio. The study showed reduction of Naa, increase of mI and of the mI/Naa ratio, and not consistent results for Cho. The results of the whole sample of AD patients compared to the pooled normal mean +/- sd were significant for Naa, mI and mI/Naa (p<0.01). Accuracy in relation to the individual values of both samples showed satisfactory levels of sensitivity, specificity and positive predictive value. CONCLUSION: The present results can be used as a helpful tool to detect pathologic changes of the hippocampus in AD, and allowing greater accuracy and an earlier diagnosis of this disease.

[Prevalence of Helicobacter pylori infection in children evaluated at "Hospital de Clínicas de Porto Alegre", RS, Brazil]. / Prevalência de infecção por, Helicobacter pylori em crianças avaliadas no Hospital de Clínicas de Porto Alegre, RS, Brasil.

OBJECTIVES: To determine prevalence of Helicobacter pylori infection in a group of symptomatic patients between 2 and 18 years old who were submitted to gastric biopsy during upper endoscopy done in the period of 1990-97. To correlate the histological findings with clinical and endoscopical data. METHODS: A cross-sectional study done after review of clinical and histopathological data. Histopathological sections were reviewed by a pathologist, who did not know the clinical information and the previous histopathological reports. RESULTS: Among 181 patients evaluated, prevalence of Helicobacter pylori infection was 24.86% (45 positive cases). In pathological analysis, gastritis was found in 38/45 of the positive Helicobacter pylori patients and in 45/136 negative Helicobacter pylori. Gastric ulceration was found in 6/45 positive Helicobacter pylori and in 3/136 negative Helicobacter pylori. CONCLUSION: This study stated a significative association between Helicobacter pylori infection and pathological abnormalities in children evaluated in the "Hospital de Clínicas de Porto Alegre", RS, Brazil.

Predicting bone scan positivity after biochemical recurrence following radical prostatectomy in both hormone-naive men and patients receiving androgen-deprivation therapy: results from the SEARCH database.

BACKGROUND: To evaluate the factors associated with positive bone scans after biochemical recurrence (BCR) following radical prostatectomy in both hormone-naive subjects and subjects after androgen-deprivation therapy (ADT). METHODS: Retrospective analysis of 380 bone scans of 301 hormone-naive subjects and 214 bone scans of 137 subjects after ADT following BCR from the Shared Equal Access Regional Cancer Hospital database. Generalized estimating equations and local regression plots were used to evaluate bone scan positivity by patients' demographics, pathological features, PSA levels and kinetics. RESULTS: Among hormone-naive subjects and subjects on ADT, bone scan positivity was seen in 24 (6%) and 65 (30%) subjects, respectively. In hormone-naive subjects, the higher prescan PSA, higher PSA velocity (PSAV) and shorter PSA doubling time (PSADT) were significantly associated with positive scans (P=0.008, P<0.001 and P<0.001, respectively). In subjects after ADT, the prescan PSA, PSAV and PSADT were significantly associated with positive scans (P=0.011, P<0.001 and P=0.002, respectively). Regression plots showed increased scan positivity with increasing PSA levels and shortening PSADT (all P<0.001) for both hormone-naive subjects and subjects after ADT. For a given PSA level and PSADT, subjects on ADT had higher bone scan positivity. CONCLUSIONS: In both hormone-naive subjects and subjects after ADT, more aggressive and advanced disease identified by higher PSA levels, higher PSAV and shorter PSADT were associated with higher bone scan positivity. For the same PSA level and PSADT, subjects after ADT had higher bone scan positivity than hormone-naive subjects. Therefore, PSA levels and kinetics may be used as selection criteria for bone scan in these patients.

Statin use and risk of prostate cancer and high-grade prostate cancer: results from the REDUCE study.

BACKGROUND: Statins are associated with lower PSA levels. As PSA is the primary method for prostate cancer (PC) screening, this confounds any associations between statins and risk of being diagnosed with PC. Thus, we examined the association between statins and cancer and high-grade cancer in REDUCE, where biopsies were largely PSA-independent. METHODS: Post-hoc secondary analysis of REDUCE, which was a prospective multinational randomized controlled trial of dutasteride vs placebo for 4 years among men aged 50-75 years with PSA of 2.5-10.0 ng ml(-1) and a negative biopsy at baseline, and included PSA-independent biopsies mandated at 2- and 4-years. Analyses were limited to men who underwent at least one biopsy while under study (n=6729). The association between baseline statin use and risk of overall, high-grade (Gleason ≥ 7) or low-grade (Gleason ≤ 6) PC vs no cancer was examined using multinomial logistic regression adjusting for age, race, baseline PSA, prostate volume, rectal examination findings, body mass index (BMI), comorbidities, smoking, alcohol intake and treatment arm. RESULTS: Of 6729 men who had at least one biopsy while on study, 1174 (17.5%) were taking a statin at baseline. Men taking statins were older, had lower PSA levels, higher BMI values and lower serum testosterone and dihydrotestosterone levels, though differences, were slight. Statin use was not associated with overall PC diagnosis (multivariable OR 1.05, 95% CI 0.89-1.24, P=0.54). When stratified by grade, statin use was not associated with low-grade (multivariable OR 1.03, 95% CI 0.85-1.25, P=0.75) or high-grade cancer (multivariable OR 1.11, 95% CI 0.85-1.45, P=0.46). The major limitation is the inclusion of only men with a negative baseline biopsy. CONCLUSIONS: Among men with a negative baseline biopsy and follow-up biopsies largely independent of PSA, statins were not associated with cancer or high-grade cancer.

Diabetes and prostate cancer risk in the REDUCE trial.

Men with diabetes mellitus are less likely to be diagnosed with prostate cancer (PCa). As diabetic men have lower serum PSA, it is unclear if this is due to lower PCa incidence or reflects detection bias from fewer PSA-triggered biopsies. To account for differential biopsy rates, we used multivariate regression to examine the link between diabetes and PCa risk in the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) trial, which required all subjects to undergo biopsy regardless of PSA. We further tested for interaction between diabetes and obesity. Diabetes status and body mass index (BMI) measurements were obtained at baseline. On multivariate analysis, diabetes was not associated with PCa risk (odds ratio (OR) 1.01, 95% confidence interval 0.79-1.30, P=0.92) or risk of low- or high-grade disease (all P ≥ 0.65). When stratified by obesity, diabetes was also not associated with PCa risk in any BMI category (all P ≥ 0.15). However, there was suggestion of effect modification by obesity for high-grade disease (P-interaction=0.053). Specifically, diabetes was associated with decreased risk of high-grade PCa in normal-weight men but increased risk in obese men (OR 0.35 vs 1.38). In the REDUCE trial, when all men underwent biopsy, diabetes was not associated with lower PCa risk, but rather equal risk of PCa, low-grade PCa and high-grade PCa.

On-demand use of erectile aids in men with preoperative erectile dysfunction treated by whole gland prostate cryoablation.

Prostate cryoablation is an established minimally invasive treatment for localized prostate cancer (PCa). However, the impairment of erectile function (EF) is considered a serious complication of the procedure. To investigate the efficacy of erectile aids following cryotherapy, 93 patients who underwent whole gland prostate cryoablation with required complete medical records were analyzed. The changes in postoperative EF were evaluated using the International Index of Erectile Function (IIEF-5) questionnaire. Additionally, independent factors that could have a correlation to the postoperative IIEF-5 score or postoperative Expanded Prostate Cancer Index Composite (EPIC) score were assessed. In the entire cohort, the mean preoperative IIEF-5 score was 7.0 ± 6.2. A total of 72 (77.4%) patients had moderate-to-severe preoperative erectile dysfunction. In longitudinal investigation, the patients using erectile aids showed the ability to recover to baseline after 24 months from cryoablation compared with the patients not using erectile aids. There were significant differences of IIEF-5 scores between these groups at 24 months (7.5 vs 3.0; P = 0.025) and 36 months (8.5 vs 3.5; P = 0.010). In multivariate analysis, the use of erectile aids correlated with restoration of IIEF-5 scores (odds ratio, 5.11; confidence interval (CI), 1.87-13.96; P < 0.001) and lower EPIC sexual bother (coef, 19.61; CI, 0.32-38.89; P = 0.046). Our data indicate that on-demand use of erectile aids could help restore EF and reduce sexual bother after whole gland prostate cryoablation. Although, erectile aids could not play a role as an adequate treatment for ED after whole gland prostate cryoablation, these results may aid in the decision-making process for PCa patients with preoperative and postoperative ED who have concern about sexual health-related quality of life.

Preoperative weight change and risk of adverse outcome following radical prostatectomy: results from the Shared Equal Access Regional Cancer Hospital database.

BACKGROUND: We examined the relationship between weight change in the year before radical prostatectomy (RP) and biochemical recurrence (BCR) and adverse pathology. METHODS: We abstracted data from 359 men undergoing RP in the SEARCH (Shared Equal Access Regional Cancer Hospital) database between 2001-2007. Logistic regression and Cox proportional hazards models were used to test the association between weight change in the year before surgery and adverse pathology and BCR, respectively. RESULTS: In all, 152 (42%) men gained weight, 193 (54%) lost weight and 14 (4%) had the same weight. Among weight gainers, median gain was 2.4 kg and among weight losers, median loss was 2.7 kg. As a continuous variable, weight change was not associated with adverse pathology or BCR (all P>0.05). In secondary analysis, on multivariate analysis, men gaining ≥ 2.5 kg were at higher BCR risk (hazards ratio=1.65, 95% confidence interval (CI): 1.03-2.64, P=0.04) while weight loss ≥ 2.5 kg was not associated with BCR (hazards ratio=0.83, 95% CI: 0.54-1.29, P=0.41). CONCLUSIONS: As a continuous variable, weight change was not associated with outcome. In secondary hypothesis-generating analyses, weight gain ≥ 2.5 kg in the year before surgery, regardless of final body mass index, was associated with increased BCR following RP. If validated, these data suggest weight gain ≥ 2.5 kg may promote prostate cancer progression.