RESUMO
PURPOSE: The recent restriction on the use of fluoroquinolones for prophylaxis by the European Commission has left a gap in clear recommendations for practical antibiotic prophylaxis (PAP) for transrectal prostate biopsy (TRPB). This analysis investigated the viability of cotrimoxazole for PAP in TRPB. METHODS: This analysis included n = 697 patients who underwent TRPB for suspected prostate cancer (PCa). All patients received either empiric PAP with four doses of cotrimoxazole 960 mg or targeted antibiotic prophylaxis in case of a positive rectal or urine screening for multiresistant gram-negatives. Infectious complications after TRPB, microbiological findings, and clinical characteristics were evaluated. A multivariable logistic regression model was calculated to identify variables associated with infectious complications. RESULTS: Of the cohort, 86% (600/697) received PAP with cotrimoxazole, 1% (8/697) received cotrimoxazole plus an additional antibiotic, 4% (28/697) received amoxicillin + clavulanic acid, 4% (28/697) received fluoroquinolones, and 5% (33/697) received a single shot intravenous antibiotic prophylaxis with meropenem or piperacillin + tazobactam due to multiresistant microbiological findings in either pre-interventional urine culture or rectal swab. Infectious complications occurred in 2.6% (18/697) of patients. Fever was noted in 89% (16/18) of cases. Inpatient treatment was given to 67% (12/18) of affected patients, with 38% (7/18) having positive blood cultures, identifying cotrimoxazole-resistant E. coli strains in six out of seven cases. Multivariable logistic regression analysis revealed no clinically significant variables, including PAP with cotrimoxazole, as independent risk factors for an infectious complication. CONCLUSIONS: Using cotrimoxazole as PAP for TRPB in cases without multiresistant gram-negatives in pre-interventional urine cultures or rectal swabs seems feasible and practical.
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Antibioticoprofilaxia , Próstata , Reto , Combinação Trimetoprima e Sulfametoxazol , Humanos , Masculino , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Antibioticoprofilaxia/métodos , Idoso , Pessoa de Meia-Idade , Próstata/patologia , Reto/microbiologia , Antibacterianos/uso terapêutico , Neoplasias da Próstata/patologia , Estudos Retrospectivos , Biópsia/métodos , Biópsia/efeitos adversosRESUMO
PURPOSE: mpMRI is routinely used to stratify the risk of clinically significant prostate cancer (csPCa) in men with elevated PSA values before biopsy. This study aimed to calculate a multivariable risk model incorporating standard risk factors and mpMRI findings for predicting csPCa on subsequent prostate biopsy. METHODS: Data from 677 patients undergoing mpMRI ultrasound fusion biopsy of the prostate at the TUM University Hospital tertiary urological center between 2019 and 2023 were analyzed. Patient age at biopsy (67 (median); 33-88 (range) (years)), PSA (7.2; 0.3-439 (ng/ml)), prostate volume (45; 10-300 (ml)), PSA density (0.15; 0.01-8.4), PI-RADS (V.2.0 protocol) score of index lesion (92.2% ≥3), prior negative biopsy (12.9%), suspicious digital rectal examination (31.2%), biopsy cores taken (12; 2-22), and pathological biopsy outcome were analyzed with multivariable logistic regression for independent associations with the detection of csPCa defined as ISUP ≥ 3 (n = 212 (35.2%)) and ISUP ≥ 2 (n = 459 (67.8%) performed on 603 patients with complete information. RESULTS: Older age (OR: 1.64 for a 10-year increase; p < 0.001), higher PSA density (OR: 1.60 for a doubling; p < 0.001), higher PI-RADS score of the index lesion (OR: 2.35 for an increase of 1; p < 0.001), and a prior negative biopsy (OR: 0.43; p = 0.01) were associated with csPCa. CONCLUSION: mpMRI findings are the dominant predictor for csPCa on follow-up prostate biopsy. However, PSA density, age, and prior negative biopsy history are independent predictors. They must be considered when discussing the individual risk for csPCa following suspicious mpMRI and may help facilitate the further diagnostical approach.
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Imageamento por Ressonância Magnética Multiparamétrica , Neoplasias da Próstata , Humanos , Masculino , Neoplasias da Próstata/patologia , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/sangue , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto , Estudos Retrospectivos , Valor Preditivo dos Testes , Hospitais com Alto Volume de Atendimentos , Medição de Risco , Biópsia Guiada por ImagemRESUMO
BACKGROUND: Benefit finding (BF) - the occurrence of positive life-changes in the aftermath of traumatic live events - has been repeatedly reported in prostate cancer (PCa) survivors, but it remains unclear in which way BF might vary over time. The current study aimed to investigate the extent of BF and associated factors in different phases of the survivorship continuum. METHODS: In this cross-sectional study, men affected by PCa who were either already treated with radical prostatectomy or going to be treated with radical prostatectomy at a large German PCa center were included. These men were stratified into four groups (prior to surgery, up to 12 months after surgery, 2-5 years and ≥ 6-10 years after surgery). BF was assessed using the German version of the 17-item Benefit Finding Scale (BFS). The items are rated on a five-point Likert scale ranging from 1 to 5. A total mean score ≥ 3 was considered as moderate-to-high BF. Associations with clinical and psychological factors were assessed in men presenting before and in those who participated after surgery. Multiple linear regression was applied to identify intendent determinants of BF. RESULTS: 2,298 men affected by PCa (mean age at survey: 69.5,SD = 8.2; median follow-up: 3 years (25th -75th percentile 0.5-7)) were included. 49.6% of men reported moderate-to-high BF. The mean BF score was 2.91 (SD = 0.92). BF reported by men before surgery did not differ significantly from BF reported by men in the years after surgery (p = 0.56). Higher BF prior to and following radical prostatectomy was associated with higher perceived severity of the disease (pre-surgery: ß = 0.188, p = 0.008; post-surgery: ß = 0.161, p = < 0.0001) and higher cancer-related distress (pre-surgery: ß ? 0.155, p = 0.03; post-surgery: ß = 0.089, p < 0.0001). Post radical prostatectomy BF was also associated with biochemical recurrence during follow-up (ß = 0.089, p = 0.001), and higher quality of life (ß = 0.124, p < 0.001). CONCLUSIONS: Many men affected by PCa perceive BF already soon after diagnosis. The subjective perception of threat or severity associated with the diagnosis of PCa is an essential factor for higher levels of BF, probably more important than objective indicators of the severity of the disease. The early onset of BF and the high degree of similarity of BF reported across the different phases of survivorship suggests that BF is, to a large extent, a dispositional personal characteristic and a cognitive strategy of positively coping with cancer.
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Neoplasias da Próstata , Qualidade de Vida , Masculino , Humanos , Estudos Transversais , Neoplasias da Próstata/terapia , Próstata , ProstatectomiaRESUMO
OBJECTIVES: To investigate prevalence, course, and predictors of longitudinal decision regret in long-term prostate cancer (PCa) survivors treated by radical prostatectomy (RP). PATIENTS AND METHODS: A total of 1003 PCa survivors from the multicentre German Familial PCa Database completed questionnaires on average 7 years after RP in 2007 and at follow-up 13 years later in 2020. Patients completed standardised patient-reported outcome measures on decision regret, decision-making, health-related quality of life, and psychosocial factors. Hierarchical multivariable logistic regression was used to assess predictors of longitudinal decision regret. RESULTS: Decision regret increased significantly over time (9.0% after 6.9 years in 2007 and 12% after 19 years in 2020; P = 0.009). Favourable localised PCa (odds ratio [OR] 1.97, 95% confidence interval [CI] 1.05-3.68), decision regret in 2007 (OR 6.38, 95% CI 3.55-11.47), and a higher depression score (OR 1.37, 95% CI 1.03-1.83) were associated with decision regret in 2020. Shared decision-making (OR 0.55, 95% CI 0.33-0.93) was associated with less decision regret. CONCLUSION: The findings of the present study underline the perseverance of decision regret in long-term PCa survivors and the definitive need for involving patients in the decision-making process to mitigate regret over the long term.
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Neoplasias da Próstata , Qualidade de Vida , Masculino , Humanos , Estudos Longitudinais , Qualidade de Vida/psicologia , Tomada de Decisões , Emoções , Prostatectomia/efeitos adversos , Neoplasias da Próstata/terapia , SobreviventesRESUMO
PURPOSE: The objective of the current study was to assess whether and how preoperative risk group distribution and pathological outcomes have changed in men treated with radical prostatectomy (RP) over the past 25 years. METHODS: 11,071 patients from a large contemporary registry-based nationwide cohort with RP as primary treatment between 1995 and 2019 were included. Preoperative risk stratification, postoperative outcomes, and 10 years other-cause mortality (OCM) were analyzed. RESULTS: After 2005, the proportion of low-risk prostate cancer (PCa) decreased from 39.6% to 25.5% in 2010 and decreased further to 15.5% in 2015, and 9.4% in 2019 (p < 0.001). The proportion of high-risk cases increased from 13.1% in 2005 to 23.1% in 2010 and 36.7% in 2015, and 40.4% in 2019 (p < 0.001). After 2005, the proportion of cases with favorable localized PCa decreased from 37.3% to 24.9% in 2010 and decreased further to 13.9% in 2015, and 1.6% in 2019 (p < 0.001). The overall 10 years OCM was 7.7%. CONCLUSION: The current analysis documents a clear shift in utilization of RP toward higher-risk PCa in men with long life expectancy. Patients with low-risk PCa or favorable localized PCa are rarely operated. This suggests a shift in applying surgery only to patients who may really benefit from RP and the long-standing discussion of overtreatment might become outdated.
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Próstata , Neoplasias da Próstata , Masculino , Humanos , Próstata/patologia , Prostatectomia/efeitos adversos , Neoplasias da Próstata/patologia , Antígeno Prostático Específico , SobretratamentoRESUMO
PURPOSE: To determine the role of biopsy experience regarding a potential benefit of additional systematic biopsies and fusion failures during MRI-targeted biopsy of the prostate. SUBJECTS/PATIENTS AND METHODS: We retrospectively evaluated 576 men undergoing transrectal (MRI)-targeted biopsy of the prostate by seven residents in urology between November 2019 and March 2022. Benefit of systematic biopsies (detection of ISUP ≥ 2 PCa (clinically significant PCa (csPCa)) solely in systematic biopsies) and fusion failure (detection of csPCa during systematic biopsies in the area of a reported MRI-lesion and no detection of csPCa in targeted biopsy) were compared by growing biopsy experience levels. Multivariable regression analyses were calculated to investigate the association with benefit of systematic biopsies and fusion failure. RESULTS: The overall PCa detection rate was 72% (413/576). A benefit of systematic biopsies was observed in 11% (63/576); of those, fusion failure was seen in 76% (48/63). Benefit of systematic biopsies and fusion failure were more common among residents with very low experience compared to highly experienced residents (18% versus 4%, p = 0.026; 13% versus 3%, p = 0.015, respectively). Increasing biopsy experience was associated with less benefit from systematic biopsies (OR: 0.98, 95% CI 0.97-0.99) and less fusion failure (OR: 0.98, 95% CI 0.97-0.99). CONCLUSIONS: The benefit of systematic biopsies following targeted biopsy decreases with growing biopsy experience. The higher risk of fusion failure among inexperienced residents necessitates systematic biopsies to ensure the detection of csPCa. Further prospective trials are warranted before a targeted only approach can be recommended in routine clinical practice.
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Próstata , Neoplasias da Próstata , Masculino , Humanos , Próstata/diagnóstico por imagem , Próstata/patologia , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , Estudos Retrospectivos , Biópsia Guiada por Imagem , Imageamento por Ressonância MagnéticaRESUMO
BACKGROUND: Patients with localized prostate cancer (PC) are faced with a wide spectrum of therapeutic options at initial diagnosis. Following radical prostatectomy (RP), PC patients may experience regret regarding their initial choice of treatment, especially when oncological and functional outcomes are poor. Impacts of psychosocial factors on decision regret, especially after long-term follow-up, are not well understood. This study aimed to investigate the prevalence and determinants of decision regret in long-term PC survivors following RP. METHODS: 3408 PC survivors (mean age 78.8 years, SD = 6.5) from the multicenter German Familial PC Database returned questionnaires after an average of 16.5 (SD = 3.8) years following RP. The outcome of decision regret concerning the initial choice of RP was assessed with one item from the Decision Regret Scale. Health-related quality of life (HRQoL), PC-anxiety, PSA-anxiety, as well as anxiety and depressive symptoms were considered for independent association with decision regret via multivariable logistic regression. RESULTS: 10.9% (373/3408) of PC survivors reported decision regret. Organ-confined disease at RP (OR 1.39, 95%CI 1.02-1.91), biochemical recurrence (OR 1.34, 1.00-1.80), low HRQoL (OR 1.69,1.28-2.24), depressive symptoms (OR 2.32, 1.52-3.53), and prevalent PSA anxiety (OR 1.88,1.17-3.01) were significantly associated with increased risk of decision regret. Shared decision-making reduced the odds of decision regret by 40% (OR 0.59, 0.41-0.86). CONCLUSIONS: PC survivors may experience decision regret even after 16 years following RP. Promoting shared decision-making in light of both established and novel, potentially less invasive treatments at initial diagnosis may help mitigate long-term regret. Awareness regarding patients showing depressive symptoms or PSA anxiety should be encouraged to identify patients at risk of decision regret in need of additional psychological support.
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Sobreviventes de Câncer , Neoplasias da Próstata , Masculino , Humanos , Idoso , Próstata , Prevalência , Antígeno Prostático Específico , Qualidade de Vida , Prostatectomia/efeitos adversos , Emoções , Neoplasias da Próstata/cirurgiaRESUMO
BACKGROUND: We compared six commonly used logistic regression methods for accommodating missing risk factor data from multiple heterogeneous cohorts, in which some cohorts do not collect some risk factors at all, and developed an online risk prediction tool that accommodates missing risk factors from the end-user. METHODS: Ten North American and European cohorts from the Prostate Biopsy Collaborative Group (PBCG) were used for fitting a risk prediction tool for clinically significant prostate cancer, defined as Gleason grade group ≥ 2 on standard TRUS prostate biopsy. One large European PBCG cohort was withheld for external validation, where calibration-in-the-large (CIL), calibration curves, and area-underneath-the-receiver-operating characteristic curve (AUC) were evaluated. Ten-fold leave-one-cohort-internal validation further validated the optimal missing data approach. RESULTS: Among 12,703 biopsies from 10 training cohorts, 3,597 (28%) had clinically significant prostate cancer, compared to 1,757 of 5,540 (32%) in the external validation cohort. In external validation, the available cases method that pooled individual patient data containing all risk factors input by an end-user had best CIL, under-predicting risks as percentages by 2.9% on average, and obtained an AUC of 75.7%. Imputation had the worst CIL (-13.3%). The available cases method was further validated as optimal in internal cross-validation and thus used for development of an online risk tool. For end-users of the risk tool, two risk factors were mandatory: serum prostate-specific antigen (PSA) and age, and ten were optional: digital rectal exam, prostate volume, prior negative biopsy, 5-alpha-reductase-inhibitor use, prior PSA screen, African ancestry, Hispanic ethnicity, first-degree prostate-, breast-, and second-degree prostate-cancer family history. CONCLUSION: Developers of clinical risk prediction tools should optimize use of available data and sources even in the presence of high amounts of missing data and offer options for users with missing risk factors.
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Neoplasias da Próstata , Humanos , Masculino , Exame Retal Digital , Antígeno Prostático Específico , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/epidemiologia , Medição de Risco/métodosRESUMO
BACKGROUND: Due to easy online accessibility of pornography its consumption is popular among adolescents and young adults. Considering recently developed frameworks on the effects of sexual media, we assessed how increased consumption of pornography is associated with the experience of certain aspects of offline and online sexual activity in German medical students. METHODS: Between April 2018 and March 2020 medical students from the Technical University of Munich in Germany were anonymously surveyed with regards to their sexual behavior, consumption of pornography, and use of social media. 468 students (female: n = 293; male: n = 175) were included in the current analysis. Data was analyzed using simple and multiple Poisson regression analysis. RESULTS: Only 7.3% of female students but the majority of male students (79.1%) consumed pornography more than 4 times in the last 4 weeks. Female and male students who reported to be inspired by pornography (female: 52.0%, male: 74.6%) and who have enjoyed the experience of anal intercourse in their life (female: 17.1%, male: 32.2%) consumed pornography more frequently. Female students who have experienced a "threesome" (9.0%), have sent erotic pictures of themselves (33.5%), or use social media in their dating life (27.6%) consumed pornography more frequently. Male students who did not experience a sexual transmitted disease (82.9%) and did not cheat on their partner (68.0%) consumed pornography more frequently (results of multiple Poisson regression analysis; all p < 0.05). CONCLUSIONS: Many students consider pornography as inspiration for their sex life and frequent consumption of pornography seems to be associated with gender specific characteristics congruent with short-term sexual quality. The desire of adolescents and young adults for practical information about sexual intercourse should be addressed openly and a proper understanding of the sexuality shown in pornography should be taught.
Assuntos
Literatura Erótica , Estudantes de Medicina , Adolescente , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Masculino , Comportamento Sexual , Adulto JovemRESUMO
BACKGROUND: Although fear of cancer recurrence (FCR) or disease progression is among the most endorsed unmet needs and concerns of cancer survivors, research on the course of FCR in long-term survivors is scarce. The objective of this study was to assess longitudinally the prevalence and predictors of FCR in long-term prostate cancer (PCa) survivors. METHODS: In all, 2417 survivors from the multicenter German Familial Prostate Cancer Database completed the Fear of Progression Questionnaire-Short Form on average 7 years (T1 in 2010) after radical prostatectomy and at follow-up 9 years later (T2 in 2019). Hierarchical multivariable logistic regression was used to assess predictors of FCR at follow-up. RESULTS: The mean age at the initial assessment was 69.5 years (standard deviation, 5.9 years); 6.5% and 8.4% of patients reported clinical FCR at the initial assessment (T1) and at the follow-up (T2), respectively. In a multivariable analysis controlling for concurrent associations, longitudinal predictors of FCR 9 years later included a lower level of education (odds ratio [OR], 4.35; 95% confidence interval [CI], 2.33-8.33), years since radical prostatectomy (OR, 1.10; 95% CI, 1.03-1.18), biochemical recurrence (OR, 1.67; 95% CI, 1.02-2.72), no current adjuvant therapy (OR, 2.38; 95% CI, 1.19-4.76), FCR (OR, 10.75; 95% CI, 6.18-18.72), and anxiety (OR, 1.35; 95% CI, 1.06-1.72). CONCLUSIONS: FCR remains a burden to certain PCa survivors even many years after their diagnosis and treatment. Health care professionals should monitor for FCR and identify patients at risk to provide appropriate psychosocial care because FCR is leading to limitations in quality of life and psychological well-being.
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Sobreviventes de Câncer , Sobreviventes de Câncer/psicologia , Progressão da Doença , Medo/psicologia , Humanos , Estudos Longitudinais , Masculino , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/psicologia , Próstata , Prostatectomia , Qualidade de VidaRESUMO
BACKGROUND: Individuals affected by cancer need to integrate this experience into their personal biography as their life continues after primary therapy, leading to substantial changes in self-perception. This study identified factors uniquely associated with 5 different cancer-related identities in order to improve the understanding of how self-perception in men affected by prostate cancer is associated with certain clinical and psychosocial characteristics. METHODS: In this cross-sectional study, long-term prostate cancer survivors after radical prostatectomy were asked to choose one of 5 cancer-related identities that described them best. Associations with sociodemographic, clinical, and psychological variables were investigated using multivariable logistic regression. RESULTS: Three thousand three hundred forty-seven men (mean age 78.1 years) surveyed on average 15.6 years after prostatectomy were included. Most men favored the terms "someone who has had cancer" (43.9%) which was associated with a mild disease course, and "patient" (26.3%) which was associated with ongoing therapy and biochemical disease recurrence. The self-descriptions "cancer survivor" (16.8%), "cancer conqueror" (10.9%) and "victim" (2.1%) were less common. "Cancer survivor" was associated with high perceived disease severity (OR: 1.86 [1.44-2.40]). "Cancer survivor" and "cancer conqueror" were related to high benefit finding (OR: 1.89 [1.48-2.40], OR: 1.46 [1.12-1.89] respectively), and only "cancer conqueror" was associated with high well-being (OR: 1.84 [1.35-2.50]). Identification as "victim" was associated with a positive depression screening and low well-being (OR: 2.22 [1.15-4.31], OR: 0.38 [0.20-0.72] respectively) (all p < 0.05). CONCLUSIONS: Although long-term survival is common among men affected by PCa, they display a large diversity in cancer-related identities, which are associated with unique clinical and psychological characteristics. These cancer-related identities and their distinctive properties are associated with psychological well-being even after a long follow-up.
Assuntos
Sobreviventes de Câncer/psicologia , Prostatectomia , Neoplasias da Próstata/psicologia , Autoimagem , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Autobiografias como Assunto , Estudos Transversais , Alemanha , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/sangue , Razão de Chances , Neoplasias da Próstata/cirurgia , Autoavaliação (Psicologia) , Fatores Socioeconômicos , Fatores de TempoRESUMO
PURPOSE: The safety of active surveillance (AS) in favorable intermediate-risk (FIR) prostate cancer (PCa) remains uncertain. To provide guidance on clinical decision-making, we examined long-term and pathological outcomes of low-risk and intermediate-risk PCa patients after radical prostatectomy (RP). METHODS: The study involved 5693 patients diagnosed between 1994 and 2019 with low-risk, FIR, and unfavorable intermediate-risk (UIR) PCa (stratification according to the AUA guidelines) who underwent RP. Pathological outcomes were compared, and Kaplan-Meier analysis determined biochemical recurrence-free survival (BRFS) and cancer-specific survival (CSS) at 5, 10, 15, and 20 years. Multiple Cox regression was used to simultaneously control for relevant confounders. RESULTS: Those at FIR had higher rates of upgrading and upstaging (12.8% vs. 7.2%, p < 0.001; 19.8% vs. 12.0%, p < 0.001) as well as pathological tumor and node stage (≥ pT3a: 18.8% vs. 11.6%, p < 0.001; pN1: 2.7% vs. 0.8%, p > 0.001) compared to patients at low risk. The 20-year BRFS was 69%, 65%, and 44% and the 20-year CSS was 98%, 95%, and 89% in low-risk, FIR, and UIR patients. On multiple Cox regression, FIR was not associated with a worse BRFS (HR 1.07, CI 0.87-1.32), UIR was associated with a worse BRFS (HR 1.49, CI 1.20-1.85). CONCLUSION: Patients at FIR had only slightly worse pathological and long-term outcomes compared to patients at low risk, whereas the difference compared to patients at UIR was large. This emphasizes AS in these patients as a possible treatment strategy in well-counseled patients.
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Tomada de Decisão Clínica , Prostatectomia , Neoplasias da Próstata/terapia , Conduta Expectante , Idoso , Antineoplásicos Hormonais/uso terapêutico , Quimioterapia Adjuvante , Intervalo Livre de Doença , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Neoplasias da Próstata/mortalidade , Neoplasias da Próstata/patologia , Radioterapia Adjuvante , Medição de RiscoRESUMO
PURPOSE: To assess whether a first-degree family history or a fatal family history of prostate cancer (PCa) are associated with postoperative upgrading and upstaging among men with low risk and favourable intermediate-risk (FIR) PCa and to provide guidance on clinical decision making for active surveillance (AS) in this patient population. METHODS: Participants in the German Familial Prostate Cancer database diagnosed from 1994 to 2019 with (1) low risk (clinical T1c-T2a, biopsy Gleason Grade Group (GGG) 1, PSA < 10 ng/ml), (2) Gleason 6 FIR (clinical T1c-T2a, GGG 1, PSA 10-20 ng/ml), and (3) Gleason 3 + 4 FIR (clinical T1c-T2a, GGG 2, PSA < 10 ng/ml) PCa who were subsequently treated with radical prostatectomy (RP) were analysed for upgrading, defined as postoperative GGG 3 tumour or upstaging, defined as pT3-pT4 or pN1 disease at RP. Logistic regression analysis was used to assess whether PCa family history was associated with postoperative upgrading or upstaging. RESULTS: Among 4091 men who underwent RP, mean age at surgery was 64.4 (SD 6.7) years, 24.7% reported a family history, and 3.4% a fatal family history. Neither family history nor fatal family history were associated with upgrading or upstaging at low risk, Gleason 6 FIR, and Gleason 3 + 4 FIR PCa patients. CONCLUSION: Results from the current study indicated no detrimental effect of family history on postoperative upgrading or upstaging. Therefore, a positive family history or fatal family history of PCa in FIR PCa patients should not be a reason to refrain from AS in men otherwise suitable.
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Neoplasias da Próstata/patologia , Neoplasias da Próstata/terapia , Conduta Expectante , Idoso , Humanos , Masculino , Anamnese , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Período Pós-Operatório , Estudos Prospectivos , Prostatectomia , Neoplasias da Próstata/genética , Neoplasias da Próstata/cirurgia , Medição de RiscoRESUMO
PURPOSE: To determine whether fatal family history (FFH) or mode of inheritance in prostate cancer (PCa) has an impact on long-term outcomes following radical prostatectomy (RP). METHODS: 1076 PCa patients after RP with at least one deceased first-degree relative with PCa were included and stratified by FFH (four subgroups: fraternal, paternal, multiple, and none) and by mode of inheritance (two subgroups: male to male, non-male to male). We compared clinicopathological characteristics between subgroups with Fisher's exact or Chi-square tests. Biochemical recurrence-free survival (BRFS) and cancer-specific survival (CSS) were analyzed using the method of Kaplan and Meier. Simple and multiple Cox regression with backward elimination were performed to select prognostic factors for BRFS and CSS. RESULTS: Median age at surgery was 63.3 (range 35.9-79.4) years. The overall Kaplan-Meier estimated BRFS rate at 10 and 15 years was 65.6% and 57.0%, respectively. The overall Kaplan-Meier estimated CSS rate at 10 and 15 years was 98.1% and 95.7%, respectively. Neither FFH nor mode of inheritance were factors associated with worse BRFS. However, in multiple Cox regression, paternal FFH was an important prognostic factor for a better CSS (HR 0.19, CI 0.05-0.71, p = 0.014) compared to non-FFH. CONCLUSION: FFH and mode of inheritance do not seem to be prognostic factors of worse long-term outcomes following RP. Rather, a paternal FFH was associated with a better CSS; however, the reasons remain unclear. Nevertheless, patients after RP and FFH could be reassured that their own PCa diagnosis is not associated with a worse long-term outcome.
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Padrões de Herança , Prostatectomia , Neoplasias da Próstata/genética , Neoplasias da Próstata/cirurgia , Adulto , Idoso , Humanos , Masculino , Anamnese , Pessoa de Meia-Idade , Prostatectomia/métodos , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
INTRODUCTION: Although low sexual desire is 1 of the most common sexual dysfunctions in men, there is a lack of studies investigating associated factors in large, population-based samples of middle-aged men. AIM: To survey the prevalence of low sexual desire in a population-based sample of 45-year-old German men and to evaluate associations with a broad set of factors. METHODS: Data were collected between April 2014-April 2016 within the German Male Sex-Study. Participants were asked to fill out questionnaires about 6 sociodemographic, 5 lifestyle, and 8 psychosocial factors, as well as 6 comorbidities and 4 factors of sexual behavior. Simple and multiple logistic regressions were used to assess potential explanatory factors. MAIN OUTCOME MEASURES: We found a notable prevalence of low sexual desire in middle-aged men and detected associations with various factors. RESULTS: 12,646 men were included in the analysis, and prevalence of low sexual desire was 4.7%. In the multiple logistic regression with backward elimination, 8 of 29 factors were left in the final model. Men having ≥2 children, higher frequency of solo-masturbation, perceived importance of sexuality, and higher sexual self-esteem were less likely to have low sexual desire. Premature ejaculation, erectile dysfunction, and lower urinary tract symptoms were associated with low sexual desire. CLINICAL IMPLICATIONS: Low sexual desire is common in middle-aged men, and associating factors that can potentially be modified should be considered during assessment and treatment of sexual desire disorders. STRENGTHS & LIMITATIONS: The strength of our study is the large, population-based sample of middle-aged men and the broad set of assessed factors. However, because of being part of a prostate cancer screening trial, a recruiting bias is arguable. CONCLUSION: Our study revealed that low sexual desire among 45-year-old men is a common sexual dysfunction, with a prevalence of nearly 5% and might be affected by various factors, including sociodemographic and lifestyle factors, as well as comorbidities and sexual behavior. Meissner VH, Schroeter L, Köhn F-M, et al. Factors Associated with Low Sexual Desire in 45-Year-Old Men: Findings from the German Male Sex-Study. J Sex Med 2019;16:981-991.
Assuntos
Disfunção Erétil/epidemiologia , Libido , Ejaculação Precoce/epidemiologia , Comportamento Sexual/estatística & dados numéricos , Humanos , Estilo de Vida , Modelos Logísticos , Sintomas do Trato Urinário Inferior/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Disfunções Sexuais Psicogênicas/epidemiologia , Sexualidade , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Erectile dysfunction (ED), premature ejaculation (PE), and low libido (LL) are reported as the most common male sexual dysfunctions. OBJECTIVE: To evaluate the prevalence of ED, PE, and LL and associations with lifestyle risk factors and comorbidities in middle-aged men. MATERIALS AND METHODS: This study included a population-based random sample of 2500 50-year-old men who completed validated questionnaires, including the International Index of Erectile Function, the Erection Hardness Score, the Sexual Complaints Screener, and further questionnaires. Multiple logistic regression of outcomes ED, PE, and LL was used to model the association with explanatory factors. RESULTS: The prevalence of at least one sexual dysfunction was 30%. 21%, 5.2%, and 7.2% of men had ED, PE, and LL, respectively. The risk of ED increased with PE (odds ratio [OR]: 1.94, 95% confidence interval [95%CI]: 1.22-3.08), LL (OR: 2.04, 95%CI: 1.26-3.29), higher waist circumference (OR: 2.23, 95%CI: 1.67-2.96), and lower urinary tract symptoms (LUTS) (OR: 1.88, 95%CI: 1.39-2.55), partnership was associated with a lower risk (OR: 0.57, 95%CI: 0.39-0.85). The risk of PE increased with ED (OR: 1.94, 95%CI: 1.23-3.07), partnership (OR:5.42, 95%CI: 1.30-22.60), depression (OR: 2.37, 95%CI: 1.09-5.14), and LUTS (OR: 2.42, 95%CI: 1.52-3.87), and decreased with physical activity (OR: 0.44, 95%CI: 0.21-0.93). The risk of LL increased with ED (OR: 2.09, 95%CI: 1.31-3.34) and poorer self-rated health (OR: 2.97, 95%CI: 1.54-5.71). DISCUSSION AND CONCLUSIONS: Roughly one in three 50-year-old men experience some form of sexual dysfunction and risk factors identified in this study underline the multifactorial nature of ED, PE, and LL. Many risk factors are modifiable which underlines the role of patient education. Modifiable risk factors should be addressed in patient education and men should take active measures to remove the risk posed by these factors.
Assuntos
Disfunção Erétil , Ejaculação Precoce , Pessoa de Meia-Idade , Humanos , Masculino , Disfunção Erétil/etiologia , Libido , Saúde do Homem , Prevalência , Fatores de Risco , Estilo de Vida , Inquéritos e Questionários , EjaculaçãoRESUMO
ß-emitting 177Lu targeting prostate-specific membrane antigen (PSMA) is an approved treatment option for metastatic castration-resistant prostate cancer. Data on its long-term nephrotoxicity are sparse. This study aimed to retrospectively evaluate post-177Lu-PSMA estimated glomerular filtration rate (eGFR) dynamics for at least 12 mo in a cohort of metastatic castration-resistant prostate cancer patients. Methods: The institutional databases of 3 German tertiary referral centers identified 106 patients who underwent at least 4 cycles of 177Lu-PSMA and had at least 12 mo of eGFR follow-up data. eGFR (by the Chronic Kidney Disease Epidemiology Collaboration formula) at 3, 6, and 12 mo after 177Lu-PSMA radioligand therapy was estimated using monoexponentially fitted curves through available eGFR data. eGFR changes were grouped (≥15%-<30%, moderate; ≥30%-<40%, severe; and ≥40%, very severe). Associations between eGFR changes (%) and nephrotoxic risk factors, prior treatment lines, and number of 177Lu-PSMA cycles were analyzed using multivariable linear regression. Results: At least moderate eGFR decreases were present in 45% (48/106) of patients; of those, nearly half (23/48) had a severe or very severe eGFR decrease. A higher number of risk factors at baseline (-4.51, P = 0.03) was associated with a greater eGFR decrease. Limitations of the study were the retrospective design, lack of a control group, and limited number of patients with a follow-up longer than 1 y. Conclusion: A considerable proportion of patients may experience moderate or severe decreases in eGFR 1 y from initiation of 177Lu-PSMA. A higher number of risk factors at baseline seems to aggravate loss of renal function. Further prospective trials are warranted to estimate the nephrotoxic potential of 177Lu-PSMA.
Assuntos
Neoplasias de Próstata Resistentes à Castração , Masculino , Humanos , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias de Próstata Resistentes à Castração/radioterapia , Neoplasias de Próstata Resistentes à Castração/patologia , Antígeno Prostático Específico , Dipeptídeos/efeitos adversos , Lutécio/efeitos adversos , Compostos Heterocíclicos com 1 Anel/efeitos adversosRESUMO
BACKGROUND: Risk-adjusted screening for prostate cancer (PCa) aims to reduce harms by less frequent retesting, especially in men at a low risk of PCa. Definitions of low risk are based mainly on studies in men starting screening at age 55-60 yr. OBJECTIVE: To identify men at age 45 yr with a low risk of PCa. DESIGN, SETTING, AND PARTICIPANTS: A population-based, risk-adjusted PCa screening trial was conducted in Germany using baseline prostate-specific antigen (PSA) starting in young men (PROBASE). INTERVENTION: PSA measurements starting at the age of 45 yr. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The incidence of PCa within 5 yr was assessed in men with screen-negative baseline PSA <1.5 ng/ml compared with those with PSA 1.5-≤3.0 ng/ml. RESULTS AND LIMITATIONS: Of 23301 men who received a first PSA test at age 45 yr, 0.79% had a screen-positive PSA value of ≥3 ng/ml. Among the 89% of men who had a screen-negative baseline PSA value of <1.5 ng/ml, only 0.45% received a positive PSA test ≥3 ng/ml upon retesting after 5 yr. By contrast, for those with a screen-negative baseline PSA value of 1.5-3 ng/ml, 13% surpassed 3 ng/ml upon biennial testing within the next 4 yr. The incidence of PCa in subsequent screening rounds increased with increasing baseline PSA levels, from 0.13 per 1000 person-years for men with initial PSA level of <1.5 ng/ml to 8.0 per 1000 person-years for those with PSA levels of 1.5-3.0 ng/ml. A limitation is a follow-up time of only 5 yr, so far. CONCLUSIONS: Men with baseline PSA <1.5 ng/ml at age 45 yr are at a very low risk of PCa over the next 5 yr. PATIENT SUMMARY: The PROBASE study showed that men with baseline prostate-specific antigen (PSA) <1.5 ng/ml at age 45 yr have a very low prostate cancer detection rate over 5 yr and do not need PSA retesting during this time.
RESUMO
BACKGROUND: Prostate cancer (PC)-related anxiety is associated with clinically significant declines in health-related quality of life (HRQoL) and psychological well-being. This longitudinal study investigates course and predictors of PC-related anxiety in long-term PC survivors treated by radical prostatectomy (RP). METHODS: Two thousand nine hundred and three survivors from the multicenter German Familial PC Database completed the Memorial Anxiety Scale for PC on average 11 years after RP at the initial assessment in 2015 and then 5 years later. Hierarchical multiple linear regression was used to assess predictors of PC-related anxiety at follow-up. RESULTS: PC-related anxiety remained stable over the 5 years. In hierarchical multiple linear regression, longitudinal predictors of PC-related anxiety 5 years later included a lower level of education (beta: -0.035, p = 0.019), biochemical recurrence (BCR; beta: 0.054, p = 0.002), late BCR (beta: 0.054, p < 0.001), PC anxiety at initial assessment (beta: 0.556, p < 0.001), HRQoL (beta: -0.076, p < 0.001), depression and anxiety symptoms (beta: 0.072, p = 0.001; beta: 0.165, p < 0.001). Predictors of prostate-specific antigen (PSA) anxiety 5 years later included late BCR (beta: 0.044, p = 0.019), PSA anxiety at initial assessment (beta: 0.339, p < 0.001), depression and anxiety symptoms (beta: 0.074, p = 0.008; beta: 0.191, p < 0.001), and treatment decision regret (beta: 0.052, p = 0.006). CONCLUSION: PC-related anxiety remains a burden to survivors many years after diagnosis and treatment. The respective disease-specific anxiety was the strongest predictor of this anxiety 5 years later, which emphasizes the need of screening and monitoring in a timely manner for PC-related anxiety. Treating urologists should screen, identify, and monitor patients at risk for targeted referrals to psychosocial services.
Assuntos
Antígeno Prostático Específico , Neoplasias da Próstata , Masculino , Humanos , Estudos Longitudinais , Qualidade de Vida/psicologia , Neoplasias da Próstata/terapia , Prostatectomia/efeitos adversos , Ansiedade/epidemiologia , Ansiedade/etiologia , Sobreviventes/psicologia , Recidiva Local de Neoplasia/cirurgiaRESUMO
BACKGROUND: Annual digital rectal examination (DRE) is recommended as a stand-alone screening test for prostate cancer (PCa) in Germany for 45+ yr olds. DRE diagnostic performance in men as young as 45 yr old has not been proved by a screening trial. OBJECTIVE: To determine DRE diagnostic performance in a screening trial. DESIGN, SETTING, AND PARTICIPANTS: This analysis was conducted within the multicentric, randomized PROBASE trial, which enrolled >46 000 men at age 45 to test risk-adapted prostate-specific antigen (PSA) screening for PCa. INTERVENTION: (1) DRE was analyzed as a one-time, stand-alone screening offer at age 45 in 6537 men in one arm of the trial and (2) PCa detection by DRE was evaluated at the time of PSA-screen-driven biopsies (N = 578). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: (1) True-/false-positive detection rates of DRE as compared with PSA screening and (2) DRE outcome at the time of a prostate biopsy were evaluated. RESULTS AND LIMITATIONS: (1) A prospective analysis of 57 men with suspicious DRE at age 45 revealed three PCa. Detection rate by DRE was 0.05% (three of 6537) as compared with a four-fold higher rate by PSA screening (48 of 23 301, 0.21%). The true-positive detection rate by DRE relative to screening by PSA was 0.22 (95% confidence interval [CI] = [0.07-0.72]) and the false-positive detection rate by DRE was 2.2 (95% CI = [1.50-3.17]). (2) Among PSA-screen-detected PCa cases, 86% had unsuspicious DRE (sensitivity relative to PSA was 14%), with the majority of these tumors (86%) located in the potentially accessible zones of the prostate as seen by magnetic resonance imaging. CONCLUSIONS: The performance of stand-alone DRE to screen for PCa is poor. DRE should not be recommended as a PCa screening test in young men. Furthermore, DRE does not improve the detection of PSA-screen-detected PCa. PATIENT SUMMARY: Our report demonstrated the poor diagnostic performance of digital rectal examination in the screening for prostate cancer in young men.