Diagnosis of prostate cancer with magnetic resonance imaging in men treated with 5-alpha-reductase inhibitors.

PURPOSE: The primary aim of this study was to evaluate if exposure to 5-alpha-reductase inhibitors (5-ARIs) modifies the effect of MRI for the diagnosis of clinically significant Prostate Cancer (csPCa) (ISUP Gleason grade ≥ 2). METHODS: This study is a multicenter cohort study including patients undergoing prostate biopsy and MRI at 24 institutions between 2013 and 2022. Multivariable analysis predicting csPCa with an interaction term between 5-ARIs and PIRADS score was performed. Sensitivity, specificity, and negative (NPV) and positive (PPV) predictive values of MRI were compared in treated and untreated patients. RESULTS: 705 patients (9%) were treated with 5-ARIs [median age 69 years, Interquartile range (IQR): 65, 73; median PSA 6.3 ng/ml, IQR 4.0, 9.0; median prostate volume 53 ml, IQR 40, 72] and 6913 were 5-ARIs naïve (age 66 years, IQR 60, 71; PSA 6.5 ng/ml, IQR 4.8, 9.0; prostate volume 50 ml, IQR 37, 65). MRI showed PIRADS 1-2, 3, 4, and 5 lesions in 141 (20%), 158 (22%), 258 (37%), and 148 (21%) patients treated with 5-ARIs, and 878 (13%), 1764 (25%), 2948 (43%), and 1323 (19%) of untreated patients (p < 0.0001). No difference was found in csPCa detection rates, but diagnosis of high-grade PCa (ISUP GG ≥ 3) was higher in treated patients (23% vs 19%, p = 0.013). We did not find any evidence of interaction between PIRADS score and 5-ARIs exposure in predicting csPCa. Sensitivity, specificity, PPV, and NPV of PIRADS ≥ 3 were 94%, 29%, 46%, and 88% in treated patients and 96%, 18%, 43%, and 88% in untreated patients, respectively. CONCLUSIONS: Exposure to 5-ARIs does not affect the association of PIRADS score with csPCa. Higher rates of high-grade PCa were detected in treated patients, but most were clearly visible on MRI as PIRADS 4 and 5 lesions. TRIAL REGISTRATION: The present study was registered at ClinicalTrials.gov number: NCT05078359.

Antegrade versus retrograde common iliac artery revascularization and occurrence of erectile dysfunction.

AIM: To assess the effect of antegrade and retrograde common iliac artery (CIA) revascularization on erectile dysfunction (ED) using the validated International Index of Erectile Function (IIEF) questionnaire, on patients treated for chronic occlusions of the CIA. MATERIALS AND METHODS: Clinical data of patients who were submitted either to endovascular CIA revascularization (group A) or to femoral-femoral crossover bypass (group B) due a unilateral total occlusion of the CIA between 01/2015 and 12/2019 were retrospectively analyzed. Primary outcomes included the evaluation of ED using the IIEF questionnaire, before and 30 days after the operation. A P value <0.05 was considered statistically significant. RESULTS: A total of 33 patients underwent endovascular (14 patients, group A) or surgical treatment (19, group B) Before the operation, no differences were recorded in the occurrence of ED between the two groups, neither in the results of the IIEF questionnaire. After the intervention, patients of group A performed significantly better than those of group B in terms of IIEF questionnaire (18 ± 10.1 versus 12.1 ± 14.8, P=0.01). Age and COPD were negatively correlated with the preoperative results of the IIEF questionnaire (OR 0.049, 95%CI 0.02-0.05, P<0.001 and OR 0.29, 95%CI 0.01-0.56, P=0.03, respectively) and the postoperative results of the IIEF questionnaire (OR 0.02, 95% CI 0.01-0.04, P<0.001, and OR 0.46, 95% CI 0.17-0.75, P=0.001, respectively). CONCLUSIONS: Patients who were submitted to endovascular antegrade revascularization for occlusion of the CIA performed significantly better in terms of IIEF questionnaire than those who underwent surgical femoral-femoral crossover bypass and therefore retrograde HA revascularization. KEY WORDS: Common iliac artery occlusion, Erectile dysfunction, Femoro-femoral bypass, Iliac artery angioplasty, IIEF-5.

Safety and feasibility of thullium laser transurethral resection of prostate for the treatment of benign prostatic enlargement in overweight patients.

OBJECTIVE: We aimed to determine safety and feasibility of thulium laser transurethral vapoenucleation of prostate (ThuVEP) for treatment of obese patients affected by benign prostatic hyperplasia (BPH). METHODS: We retrospectively analysed data of 452 patients with BPH who underwent ThuVEP from February 2012 to March 2016 in a single center. Patients were divided into three groups according to body mass index (BMI, kg/m2): Normal weight (18.5 ≤ BMI < 25; Group A), overweight (25 ≤ BMI < 30; Group B) and obese (BMI ≥ 30; Group C), for a total of 412 patients evaluable for this study. Preoperative total serum prostate-specific antigen (PSA), digital rectal examination of the prostate, transrectal ultrasound (TRUS), renal ultrasound, urine culture, uroflowmetry, International Prostate Symptoms Score (IPSS), and Quality of Life (QoL) score were analyzed. Post-operative complications, hospital stay and days of catheterization, questionnaires and uroflowmetry at 1 and 3 months after surgery were evaluated. Preoperative data, surgical outcomes, complication rate and clinical outcomes were compared between groups. RESULTS: The median age of patients was 69 years (Interquartile Range [IQR 10]). The preoperative median IPSS among groups was 19 (IQR 8.75), 20 (IQR 10), and 18 (IQR 10) respectively. At 1 and 3 months of follow-up, this value was 8 (IQR 7), 8 (IQR 4), 7 (IQR 5) and 5 (IQR 6.25), 5 (IQR 6), 6 (IQR 5), respectively (all p between groups > 0.05). There was no statistically significant difference among three groups as for hospital stay and days of catheterization (p > 0.05). CONCLUSION: Our results showed that ThuVEP was safe and feasible even in overweight patients with substantially enlarged prostate.