Antibiotics and observation have a similar impact on asymptomatic patients with a raised PSA.

OBJECTIVES: • To compare the influence of a 4-week course of empirical antimicrobial therapy or observation on the prostate-specific antigen (PSA) levels of asymptomatic patients with a raised baseline PSA. • To identify whether a decrease in PSA can predict the risk of prostate cancer (PCa) detection on prostate biopsy. PATIENTS AND METHODS: • Patients were referred to our ambulatory centre because of a raised PSA level (>2.5 ng/mL) with a normal digital rectal examination. A 12-core prostate biopsy was indicated in these patients and they were offered antibiotic treatment with levofloxacin 500 mg daily for 30 days. • Patients who did not agree to use antibiotics but who still showed interest in participating underwent simple observation, serving as controls. • Total and free PSA levels at baseline and after 45 days were measured. Variation in PSA level was calculated. • All patients underwent a 12-core prostate biopsy 6 weeks after the initial visit. RESULTS: • In all, 245 men were enrolled, but 43 were lost due to follow-up. A total of 145 patients who used antibiotics and 57 controls were included in the analysis. • The median baseline PSA levels were 7.6 and 7.7 ng/mL in the antibiotic and control groups, respectively, with median follow-up levels of 6.8 and 7.0 ng/mL. The follow-up PSA level was significantly lower than the initial PSA level (P = 0.009). • Mean absolute and percentage variation in PSA level were similar in both groups (P = 0.828 and 0.128, respectively). • The overall PCa detection rate was 15.8%, and did not differ among the groups (P = 0.203). Regarding the percentage variation in PSA level, patients diagnosed with PCa tended to have their PSA level increased (22.4 vs -5.3%; P = 0.001). Indeed, a decrease of 20% in PSA was not predictive of a negative prostate biopsy (P = 0.41). • The area under the receiver operating characteristic curve for percentage PSA variation as a predictor of PCa was 0.660. CONCLUSIONS: • PSA levels tend to fall when repeated after 45 days, regardless of antibiotic use. • Despite being associated with the chance of PCa, no percentage PSA variation threshold value exhibits satisfactory discriminatory properties.

Androgen replacement in men undergoing treatment for prostate cancer.

INTRODUCTION: Hypogonadism is a clinical and biochemical syndrome that may cause significant detriment in the quality of life and adversely affect the function of multiple organ systems. With the increase in life expectancy and prostate cancer (PCa) survival, a significant increase in the number of men with hypogonadism who have undergone presumably curative treatment for PCa is anticipated. AIM: To critically review the literature regarding testosterone replacement therapy (TRT) after PCa treatment with curative intent. MAIN OUTCOME MEASURES: Review of peer-reviewed literature. There was special focus on the potential implications and safety of TRT in men with hypogonadism who have undergone curative treatment for PCa. METHODS: English-language relevant publications were identified via electronic medical databases (MEDLINE, EMBASE, and DARE). RESULTS: Despite the wide spread of contraindication of testosterone replacement in men with known or suspected PCa, there is no convincing evidence that the normalization of testosterone serum levels in men with low but no castrate levels is deleterious. In the few available case series describing testosterone replacement after treatment for PCa, no case of clinical or biochemical progression was observed. CONCLUSIONS: Although further studies are necessary before definitive conclusions can be drawn, the available evidence suggests that TRT can be cautiously considered in selected hypogonadal men treated with curative intent for PCa and without evidence of active disease.

Overactive bladder: prevalence and implications in Brazil.

OBJECTIVES: To assess overactive bladder (OAB) prevalence, associated factors and implications in a young population. METHODS: An independent population-based study was carried out. A self-applicative questionnaire covering urinary symptoms, coping strategies, quality of life and treatment seeking behavior was developed. RESULTS: A total of 848 subjects between 15 and 55 years completed the questionnaire. The overall prevalence of OAB was 18.9%. Women were significantly more affected than men (p = 0.001). All age groups were equally affected (p = 0.152). Subjects with OAB reported significant impairment on household chores (p = 0.009), physical activities (p = 0.016), sleep (p < 0.001), work (p < 0.001), social life (p < 0.001) and sexual life (p < 0.001). In addition, OAB individuals present higher prevalence of depression (p = 0.036), anxiety (p < 0.001), shame (p < 0.001) and tiredness (p < 0.001) OAB was independently associated to sexual life impairment (OR = 3.36, 95% CI=1.20-9.39). Only 27.5% of OAB subjects sought for medical counseling. CONCLUSIONS: OAB is a highly prevalent condition, even in such a young population. It affects both genders, yet it is more frequently observed in women. OAB is an important health condition, with serious impact on quality of life and sexual function. A large percentual of individuals remain unrecognized, under treated and consequently suffer for long periods of time.

Intracavernosal etilefrine self-injection therapy for recurrent priapism: one decade of follow-up.

Recurrent idiopathic priapism is a rare condition that, if not properly treated, may lead to impaired quality of life and erectile dysfunction. Treatment can be achieved by prevention of priapism episodes with systemic therapy or by early intervention with intracavernosal self-injection of sympathomimetic agents. We describe a case of a young patient with recurrent idiopathic priapism who has used etilefrine self-injection for the past 10 years with good efficacy and libido and erectile function preservation. This report suggests that this approach may be safely indicated in selected cases, particularly when sexual function preservation is a major concern.