Expanding the prostate cancer cell line repertoire with ACRJ-PC28, an AR-negative neuroendocrine cell line derived from an African-Caribbean patient.

Prostate cell lines from diverse backgrounds are important to addressing disparities in prostate cancer (PCa) incidence and mortality rates among Black men. ACRJ-PC28 was developed from a transrectal needle biopsy and established via inactivation of the CDKN2A locus and simultaneous expression of human telomerase. Characterization assays included growth curve analysis, immunoblots, IHC, 3D cultures, immunofluorescence imaging, confocal microscopy, flow cytometry, WGS, and RNA-Seq. ACRJ-PC28 has been passaged more than 40 times in vitro over 10 months with a doubling time of 45 hours. STR profiling confirmed the novelty and human origin of the cell line. RNA-Seq confirmed the expression of prostate specific genes alpha-methylacyl-CoA racemase (AMACR) and NKX3.1 and Neuroendocrine specific markers synaptophysin (SYP) and enolase 2 (ENO2) and IHC confirmed the presence of AMACR. Immunoblots indicated the cell line is of basal-luminal type; expresses p53 and pRB and is AR negative. WGS confirmed the absence of exonic mutations and the presence of intronic variants that appear to not affect function of AR, p53, and pRB. RNA-Seq data revealed numerous TP53 and RB1 mRNA splice variants and the lack of AR mRNA expression. This is consistent with retention of p53 function in response to DNA damage and pRB function in response to contact inhibition. Soft agar anchorage-independent analysis indicated that the cells are transformed, confirmed by principal component analysis (PCA) where ACRJ-PC28 cells cluster alongside other PCa tumor tissues, yet was distinct. The novel methodology described should advance prostate cell line development, addressing the disparity in PCa among Black men.

External validation of the priapism impact profile in a Jamaican cohort of patients with sickle cell disease.

BACKGROUND: Priapism impairs quality of life and has a predilection for males with sickle cell disease (SCD). The Priapism Impact Profile (PIP) is a novel 12-item instrument designed to measure general health-related impact of priapism. The aim of the study was to evaluate the validity and reliability of the PIP in a Jamaican cohort of SCD patients experiencing priapism. METHODS: One hundred SCD patients with a history of priapism were recruited from a sickle cell clinic in Kingston, Jamaica and administered the PIP questionnaire. Patients rated each item of the PIP for clarity and importance. Statistical testing was employed to evaluate the psychometric performance of the PIP. Content validation was assessed based on patient descriptive rating of the items based on clarity, and importance and criterion-oriented validity were assessed by evaluating the PIP's ability to distinguish between patient subgroups. Test-retest repeatability was assessed in 20 of the 100 patients. RESULTS: Patients were stratified into active (54) and remission (46) priapism groups based on their experience of priapism within the past year. Patients in the active priapism group were younger (p = 0.011), had a shorter duration of disease (p = 0.023), and had more frequent priapism episodes (p = 0.036) than the remission group. PIP questionnaire scores differed significantly with respect to priapism activity (p < 0.001) and prevalence of erectile dysfunction (p < 0.05) but not by priapism severity (p = 0.62). The PIP questionnaire had good content validity, with questions rated as having medium or high clarity and importance by an average of 82.8% and 69.2% of patients, respectively. CONCLUSION: The PIP questionnaire was successfully validated in a Jamaican cohort of SCD patients and adequately discriminated patients with active priapism from those in remission. The instrument may be utilized in routine clinical management of patients with SCD-associated priapism. Further clinical investigations are warranted in other populations.

Time for a mandatory urology rotation? Adequacy of urological exposure during medical school - a survey of graduates of the University of the West Indies, Trinidad and Tobago.

INTRODUCTION: To objectively assess the self-reported adequacy and utility of exposure of our students to urology during their training. MATERIALS AND METHODS: A questionnaire was sent to the University of the West Indies graduating class of 2018, now functioning as medical interns. A questionnaire was designed to collect information regarding respondent demographics, perceptions of their urology exposure during their medical school training as well as their attitudes towards the specialty. The survey was also designed to capture respondents' comfort levels with commonly encountered urological scenarios and investigations. The survey was distributed in February 2019 using the online survey tool, Survey Monkey. RESULTS: A total of 196 surveys were distributed, of which 107 responses were returned. Clinic exposure was the most common form of interaction with the specialty during training. Their exposure to common urological procedures was low with only 9.3% and 4.7% having seen a circumcision or prostate biopsy respectively by graduation; 21.7% and 47.7% indicated that they were uncomfortable to review a KUB X-ray and CT respectively to identify a stone; 96.2% considered urology to be an important clinical sub-specialty but 42.4% indicated that their exposure to urology did not prepare them to manage urological conditions that they have encountered since graduation; 87.8% of respondents supported the idea of a urology rotation. CONCLUSION: The exposure of medical students to urology during their medical training is poor. There remains much room for improvement in exposing our medical students to urology during their training. A dedicated urology rotation should be strongly considered. This study has applications not just within the Caribbean, but further afield.

Disparities in prostate cancer incidence and mortality rates: Solvable or not?

Prostate cancer (PCa) is recognized as a disease possessing not only great variation in its geographic and racial distribution but also tremendous variation in its potential to cause morbidity and death and it, therefore, ought not to be considered a homogenous disease entity. Morbidity and death from PCa are disproportionately higher in men of African ancestry (MAA) who are generally observed to have more aggressive disease and worse outcomes following treatment compared to men of European ancestry (MEA). The higher rates of PCa among MAA relative to MEA appear to be multifactorial and related to inherent differences in biological aggressiveness; a continued lack of awareness of the disease and methods of prevention; a lower prevalence of screen-detected PCa; comparatively lower access to quality healthcare as well as systemic and institutionalized disparities in the administration of optimal care to MAA in developed countries such as the United States of America where high-quality care is available. Even when access to quality healthcare is assured in equal access settings, it appears that MAA still have worse outcomes after PCa treatment stage-for-stage and grade-for-grade compared to MEA, suggesting that, inherent racial, ethnic and biological differences are paramount in predicting poor outcomes. This review has explored the different contributing factors to the current disparities in PCa incidence and mortality rates with emphasis on the incongruence in how research has been conducted in understanding the disease towards developing therapies.

Home grown: the development and structure of urological training in the Caribbean.

Training in general surgery at the University of the West Indies commenced in Jamaica in 1972 and urology training followed just over a decade later. Since then, the 'Doctor of Medicine' diploma offered by the university has also expanded to include the Trinidadian campus. Most urologists in the English-speaking Caribbean are, in fact, graduates of this programme. Residents follow a two-part training plan and two years of core surgical training are followed by four years of urology training. Despite the tremendous regional impact of this training programme, there is a lack of awareness of its existence among the wider urology community. This article reviews the history, development and structure of urology training in the English-speaking Caribbean.

Pathological upgrading and upstaging at radical prostatectomy in Jamaican men with low-risk prostate cancer.

Several studies suggest race-based health disparities in men with low-risk prostate cancer (PCa), with African American males having poorer oncological outcomes. We sought to determine the prevalence and predictors of pathological upgrading and upstaging in Jamaican men with low-risk PCa treated with radical prostatectomy (RP). Data on 141 men who met the National Comprehensive Cancer Network criteria for low-risk PCa and underwent RP at a single institution were reviewed. All men had a transrectal ultrasound-guided biopsy. Pre-operative clinical and final pathological data were obtained. Data were summarised as means and standard deviations or percentages as appropriate. Bivariate analyses such as independent samples t-tests and chi-square tables were conducted and logistic regression models were estimated to predict upgrading (>Gleason 6) and upstaging (p ≥ T3). The mean age was 59.5 ± 7.8 years with mean prostate specific antigen (PSA) of 6.6 ± 2 ng/mL. A total of 48.3% of men were upgraded and 11.4% were upstaged. Bivariate analyses indicated that PSA (p = 0.008) and percentage positive cores (p = 0.002) were associated with upgrading. PSA (p = 0.042) and percentage positive cores (p = 0.003) were significantly associated with upstaging. The odds of upgrading increased with increased PSA levels (OR 1.40, 95% CI 1.05-1.87, p = 0.021) or increased percentage positive cores (OR 8.27, 95% CI 2.19-31.16, p = 0.002). The odds of upstaging increased with increased PSA levels (OR 1.4, 95% CI 1.01-1.96, p = 0.046) and with increased percentages positive cores (OR 11.4; 95% CI 2.06-63.09, p = 0.005). Jamaican men with low-risk PCa are at high risk of pathological upgrading and upstaging at RP. These findings should be taken into consideration when discussing treatment options with these patients.

Does a family history of prostate cancer affect screening behavior in Jamaican men?

[ABSTRACT]. Objective. To determine 1) the characteristics of males with a family history of prostate cancer who presented for screening and 2) the association between family history and diagnosis of prostate cancer in a cohort of screened Jamaican men. Methods. The study consisted of a prospective cohort of black men who screened at the Jamaica Cancer Society in Kingston between 2006 and 2016. Data were collected on: 1) age at screening and age at diagnosis of prostate cancer, 2) family history of prostate cancer, and 3) prostate-specific antigen (PSA) and digital rectal examination (DRE) findings. Results. Approximately 600 (21.4%) of screened men who reported data on family history (2 791 / 2 867) said they had a family history of prostate cancer. Men with a family history of prostate cancer 1) commenced screening at a younger age than men without a family history (P <0.001) and 2) tended to have a younger age at diagnosis of prostate cancer (P = 0.262). There was no significantly increased risk of prostate cancer in men with a reported family history of prostate cancer (odds ratio: 1.4; 95% confidence interval: 0.821–2.386; P = 0.217). Conclusions. Men with a family history of prostate cancer presented frequently for screening and earlier than those without. There was a lack of association between family history of prostate cancer and diagnosis. Further studies are needed to investigate this association and validate family histories.

[RESUMEN]. Objetivos. Determinar 1) las características de los hombres con antecedentes familiares de cáncer de próstata que se presentaron para el tamizaje, y 2) la asociación entre los antecedentes familiares y el diagnóstico de cáncer de próstata en la cohorte de hombres jamaiquinos que participó en el tamizaje. Métodos. El estudio consistió en una cohorte prospectiva de hombres negros que se sometieron a un tamizaje realizado en la Jamaica Cancer Society [Sociedad del Cáncer de Jamaica] en Kingston entre el 2006 y el 2016. Se recopilaron los siguientes datos: 1) edad en el momento del tamizaje y edad en el momento del diagnóstico de cáncer de próstata, 2) antecedentes familiares de cáncer de próstata y 3) resultados del antígeno prostático específico (APE) y del tacto rectal (EDR). Resultados. De los hombres que informaron antecedentes familiares en el tamizaje (2 791/2 867), aproximadamente 600 (21,4%) tenían antecedentes familiares de cáncer de próstata. Los hombres con antecedentes familiares de cáncer de la próstata: 1) empezaron a participar en el tamizaje a una edad más temprana que los hombres sin antecedentes familiares (P <0,001) y 2) tenían una edad menor en el momento del diagnóstico de cáncer de próstata (P = 0,262). No se observó un aumento significativo en el riesgo de cáncer de próstata en hombres que informaron de antecedentes familiares de cáncer de próstata (razón de posibilidades [OD] de 1,4; intervalo de confianza de 95%: 0,821 – 2,386; P = 0,217). Conclusiones. Los hombres con antecedentes familiares de cáncer de próstata se presentaron con frecuencia a las pruebas de tamizaje y a una edad más temprana que los hombres sin antecedentes. No se observó una asociación entre los antecedentes familiares de cáncer de próstata y el diagnóstico. Es necesario realizar estudios adicionales para investigar esta asociación y validar los antecedentes familiares.

[RESUMO]. Objetivos. Determinar as características dos homens com história familiar de câncer de próstata que buscaram fazer o rastreamento e examinar a associação entre história familiar e diagnóstico de câncer de próstata em uma coorte de homens jamaicanos rastreados. Métodos. O estudo compreendeu uma coorte prospectiva de homens negros que fizeram o rastreamento de câncer no serviço da Sociedade do Câncer da Jamaica em Kingston entre 2006 e 2016. Foram coletadas informações sobre: idade ao rastreamento e idade ao diagnóstico de câncer de próstata, história familiar de câncer de próstata e resultados da dosagem do antígeno prostático específico (PSA) e do exame de toque retal. Resultados. Cerca de 600 (n = 2.791; 21,4%) dos homens rastreados que deram informações sobre a história familiar (n = 2.867) disseram que tinham história familiar de câncer de próstata. Os homens com história familiar de câncer de próstata: começaram o rastreamento quando eram mais jovens que os homens sem história familiar (P < 0,001) e tiveram uma tendência de serem mais jovens ao diagnóstico de câncer de próstata (P = 0,262). Não se observou risco significativamente maior de câncer de próstata nos homens com história familiar informada de câncer de próstata (odds ratio 1,4; intervalo de confiança de 95% 0,821–2,386; P = 0,217). Conclusões. Os homens com história de câncer de próstata buscaram com frequência fazer o rastreamento e a uma idade mais jovem em relação aos homens sem história familiar. Observou-se a ausência de associação entre história familiar e diagnóstico de câncer de próstata. Outros estudos são necessários para investigar esta associação e validar as histórias familiares.

Does a family history of prostate cancer affect screening behavior in Jamaican men?

OBJECTIVE: To determine 1) the characteristics of males with a family history of prostate cancer who presented for screening and 2) the association between family history and diagnosis of prostate cancer in a cohort of screened Jamaican men. METHODS: The study consisted of a prospective cohort of black men who screened at the Jamaica Cancer Society in Kingston between 2006 and 2016. Data were collected on: 1) age at screening and age at diagnosis of prostate cancer, 2) family history of prostate cancer, and 3) prostate-specific antigen (PSA) and digital rectal examination (DRE) findings. RESULTS: Approximately 600 (21.4%) of screened men who reported data on family history (2 791 / 2 867) said they had a family history of prostate cancer. Men with a family history of prostate cancer 1) commenced screening at a younger age than men without a family history (P <0.001) and 2) tended to have a younger age at diagnosis of prostate cancer (P = 0.262). There was no significantly increased risk of prostate cancer in men with a reported family history of prostate cancer (odds ratio: 1.4; 95% confidence interval: 0.821-2.386; P = 0.217). CONCLUSIONS: Men with a family history of prostate cancer presented frequently for screening and earlier than those without. There was a lack of association between family history of prostate cancer and diagnosis. Further studies are needed to investigate this association and validate family histories.

Does a family history of prostate cancer affect screening behavior in Jamaican men? / ¿Influyen los antecedentes familiares de cáncer de próstata en la disposición de los hombres jamaiquinos a participar en pruebas de tamizaje? / Ter uma história familiar de câncer de próstata influi na conduta de rastreamento em homens jamaicanos?

ABSTRACT Objective To determine 1) the characteristics of males with a family history of prostate cancer who presented for screening and 2) the association between family history and diagnosis of prostate cancer in a cohort of screened Jamaican men. Methods The study consisted of a prospective cohort of black men who screened at the Jamaica Cancer Society in Kingston between 2006 and 2016. Data were collected on: 1) age at screening and age at diagnosis of prostate cancer, 2) family history of prostate cancer, and 3) prostate-specific antigen (PSA) and digital rectal examination (DRE) findings. Results Approximately 600 (21.4%) of screened men who reported data on family history (2 791 / 2 867) said they had a family history of prostate cancer. Men with a family history of prostate cancer 1) commenced screening at a younger age than men without a family history (P <0.001) and 2) tended to have a younger age at diagnosis of prostate cancer (P = 0.262). There was no significantly increased risk of prostate cancer in men with a reported family history of prostate cancer (odds ratio: 1.4; 95% confidence interval: 0.821-2.386; P = 0.217). Conclusions Men with a family history of prostate cancer presented frequently for screening and earlier than those without. There was a lack of association between family history of prostate cancer and diagnosis. Further studies are needed to investigate this association and validate family histories.

RESUMEN Objetivos Determinar 1) las características de los hombres con antecedentes familiares de cáncer de próstata que se presentaron para el tamizaje, y 2) la asociación entre los antecedentes familiares y el diagnóstico de cáncer de próstata en la cohorte de hombres jamaiquinos que participó en el tamizaje. Métodos El estudio consistió en una cohorte prospectiva de hombres negros que se sometieron a un tamizaje realizado en la Jamaica Cancer Society [Sociedad del Cáncer de Jamaica] en Kingston entre el 2006 y el 2016. Se recopilaron los siguientes datos: 1) edad en el momento del tamizaje y edad en el momento del diagnóstico de cáncer de próstata, 2) antecedentes familiares de cáncer de próstata y 3) resultados del antígeno prostático específico (APE) y del tacto rectal (EDR). Resultados De los hombres que informaron antecedentes familiares en el tamizaje (2 791/2 867), aproximadamente 600 (21,4%) tenían antecedentes familiares de cáncer de próstata. Los hombres con antecedentes familiares de cáncer de la próstata: 1) empezaron a participar en el tamizaje a una edad más temprana que los hombres sin antecedentes familiares (P <0,001) y 2) tenían una edad menor en el momento del diagnóstico de cáncer de próstata (P = 0,262). No se observó un aumento significativo en el riesgo de cáncer de próstata en hombres que informaron de antecedentes familiares de cáncer de próstata (razón de posibilidades [OD] de 1,4; intervalo de confianza de 95%: 0,821 - 2,386; P = 0,217). Conclusiones Los hombres con antecedentes familiares de cáncer de próstata se presentaron con frecuencia a las pruebas de tamizaje y a una edad más temprana que los hombres sin antecedentes. No se observó una asociación entre los antecedentes familiares de cáncer de próstata y el diagnóstico. Es necesario realizar estudios adicionales para investigar esta asociación y validar los antecedentes familiares.

RESUMO Objetivos Determinar as características dos homens com história familiar de câncer de próstata que buscaram fazer o rastreamento e examinar a associação entre história familiar e diagnóstico de câncer de próstata em uma coorte de homens jamaicanos rastreados. Métodos O estudo compreendeu uma coorte prospectiva de homens negros que fizeram o rastreamento de câncer no serviço da Sociedade do Câncer da Jamaica em Kingston entre 2006 e 2016. Foram coletadas informações sobre: idade ao rastreamento e idade ao diagnóstico de câncer de próstata, história familiar de câncer de próstata e resultados da dosagem do antígeno prostático específico (PSA) e do exame de toque retal. Resultados Cerca de 600 (n = 2.791; 21,4%) dos homens rastreados que deram informações sobre a história familiar (n = 2.867) disseram que tinham história familiar de câncer de próstata. Os homens com história familiar de câncer de próstata: começaram o rastreamento quando eram mais jovens que os homens sem história familiar (P < 0,001) e tiveram uma tendência de serem mais jovens ao diagnóstico de câncer de próstata (P = 0,262). Não se observou risco significativamente maior de câncer de próstata nos homens com história familiar informada de câncer de próstata (odds ratio 1,4; intervalo de confiança de 95% 0,821-2,386; P = 0,217). Conclusões Os homens com história de câncer de próstata buscaram com frequência fazer o rastreamento e a uma idade mais jovem em relação aos homens sem história familiar. Observou-se a ausência de associação entre história familiar e diagnóstico de câncer de próstata. Outros estudos são necessários para investigar esta associação e validar as histórias familiares.

Evaluation of sexual and fertility dysfunction in spinal cord-injured men in Jamaica.

INTRODUCTION: Sexual dysfunction and infertility are common in males with traumatic spinal cord injuries (SCIs). The objective of this study was to determine the prevalence of sexual dysfunction and infertility in males with traumatic SCI managed in Jamaica, as well as the therapeutic options offered. CASE PRESENTATION: A cross-sectional study including males with traumatic SCI managed at the Sir John Golding Rehabilitation Centre, Kingston, Jamaica was carried out between 1 January and 31 December 2015. Sexual function was measured with the International Index of Erectile Function Questionnaire, and further information on social history, fertility desires and treatment options offered were collected. Data were analyzed using Stata 12 for Windows (College Station, TX, USA). The mean age of patients at the time of study was 38.8±15.3 years (range 19-71) with a mean duration of injury of 3.7±2.4 years (range 1.3-15.6). Of 45 patients with traumatic SCI surveyed, 90.7% had erectile dysfunction, with 62.8% being classified as severe and 73.3% of men were unable to ejaculate. Treatment for erectile and ejaculatory dysfunction was offered in only two patients, respectively. Most (71.1%) patients indicated that they wanted to have children in the future, however, no one had been referred for assisted reproductive techniques. DISCUSSION: Men with traumatic SCI have high rates of severe erectile and ejaculatory dysfunctions, but have preserved interests in maintaining fertility. Adherence to guidelines for sexual education for men with traumatic SCI in Jamaica and the Caribbean is needed.

Prostate Cancer Knowledge, Prevention, and Screening Behaviors in Jamaican Men.

Screening is the only effective method of reducing prostate cancer mortality. Several reports have documented poor prostate cancer awareness and screening practices in Jamaican men. The Jamaica Cancer Society provides the most organized and largest form of screening in Jamaica and hosts an annual mass screening clinic on Prostate Cancer Awareness Day in September. We sought to determine the knowledge and attitudes towards screening and risks and prevention of prostate cancer. The study represented a cross-sectional analysis of 55 men presenting for screening on Prostate Cancer Awareness Day, September 2014 in Kingston, Jamaica. Information on prostate cancer knowledge and attitudes towards screening was obtained using interviewer-administered questionnaires (The Integrative Model of Prostate Cancer Disparity (PIPCaD). Prostate specific antigen (PSA) and digital rectal examination (DRE) were obtained from all patients. Mean PSA of participating men was 1.5 ± 1.48 ng/ml. Fifteen percent of men surveyed had a family history of prostate cancer. Prostate cancer knowledge was moderate, with at least 84 % of men responding correctly to 5 of 10 questions referring to prostate cancer risk and prevention. Most men had a favorable attitude towards screening. Starch formed the major portion of the diet in 68 % of men and 35 % of men engaged in no physical activity. Jamaican men surveyed have moderate prostate cancer knowledge and a positive attitude towards screening and prostate cancer prevention activities. However, the application of activities for potential prevention of modifiable risk factors is poor.

Prostate Cancer Screening in Jamaica: Results of the Largest National Screening Clinic.

Prostate cancer is highly prevalent in Jamaica and is the leading cause of cancer-related deaths. Our aim was to evaluate the patterns of screening in the largest organized screening clinic in Jamaica at the Jamaica Cancer Society. A retrospective analysis of all men presenting for screening at the Jamaica Cancer Society from 1995 to 2005 was done. All patients had digital rectal examinations (DRE) and prostate specific antigen (PSA) tests done. Results of prostate biopsies were noted. 1117 men of mean age 59.9 ± 8.2 years presented for screening. The median documented PSA was 1.6 ng/mL (maximum of 5170 ng/mL). Most patients presented for only 1 screen. There was a gradual reduction in the mean age of presentation for screening over the period. Prostate biopsies were requested on 11% of screening visits; however, only 59% of these were done. 5.6% of all persons screened were found to have cancer. Of the cancers diagnosed, Gleason 6 adenocarcinoma was the commonest grade and median PSA was 8.9 ng/mL (range 1.5-1059 ng/mL). Older men tend to screen for prostate cancer in Jamaica. However, compliance with regular maintenance visits and requests for confirmatory biopsies are poor. Screening needs intervention in the Jamaican population.

Overactive bladder in adults with sickle cell disease.

AIMS: To characterize the prevalence and impact of nocturnal enuresis and overactive bladder (OAB) symptomatology in the adult sickle-cell disease (SCD) population. METHODS: We performed a single-center, cross-sectional study of adult SCD patients from October 2012 to February 2014, using the validated Pfizer OAB short form questionnaire and brief voiding history surveys. Patient responses and scores were compared to that of controls having normal or sickle cell trait hemoglobin genotypes. RESULTS: A group of 239 SCD patients (116 males, 123 females) were compared with 104 normal and 57 sickle cell trait patients. Seven of 239 (2.9%) SCD patients compared to none of the 161 patients without SCD (P = 0.04) reported current nocturnal enuresis. The median age of nocturnal enuresis cessation was higher in SCD patients (12.0, IQR 9.0-15.0 years) compared to that of both normal (7.5, IQR 6.0-9.8 years) and sickle cell trait (7.5, IQR 6.0-8.8 years) groups (P < 0.0001). Ninety-three of 239 (38.9%) SCD patients compared to 17 of 104 (16.3%) normal and 11 of 57 (19.3%) sickle cell trait had scores indicating OAB symptomatology (P < 0.0001). Patients with SCD had higher OAB symptom severity and lower health-related quality of life (HRQL) scores compared to the normal and sickle cell trait groups (P < 0.0001 and P < 0.0001, respectively). CONCLUSIONS: We demonstrate an elevated rate of nocturnal enuresis and OAB symptoms in the adult SCD population. An OAB phenotype may be an under-recognized complication of SCD irrespective of age. Neurourol. Urodynam. 35:642-646, 2016. © 2015 Wiley Periodicals, Inc.

A delayed foreskin-sparing approach to the management of penile fractures in uncircumcised Jamaican men.

INTRODUCTION: The traditional surgical approach to penile fracture is to perform a circumferential subcoronal degloving incision emergently to repair the injury. This approach necessitates circumcision to avoid foreskin complications. We present four men who had a delayed foreskin-sparing approach and discuss its advantages. PRESENTATION OF CASE: Four of five uncircumcised patients who had suspected penile fractures secondary to coital injury, and without suspicion of concomitant urethral injury, had a delayed exploration, seven days after injury, utilizing an incision directly over the palpable haematoma, at the location of the tunical defect, thereby resulting in foreskin preservation. Two of 5 patients had repair under general anaesthesia, one under local anaesthesia and surgery was cancelled in another because upon reassessment at seven days he had normal erections and a normal penile examination. At follow up, all men had good functional and cosmetic outcomes. DISCUSSION: Uncircumcised patients with penile fractures, without suspicion of urethral injury, may undergo a delayed repair without prophylactic circumcision since there is minimal risk of foreskin complications. Delayed repair decreases the incidence of negative explorations by fostering a conservative approach in mimicking conditions such as superficial vein lacerations. It also enables the use of local anaesthesia in an elective ambulatory setting. CONCLUSION: Delayed repair of penile fractures results in foreskin preservation, facilitates elective ambulatory care under local anaesthesia and decreases the incidence of negative surgical explorations.

Molecular pathophysiology of priapism: emerging targets.

Priapism is an erectile disorder involving uncontrolled, prolonged penile erection without sexual purpose, which can lead to erectile dysfunction. Ischemic priapism, the most common of the variants, occurs with high prevalence in patients with sickle cell disease. Despite the potentially devastating complications of this condition, management of recurrent priapism episodes historically has commonly involved reactive treatments rather than preventative strategies. Recently, increasing elucidation of the complex molecular mechanisms underlying this disorder, principally involving dysregulation of nitric oxide signaling, has allowed for greater insights and exploration into potential therapeutic targets. In this review, we discuss the multiple molecular regulatory pathways implicated in the pathophysiology of priapism. We also identify the roles and mechanisms of molecular effectors in providing the basis for potential future therapies.

Is testosterone deficiency a possible risk factor for priapism associated with sickle-cell disease?

PURPOSE: The purpose of this study was to determine the association of testosterone deficiency and priapism in adult men with sickle cell disease (SCD). METHODS: A cross-sectional study of 50 adult men with SCD (hemoglobin SS) was performed. All patients had early morning blood taken for total and free testosterone, FSH, LH, prolactin, lipid levels, LDH and hematological indices. Patients completed an interviewer-administered questionnaire regarding priapism frequency, duration and treatment. Testosterone deficiency was defined as a serum total testosterone<12 nmol/L (346 ng/dL). RESULTS: The mean age of the study population was 34.2±8.9 years. Priapism was noted in 24 (48%) patients and was most frequently seen in men between ages 18-25 years. Testosterone deficiency was observed in 11 of the 50 (22%) patients, particularly in 6 of 24 (25%) patients with histories of priapism. There was no difference in mean total testosterone levels in patients with and without a history of priapism (16.7±4.9 nmol/L and 15.4±5.9 nmol/L, respectively) (p=0.43). Similarly, there was no difference in serum LH and FSH levels based on history of priapism. CONCLUSION: Testosterone deficiency is prevalent in patients with SCD; however, we did not identify an association based on a history of priapism. Larger, prospectively gathered data are needed to define the priapism profile of SCD patients with testosterone deficiency.

Testosterone Replacement Therapy in Adolescents With Sickle Cell Disease Reverses Hypogonadism Without Promoting Priapism: A Case Report.

Delayed puberty secondary to hypogonadism is commonly seen in sickle cell disease (SCD), affecting normal growth and development. The condition is rarely treated in SCD for fear of inducing priapism episodes. We present a case report of an Afro-Jamaican adolescent male at 16 years of age who presented with symptoms of delayed puberty as well as frequent stuttering priapism episodes. Endocrinological assessment revealed low serum total testosterone levels. Treatment was commenced monthly with testosterone enanthate which resulted in improved symptoms of delayed puberty, improvement in anthropometric parameters while apparently ameliorating priapism episodes.

Current state of prostate cancer treatment in Jamaica.

Prostate cancer is the commonest cancer in Jamaica as well as the leading cause of cancer-related deaths. One report suggested that Jamaica has the highest incidence rate of prostate cancer in the world, with an age-standardised rate of 304/100,000 per year. The Caribbean region is reported to have the highest mortality rate of prostate cancer worldwide. Prostate cancer accounts for a large portion of the clinical practice for health-care practitioners in Jamaica. The Jamaica Urological Society is a professional body comprising 19 urologists in Jamaica who provide most of the care for men with prostate cancer in collaboration with medical oncologists, radiation oncologists, and a palliative care physician. The health-care system is structured in two tiers in Jamaica: public and private. The urologist-to-patient ratio is high, and this limits adequate urological care. Screening for prostate cancer is not a national policy in Jamaica. However, the Jamaica Urological Society and the Jamaica Cancer Society work synergistically to promote screening as well as to provide patient education for prostate cancer. Adequate treatment for localised prostate cancer is available in Jamaica in the forms of active surveillance, nerve-sparing radical retropubic prostatectomy, external beam radiation, and brachytherapy. However, there is a geographic maldistribution of centres that provide prostate cancer treatment, which leads to treatment delays. Also, there is difficulty in affording some treatment options in the private health-care sectors. Androgen deprivation therapy is available for treatment of locally advanced and metastatic prostate cancer and is subsidised through a programme called the National Health Fund. Second-line hormonal agents and chemotherapeutic agents are available but are costly to most of the population. The infrastructure for treatment of prostate cancer in Jamaica is good, but it requires additional technological advances as well as additional specialist services.

Pathological outcome and biochemical recurrence-free survival after radical prostatectomy in African-American, Afro-Caribbean (Jamaican) and Caucasian-American men: an international comparison.

OBJECTIVE: To compare pathological and biochemical outcomes of radical prostatectomy (RP) among African-American (AA), Afro-Caribbean (AC; Jamaican) and Caucasian-American (CA) men using an international cohort of patients who underwent RP in the USA and Jamaica. MATERIALS AND METHODS: A retrospective review was performed of men who underwent RP for clinically organ-confined (OC) prostate cancer between 2000 and 2011 at Columbia University Medical Center (New York, USA) and the University Hospital of the West Indies (Kingston, Jamaica) between 2000 and 2007. Men who had received neoadjuvant or adjuvant (within 3 months) therapy were excluded. Clinicopathological variables were compared among the three groups, focusing on age, stage, PSA level, Gleason sum (GS) and margin status. Multivariate analysis was performed to determine the predictors of biochemical recurrence (BCR; PSA >0.2 ng/mL), and Kaplan-Meier analysis was performed to determine BCR-free survival rates in AA, AC and CA men. RESULTS: A total of 483 men underwent RP for clinically OC disease (CM, n = 309, AA, n = 93 and AC, n = 81). The mean patient age was 59 years, with AA men being younger than CA men (58 vs 60 years, P< 0.05). The mean (range) follow-up was 49 (13-133) months with no significant difference among the groups. The men in the AC cohort had a higher mean PSA level than AA and CA men (8.8 vs 6.2 and 5.0 ng/mL, respectively, P< 0.05) and more clinical GS ≥7 (44%) tumours than AA (8%) and CA men (0%; P< 0.01). On multivariate analysis, controlling for stage, grade, PSA level and margins, AA and AC race were independent predictors of BCR. AA and AC men had significantly lower 5-year BCR-free survival (76 and 74%, respectively) than CA men (98% [P < 0.001]). CONCLUSIONS: This international comparison of clinicopathological outcomes in AA, AC and CA men undergoing RP shows that AA and AC men present similarly with more aggressive disease features than CA men and have lower 5-year BCR-free survival. Both AA and AC race are significant predictors of BCR, independently of stage, grade, PSA level and margin status. Further research is needed to elucidate and correct the mechanisms behind the observed difference in outcome among these populations.

Stuttering priapism: insights into pathogenesis and management.

Priapism is defined as a persistent, painful erection that continues beyond, or is unrelated to, sexual stimulation. It may be categorized as either ischemic (low/absent flow) or nonischemic (high flow). Stuttering priapism is a variant of the ischemic type that is characterized by repetitive, transient, painful, self-limiting episodes of priapism. It is associated with various hematological disorders, including sickle cell disease and pharmacological treatments. The consequences of ineffective treatment of priapism are erectile dysfunction and impaired quality of life due to chronic pain and physical disfigurement. Many of the existing medical therapeutic options for treatment of stuttering priapism are nonmechanistic and associated with significant adverse effects. However, the scientific knowledge of stuttering priapism has transitioned in the past few years, from a condition that is poorly understood to one that has borne a burst of evolving molecular science. In this review, the pathophysiology of priapism is discussed, with particular emphasis on new molecular effectors and mechanisms. Novel treatment methods, as well as potential future agents, based on the emerging molecular evidence are discussed.