Increased prevalence of impulse control disorder symptoms in endocrine diseases treated with dopamine agonists: a cross-sectional study.

INTRODUCTION: Impulse control disorders (ICDs) have been described as a side effect of dopamine agonists (DAs) in neurological as well as endocrine conditions. Few studies have evaluated the neuropsychological effect of DAs in hyperprolactinemic patients, and these have reported a relationship between DAs and ICDs. Our objective was to screen for ICD symptoms in individuals with DA-treated endocrine conditions. MATERIALS AND METHODS: A cross-sectional analysis was conducted on 132 patients with pituitary disorders treated with DAs (DA exposed), as well as 58 patients with pituitary disorders and no history of DA exposure (non-DA exposed). Participants responded to the full version of the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's disease (QUIP). RESULTS: Compared with the non-DA-exposed group, a higher prevalence of DA-exposed patients tested positive for symptoms of any ICD or related behavior (52% vs. 31%, p < 0.01), any ICD (46% vs. 24%, p < 0.01), any related behavior (31% vs. 17%, p < 0.05), compulsive sexual behavior (27% vs. 14%, p < 0.04), and punding (20% vs. 7%, p < 0.02) by QUIP. On univariate analysis, DA treatment was associated with a two- to threefold increased risk of any ICD or related behavior [odds ratio (OR) 2.43] and any ICD (OR 2.70). In a multivariate analysis, independent risk factors for any ICD or related behavior were DA use (adjusted OR 2.22) and age (adjusted OR 6.76). Male gender was predictive of the risk of hypersexuality (adjusted OR 3.82). DISCUSSION: Despite the QUIP limitations, a clear sign of increased risk of ICDs emerges in individuals with DA-treated pituitary disorders. Our data contribute to the growing evidence of DA-induced ICDs in endocrine conditions.

Results of radical cystectomy for primary bladder cancer. Retrospective study of more than 200 cases.

During a seven-year period 202 patients with primary bladder cancer had radical cystectomy with bilateral pelvic lymphadenectomy and urinary diversion. Lymph node metastases were found in 28.7 per cent. No significant differences in overall survival owing to age were apparent. Only extension and grade of histopathologic differentiation of the tumor proved to be an important prognostic factor. The five-year survival rates for pT1, pT2, pT3, and pT4 tumors were 76, 56, 19, and 0 per cent, respectively. In patients with deep invasive (T3 and T4) tumors no significant differences of survival rate depending on N and M categories were found. Nevertheless in pT3 tumors the probability of remaining alive was significantly decreased in those patients with histologic grade 3 compared with grade 2 tumors (P less than 0.01). The prognosis for patients submitted to radical cystectomy for bladder cancer has been classified as good: tumors confined to superficial muscle (pT1 and pT2); intermediate: tumors mildly differentiated infiltrating the deep muscle (pT3/G2); fairly poor: tumors undifferentiated infiltrating deep muscle (pT3/G3); and poor: adjacent invasive bladder tumors (pT4).

Treatment of advanced prostatic carcinoma with cyproterone acetate and orchiectomy--5-year follow-up.

We report the results from 106 patients with extracapsular (stage C) or widespread (stage D) prostatic cancer, who were treated with cyproterone acetate and orchiectomy and followed for 5 years. As controls we used 40 patients, chosen at random, with stage C and stage D cancer of the prostate gland who were treated with stilbestrol and orchiectomy. The survival rate is improved in patients treated with cyproterone acetate and orchiectomy compared to the patients treated with stilbestrol and orchiectomy. Treatment with cyproterone seems more effective in those patients with low-stage and low-grade prostatic cancer. The side effects of this therapy are less and milder than those described in estrogenic treatment alone or with orchiectomy.

The effect of cyproterone acetate and orchiectomy on metastases from prostatic cancer.

We have studied 38 patients with previously untreated, widespread prostatic cancer, who were submitted to therapy with cyproterone acetate and orchiectomy. 70% of patients with symptoms have shown subjective improvement. Moreover, it was possible to observe the regression, stabilization or progression of metastases in 32, 50 and 18% of the cases, respectively. We conclude that such therapy is effective in the initial treatment of metastatic prostate cancer and can be continued under radiographic control until the appearance of new metastases. At this point radiotherapy and alkylating agents may be effective.