Distribution of neurovascular structures within the prostate gland and their relationship to complications after radical prostatectomy.

BACKGROUND: Radical prostatectomy remains the main choice of treatment for prostate cancer. However, despite improvements in surgical techniques and neurovascular sparing procedures, rates of erectile dysfunction, and urinary incontinence remain variable. This is due, at least in part, to an incomplete understanding of neurovascular structures associated with the prostate. The objective of this study was to provide a comprehensive, detailed histological overview of the distribution of nerves and blood vessels within the prostate, facilitating subsequent correlation of prostatic neurovascular structures with patients' clinical outcomes after radical prostatectomy. METHODS: Neurovascular structures within the prostate were investigated in a total of 309 slides obtained from 15 patients who underwent non-nerve-sparing radical prostatectomy. Immunohistochemical staining was performed to identify and distinguish between parasympathetic and sympathetic nerves, whereas hematoxylin and eosin staining was used to identify blood vessels. The total number, density, and relative position of nerves and blood vessels were established using quantitative morphometry and illustrated using visualization approaches. Patient-specific outcome data were then used to establish whether the internal distribution of nerves and blood vessels within the prostate correlated with the nature and extent of complications after surgery. One-way analysis of variance tests and unpaired t tests were applied to establish statistically significant differences across the measured variables. RESULTS: Nerves and blood vessels were present across all prostatic levels and regions. However, their number and density varied considerably between regions. Assessment of the precise positioning of neurovascular structures revealed that the majority of nerve fibers were located within the dorsal and peripheral aspects of the gland. In contrast, blood vessels were predominantly located within ventral and dorsal midline regions. The number of intraprostatic nerves was found to be significantly lower in patients who recovered their continence within 12 months of surgery, compared to those whose recovery took 12 months or longer. CONCLUSION: We report an unexpected disconnect between the localization and positioning of nerve fibers and blood vessels within the prostate. Moreover, individual variability in the density of intraprostatic neurovascular structures appears to correlate with the successful recovery of urinary continence after radical prostatectomy, suggesting that differences in intrinsic neurovascular arrangements of the prostate influence postoperative outcomes.

The Future of Morphological Science Education: Learning and Teaching Anatomy in the Wake of the COVID-19 Pandemic.

The COVID-19 Pandemic has conveyed an unprecedented worldwide challenge. Although there is much emphasis on caring for patients and communities, the high incidence of SARS-CoV-2 had seriously disturbed education and calls for prompt as well as serious consideration from educators in medical schools. The necessity to teach and prepare prospective medics, as well as clinicians, has certainly not been as intense as it is currently. The global effects of coronavirus disease 2019 may cause a permanent change in the education of future clinicians. The COVID-19 era presented logistical and practical obstacles and fears for the patients' well-being, taking into consideration the fact that students may be potential channels for the spread of the virus when asymptomatic and may get infected while being in training and attending lectures. This paper discusses the present state of morphological science education, depicting the effect of COVID-19 on learning environments, as well as highlights the probable effects of COVID-19 on medical instruction in the future.

Anatomical, functional and biomechanical review of the glenoid labrum.

The glenohumeral joint is the most mobile joint in the human skeleton, supported by both active and passive stabilisers. As one of the passive stabilisers, the glenoid labrum has increasingly been recognised to play an important role in stability of the glenohumeral joint, acting to maintain intraarticular pressure, centralise the humeral head and contribute to concavity-compression stability. Several studies have investigated the macro- and micro-anatomical features of the labrum as well as its biomechanical function. However, in order to better understand the role of the labrum and its mechanics, a comprehensive anatomical, functional and biomechanical review of these studies is needed. Therefore, this article reviews the current literature detailing anatomical descriptions of the glenoid labrum, with an emphasis on its function(s) and biomechanics, as well as its interaction with neighbouring structures. The intimate relationship between the labrum and the surrounding structures was found to be important in glenohumeral stability, which owes further investigation into the microanatomy of labrum to better understand this relationship.

The association between coracoacromial ligament morphology and rotator cuff tears: A cadaveric study.

To determine the association between coracoacromial ligament (CAL) morphology and rotator cuff tears. The present study is a prospective cohort study based on the dissection of 172 shoulders from 86 (46 female, 40 male) formalin embalmed European Caucasian cadavers, with a median age of 82 years. The anatomy of CAL was examined, including its morphology and parametric measurements, while the rotator cuff tendons were inspected for the presence of tears. Gross examination of the CAL in 155 shoulders revealed a variable number of bands as follows: 28 (18%) had one band, 56 (36%) two bands and 71 (46%) three or more bands. Inspection of the rotator cuff tendons showed the presence of tears in 77 (50%) shoulders, of which 37 (24%) were partial and 40 (26%) were full-thickness tears. Statistical analysis showed a significant association (P < 0.05) between CAL band number and the prevalence of a rotator cuff tear. A high proportion of rotator cuff tears were observed in shoulders with two (52%) and three or more CAL bands (56%) compared to single band ligaments (29%). Parametric assessment of the CAL in shoulders with rotator cuff tears showed significantly greater (P < 0.05) attachment widths and ratios, thicker ligament bands, and larger cross-sectional areas compared to the control group. Coracoacromial ligaments with more than a single band have a strong association with rotator cuff tears.

Improving surgical training: Establishing a surgical anatomy programme in Scotland.

BACKGROUND: It is well recognized that a sound foundation in surgical anatomy is a cornerstone of safe surgical practice, yet many trainees struggle with the upskilling in anatomy that is required to support their day-to-day practice. In the context of the UK-wide Improving Surgical Training pilot, we set out to establish a surgical anatomy programme for core surgical trainees in the Scotland Deanery. The aim was to enable all trainees to review the surgical anatomy of the whole body to MRCS level at least once during core surgical training. MATERIALS AND METHODS: Teaching was delivered in Edinburgh, with trainees commuting from all parts of the Scotland Deanery. Individual teaching days focused on the surgical anatomy of the head and neck, trunk and limbs, using a combination of lectures (principles and cases) and interactive demonstrations on prosected specimens. Faculty comprised a balance of surgical demonstrators and senior academic staff, including MRCS examiners. RESULTS: In total, 16 individual teaching sessions were attended by over 300 trainees across the first 2 years of the programme. Evaluation form response rate was nearly 80%. The programme was highly rated by trainees in relation to the method of delivery, level of teaching and surgical focus. CONCLUSION: Surgical anatomy remains an integral part of surgical training. Our experience in developing a deanery-wide surgical anatomy programme highlights the crucial links between medical school, training deanery and surgical college. This collaborative approach can be extended to higher surgical training and continuing professional development, and the methods can be adapted to meet the needs of trainees in different parts of the globe.

The glenoid and humeral head in shoulder osteoarthritis: A comprehensive review.

The key management of glenohumeral osteoarthritis is shoulder arthroplasty which aims to reduce pain and restore full shoulder function: it has increased in recent years. A detailed understanding of the anatomy of the glenoid and humeral head, as well as morphological changes of the glenoid in osteoarthritis, are important factors to consider when deciding on replacement components. This review begins with a brief introduction of the glenohumeral joint itself, and then considers the detailed anatomy of the glenoid fossa and humeral head, both of which are reported to have variable morphology. Several studies have been undertaken to assess various parameters, especially of the glenoid fossa including its shape, height, width, and articular surface area, version and inclination, in an attempt to define a standard classification that can be applied to surgical intervention. Nevertheless, no definitive consensus concerning the classification of these morphologies has been forthcoming, hence the need for this review. Following a consideration of these morphologies, the current state of knowledge regarding glenoid deformity in osteoarthritis, as well as its surgical management, is considered.

The prevalence of acromial spurs in relation to study type and specimens examined

Advanced cases of subacromial impingement syndrome usually present with acromial spurs. However, previous studies have reported variations in the prevalence of acromial spurs in shoulders with or without subacromial impingement syndrome as well as with age, sex, and side. Therefore, this study is aimed at investigating the prevalence of acromial spurs in cadaveric shoulders and reviewing the factors leading to the reported variable frequencies. The study examined 220 cadaveric shoulders (110 male and 110 female), with a median age of 82 years (with a range of 53 to 102 years). In 155 shoulders, the rotator cuff tendons were evaluated for tears; acromial spurs were observed in 95 shoulders (43%). No significant association was observed between the prevalence of acromial spurs and sex or side. However, a significant prevalence of spurs (57%) was observed in the oldest-old group, aged ≥ 85 years. Those with acromial spurs also tended to be older (84 years) than those without spurs (81 years). A significant difference in the prevalence of acromial spurs was observed in shoulders with rotator cuff tears compared to those without them: 80% compared to 20%, respectively. Analysis showed a significant number of acromial spurs in shoulders with full-thickness tears (46%) and partial tears (34%). A significant prevalence of acromial spurs was found in shoulders with rotator cuff tears, as well as in aged shoulders. In relevant literature, the prevalence of acromial spurs varies with the type of study undertaken, age, prevalence of rotator cuff tears, and type of radiograph examined

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A left vertebral artery arising from the aortic arch: a cadaveric study

Variations in the major arteries and their branches of the thoracic region have been well described with variations of the aortic arch, pulmonary trunk, common carotid arteries and vertebral arteries being among the most common in the thoracic region. During routine dissection of the thoracic and neck regions, the left vertebral artery in a 58-year-old female cadaver was found to arise from the arch of the aorta between the left common carotid and the left subclavian arteries. The left vertebral artery was traced along its course and was observed to enter the transverse foramen of the fifth cervical vertebral body. With such variation, the findings can influence predisposition to diseases, symptomatology, clinical examination, investigation and patient management, including operative surgery

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What is the impact of diabetes mellitus on radiation induced acute proctitis after radical radiotherapy for adenocarcinoma prostate? A prospective longitudinal study.

BACKGROUND: Long-term complications of diabetes include cardiovascular disease, retinopathy, nephropathy, and neuropathy. Diabetic patients with prostate cancer could be at a high risk of radiation-induced acute proctitis following radical radiotherapy. Our aims were to analyse the incidence, severity, and duration of radiation proctitis in diabetic patients treated by radical radiotherapy and combined androgen deprivation for prostate cancer. MATERIAL AND METHODS: On the bases of inclusion and exclusion criteria 716 patients with prostate cancer were retrospectively recruited. Patients were stratified into diabetic patients and non-diabetic patients. The incidence, severity, and duration of proctitis were the main outcomes. A polynomial ordered logistic regression was fitted to determine the influence of diabetes status, age, blood pressures medication, co-morbidities, Gleason score, PSA after treatment, and tumour stage on the grades of proctitis. Time to resolution per year was modelled as a negative binomial generalised linear model. RESULTS: The overall mean age of patients was 67.44 (SD 6.77) years with a follow-up time of 3.36 (SD 2.05) years. Data exploratory analysis suggested that the only highly significant explanatory variable was the presence or absence of diabetes. Polynomial ordered logistic regression, however, showed that the presence (or not) of diabetes remained as the only significant predictor (t = -2.74; p = 0.0059) of severity of proctitis. A negative binomial generalised linear model showed that both grade of proctitis (z = -17.178; p < 0.001), and diabetes (z = -5.92; p < 0.001), were highly significant predictors of time to resolution. CONCLUSIONS: Diabetic patients were significantly more likely to have proctitis after radical radiation therapy for prostate cancer. Diabetes was significantly associated with an induced risk of radiation induced proctitis and also with deceleration of its resolution.

Morphometric parameters of the glenoid labrum

The glenoid labrum has an important role in glenohumeral joint stability, yet its morphometric parameters are seldom reported. This study aimed to (I) investigate the thickness and height of the glenoid labrum, and (ii) determine whether there is any significant difference between side and sex. A total of 140 shoulders (30 male and 40 female cadavers, average age of 81.5 years) were obtained for this study. All muscles and blood vessels surrounding the glenohumeral joint, as well as the fibrous capsule, were inspected and then removed to expose the glenoid fossa with the labrum attached. Measurement of labral height and thickness at the superior (12 o'clock), anterior (3 o'clock), inferior (6 o'clock) and posterior (9 o'clock) regions were taken. Gender, side and thickness and height measurements of the glenoid labrum were double- entered into the Statistical Package for Social Sciences. ANOVA and MANOVA tests were conducted to determine statistical significance, which was set at P<0.05. Significant differences in thickness (at the superior, inferior and posterior aspects) and height (at the superior and inferior aspects) of the glenoid labrum were observed between males and females, being thicker and taller in males in all regions. Based on the side of the limb, no differences in labral thickness and height were observed with respect to side. The current observations confirm that the glenoid labrum height and thickness are associated with sex, but not with side

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Is the existence of sublabral foramen age-related?

Although a sublabral foramen does not require treatment, its association with age, sex or side remains unknown. Therefore, the aim of the current study was to investigate the incidence of a sublabral foramen and age, sex and side in a British population. A total of 140 shoulders (30 male and 40 female cadavers, with an average age of 81.5 years), were obtained from the Centre for Anatomy and Human Identification University of Dundee, in accordance with the Human Tissue (Scotland) Act 2006. All muscles and blood vessels surrounding the glenohumeral joint, as well as the fibrous capsule, were inspected and then removed to expose the glenoid fossa with the glenoid labrum attached. The gender, age, side and presence of a sublabral foramen were double-entered into the Statistical Package for Social Sciences (Version 21; IBM, Armonk, NY, USA). Chi Square tests were conducted to determine statistical significance, which was set at P<0.05. A sublabral foramen was observed in 28.6% (n=40) of shoulders, being marginally more in females than males. A sublabral foramen was more common in elderly individuals (>70 years old), no significant difference being observed between the presence of a sublabral foramen and age. It was also more common on the right than the left side in both genders with no significant difference between the presence of a sublabral foramen and sex or side. The current observations confirm that a sublabral foramen was more common in older individuals, but was not significantly different from other age groups

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Examining changes in acromial morphology in relation to spurs at the anterior edge of acromion.

BACKGROUND: Although acromial morphology is classified as flat, curved, and hooked, whether the morphology is primary or acquired is debated. There have been no investigations on the effect of acromial spurs on acromial morphology. This study therefore aimed to evaluate acromial morphology in relation to spur formation at the anterior edge of the acromion. MATERIALS AND METHODS: Acromial morphology was investigated in 40 scapulae taken from 20 cadavers (10 male and 10 female), with a median age of 82 years (range 62-97 years). Ink prints of the anteroposterior aspect of the acromion were used to evaluate acromial slope angle and curvature height in relation to spur incidence, length, and shape at the anterior edge of the acromion. RESULTS: Differences were observed in acromial morphology and acromial curvature in relation to acromial spurs (incidence, size, and shape). A hooked acromion was observed as a primary structure in 25% of specimens, which increased to 43% when acromial spurs were involved. No differences were observed in relation to sex or side, while a significant correlation was observed between acromial curvature and the age of the specimens. CONCLUSION: Acromial spurs increase acromial curvature and therefore change acromion morphology. Nevertheless, it is concluded that a hooked acromion occurs as a primary formed structure. LEVEL OF EVIDENCE: Basic science study, anatomy, cadaver dissection.

Diagnostic accuracy of image-guided biopsies in small (<4 cm) renal masses with implications for active surveillance: a systematic review of the evidence.

OBJECTIVE:: To determine the safety and diagnostic accuracy of renal tumour biopsies in a defined population of small renal masses (SRMs) only <4 cm using 3 × 2 table, intention to diagnose approach. 3 × 2 table approach examines indeterminate results as a separate category rather than pushing these through traditional 2 × 2 table (four-cell matrix) approach. METHODS:: A highly sensitive search was performed in the Cochrane Library, Database of Abstracts of Reviews of Effects; MEDLINE and MEDLINE in Process, EMBASE and conference proceedings (1966-2016) for the acquisition of data on the diagnostic accuracy and complications of RTB in patients with SRM <4 cm. Methodological quality and risk of bias was assessed using QUADAS-2. Test characteristics were calculated using conventional 2 × 2 contingency table analysis excluding non-diagnostic biopsies, and an intention-to-diagnose approach with a 3 × 2 table for pooled estimates of the sensitivity and specificity. RESULTS:: A total of 20 studies were included with a total sample size of 974. The pooled estimates for sensitivity and specificity of RTB based upon univariate analysis using 2 × 2 table observed sensitivity 0.952 [confidence interval (CI) 0.908-0.979] and specificity 0.824 (CI 0.566-0.962). Using the 3 × 2 table and intention-to-diagnose principle, sensitivity 0.947 (CI 0.925-0.965) and specificity 0.609 (CI 0.385-0.803) decreased. CONCLUSION:: RTB in SRMs (<4 cm) is associated with a high diagnostic sensitivity but poor specificity when non-diagnostic results are included by a 3 × 2 table for analysis (intention to diagnose approach). Risk of non-diagnostic results and poor quality of research need addressing through future studies, preferably by a well-designed prospective study appropriately powered for diagnostic accuracy using valid reference standards. ADVANCES IN KNOWLEDGE:: A comprehensive synthesis of literature on image-guided biopsies in SRMs using a different methodology and study design.

Origin of the long head of biceps brachii from the supraglenoid tubercle and glenoid labrum

The long head of the biceps tendon (LHBT) provides stability to the glenohumeral joint. Although it has been observed to arise from the supraglenoid tubercle and glenoid labrum, its mode of attachment to the glenoid labrum is variable. This study therefore aimed to (I) identify the origin of the LHBT, and (II) investigate if there are differences in attachment related to age, gender and side. A total of 140 shoulders from 30 male and 40 female cadavers were examined: the glenoid fossa with the glenoid labrum and LHBT attached were exposed. The classification of Vangsness et al. (1994) was adopted to determine the mode of attachment of the LHBT. Gender, age, side and type of attachment were double-entered into the Statistical Package for Social Sciences. Chi square tests were conducted to determine statistical significance, which was set at P<0.05. Type I was the most common attachment (47.7%) of the LHBT, then Type II (31.5%), Type III (16.2%) and Type IV (4.6%). No significant difference was observed between the type of attachment of the LHBT and sex, side or age. The LHBT consistently arose from the glenoid labrum and supraglenoid tubercle in all the specimens, with the majority of tendons having a posterior orientation. Involvement of the glenoid labrum can be associated with injury to the LHBT: this may explain the existence of a combined injury in shoulder joint instability. Further study is needed to investigate the association between variations of the LHBT attachment to the glenoid labrum and shoulder joint stability

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Histology, vascularity and innervation of the glenoid labrum.

BACKGROUND: Although the glenoid labrum has an important role in shoulder stability, little is known about its composition, vascularity and innervation. The aims of this study were therefore to evaluate the histology, vascularity and innervation of the glenoid labrum. MATERIALS AND METHODS: Ten glenoid labrum specimens (three male, two female: mean age 81.2 years, range 76-90 years) were detached at the glenoid neck. Following decalcification, sections were cut through the whole thickness of each specimen perpendicular to the glenoid labrum at 12 radii corresponding to a clock face superimposed on the glenoid fossa. Then they were stained using haematoxylin and eosin, a silver nitrate protocol or subjected to immunohistochemistry using anti-protein gene protein 9.5 to demonstrate neuronal processes. RESULTS: The labrum was fibrocartilaginous, being more fibrous in its free margin. There was a variable distribution of blood vessels, being more vascular in its periphery, with many originating from the fibrous capsule and piercing the glenoid labrum. Immunohistochemistry revealed positive staining of nerve fibres within the glenoid labrum. CONCLUSION: The glenoid labrum is fibrocartilaginous, being more fibrous in its periphery, and is vascularized, with the anterosuperior aspect having a rich blood supply. Free sensory nerve fibres were also present; no encapsulated mechanoreceptors were observed. The presence of sensory nerve fibres in the glenoid labrum could explain why tears induce pain. It is postulated that these sensory fibres could play a role in glenohumeral joint proprioception.

Blood supply and vascularity of the glenoid labrum: Its clinical implications.

BACKGROUND: Tears of the glenoid labrum are common after dislocation of the glenohumeral joint. The outcome for healing or surgical reconstruction of the glenoid labrum relies on the extent of its vascularization. This study aims to evaluate the glenoid labrum blood supply and to determine its regional vascularity. MATERIALS AND METHODS: A total of 140 shoulders (30 male and 40 female cadavers) were examined: mean age 81.5 years, range 53-101 years. All blood vessels around the glenohumeral joint were dissected and recorded. Ten specimens with the glenoid labrum and fibrous capsule attached were randomly selected and detached at the glenoid neck and subjected to decalcification. Sections (10-20 µm) were cut through the whole thickness of each specimen from the centre of the glenoid fossa perpendicular to the glenoid labrum at 12 radii corresponding to a clock face superimposed on the glenoid. Sections were stained using haematoxylin and eosin and then examined. RESULTS: The blood supply to the glenoid labrum is by direct branches from the second part of the axillary artery, subscapular, circumflex scapular and anterior circumflex humeral and posterior circumflex humeral arteries, as well as branches of muscular arteries supplying the surrounding muscles. CONCLUSION: This study shows that the glenoid labrum has a rich blood supply suggesting that, regardless of the types of the glenoid labrum lesions or their management, an excellent outcome for glenoid labrum healing and joint stability is possible. The observations also suggest that the blood supply to the glenoid labrum is sufficient, enabling its reattachment.

Variability in attachment of the coracoacromial ligament in relation with its morphology.

PURPOSE: The coracoacromial ligament (CAL) presents with variable morphology and plays a significant role in the development of subacromial impingement syndrome. Sectioning the CAL has been suggested to relieve impingement of the rotator cuff. The aim of the current study was to investigate the CAL attachment in relation with ligament morphology. MATERIALS AND METHODS: The CAL was investigated in 220 cadaveric shoulders from 58 males and 59 females, with a median age of 82 years (range 53-102 years). CALs were classified according to three factors: (1) number of bands present; (2) shape; and (3) attachment to the acromial and coracoid processes. RESULTS: 35 (16%) CALs had a single band, 84 (38%) two bands, and 101 (46%) three or more bands. CAL shape was either broadband (14: 6%), quadrangular (21: 10%), Y-shaped (84: 38%), or multiple-banded (101: 46%). More ligaments were attached to the medial aspect of the acromion (60%) and medial end of the coracoid (75%) than those restricted to the anterior edge of the acromion (40%) and posterior aspect of the coracoid (25%). Multiple-banded ligaments attached significantly more medially at the acromion and coracoid processes, while single band ligament attachments were restricted to the anterior edge of the acromion and posterior aspect of the coracoid process. CONCLUSION: The CAL has variable morphology and attachments with interconnections to different structures around the shoulder. CALs with a medial acromial attachment may narrow the subacromial space leading to further shoulder impingement.

Bare spot and tubercle of Assaki.

BACKGROUND: The definition of the bare spot and tubercle of Assaki is controversial, with studies reporting different incidences, locations, and clinical significance. The aims of this study were to evaluate the incidence of the bare spot, to determine the length and width of the bare spot, and to assess the relationship between the bare spot and tubercle of Assaki. MATERIALS AND METHODS: A total of 140 shoulders from 30 men and 40 women were dissected and examined. After exposure of the glenoid fossa with the glenoid labrum attached, direct measurement of the length and width of the bare spot was undertaken using digital calipers. The repeatability and reliability of the measurements was assessed using Kruskal-Wallis one way analysis of variance on ranks, with statistical significance set at P < .05. RESULTS: A bare spot was observed in 80.7% (n = 113) of shoulders, being more common in men than in women, with an overall mean length and width of 7.2 mm and 6.2 mm. It was significantly longer (P = .002) and wider (P = .018) in men. CONCLUSION: A bare spot exists within the glenoid fossa and differs from the tubercle of Assaki. It is a characteristic round to oval lesion in the central or eccentric cartilage. It should not be misdiagnosed as a pathologic lesion.

The Incidence and Risk of Biochemical Recurrence Following Radical Radiotherapy for Prostate Cancer in Men on Angiotensin-Converting Enzyme Inhibitors (ACEIs) or Angiotensin Receptor Blockers (ARBs).

BACKGROUND: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are linked to prostate cancer, but their effect on biochemical recurrence (BR) remains unknown. Our aims were to investigate the incidence and risk of BR in men on ACEIs/ARBs after radical radiotherapy with adjuvant∖neoadjuvant hormone treatment. MATERIAL AND METHODS: A propensity score analysis of 558 men was conducted. Men were stratified into 3 groups: hypertensive men on ACEIs/ARBs (as a study group), non-hypertensive men not on ACEIs/ARBs, and hypertensive men not on ACEIs/ARBs (both as a control group). The multivariate analysis of variance, chi-square, Kruskal-Wallis, analysis of variance, risk ratio, confidence interval, Kaplan-Meier plots, and log-rank tests were used. RESULTS: The mean age and follow-up were 68.51 and 3.33 years, respectively. There was a statistically significant difference in the prevalence of BR among the treatment groups (P < .001). The incidence of BR was significantly lower in hypertensive men taking ACEIs/ARBs than in non-hypertensive men not taking ACEIs/ARBs (P < .001) or in hypertensive men not taking ACEIs/ARBs (P < .009). The incidence of BR was significantly lower in hypertensive men not taking ACEIs/ARBs than in non-hypertensive men not taking ACEIs/ARBs (P < .013). The risk ratio (RR) of BR in the group of hypertensive men taking ACEIs/ARBs was significantly lower than in the group of non-hypertensive men not taking ACEIs/ARBs (RR, 0.74; 95% CI, 0.64-0.86; P < .001) and in the group of hypertensive men not taking ACEIs/ARBs (RR, 0.78; 95% CI, 0.67-0.91; P < .001). The time-to-event analysis revealed that the group of hypertensive men taking ACEIs/ARBs was significantly different compared with the control groups (P < .031). CONCLUSION: Men who were taking ACEIs/ARBs had significantly lower incidence of BR after radical radiotherapy with hormone treatment. The intake of ACEIs/ARBs was associated with reduced risk of BR.

Early oncological and functional outcomes following radical treatment of high-risk prostate cancer in men older than 70 years: A prospective longitudinal study.

BACKGROUND: Assess early oncological and functional outcomes following radical treatment of men with high-risk prostate cancer and aged more than 70 years. PATIENTS AND METHODS: A total of 335 men with high-risk prostate cancer (prostate-specific antigen ≥20ng/ml or biopsy Gleason score 8 to 10 or≥cT2c) received radical treatment between 2007 and 2014. Men were identified from comprehensive clinical databases hosted at a tertiary cancer center in the UK. The data included basic demographics, and follow-up on functional and oncological outcomes using validated patient-reported outcome questionnaires. Univariate and multivariate analyses were used. RESULTS: In all, 117 patients received radical radiotherapy (RT) alone, 167 patients received neoadjuvant hormone therapy and RT, and 54 patients underwent radical prostatectomy with extended lymph node dissection. Mean age was 72.8, standard deviation (SD) = 2.1, mean follow-up of 40.9 months, SD = 25.5 months. Patients who underwent laparoscopic prostatectomy = 24 (44.4%) had positive surgical margins, and mean lymph nodes dissected were 18.7, SD = 6.7. Further, 5 men experienced postoperative complications in the form of pseudoaneurism of internal iliac branch, leg ischemia, high CO2 retention, and 2 men experienced sepsis. Incidence of biochemical recurrence was significantly lower at 16.7% in the surgery group, compared with RT 51.3% and RT and hormone therapy 30.5%, and Kaplan-Meier analysis P<0.001 over 3 years of follow-up CONCLUSION: Radical surgery with extended lymph nodes dissection appears to have good short-term oncological and functional outcomes compared with RT with or without hormones in high-risk men older than 70 years of age. Based on these findings, treatment decisions and surgical therapy should be considered on individual basis in older men with high-risk disease.