Oral ethinylestradiol in castration-resistant prostate cancer: a 10-year experience.

OBJECTIVES: To describe our 10-year experience with the use of oral ethinylestradiol in the treatment of metastatic castration-resistant prostate cancer. METHODS: From February 2000 to April 2010, 116 patients with a metastatic castration-resistant prostate cancer were prospectively submitted to oral ethinylestradiol monotherapy. Inclusion criteria were: diagnosis of castration-resistant prostate cancer after failure of at least two lines of androgen deprivation therapy and radiological evidence of metastases. Exclusion criteria were: symptomatic cases with a European Cooperative Oncology Group score >2 and severe or uncontrolled cardiovascular diseases. At inclusion in the study, all patients discontinued the previous androgen deprivation therapy and started oral ethinylestradiol at the daily dose of 1 mg. Aspirin (100 mg/daily) was concomitantly given. RESULTS: The median ethinylestradiol therapy duration was 15.9 months (range 8-36 months), whereas the median follow up of patients was 28 months (range 13-36 months). During ethinylestradiol therapy, a confirmed prostate-specific antigen response was found in 79 patients (70.5%). The median time to prostate-specific antigen progression was 15.10 months (95% confidence interval 13.24-18.76 months). A toxicity requiring treatment cessation was observed in 26 patients (23.2%) at a median time of 16 months (mainly thromboembolism). CONCLUSIONS: Our 10-year experience shows that ethinylestradiol provides a prostate-specific antigen response in a high percentage of patients with metastatic castration-resistant prostate cancer. Cardiovascular toxicity can be managed through accurate patient selection, close follow up and a concomitant anticoagulation therapy.

Use of multiparametric MR with neurovascular bundle evaluation to optimize the oncological and functional management of patients considered for nerve-sparing radical prostatectomy.

INTRODUCTION: To obtain the best results with radical prostatectomy, either from an oncological or a functional point of view, a correct selection of cases and planning of surgery are crucial. Multiparametric magnetic resonance imaging (MRI) promises to make it a successful imaging tool for improving many aspects of prostate cancer management. AIM: The aim of this study is to evaluate whether a modern multiparametric MRI can help either to better select prostate cancer cases for a nerve-sparing radical prostatectomy or to improve the functional evaluation related to neurovascular bundles preservation. MAIN OUTCOME MEASURES: The effect of preoperative MRI on neurovascular bundle management was examined for the frequency and the appropriateness of changes of the surgical plane on the basis of MRI indications. METHODS: In a prospective study, 125 consecutive patients with biopsy proven prostate cancer who were scheduled to undergo bilateral nerve-sparing surgery. All patients included into the study were submitted to a preoperative multiparametric MRI. On the basis of MRI evaluation, patients were divided into two groups. Patients in group A were then submitted to a bilateral nerve-sparing (NS) radical prostatectomy (RP), whereas patients in group B were submitted to unilateral NS or non-NS RP. RESULTS: In group A, the confirmation from the MRI study to perform a bilateral NS procedure was appropriate in 70 of 73 cases (95.9%), whereas in group B, the surgical plan was appropriate in 28 of 32 cases (87.5%). On the contrary, MRI findings suggested a change in the initial surgical plan (group B) for 32 of 105 cases (30.5%). Of these 32 cases in group B, MRI suggested to perform a unilateral NS procedure in 21 of 32 cases (65.6%) and a non-NS procedure in 11 of 32 cases (34.4%). CONCLUSIONS: Multiparametric MRI analysis can significantly improve the standard selection and management of prostate carcinoma cases considered for an NS RP.

Magnetic resonance spectroscopic imaging (1H-MRSI) and dynamic contrast-enhanced magnetic resonance (DCE-MRI): pattern changes from inflammation to prostate cancer.

PURPOSE: To assess (1)H-magnetic resonance spectroscopic imaging ((1)H-MRSI) and dynamic contrast-enhanced magnetic resonance (DCE-MRI) features in histologically confirmed prostatic chronic inflammation, prostatic intraepithelial neoplasia (PIN), low grade prostate cancer (LGPCa), and high grade prostate cancer (HGPCa). MATERIALS AND METHODS: Ninety-six men were selected, who showed at histology a diagnosis of chronic inflammation (Group B), high grade (HG) PIN (Group C), or prostate cancer (LGPCa = Group D and HGPCa = Group E). RESULTS: ANOVA analysis shows that inflammation (Group B) displays no significantly (p >.05) different choline and citrate levels when compared to HGPIN and LGPCa. CONCLUSION: our results suggest the potential for these MR imaging techniques in the description of inflammatory and proliferative lesions inside the prostate gland.

Early recovery of urinary continence after radical prostatectomy using early pelvic floor electrical stimulation and biofeedback associated treatment.

PURPOSE: We analyzed the benefit of the early combined use of functional pelvic floor electrical stimulation and biofeedback in terms of time to recovery and rate of continence after radical prostatectomy. MATERIALS AND METHODS: A total of 60 consecutive patients who underwent radical prostatectomy were included in the study. Patients were prospectively randomized to a treatment group (group 1) vs a control group (group 2). In group 1 a program of pelvic floor electrical stimulation plus biofeedback began 7 days after catheter removal, twice a week for 6 weeks. Each of the 12 treatment sessions was composed of biofeedback (15 minutes) followed by pelvic floor electrical stimulation (20 minutes). The evaluation of continence was performed at time 0, at 2 and 4 weeks, and at 2, 3, 4, 5 and 6 months during followup. Evaluations were performed using the 24-hour pad test and the incontinence section of the International Continence Society questionnaire. RESULTS: The mean leakage weight became significantly lower (p <0.05) in group 1 than in group 2 starting at 4 weeks until 6 months of followup. A significant difference (p <0.05) between groups 1 and 2 in terms of percentage of continent patients was achieved from 4 weeks (63.3% group 1 and 30.0% group 2) to 6 months (96.7% group 1 and 66.7% group 2). CONCLUSIONS: Early, noninvasive physical treatment with biofeedback and pelvic floor electrical stimulation has a significant positive impact on the early recovery of urinary continence after radical prostatectomy.

Use of 3D T2-weighted MR sequences for the assessment of neurovascular bundle changes after nerve-sparing radical retropubic prostatectomy (RRP): a potential diagnostic tool for optimal management of erectile dysfunction after RRP.

INTRODUCTION: Erectile dysfunction (ED) is one of the complications after radical retropubic prostatectomy (RRP), and recovery of erectile function is quantitatively related to the preservation of the neurovascular bundles (NVBs). AIM: The aim of our study was to assess, in patients submitted to a nerve-sparing RRP, the capability of a dedicated 3D isotropic magnetic resonance imaging (MRI) T2-weighted sequence in the depiction of postsurgical changes of NVB formation. METHODS: Fifty-three consecutive patients underwent a bilateral nerve-sparing RRP. Two postoperative magnetic resonance (MR) examinations and International Index of Erectile Function Five-Item (IIEF-5) questionnaire were carried out at 6 and 12 months. Morphological imaging of the postprostatectomy fossa was performed by first acquiring turbo spin echo T2-weighted sequences in the axial and coronal planes and then with 3D T2-weighted isotropic sequence on axial plane. Image findings were scored using a relative 5-point classification (0 = normal; I = mild; II = mild to moderate; III = moderate; IV = severe alterations) and correlated with postoperative IIEF-5 score questionnaire. MAIN OUTCOME MEASURES: The degree of association between the alteration score values obtained by postoperative MR morphologic evaluation for MR sequence and IIEF-5 score. RESULTS: Image interpretation was performed by two radiologists, that scoring MR alterations by the use of axial and multiplanar reconstruction 3D T2 isotropic sequence. The radiologists placed 43.30% of patients in class 0 (23/53 normal or quite normal), 32.00% in class I (17/53 mild), 11.40% in class II (6/53 mild to moderate), 7.50% in class III (4/53 moderate), and 5.70% in class IV (3/53 severe). In all cases, the correlation and regression analyses between the 3D T2 isotropic sequence and IIEF-5 score, resulted in higher coefficient values (rho = 0.45; P = 0.0010). CONCLUSION: The MRI protocol and NVB change classification score proposed in this study would represent an additional tool in the postoperative phase of those patients with ED.

Distribution of high chromogranin A serum levels in patients with nonmetastatic and metastatic prostate adenocarcinoma.

OBJECTIVES: We analyzed the incidence of elevated serum levels of chromogranin A (CgA) (as marker of neuroendocrine activity) in nonmetastatic and metastatic prostate cancer populations. MATERIAL AND METHODS: 264 consecutive men with nonmetastatic prostate adenocarcinoma considered for radical prostatectomy (group 1) and 89 consecutive men with metastatic prostate adenocarcinoma (group 2) represented our population. In all 353 cases a blood sample for the determination of serum total PSA and CgA levels was obtained (RIA). Two different cut-off for elevated serum CgA levels were used: >60 and >90 ng/ml. RESULTS: In group 1, 35.0% of cases presented CgA levels >60 ng/ml and 6.4% >90 ng/ml. In group 2, 100% of cases presented CgA levels >60 ng/ml and 69.7% >90 ng/ml. The OR for CgA level >60 and >90 ng/ml significantly increased from nonmetastatic to metastatic cases (p = 0.0001). In group 1 the percentage of cases with CgA >60 ng/ml was 29.6% in Gleason score or=7 (4 + 3) (p = 0.0001). In group 2, the percentage of cases with CgA >90 ng/ml was 51.8% in Gleason score or=7 (4 + 3) (p = 0.0028). CONCLUSIONS: We describe a significant incidence of elevated serum levels of CgA either in nonmetastatic (using 60 ng/ml as cut-off) or in metastatic (using 90 ng/ml as cut-off) prostate adenocarcinoma cases.

Predictors for response to intermittent androgen deprivation (IAD) in prostate cancer cases with biochemical progression after surgery.

OBJECTIVE: To define characteristics of the first cycle of intermittent androgen deprivation (IAD) that would predict for outcomes in a long term follow-up. MATERIAL AND METHODS: In 1996 we started a prospective study of IAD for the treatment of biochemical progression (BP) after radical prostatectomy (RP) for prostate cancer (PC). The end-points of the trial were time to clinical progression (CP) and time to castration resistance PC (CRPC). Eighty-four cases were included in the study. In all cases, after an initial induction period, an acceptable nadir to switch from on-to-off-phase of IAD was considered to be a serum PSA < 1.0 ng/ml. MEASUREMENTS: As possible predictors for time to CP and CRPC, we analyzed pretreatment parameters such as age, Gleason Score, serum PSA, testosterone, chromogranina A (CgA) levels, and characteristics from the first cycle of IAD. RESULTS: Mean follow-up during IAD was 88.6 ± 16.7 months; 29.7% of patients developed CRPC and 14.2% of cases showed a CP with a mean time of 88.4 ± 14.3 months and 106.5 ± 20.6 months, respectively. At univariate and multivariate analysis, the PSA nadir during the first on-phase period and the first off-phase interval resulted in significant and independent predictors (P < 0.001) of the time to CRPC and CP. In particular for cases with a PSA nadir > 0.4 ng/ml and for those with an off-phase interval ≤ 24 weeks, the risk of CRPC and CP during IAD was 2.7-2.5 and 3.0-3.1 times that for patients with a PSA nadir ≤ 0.1 ng/ml and with an off-phase interval > 48 weeks, respectively. CONCLUSIONS: Cases with BP after RP selected to IAD that show at the first cycle a PSA nadir ≤ 0.1 ng/ml and a off-phase interval ≥ 48 weeks may identify candidates who will experience better response to IAD treatments and delayed CP or CRPC development.

Supernumerary kidney laparoscopically treated.

Congenital anomalies of the kidney and urinary tract are part of a family of diseases with different anatomical origins. Duplicated collecting systems can be defined as a renal unit containing 2 pyelocalyceal systems associated with a single ureter or with double ureters. The supernumerary kidney is a definitive accessory organ with its own collecting system, blood supply, and distinct encapsulated parenchima. The true incidence of supernumerary kidney remains unknown, but most cases are in males, are unilateral and on the left side. We present a case of an adult woman with a hypoplastic supernumerary kidney with a complete ureteral duplication and an ectopic junction. The case has been laparoscopically treated. We demonstrate that a laparoscopic nephro-ureterectomy is feasible and that the management of the complication (urinoma and fistula) can be managed conservatively.

The emerging role of targeted therapy in renal cell carcinoma (RCC): is it time for a neoadjuvant or an adjuvant approach?

PURPOSE: We address whether rational and significant clinical data exist on using angiogenic targeted therapies as neoadjuvant or adjuvant options to nephrectomy in non-metastatic RCC. METHODS: We reviewed the recent international literature by carrying out a PUBMED search. RESULTS: Neoadjuvant: a possible indication for a neoadjuvant targeted therapy approach is to facilitate surgery, reducing risks for patients and increasing the possibility of removing the mass and improving oncological results. Adjuvant: three major phase III clinical trials are currently ongoing. The ASSURE trial (1 year on oral sunitinib, sorafenib or placebo), the SORCE trial (3 years on placebo versus 1 year on sorafenib, followed by 2 years on placebo versus 3 years on sorafenib), and the S-TRAC trial (1 year on sunitinib or placebo) analyze patients who are at high risk of relapse. CONCLUSIONS: Rationale and needs for the neoadjuvant or adjuvant use of targeted therapies in RCC are relevant. Significant phase III trials on the adjuvant use of targeted therapy in RCC are ongoing.

Determination of the time for maximal response to neoadjuvant hormone therapy for prostate cancer using magnetic resonance with spectroscopy (MRSI) and dynamic contrast enhancement (DCEMR).

PURPOSE: To determine the time-dependent metabolic and angiogenic changes that occur in prostate cancer (CaP) during neoadjuvant hormone therapy (HT), using a combination of MRSI and DCEMR analysis. MATERIALS AND METHODS: This is a prospective study on a population of non-metastatic CaP submitted to neoadjuvant HT prior to radiation therapy. All cases homogeneously received a 6-month period of neoadjuvant HT using leuprorelin acetate 7.5 mg every 28 days. In all cases, a MRSI/DCEMR study was performed at baseline (pretreatment) and at regular intervals (4, 12, 24 weeks) during HT. Serum PSA was measured at baseline and at the same intervals (4, 12, 24 weeks). All MRI examinations were performed on a commercially available 3 T scanner. RESULTS: There was a significant ( P < 0.01) time-dependent loss of all prostate metabolites during HT. In regions of CaP no significant variation in the absolute value of metabolites was reported at 1-month interval and a higher variation was observed at 24-week compared with 12-week interval. A complete metabolic atrophy was a common feature (30%) at a 24-week interval of HT, but not at short (4-week 0%), and lower at an intermediate interval (12-week 10%). At DCEMR, onset time and time to peak parameters significantly (P < 0.05) increased at 12- and 24-week intervals. CONCLUSIONS: To individualize neoadjuvant HT courses prior to definitive treatment, the combination of MRSI and DCEMR may represent a valid noninvasive method, and the addition to PSA data could be used to better assess the time-dependent efficacy of HT in our patients.

[Prostate cancer unit for an optimal management of prostate cancer unit]. / "Prostate cancer unit" per un management ottimale dei pazienti con tumore prostatico.

Prostate cancer (PC) is established as one of the most important medical problems affecting the male population. PC is the most common solid neoplasm (214 cases per 1000 men) and the second most common cause of cancer death in men. Its management involves several complex issues for both clinicians and patients. An early diagnosis is necessary to implement well-balanced therapeutic options, and the correct evaluation can reduce the risk of overtreatment with its consequential adverse effects. Breast and Prostate cancers, respectively, are the most common cancers in women and in men, and different similarities have been underlined. The paradigm of the patient consulting a multidisciplinary medical team has been an established standard approach in treating breast cancer. Such multidisciplinary approach can offer the same optional care for men with PC as it does for women with breast cancer. A multidisciplinary team (MDT) comprises healthcare professionals from different disciplines whose goal of providing optimal patient care is achieved through coordination and communication with one another. A Prostate Cancer Unit is a place where men can be cared for by specialists in PC, working together within a multi-professional team. The MTD approach guarantees a higher probability for the PC patient to receive adequate information on the disease and on all possible therapeutic strategies, balancing advantages and related side effects. The future of PC patients relies on a successful multidisciplinary collaboration between experienced physicians, which can lead to important advantages in all the phases and aspects of PC management.

Comparative analysis of multiparametric magnetic resonance and PET-CT in the management of local recurrence after radical prostatectomy for prostate cancer.

PURPOSE: Our aim was to assess whether multiparametric magnetic resonance and PET-CT can have a role in detecting local recurrence in patients with biochemical recurrence after radical prostatectomy. METHODS: We reviewed the recent international literature by carrying out a PUBMED search. RESULTS: We critically reviewed 11 recent original studies about the use of PET-CT and 5 recent studies about the use of multiparametric magnetic resonance. PET-CT has not shown significant results in terms of detection rate for local recurrence in patients with low level of PSA. Multiparametric magnetic resonance showed encouraging results to detect local recurrence in patients with low PSA and with small diameter lesions. CONCLUSIONS: Currently, most important urological societies do not consider multiparametric magnetic resonance and PET-CT in the follow-up of patients with suspected local recurrence after radical prostatectomy. We can assert that multiparametric magnetic resonance seems to have excellent results in detecting local recurrence in patients submitted to radical prostatectomy and PSA<1.5 ng/ml.

Update on screening in prostate cancer based on recent clinical trials.

INTRODUCTION AND AIM: prostate cancer (Pc) is a major public health problem, affecting 679,000 men and causing 221,000 deaths every year. Over the past decade, there has been a marked decline in Pc mortality corresponding to the introduction of prostate specific antigen (PSA) test as a screening tool (1986). Despite this clear result, the screening recommendations of various organizations differ. Recently, a large number of studies have highlighted the benefits and risks of PSA based screening. The aim of this article is to review the current screening guidelines and summarise the benefits and harms of PSA testing, analysing two large long awaited randomized multicenter clinical trials of PSA screening reported this year. METHODS FOR THE REVIEW: we reviewed the recent literature using PUBMED research, using as words for research: Prostate-Specific Antigen, mass screening, Prostatic neoplasm mortality, follow-up studies, overdiagnosis and overtreatment. In particular, we analysed two clinical trials reported on "The New England Journal of Medicine" this year: the European Randomized Study of Screening for Prostate Cancer (ERSPC) by Scroeder et al. and the U.S. Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial by Andriole et al. RESULTS AND CONCLUSIONS: the goal of a screening is to detect a cancer at an early stage, when it is still curable. In Pc case there are different treatments with curative intent, that are associated with significant morbidity. Some man have an aggressive form for which screening might be helpful but many have a slow growing cancer that would never progress and their detection could cause anxiety and bring unnecessary medical treatment. With this review we tried to understand where we should stop the management: Overdiagnosis or Overtreatment?.

Modern role of magnetic resonance and spectroscopy in the imaging of prostate cancer.

Recently, a large number of studies have shown that the addition of proton 1H-spectroscopic imaging (1H-MRSI) and dynamic contrast enhanced imaging (DCEMR) to magnetic resonance (MR) could represent a powerful tool for the management of prostate cancer (CaP) in most of its aspects. This combination of MR techniques can substantially sustain the clinical management of patients with CaP at different levels: in particular, (1) in the initial assessment, reducing the need for more extensive biopsies and directing targeted biopsies; (2) in the definition of a biochemical progression after primary therapies, distinguishing between fibrotic reaction and local recurrence from CaP.

[Role of neuroendocrine cells in prostate cancer progression]. / Ruolo delle cellule neuroendocrine nella progressionedel carcinoma prostatico.

Neuroendocrine (NE) cells represent the third epithelial cell type on normal prostatic tissue (in addition to basal and secretory cells). They are localized in all regions of the human prostate at birth but rapidly decrease in the peripheral prostate after birth, and then reappear at puberty. After puberty, their number seems to increase until an apparently optimum level is reached, which persists between the age of 25 and 54. NE cells were defined by Pearse as APUD to refer to chemical characteristics of amine precursor uptake and decarboxylation, common to the cells of this system. The most predominant product of prostatic NE cells is Chromogranin A, but they also produce serotonin, CgB, secretogranin or CgC, thyroid-stimulating hormone-like peptide, calcitonin, katacalcin, PTHrP and a-human chorionic gonadotropin-like peptide. NE cells in normal and neoplastic prostates are devoid of androgen receptors, but they express epidermal growth factor (EGF) receptor and c-erbB-2. For these reason NE cells are androgen-insensitive. The NE component of prostate adenocarcinoma is resistant to hormone therapy; some studies showed that the number of NE tumor cells and CgA serum levels increase with the recovery of human prostate tumor from hormonal therapy. Currently there are no clinical data available to support an active role of radiotherapy in NE differentiation.

[Current diagnostic procedure on neuroendocrine differentiation of prostate cancer]. / Attuale iter diagnostico sulla differenziazione neuroendocrina del carcinoma prostatico.

Chromogranin A (CgA) is considered as a major specific neuroendocrine tumor marker. It belongs to the secretogranin family, which is present in the gastrointestinal tract, respiratory system, endocrine glands and in a group of endocrine cells such us pancreas and thyroid. Serum levels of CgA could reflect the neuroendocrine activity and could be used when evaluating advance prostate carcinoma. Moreover, there are also several factors that may increase the serum level of CgA: treatment with proton-pump inhibitors or H2-receptor blockers, chronic atrophic gastritis, rheumatoid arthritis, liver and renal failure. Another method to evaluate NE differentiation is scintigraphy with the 111In-labeled somatostatin analogue (DTPA-D-Phe)-octrotide, (Octreoscan). This method takes advantage of the overexpression of type II somatostatin receptors on the cell surface of NE tumors. With this technique the presence of NE differentiation can be detected both at the primary (prostate) and the metastatic sites. A more specific system to detect NE cell activity is obtained by analyzing CgA gene expression in prostate tissue by a semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR).

[Neuroendocrine target therapies for prostate cancer]. / "Neuroendocrine target therapies" per il carcinoma prostatico.

It is important to determine whether an increase in Chromogranin A levels and neuroendocrine (NE) cell activation are associated with progression towards on hormone-independent prostate-cancer. We proposed a combination of estrogens and somatostatin analogues as therapy of NE activation in hormone-independent prostate cancer. The combined therapy with ethinyl estradiol and lanreotide offered objective and symptomatic responses in patients with limited treatment options and refractoriness to conventional hormonal therapy strategies; in particular, it offered a median overall survival that was superior to the 10-month median survival in patients with hormone refractory disease. This combined therapy also sustains the new concept in cancer treatment in which therapies may target not only cancer cells but also its microenvironment, which can yield protection against apoptosis.

Value of magnetic resonance spectroscopy (MSR) and dynamic contrast-enhanced magnetic resonance (DCEMR) imaging for the characterization of high-grade prostatic intraepithelial neoplasia (HGPIN) foci.

BACKGROUND: Despite an increasing interest in high-grade prostatic intraepithelial neoplasia (HGPIN), the clinical suspicious aspect of this premalignant lesion remains poorly characterized. The aim of this study was to analyze the magnetic resonance spectroscopy (MSR) and dynamic contrast-enhanced magnetic resonance (DCEMR) imaging features of isolated HGPIN lesions. MATERIALS AND METHODS: From January 2007 to January 2009, 330 cases were included in a protocol that involve the use of MSR and DCEMR for the diagnosis of prostate diseases. Of these, 27 patients with isolated (no associated prostate cancer diagnosis) HGPIN histologic diagnosis at the first prostate biopsy were included in the present study. All cases were previously submitted to MSR/DCEMR (1.5 T scanner) and, no later than 10 days to a random 12-core biopsy scheme. Biopsy targeting was done in zones corresponding to those analyzed with MSR and DCEMR. RESULTS: In the 27 patients, 30 HGPIN foci with a diameter of 6 mm or greater were analyzed and compared with 27 peripheral zone areas of normal prostate tissue. With MSR, HGPIN foci were characterized by a significantly higher (P < 0.05) absolute value of choline and choline + creatine/citrate ratio compared with normal tissue. With DCEMR, HGPIN foci were characterized by lower values of all dynamic parameters but differences did not reach statistical significance (P > 0.05). CONCLUSIONS: In our experience, HGPIN lesions can be metabolically characterized by MSR through the absolute value of choline and the choline + creatine/citrate ratio.

Comparative effect of finasteride and dutasteride on chromogranin A levels.

UNLABELLED: The aim of this study was to verify and to compare in benign prostatic hyperplasia (BPH) patients, the effect of finasteride versus dutasteride therapy on chromogranin A (CgA) serum levels, as a marker of neuroendocrine (NE) differentiation. PATIENTS AND METHODS: This was a prospective randomised study in which 60 consecutive men with clinical diagnosis of BPH were randomised to a 6-month period of finasteride 5 mg/day versus dutasteride 4 mg/day versus control (no therapy). Total prostate-specific antigen (PSA), testosterone and CgA were analysed at randomisation and thereafter at one-, three- and six-month intervals. RESULTS: In both Group A (finasteride) and Group B (dutasteride), but not in Group C (no therapy), a statistically significant increase (p<0.05) in serum CgA levels was found at the three- and six-month intervals of therapy when compared with the start. Comparing the three groups, at three- and six-month intervals, serum CgA was significantly (p<0.05) higher in Group A and B than in Group C. At each interval, no significant (p>0.05) difference between Group A and B was found. CONCLUSION: In this population, 5-alpha reductase inhibitors, with no difference between finasteride and dutasteride, produced a significant increase in serum CgA levels, probably related to NE activation.

Value of magnetic resonance spectroscopy imaging and dynamic contrast-enhanced imaging for detecting prostate cancer foci in men with prior negative biopsy.

PURPOSE: This study aimed to prospectively analyze the role of magnetic resonance spectroscopy imaging (MRSI) and dynamic-contrast enhancement magnetic resonance (DCEMR) in the detection of prostate tumor foci in patients with persistently elevated prostate-specific antigen levels (in the range of >or=4 ng/mL to <10 ng/mL) and prior negative random trans-rectal ultrasound (TRUS)-guided biopsy. EXPERIMENTAL DESIGN: This was a prospective randomized single-center study. One hundred and eighty eligible cases were included in the study. Patients in group A were submitted to a second random prostate biopsy, whereas patients in group B were submitted to a (1)H-MRSI-DCEMR examination and samples targeted on suspicious areas were associated to the random biopsy. RESULTS: At the second biopsy, a prostate adenocarcinoma histologic diagnosis was found in 22 of 90 cases (24.4%) in group A and in 41 of 90 cases (45.5%) in group B (P = 0.01). On a patient-by-patient basis, MRSI had 92.3% sensitivity, 88.2% specificity, 85.7% positive predictive value (PPV), 93.7% negative predictive value (NPV), and 90% accuracy; DCEMR had 84.6 % sensitivity, 82.3% specificity, 78.5% PPV, 87.5% NPV, and 83.3% accuracy; and the association MRSI plus DCEMR had 92.6% sensitivity, 88.8% specificity, 88.7% PPV, 92.7% NPV, and 90.7% accuracy, for predicting prostate cancer detection. CONCLUSIONS: The combination of MRSI and DCEMR showed the potential to guide biopsy to cancer foci in patients with previously negative TRUS biopsy. To avoid a potential bias, represented from having taken more samples in group B (mean of cores, 12.17) than in group A (10 cores), in the future a MRSI/DCEMR directed biopsy could be prospectively compared with a saturation biopsy procedure.