Anti-Müllerian hormone: a novel biomarker for aggressive prostate cancer? Emerging evidence from a prospective study of radical prostatectomies.

PURPOSE: Prostate cancer patients are a heterogeneous group as regards the aggressiveness of the disease. The relationship of steroid hormones with the aggressiveness of prostate cancer is unclear. It is known that the anti-Müllerian hormone (AMH) inhibits prostate cancer cell lines in vitro. The aim of this study is to investigate the relationship of AMH and steroid hormones with the aggressiveness of prostate cancer. METHODS: This was a prospective study of consecutive radical prostatectomy patients. We measured the following hormones: total testosterone, sex hormone-binding globulin, albumin, luteinizing hormone, follicle-stimulating hormone, estradiol, dehydroepiandrosterone sulfate, androstenedione, and AMH. The minimum follow-up after radical prostatectomy was 5 years. For the aggressiveness of prostate cancer, we considered the following three variables: post-operative Gleason score (GS) ≥ 8, TNM pΤ3 disease, and prostate-specific antigen (PSA) biochemical recurrence (BCR). RESULTS: In total, 91 patients were enrolled. The mean age and PSA were 64.8 years and 9.3 ng/dl, respectively. The median post-operative GS was 7. Low AMH blood levels were correlated with higher post-operative GS (p = 0.001), as well as with PSA BCR (p = 0.043). With pT3 disease, only albumin was (negatively) correlated (p = 0.008). ROC analysis showed that AMH is a good predictor of BCR (AUC 0.646, 95% CI 0.510-0.782, p = 0.043); a cutoff value of 3.06 ng/dl had a positive prognostic value of 71.4% and a negative prognostic value of 63.3% for BCR. Cox regression analysis showed that AMH is a statistically significant and independent prognostic marker for BCR (p = 0.013). More precisely, for every 1 ng/ml of AMH rise, the probability for PSA BCR decreases by 20.8% (HR = 0.792). Moreover, in Kaplan-Meier analysis, disease-free survival is more probable in patients with AMΗ ≥ 3.06 ng/ml (p = 0.004). CONCLUSIONS: Low AMH blood levels were correlated with aggressive prostate cancer in this radical prostatectomy cohort of patients. Therefore, AMH could be a prognostic biomarker for the aggressiveness of the disease.

La efectividad del sildenafil en hombres diabéticos con disfuncion eréctil tratados exitosamente con autoinyección de drogas vasoactivas / The effectiveness of sildenafil in diabetic men with erectile dysfunction successfully treated with self-injections of vasoactive drugs

Switching to oral treatment is a challenge for diabetic men with erectile dysfunction (ED), who have started on and are successfully treated with self-injections of prostaglandin E1 (PGE1) or a mixture of PGE1 and papaverine (MIX). Ninety-five diabetic men (34 with type 1 and 61 with type 2) treated from 1 to 10 years with injections (31 men on PGE1 and 64 on MIX) switched to oral sildenafil on demand. The change was successful if the patient achieved even 1 erection firm enough for satisfactory intercourse. Thirteen men (13.7%), all with type 2 diabetes and previously treated with PGE1, responded to sildenafil. Thus, 41.9% of the patients treated with PGE1 responded. Patient age and duration of self-injection treatment negatively influenced the response to sildenafil, while type 2 diabetes and PGE1 previous treatment were significant determinants for response. The 13 responders recorded a rate of 57.6% successful attempts (136/236). Of the 13 responders, 11 were satisfied and changed treatment. Thus, the overall satisfaction with oral treatment and preference for change was 11.6%. This study provides evidence that despite the availability of effective oral agents, self-injections continue to be a highly effective therapy in diabetic men with ED. Those with type 1, already treated with a mixture of injected vasoactive drugs are not likely to respond to sildenafil, while the younger men with type 2 and injected with PGE1 are more likely to respond and change treatment.

El pasaje del tratamiento a la vía oral es un desafío para los hombres diabéticos con disfunción eréctil (DE) que comenzaron y que son tratados en forma efectiva con autoinyecciones de prostaglandina E1 (PGE1) o la combinación de PGE1 y papaverina (MIX). Noventa y cinco hombres (34 con diabetes tipo 1 y 61 con diabetes tipo 2) tratados entre 1 y 10 años con inyecciones (31 con PGE1 y 64 con MIX) realizaron el cambio por tratamiento oral a demanda con sildenafil. El cambio fue exitoso si el paciente lograba por lo menos una erección lo suficientemente firme como para mantener una relación sexual satisfactoria. Trece hombres (13.7%), todos con diabetes tipo 2 y tratados previamente con PGE1, respondieron al sildenafil. Por lo tanto, respondió el 41.9% de los pacientes tratados con PGE1. La edad del paciente y la duración del tratamiento con autoinyecciones tuvieron una influencia negativa sobre la respuesta al sildenafil, mientras que la diabetes tipo 2 y el tratamiento previo con PGE1 fueron determinantes significativos para la respuesta. Los 13 pacientes que respondieron registraron una tasa de intentos exitosos del 57.6% (136/236) y 11 estuvieron satisfechos y cambiaron la modalidad terapéutica. Así, la satisfacción global con el tratamiento por vía oral y la preferencia por el cambio fue del 11.6%. Este estudio aporta indicios de que, a pesar de la disponibilidad de agentes efectivos por vía oral, las autoinyecciones continúan siendo una terapéutica sumamente efectiva en hombres diabéticos con DE. Es poco probable que los pacientes con diabetes tipo 1, tratados previamente con una combinación de sustancias vasoactivas respondan al sildenafil, mientras que es más probable que los hombres más jóvenes con diabetes tipo 2 que utilizaron PGE1 respondan y cambien el tratamiento.

El manejo de la disfunción eréctil en pacientes con trastornos respiratorios durante el sueño y enfermedad pulmonar obstructiva crónica / The management of erectile dysfunction in patients with sleep-disordered breathing and chronic obstructive pulmonary disease

En hombres con apnea obstructiva del sueño y enfermedad pulmonar obstructiva crónica (síndrome superpuesto) la disfunción eréctil es un motivo de consulta frecuente. La evidencia señala una relación etiológica, por lo tanto el tratamiento de los trastornos respiratorios mejoraría la función eréctil. Cuarenta y ocho hombres con síndrome superpuesto y disfunción eréctil fueron tratados de manera convencional mediante presión continua positiva de las vías aéreas y broncodilatadores durante seis meses. El puntaje que medía la intensidad de la disfunción eréctil mejoró significativamente en toda la población en estudio. Cuando se utilizó el criterio clínico de mejoría de por lo menos 5 puntos de aumento en el puntaje de la intensidad de la disfunción eréctil sólo 12 pacientes (25%) lo lograron. Un porcentaje significativo de los pacientes sin respuesta, o que no estaban satisfechos con el manejo convencional respondieron a la ingesta de sildenafil a demanda. Si bien el mejoramiento de la función respiratoria generalmente se acompañaba de una mejora en la función eréctil, debería considerarse el tratamiento específico de la disfunción eréctil si la satisfacción del paciente es la meta del tratamiento.

In men with obstructive sleep apnea and chronic obstructive pulmonary disease (overlap syndrome), erectile dysfunction is a frequent complaint. Evidence suggests an etiologic link, and therefore treatment of breathing disorders would improve erectile function. Forty-eight men with overlap syndrome and erectiledysfunction were treated conventionally with continuous positive airway pressure and bronchodilators for 6 months. Erectile dysfunction intensity score improved significantly in the entire study population. When the clinical improvement criterion of at least a 5-point increase in erectile dysfunction intensity score was used only 12 patients (25%) responded. A significantpercentage of patients whose erectile dysfunction did not respond, or who were not satisfied with conventionalmanagement, responded to on-demand sildenafil. Even though improvements in respiratory function generally improve erectile function, specific ED treatment may be considered if patient satisfaction is the treatment goal.