The flare in alkaline phosphatase activity post-orchidectomy predicts which patient may benefit from early chemotherapy in metastatic prostate cancer

BACKGROUND: A flare in serum alkaline phosphatase (ALP) activity post-orchidectomy has been shown to be of negative prognostic value for progression-free survival (PFS) in patients with prostate cancer. The aim of this study was to investigate whether a flare in ALP may help identify patients in whom prognosis could be positively influenced by early chemotherapy. METHODS: A retrospective analysis of the database of a Dutch multicenter study was conducted to evaluate the prognostic value of the flare in ALP post-orchidectomy for survival and PFS in 112 patients treated with orchidectomy (previously reported) compared to 121 age- and stage-matched patients additionally treated with estramustine-phosphate (EMP) as first line therapy. RESULTS: There was no overall difference in PFS and survival between the two treatment regimen. Subgroup analysis of patients demonstrating a greater than 50% increase in ALP post-orchidectomy showed, however, a significant increase in PFS in patients additionally treated with EMP. CONCLUSIONS: Our data suggest that the simple measurement of ALP activity within 4 weeks of castration represents a useful adjunct in assessing which patients with prostate cancer undergoing androgen ablation may benefit from additional early chemotherap

How Do Continence Nurses Address Sexual Function and a History of Sexual Abuse in Daily Practice? Results of a Pilot Study

Introduction. There is a strong association between urological complaints, sexual dysfunction, and history of sexual abuse (SA), and it is unknown whether urological continence nurses integrate this knowledge in their daily practice. Aim. To evaluate how, in their daily practice, Dutch urological continence nurses address sexual dysfunction and possible SA. Methods. An anonymous 19-item questionnaire was distributed among all Dutch urinary continence nurses visiting their yearly congress. Main Outcome Measures. The survey results. Results. The response rate was 48.9% (93/190). Of the respondents, 11.8% did not ask their female patients about sexual function; 37.6% asked only rarely; 44.1% asked often; and 6.5% always asked. Sexual functioning in males was not evaluated by the majority of the nurses (13.2% never, and 46.2% rarely). A minority of continence nurses asked males about sexual functioning (36.3% often and 4.3% always). Important reasons for not asking were insufficient knowledge of how to adequately ask males (38.9%) and females (47.8%) about sexual problems, and because nurses assumed the urologist had addressed this issue (48.1% asking males, 39.1% asking females). Younger nurses found it particularly difficult to raise sexual issues with both male and female patients (P = 0.001 and P = 0.003, respectively). Screening for sexual dysfunction was stated to be important by almost all nurses (65.2% "quite important," and 31.5% "very important"). Within their patient population, both male and female, 28% of the nurses never asked about SA and 49.5% asked only rarely. Conclusion. Dutch urological incontinence nurses acknowledge the importance of sexual problems in their patient population, but asking about this issue was not part of routine care. The main reasons for not asking, according to the nurses' responses, were that they had insufficient knowledge and that they assumed the urologist had already asked about sexual problems. Bekker MD, Van Driel MF, Pelger RCM, Lycklama a Nijeholt GAB, and Elzevier HW. How do continence nurses address sexual function and a history of sexual abuse in daily practice? Results of a pilot study. J Sex Med 2011;8:367-375

Strontium-89 (Metastron) and the bisphosphonate olpadronate reduce the incidence of spinal cord compression in patients with hormone-refractory prostate cancer metastatic to the skeleton

Spinal cord compression (SCC) is a devastating complication of metastatic cancer. We investigated the potential beneficial effect of two palliative therapies--strontium-89 (Metastron) and the nitrogen-containing bisphosphonate olpadronate--on the incidence of SCC in hormone-refractory prostate cancer (HRPC) metastatic to the skeleton. We retrospectively studied 415 patients with histologically proven prostate cancer who underwent bone scintigraphy at the time of diagnosis and were followed up at the Leiden University Medical Center between 1990 and 1999. Medical or surgical castration was undertaken in 172 patients with evidence for skeletal metastases. Within 2 years, 147 of these patients (85%) developed HRPC associated with severe progressive bone pain. Palliative treatment was given to 131 patients in the form of local radiotherapy ( n=10), 89Sr ( n=46) or intravenous olpadronate ( n=66), with ( n=57) or without ( n=9) maintenance oral olpadronate. Nine patients received both 89Sr and olpadronate at various intervals. Sixteen patients who did not receive any of these treatments were used as historical controls. There was no significant difference in baseline characteristics between treatment modalities. The incidence of SCC was 17% in the whole group, and highest in controls receiving no palliation (50%). None of the patients treated with local radiotherapy, only 4% of patients receiving 89Sr and 21% of patients given olpadronate developed this complication. Our findings suggest a significant reduction in SCC in patients with symptomatic HRPC metastatic to the skeleton who receive palliative therapies. Local radiotherapy completely prevents the incidence of SCC, 89Sr leads to an important decrease in this complication and olpadronate induces a significant, albeit smaller decrease in the incidence of SCC. The use of these agents opens new avenues in the difficult management of patients with advanced prostate cancer who are most at risk of developing SC

Sexual Experiences of Men with Incontinent Partners

Introduction. Several studies show that urinary incontinence (UI) impairs women's sexual functioning and sexual satisfaction. However, there is no scientific knowledge about the effects of UI on sexual functioning of the male partners. Aim. To analyze sexual functioning of the male partners of females with UI. Methods. During a period of 2.5 years all new female patients and their partners (both groups aged 18 years and older), who presented at our outpatient clinic for urological evaluation, were asked for demographic characteristics, medical history, and referral indication including the main urological complaint. In addition they were asked to fill in the Golombok Rust Inventory of Sexual Satisfaction questionnaires about sexual functioning. Main Outcome Measures. Sexual function measured by the Golombok Rust Inventory of Sexual Satisfaction questionnaire. Results. A total of 189 sexually active couples completed the questionnaires. Eighty-one (42.9%) of the women had UI as main urological complaint. Differences were found between women with UI and those without. Women with UI have a lower overall sexual function (P = 0.02), lower frequency of intercourse (P = 0.02), more problems with communication (P = 0.036), and more often show avoidable behavior with regard to sexual activity. (P = 0.002) Men with partners with UI showed a diminished overall sexual function (6.66 +/- 1.53) compared with men with women without UI (5.95 +/- 1.22, P = 0.001). Furthermore, comparisons of subscales also demonstrate a lower frequency of intercourse (5.62 +/- 2.00, 6.49 +/- 1.96), less satisfaction (8.08 +/- 2.79, 9.69 +/- 3.63), and more erectile problems (6.01 +/- 2.28, 6.87 +/- 3.23) in men with partners with UI. (P = 0.03, P = 0.001, P = 0.037) Conclusions. This study shows that female urinary incontinence correlates with their partners' overall sexual functioning and sexual satisfaction. In addition, significant differences were found with regard to the satisfaction with one's sex life between a woman with UI and her partner. Bekker MD, Beck JJH, Putter H, van Driel MF, Pelger RCM, Weijmar Schultz WC, Lycklama a Nijeholt GAB, and Elzevier HW. Sexual experiences of men with incontinent partners. J Sex Med 2010;7:1877-1882