New Treatment Strategies in the Management of Hormone Refractory Prostate Cancer (HRPC): Only Chemotherapy?

[No abstract available

Up-to-date on erectile dysfunction and treatment

Erection is a haemodynamic event that involves the central nervous system and local factors and is the recurrent or persistent inability to achieve and or maintain an erection to allow satisfactory intercourse. The ED is a disease of great social impact: it is estimated that in Italy, 11-13% of men, or about 3 million are affected in part by ED. Main risk factors are: age, education level, anxiety, reactive depression, diabetes, heart disease, high blood pressure; disorders (hepatic failure, chronic renal failure, obesity, dyslipidemia); hormonal disorders (hypogonadism, hyperprolactinemia, hypo/hyperthyroidism); neuropathies (Alzheimer’s disease, Parkinson’s disease, degenerative diseases); urologic surgery, colorectal and vascular. Regarding therapy first and most important form of treatment for a patient suffering from erectile dysfunction is to identify and possibly modify or remove all hazardous conditions for sexual health. First line treatments are selective inhibitors of 5-phosphodiesterase; second-line treatments essentially include intracavernous injection of vasoactive substances and third line treatments include revascularization of the penis and prostesis implants

High frequency of JCV DNA detection in prostate cancer tissues

BACKGROUND: Prostate cancer (PC) represents the most frequently diagnosed cancer in men. Exposure to infectious agents has been considered to induce prostatic inflammation and cancerous transformation. Controversial data exist concerning the role of the human polyomaviruses BK (BKV) and JC (JCV) in PC etiology. Therefore, a possible association between these polyomaviruses and PC was investigated. MATERIALS AND METHODS: Urine, blood and fresh prostatic tissue specimens were collected from 26 patients with PC. The presence of BKV and JCV, the possible non-coding control region (NCCR) variations and the genotyping analysis of viral protein 1 (VP1) of both viruses were assessed. RESULTS: Data showed a preferential viral re-activation in the urinary compartment and a statistically significant prevalence of JC viruria and of BKV in PC tissues. A BKV DDP-like NCCR sequence was isolated in two patients, whereas JCV NCCR was consistently of an archetypal structural organization. A prevalence of the European genotypes was observed for both viruses. CONCLUSION: Our data demonstrated the presence of JCV DNA in 14/24 (58.3%) cancerous prostatic tissue specimens, confirming the results obtained in a previous study, in which JCV has been defined as common inhabitant of the prostate, and opening the discussion about its potential role in PC

New anti-angiogenic targeted therapy in advanced renal cell carcinoma (RCC): Current status and future prospects

Objectives: To address the rationale for anti-angiogenic targeted therapies in advanced RCC. Methods: We reviewed the international recent literature, using Pubmed search. Results: RCC is genetically linked to factors regulating angiogenesis, in particular vascular endothelial growth factor (VEGF). Sunitinib is a multitarget receptor tyrosine-kinase (TK) inhibitor, acting on VEGF receptor (VEGFR) and platelet-derived growth factor receptors (PDGFR). Sorafenib is an oral multikinase inhibitor (VEGFR and PDGFR) showing also inhibitors effect on the Raf system. Phase I trials showed no life threatening toxicities relates to these agents. Phase II and phase III trials showed that these antiangiogenic agents are effective in the treatment of advanced RCC, mainly in cytokine refractory metastatic RCC. Survival benefits exist in particular when advanced RCC patients undergo cytoreductive nephrectomies before the initiation of the systemic therapy. To better use this kind of targeted therapy in advanced RCC, different points must be developed: the identification of clinical characteristic of RCC able to predict outcomes and responses to therapy; differences among different compounds; advantages of combination or sequential therapies. Conlusions: Targeted therapy with Sunitinib and Sorafenib has been approved to FDA and is revolutioning how we clinically approach advanced RCC. © 2008 Bentham Science Publishers Ltd

Laparoscopic versus open radical prostatectomy in high prostate volume cases: impact on oncological and functional results

To prospectively compare the laparoscopic versus open approach to RP in cases with high prostate volume and to evaluate a possible diferente impact of prostate volume

A meta-analysis and systematic review of randomized controlled trials with degarelix versus gonadotropin-releasing hormone agonists for advanced prostate cancer

Our aim was to systematically evaluate the benefits of degarelix as antagonist versus agonists of gonadotropin-releasing hormones (GnRH) for the treatment of advanced prostate cancer (PC). This comparison was performed either in terms of biochemical or oncological or safety profiles. To this end we, carried out a systematic review and meta-analysis of the literature.We selected only studies directly and prospectively analyzing the two treatments in the same population (randomized phase III studies). We followed the Preferred Reporting Items for Systematic Reviews and meta-analyses process for reporting studies.After we eliminated studies according to the exclusion criteria, 9 publications were considered relevant to this review. These articles described 5 clinical trials that were eligible for inclusion. The follow-up duration in all trials did not exceed 364 days. This meta-analysis and review comprised a total of 1719 men, 1061 randomized to degarelix versus 658 to GnRH agonists treatment for advanced PC. Oncological results were evaluated only in 1 trial (CS21:408 cases) and they were not the primary endpoints of the study. Treatment emerging adverse events were reported in 61.4% and 58.8% of patients in the degarelix and GnRH agonists group, respectively (odds ratio, OR = 1.17; 95% confidence interval, 95% CI: 0.78-1.77, P > 0.1). Treatment related severe cardiovascular side effects were reported (trial CS21-30-35) in 1.6% and 3.6% of patients in the degarelix and GnRH agonists group, respectively (OR = 0.55, 95% CI: 0.26-1.14, P > 0.1).Our analysis evidences relevant limitations in particular for the comparative evaluation of the efficacy and the oncological results related to degarelix

Loss of Renal Function After Retrograde Ureteral Placement of an Allium Stent for Severe Ureteral Stricture

Background: Ureteral strictures are a recurrent chronic condition that leads to severe side effects and poor quality of life. Management of ureteral stricture is a great challenge for urologists and no specific guidelines exist. Retrograde Allium®ureteral stent (AUS) is a newly developed ureteral stent to treat either bulbar urethral or ureteral stenosis. Case Presentation: We describe a case of a 74-year-old Caucasian adult male presenting with a severe ureteral stricture secondary to an ureteroscopy for stone disease. Treatment with retrograde AUS placement produced a complete loss of renal function after 36 months, probably because of the development of a long achalasic stretch of the ureter. Conclusions: AUS is a new and promising device for the treatment of ureteral stenosis. However, a lack of standardization of the technique recommends a close instrumental follow-up after the procedure to decide the optimal time for stent removal

Unexpected discovery of surgical gauze during a robotic radical prostatectomy identified as a capturing lymph node on magnetic resonance

Multiparametric magnetic resonance, plays a crucial role in several steps of the management of prostate cancer. Various factors could alter the interpretation and reduce the accuracy of MR. Among these the group of the retained surgical items, can produce serious implications for the health of patient, as well as medical-legal consequences. Here we report the case of a patient, with a prostate tumor, who performed a mp-MRI of the prostate, where it was reported as collateral finding, compatible thesis with lymphadenopathy. During robotic assisted radical prostatectomy, was found a gauze, which persisted asymptomatic, retained after a previous right inguinal hernioplast

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

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). 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. 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. The degree of association between the alteration score values obtained by postoperative MR morphologic evaluation for MR sequence and IIEF-5 score. 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). 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. Sciarra A, Panebianco V, Salciccia S, Alfarone A, Gentilucci A, Lisi D, Passariello R, and Gentile V. 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. J Sex Med 2009;6:1430-1437

Chronic kidney disease and urological disorders: systematic use of uroflowmetry in nephropathic patients

Background. Chronic kidney disease (CKD) is a highly prevalent condition. Urologic disorders are known causes of CKD, but often remain undiagnosed and underestimated also for their insidious onset and slow progression. We aimed to evaluate the prevalence of urological unrecognized diseases in CKD patients by uroflowmetry. Methods. We enrolled consecutive stable CKD outpatients. The patients carried out two questionnaires, the International Prostate Symptom Score and Incontinence Questionnaire-Short Form, and they also underwent uroflowmetry, evaluating max flow rate (Qmax), voiding time and voided volume values. Results. A total of 83 patients (43 males, mean age of 59.8613.3 years) were enrolled. Our study showed 28 males and 10 females with a significant reduction of Qmax (P<0.001) while 21 females reported a significant increase of Qmax (P<0.001) with a prevalence of 49.5% of functional urological disease. Moreover, we showed a significant association between Qmax and creatinine (P¼0.013), estimated glomerular filtration rate (P¼0.029) and voiding volume (P¼0.05). We have not shown significant associations with age (P¼0.215), body mass index (P¼0.793), systolic blood pressure (P¼0.642) or diastolic blood pressure (P¼0.305). Moreover, Pearson’s chi-squared test showed a significant association between Qmax altered with CKD (v2 ¼1.885, P¼0.170) and recurrent infection (v2¼8.886, P¼0.012), while we have not shown an association with proteinuria (v2¼0.484, P¼0.785), diabetes (v2¼0.334, P¼0.563) or hypertension (v2¼1.885, P¼0.170).Conclusions. We showed an elevated prevalence of urological diseases in nephropathic patients; therefore, we suggest to include uroflowmetry in CKD patient assessment, considering the non-invasiveness, repeatability and low cost of examination. Uroflowmetry could be used to identify previously unrecognized urological diseases, which may prevent the onset of CKD or progression to end-stage renal disease and reduce the costs of management