Prostate Cancer Microparticles as a Next Generation Screening Tool for Prostate Cancer

Currently available screening tests for prostate cancer (PCa) are neither very sensitive nor specific. Microparticles (MP) are submicron tumor cell fragments released by PCa cells into the circulation and offer a possible means of sampling the tumor. We evaluated the utility of a MP blood test using nanoscale flow cytometry to distinguish patients with PCa from patients with benign prostatic hyperplasia (BPH). We used monoclonal antibodies against prostate specific membrane antigen, gastrin releasing peptide receptor and ghrelin peptide ligand. We found higher but statistically insignificant, PSMA and Ghrelin dual +ve MP counts in the BPH group. Our results show that although MP can be enumerated, better more exclusive surface antigens and different antibodies, are required to test the utility of MP for this to be used as a Next Generation Screening Tool for PCa. In addition, comparison with a more suitable control group would improve accuracy of the experimental test

Surgical ligation of scrotal varicocele for male factor infertility is a valid option of treatment

Objective: To evaluate the role of surgical ligation of scrotal varicocele for treatment of male factor infertility. Methods: We studied 60 patients who presented with infertility and were also found to have scrotal varicocele. Patients with other probable causes contributing to infertility were excluded. Diagnosis was made by clinical examination and scrotal ultrasonography. All the patients underwent either laparoscopic varicocelectomy or open retroperitoneal high ligation of the testicular veins. Operative time and hospital stay was recorded. All patients were evaluated for postoperative improvement of semen parameters and development of any postoperative complication. The results were analyzed by commercially available software. Results: During the study period 5 patients were lost to follow up and were excluded. The rest of patients (n=55) were young, with age ranging from 20-35 years (Mean age 27.8 years, SD +/- 4.38). All patients had unilateral left sided varicocele; two patients (3.6%) had grade I varicocele, 21 patients (38.2%) had grade II varicocele and 32 patients (58.2%) had grade III varicocele. Statistically significant improvement in sperm density (p value \u3c 0.05), sperm activity (p value \u3c 0.05) and sperm morphology (p value \u3c 0.05) was observed after the surgical ligation. The mean operative time was 54.88 minutes (SD + 13). The mean hospital stay in laparoscopic procedure was 33.4 (SD + 15.3). Minor complications were noted in 13 patients and included superficial wound infection in 3 patients, 6 patients exhibited testicular pain and persistence of varicocele in 4 patients. Conclusion: Surgical ligation of scrotal varicocele is asafe and effective mode of treatment of male factor infertility in selected population

Role of estrogens in the secondary hormonal manipulation of hormone refractory prostate cancer

Objective: To evaluate the role of Estrogens (Honvan) in the secondary hormonal manipulation of patients with hormone refractory prostate cancer (HRCP). Methods: Twelve patients diagnosed as hormone refractory prostate cancer received intravenous estrogens for six days (Fosfestrol, a synthetic phosphorylated estrogen derivative), followed by a maintenance oral dose of 120 mg thrice daily as second line hormonal treatment. During the treatment they were given deep venous thrombosis prophylaxis. Their stage at initial presentation, primary treatment, mode of androgen ablation, prostate specific antigen (PSA) level, duration of remission prior of HRPC status, PSA doubling time before and after estrogen treatment were recorded. The morbidity and mortality of the treatment was also recorded. A drop in PSA of \u3e 50% was classified as major responder. The drop of \u3c 50% was defined as minor responders. Treatment failure was defined as a rise in PSA \u3e the level prior to the start of treatment. Results: The mean age at diagnosis of prostate cancer was 66.6 + 5.4 years (range 57-73). At the time of initial diagnosis only 3 patients (25%) had localized disease and 9 (75%) had metastatic prostate cancer. Six patients each opted for surgical or medical castration (LHRH analogs) as the mode of androgen ablation. The mean initial PSA at diagnosis was 340 + 728.1 ng/ml (range 4.1-2375, Median 94). After development of HRPC, six patients (50%) had major response, four (33%) had minor response to estrogen administration. Two patients (17%) did not respond to estrogens. The mean PSA before receiving Fosfestrol was 60.5 + 82 ng/ml (range 0.013-246). The PSA (nadir) after treatment was 24.3 + 33.2 ng/ml (range 0.9-81.3). One patient developed gynaecomastia and one had congestive cardiac failure. Two patients died of non cancer related deaths and one patient died of cancer related death. Conclusion: Synthetic estrogens are well tolerated, in-expensive agents and could be considered for palliative use against hormone resistant prostate cancer (JPMA 54:445;2004)

Evolution of Minimally Invasive Adrenal Surgery at a Tertiary Care Centre in Oman

Objective: We reviewed the case records of adrenalectomy cases at our institution between January 2010 and December 2020 and report the outcomes of both open and laparoscopic adrenalectomy (LA). Methods: This retrospective study included patients who underwent adrenal surgery from January 2010 to December 2020. We recorded demographic details, indications, surgical approach, intra operative data and complications. The final pathology and outcome at the last follow up was also documented. Data was analyzed through the SPSS program. Results: Fifty two patients underwent 61 adrenalectomy procedures. Six patients had bilateral procedure and 3 patients underwent redo surgery accounting for 55 subjects. Open adrenalectomy (OA) was performed on 11 patients and 44 patients underwent LA. Majority of the patients (27) were obese having BMI > 30. Functional adenoma was excised in 36 patients with final diagnosis of Conn’s syndrome in 15, Pheochromocytoma in 13 and Cushing syndrome in 9 patients. Five patients had surgery for oncological indications. Nonfunctional adenoma was excised in 13 patients, with a mean size of 8.9 cm (range 4-15 cm). The mean duration of surgery was less in laparoscopic procedure (199 min) compared to open (246 min). The mean estimated blood loss in LA was significantly less (108ml vs 450 ml, p-value < 0.05). Out of 55 subjects only 1 patients developed Clavien-dindo grade 2 complication. Conclusion: At our institution both laparoscopic and open adrenalectomy were safely performed. There is a trend to perform LA and with experience the duration of surgery and EBL are demonstrating positive trend. Keywords: Adrenal Gland Surgery; Laparoscopic Adrenalectomy; Open Adrenalectomy; Pheochromocytoma; Adrenal Metastasis; Nonfunctional Adrenal Tumors; Oman

A three gene DNA methylation biomarker accurately classifies early stage prostate cancer

Background: We identify and validate accurate diagnostic biomarkers for prostate cancer through a systematic evaluation of DNA methylation alterations. Materials and methods: We assembled three early prostate cancer cohorts (total patients = 699) from which we collected and processed over 1300 prostatectomy tissue samples for DNA extraction. Using real-time methylation-specific PCR, we measured normalized methylation levels at 15 frequently methylated loci. After partitioning sample sets into independent training and validation cohorts, classifiers were developed using logistic regression, analyzed, and validated. Results: In the training dataset, DNA methylation levels at 7 of 15 genomic loci (glutathione S-transferase Pi 1 [GSTP1], CCDC181, hyaluronan, and proteoglycan link protein 3 [HAPLN3], GSTM2, growth arrest-specific 6 [GAS6], RASSF1, and APC) showed large differences between cancer and benign samples. The best binary classifier was the GAS6/GSTP1/HAPLN3 logistic regression model, with an area under these curves of 0.97, which showed a sensitivity of 94%, and a specificity of 93% after external validation. Conclusion: We created and validated a multigene model for the classification of benign and malignant prostate tissue. With false positive and negative rates below 7%, this three-gene biomarker represents a promising basis for more accurate prostate cancer diagnosis

Three-year outcomes of recovery of erectile function after open radical prostatectomy with sural nerve grafting

© 2014 International Society for Sexual Medicine.Introduction: Optimal oncologic control of higher stage prostate cancers often requires sacrificing the neurovascular bundles (NVB) with subsequent postoperative erectile dysfunction (ED), which can be treated with interposition graft using sural nerve.AIMS: To examine the long term outcome of sural nerve grafting (SNG) during radical retropubic prostatectomy (RRP) performed by a single surgeon.Methods: Sixty-six patients with clinically localized prostate cancer and preoperative International Index of Erectile Function (IIEF) score \u3e20 who underwent RRP were included. NVB excision was performed if the risk of side-specific extra-capsular extension (ECE) was \u3e25% on Ohori\u27 nomogram. SNG was harvested by a plastic surgeon, contemporaneously as the urologic surgeon was performing RRP. IIEF questionnaire was used pre- and postoperatively and at follow-up.MAIN OUTCOME MEASURES: Postoperative IIEF score at three years of men undergoing RRP with SNG. Recovery of potency was defined as postoperative IIEF-EF domain score \u3e22.Results: There were 43 (65%) unilateral SNG and 23 (35%) bilateral SNG. Mean surgical time was 164 minutes (71 to 221 minutes).The mean preoperative IIEF score was 23.4+1.6. With a mean follow-up of 35 months, 19 (28.8%) patients had IIEF score \u3e22. The IIEF-EF scores for those who had unilateral SNG and bilateral SNG were 12.9+4.9 and 14.8+5.3 respectively. History of diabetes (P=0.001) and age (P=0.007) negatively correlated with recovery of EF. 60% patients used PDE5i and showed a significantly higher EF recovery (43% vs. 17%, P=0.009).CONCLUSIONS: SNG can potentially improve EF recovery for potent men with higher stage prostate cancer undergoing RP. The contemporaneous, multidisciplinary approach provides a good quality graft and expedited the procedure without interrupting the work-flow

The TOS2 study: An international multi-centre audit assessing the standard of neurological examination

Having previously demonstrated that in-patients referred to neurology at two UK hospitals were not fully examined prior to referral, we designed an audit with 80% power to detect a 10% increase in tendon hammer or ophthalmoscope use following an educational intervention. In-patients referred to neurology over a 4 month period in the UK, Jordan, Sweden and the United Arab Emirates were asked whether they recalled examination with a Tendon hammer, Ophthalmoscope and Stethoscope since admission. Results were disseminated to local medical teams and data were collected for a further 4 months. Pre and post-intervention data were available for 11 centres with 407 and 391 patients in each arm. 264 patients (64.86%) recalled examination with a tendon hammer preintervention, which significantly improved to 298 (76.21%) (