Using Artificial Intelligence for the Diagnosis of Prostate Cancer: The Paper of Yuichiro Oishi et al. Is a Step Forward on the Way of Precision Medicine

Yuichiro Oishi et al. presented an interesting study reporting the ability of Artifi- cial Intelligence (AI) to diagnose and locate prostate cancer from multiparametric MRI (mpMRI) [1]. The authors evaluated the diagnostic performance of their AI with a ROC analysis; interestingly the area under the ROC curve was 0.985, while the sensitivity and the specificity were 0.875 and 0.961 (p < 0.01), respectively. Figure 1 of the paper shows that the regions of the prostate labeled by AI as prostate cancer correspond strictly to the cancer areas identified at pathological examination of the gland. These good results justified the strong conclusions of the paper: “diagnostic partition using the superpixel method and SVM-computed likelihood maps enables automated diagnosis of prostate cancer location and shape in mpMRI” [1]. Many aspects of this paper deserve to be emphasized. During the last two decades, numerous attempts to use radiomics for the diagnosis of cancer have been made [2]. So far, the dimensions of the dataset have always been a major limiting factor for the AI training and consequently for its diagnostic performance. The AI-based computer-aided diagnosis used in this study interestingly reached a good result with only a small number of patients, apparently overcoming the need for a large dataset. The authors achieved this result by sampling all the peripheral zone pixels for training the Support Vector Machine. Using this strategy, the dataset which resulted was very large despite the small number of patients included in the study. Because of the previous consideration, the strategy proposed by Yuichiro Oishi et al. will probably be crucial in the development of future diagnostic tools

An observational retrospective evaluation of 79 young men with long-term adverse effects after use of finasteride against androgenetic alopecia

Concern regarding adverse effects of finasteride is increasing. We aimed to determine the type and frequency of symptoms in men having long-term sexual and non-sexual side effects after finasteride treatment (a condition recently called post-finasteride syndrome, PFS) against androgenetic alopecia (AGA). Subjects were recruited at the Urology Unit of the Trieste University-Hospital, and from a dedicated website. Out of 79 participants, 34% were white Italians, mean age was 33.4\ua0\ub1\ua07.60\ua0years, mean duration of finasteride use was 27.3\ua0\ub1\ua033.21\ua0months; mean time from finasteride discontinuation was 44.1\ua0\ub1\ua034.20\ua0months. Symptoms were investigated by an ad hoc 100 questions' questionnaire, and by validated Arizona Sexual Experience Scale (ASEX) and Aging Male Symptom Scale (AMS) questionnaires. By ASEX questionnaire, 40.5% of participants declared getting and keeping erection very difficult, and 3.8% never achieved; reaching orgasm was declared very difficult by 16.5%, and never achieved by 2.5%. By the ad hoc questionnaire, the most frequent sexual symptoms referred were loss of penis sensitivity (87.3%), decreased ejaculatory force (82.3%), and low penile temperature (78.5%). The most frequent non-sexual symptoms were reduced feeling of life pleasure or emotions (anhedonia) (75.9%); lack of mental concentration (72.2%), and loss of muscle tone/mass (51.9%). We contributed to inform about symptoms of PFS patients; unexpectedly loss of penis sensitivity was more frequent than severe erectile dysfunction and loss of muscle tone/mass was affecting half of the subjects. Further studies are necessary to investigate the pathophysiological and biochemical pathways leading to the post-finasteride syndrome

Human immunodeficiency virus and sexually transmitted disease disparities among transgender persons

Experiencies of transphobic discrimination and victimization negatively impact on mental health, and the lack of social support has been found to be associated with a higher rate of undiagnosed HIV infection. To accurately assess the prevalence of HIV infection and other sexually transmitted diseases in the transgender population it is essential to create centres that can offer a comprehensive, multidisciplinary and adequate support to these patients

Selective arterial embolization for a high-flow priapism following perineal trauma in a young gymnast

Introduction. High-flow priapism is a rare condition in children, usually due to a perineal trauma. Materials and methods. We present a case of traumatic highflow priapism investigated by Doppler ultrasound and managed by angiography and selective embolization of a branch of the internal pudendal artery. Results. A 13-year-old gymnast underwent perineal trauma during training and developed a high-flow priapism. The first ultrasound (immediately after the trauma) showed the presence of an inhomogeneous area of 3 x 2 cm associated with an anechoic vascularized area (pseudoaneurysm) in the right corpus cavernosum. On the left side there was a similar finding, but of smaller size. After 3 weeks the pseudoaneurysm on the left was completely obliterated while the right one was still present. Angiography and superselective catheterization of a branch of the left pudendal artery and its embolization with microspheres and with metal microcoils were performed. After the procedure, ultrasound showed that the right pseudoaneurysm was completely obliterated and there were no more branches reaching it. The cavernous arteries were both pervious. Conclusions. Selective arterial embolization is a safe treatment that can also be used in pediatric patients

Pulmonary recurrence from prostate cancer and biochemical remission after metastasis directed therapy. A case report.

We report a case of a 69-years-old man who presented with a solitary 1 cm nodule in the lower lobe of the left lung almost 3 years after radical prostatectomy for pT3aN0M0, Gleason score 4+3 disease, without evidence of osseous or lymphatic spread. Surgical resection of the pulmonary lobe confirmed the metastatic nature of the lesion, with subsequent reduction of serum PSA to undetectable levels. After 2 years from the metastasis resection, serum PSA is still undetectable, without the necessity of additional treatments. Solitary pulmonary metastases from prostate cancer (Pca) are rare in clinical practice, with only 29 previous cases described besides the one that we present

It's not always varicocele: A strange case of Zinner syndrome

A 42-year-old man presented with a huge varicocele. The patient was completely asymptomatic and he did not complain of dysuria, perineal discomfort, or ejaculatory pain. During the visit, the mass mimicked a varicocele and during the Valsalva maneuver a reflux was documented by colour Doppler ultrasound and an abdominal ultrasound revealed an agenesis of the right kidney and a 4.5-cm diameter intra-prostatic cyst. An abdominal and pelvis magnetic resonance imaging was then performed, which confirmed the right renal agenesis, with an epididymal enlargement in the body and tail. This is a unique case of Zinner syndrome in which the patient presented with a paratesticular mass mimicking a varicocele. \ua9 2015 Canadian Urological Association

Inguinal recurrence of malignant mesothelioma of the tunica vaginalis: one case report with delayed recurrence and review of the literature

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Syphilitic Balanitis of Follmann: Can Dermoscopy Be Useful Tool in the Differential Diagnosis?

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Androgen Receptor (AR) Gene (CAG)n and (GGN)n Length Polymorphisms and Symptoms in Young Males With Long-Lasting Adverse Effects After Finasteride Use Against Androgenic Alopecia

INTRODUCTION: Long-term adverse symptoms of men who used oral finasteride against androgenic alopecia have been recently described as post-finasteride syndrome (PFS). AIM: To determine whether (CAG)n-rs4045402 and (GGN)n-rs3138869 polymorphisms in the androgen receptor (AR) gene are implicated in PFS. METHODS: AR polymorphisms were studied according to PFS symptoms in 66 white participants (31.8% Italian, 28.8% American, and 39.4% other). MAIN OUTCOME MEASURES: Symptoms were investigated by an ad hoc 100-item questionnaire and the Arizona Sexual Experience Scale and Aging Male Symptom Scale (AMS). (CAG)n and (GGN)n repeats were categorized as short ([CAG]9-19, [GGN]23). RESULTS: Median age was 32 years, duration of finasteride use was 360 days, and time from finasteride discontinuation was 1,053 days. We observed several frequency differences in symptoms according to (CAG)n and (GGN)n repeat numbers. Three AMS items were worse for medium (GGN)23 than for long (GGN)>23 carriers and one item was worse for short (GGN)2 kg), increased skin dryness, and onset of symptoms after finasteride use. CONCLUSION: This study showed that short and/or long (CAG)n and (GGN)n repeats had different frequencies according to symptoms reported by patients with PFS, likely reflecting the vast array of genes modulated by the AR. This study showed a U-curvilinear profile of (CAG)n repeats for skin dryness symptoms, where the two extremes exhibited a worse condition than medium repeats. Further studies are necessary to investigate the PFS pathophysiology using a precision medicine approach

Low back pain and FokI (rs2228570) polymorphism of vitamin D receptor in athletes

Background: Low back pain (LBP) is common in athletes. LBP can be detrimental to athletic performance and health. Factors predisposing to LBP in athletes remain elusive and require further studies. We investigated whether carriage of a specific genotype and/or allele of vitamin D receptor gene (VDR) FokI polymorphism (rs2228570) was a risk factor for LBP in athletes of different sports disciplines. Methods: This genotype/phenotype association case-control study included 60 Italian athletes (25 females and 35 males; mean age 33.9 \ub1 13.3 years; body-mass-index 23.5 \ub1 3.5 kg/m2) of which 16.7% were swimmers, 11. 7% soccer players, 11.7% volleyball players, 10.0% rugby players and other disciplines. VDR-FokI polymorphism was measured by PCR-RFLP in 24 athletes with LBP and 36 athletes without LBP episodes. Absence or presence of the FokI restriction site was denoted \u201cF\u201d and \u201cf\u201d, respectively. Other risk factors were evaluated by a questionnaire. Results: The homozygous FF genotype was found in 58.3% (14/24) of athletes with LBP versus 27.8% (10/36) of athletes without LBP, adjusted OR = 5.78, 95% CI 1.41\u201323.8, P = 0.015. The F allele was a 2-fold risk factor to develop LBP, adjusted OR = 2.55, 95% CI 1.02\u20136.43, P = 0.046, while f allele was protective. Exposure to vehicle vibrations 652 h daily, and family history of lumbar spine pathology were significant risk factors for LBP with OR=3.54, and OR=9.21, respectively. Conclusions: This is the first study in which an association between VDR-FokI polymorphism and LBP in athletes was found. Further research is needed to extend our results, and to clarify the biochemical pathways associated with how vitamin D modulates LBP in athletes. The VDR-FokI polymorphism should be considered when developing genetic focused studies of precision medicine on health in athletes