Serum levels of Sex hormone Binding globulin (ShBg) are not predictive of prostate cancer diagnosis and aggressiveness: results from an italian biopsy cohort

Purpose To explore the association between serum levels of Sex Hormone Binding Globulin (SHBG) and the risk of developing prostate cancer (PCa) as well as high grade disease in men undergoing prostate biopsy. Materials and Methods Between 2006 and 2012, we prospectively enrolled 740 patients with no history of PCa undergoing prostate biopsy. Before biopsy general data of the patient DRE, PSA and BMI were recorded. The risk of detecting cancer and high grade cancer was assessed as a function of SHBG using crude and adjusted logistic regressions. Results Serum levels of SHBG were not associated with an increased risk of PCa or high grade disease. Age (OR 1.027 95% CI 1.003-1.052 p = 0.027), DRE (OR 3.391 95% CI 2.258-5.092 p = 0.000) and PSA (OR 1.078 95% CI 1.037-1.120 p = 0.000) were found to be independent predictors of prostate cancer risk. Age (OR 1.051 95% CI 1.009-1.095 p = 0.016), DRE (OR 2.519 95% CI 1.384-4.584 p = 0.000), BMI (OR 1.098 95% CI 1.011-1.193 p = 0.027) and PSA (OR 1.074 95% CI 1.014-1.137 p = 0.015) were found to be independent predictors of high grade disease. Conclusions In our cohort of patients, serum levels of SHBG are not predictive of PCa or high grade disease. According to our experience SHBG should not be considered a biomarker in PCa diagnosis neither a marker for high grade disease

Quality of Life and Sexual Health in the Aging of PCa Survivors.

Prostate cancer (PCa) is the most common malignancy in elderly men. The progressive ageing of the world male population will further increase the need for tailored assessment and treatment of PCa patients. The determinant role of androgens and sexual hormones for PCa growth and progression has been established. However, several trials on androgens and PCa are recently focused on urinary continence, quality of life, and sexual function, suggesting a new point of view on the whole endocrinological aspect of PCa. During aging, metabolic syndrome, including diabetes, hypertension, dyslipidemia, and central obesity, can be associated with a chronic, low-grade inflammation of the prostate and with changes in the sex steroid pathways. These factors may affect both the carcinogenesis processes and treatment outcomes of PCa. Any treatment for PCa can have a long-lasting negative impact on quality of life and sexual health, which should be assessed by validated self-reported questionnaires. In particular, sexual health, urinary continence, and bowel function can be worsened after prostatectomy, radiotherapy, or hormone treatment, mostly in the elderly population. In the present review we summarized the current knowledge on the role of hormones, metabolic features, and primary treatments for PCa on the quality of life and sexual health of elderly Pca survivors

Adherence to Guidelines among Italian Urologists on Imaging Preoperative Staging of Low-Risk Prostate Cancer: Results from the MIRROR (Multicenter Italian Report on Radical Prostatectomy Outcomes and Research) Study

Objective. A number of evidence-based guidelines for diagnosis and management of prostate cancer have been published. The aim of this study is to evaluate the adherence of Italian urologists to the guidelines concerning the preoperative imaging staging of prostate cancer. Methods. In October 2007 a multicentric observational perspective study called Multicentric Italian Report on Radical prostatectomy Outcome and Research (MIRROR) was started in 135 Italian urology centers. Recruitment was closed in December 2008 and 2,408 cases were collected. In this paper we have taken into consideration all examinations carried out for preoperative imaging staging, evaluating compliance with the recommendations in the American Urological Association (AUA) and European Association of Urology (EAU) guidelines. Results. Five hundred sixty-seven (53.34%) patients were not managed according to the EAU guidelines concerning T-staging, 545 (51.27%) concerning N-staging and 757 (71.21%) concerning M-staging. According to AUA guidelines, we also analyzed patients with a Gleason grade of biopsy specimens of 7: 238 (57.35%) of these patients had undergone testing for T staging, 244 (57.35%) for N-staging and 322 (77.60%) for M-staging. Conclusions. The compliance of Italian urologists with the guidelines is low, leading to an inappropriate increase in cost of care and unnecessary anxiety for the patients

Tolterodine extended release in the treatment of male oab/storage luts: A systematic review

Overactive bladder (OAB)/ storage lower urinary tract symptoms (LUTS) have a high prevalence affecting up to 90\% of men over 80 years. The role of sufficient therapies appears crucial. In the present review, we analyzed the mechanism of action of tolterodine extended-release (ER) with the aim to clarify its efficacy and safety profile, as compared to other active treatments of OAB/storage LUTS.A wide Medline search was performed including the combination of following words: "LUTS", "BPH", "OAB", "antimuscarinic", "tolterodine", "tolterodine ER". IPSS, IPSS storage sub-score and IPSS QoL (International Prostate Symptom Score) were the validated efficacy outcomes. In addition, the numbers of urgency episodes/24 h, urgency incontinence episodes/24 h, incontinence episodes/24 h and pad use were considered. We also evaluated the most common adverse events (AEs) reported for tolterodine ER.Of 128 retrieved articles, 109 were excluded. The efficacy and tolerability of tolterodine ER Vs. tolterodine IR have been evaluated in a multicenter, double-blind, randomized placebo controlled study in 1529 patients with OAB. A 71\% mean reduction in urgency incontinence episodes was found in the tolterodine ER group compared to a 60\% reduction in the tolterodine IR (p 29 cc) only the combination therapy significantly reduced 24-h voiding frequency (2.8 vs. 1.7 with tamsulosin, 1.4 with tolterodine, or 1.6 with placebo). A recent meta-analysis evaluating tolterodine in comparison with other antimuscarinic drugs demonstrated that tolterodine ER was significantly more effective than placebo in reducing micturition/24 h, urinary leakage episodes/24 h, urgency episodes/24 h, and urgency incontinence episodes/24 h. With regard to adverse events, tolterodine ER was associated with a good adverse event profile resulting in the third most favorable antimuscarinic. Antimuscarinic drugs are the mainstay of pharmacological therapy for OAB / storage LUTS; several studies have demonstrated that tolterodine ER is an effective and well tolerated formulation of this class of treatment.Tolterodine ER resulted effective in reducing frequency urgency and nocturia and urinary leakage in male patients with OAB/storage LUTS. Dry mouth and constipation are the most frequently reported adverse events

Advanced multimodal laser imaging tool for urothelial carcinoma diagnosis (AMPLITUDE)

Bladder cancer (BC) is the eleventh most diagnosed cancer worldwide. The age-standardized incidence rate (per 100 000 person/years) is 9.0 for men and 2.2 for women [1]. Urothelial carcinoma (UC) represents about 90% of all bladder tumors, thus carrying an enormous social and economic burden [2]. UCs are classified in different stages and grades, depending on their invasiveness and on their degree of cytological abnormalities. The key aspect for a positive prognosis is the early and accurate diagnosis of the lesion stage, in order to identify the most aggressive disease forms and treat them promptly. It is well known that tissue metabolism constitutes a basic mechanism, which is at the base of many pathologies, especially BC. Being able to detect and characterize tissue metabolism and molecular fingerprints at the cellular level could be a key aspect in characterizing the pathology and enabling both early detection and therapy monitoring. The new European Union Horizon 2020 project called AMPLITUDE, the ‘Advanced Multimodal Photonics Laser Imaging Tool for Urothelial Diagnosis in Endoscopy’, starting in January 2020, proposes the development of an advanced multi-modal imaging tool exploiting new laser technologies in an approach combining confocal and non-linear imaging to fulfil unmet clinical needs in terms of the specificity and accuracy of urothelial cancer diagnosis and therapy monitoring. The project is coordinated by Tampere University (Finland) and carried out in cooperation with leading European research organizations including Aston Insitute of Photonic Technologies—AIPT (UK), Consiglio Nazionale delle Ricerche—CNR (Italy), Institute of Photonic Sciences—ICFO (Spain), University of Milan-Bicocca, Modus Research and Innovation Ltd. (UK) and University of Florence (Italy), as well as industrial partners: Ampliconyx Oy (Finland), Femtonics Ltd. (Hungary), HC Photonics (Taiwan), and LEONI Fiber Optics GmbH (Germany)

What Is the Required Certainty of Evidence for the Implementation of Novel Techniques for the Treatment of Benign Prostatic Obstruction?

Peer reviewedPostprin