Abstract

We evaluated the efficacy and outcome of laser photoselective vaporization of prostate (PVP) in patients with voiding difficulty due to prostatic obstruction induced by advanced prostate cancer (PC). We retrospectively studied the records of 13 patients with advanced PC and prostatic obstruction with a mean prostate volume of 65.0 ml. All of the 13 patients received PVP between 2006 and 2010 due to the symptoms of voiding difficulty or acute urinary retention (AUR, N = 10) refractory to medical treatment. Perioperative safety and functional results were evaluated. Lasering time ranged from 24 to 20 minutes (mean 67 ± 26), during which 66–423 KJ (mean 172 ± 95) of laser energy was delivered. All patients could resume voiding function with a mean catheterization time of 3.0 days. Our preliminary results suggest that PVP is a safe and effective procedure for relieving prostatic obstruction without intraoperative blood transfusion, water intoxication, or other complications in patients with advanced prostate cancer.

Abstract

In the PSA era, the incidence of localized prostate cancer has been increasing. This reality requires new therapeutic strategies, in order to give an answer to patients, in whom active surveillance may be indicate but desire more interventionist strategy with minimal side effects and without compromising cancer control. In these cases, focal therapies that include irreversible electroporation may be effective alternative strategies. The irreversible electroporation is an emergent approach on focal treatment of localized PCa. The nonthermal mechanism that preserves the tissue architecture without damaging tissue structures, such as vessels and nerves within the target region, is the main advantage comparatively to other techniques used in focal treatment. The number of clinical studies is reduced and the results still immature.

Abstract

The impact of using ASA (acetylsalicylic acid), metformin and statins on the prostate cancer may be significant, but is not clear and findings from previous studies are inconsistent. This study aims to evaluate the relationship between the use of ASA, metformin and statins and the pathological characteristics and risk of biochemical recurrence (BCR) of prostate cancer. A total of 311 patients submitted to radical prostatectomy (RP) at Hospital de Braga between January 2010 and June 2014 were analyzed. Data were obtained from clinical records and the crude and adjusted association between the use of a specific drug and prostate specific antigen (PSA), pathological stage, Gleason score, positive surgical margin and risk of biochemical recurrence were calculated. Overall, 26 (8.4%) of the patients used ASA, 35 (11.3%) metformin and 112 (36%) statins. The ASA users had a lower PSA compared with the non users (5.9 vs. 8.9 ng/m, p = 0.008). Its use was an independent predictor of positive surgical margin (OR = 3.77, IC 95%: 1.45‐9.78). The use of metformin was associated with advanced pathological stages, more precisely pT3b (20% vs. 7.7%, p = 0.048). No other differences were detected between ASA, metformin and statins users. The use of ASA, metformin and statins has no beneficial effect on prostatic cancer patients. On the opposite, an association between the use of metformin and advanced pathological stages was observed. These results should be validated in other larger samples and longer follow‐up. The association between the use of ASA and lower PSA was already detected in other studies, whose mechanism should be clarified in future

Abstract

To quantify the effect of statins’ use on Prostate Specific Antigen (PSA) levels in patients referred to prostate biopsy and to determinate if the exposure to statins must be considered to improve the prostate cancer diagnostic accuracy of PSA. We selected 551 subjects with PSA <10.0 ng/mL, referred to ultrasound guided trans-rectal prostate biopsy and classified as cancer or non-cancer patients after biopsy. Information regarding statins’ use was obtained from clinical records. We used path analysis to quantify the direct (reflects the influence on PSA biology and metabolism) indirect (reflects the influence on PSA through the effect on the risk of prostate cancer) and total effects (net result of direct and indirect effects) of statins’ use on PSA. We used Receiver Operating Characteristic curves to assess the global predictive accuracy of models including PSA, age, body mass index, 5-α-reductase inhibitors, aspirin and statins’ use for distinguishing between prostate cancer and benign conditions. We observed a negative total effect of statins on PSA levels (users vs. non-users: −0.633 ng/mL, 95% CI: −1.087, −0.179), which corresponds to approximately 8.9% lower levels among statins’ users, mostly due to the direct effect (−0.588 ng/mL, 95% CI: −1.034, −0.141) rather than that by the indirect effect (−0.045 ng/mL, 95% CI: −0.152, 0.061). There were no statistically significant differences between the area under the curve corresponding to the models with or without statins (P = 0.274). In patients referred to prostate biopsy, statins’ use contributed to lower Prostate Specific Antigen levels, but the clinical impact in these patients is low.

Abstract

To evaluate the relationship between mean apparent diffusion coefficient (ADC) and post-surgical Gleason scores. To determine the diagnostic accuracy of multiparametric magnetic resonance imaging (mp-MRI) on a 1.5 T magnet in distinguishing low, intermediate and high-grade prostate tumors. This is a retrospective institutional-review-board-approved, single-center study including 30 patients (median age, 60 years) who underwent mp-MRI before prostatectomy for prostate cancer. Using histological reports for guidance, the tumors were localized in ADC maps, and mean ADCs were measured and examined for correlation with Gleason scores. 2 patients had 2 measurable foci, so a total of 32 tumors were studied. The diagnostic accuracy of the mean ADC was assessed by using the area under the receiver operating characteristic curve (ROC). In the differentiation of tumors with a Gleason score of 6 from those with a Gleason score of at least 7, mean ADC yielded an AUC of 0.76 (95% confidence interval: 0.59, 0.93). In the differentiation of tumors with Gleason scores of 6 or 7 from those with a Gleason score of at least 8, mean ADC yielded an AUC of 0.94 (95% confidence interval: 0.86, 1.00). Mean ADC values may allow a correct assessment of the patient risk using a 1.5 T magnet without ERC.