Urology News
Risk Profiles and Treatment Patterns Among Men Diagnosed as Having Prostate Cancer and a Prostate-Specific Antigen Level Below 4.0 ng/mL
Despite controversy over the benefit of prostate-specific antigen (PSA) screening, little is known about risk profiles and treatment patterns in men diagnosed as having prostate cancer who have a PSA value less than or equal to 4.0 ng/mL. This study found that most men diagnosed as having prostate cancer with a PSA threshold below 4.0 ng/mL had low-risk disease but underwent aggressive local therapy. Lowering the biopsy threshold but retaining our inability to distinguish indolent from aggressive cancers might increase the risk of overdiagnosis and overtreatment.
Black Men at Greater Risk of Aggressive Prostate Tumors
Black men are already known to be at higher risk of developing prostate cancer than white men, but now a new study reports that they also appear to be more likely to develop aggressive forms of the disease.Researchers analyzed biopsies from 131 men -- 67 blacks and 64 whites -- whose prostates were removed at the Durham Veterans Affairs Medical Center in North Carolina. The investigators found signs that the black men had more aggressive forms of prostate cancer. The findings are scheduled to be released Wednesday at American Urological Association annual meeting in San Francisco.
Doxazosin as a Medical Expulsive Therapy of Distal Ureteric Stones in a Randomized Clinical Trial
This articel assessed the clinical efficacy of doxazosin as the medical-expulsive therapy for distal ureterolithiasis. A total of 65 patients with a symptomatic 4-7 mm distal ureteral stone were included in the study. Patients were randomized to 1 of the 2 treatment groups. Group 1 (n = 32 patients) was the control group and received diclofenac sodium 50 mg for their pain and group 2 (n = 33 patients) received doxazosin (2 mg daily at the night) along with diclofenac sodium 50 mg. Stone expulsion rate was significantly higher in the treatment group (38% for group 1 and 70% for group 2, P = .009) while the expulsion time was significantly lesser in group 2 patients (P = .005).
Association of Body Mass Index With Prostate Cancer Biochemical Failure
The association between obesity and biochemical failure measured by prostate specific antigen after prostate cancer treatment is controversial. An article in the Journal of Urology determined whether there is an association between body mass index and biochemical failure in men treated for low and intermediate risk prostate cancer with various treatment modalities.
There was a significant association with biochemical failure when comparing normal vs overweight and normal vs obese men but not overweight vs obese men. Overall a significant association between body mass index and biochemical failure on univariate analysis that did not hold true on multivariate analysis was found. Black race was associated with biochemical failure on multivariate analysis. The reason for this is unclear. Future studies should further characterize the relationship between race and biochemical failure.
Is statin use associated with prostate cancer aggressiveness?
To further examine the association between statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) and pathological features in a large group of patients undergoing radical prostatectomy (RP), as epidemiological studies have suggested that statins, in addition to their beneficial cardiovascular effects, might reduce the risk of aggressive prostate cancer.From 2003 to 2009, 1351 men with data on preoperative statin use had RP by one surgeon. The clinical and pathological tumour features were compared between 504 users of statins and 847 who were not users.The preoperative serum prostate-specific antigen levels, tumour volume and percentage of cancer in the RP specimen were significantly lower in patients taking statins. Overall, statin users had a proportionately lower rate of adverse tumour pathology features, including a significantly lower risk of positive (cancerous) surgical margins.
Effect of Dutasteride on the Risk of Prostate Cancer
A study published in this weeks New England Journal of Medicine conducted a study to determine whether dutasteride reduces the risk of incident prostate cancer, as detected on biopsy, among men who are at increased risk for the disease. In this 4-year, multicenter, randomized, double-blind, placebo-controlled, parallel-group study, we compared dutasteride, at a dose of 0.5 mg daily, with placebo. Among 6729 men who underwent a biopsy or prostate surgery, cancer was detected in 659 of the 3305 men in the dutasteride group, as compared with 858 of the 3424 men in the placebo group, representing a relative risk reduction with dutasteride of 22.8%. Over the course of the 4-year study period, dutasteride reduced the risk of incident prostate cancer detected on biopsy and improved the outcomes related to benign prostatic hyperplasia.
Serum testosterone is associated with aggressive prostate cancer in older men: results from the Baltimore Longitudinal Study of Aging
An Article in the British Journal of Urology evaluated the relationship between testosterone levels and the development of high-risk prostate cancer, by prospectively examining serum androgen concentrations in a well-studied cohort, as the role of testosterone in prostate cancer progression is debated. The study comprised 781 men in the Baltimore Longitudinal Study of Aging who had sex steroid measurements before a diagnosis of prostate cancer, or at their last visit for those without cancer. The likelihood of high-risk prostate cancer doubled per unit (0.1) increase in the free testosterone index (FTI) for patients aged >65 years and concluded that higher levels of serum free testosterone are associated with an increased risk of aggressive prostate cancer among older men. These data highlight the importance of prospective trials to insure the safety of testosterone-replacement therapy.
Initial Prostate Specific Antigen 1.5 ng/ml or Greater in Men 50 Years Old or Younger Predicts Higher Prostate Cancer Risk
Screening with PSA has been widely used to detect PCa for 2 decades but it continues to be controversial. The results of 2 large randomized, controlled trials were recently released but due to conflicting results the usefulness of PSA screening for decreasing PCa mortality remains hotly debated. A study out of the Journal of Urology showed a median prostate specific antigen in black and white men was 0.7 ng/ml at age 50 years or less. The prostate cancer rate was not significantly different in the groups with prostate specific antigen less than 0.6 and 0.7 to 1.4 ng/ml in black or white men. Black and white men with initial prostate specific antigen in the 1.5 to 2.4 ng/ml range had a 9.3 and 6.7-fold increase in the age adjusted prostate cancer RR, respectively. At up to 9 years of followup initial prostate specific antigen 1.5 ng/ml or greater was associated with gradually increased detection at followup in black and white men.
Flomax Helps Pass Kidney Stones
A total of 100 patients with stones sized 10 mm or smaller, located in the distal part of the ureter were included. Patients were randomly assigned to 2 equal groups. Group 1 received 0.4 mg tamsulosin once daily and group 2 received placebo. The investigators and the patients were masked to the type of treatment. Patients were followed-up until passage of the stone, or for a maximum of 4 weeks. Apart from 4 patients in the placebo group who were lost to follow-up, all patients complied with the prescribed medications and continued the study. Stone expulsion occurred in 41 of 50 patients (82%) in group 1 and in 28 of 46 patients (61%) in group 2 (P = .02). The chance of stone expulsion was 3 times higher in the tamsulosin group. Urology
.Gastric Banding Doesn't Increase Kidney Stone Disease
Bariatric surgical procedures are being increasingly utilized in the treatment of patients with morbid obesity. Certain malabsorptive bariatric procedures have been associated with an increased risk for kidney stone formation. However, the kidney stone risk of gastric banding, a restrictive bariatric procedure, is unknown. After gastric banding, the diagnosis of an upper urinary tract calculus occurred in 3 subjects (1.49%), as compared with 12 subjects (5.97%) in the comparison cohort (P = .0179). Overall it was shown that Gastric banding is not associated with an increased risk for kidney stone disease or kidney stone surgery in the postoperative period.
Hormonal Therapy Use for Prostate Cancer Increases Mortality in Men With Coronary Artery Disease
JAMA Abstract
Hormonal therapy (HT) when added to radiation therapy (RT) for treating unfavorable-risk prostate cancer leads to an increase in survival except possibly in men with moderate to severe comorbidity. However, it is unknown which comorbid conditions eliminate this survival benefit. This study showed that for men with CAD-induced CHF or MI, after a median follow-up of 5.1 years, neoadjuvant HT use was significantly associated with an increased risk of all-cause mortality (26.3% vs 11.2%, adjusted HR, 1.96; 95% CI, 1.04-3.71; P = .04).
Sound Waves Treat Prostate Cancer With Fewer Side Effects
An Experimental cancer therapy for prostate cancer may be able to treat men without surgery and offer fewer side effects according to the results of a UK study published in the British Journal of Cancer* today (Wednesday).
Botulinum treatment improves quality of life in patients with idiopathic overactive bladder
Injection of botulinum toxin A (Botox) is associated with improvement in patient-reported quality of life in the treatment of idiopathic overactive bladder, the authors of a 36-week, multinational, multicenter study reported at the AUA annual meeting.
Postoperative PSA measures separate prostate cancer and BPH patients
Prostate cancer patients can be distinguished from those with histologic benign prostatic hyperplasia (BPH) using postoperative prostate-specific antigen (PSA) levels and velocity, conclude US researchers.
