Assessment Of Men Research Articles

Factors Associated with Men's Assessment of Prostate Cancer Treatment Choice.

The objective of this study is to examine factors among a group of African American and White men in North Carolina and their assessment of prostate cancer treatment choice or belief that treatment chosen was best. A sample of men (N = 877) with a history of prostate cancer diagnosis was recruited from the North Carolina Cancer Registry during 2007-2008 and asked to participate in a telephone interview covering several measures about their initial prostate cancer treatment. Logistic regression was used to assess demographic, psychosocial, and clinical factors on whether they felt that they had chosen the best treatment for the disease. Respondents were majority White (52.7 %), married (75.9 %), and had surgery (67.9 %) as their initial treatment. At the bivariate level, factors associated with the belief that the treatment chosen was best were as follows: White race/ethnicity, higher levels of education, a more recent treatment date, having health insurance coverage, type of treatment received, higher levels of bother from side effects, greater contentment with their quality of life, and doctor discussions of the various treatment options. Similarly, the multivariate analysis showed increased odds of belief that the treatment chosen was the best among demographic (i.e., race/ethnicity, level of education, and health insurance coverage) as well as psychosocial and clinical variables (i.e., greater bother from side effects, greater contentment with their quality of life, and initial treatment received). Results suggest that demographic, psychosocial, and clinical factors play an important role for men in assessing their treatment choices for prostate cancer.

PD34-09 COMPARISON OF PATHOLOGIC OUTCOMES IN MEN WITH FAVORABLE-RISK PROSTATE CANCER UNDERGOING DELAYED SURGERY AFTER ACTIVE SURVEILLANCE VERSUS IMMEDIATE SURGERY

You have accessJournal of UrologyProstate Cancer: Localized IV1 Apr 2015PD34-09 COMPARISON OF PATHOLOGIC OUTCOMES IN MEN WITH FAVORABLE-RISK PROSTATE CANCER UNDERGOING DELAYED SURGERY AFTER ACTIVE SURVEILLANCE VERSUS IMMEDIATE SURGERY Jeffrey Tosoian, Debasish Sundi, Bruce Trock, Patricia Landis, Jonathan Epstein, Edward Schaeffer, Mufaddal Mamawala, and H. Ballentine Carter Jeffrey TosoianJeffrey Tosoian More articles by this author , Debasish SundiDebasish Sundi More articles by this author , Bruce TrockBruce Trock More articles by this author , Patricia LandisPatricia Landis More articles by this author , Jonathan EpsteinJonathan Epstein More articles by this author , Edward SchaefferEdward Schaeffer More articles by this author , Mufaddal MamawalaMufaddal Mamawala More articles by this author , and H. Ballentine CarterH. Ballentine Carter More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2245AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Long-term survival data comparing men in active surveillance (AS) to those undergoing surgery are limited. Prior studies of surgical outcomes that compare men undergoing delayed surgery in AS to those undergoing immediate surgery are biased by assessment of men in AS whose surgery was triggered by reclassification. Utilizing a unique population of men in AS that elected to undergo radical prostatectomy (RP) in the absence of reclassification, we compared pathological outcomes from a representative AS cohort to men who underwent immediate RP. METHODS Of 1,298 men on AS with favorable-risk (very low risk [VLR] or low risk [LR]) prostate cancer, 516 (39.8%) have been reclassified by grade and/or extent of cancer and 782 (60.2%) were not reclassified. We identified 57 men who initiated AS but subsequently elected RP in the absence of reclassification. These men provided unique pathologic data from an AS population typically excluded from outcome studies (i.e. patients without reclassification, 60% of AS cohort). Outcomes were combined with 38 men who were reclassified prior to surgery to compose a delayed RP (DRP) cohort representative of the overall AS population (i.e. 60% non-reclassified, 40% reclassified; including 6.5% by grade, 21.9% by volume, 11.6% by grade + volume). Pathology was compared with favorable-risk men who elected immediate RP (IRP) during the study period. The primary outcome was adverse pathology associated with increased prostate cancer-specific mortality, defined as primary Gleason pattern 4 or 5, seminal vesicle invasion, or positive lymph nodes. RESULTS There were no differences in the DRP sample and the overall AS cohort in terms of age, PSA density, and proportion of men with LR (28.4%) and VLR (71.6%) cancer (all p>0.05). Comparison of the DRP and IRP groups demonstrated a similar proportion of men with adverse pathology (23.1% vs. 21.3%, p=0.70). After adjustment for age, PSA density, number of positive biopsy cores, and percent core involvement, the odds ratio for adverse pathology in the DRP group after a median delay to surgery of 2.0 years (range 0.1-9.0) was 1.41 (95% CI 0.81-2.89, p=0.19) as compared to the IRP group. CONCLUSIONS Even considering the risk of reclassification during AS, carefully monitored men with favorable-risk prostate cancer are no more likely to demonstrate adverse features associated with prostate cancer death 15 years after surgery. These data suggest that long term outcomes with AS will be similar to outcomes of men undergoing immediate treatment. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e757-e758 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jeffrey Tosoian More articles by this author Debasish Sundi More articles by this author Bruce Trock More articles by this author Patricia Landis More articles by this author Jonathan Epstein More articles by this author Edward Schaeffer More articles by this author Mufaddal Mamawala More articles by this author H. Ballentine Carter More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Analysis of over-the-counter medicines use among nursing students.

The use of over-the-counter (OTC) medication is widespread among the adult and student populations in Slovenia. The aim of the study was to analyse the prevalence of OTC medicines use among nursing students with respect to sociodemographic characteristics. A total of 241 nursing students in the Faculty of Health Sciences, Ljubljana, were included in the cross-sectional study. A questionnaire was created for the purposes of the study. Statistical analysis was performed with SPSS 20. Descriptive statistics, t-test and the contingency coefficient were calculated. Statistical significance was set at the p-value of < 0.05. The study showed that the use of prescription drugs was significantly higher in women (p = 0.029), students living in rural areas (p = 0.005) and students who described themselves as being of bad health (p = 0.008). At the same time, a third of the respondents had been taking one OTC medicine within the last month; those taking several prescription drugs commonly administered several over-the-counter medicines (p = 0.027). Women used OTC medicines to treat pain and fever (p = 0.001), respiratory issues (p = 0.015), and fungal infections (p < 0.000) more often than men. OTC medicines were also used to treat minor mental health issues by a higher proportion of respondents over 21 years of age (p = 0.005) and women (p < 0.000), while over-the-counter medicines for treating skin conditions were more frequently used in rural areas (p = 0.006). Nursing students tend to use OTC medicines on their own accord, receiving instructions for safe use with their purchase, which points to adequate promotion of safe use of medications in Slovenia. Men's assessment of their personal health tends to be better than that of women, who also use medication more frequently. A connection between poor health and a higher incidence of the use of OTC medicines was established. The use of OTC medicines to treat minor mental health issues increased with age and was more typical of women. The results obtained demonstrate the importance of personal control over the safe use of medicines, motivation for personal good health and a healthy lifestyle.

Application of guidelines to the evaluation of the male patient with urgency and/or incontinence.

To review and evaluate the evidence from contemporary evidence-based guidelines regarding the assessment of men with urinary urgency and/or incontinence. There are a number of evidence-based guidelines which describe the pathways for assessing men with the symptoms of urgency and/or incontinence. We summarize the conclusions of the European Association of Urology, American Urological Association and National Institute of Clinical Excellence guidelines. All guidelines recommend a directed history, examination (including digital rectal examination), urinalysis and bladder diary as being essential in the assessment of men with lower urinary tract symptoms, although there are no high levels of evidence studies to support this. Creatinine estimation and prostate-specific antigen are recommended in selected groups of men, the latter after appropriate counselling. Uroflowmetry with postvoid residual assessment is recommended for at specialist assessment. Pad tests may be useful to quantify leakage. Ultrasound assessment of prostatic size and protrusion into the bladder base may be useful. Cystometry is recommended for men considering prostatic surgery, although there is a poor level of evidence underpinning this. Noninvasive surrogates for cystometry, such as penile plethysmography, lack sufficient evidence to allow recommendations to be made.

A Prospectively-Designed Study to Determine the Association of a 17-Gene Genomic Prostate Score with Recurrence Following Surgery for Localised Prostate Cancer (Pca)

Aim: Molecular markers of tumor aggressiveness can improve risk assessment for men with PCa. A large, racially diverse cohort of men (21% African-American -AA) with PCa in the Center for Prostate Disease Research multi-center national database was used to determine the association of the Oncotype DX® Genomic Prostate Score (GPS) with recurrence following radical prostatectomy (RP) for localized PCa. Methods: Archival biopsy specimens from 431 eligible men treated with RP for NCCN very low, low or intermediate risk PCa from 1990-2011 at 2 U.S. military medical centers were tested to validate the association between GPS and recurrence following RP, and adverse pathology (AP) at RP. Biochemical recurrence (BCR) was defined as 2 successive PSA levels > 0.2 ng/mL or initiation of salvage therapy for a rising PSA. AP was defined as high-grade (primary Gleason pattern 4 or any pattern 5) and/or pT3 disease. RPs were centrally reviewed by a uropathologist (IAS). Cox proportional hazards and logistic regression models were used. Results: GPS (scale 0-100) was successfully obtained in 402 cases (93%). 62 men (15%) experienced BCR, 5 developed metastases (MR) and 163 had AP at RP. In univariate analysis, PSA, biopsy GS and NCCN risk group were associated with BCR, but race was not. GPS was predictive of time to BCR by univariate analysis (HR/20 GPS units = 2.9; 95% CI: 2.0-4.2; p < 0.001), and after adjusting for age, NCCN risk group, and race ((HR/20 units = 2.7; p < 0.001). The gene groups in GPS most strongly associated with BCR included androgen signaling and stromal response genes. GPS was predictive of time to MR (HR/20 units = 3.8; p = 0.032). GPS was strongly associated with AP - OR/ 20 units = 3.3 (95% CI: 2.1–5.1; p < .001) and high-grade disease - OR/20 units = 2.5 (95% CI: 1.6–4.0; p < .001), adjusted for NCCN risk group. GPS values were similar between AA and Caucasians, and similarly predictive of disease outcome. Conclusions: GPS is a significant independent predictor of BCR, MR and AP in men treated with RP for localized PCa. Tumor aggressiveness, as measured by GPS, and clinical outcomes were similar in AA and Caucasians in this patient population with equal healthcare access.

Factors Underlying the Psychological and Behavioral Characteristics of Office of Strategic Services Candidates: The Assessment of Men Data Revisited

During World War II, the Office of Strategic Services (OSS), the forerunner of the Central Intelligence Agency, sought the assistance of clinical psychologists and psychiatrists to establish an assessment program for evaluating candidates for the OSS. The assessment team developed a novel and rigorous program to evaluate OSS candidates. It is described in Assessment of Men: Selection of Personnel for the Office of Strategic Services (OSS Assessment Staff, 1948). This study examines the sole remaining multivariate data matrix that includes all final ratings for a group of candidates (n = 133) assessed near the end of the assessment program. It applies the modern statistical methods of both exploratory and confirmatory factor analysis to this rich and highly unique data set. An exploratory factor analysis solution suggested 3 factors underlie the OSS assessment staff ratings. Confirmatory factor analysis results of multiple plausible substantive models reveal that a 3-factor model provides the best fit to these data. The 3 factors are emotional/interpersonal factors (social relations, emotional stability, security), intelligence processing (effective IQ, propaganda skills, observing and reporting), and agency/surgency (motivation, energy and initiative, leadership, physical ability). These factors are discussed in terms of their potential utility for personnel selection within the intelligence community.

AB1051 Arthro-Perception: Predictors of Agreement between Patient and Physician's Disease Status Assessment

BackgroundJoint counts performed by the rheumatologist, included in indices such as DAS (Disease Activity Score), are the main measure of disease activity in patients with Rheumatoid Arthritis (RA) and Psoriatic...

Assessment of BPH/BOO.

The assessment of men with bladder outflow obstruction relies on an adequate history and examination. Uroflowmetry and post-void residue estimation are very revealing and may be sufficient in the majority of men. The prostate-specific antigen test may be used to select men who are at a high risk of progression. In specific situations, cystometry may be required. We discuss the use of cystometry and the newer less-invasive methods of assessment that have emerged over the last few years, including ultrasound estimation of intravesical prostatic protrusion, prostatic urethra angle, detrusor wall thickness, ultrasound-estimated bladder weight, near-infrared spectroscopy and the condom catheter and penile cuff tests. Although these techniques show promise, they still require further modifications, standardization and testing in larger populations. In addition, they should be used in men where only specific questions need to be answered.

Modern evaluation of lower urinary tract symptoms in 2014

To evaluate and present the evidence for the use of different investigation modalities in men with benign prostatic hyperplasia/lower urinary tract symptoms (LUTS) in 2014. Cystometry remains the gold standard in differentiating obstructed from nonobstructed men with LUTS. Prostatic ultrasound measures such as the intravesical prostatic protrusion may be useful in counselling men before a trail without catheter or commencing α antagonists. Using a higher cut-off, the bladder thickness/weight measurement has a higher sensitivity but lower specificity and may allow men with obstruction to be excluded from requiring cystometry. These and other techniques such as near-infrared spectroscopy, penile cuff compression and computational flow modelling have shown good correlation with cystometry but still require more data, technical refinement and standardization, before they can be considered to be appropriate in routine clinical practice. The last few years have seen an increase in the data regarding less invasive methods of cystometry. Although these do not provide the same information as cystometry, they may have a role in answering specific questions and counselling men with benign prostatic hyperplasia/LUTS. The key to incorporating these techniques in the assessment of men will lie with standardization and use for specific indications.

Supplemental Material for Return to Oz: Voice Pitch Facilitates Assessments of Men’s Body Size

Supplemental Material for Return to Oz: Voice Pitch Facilitates Assessments of Men’s Body Size

Diagnosis of male incontinence

A review of the diagnosis of male urinary incontinence, with particular reference to studies published within the last year. One of the most important studies from the last year is the drafting of a bladder diary, consistent with the International Consultation on Incontinence modular Questionnaire modules. Patients and clinicians have been consulted on content and format, and further phases are intended to test validity and reliability of the diary. Initial assessment of men with incontinence involves a focussed history, examination and simple investigations. It is imperative to accurately define terminology of lower urinary tract symptoms. Questionnaires and bladder diaries are important adjuncts. Further urodynamic assessment may also aid diagnosis, particularly in situations where surgery is contemplated.

The role of uroflowmetry in the assessment and management of men with lower urinary tract symptoms – revisiting the evidence

Uroflowmetry is variably used for the assessment of men with lower urinary tract symptoms (LUTS). There is discrepancy in practice guidelines regarding recommendations for use of uroflowmetry in the initial assessment of men with LUTS. To explain this discrepancy, we systematically reviewed relevant literature to detail currently available evidence and identify evidence gaps requiring further research. PubMED, EMBASE and Medline literature databases were searched for the period between January 1970 and July 2012 to identify articles pertaining to uroflowmetry and outcomes of treatment for men with LUTS. We identified 30 studies for inclusion – none of which had a randomised design. The majority of the studies were prospective or retrospective cohort studies with some cross-sectional and observational reports. The methodology of measurement and reporting urine flow rate has been standardised by reports from the International Continence Society. The current available literature on the reproducibility of urine flow rate is inconclusive and suggests that there may be variability between measurements for a number of different reasons and that repeated tests could be of value clinically. There is also general agreement that a Qmax cut-off of 10 ml/s−1 is suggestive of bladder outlet obstruction. Despite guideline recommendations, there remains a lack of high-quality evidence from studies with robust design to fully ascertain the clinical utility of uroflowmetry and its place in the care pathway for men with LUTS. Future well-designed studies should focus on this evidence gap.

Effect of finite element model loading condition on fracture risk assessment in men and women: The AGES-Reykjavik study

Proximal femoral (hip) strength computed by subject-specific CT scan-based finite element (FE) models has been explored as an improved measure for identifying subjects at risk of hip fracture. However, to our knowledge, no published study has reported the effect of loading condition on the association between incident hip fracture and hip strength. In the present study, we performed a nested age- and sex-matched case–control study in the Age Gene/Environment Susceptibility (AGES) Reykjavik cohort. Baseline (pre-fracture) quantitative CT (QCT) scans of 5500 older male and female subjects were obtained. During 4–7years follow-up, 51 men and 77 women sustained hip fractures. Ninety-seven men and 152 women were randomly selected as controls from a pool of age- and sex-matched subjects. From the QCT data, FE models employing nonlinear material properties computed FE-strength of the left hip of each subject in loading from a fall onto the posterolateral (FPL), posterior (FP) and lateral (FL) aspects of the greater trochanter (patent pending). For comparison, FE strength in stance loading (FStance) and total femur areal bone mineral density (aBMD) were also computed. For all loading conditions, the reductions in strength associated with fracture in men were more than twice those in women (p≤0.01). For fall loading specifically, posterolateral loading in men and posterior loading in women were most strongly associated with incident hip fracture. After adjusting for aBMD, the association between FP and fracture in women fell short of statistical significance (p=0.08), indicating that FE strength provides little advantage over aBMD for identifying female hip fracture subjects. However, in men, after controlling for aBMD, FPL was 424N (11%) less in subjects with fractures than in controls (p=0.003). Thus, in men, FE models of posterolateral loading include information about incident hip fracture beyond that in aBMD.

Chirurgie cosmétique de l’appareil génital masculin

To describe the indications and results of techniques to change the appearance of the penis for aesthetic reasons. Provide recommendations concerning cosmetic surgery of the male genitalia. We have selected from Medline Database, articles published between 1990 and 2011. Forty articles have been selected excluding papers reporting populations less than five cases per type of procedure. There is no consensus on the size below which it is justifiable to accept or attempt to modify the size of the penis. Length of the penis in maximal tension less than 9.5 cm or 10 cm in erection can be considered as an acceptable limit, in a patient who suffers from it. The assessment of men asking for penile enlargement must include a psychosexological or psychiatric evaluation, looking for a dysmorphophobia or another psychiatric condition. Penile extenders under medical control must be the first-line treatment option for patient seeking penile lenghtening procedure when justified. In case of failure, three techniques can be used alone or in combination: penile lengthening by section of the suspensory ligaments and suprapubic skin advancement, lipectomy of Mons pubis and scrotal webbing section. The results are modest, the rate of complications significant and satisfaction low. Girth enlargement techniques by injection of autologous fat give inconsistent aesthetic results and satisfaction rates are low. All other techniques remain experimental. Cosmetic surgery of the penis is associated with a high risk of forensic exposure and surgery should be only proposed after a multidisciplinary consensus, followed by a time of reflection given to the patient after full disclosure. Applications for the purpose of reconstruction surgery after trauma or consequences of cancer treatment are justified.

The diagnostic value of clinical examination and imaging used as part of an age-related protocol when diagnosing male breast disease: An audit of 1141 cases from a single centre

Triple assessment in men varies, possibly in response to currently published non-specific guidance. The study aims to assess the efficacy of triple assessment as part of an age related protocol currently used in the clinical setting.1141 referrals between 01.01.01 and 31.12.09 were evaluated. Patient age ranged from 29 to 89 years. Mammography (M) was performed in men ≥35years. Sensitivity for clinical examination (CE) was 64.0%, M 77.8%, US 92.0%. 25 cancers were diagnosed, 24 aged >40years, 1 aged 29. 2 presented with nipple discharge. The cancer <40years was diagnosed with CE and US, all others had suspicious CE and/or M necessitating US and biopsy.We suggest a protocol incorporating mammography in men ≥40years would capture all cancers. Combined specificities approaching 100% suggest men >40 years scored benign after CE and M warrant no further assessment. Bloody nipple discharge is a suspicious sign and the reassurance of non-bloody discharge should be treated with caution.

Erectile dysfunction severity as a risk marker for cardiovascular disease hospitalisation and all-cause mortality: a prospective cohort study.

Erectile dysfunction is an emerging risk marker for future cardiovascular disease (CVD) events; however, evidence on dose response and specific CVD outcomes is limited. This study investigates the relationship between severity of erectile dysfunction and specific CVD outcomes. We conducted a prospective population-based Australian study (the 45 and Up Study) linking questionnaire data from 2006-2009 with hospitalisation and death data to 30 June and 31 Dec 2010 respectively for 95,038 men aged ≥45 y. Cox proportional hazards models were used to examine the relationship of reported severity of erectile dysfunction to all-cause mortality and first CVD-related hospitalisation since baseline in men with and without previous CVD, adjusting for age, smoking, alcohol consumption, marital status, income, education, physical activity, body mass index, diabetes, and hypertension and/or hypercholesterolaemia treatment. There were 7,855 incident admissions for CVD and 2,304 deaths during follow-up (mean time from recruitment, 2.2 y for CVD admission and 2.8 y for mortality). Risks of CVD and death increased steadily with severity of erectile dysfunction. Among men without previous CVD, those with severe versus no erectile dysfunction had significantly increased risks of ischaemic heart disease (adjusted relative risk [RR] = 1.60, 95% CI 1.31-1.95), heart failure (8.00, 2.64-24.2), peripheral vascular disease (1.92, 1.12-3.29), "other" CVD (1.26, 1.05-1.51), all CVD combined (1.35, 1.19-1.53), and all-cause mortality (1.93, 1.52-2.44). For men with previous CVD, corresponding RRs (95% CI) were 1.70 (1.46-1.98), 4.40 (2.64-7.33), 2.46 (1.63-3.70), 1.40 (1.21-1.63), 1.64 (1.48-1.81), and 2.37 (1.87-3.01), respectively. Among men without previous CVD, RRs of more specific CVDs increased significantly with severe versus no erectile dysfunction, including acute myocardial infarction (1.66, 1.22-2.26), atrioventricular and left bundle branch block (6.62, 1.86-23.56), and (peripheral) atherosclerosis (2.47, 1.18-5.15), with no significant difference in risk for conditions such as primary hypertension (0.61, 0.16-2.35) and intracerebral haemorrhage (0.78, 0.20-2.97). These findings give support for CVD risk assessment in men with erectile dysfunction who have not already undergone assessment. The utility of erectile dysfunction as a clinical risk prediction tool requires specific testing.

Management of recalcitrant urethral strictures with self-dilatation balloon catheter

Urethral strictures constitute a significant clinical problem that often requires long-term management. To report the long-term outcomes of adjuvant home self-urethral dilatation of recurrent urethral strictures using a balloon catheter. Male patients (N = 11), performing self-dilatation with a balloon catheter (minimum 24 months) were assessed by patient-reported outcome measures (PROMs) health questionnaire specific for post treatment assessment of men with urethral stricture disease. Median duration of balloon catheter use is 46.5 months, IQR (24-150). Patients performed self-balloon dilatation on average 1.4 times a week, median 1, IQR (1-2) to maintain the patency of their urethra. The mean PROMs LUTS score of the patients was 2.45, median 2, IQR (1-4). The median and mean Peeling score was 2 IQR (1-2). 100 % patient reported that they either very satisfied or satisfied with the overall outcome and QoL. Our initial experience of outpatient self-dilatation with a balloon dilatation is encouraging and is an acceptable inexpensive and simple treatment for patient maintains urethral patency and potentially decreases stricture recurrence.

HIV Health Center Affiliation Networks of Black Men Who Have Sex With Men

In the United States, black men who have sex with men (BMSM) are at highest risk for HIV infection and are at high risk for limited health service utilization. We describe HIV health center (HHC) affiliation network patterns and their potential determinants among urban BMSM. The Men's Assessment of Social and Risk Network instrument was used to elicit HHC utilization, as reported by study respondents recruited through respondent-driven sampling. In 2010, 204 BMSM were systematically recruited from diverse venues in Chicago, IL. A 2-mode data set was constructed that included study participants and 9 diverse HHCs. Associations between individual-level characteristics and HHC utilization were analyzed using Multiple Regression Quadratic Assignment Procedure. Visualization analyses included computation of HHC centrality and faction membership. High utilization of HHCs (45.9%-70.3%) was evident among BMSM, 44.4% who were HIV infected. Multiple Regression Quadratic Assignment Procedure revealed that age, social network size, and HIV status were associated with HHC affiliation patterns (coeff., 0.13-0.27; all P < 0.05). With the exception of one HHC, HHCs offering HIV prevention services to HIV-infected participants occupied peripheral positions within the network of health centers. High-risk HIV-uninfected participants affiliated most with an HHC that offers only treatment services. Subcategories of BMSM in this sample affiliated with HHCs that may not provide appropriate HIV prevention services. Using 2-mode data, public health authorities may be better able to match prevention services to BMSM need; in particular, HIV prevention services for high-risk HIV-uninfected men and HIV "prevention for positives" services for HIV-infected men.

Resistive Index of Prostate Capsular Arteries: A Newly Identified Parameter to Diagnose and Assess Bladder Outlet Obstruction in Patients with Benign Prostatic Hyperplasia

We evaluated the association of the resistive index of the prostate capsular arteries and bladder outlet obstruction severity in men with benign prostatic hyperplasia. A total of 74 patients histologically diagnosed with benign prostatic hyperplasia were ultimately enrolled in this prospective study. Urodynamics were performed by a urologist to determine bladder outlet obstruction. Baseline parameters measured in patients with benign prostatic hyperplasia were the prostate capsular artery resistive index, International Prostate Symptom Score, quality of life score, total prostate and transition zone volume, and the transition zone index. ROC curves were produced to calculate the ROC AUC and evaluate the diagnostic performance of the prostate capsular artery resistive index, International Prostate Symptom Score, obstructive symptoms, total prostate and transition zone volume, and the transition zone index for bladder outlet obstruction. Significant difference between patients with and without bladder outlet obstruction was observed in the resistive index, which showed the highest coefficient with the degree of obstruction (r = 0.712, p <0.0001). At a cutoff of 0.69 the resistive index distinguished patients with and without bladder outlet obstruction with 78% sensitivity and 86.4% specificity. The prostate capsular artery resistive index had the maximum AUC of 0.823. The prostate capsular artery resistive index is significantly higher in patients with benign prostatic hyperplasia related bladder outlet obstruction than in those without such obstruction. The resistive index might serve as a novel indicator to diagnose and assess bladder outlet obstruction in patients with benign prostatic hyperplasia.

Association of prostate‐specific antigen doubling time and cancer in men undergoing repeat prostate biopsy

To analyze the association between prostate-specific antigen doubling time with prostate cancer risk and grade among men with prostate-specific antigen levels ≥4.0 ng/mL undergoing repeat prostate biopsy. A total of 286 patients with prostate-specific antigen ≥4 ng/mL and available prostate-specific antigen doubling time data, who underwent repeat prostate biopsy from 1996-2009, were included in this analysis. Prostate-specific antigen doubling time was divided into three groups: >9 years, 3-9 years and <3 years. Multivariate analyses of prostate-specific antigen doubling time with cancer risk and grade (≤3 + 4 vs ≥4 + 3) were carried out using logistic regression adjusting for prebiopsy prostate-specific antigen, race, age, digital rectal examination, year of biopsy and number of prior negative biopsies. The median prostate-specific antigen doubling time before biopsy was 4.5 years (interquartile range = 2.5-10). Shorter prostate-specific antigen doubling time was associated with higher prostate-specific antigen (P < 0.001), but it was unrelated to age, digital rectal examination or race. Shorter prostate-specific antigen doubling time as a continuous variable was associated with greater prostate cancer risk in both uni- (hazard ratio = 0.99, 95% confidence interval = 0.98-0.99, P = 0.001) and multivariate analysis (hazard ratio = 0.99, 95% confidence interval = 0.98-0.99, P = 0.004). The prevalence of cancer among prostate-specific antigen doubling time groups (>9, 3-9, <3 years) was 17%, 37% and 40%, respectively. Shorter prostate-specific antigen doubling time groups were associated with higher cancer risk (P = 0.001). Stratified by grade, short prostate-specific antigen doubling time as a continuous variable significantly predicted both low- (P = 0.010) and high-grade disease (P = 0.049). The inclusion of prostate-specific antigen doubling time groups in a multivariate model to predict biopsy positivity increased its accuracy from 0.69 to 0.74. Prostate-specific antigen doubling time seems to provide further cancer risk assessment in men undergoing repeat biopsy for prostate-specific antigen ≥4.0 ng/mL. If validated in future studies, the present findings support the use of prostate-specific antigen doubling time in the risk stratification of this patient population.