Average Prostate Volume Research Articles

The effect of tamsulosin and dutasteride combination drug therapy on prostate volume in patients with benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) is a benign enlargement of the prostatic gland. This study was conducted to measure the improvement of prostate volume after treatment with Tamsulosin and Dutasteride as a combination drug in BPH patient at RSUD Kota Mataram from February 2020 to April 2020. The data were obtained by documenting the medical records of 20 new BPH patients ultrasound before and after 2 months therapy. This study was conducted using a comparative numerical analytical research model. The analysis was carried out by paired T-test in SPSS. A total of 20 medical records observed, the mean age of the study sample was 67.4 years, with the lowest age at 56 years and the oldest were 79 years, and 85% (17) of samples are more than 60 years old. The average prostate volume pre-therapy was 51.71 cc with the lowest volume was 25 cc and the highest volume 118 cc. Average prostate volume post-therapy was 42.38 cc, with the lowest volume was 22 cc and the highest 92 cc. The ratio of prostate volume more than 40 cc at pre-therapy was 50% (10 samples), and after therapy was decreased to 40% (8 samples). There are significant difference in comparison of pre and post-therapy prostate volume.

Evaluation cut-off point of Prostate-Specific Antigen (PSA) and Prostate-Specific Antigen (PSA)-density in prostate cancer suspected patients at Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia

Background: PSA is a test performed to detect prostate cancer. There is currently no rational standard for its cut-off point, resulting in the increasing number of patients with prostate biopsy complications. This study aims to determine the estimated cut-off point of PSA and PSAD among patients with suspected prostate cancer (PCa) in Makassar.Methods: A single-center retrospective analysis using a cross-sectional design was applied in this research. The sample was obtained through medical record data from benign prostate enlargement (BPE) and PCa patients in three affiliate hospitals from January 2014 to December 2019. Mann-Whitney U, Chi-Square, Fisher's Exact, and ROC tests were performed in the statistical analysis (considered significant if p <0.05). Data were analyzed using SPSS version 22 for Windows.Results: Among 470 subjects, 88.3% were BPE patients, and 11.7% were PCa. Lower urinary tract symptoms (LUTS) were found in 70.6% of patients, and those with hematuria remained at 10.6%. The average prostate volume was 53.8±25.72 ml. The prostate consistency examination with the digital rectal examination (DRE) made up 84.3% Solid Chewy in the BPE sample and 96.4% hard solid in the PCa sample. The average PSA value in BPE was 14.82±20.1 ng/ml, and the PCa was 48.10±42.58 ng/ml, while the average PSAd BPE value was 0.287±0.40 ng/ml, and PCa was 1.19±1.32 ng/ml. PSA cut-off point was 18.62 ng/ml. PSAD cut-off point was 0.533.Conclusion: PSA and PSAD cut-off points in this study 18.62 ng/ml and 0.533. The cut-off point obtained is far higher than the value agreed upon in advance.

IL-27/IL-27RA signaling may modulate inflammation and progression of benign prostatic hyperplasia via suppressing the LPS/TLR4 pathway.

BackgroundBenign prostatic hyperplasia (BPH) is the most common urologic disease affecting aging men. The pathogenesis of BPH is multi-factorial, and chronic inflammation (CI) might be the central mechanism. Interleukin (IL)-27 signaling has been suggested as a modulator in autoimmune and inflammatory conditions. In this study, we used microarray experiments to analyze gene expression and molecular phenotypic associated with BPH progression, with a particular focus on CI and IL-27/IL-27RA signaling, and verified the microarray data in cell biology experiments.MethodsThirty BPH patients’ specimens and clinical parameters were analyzed. BPH patients were divided into two groups based on the average prostate volume (41.5 mL): group 1, ≤40 mL; and group 2, >40 mL. Microarray experiments were conducted to identify differentially expressed genes (DEGs) by applying appropriate biostatistics to normalize and analyze the dataset. The candidate gene (IL27RA) was validated by quantitative reverse transcriptase-PCR (qRT-PCR) and immunohistochemistry (IHC). The interaction of IL27RA with genes involved in canonical inflammation-associated pathways was investigated by cell biology experiments.ResultsEighty-three percent of BPH specimens contained inflammatory infiltrates, and the predominant type was CI. The serum PSA levels and prevalence of CI were higher in group 2. Microarray experiments identified 361 DEGs between these 2 groups. IL27RA was down-regulated and associated with prominent CI in BPH tissues of group 2. Validated by qRT-PCR and IHC, the results showed IL-27RA might modulate CI and progression of BPH. Thus, we investigated the interaction of IL27RA with TLR4, IL6, and IL8, which were involved in inflammation-associated pathways. We found the activation of IL-27RA after IL-27 treatment led to phosphorylation of STAT1 and STAT3 in prostate epithelial cells. By comparative treatments with lipopolysaccharide (LPS), IL-27, or combination, we found that IL-27/IL-27RA signaling suppressed the production of inflammatory cytokines, IL-6 and IL-8, induced by LPS/TLR4 pathway.ConclusionsOur study revealed that down-regulation of IL27RA in prostate tissue was associated with higher prevalence of CI and BPH progression. IL-27/IL-27RA signaling suppressed the LPS/TLR4 pathway. We conclude the IL-27/IL-27RA signaling might modulate CI and provide potential therapeutic strategies to prevent BPH progression.

Assessment of Efficiency of Transuretral Radio-wave Prostate Thermotherapy in Patients with Chronic Nonbacterial Prostatitis

Among men of working age chronic prostatitis is the most frequent urological illness, and characteristic symptoms of it are frequent reason of the urological recourse. Nowadays, there is no single universal successful therapy of chronic prostatitis. Therefore, this excuses a search for new methods of treatment of the patients with this pathology.The objective: was to evaluate the efficiency of transurethral radio wave bipolar thermotherapy (TURF) of the prostate in patients with chronic nonbacterial prostatitis with inflammatory chronic pelvic pain syndrome (CP/CPPS (NIH III A)).Materials and methods. There were 57 patients with chronic nonbacterial prostatitis under supervision, with inflammatory chronic pelvic pain syndrome (NIH IIIA), with a disease duration of more than 4 years, and low treatment efficiency on the background of standard therapy. All patients received standard therapy according to the clinical protocol. Part of the patients (Group 37) received transurethral bipolar prostate radiotherapy using the Tempro apparatus on the background of standard therapy, with subsequent comparative evaluation of clinical results relatively to the control group (20 – I group), which received only standard therapy after 3,6 and 12 months after treatment.Results. It was found that the use of transurethral radio wave bipolar thermotherapy with the Tempro system on the background of standard therapy in patients with chronic nonbacterial prostatitis with inflammatory chronic pelvic pain syndrome (CP/CPPS – NIH III A), facilitated more extended and clinical result, in contrast to the results in the group of patients who received only standard therapy. If, according to the assessment of general condition (S+QoL) in group II of patients, after 3 and 6 months after the standard course of treatment, the indicator improved by 38,9 % and 41,4 %, respectively (p<0,05), after 12 months only by 10,3 %, with no significant statistical difference with an indicator before treatment (p>0,05). Whereas in group II of patients who additionally recieved transurethral radio wave bipolar thermotherapy, the score (S+QoL) after 3 months and 6 months was 64,0 % and 68,2 %, respectively, lower than before treatment (p<0,05). After 12 months after treatment, this result remained without negative dynamics, 68,4 % below the pre-treatment index (p<0,05). Appropriate results were also obtained in a detailed assessment of the dynamics of the main symptoms 3, 6 and 12 months after treatment. Manifestations of pain, discomfort, or discomfort in typical areas returned to patients in group I 12 months after treatment, whereas in group II, such patients had a small percentage, except for discomfort over the womb in 27 % of patients. TURF has also been shown to be highly effective in the severity of the inflammatory process as a result of prostate secretion microscopy. Accordingly, after 12 months, less than 10 leukocytes in the field of view were in 35 % of patients of group I, while in group II it was – 73 %, from 11 to 20 leukocytes were in 60 % of patients – group I, and 37 % – group II. According to the TRUSD of the prostate, the median volume of the prostate 12 months after treatment in group II was 28,1 % lower than the indicator before treatment (p<0,05). If, after 3 and 6 months after treatment, the average prostate volume in group I of patients decreased significantly by 14,1 % and 11,9 % respectively, there was no statistically significant difference after 12 months (p>0,05).Conclusion. The use of transurethral bipolar radiotherapy on the background of standard therapy in patients with inflammatory CP/CPPS who are hardly succumbed to traditional therapy, is safe with long-lasting and sustained clinical effects against standard therapy.

The effectiveness of tamsulosin in Benign Prostate Hyperplasia (BPH) patients with Lower Urinary Tract Symptoms (LUTS): a multi-centre cohort retrospective study

Introduction: Lower urinary tract symptoms (LUTS) due to Benign Prostatic Hyperplasia (BPH) is a common condition in the ageing male. The first-line treatment of LUTS due to BPH is medical management with α-blockers or 5α-reductase inhibitors (5-ARIs). This study aims to analyze the effectiveness of tamsulosin to improve patients symptoms with LUTS due to BPHMethods: A cohort retrospective study was conducted among 62 respondents with BPH at dr. Soetomo Hospital and Airlangga University Hospital from 2014-2016. The data collected related to characteristics of patients were age, prostate volume, Prostate-Specific Antigen (PSA), IPSS score, IPSS voiding score, IPSS storage score, IPSS quality of life, Qmax, voided volume and post voiding residual urine (PVR). All of the data were analyzed using SPSS version 17.0 for Windows.Results: There were 62 samples with a mean age of 62.28 ± 7.3 years old. The average prostate volume was 36.09 ± 8.3 cc, and the PSA level was 2.8 ± 1.45 ng/dl. Most of the respondents were in moderate LUTS criteria (54.8%). IPSS and Qmax score significantly improved in a comparison between pre-treatment, 1 month and 3 months after treatment (p<0.01). There was no adverse event or severe side effect reported.Conclusion: Tamsulosin 0.4 mg daily resulted in statistically significant improvements of IPSS score, IPSS storage score, IPSS voiding score, IPSS Quality-of-life score, Qmax, Voided Volume and PVR through 1 month, but it also significantly improved IPSS score and uroflowmetry results in 3 months after treatment.

The application and outcomes of C. R.P.C. four-step radical prostatectomy under extraperitoneal laparoscopy

Objective To summarize the preliminary experience of extraperitoneal laparoscopic radical prostatectomy (C.R.P.C. four-step) for localized prostate cancer and the outcomes based on early follow-up. Methods A total of 102 prostate cancer patients were screened by prostate specific antigen (PSA) and diagnosed by prostate magnetic resonance imaging and prostatic puncture biopsy with cT1c-cT3b, with average age of (67±5) years old, average preoperative total PSA value of (45.32±18.33) ng/ml, and average prostate volume was (42±12)cm3. All these patients underwent extraperitoneal laparoscopic radical prostatectomy by the four-step technique, abbreviating as C. R.P.C.[C: control DVC (dorsal deep venous complex). R: recognize three anatomical layers (prostate and bladder junction, seminal vesicle, and Denonvilliers’fascia surface). P: preserve urethral sphincter and bladder neck. C: continuous anastomosis between urethra and bladder neck (4 key needles at 3, 5, 7 and 9 o’clock)]. The operative time, estimated blood loss, length of hospital stay and postoperative complications were recorded, and the postoperative PSA was followed up. Results All the 102 cases were successfully treated by laparoscopic radical prostatectomy. The operative time was from 55 to 156 min (mean 92 min), and the estimated blood loss was from 55 to 185 ml (mean 105 ml). There was no case converted of open surgery, only one case received blood transfusion for postoperative hemorrhage (0.98%), and positive surgical margin was found in 15 case (14.70%) by pathological examination. Postoperative urinary extravasation within one week occurred in 2 (1.96%) cases, and resolved after tensioning the catheter and prolonging the indwelling time. During the follow-up period of 12 to 45 months, 2 cases were incontinent (grade Ⅰ-Ⅱ), and the other cases(98.04%) had no incontinence or dysuria . However, 11 cases(10.78%) developed to biochemical recurrence within 6 months after the operation. Conclusions The C. R.P.C. four-step technique of lparoscopic radical prostatectomy is easily to be grasped and performed by the greenhand urologists, and was efficient and safe. Key words: Prostatic neoplasms; Radical prostatectomy; Extraperitoneal laparoscopy; Prostate cancer; Four-step method; Curative effect

Prostate volume as an independent predictor of results robot-assisted prostatectomy

Background. The presence of benign hyperplastic tissue does not exclude the malignant process within one prostate gland. According to various sources, almost 40 % of patients with prostate hyperplasia can be diagnosed of prostate cancer. The large adenoma seriously complicates of radical surgery, which in this group patients, is perhaps, the only effective method of treatment. The effect of prostate volume on the main criteria the effectiveness of treatment is ambiguous. Robotic technologies, introduced into clinical practice, may have the advantages of this complicated group of patients.Materials and methods. Study group (1st group): 40 patients with prostate volume ≥80cm3 (9.4 %) over the period December 2014. to December 2018. were performed robot-assisted radiсal prostatectomy. The comparison group included 54 patients with prostate volume <80 см3. The average prostate volume in 1st group was 112.2 ± 26 (80–195) cm3, in the 2nd group – 38 ± 11.2 (17–62) cm3 (p <0.001). The 1st group consists of older patients with a higher level of prostate-specific antigen (p <0.001).Results. The difference in the operation time was 18.2 min, which was statistically insignificant (p >0.05). The average volume of blood loss in the 1st group was 282.5 ± 227.5 (50–1000) ml, with 175 ± 147.2 (50–700 ml) ml in the 2nd group (р >0,02). After 12 months, 100 % of patients in the 1st group showed no relapse (prostate-specific antigen ≤0.2 ng/ml). The level of continental function was comparable of the monitoring group.Conclusion. When performing robot-assisted prostatectomy increased prostate size has no effect on operating time, but significantly increases of the blood loss. The size of the prostate may serve as an important variable to predict the functional and oncological results of treatment.

Ergonomics and musculoskeletal symptoms in surgeons performing endoscopic procedures for benign prostatic hyperplasia.

Background and purpose:Benign prostatic hyperplasia (BPH) is the most common urologic disorder affecting older men, necessitating medical or surgical intervention. Limited data exists regarding the effect these surgeries have on the endourologist’s musculoskeletal system following the surgery because of the required difficult posture, prolonged procedures, repetitive movements, and the settings of an adjustable visual display terminal workstation. The aim of our study was to survey the prevalence and possible causes of musculoskeletal disorders among endourologists performing transurethral resection of the prostate (TURP) or laser prostatectomy using either holmium laser enucleation or thulium laser enucleation.Materials and methods:An email inviting all members of the Endourological Society to participate in the survey was sent. The questionnaire included different demographic and practice characteristics, with concern regarding performing either TURP or laser prostatectomy and the incidence and type of musculoskeletal incidents following these surgeries. All responses were collected by a commercially available internet based survey host (www.surveymonkey.com) over a period of 6 weeks.Results:Of the 121 complete responses, 84 (69%) of endourologists complained of a musculoskeletal disorder following TURP or laser prostatectomy. The most frequent complaint was for neck (64%), followed by back (57%), shoulder (48%), hand (40%), and elbow (18%). The average prostate volume turned out to be the most compelling predictor for musculoskeletal disorder occurrence with an average prostate volume of 76 g operated on by the complaining group compared with 59 g in the noncomplaining group. Those with more severe symptoms were linked to a mean prostate size of 80 g (60–146) and constantly complained of shoulder, neck, or back trouble compared with the less-severely complaining group.Conclusions:A high prevalence of musculoskeletal complaints among urologists performing endourologic prostatectomy was confirmed and was found to be proportionally related to the size of the prostate. The integration of an ergonomic specialist inside the operation room to watch and correct the surgeon’s position during endourologic procedures may reduce the endourologist’s exposure to these occupational hazards.

Anterior bladder wall thickness, post-void urine residue, and bladder emptying efficiency as indicators of bladder dysfunction in Nigerian men with benign prostatic hyperplasia.

Benign Prostatic Hypertrophy [BPH] is associated with voiding dysfunctions. Urodynamic study is the gold standard for diagnosis of voiding dysfunctions but is invasive. Bladder wall thickness (BWT), post-void urine residue (PVR), and bladder emptying efficiency (BEE) are noninvasive predictors of voiding dysfunction. To study the relationship among BWT, PVR, and BEE in BPH. A hospital-based cross-sectional prospective study of new BPH patients at Nnamdi Azikiwe University Teaching Hospital, Nnewi. The participants had abdominal ultrasonography measurement of anterior BWT (at bladder volume ≥200 mls), prostate volume (PV), and PVR using Prosound SSD3500 (Aloka Co Ltd, Tokyo, Japan) with an abdominal probe frequency of 3.5 MHz. Then the BEE was calculated. The anterior BWT was divided into two groups: <5 mm and ≥5 mm. The data were analyzed using SPSS version 20. Pearson's correlation was used to assess correlation and the differences between the means of the two groups of BWT were compared by Mann-Whitney test. A P- Value <0.05 was considered significant. Seventy seven men with a mean age of 66.66 ± 10.74 years were included in the study. Sixty one percent had symptoms lasting >12 months. The average anterior BWT, PBV, PVR, BEE, PV, and PSA were 4.55 ± 1.02 mm, 260.98 ± 57.44 mls, 58.36 ± 52.94 mls, 77.98 ± 17.37%, 66.31 ± 46.38 mls, and 8.04 ± 5.97 ng/ml, respectively. There was a significant positive correlation between BWT and duration of symptoms (P = 0.044) and a significant negative correlation between BWT and BEE (P = 0.005). An insignificant positive correlation was found between BWT and PVR (P = 0.255). Fifty four (70.1%) had BWT <5 mm and 29.9% had BWT ≥5 mm. The mean IPSS (P = 0.000), PV (P = 0.032) and PVR (P = 0.020) were significantly higher in the ≥5 mm group. The ≥5 mm group also had a significantly lower BEE (P = 0.002). Voiding dysfunction was more severe in patients with BWT of 5 mm or more. There was a positive, but insignificant, correlation between anterior BWT and PVR and a significant negative correlation between BWT and BEE.

The decision of targeted, systematic or combined biopsy in a biopsy naïve patient for the diagnosis of prostate cancer, can be made on the basis of multiparametric magnetic resonance imaging

Introduction: The current trend to implement multiparametric magnetic resonance imaging (mpMRI)-guided targeted biopsy (TB) as primary biopsy for the diagnosis of suspected prostate cancer and to avoid systematic biopsy (SB) is growing. However, concern remains regarding missing clinically significant (Cs) cancer on the normal mpMRI areas of the prostate. Therefore, we compared the normal and abnormal areas from mpMRI at the same prostate biopsy, using simultaneous SB and TB technique. Methods: A prospective, comparative effectiveness study included 134 patients initially referred for primary biopsy (from October 2017 to June 2018); 100 men were selected, mean age 68 years, with a median level of prostate specific antigen of 7.6, with average prostate volume of 52 cm3 (T3 disease and prostate imaging reporting and data system (PI-RADS) score &lt; 3 were excluded). All underwent six cores TB (median), from an average of two lesions on mpMRI and also eight cores SB (median) from normal mpMRI areas of the prostate after informed consent. Results: The combined (SB + TB) biopsy cancer detection rate was 67%, 51% having Cs disease. For Cs cancer, 35 patients were detected by both techniques. TB missed four Cs cancer (95% confidence interval (CI), p &lt; 0.0001). Fewer men in the TB group than in the SB group were found to have clinically insignificant (Ci) cancer (95% CI, p &lt; 0.0001). No Cs cancer diagnosis was missed on TB from PI-RADS 5 lesion. Overall, 4% Cs cancers were missed on TB and avoided over diagnosis of 9% Ci cancer. Conclusions: Cognitive TB didn’t miss any Cs cancer from PI-RADS 5 lesion found on mpMRI. Only doing Cognitive TB on PI-RADS 5 lesion would save time, reduce workload and will be cost effective both for Urology and Pathology. PI-RADS 3 and 4 lesions on mpMRI will benefit from adding systematic samples. Level of evidence: 4 Oxford Centre for Evidence-Based Medicine (CEBM).

IMPROVING THE QUALITY OF PROSTATE TRANSURETHRAL RESECTION IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA THROUGH INTRAOPERATIVE TRANSRECTAL ULTRASOUND MONITORING OF THE REMOVED TISSUE VOLUME

Purpose of the study. To improve the quality of prostate transurethral resection by means of intraoperative ultrasound monitoring of the removed tissue volume.Patients and methods. The study included 92 patients who, according to indications, underwent prostate transurethral resection. Patients were divided into 2 groups. The 1st group included patients (n = 50) operated on using the method of monitoring the removed tissue volume, proposed in the study. The average age of patients in this group was 67.4 ± 3.88 years, the average prostate volume before surgery was 59.5 ± 4.5 cm3 with a range of values from 42 cm3 to 94 cm3. The 2nd group (n = 42) included patients operated on according to the classical method of prostate transurethral resection. The average age of patients in this group was 68.1 ± 2.9 years, the average prostate volume before surgery was 53.5 ± 4.5 cm3. Results. The average prostate volume atier surgery in patients of the 1st group was 23.2 ± 1.8 cm3. Thus, the average volume of the removed tissue was 63.2% of the prostate gland initial volume. The average prostate volume atier surgery in patients of the 2nd group was 25.6 ± 1.9 cm3 (p &lt; 0.05). The average volume of the removed tissue was 52.1% of the prostate gland initial volume. The number of complications is comparable in groups of patients. When using the removed tissue control during surgery, it was possible to increase the resection radicality, which is refl ected by a smaller average residual volume of the prostate gland (by 9.4%) atier surgery.Conclusion. The use of ultrasonic control of the prostate adenoma removed tissue volume during prostate transurethral resection does not increase the risks of possible postoperative complications, wherein increases radicality of the performed operation.

The Effect of Intravesical Prostatic Protrusion in Patients with Benign Prostatic Hyperplasia: Controlled, Clinical Study

Background: Although prostate cancer releases more prostate-specific antigen (PSA) per unit of prostate volume (PV), data are limited regarding the association between intravesical prostatic protrusion (IPP) and the PSA level. Objectives: The study aim was to evaluate the IPP effect in patients with benign prostatic hyperplasia. Method: This study included patients with (n = 119) and without (n = 121) IPP. The age, International Prostate Symptom Score (IPSS), PSA level, maximum and average flow rates, PV, hematuria, urinary retention, and post-void residual (PVR) volume were compared between the 2 groups. Results: The mean ages were similar between the 2 groups (66.56 ± 8.67 and 66.92 ± 8.7 years, respectively, p = 0.747), and there were no statistically significant differences in the IPSS, maximum and average flow rates, hematuria, PVR volume, and urinary retention means (p > 0.05). However, the IPP patients had lower total PSA (tPSA) and free PSA (fPSA) levels than those without IPP (3.55 [4.18] vs. 5.26 [5.24] ng/mL, p = 0.013 and 0.7 [1.09] vs. 1.05 [1.23] ng/mL, p = 0.029, respectively). Moreover, there were strong positive correlations between the IPP grade and the tPSA and fPSA levels (r = 0.262, p = 0.001 and r = 0.254, p = 0.002 respectively). Conclusions: This study demonstrated that IPP results in a decreased PSA level, even with a higher PV.

A Novel Calculator for Estimating Prostate Volume in Daily Urology Services

To develop a simple prostate volume (PV) calculator that can aid in managing patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic enlargement at daily urology services in developing Asian countries. We conducted a cross-sectional study of men aged above 40 years with no history of prostate cancer, prostate surgery, or 5α-reductase inhibitor treatment. Serum prostate-specific antigen (PSA) and total PV were measured in each subject. Potential sociodemographic and clinical variables including age, weight, comorbidities, and International Prostate Symptom Score (IPSS) were collected. Of 1034 subjects, 837 were used in building the PV calculator using regression analysis. The remaining 1/5 (n = 197) was used for model validation. There were 1034 multiethnic Asian men (Chinese 52.9%, Malay 35.4%, and Indian 11.7%) with mean age of 60 ± 7.6 years. Average PV was 29.4 ± 13.0 mL while the overall mean of PSA was 1.7 ± 1.7 ng/mL. We identified age, IPSS, weight, and PSA (all P <.05) in the PV regression model. Using the validation set, the coefficient of determination (R2) of this PV calculator was 0.47 where PV = 20.6 + (age - 60) × 0.1 + (IPSS score) × 0.1 + (Weight - 70) × 0.3 + (history of alpha-blocker treatment for LUTS) × 9.6 + PSA × 3.7. The area under curve of this model in predicting PV above 30 mL and 40 mL were 0.82 (95% confidence interval, 0.75-0.88) and 0.91 (95% confidence interval, 0.87-0.96), respectively. We develop a PV calculator that is simple and accurate to be used in routine clinical consultation for patients with LUTS. A separate study is important to confirm and to validate the findings in other populations.

Prediction of acute gastrointestinal and genitourinary radiation toxicity in prostate cancer patients using lymphocyte microRNA.

To search for novel biomarkers that can predict acute radiation toxicity, we conducted microRNA expression analysis of peripheral blood lymphocytes (PBLs). The discovery cohort was 69 patients with localized adenocarcinoma of the prostate who received intensity-modulated radiation therapy between October 2007 and October 2010. The validation cohort was 72 patients treated with low-dose-rate brachytherapy between May 2008 and March 2014. After13 microRNAs were selected by TaqMan® Array analysis in a preliminary experiment, expression of these microRNAs in all samples was analyzed by RT-PCR. In the discovery cohort, the average prostate volume, the rectal volume receiving 70 Gy, and expression of miR-410 and miR-221 were significant risk factors for Grade 1-2 gastrointestinal toxicity. Receiver operating characteristic analysis showed that the area under the curve (AUC) was 0.807. The maximum dose to the urinary bladder, prostate volume, pretreatment urinary function score, and miR-99a and miR-221 expression were risk factors for Grade 2 genitourinary toxicity. The corresponding AUC was 0.796. In the validation cohort, reproducibility of these markers was confirmed for gastrointestinal toxicity, but not for genitourinary toxicity. Combining radiation dose parameters with microRNA expression in PBLs may be useful for predicting acute gastrointestinal toxicity of radiation therapy, thus contributing to personalized treatment of prostate cancer.

Whole-Gland Prostate Cancer Cryoablation with Magnetic Resonance Imaging Guidance: One-Year Follow-Up

Patients who develop prostate cancer after prior abdominal perineal resection are poor surgical candidates, and have limited treatment options. Therefore, our goal is to present results from a single institutional experience of four patients who underwent whole gland MRI-guided cryoablation with a history complicated by prior abdominoperineal resection. Four MRI-guided cryoablative treatments (mean age 64, range 59-69 years) for primary and locally recurrent prostate adenocarcinoma were retrospectively reviewed in patients with prior abdominal perineal resection for colorectal cancer (3) and juvenile polyposis (1). Average prostate volume prior to ablation was 23 cc, with an average PSA of 5.6 ng/mL. For each gland, 7-10 cryoprobes were placed approximately 0.5 cm apart in the prostate gland under MRI guidance by a transperineal approach with 3-4 freeze-thaw cycles performed. Each patient had follow up imaging and PSA measurements out to 12 months post ablation. All four patient's PSA dropped below 0.1 ng/mL at 3-6 month post-ablation and remained at these levels at 12 months. Three of the 4 patients had PSA measurements to 33 months post-ablation, with no evidence of recurrence. No patient developed urinary incontinence due to the whole gland cryoablation. With all four patients in our study having undetectable PSAs 12 months post ablation, and with no patient developing urinary incontinence due to the cryoablation, MRI-guided cryoablation appears to be a promising treatment option in patients who are poor surgical candidates due to prior pelvic surgery and/or radiation.

US-Planned HDR Prostate Brachytherapy Boost: Acute and Late Toxicity

HDR prostate brachytherapy has been combined with external beam (EBRT) for over 2 decades, using a wide range of dose and fractionation schedules. Complications such as urethral strictures are reported from 2-30%. We evaluate acute and long term urinary and bowel toxicity in our first 5 years’ experience. From 06/2011 to 05/2016, 123 patients with upper tier intermediate and high risk prostate cancer were treated by 192-Ir HDR brachytherapy combined with EBRT in 3 consecutive IRB-approved clinical trials with data collected prospectively. EBRT with fiducials for image-guidance followed US-planned HDR BT within 7 days (46Gy/ 23: 81% 3DcRT, 19% IMRT/VMAT). Initially 20Gy/2 in 2 separate implants was prescribed (42%), but later 15Gy/ 1 (58%). HDR planning constraints were prostate V100 ≥98% and V125: 55-62%, urethra Dmax <115% and rectal D1cc ≤70%. Tumor stage was T1c: 16%, T2: 77% and T3: 7%. Gleason score was 7 in 68%; 8-10 in 32%. Median PSA was 10.1 (range: 1.7-35.8). 65% were upper tier intermediate risk; 35% high risk. 54% had androgen ablation (< 6 mos: 7.5%, 6 mos: 21.5%, 9-12 mos: 60%). Median prostate volume at HDR was 35cc (range: 14-82) Toxicities were graded using CTCAE, V3.0. Median follow-up is 24.3 mos (range: 7– 69) but differed between the 2 cohorts, being 43 mos for 20 Gy/2 (range: 23-69) and 17 mos for 15 Gy/1 (range: 7-43).Catheterization was required post implant in 3.3% and in all cases consisted of clean intermittent self-catheterization for 1-5 weeks during the EBRT that immediately followed the HDR, the majority in the 15 Gy/1 cohort (3 of 4). The average prostate volume for these patients was 48cc vs 37cc for all patients. Acute Grade 1 GU toxicity occurred in 52%, G2 in 13%, and G3 in 3.3%. Acute Grade 1 GI toxicity occurred in 43%, G2 in 5.7%, with no G3 or G4 toxicity. Late GU toxicity was Grade 1: 40%, G2: 7.3%, and G3: 4.0 %. Of these, late Grade 1 hematuria was reported by 5.7% and Grade 2 in 1.6%. Urethral strictures occurred in 3.2% (n=4) after an average of 2.8 years (range: 2.2- 3.5 years), equally divided between the two fractionation schemes. All 4 have been effectively managed, 3 with a single visual internal urethrotomy and one with dilatation. Late GI toxicity was Grade 1: 14.6%, G2: 7.3%, and G3: 3.2%. One patient had a colostomy for a sigmoid stricture outside the HDR radiation volume. Rectal bleeding occurred in 11 patients (8.9%), Grade 1 in 7 patients, and G3 in 4, after an average of 17.5 mos (range 3-35). For G3 bleeding, 75% received 15Gy/ 1. The average rectal D1cc for all patients was 61.5% (range 51%-71%) and was not different for those with rectal bleeding (p=0.43). US-planned HDR brachytherapy as 2 fractions of 10 Gy or a single 15 Gy combined with EBRT is well tolerated with low risk of late toxicities. Urethral strictures were seen in 3.2% and grade 3 rectal bleeding in 3.2%. A single 15 Gy is convenient and cost-effective but observed toxicity may increase with longer follow up as only 50% have reached the median time for toxicity development.

EMBOLIZATION AND CHEMOEMBOLIZATION PROSTATIC ARTERIES OF BENIGN PROSTATIC HYPERPLASIA AND PROSTATE CANCER

The article gives the results of the use of embolization of prostatic arteries in benign prostatic hyperplasia in 3 patients, two of whom have been with suprapubic drainage of the bladder. The patient was 120 ml without suprapubic drainage of the bladder residual urine. The age of patients was 68 to 70 years. According TRUS, the average prostate volume was 86.0 ± 12.6 cm3 . 4 patients» superselective prostatic artery chemoembolization was performed in prostate cancer. Chemicals for carrying out this procedure served adriamycin at a dose of 50 mg. Two of the four patients with prostate cancer was hormone-resistant form. Three patients had PCa T3b N0M0 stage T2bN0M0 histologically verified number Gleason 7, 7, 8, 9. All four had difficulty urinating, the amount of residual urine was 54 to 98 ml. As a source of transportation used chemotherapy microspheres (gepasfery) size of 300–500 microns. Treatment outcomes assessed at one month. The efficiency of the methods for the treatment of benign prostatic hyperplasia and prostate cancer in the form of return of spontaneous urination, decrease in residual urine, reducing the prostate-specific antigen.

Bladder neck preservation improves time to continence after radical prostatectomy: a systematic review and meta-analysis.

Bladder neck preservation (BNP) during radical prostatectomy (RP) may improve postoperative urinary continence, although its overall effectiveness remains controversial. We systematically searched PubMed, Ovid Medline, Embase, CBM and the Cochrane Library to identify studies published before February 2016 that assessed associations between BNP and post-RP urinary continence. Thirteen trials (1130 cases and 1154 controls) assessing BNP versus noBNP (or with bladder neck reconstruction, BNR) were considered suitable for meta-analysis, including two randomized controlled trials (RCT), six prospective and five retrospective studies. Meta-analysis demonstrated that BNP improved early urinary continence rates (6 mo, OR = 1.66; 95% CI, 1.21–2.27; P = 0.001) and long-term urinary continence outcomes (>12 mo, OR = 3.99; 95% CI, 1.94–8.21; P = 0.0002). Patients with BNP also had lower bladder neck stricture frequencies (OR = 0.49; 95% CI, 0.29–0.81; P = 0.006). Anastomotic leak rates, positive surgical margins and biochemical failure rates were comparable between the two groups (P>0.05). There were no differences in baseline characteristics except for a smaller average prostate volume (WMD = −2.24 ml; 95% CI, -4.27 to -0.22; P = 0.03) in BNP patients. Our analyses indicated that BNP during RP improved early recovery and overall long-term (1 year) urinary continence and decreased bladder neck stricture rates without compromising oncologic control.

Efficacy and safety of testosterone replacement therapy in men with hypogonadism: A meta-analysis study of placebo-controlled trials.

The purpose of the present meta-analysis was to evaluate the efficacy and safety of testosterone replacement therapy in men with hypogonadism. A search was conducted for appropriate randomized controlled trials and the data from 16 trials were pooled. The intended primary outcome of the present study was to determine the efficacy and safety of testosterone replacement therapy. The current data demonstrated that scores for Aging Male Symptoms (AMS) were significantly reduced following testosterone replacement therapy, with a mean decrease in AMS score of 1.52 [95% confidence interval (CI), 0.72 to 2.32; P=0.0002]. Testosterone replacement therapy increased lean body mass [mean difference (MD), 1.22; 95% CI, 0.33 to 2.11; P=0.007], reduced fat mass in a non-significantly manner (MD, −0.85; 95% CI, −1.74 to 0.04; P=0.06) and significantly reduced total cholesterol (MD, −0.16; 95% CI, −0.29 to −0.03; P=0.01). No significant differences were identified in body weight (MD, 0.09; 95% CI, −1.13 to 1.31; P=0.89), body mass index (MD, 0.10; 95% CI, −0.62 to 0.82; P=0.78) or bone mineral density (MD, −0.01; 95% CI, −0.03 to 0.02; P=0.60). Average prostate volume increased (MD, 1.58; 95% CI, 0.6 to 2.56; P=0.002) following testosterone replacement therapy, but the levels of prostate-specific antigen (PSA) (MD, 0.10; 95% CI, −0.03 to 0.22; P=0.14) and the International Prostate Symptom Scores (MD, 0.01; 95% CI, −0.37 to 0.39; P=0.96) did not change. In conclusion, testosterone replacement therapy improves quality of life, increases lean body mass, significantly decreases total cholesterol, and is well-tolerated and safe for men with hypogonadism who are exhibiting PSA levels of <4 ng/ml.

SU‐E‐J‐232: Feasibility of MRI‐Based Preplan On Low Dose Rate Prostate Brachytherapy

Purpose:To investigate the feasibility of using MRI‐based preplan for low dose rate prostate brachytherapy.Methods:12 patients who received transrectal ultrasound (TRUS) guided prostate brachytherapy with Pd‐103 were retrospectively studied. Our care‐standard of the TRUS‐based preplan served as the control. One or more prostate T2‐weighted wide and/or narrow‐field of view MRIs obtained within the 3 months prior to the implant were imported into the MIM Symphony software v6.3 (MIM Software Inc., Cleveland, OH) for each patient. In total, 37 MRI preplans (10 different image sequences with average thickness of 4.8mm) were generated. The contoured prostate volume and the seed counts required to achieve adequate dosimetric coverage from TRUS and MRI preplans were compared for each patient. The effects of different MRI sequences and image thicknesses were also investigated statistically using Student's t‐test. Lastly, the nomogram from the MRI preplan and TRUS preplan from our historical treatment data were compared.Results:The average prostate volume contoured on the TRUS and MRI were 26.6cc (range: 12.6∼41.3cc), and 27.4 cc (range: 14.3∼50.0cc), respectively. Axial MRI thicknesses (range: 3.5∼8.1mm) did not significantly affect the contoured volume or the number of seeds required on the preplan (R2 = 0.0002 and 0.0012, respectively). Four of the MRI sequences (AX‐T2, AX‐T2‐Whole‐Pelvis, AX‐T2‐FSE, and AXIALT2‐ Hi‐Res) showed statistically significant better prostate volume agreement with TRUS than the other seven sequences (P &lt;0.01). Nomogram overlay between the MRI and TRUS preplans showed good agreement; indicating volumes contoured on MRI preplan scan reliably predict how many seeds are needed for implant.Conclusion:Although MRI does not allow for determination of the actual implant geometry, it can give reliable volumes for seed ordering purposes. Our future work will investigate if MRI is sufficient to reliably replace TRUS preplanning in patients where preplan TRUS may be technically challenging.