Prostate In Men Research Articles

Effect of lycopene on prostate cancer among native African men: A protocol for an open-label randomized clinical trial in Tanzania

Background Prostate cancer (PCa) is the most common cancer and the fifth leading cause of death in men worldwide. The treatment of PCa depends on the clinical stage of the disease, prostate-specific antigen (PSA) level, and histology. Lycopene is a bright red carotenoid found in tomatoes, which enhances apoptosis in prostate cells, but its effectiveness has not been studied in East African countries. This study aimed to determine the effectiveness of lycopene from tomato extracts in reducing PSA levels, disease progression, and apoptosis in the prostate glands of men with PCa in Tanzania. Methods This study will be a randomized phase III clinical trial of men diagnosed with PCa in Tanzania. In total, 400 men will be randomized in a 1:1 ratio to receive intervention (n=200) and control (n=200) and followed for 12 months. The intervention arm will receive tomato paste for daily use in addition to the standard treatment, whereas the control arm will only follow the standard of care. The primary endpoints will be a reduction in PSA levels, improved clinical status, and apoptosis of the prostate gland. Data analysis was performed based on the intention-to-treat principle. Descriptive statistics were used to compare average lycopene and PSA levels in the intervention group using T-test and Chi-squared tests. Generalized linear mixed models will be used to further assess the effect of lycopene on PCa progression, urinary symptoms, and PSA reduction. All statistical tests were two-sided at an alpha level of <0.05. Discussion The study used a food supplement as a drug/intervention with minimal or no adverse reactions. However, there is a fear that the control group may not adhere to the protocol after learning the benefits of tomato paste. The study findings will promote the consumption of tomato paste in males diagnosed with PCa to improve the clinical status and reduce disease progression. Trial registration The study has been registered at the Pan African Clinical Trial Registry with registration No PACTR202405488763956.

Evaluation of prostate cancer on MRI with PI-RADS 2.1: A serial case

Background: Cancer that affects men's prostate glands is called prostate cancer. Magnetic resonance imaging (MRI) is a much more recommended method of examination because it evaluates the prostate in detail. MRI with Prostate Imaging–Reporting and Data System (PI-RADS) 2.1 can be used as a reporting system for prostate expertise and looking at the character of a lesion. This case series aims to present the prostate cancer cases on MRI with PI-RADS 2.1. Case report: First case, a 61-year-old male patient came with complaints of bloody urine and difficulty urinating. MRI results showed a well-defined lesion at the apex to mid of the peripheral zone in the right and left posteromedial sector, without extraprostatic extension, according to PI-RADS 4, and a lesion with indistinct boundaries at the apex, mid to base of the transition zone, with extraprostatic extension to the bladder, according to PI-RADS 5. The second case, a man aged 63 years with complaints of difficulty urinating and feeling incomplete for 1 month. The MRI results suggested prostatic hypertrophy with intravesical protrusion of +/- 1.2 cm with an ill-defined lesion in the mid portion of the right and left posterolateral peripheral zone, suggesting PI-RADS 4 and an ill-defined lesion at the left anterior transitional zone apex, suggesting PI-RADS 3. In the third case, a 79-year-old man came with complaints of discomfort when urinating. The MRI showed lesions with ill-defined borders on the posterior aspect of the mid-inferior portion of the right peripheral zone according to PI-RADS 5, and multiple lesions with ill-defined borders on the anteroposterior segment of the apex-inferior portion transitional zone correspond to PI-RADS 5. Conclusion: MRI with PI-RADS 2.1 can evaluate suspected malignancy in the prostate, so it can be considered as the modality of choice in evaluating malignancy in the prostate.

Воспаление парауретральных протоков и желез у женщин: проблема с 350-летней историей.

Introduction. Inflammation of the Skene glands is one of the common causes of persistent dysuria and recurrent lower urinary tract infections. Lack of awareness about this pathology can lead to diagnostic errors and inadequate treatment. This pathology is not sufficiently covered in the literature, which was the reason for preparing this lecture. Results. The lecture review covers the history of studying the anatomy of the paraurethral glands in women, the first attempts to diagnose and treat various diseases. The issues of homology of the paraurethral ducts and glands in women with the prostate gland in men are considered, the anatomy, morphology and immunohistochemical properties of the Skene glands are described, as well as modern ideas about their function. The historical background, nomenclature and classification are presented. The role of inflammation in these structures as a cause of persistent dysuria and a source of persistent lower urinary tract infections has been demonstrated. The need to standardize the methodology for examining patients with skineitis and the search for a specialized instrument for an adequate examination of the female urethra is substantiated. An analysis of the effectiveness of electrical resection of Skene's glands was carried out. Conclusions. One of the main factors behind unsatisfactory treatment results for lower urinary tract infections is inflammation of the paraurethral ducts and glands. Their insufficient visualization and assessment are the reasons for frequent relapses of the disease and repeated surgical interventions.

Metabolic-associated fatty liver disease (NAFLD) as a cancer risk factor

The purpose of this review was to update information on the prevalence and relationship of cancer development of various localizations with non-alcoholic, metabolic-associated fatty liver disease (NAFLD/MAFLD). Discussion: The second most common cause of death among patients with NAFLD are malignant neoplasms both in the gastrointestinal tract (liver, colon, esophagus, stomach and pancreas) and in other organs (kidneys, prostate gland in men and mammary gland in women). Obesity and other metabolic disorders are associated with an increase in morbidity or mortality from various types of cancer. Due to the high prevalence of NAFLD among patients with metabolic syndrome, type 2 diabetes mellitus, an extrapolation of this development is assumed among patients with NAFLD. Metabolic disorders, imbalance of the intestinal microflora are considered as possible pathogenetic mechanisms for increasing the risk of cancer among patients suffering from NAFLD. Conclusion: in addition to the risk of developing hepatocellular carcinoma as a natural course of the disease, convincing evidence is accumulating for the role of NAFLD as an independent risk factor for the development and progression of cancer, especially in the gastrointestinal tract.

The Prostate Gland In Men – What is it? Where is it? Important? Annual Screening?

The Prostate Gland In Men – What is it? Where is it? Important? Annual Screening?

Frequency of Scrotal Pathologies on Ultrasound Associated with Benign Prostatic Hyperplasia

Background: Men's lower urinary tract symptoms are frequently caused by benign prostatic hyperplasia (BPH), which is the non-cancerous expansion or hyperplasia of prostate tissue. In these patients, a accurate diagnosis of testicular pathologies and the avoidance of testicular infarction are of highest importance. Duration of study: study was conducted from January 2022, till June 2022. Place of study: Department of Radiology, Sheikh Zayed medical college and hospital Lahore, Pakistan Study design: A cross-sectional study. Objective: To find the frequency of scrotal pathologies on ultra sound in benign prostatic hyperplasia patients Methodology: A cross sectional study was conducted at Department of Radiology, Sheikh Zayed medical college and hospital Lahore, Pakistan (SZMC). SPSS version 21.0 was used for data analysis. The inclusion criteria for present study considered the enlargement of prostate gland in men with age which is very common. Uncomfortable urinary symptoms, such as a bladder blockage, might be brought on by an enlarged prostate gland. It may also result in issues with the kidney, urinary system and bladder. The exclusion criteria were patients who had any history of previous testicular pathology and men who were uncooperative. Frequency of scrotal pathologies in patients with benign prostatic hyperplasia were calculated by using ultrasound machine Mindray Z5 and Toshiba Xario 100 with linear probe of 7.5-11MHz were used. Results: In current study 159 men with benign prostatic hyperplasia visiting radiology department for ultrasound were included. Out of 159 men with BPH, 37(23.3%) had epididymal cysts, 24(15.1%) had undescended testis, 18(11.3%) had epidydmo-orchitis, 39(24.5%) had epididmytis, 22(13.8%) had microlithiasis, 37(23.3%) had varicocele, 85(53.3%) had hydrocele and 32(20.1%) patients had normal scrotal findings. In patients with no epididymitis mean value of Prevoid was 376 ml and post void were 49 ml and prostate volume was 49 grams. In patients with epididymitis mean value of Prevoid was 377 ml and post void were 48 ml and prostate volume was 46 grams respectively. Practical implication: This research is very informative for men community regarding urological complications especially about enlargement of prostate gland and its complications. Conclusion: Our study concluded that, most patients coming with BPH had scrotal pathologies. Hydrocele was most common pathology in patients with BPH. Keywords: Scrotal Ultrasound, Hydrocele, Varicocele, Ultrasonography, Hyperplasia, Prostate gland, Epididymitis, Microlithiasis

Modulatory effects of Saccharomyces cerevisiae var. boulardii on experimentally induced benign prostatic hyperplasia in rats

Benign prostatic hyperplasia (BPH) is an age-related non-neoplastic disease of the prostate gland in men that has become a global health issue in recent years. Due to the side effects of conventional treatment options, attention is now focused on phytotherapeutics for its management. We investigated the possible protective effect of Saccharomyces cerevisiae var. boulardii in a rat model of testosterone propionate (TP) induced BPH. Rats were divided into five groups: Gr. I, untreated control group; Gr. II, TP group; Gr. III, TP + finasteride; Gr. IV, TP + S. cerevisiae var. boulardii; and Gr. V, S. cerevisiae var. boulardii group. Treatments were given daily for 28 days. At the end of the experiment, all rats were weighed and the prostatic indices, prostate specific antigen, serum testosterone concentration as well as the histological and histomorphometric changes were evaluated. Saccharomyces cerevisiae var. boulardii significantly (P <0.05) reduced prostate weight, prostatic index, serum prostate specific antigen, prostatic epithelial thickness and increased luminal diameter. Thus, the results of this study suggest that S. cerevisiae var. boulardii is a potential pharmacological candidate for management of benign prostatic hyperplasia.

Phosphorylation of androgen receptor by mTORC1 promotes liver steatosis and tumorigenesis.

Background and AimsAndrogen receptor (AR) has been reported to play an important role in the development and progression of man’s prostate cancer. Hepatocellular carcinoma (HCC) is also male‐dominant, but the role of AR in HCC remains poorly understood. Mechanistic target of rapamycin complex 1 (mTORC1) also has been reported to be highly activated in HCC. In this study, we aimed to explore the role of AR phosphorylation and its relationship with mTORC1 in hepatocarcinogenesis.Approach and ResultsIn vitro experiment, we observed that mTORC1 interacts with hepatic AR and phosphorylates it at S96 in response to nutrient and mitogenic stimuli in HCC cells. S96 phosphorylation promotes the stability, nuclear localization, and transcriptional activity of AR, which enhances de novo lipogenesis and proliferation in hepatocytes and induces liver steatosis and hepatocarcinogenesis in mice independently and cooperatively with androgen. Furthermore, high ARS96 phosphorylation is observed in human liver steatotic and HCC tissues and is associated with overall survival and disease‐free survival, which has been proven as an independent survival predictor for patients with HCC.ConclusionsAR S96 phosphorylation by mTORC1 drives liver steatosis and HCC development and progression independently and cooperatively with androgen, which not only explains why HCC is man‐biased but also provides a target molecule for prevention and treatment of HCC and a potential survival predictor in patients with HCC.

Assessment of Factors Contributing to Delayed Surgeries in Enlarged Prostate Patients: A Survey at Kisumu County Referral Hospital

Enlarged prostate, also known as Benign Prostatic Hyperplasia (BPH) is the enlargement of the prostate gland in men resulting in frequent urination, weak urine stream, and inability to completely empty the bladder. Prostate cancer is the second most commonly occurring cancer in men and the fourth most commonly occurring cancer overall. There were 1.3 million new cases of prostate cancer globally in 2018. Although there is a scarcity of information on the disease in African men, past studies have revealed that the disease can be managed if detected in its early stages. The purpose of the study was to assess the factors contributing to delayed surgeries in enlarged prostate patients at Kisumu County Referral hospital. Specific objectives were to determine the level of knowledge and awareness on enlarged prostate; assess institutional factors hindering surgeries in enlarged prostate and determine socio-economic factors of the patients’ hindering surgeries in enlarged prostate at Kisumu County Referral hospital. A descriptive survey design was adopted for the study. The study targeted enlarged prostate patients and top management of the Kisumu County Referral Hospital from which a sample of 50 respondents was selected using the inclusion-exclusion criteria to participate in the study. The study adopted structured questionnaires for data collection. Data were analysed using descriptive statistics with both qualitative and quantitative analysis and the findings were presented in frequency distribution tables and percentages. The study achieved a questionnaire return rate of 94% with the majority of the respondents, 45%, earning a monthly income ranging from 10,000 to 20,000. Findings revealed that 91%, had knowledge of prostate cancer with 83% stating that the medium through which they learned of the disease was the media, friends, relatives, and at the workplace. Unwillingness to be screened for prostate cancer was due to a lack of knowledge (53%). The study established the hospital was crowded, 78%, and thus the available resources were not sufficient to cater to the population seeking medical attention. Institutional factors related to doctors’/nurses’ workmanship were the common contributors to delayed surgeries and medical attention in terms of negligence, 66%, poor communication channels hence conflicting information, 72%, and doctors’/nurses’ competence at work, 42%. Evidently, the family plays a major role in one’s health decisions especially pertaining to chronic diseases such as cancer, 66%. Lack of finances limits access to quality and timely healthcare with 83% and 87% respectively. Conclusively, the majority of the delays in surgeries in enlarged prostate patients at the hospital were due to the institution’s inability in terms of resources, facilities, and qualified and competent personnel. Socio-economic factors also contributed to delayed surgeries in enlarged prostate patients at Kisumu County Referral Hospital. The study recommends mobilization and sensitization to create awareness and increase the knowledge of prostate cancer, the government should intervene through improving the facilities, resources, and staff as a measure to manage the ever-increasing population seeking medical care at the hospital and to find ways of reducing medical costs, especially for cancer patients, so as to enable victims’ access medical care with ease.

MP05-12 SHOULD WE ROUTINELY RECOMMEND A CENTRAL REVIEW OF MAGNETIC RESONANCE IMAGING OF THE PROSTATE IN MEN WITH POSITIVE MP-MRI? IMPLICATION FOR TARGETED BIOPSIES

MP05-12 SHOULD WE ROUTINELY RECOMMEND A CENTRAL REVIEW OF MAGNETIC RESONANCE IMAGING OF THE PROSTATE IN MEN WITH POSITIVE MP-MRI? IMPLICATION FOR TARGETED BIOPSIES

P–052 Structural and functional changes in the prostate gland of men following orchitis

Abstract Study question The aim of the study was to establish echometric parameters, hemodynamic and cytohistological changes in the prostate gland in men of reproductive age after orchitis. Summary answer After orchitis, volume and mass of the prostate increased compared to the control group, blood flow was reduced, histologically and electron microscopy changes were observed. What is known already According to the literature, prostate diseases in men of reproductive age are an important issue in urology and andrology. The most common among them are infectious lesions of the genitourinary system, which constitute about 45%. These include, orchitis, as a part of the infectious process of the entire reproductive system. Half of the cases of orchitis are sexually transmitted infections or associated with infections that come from urogenital tract. In the majority of patients orchitis leads to infertility. But the state of the prostate, under these conditions, remains poorly understood. Study design, size, duration We used ultrasound diagnostics and colour ultrasound angiography of the prostate gland of 10 men aged 36–42 years, who suffered from orchitis. The data of 7 healthy men of the same age served as control. For histological and electron microscopy served tissues of prostate gland obtained from the 5 men of the same age group during minor invasive surgery. Statistical processing of the results was carried out using the program Statistica 10. Participants/materials, setting, methods: The length, width, height, volume and mass of the prostate were determined in the grey scale mode. The vascular pattern was determined by colour Doppler mapping (the course of the blood vessels, their diameter, the number in the symmetric sections of prostate). Qualitative hemodynamic indicators: peak systolic blood flow velocity (Vps) cm/s, diastolic blood flow velocity (Vd) cm/s, time average velocity (TAV) cm/s, pulsatility index (PI), volumetric flow rate (V) L/min. Histological methods and TEM. Main results and the role of chance After orchitis, the volume of prostate gland increased to (26.0 ± 1.4) cm3 vs (21.2±1.3) cm3 in control and its mass increased to (27.4±1.2) g vs (22.1±1.6) g in control group. The blood flow in the prostate was reduced: peak arterial blood flow velocity in the peripheral zone decreased up to (6.8±0.46) cm/s vs (18.8±3.0) cm/s in control and diastolic blood flow velocity decreased up to (2.75 ± 0.26) cm/s vs (5.7±0.1) cm/s in the control group. The final sections of the glands were cystically enlarged, the squamous epithelium was flattened, the nuclei were pyknotic and the cell borders were indistinguishable. Epithelial folds and shape were preserved, prostatic bodies and acidophilus secretion in the gaps were preserved. The relative volume of the glandular epithelium decreased up to 56.5% and the volume of the fibrous-muscular-elastic component around the lobules increased up to 43.5%. In the capillaries of the prostate, the nuclei of the endothelial cells were deformed, the cytoplasm was vacuolated, the crysts in the mitochondria were reduced, the basement membrane was expanded and uneven. In the nuclei of the prostatic epithelium the perinuclear condensation of chromatin observed, cytoplasm was vacuolated and accumulated drops of fat, the mitochondrial cristae were homogenized. Limitations, reasons for caution The results of the investigation approved by the Commission on Biomedical Ethics of the Precarpathian National University as appropriate and those do not violate moral and ethical norms in conducting research (Protocol №3 dated 16.10.2019). Wider implications of the findings: The results of research indicated changes in the prostate, which require further investigation of hormonal balance in men under these conditions. Trial registration number *

Comparing Outcomes of Transurethral Resection of the Prostate in Men with Greater Than or Less Than 100 cc Prostate Volume: A Single-Centre Study

Objective: This study describes the peri-operative results, safety, and functional outcomes of transurethral resection of the prostate (TURP) performed in men with benign prostatic hyperplasia [or hypertrophy; (BPH)] and a prostate gland volume ≥100 cc. Materials and Methods: A retrospective analysis of a cohort of patients undergoing TURP at a single institution over four years was undertaken. Patients with known prostate cancer were excluded. Clinical outcomes were between men with a prostate volume of ≥100 cc and men with a prostate volume <100 cc. Functional outcomes were assessed by defining a series of measurable post-operative “lower urinary tract symptoms (LUTS) events” and comparing the time-to-event profile using a Kaplan-Meier estimator. Results: Out of a total of 238 men who underwent TURP for BPH during the study period, 72 had a prostate volume ≥100 cc (30%). Baseline demographics were similar to the group of patients with a prostate volume <100 cc. Patients with large prostates had a significantly longer mean operating time (56 vs 98 minutes, p<0.0001). The peri-operative complication profile and post-operative complication rate were similar between the two groups. During a median follow-up period of 27 months (range, 2-54 months), no difference in LUTS events-free survival was observed (p=0.93). Conclusion: Our results show that TURP can be safely performed in patients with large prostate glands (≥100 cc). Although operating times were longer in the large prostate group, this did not significantly affect the complication rate nor compromise a good functional outcome.

Holmium laser enucleation of the prostate vs monopolar transurethral resection of the prostate in management of benign prostatic hyperplasia

Objective The aim was to compare the efficacy, safety, and cost-effectiveness of holmium laser enucleation of the prostate (HoLEP) vs monopolar transurethral resection of the prostate (TURP) in the management of benign prostatic hyperplasia. Materials and methods Between February 2018 and February 2020, 70 patients who underwent surgical treatment for benign prostatic hyperplasia were randomized into two equal groups, representing HoLEP and monopolar TURP. All the patients were assessed preoperatively and followed up for 12 months postoperatively. The primary preoperative and postoperative parameters were the international prostate symptom score (IPSS) and maximum urine flow rate (Qmax), whereas the secondary parameters were operative time, resected volume, postoperative drop in hemoglobin level, postoperative change in sodium level, postoperative catheterization time, duration of hospital stay, and postvoiding residual urine. All complications were recorded. Cost analysis was evaluated. Results A total of 60 patients (30 HoLEP and 30 TURP) of the initial 70 patients completed our study. Mean baseline prostate sizes were similar in both groups. HoLEP group had longer operative time of 80 min compared with 60 min in the TURP group. HoLEP was associated with shorter postoperative catheter time and hospital stay compared with those of TURP group. There were no statistically significant differences between both groups regarding perioperative parameters such as resected volume, hemoglobin drop, and sodium level drop. Moreover, postoperative international prostate symptom score, Qmax, postvoiding residual urine, prostatic specific antigen, and quality of life were comparable in both groups. There was no statistically significant difference between both groups regarding postoperative complications. Regarding cost analysis, HoLEP was more cost-effective than TURP. Conclusion Both HoLEP and monopolar TURP are safe and effective. However, HoLEP has shorter catheterization time and hospital stay and was more cost-effectiveness but had longer operative time than monopolar TURP.

An Optimized Approach for Prostate Image Segmentation Using K-Means Clustering Algorithm with Elbow Method.

Prostate cancer disease is one of the common types that cause men's prostate damage all over the world. Prostate-specific membrane antigen (PSMA) expressed by type-II is an extremely attractive style for imaging-based diagnosis of prostate cancer. Clinically, photodynamic therapy (PDT) is used as noninvasive therapy in treatment of several cancers and some other diseases. This paper aims to segment or cluster and analyze pixels of histological and near-infrared (NIR) prostate cancer images acquired by PSMA-targeting PDT low weight molecular agents. Such agents can provide image guidance to resection of the prostate tumors and permit for the subsequent PDT in order to remove remaining or noneradicable cancer cells. The color prostate image segmentation is accomplished using an optimized image segmentation approach. The optimized approach combines the k-means clustering algorithm with elbow method that can give better clustering of pixels through automatically determining the best number of clusters. Clusters' statistics and ratio results of pixels in the segmented images show the applicability of the proposed approach for giving the optimum number of clusters for prostate cancer analysis and diagnosis.

Holmium laser enucleation of the prostate versus bipolar transurethral enucleation of the prostate in management of benign prostatic hyperplasia: A randomized controlled trial

To evaluate the safety, efficacy and cost-effectiveness of holmium enucleation of the prostate and bipolar transurethral enucleation of the prostate. In our randomized controlled trial, 120 patients were allocated into two equal groups representing holmium enucleation of the prostate and bipolar enucleation of the prostate. Operative parameters were recorded according to operative, enucleation and resection time in addition to the intraoperative complications. Patients were followed up at 1, 3 and 12months postoperative to assess the prostate size, post-voiding residual urine, International Prostate Symptom Score, peak urine flow rate and quality of life, and compared with the preoperative parameters. Cost analysis was evaluated for both procedures. We evaluated 107 patients who finished our follow up and their data were analyzed. The prostate size was 135.2±34.8mL and 125±26.9mL for holmium enucleation of the prostate and bipolar enucleation of the prostate, respectively. Holmium enucleation of the prostate was associated with a shorter operative time of 83.43±6.92min compared with 94.7±12.2min in bipolar enucleation of the prostate groups. Holmium enucleation of the prostate was associated with an earlier catheter removal time and shorter hospital stay compared with bipolar enucleation of the prostate. Postoperative International Prostate Symptom Score, quality of life, post-voiding residual urine, peak urine flow rate, prostate-specific antigen and prostate volume reduction were comparable between both groups, and they both showed statistically significant improvement compared with their preoperative parameters. In the cost analysis, holmium enucleation of the prostate was more cost-effective than bipolar enucleation of the prostate. Both holmium enucleation of the prostate and bipolar enucleation of the prostate are safe and effective in the surgical management of large prostatic adenomas. Holmium enucleation of the prostate has a shorter operative time and hospital stay with earlier catheter removal time, and is more cost-effective than bipolar enucleation of the prostate.

Role of multiparametric prostate MRI in the management of prostate cancer.

Prostate cancer has traditionally been diagnosed by an elevation in PSA or abnormal exam leading to a systematic transrectal ultrasound (TRUS)-guided biopsy. This diagnostic pathway underdiagnoses clinically significant disease while over diagnosing clinically insignificant disease. In this review, we aim to provide an overview of the recent literature regarding the role of multiparametric MRI (mpMRI) in the management of prostate cancer. A thorough literature review was performed using PubMed to identify articles discussing use of mpMRI of the prostate in management of prostate cancer. The incorporation of mpMRI of the prostate addresses the shortcomings of the prostate biopsy while providing several other advantages. mpMRI allows some men to avoid an immediate biopsy and permits visualization of areas likely to harbor clinically significant cancer prior to biopsy to facilitate use of MR-targeted prostate biopsies. This allows for reduction in diagnosis of clinically insignificant disease as well as improved detection and better characterization of higher risk cancers, as well as the improved selection of patients for active surveillance. In addition, mpMRI can be used for selection and monitoring of patients for active surveillance and treatment planning during surgery and focal therapy.

Abstract A047: An ethnographic study of African American men's prostate cancer treatment decision-making

Abstract Purpose: Compared to White men, African American men bear a disproportionate burden of prostate cancer (PCa), including higher mortality, widespread undertreatment, and greater dissatisfaction with care and decisional regret. We explored the process of treatment decision-making to inform future interventions to achieve patient-centered communication and guideline-concordant care. Methods: We conducted an ethnographic cohort study at two public hospitals following African American men newly diagnosed with PCa, from diagnosis through treatment decision. Data sources included audio-recorded observations of urology and radiation oncology appointments, field notes from observations of multiple clinic appointments, and two in-depth interviews with patients (post-diagnosis and post-treatment decision). We explored how patients chose their treatment, who they consulted, and the information they sought. Audio recordings of clinic appointments and in-depth interviews were transcribed verbatim. We used an iterative process of coding and team discussion to conduct a thematic analysis of qualitative data to examine the experiences, refine codes, and identify key themes. Results: Among 16 African American men diagnosed with PCa, four key themes emerged regarding treatment decision-making: feelings of anxiety/fear, impact of others' cancer narratives, interactions with clinical team, and sociocultural support. Men expressed a desire to quickly get past PCa due to anxiety/fear and viewed surgery as their best option to achieve this goal. Patients' sense of urgency varied based on diagnosis (low-risk vs. intermediate- or high-risk PCa). Many men reflected on negative things they heard from other people's cancer experience, often not related to PCa, which elevated their own apprehension of certain treatment options. Patients expressed confidence in and level of comfort with their urologist and his/her recommendation, despite the absence of a second opinion or radiation oncology consultation. Notable sociocultural dynamics emerged, such as men hiding their diagnosis from family, and family members questioning care plans (e.g., active surveillance vs. active treatment). Partners, family members, and friends played an important role, despite their absence at clinic appointments. Conclusions: Study results thus far reveal a range of influences on PCa treatment decision-making among African American men, including fear/anxiety and sociocultural networks that may contribute to rushed and ill-informed decisions. A more nuanced probing of sociocultural aspects is needed. Future studies should further explore these factors as nodes shaping decision trajectories, and therefore as potential points for intervention. For example, educational efforts might highlight the availability of time to consider treatment options and the value of second opinions. PCa survivors' stories could also be a powerful resource, although efforts may need to demystify misinformation that incites fear. Citation Format: Nynikka R. Palmer, Richard L. Street, Dean Schillinger, Janet K. Shim, Sarah D. Blaschko, Benjamin N. Breyer, Rena J. Pasick. An ethnographic study of African American men's prostate cancer treatment decision-making [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A047.

Prostatic artery embolization versus transurethral resection of the prostate in management of benign prostatic hyperplasia.

BackgroundTransurethral resection of the prostate (TURP) is considered the gold standard surgical intervention for prostate size less than 80 g. Prostatic artery embolization (PAE) has been suggested as a minimally invasive interventional radiological procedure in the management of benign prostatic hyperplasia (BPH), especially by using the PErFecTED technique. We aim through our study to evaluate the efficacy and safety of PAE compared with those of monopolar transurethral resection of prostate (M-TURP) and bipolar transurethral resection of prostate (B-TURP) in treating lower urinary tract symptoms (LUTSs) secondary to BPH.MethodsWe randomized 60 patients into 3 equal groups representing M-TURP, B-TURP, and PAE. Patients were followed up at 1 and 6 months postoperatively with regard to the International prostate symptom score (IPSS) score; uroflowmetry; prostate volume by transrectal ultrasound; and postvoid residual urine.ResultsThe mean operative time was 59, 68, and 89 minutes for the M-TURP group, the B-TURP group, and the PAE group, respectively; only one patient, who represented 5% of the M-TURP group and 1.7% of the whole study population, developed transurethral resection syndrome. Four patients of the PAE group complained of postembolization syndrome, which represented 20% of the cases. Only two patients in our study, both belonging to the PAE group, developed acute urinary retention after catheter removal, representing 10% of the PAE group and 3.33% of the whole study population. The improvement in the IPSS score, the average uroflowmetry (Q-average) score, postvoid residual urine, and prostate volume reduction was noted in all groups, with more statistically significant improvement in each of the M-TURP and the B-TURP groups than in the PAE group.ConclusionPErFecTED technique is a novel way of embolization, with statistically significant improvement for patients complaining of LUTSs due to BPH in terms of improvement of IPSS, uroflowmetry, prostate size, and amount of postvoid residual urine, yet these results are still not comparable with either the results of M-TURP or B-TURP that still show more effective improvement.

Prostate cancer survivorship priorities for men and their partners: Delphi consensus from a nurse specialist cohort.

To describe the prostate cancer survivorship experience and priorities from the perspective of prostate cancer specialist nurses. Specialist nurses are providing long-term survivorship care to men and their partners however, few prostate cancer survivorship interventions are effective and priorities for nurse-led survivorship care are poorly understood. A three-round modified Delphi approach. The study was conducted between 1 December 2018 and 28 February 2019 to develop a consensus view from an expert nurse cohort (43 prostate cancer specialist nurses: 90% response). First, participants described men's prostate cancer survivorship experience and priorities for improving care for men and partners. In subsequent rounds, participants identified key descriptors of the survivorship experience; rated priorities for importance and feasibility; and identified a top priority action for men and for partners. Thematic analysis and descriptive statistics were applied. Guidelines for Reporting Reliability and Agreement Studies informed the conduct of the study. Prostate cancer specialist nurses characterised the prostate cancer survivorship experience of men as under-resourced, disjointed and distressing. In all, 11 survivorship priorities for men and three for partners were identified within five broad areas: capacity building; care coordination; physical and psychosocial care; community awareness and early detection; and palliative care. However, feasibility for individual items was frequently described as low. Internationally, prostate cancer survivorship care for men and their partners requires urgent action to meet future need and address gaps in capacity and care coordination. Low feasibility of survivorship priorities may reflect translational challenges related to capacity. Prostate cancer survivorship care guidelines connected to practice priorities are urgently needed. These findings address key gaps in the evidence for developing national nurse-led prostate cancer survivorship priorities. These priorities can be used to inform survivorship guidelines including nursing care for men with prostate cancer and their partners.

Transperineal intraprostatic injection of botulinum neurotoxin A vs transurethral resection of prostate for management of lower urinary tract symptoms secondary to benign prostate hyperplasia: A prospective randomised study

ABSTRACTObjectives: To evaluate transperineal intraprostatic injection of botulinum neurotoxin A (BoNT-A) in patients with lower urinary tract symptoms (LUTS) secondary to benign prostate hyperplasia (BPH) who failed to respond to 6-month medical treatment compared with transurethral resection of the prostate (TURP).Patients and methods: In all, 92 men were divided into TURP and BoNT-A groups after being evaluated using the International Prostate Symptom Score (IPSS) and five-item version of the International Index of Erectile Function, estimation of serum total prostate-specific antigen (tPSA), ultrasonographic estimation of prostatic volume (PV), and uroflowmetry determination of voiding volume (VV), maximum urinary flow rate (Qmax) and post-void residual urine volume (PVR). BoNT-A (200 U diluted in 3 mL saline) was injected, using a 22-G spinal needle under transrectal ultrasonography guidance, with 1-mL in each lobe. Patients were assessed 3-monthly for 12 months.Results: The IPSS significantly decreased in all patients with a non-significant difference between the groups. The mean VV and Qmax increased, whilst PVR, PV and serum tPSA significantly decreased. Patients who showed deterioration at 12 months were re-evaluated and underwent TURP. BoNT-A injection significantly maintained erectile function compared with TURP.Conclusion: Intraprostatic BoNT-A injection reduced PV with subsequent increases in VV and Qmax, and decreases in PVR and serum tPSA level. Intraprostatic BoNT-A injection allowed surgery sparing in >70% and preserved erectile function in 91.3% of patients.Abbreviations: BoNT-A: botulinum neurotoxin A; HRQOL: health-related quality of life; IIEF-5: five-item version of the International Index of Erectile Function; PV: prostatic volume; PVR: post-void residual urine volume; Qmax: maximum urinary flow rate; tPSA: total PSA; VV: voided volume