Surgical Castration Research Articles

Inguinal metastases of testicular cancer. Report of two cases

Case description: We present a series of two cases of patients presenting testicular cancer associated to inguinal masses. First, a 28 year-old male with history of bilateral orchidopexy presenting a right abscessed inguinal mass associated to a left testicular mass. Teratoma was diagnosed by the pathological anatomy. The second case is a 52 year-old male patient with a history of bilateral orchidopexy and right inguinal orchiectomy due to seminoma. A PET scan obtained during follow-up, showed a right inguinal mass with enhanced tracer uptake. A biopsy of such mass was performed, reporting metastasis of seminoma. Relevance: Due to the anatomy of the lymphatic drainage of the testes, retroperitoneal nodes constitute the first station for metastases. However, this drainage is modified in patients with history of inguinal or scrotal surgery, as anastomosis with inguinal vessels are formed. Clinical implication: Even though testicular cancer spreads through the lymphatic system to retroperitoneal nodes, in the rare cases that inguinal masses occur, these are considered as distant metastasis, changing the patient´s stage. Conclusion: Although inguinal metastases in testicular cancer are infrequent, they can be present in patients who underwent scrotal surgery. These should be considered as regional and not distant metastases.

Synchronous Primary Testicular Tumor: a case report of diffuse large B-cell lymphoma

Case description: 63-year-old man of with 7-month history of progressive and gradual increase in testicular size without pain, symptoms of local or systemic infection. Biomarkers for testicular neoplasia were within the reference range: LDH(167 U/L), AFP( 1.49 IU/mL), and HCG( 0.2 mUI/mL). MR): enlarged testicular dimensions showing nodular lesions of heterogeneous enhancement. The patient initially underwent a inguinal orchiectomy who revealed diffuse large B-cell lymphoma. Relevance: primary testicular lymphoma (PTL) is a rare non-Hodgkin lymphoma (NHL) that occurs in 1–2% of all cases of NHL and commonly presents as diffuse large B-cell lymphoma in 80–90% of cases. Bilateral and synchronous lesions are observed in 1–2% and 10% of cases, respectively. In this report, we describe our experience regarding this cancer. Clinical implications: if not properly conducted, it can end in advanced disease with no prospect of cure, infertility, primary hypogonadism and psychological alterations due to the removal of the gonads. Conclusions: PTL is a rare malignancy associated with high recurrence rates and poor prognosis, and multimodal therapy is warranted to achieve better long-term survival and cure rates.

Ranking bovine pain-related behaviors using a logistic regression algorithm

Pain identification in farm animals is a welfare challenge worldwide. In the last decade, our research team validated the Unesp-Botucatu Cattle Acute Pain Scale (UCAPS) based on specific pain or discomfort behaviors and alterations to maintenance behaviors when the cattle experiences pain. Recently, for other specific-species pain scales, such as sheep, pigs, and horses, we have used algorithms to weigh the pain-related behaviors, ranking their heterogeneous importance. Because the ranking of cattle pain-related behaviors' importance is still unknown, we aimed to investigate whether UCAPS pain-related behaviors have different statistical weights and rank their importance. We used a dataset comprising behavioral scores from 40 bulls in the perioperative period subjected to surgical castration in our previous study. Bulls were filmed between 16 and 24 hours before castration, between 1 and 4 hours after castration, 1 hour after analgesia, and 24 hours after the end of the surgery. Three experienced observers assessed all videos blind to the timepoint. After watching each video, the observers decided whether they felt analgesia should be indicated for the individual (expert assessment) and score UCAPS behaviors. Each pain-related behavior was weighted using a multilevel binomial logistic regression. Among the 17 UCAPS behaviors, four were not significant (‘Activity 1: restless, moves more than normal or lies down and stands up with frequency’, ‘Appetite 1: hyporexia’, ‘Wagging tail’, and ‘Licking wound’), suggesting minor importance. The algorithm highlighted ‘Kicking’, ‘Hind limbs extended’, ‘Extends neck’, ‘Head down’, and ‘Interaction 2’ (apathetic: may be isolated or may not accompany the other animals; does not react to tactile, visual and/or audible environmental stimuli) respectively, as the five most important pain-related behaviors within this sample. Statistical weighting might contribute to the acute pain scoring approach and selecting behaviors in the psychometric validation process for pain scales. In conclusion, the statistical weighting based on multilevel binomial logistic regression raised evidence for a ranking of the importance of UCAPS pain-related behaviors in determining the need for analgesia in bulls after surgical castration. These findings contribute to a better understanding of bulls' behavioral responses to acute pain, potentially improving pain identification and monitoring, and enhancing welfare.

Evaluación de parámetros hematológicos, estrés oxidativo, niveles de capacidad de unión de hierro y hierro insaturado en perros pastores Kangal, antes y después de la orquiectomía

Gonadectomy is a widely used method in reproductive health management, and behavior disorder therapies of domestic animals. Anemia and its development, one of the complications of surgical castration, which has been done so much recently in shelter dogs and dogs kept at home, has been investigated in male Kangal shepherd dogs. In castrated male Kangal shepherd dogs was to investigate the relationship between gonadectomy and oxidant and antioxidant levels, Iron (Fe) concentrations, unsaturated iron binding capacity (UIBC) and some blood parameters (RBC, HGB, HCT, MCV, RDW, MCHC). Blood samples were taken from 20 adult Kangal dogs brought to a clinic before castration (Day 0) and on the 1st, 3rd and 7th days. Some biochemical analyzes and blood parameters were evaluated in the blood samples taken. For this purpose, serum total oxidant–antioxidant capacity (TAC–TOC), Iron (Fe) concentrations, unsaturated iron binding capacity (UIBC) and some blood parameters (RBC, HGB, HCT, MCV, RDW, MCHC) were examined. In this study, it was evaluated the relationship between gonadectomy and oxidant–antioxidant capacity and Fe metabolism at some serum parameters in male dogs. After the orchidectomy operation, a remarkable decrease in clinical and statistical blood parameters was observed. As a result of this study, in the analysis of blood parameters, a severe picture of anemia was observed. It was determined an important role in erythropoiesis, with orchidectomy. The statistical difference in blood parameters (P<0.05) was indicative of this.

Half-life of serum anti-Müllerian hormone and changes after gonadectomy in adult female and male dogs with normal and abnormal gonads

Anti-Müllerian hormone (AMH) is a biomarker for the presence of gonadal tissue. Changes in serum AMH after gonadectomy are not well established, and its serum half-life is unknown in dogs. We measured serum AMH with a validated electro-chemiluminescent immunoassay in adult female (n = 12) and male (n = 7) dogs with normal gonads, as well as in dogs with gonadal pathology (ovarian remnant syndrome, ORS n = 3, testicular tumor [Leydig cell, Sertoli cell, seminoma] n = 3, unilateral abdominal cryptorchid n = 4) on the day of gonadectomy (D0), and on D3, D7, D14 (females and males), and D21, D28 (males only). Males had higher AMH concentrations than females independent of gonadal status (P < 0.001). Dogs with ORS had lower initial AMH (0.45 ± 0.43 ng/ml) than bitches with normal gonads (1.16 ± 0.44 ng/ml; P = 0.027). Cryptorchid dogs had higher initial concentrations (80.57 ± 52.81 ng/ml) than males with normal gonads (7.92 ± 2.45 ng/ml; P = 0.004), and those with testicular tumors (18.63 ± 5.04 ng/ml) were intermediate (P ≥ 0.250). AMH decreased over time (P ≤ 0.012) and was 0.01–0.04 ng/ml by D14 in females and 0.02–0.12 ng/ml by D28 in males. Serum half-life in the whole study population was 2.85 ± 0.51 days and did not differ between groups. In conclusion, serum AMH can differentiate between intact and gonadectomized status of adult dogs by 14 days after ovario(hyster)ectomy in females and by 28 days after surgical castration in males.

Testosterone regulates thymic remodeling by altering metabolic reprogramming in male rats

The thymus is an energy-consuming organ, and its metabolism changes with atrophy. Testosterone regulates thymus remodeling (atrophy and regeneration). However, the characteristics of the energy metabolism during testosterone-mediated thymic atrophy and regeneration remain unclear. In this study, we demonstrated that testosterone ablation (implemented by immunocastration and surgical castration) induced global metabolic changes in the thymus. Kyoto Encyclopedia of Genes and Genomes pathway enrichment for differential metabolites and metabolite set enrichment analysis for total metabolites revealed that testosterone ablation affected thymic glycolysis, glutamate metabolism, and fatty acid β-oxidation. Testosterone ablation-induced thymic regeneration was accompanied by attenuated glycolysis and glutamate metabolism and changed fatty acid composition and content. Testosterone supplementation in immunocastrated and surgically castrated rats enhanced glutaminolysis, reduced the level of unsaturated fatty acids, enhanced the β-oxidation of unsaturated fatty acids in the mitochondria, boosted the tricarboxylic acid (TCA) cycle, and accelerated thymic atrophy. Overall, these results imply that metabolic reprogramming is directly related to thymic remodeling.

Clinical outcomes in metastatic prostate adenocarcinoma treated with abiraterone and enzalutamide.

The management of metastatic prostate cancer has progressed immensely in the last decade. This study aims to investigate the real-world clinical outcomes of metastatic prostate adenocarcinoma treated with abiraterone and enzalutamide. The findings will assist healthcare providers in making more informed decisions when choosing between these two drugs for treating these patients. A retrospective analysis of 80 patients at our tertiary care hospital was conducted from January 2015 to July 2022. Data were analysed using SPSS version 20.0. An independent sample T-test was used for continuous data and the chi-square test for categorical data. Medians and means were calculated for continuous or ordinal variables. Kaplan-Meier survival curves presented progression-free and overall survival (OS), with comparisons made using the log-rank test. Survival rates with 95% CIs were reported, with p < 0.05 considered significant. In our final analysis of 80 patients, the median age was 65 years, with 88% having an eastern cooperative oncology group performance status between 0 and 2. Histopathology showed adenocarcinoma in 91% of cases. Grade Group III-IV disease was present in 51.3%, and 67.5% had a Gleason Score of >8. Bilateral orchidectomy was performed in 41 patients (51.25%), with a median Gonadotropin-releasing hormone analogue use of 32 months. Most patients (72.5%) were castration-sensitive. Among the 80 patients, 60 (75%) were treated with abiraterone and 20 (25%) with enzalutamide. The prostate-specific antigen (PSA) doubling time was >6 months in 80% of the abiraterone group and 75% of the enzalutamide group. PSA response rates were similar for both drugs, with comparable rates of progressive disease, partial response, stable disease and complete response (p = 0.036). There was no significant difference in median time to progression (19 months for abiraterone versus 18 months for enzalutamide) (95% CI 9.7-27.9; p = 0.004). The median OS for the entire cohort was 67 months (95% CI 39-94; p = 0.003). The findings suggest that both abiraterone and enzalutamide are effective in prolonging progression-free and overall survival in this patient population, providing comparable safety. Further studies are recommended to validate these findings and inform clinical decision-making.

Simple and Epididymal-Sparing Orchiectomy for Surgical Castration in Stage IV Prostate Cancer.

Background: Androgen deprivation therapy, the mainstay of treatment for patients with advanced prostate cancer, can be either medical or surgical. Surgery has cost benefits compared to medical treatment. In this study, we evaluated the use of simple and epididymal-sparing orchiectomy in 2 different practice settings for the treatment of metastatic prostate cancer. Methods: We reviewed patients who underwent surgical castration for metastatic prostate cancer between 2011 and 2022. The primary outcome was achieving castration-level total testosterone of <50 ng/dL. We also compared the characteristics of patients who were seen at a public academic teaching hospital vs those who were seen at a private community hospital (oncology group practice), and we evaluated the impact of orchiectomy approach (simple vs epididymal-sparing orchiectomy) on patient outcomes. Results: We analyzed 101 patients who underwent orchiectomy: 40 (39.6%) at a public academic teaching hospital and 61 (60.4%) at a private community hospital (oncology group practice). Of these patients, 81 (80.2%) underwent simple orchiectomy and 20 (19.8%) underwent epididymal-sparing orchiectomy. Forty-nine patients (48.5%) had previously received medical androgen deprivation therapy, 9 (18.4%) of whom had medication adherence issues. Patient age, race, and marital status differed significantly between hospital facilities. The overall surgical complication rate was 3.0%. Postoperative total testosterone levels were available for 81 patients, drawn a median of 57 days after surgery [IQR 30, 123]. All patients had castrate-level total testosterone (median 10 ng/dL [IQR 9, 19]) postoperatively, with no differences seen between surgery location (P= 0.84) or surgical technique (P= 0.90). Conclusion: Simple or epididymal-sparing orchiectomy is safe and effective for surgical castration and is an alternative to medical androgen deprivation therapy for patients diagnosed with metastatic prostate cancer regardless of the practice demographics.

Liposarcoma of the testis: A case report

Liposarcoma of the testis is a rare genitourinary tumor. Liposarcoma commonly arises in the spermatic cord and rarely arises in the testis. We describe the case of a 60-year-old man who presented with complaints of swelling, associated with pain, in the right testicular region for 3 weeks. The scrotal ultrasound showed a heterogenous, hyperechoic lesion measuring 10 × 7 cm on the right. The testicular lesion appeared irregularly marginated with heterogeneous echotexture, with a central hyperechoic area and peripheral hypoechogenicity. Contrast-enhanced computed tomography of the abdomen showed no intra-abdominal mass or lymphadenopathy. Tumor markers including alpha-fetoprotein, human chorionic gonadotropin, and lactate dehydrogenase were normal. A right high inguinal orchiectomy was performed, and the postoperative histopathologic examination showed features of liposarcoma of the testis with components of myxoid liposarcoma and well-differentiated liposarcoma. There was no evidence of recurrence up to 4 years post-surgery. Thus, misdiagnosis is common in liposarcoma testis due to the rarity and vague presentation. Ultrasound and tumor makers are often negative. A high index of suspicion is required in cases of tumor marker-negative testicular masses. The treatment of choice is high inguinal orchiectomy; evidence for the utility of chemotherapy and radiotherapy is limited.

Leptin promotes proliferation of human undifferentiated spermatogonia by activating the PI3K/AKT/mTOR pathway.

Male infertility is a common disease affecting male reproductive health. Leptin is an important hormone that regulates various physiological processes, including reproductive function. However, few experimental studies have been carried out to elucidate the mechanism of leptin's effects on male reproductive function. The purpose of this study was to investigate the effects of leptin on testicular spermatogenesis and its mechanism, so as to provide potential targets for the treatment of patients with spermatogenic dysfunction. Testicular tissues were collected from eight prostate cancer patients undergoing surgical castration. GPR125-positive spermatogonia were isolated by two consecutive magnetic activated cell sorting (MACS), followed by incubation with conditioned medium. To identify the signaling pathway(s) involved in the effects of leptin, undifferentiated spermatogonia were treated with different concentrations of leptin and antagonists of leptin-related pathways. The proliferative effect of leptin was evaluated by cell counting using a hemocytometer. Expressions of p-AKT, p-ERK, p-STAT, and p-S6K were determined by western blotting analysis. Leptin promoted the growth of human GPR125-positive spermatogonia in a concentration-dependent manner. The most significant proliferative effect was observed using 100ng/mL leptin after 6 days of culture. Leptin significantly increased the phosphorylation of STAT3, AKT, and ERK in undifferentiated spermatogonia. Phosphatidylinositol 3-kinase (PI3K) inhibitor LY294002 inhibited the leptin-induced activation of AKT, ERK, and downstream S6K. Treatment with the mammalian target of rapamycin (mTOR) inhibitor rapamycin also inhibited S6K phosphorylation. Moreover, both LY294002 and rapamycin were found to inhibit the leptin-induced proliferation of undifferentiated spermatogonia. These results suggested that the leptin-induced proliferation of GPR125-positive spermatogonia was dependent on the PI3K/AKT/mTOR pathway. Further exploration of proliferation and apoptotic markers suggested that leptin may alleviate cell apoptosis by regulating the expression of Bax and FasL. A certain concentration of leptin (25∼100ng/mL) could promote proliferation of undifferentiated spermatogonia, which was mediated by PI3K/AKT/mTOR pathway.

Cloning and Expression of Gonadotropin-releasing Hormone to Develop an Immunological-based Sterilization Vaccine

Background: Gonadotropin hormone-releasing hormone (GnRH) is a peptide involved in mammals’ fertility and may also serve as a candidate target for cancer immunotherapy. Immunonsterilization is known as a proper alternative to surgical castration and has been advocated by European countries in recent years. Immunization with GnRH can effectively inhibit the secretion of gonadotropins and cause infertility in both genders of mammals. In this study, a recombinant trimer of GnRH is designed and expressed in a prokaryotic system. Materials and Methods: A construct containing GnRH trimer was designed and prepared using gene synthesis. A cloning site was embedded and connected to the GnRH using a linker to further clone any protein of interest. The construct was subcloned into a pET-32a+ plasmid vector. The recombinant vector was transferred to BL21, an Escherichia coli strain, and the expression was induced using isopropyl β- d-1-thiogalactopyranoside (IPTG). The cell lysate was prepared using lysis buffer and nickel affinity chromatography purification. The GnRH expression was evaluated using sodium dodecyl sulfate-polyacrylamide gel electrophoresis after protein purification. Results: The cloning was verified using a polymerase chain reaction (PCR) followed by sequencing the recombinant vector. The result of the sodium dodecyl sulfate-polyacrylamide gel electrophoresis verified the recombinant protein’s expression and the purification process’s function. Conclusion: The GnRH was properly cloned and expressed in BL21. The results also verified the reliability of the purification process. The construct design allows the researchers to express another peptide sequence attached to the GnRH using the embedded linker to improve the stability and antigenicity. A stable recombinant GnRH would be applied in immunocastration and cancer immunotherapies.

Male animal sterilization: history, current practices, and potential methods for replacing castration.

Sterilization and castration have been synonyms for thousands of years. Making an animal sterile meant to render them incapable of producing offspring. Castration or the physical removal of the testes was discovered to be the most simple but reliable method for managing reproduction and sexual behavior in the male. Today, there continues to be global utilization of castration in domestic animals. More than six hundred million pigs are castrated every year, and surgical removal of testes in dogs and cats is a routine practice in veterinary medicine. However, modern biological research has extended the meaning of sterilization to include methods that spare testis removal and involve a variety of options, from chemical castration and immunocastration to various methods of vasectomy. This review begins with the history of sterilization, showing a direct link between its practice in man and animals. Then, it traces the evolution of concepts for inducing sterility, where research has overlapped with basic studies of reproductive hormones and the discovery of testicular toxicants, some of which serve as sterilizing agents in rodent pests. Finally, the most recent efforts to use the immune system and gene editing to block hormonal stimulation of testis function are discussed. As we respond to the crisis of animal overpopulation and strive for better animal welfare, these novel methods provide optimism for replacing surgical castration in some species.

A Case Report of Self-Inflicted Surgical Castration

A Case Report of Self-Inflicted Surgical Castration

NR5A1-related 46,XY partial gonadal dysgenesis: A case report and literature review

Rationale: Disorders/differences of sex development (DSD) include a diverse group of congenital conditions in which the development of chromosomal, gonadal, or anatomical sex is discordant. It involves several variant genes, and one of them is NR5A1. NR5A1 encodes a signal transduction regulator in the hypothalamic-pituitary-gonadal and hypothalamic-pituitary-adrenal pathway, and pathogenic mutation in this gene is a cause of 46,XY DSD. Patient concerns: A 12-year-old individual raised as a girl was admitted to the hospital due to hirsutism and a deep voice that began at 11 years old. The individual exhibited testicular hypoplasia, clitoral hypertrophy, and female external genitalia. Diagnoses: The patient was diagnosed 46,XY partial gonadal dysgenesis. The cytogenetics revealed a 46,XY karyotype and DNA sequencing shown a variant in NR5A1. Pelvic magnetic resonance imaging showed absence of uterus and ovaries. The abdominopelvic ultrasound revealed bilateral testicle in bilateral groin. Pathology confirmed testes dysgenesis. Interventions: The patient underwent bilateral orchiectomy at age 12 years and was given a feminizing hormonal treatment of 0.5 mg/day of estradiol valerate tablets. Outcomes: The patient recovered well after surgery and hormonal treatment and had a regression in hirsutism and clitoromegaly. Lessons: 46,XY DSD is a rare disease that the development of chromosomal, gonadal, or anatomical sex is discordant, when diagnosed 46,XY DSD, the identification of an NR5A1 variant should be considered.

Statin use and mortality risk in Asian patients with prostate cancer receiving androgen deprivation therapy: A population-based cohort study.

This study aimed to examine the associations between the use of statins concurrent with androgen deprivation therapy (ADT) and the risks of mortality in Asian patients diagnosed with prostate cancer (PCa). Adult patients (≥18 years old) diagnosed with PCa who were receiving any form of ADT and were being treated at public hospitals in Hong Kong from December 1999 to March 2021 were retrospectively identified, with follow-up conducted until September 2021. Patients who had received medical castration for <180 days without subsequent bilateral orchidectomy, those who had used statins concurrently with ADT for <180 days, and those with missing baseline total cholesterol levels were excluded. Statin users were defined as individuals who had used statins for ≥180 days concurrent with ADT, while non-users were those who had not used any statins. PCa-related mortality was the primary outcome, while all-cause mortality served as the secondary outcome. Inverse probability treatment weighting was employed to balance the covariates. A total of 4920 patients were included, consisting of 2578 statin users and 2342 non-users (mean age 76.1 ± 8.2 years). Over a mean follow-up period of 4.2 ± 3.3 years, it was observed that statin users had significantly lower risks of both PCa-related mortality (weighted hazard ratio [wHR] 0.56 [95% confidence interval (CI) 0.48, 0.65], p < 0.001) and all-cause mortality (wHR 0.57 [95% CI 0.51, 0.63], p < 0.001), regardless of the type of ADT used. Notably, these associations were more pronounced among patients with less advanced PCa, as indicated by the absence of androgen receptor antagonist or chemotherapy usage (p value for interaction <0.001 for both outcomes). The use of statins concurrent with ADT was associated with reduced mortality risks among Asian patients with PCa. These findings suggest the need for additional research to explore the potential role of statins in the treatment of PCa patients.

FABP5 Inhibition against PTEN-Mutant Therapy Resistant Prostate Cancer.

Resistance to standard of care taxane and androgen deprivation therapy (ADT) causes the vast majority of prostate cancer (PC) deaths worldwide. We have developed RapidCaP, an autochthonous genetically engineered mouse model of PC. It is driven by the loss of PTEN and p53, the most common driver events in PC patients with life-threatening diseases. As in human ADT, surgical castration of RapidCaP animals invariably results in disease relapse and death from the metastatic disease burden. Fatty Acid Binding Proteins (FABPs) are a large family of signaling lipid carriers. They have been suggested as drivers of multiple cancer types. Here we combine analysis of primary cancer cells from RapidCaP (RCaP cells) with large-scale patient datasets to show that among the 10 FABP paralogs, FABP5 is the PC-relevant target. Next, we show that RCaP cells are uniquely insensitive to both ADT and taxane treatment compared to a panel of human PC cell lines. Yet, they share an exquisite sensitivity to the small-molecule FABP5 inhibitor SBFI-103. We show that SBFI-103 is well tolerated and can strongly eliminate RCaP tumor cells in vivo. This provides a pre-clinical platform to fight incurable PC and suggests an important role for FABP5 in PTEN-deficient PC.

Vortioxetine Reverses Impairment of Visuospatial Memory and Cognitive Flexibility Induced by Degarelix as a Model of Androgen Deprivation Therapy in Rats

Introduction: Androgen deprivation therapy (ADT) is a mainstay treatment for prostate cancer, but many patients experience cognitive impairment in domains mediated by the medial prefrontal cortex (mPFC) and hippocampus. Prostate cancer typically occurs in older patients (>65 years). As age is often accompanied by cognitive decline, it may impact the efficacy of any treatment aimed at restoring cognitive impairment induced by ADT. Vortioxetine, a multimodal antidepressant that improves cognition in depression, has been shown to be efficacious in elderly patients. Therefore, vortioxetine may improve cognition in older patients who experience cognitive decline after ADT. Methods: Young (3 months) and middle-aged (13 months) rats were used to investigate the influence of age on treating ADT-induced cognitive decline. As our previous studies used surgical castration, we tested if vortioxetine would reverse cognitive deficits associated with more translationally relevant chemical castration using degarelix. Vortioxetine was given in the diet for 21 days. Animals underwent behavioral testing to assess visuospatial memory mediated by the hippocampus and cognitive flexibility mediated by the mPFC. We also investigated changes in afferent-evoked responses in these regions in middle-aged rats. Results: Degarelix induced impairments in both visuospatial memory and cognitive flexibility that were reversed by vortioxetine. Vortioxetine also rescued afferent-evoked responses in the mPFC and hippocampus. However, modest age-related reductions in baseline visuospatial memory limited our ability to detect further decreases induced by degarelix in middle-aged rats due to a floor effect. Conclusion: These results suggest that vortioxetine may be a treatment option for older prostate cancer patients who experience cognitive decline after ADT.

The histomorphological appearance of the testes in Alloxan-induced diabetic rabbits

This study assessed the histomorphological changes in testicular tissues due to the experimental diabetes mellitus (DM) generated in rabbits with Alloxan. Twenty-four adult male rabbits were used and allocated randomly into two equal groups (n=12 of each). The first group served as a control group and received normal saline only. The second group (diabetic group) was injected with Alloxan at a 100mg/kg IP dose. The serum glucose level was estimated at (0 min), 3 days and then (1,2 and 3 months), by aspiration of a blood sample from the jugular vein mixed with anticoagulant (EDTA) to obtain serum. The testosterone hormone was assayed from the serum obtained by centrifugation of blood samples using a special kit. Testicular biopsies were harvested through surgical castration at (1,2, and 3 months) post-administration of Alloxan. Results displayed a marked increase in glucose levels in the diabetic group starting from day three till the end of the experiment, with high differences between the two groups. Moreover, testosterone levels significantly decreased in the diabetic group compared to the control group. Our histomorphological examination confirmed that Alloxan leads to testicular damage in rabbits, represented by testicular atrophy, necrosis focusing in spermatogenic cells and separation of germinal epithelium. In conclusion, the injection of Alloxan succeeded in inducing (DM) with clear alteration in studied parameters. . Key Words: Biochemical, Testicular Parameters, Alloxan, Rabbits.

Incidental discovery of seminoma after simple orchiectomy in transgender individuals: A case series

Introduction: Seminoma is a common malignancy reported in young, cisgender men. However, there is sparse literature describing cases of seminoma in the transgender and gender diverse patient population. Case Series: We present two cases of seminoma incidentally discovered after simple bilateral orchiectomy performed as part of genital gender affirming surgery. In both instances, patients had not reported any testicular firmness or abnormality prior to surgery. After a thorough literature review, only two other such cases have been reported. Herein, we discuss our two cases and their implications for surgical management of suspected testicular malignancy intraoperatively, a methodical inspection of testicles removed during gender affirming surgery and providing affirming care when navigating discussions of genitalia with transgender and gender diverse patients. Conclusion: Testicular malignancy such as seminoma may be found incidentally when transgender and gender diverse patients undergo genital gender affirming surgery. Thus, special attention is required to identify suspicious exam findings, adjust surgical techniques as indicated, and properly examine surgical specimens. As there is a significant paucity of literature surrounding testicular malignancies in the transgender and gender diverse patient population, it is crucial to continue to investigate how to provide affirming care in these situations.

Efficacy of Treatment for Metastatic Hormone-Sensitive Prostate Cancer: An Umbrella Review of Systematic Reviews and Meta-Analyses.

This umbrella review focused on evaluating the efficacy and adverse events of the metastatic hormone-sensitive prostate cancer patients receiving any treatment regimens, including ADT alone or combination treatments. This study conducted an umbrella review following the PRISMA 2020 checklist, aiming to summarize the available studies to evaluate the efficacy of medical treatments for metastatic hormone-sensitive prostate cancer. A literature search was performed to identify systematic reviews and meta-analyses (SRMAs) that included only randomized controlled trials (RCTs) up to September 2023. This study summarized their findings, evaluated overlapping data (i.e., the same RCTs were included in >one SRMA), tested for excessive significance (i.e., observed number of statistically significant studies > expected number by chance) and assessed the quality of the studies. A total of 4191 studies were identified, but only 27 were included. Among those 27 studies, 12 were network meta-analyses and 15 were direct meta-analyses. Most studies showed no statistically significant difference in overall mortality among GnRH agonists, antagonists and bilateral orchiectomy. Combination treatment is more beneficial than ADT alone in both OS and PFS outcomes with more adverse events. Nevertheless, there is no OS advantage of any combination regimen over the others. Combination treatments demonstrated clear benefits in OS and PFS over ADT alone with more AEs. Further studies are needed to compare among combination treatments.