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Jones RB, Snyder PJ. Testosterone Treatment of Men with Unequivocal Hypogonadism Following Treatment of Organ-Confined Prostate Cancer. Endocr Pract 2023; 29:723-726. [PMID: 37236354 DOI: 10.1016/j.eprac.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To determine if testosterone treatment of men with unequivocal hypogonadism and organ-confined prostate cancer is associated with recurrence of the cancer. The testosterone dependence of metastatic prostate cancer has made physicians reluctant to treat hypogonadal men with testosterone even after treatment of prostate cancer. Prior studies of testosterone treatment of men with treated prostate cancer have not documented that the men were unequivocally hypogonadal. METHODS A computerized search of electronic medical records from January 1, 2005, to September 20, 2021, identified 269 men aged ≥50 years who were diagnosed with prostate cancer and hypogonadism. We reviewed the individual records of these men and identified those treated by radical prostatectomy and had no evidence of extraprostatic extension. We then identified men who were hypogonadal prior to the diagnosis of prostate cancer based on at least 1 morning serum testosterone concentration of ≤220 ng/dL, discontinued testosterone treatment when the prostate cancer was diagnosed, resumed testosterone treatment within 2 years after treatment of the cancer, and were monitored for cancer recurrence, defined by a prostate-specific antigen level of ≥0.2 ng/mL. RESULTS Sixteen men met the inclusion criteria. Their baseline serum testosterone concentrations were 9-185 ng/dL. The median duration of testosterone treatment and monitoring was 5 years (range, 1-20 years). None of the 16 men had biochemical recurrence of prostate cancer during this period. CONCLUSION Testosterone treatment of men with unequivocal hypogonadism whose organ-confined prostate cancer is treated by radical prostatectomy may be safe.
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Affiliation(s)
- Robert Benson Jones
- Division of Endocrinology, Diabetes, and Metabolism, Perelman School of Medicine University of Pennsylvania, Philadelphia, Pennsylvania
| | - Peter J Snyder
- Division of Endocrinology, Diabetes, and Metabolism, Perelman School of Medicine University of Pennsylvania, Philadelphia, Pennsylvania.
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Testosterone therapy in prostate cancer: is it still a controversy? Curr Opin Urol 2022; 32:598-606. [PMID: 36081393 DOI: 10.1097/mou.0000000000001039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The benefits of testosterone therapy (TTh) in the hypogonadal male can be dramatic. Historically, TTh has been contraindicated in prostate cancer (PCa). Current evidence has redefined our understanding of the influence serum testosterone has on prostatic androgen activity. Increasing numbers of hypogonadal men with coexisting PCa emphasizes the importance of describing those who may safely receive TTh. This review aims to present literature that evaluates the efficacy and safety of TTh in men with coexisting PCa. RECENT FINDINGS Our study, a comprehensive review of published literature regarding TTh in men with a history of PCa, consisted of studies conducted from the 1940s to 2022. Our review discusses evidence in accordance with previous studies that TTh has a role in patients with localized PCa as it has not been reported to increase rates of recurrence or progression of PCa. SUMMARY The use of TTh in hypongonadal men with a localized PCa has been shown to have positive clinical outcomes without increasing the rate of disease progression or recurrence. Further research, in a randomized controlled setting, is warranted.
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Current strategies to improve erectile function in patients undergoing radical prostatectomy - postoperative scenario. Urol Oncol 2022; 40:87-94. [DOI: 10.1016/j.urolonc.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/01/2021] [Accepted: 12/07/2021] [Indexed: 11/15/2022]
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Learning curve in aquablation: an international multicenter study. World J Urol 2022; 40:773-779. [PMID: 34988648 DOI: 10.1007/s00345-021-03898-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES To describe and analyze the learning curve (LC) of aquablation for the treatment of benign prostatic obstruction and determine the number of cases needed to achieve acceptable surgical safety, efficiency, and efficacy. METHODS A retrospective analysis of prospectively maintained aquablation databases from France, Lebanon, and Spain was conducted. The combined LC of three surgeons was defined by trifecta and pentafecta outcomes. Trifecta reflected efficiency and safety: operative time < 60 min, hemoglobin reduction ≤ 2 mg/dL, and no 90 day Clavien-Dindo grade ≥ 2 complications. Pentafecta reflected effectiveness: percent reduction in International Prostate Symptom Score (IPSS) and ejaculation preservation. The combined LC was plotted using a moving average with polynomial fitting. RESULTS The cohort included 175 consecutive patients. Median (IQR) prostate volume was 70 (50-91) cc, and baseline IPSS was 23 (18-27). The achievement of trifecta exceeded 50% after 4 cases, and 70% after 50 cases. Pentafecta achievement exceeded 50% after 38 cases. Logistic regression showed significant improvement in hemoglobin reduction and ejaculation preservation. Grade ≥ 2 complication was not affected by experience, and neither was 3 month %IPSS reduction as 94% of patients showed ≥ 50% symptoms' improvement. CONCLUSION Aquablation is associated with a quick learning curve for the defined trifecta and pentafecta outcomes. It provided effective LUTS relief and low complication rates independent of surgeon experience. Hemoglobin drop and ejaculatory function preservation were the two factors influenced by the surgeons' LC. Training to reduce operative time, standardization of hemostasis techniques, and early assistance to improve veru-protection zone planning are keys to quicker learning.
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Javaroni V. Editorial Comment: Testosterone replacement therapy (TRT) and prostate cancer: An updated systematic review with a focus on previous or active localized prostate cancer. Int Braz J Urol 2021; 48:188-195. [PMID: 34735092 PMCID: PMC8691234 DOI: 10.1590/s1677-5538.ibju.2022.01.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Valter Javaroni
- Departamento de Andrologia, Hospital Federal do Andaraí, Rio de Janeiro, RJ, Brasil
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Pencina KM, Burnett AL, Storer TW, Guo W, Li Z, Kibel AS, Huang G, Blouin M, Berry DL, Basaria S, Bhasin S. A Selective Androgen Receptor Modulator (OPK-88004) in Prostate Cancer Survivors: A Randomized Trial. J Clin Endocrinol Metab 2021; 106:2171-2186. [PMID: 34019661 PMCID: PMC8277210 DOI: 10.1210/clinem/dgab361] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Androgen deficiency is common among prostate cancer survivors, but many guidelines consider history of prostate cancer a contraindication for testosterone replacement. We determined the safety and efficacy of a selective androgen receptor modulator (OPK-88004) in symptomatic, testosterone-deficient men who had undergone radical prostatectomy for low-grade, organ-confined prostate cancer. METHODS In this placebo-controlled, randomized, double-blind trial, 114 men, ≥19 years of age, who had undergone radical prostatectomy for low-grade, organ-localized prostate cancer, undetectable PSA (<0.1 ng/mL) for ≥2 years after radical prostatectomy and testosterone deficiency were randomized in stages to placebo or 1, 5, or 15 mg OPK-88004 daily for 12 weeks. Outcomes included PSA recurrence, sexual activity, sexual desire, erectile function, body composition, muscle strength and physical function measures, mood, fatigue, and bone markers. RESULTS Participants were on average 67.5 years of age and had severe sexual dysfunction (mean erectile function and sexual desire domain scores 7.3 and 14.6, respectively). No participant experienced PSA recurrence or erythrocytosis. OPK-88004 was associated with a dose-related increase in whole-body (P < 0.001) and appendicular (P < 0.001) lean mass and a significantly greater decrease in percent body fat (P < 0.001) and serum alkaline phosphatase (P < 0.001) than placebo. Changes in sexual activity, sexual desire, erectile function, mood, fatigue, physical performance, and bone markers did not differ among groups (P = 0.73). CONCLUSIONS Administration of OPK-88004 was safe and not associated with PSA recurrence in androgen-deficient men who had undergone radical prostatectomy for organ-confined prostate cancer. OPK-88004 increased lean body mass and decreased fat mass but did not improve sexual symptoms or physical performance.
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Affiliation(s)
- Karol M Pencina
- Research Program in Men’s Health: Aging and Metabolism, Claude D. Pepper Older Americans Independence Center, Brigham and Women’s Hospital, Boston, MA, USA
| | - Arthur L Burnett
- Department of Urology, The Johns Hopkins University School of Medicine, The James Buchanan Brady Urological Institute, Baltimore, MD, USA
| | - Thomas W Storer
- Research Program in Men’s Health: Aging and Metabolism, Claude D. Pepper Older Americans Independence Center, Brigham and Women’s Hospital, Boston, MA, USA
| | - Wen Guo
- Research Program in Men’s Health: Aging and Metabolism, Claude D. Pepper Older Americans Independence Center, Brigham and Women’s Hospital, Boston, MA, USA
| | - Zhuoying Li
- Research Program in Men’s Health: Aging and Metabolism, Claude D. Pepper Older Americans Independence Center, Brigham and Women’s Hospital, Boston, MA, USA
| | - Adam S Kibel
- Division of Urology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Grace Huang
- Research Program in Men’s Health: Aging and Metabolism, Claude D. Pepper Older Americans Independence Center, Brigham and Women’s Hospital, Boston, MA, USA
| | - Michelle Blouin
- Research Program in Men’s Health: Aging and Metabolism, Claude D. Pepper Older Americans Independence Center, Brigham and Women’s Hospital, Boston, MA, USA
| | - Donna L Berry
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA
| | - Shehzad Basaria
- Research Program in Men’s Health: Aging and Metabolism, Claude D. Pepper Older Americans Independence Center, Brigham and Women’s Hospital, Boston, MA, USA
| | - Shalender Bhasin
- Research Program in Men’s Health: Aging and Metabolism, Claude D. Pepper Older Americans Independence Center, Brigham and Women’s Hospital, Boston, MA, USA
- Correspondence: Shalender Bhasin, MB, BS, Research Program in Men’s Health: Aging and Metabolism, Claude D. Pepper Older Americans Independence Center, Brigham and Women’s hospital, 221 Longwood Avenue, Boston, MA 02115, USA.
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Higazy A, Osman D, Osman T. Rezum: a novel minimally invasive treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia. A review article. Int Urol Nephrol 2021; 53:1747-1756. [PMID: 33932221 DOI: 10.1007/s11255-021-02878-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/22/2021] [Indexed: 11/29/2022]
Abstract
Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) are one of the most common morbidities in elderly men, especially in aging societies. Minimally invasive surgical treatments (MISTs) for BPH have gained an increasing interest in the current time. Rezum system is a novel MIST that uses water vapour-based convective thermal therapy to ablate prostatic tissue. According to our evaluation of the existing literature, Rezum offers a meaningful relief of LUTS with a high safety profile without compromising the sexual activity especially to those who are unfit for surgery or to those who do not desire to continue on lifelong pharmacotherapy.
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Affiliation(s)
- Ahmed Higazy
- Ain Shams University Hospitals, Cairo, 11376, Egypt.
| | - Dana Osman
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Tarek Osman
- Ain Shams University Hospitals, Cairo, 11376, Egypt
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Destefanis P, Sibona M, Soria F, Vercelli E, Vitiello F, Bosio A, Bisconti A, Lillaz B, Gontero P. Ejaculation-sparing versus non-ejaculation-sparing anatomic GreenLight laser enucleo-vaporization of the prostate: first comparative study. World J Urol 2021; 39:3455-3463. [PMID: 33591378 DOI: 10.1007/s00345-021-03615-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 01/25/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To present the step-by-step description of an ejaculation-sparing anatomic photo-selective vaporization of the prostate (PVP) technique. To report the results of a series of ejaculation-sparing versus non-ejaculation-sparing anatomic PVPs. METHODS Sexually active, benign prostatic hyperplasia (BPH) patients undergoing an anatomic PVP between 11/2018 and 2/2020 were included. Patients were divided into group A (ejaculation-sparing surgery) and group B (control group). Baseline, peri-operative and 6-months follow-up data were evaluated. Lower urinary tract symptoms (LUTS) and sexual function were assessed through internationally validated questionnaires. Groups were matched by an inverse probability of treatment weighting (IPTW) analysis. Logistic univariable regression analysis was performed to detect predictors of antegrade ejaculation preservation. RESULTS Overall, 76 patients were included, among which 15 in group A and 61 in group B. Median (inter-quartile range, IQR) age was 72 (66.5-77) years, median (IQR) prostate volume 63.5 (54.5-98.5) cc. No differences about peri-operative outcomes were detected, included high-grade complications. At 6-months follow-up, no differences in urinary or erectile function were detected between groups, while ejaculation-sparing patients showed better Male Sexual Health Questionnaire (MSHQ) scores [7 (1-13) vs. 1 (1-1), p < 0.001] and higher rates of antegrade ejaculation (60% vs. 13.1%, p < 0.001). The ejaculation-sparing technique was identified as a predictor of post-operative antegrade ejaculation (OR 19.3, CI 95% 7.2-51.2, p < 0.001). CONCLUSION The ejaculation-sparing anatomic PVP showed superiority over the control group in post-operative ejaculatory function scores and antegrade ejaculation rates. Besides, preliminary results suggested similar effectiveness in LUTS relief at a short-term follow-up.
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Affiliation(s)
- Paolo Destefanis
- Division of Urology, Department of Surgical Sciences, Molinette Hospital - A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Mattia Sibona
- Division of Urology, Department of Surgical Sciences, Molinette Hospital - A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy.
| | - Francesco Soria
- Division of Urology, Department of Surgical Sciences, Molinette Hospital - A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Eugenia Vercelli
- Division of Urology, Department of Surgical Sciences, Molinette Hospital - A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Federico Vitiello
- Division of Urology, Department of Surgical Sciences, Molinette Hospital - A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Andrea Bosio
- Division of Urology, Department of Surgical Sciences, Molinette Hospital - A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Alessandro Bisconti
- Division of Urology, Department of Surgical Sciences, Molinette Hospital - A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Beatrice Lillaz
- Division of Urology, Department of Surgical Sciences, Molinette Hospital - A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, Molinette Hospital - A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy
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