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Cilio S, Capogrosso P, Pozzi E, Belladelli F, Corsini C, Raffo M, Candela L, Fallara G, Boeri L, d'Arma A, Imbimbo C, Mirone V, Montorsi F, Salonia A. PDE5is-naïve versus non-naïve patients at first investigation for erectile dysfunction-findings from a long-term, real-life cross-sectional study. Andrology 2024. [PMID: 38588296 DOI: 10.1111/andr.13641] [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: 09/23/2023] [Revised: 01/04/2024] [Accepted: 03/17/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Phosphodiesterase 5 inhibitors (PDE5is) represent a first-line pharmacological therapy for erectile dysfunction (ED). Men could obtain PDE5is for recreational purposes without any proper medical prescription. OBJECTIVE We aimed to analyze clinical characteristics of patients who already used any PDE5i for ED without previous formal medical prescription. MATERIALS AND METHODS Data from 2012 heterosexual, sexually active men seeking first medical help for ED at our outpatient clinic between 2005 and 2022 were analyzed. All patients were assessed with a comprehensive sexual and medical history and completed the International Index of Erectile Function (IIEF) at baseline. Comorbidities were scored with the Charlson comorbidity index (CCI). Thereof, according to exposure to any PDE5i before their first visit, patients were subdivided into: PDE5i-naïve and non-PDE5i-naïve patients. Descriptive statistics tested the sociodemographic and clinical characteristics of both groups. A logistic regression model predicted the likelihood of being PDE5i-naïve at the baseline. Linear regression analysis (LRA) estimated the likelihood of being PDE5i-naïve versus non-PDE5i-naïve over the analyzed timeframe. Lastly, local polynomial regression models graphically explored the likelihood of being PDE5i-naïve at the first clinical assessment over the analyzed timeframe, and the sensitivity analyses tested the probability of being PDE5i-naïve at baseline. RESULTS Overall, 1,491 (70.9%) patients were PDE5i-naïve and 611 (29.1%) were non-PDE5i-naïve at the first assessment. PDE5is-naïve patients were younger, with a lower prevalence of CCI ≥ 1 and of normal erectile function (EF) than non-PDE5i-naïve men (all p < 0.05). Multivariable logistic regression found that patients with lower BMI (OR: 0.99), higher IIEF-EF scores (OR: 1.02), lower rates of severe ED (OR: 0.94), and who had been assessed earlier throughout the study timeframe (OR: 1.27) were less likely to be PDE5i-naïve at baseline. Univariate LRA revealed that younger patients (Coeff: -0.02), with lower CCI (Coeff: -0.29) and higher alcohol intake per week (Coeff: 0.52) were more likely to be PDE5i-naïve over the analyzed timeframe. Moreover, for the same IIEF-EF score, patients with higher CCI had lower probability of being PDE5i-naïve. CONCLUSIONS Self-prescription of PDE5is is an attitude presents in the general population, despite this phenomenon has decreased overtime. Current data outline the importance to keep promoting educational campaigns to promote PDE5is as effective and safe medicinal products, while avoiding their improper use.
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Affiliation(s)
- Simone Cilio
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy
| | - Paolo Capogrosso
- Department of Urology, Circolo & Fondazione Macchi Hospital-ASST Sette Laghi, Varese, Italy
| | - Edoardo Pozzi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | - Federico Belladelli
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | - Christian Corsini
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimiliano Raffo
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Luigi Candela
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Fallara
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Luca Boeri
- Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Alessia d'Arma
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Ciro Imbimbo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy
| | - Vincenzo Mirone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Vita-Salute San Raffaele University, Milan, Italy
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Silver JK, Flores LE. Integrating Prehabilitation into the Cancer Survivorship Framework. Eur Urol Focus 2024; 10:23-25. [PMID: 37996272 DOI: 10.1016/j.euf.2023.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023]
Abstract
The aim of prehabilitation is to improve the physical and emotional health of patients before upcoming surgery or therapies. This mini-review focuses on current advances in urological prehabilitation and how it can be used together with enhanced recovery after surgery and conventional rehabilitation protocols. Urological prehabilitation has primarily focused on improving urinary continence, erectile function, bone density, and lean body mass, with some promising results for all of these outcomes. Although all cancer patients should be considered for prehabilitation, older or medically frail individuals may derive the greatest benefit. PATIENT SUMMARY: This mini-review discusses prehabilitation as part of the care for cancer patients. Although the research on prehabilitation is evolving, current studies generally demonstrate that it may help to enhance a patient's strength and endurance before upcoming surgery or other treatments.
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Affiliation(s)
- Julie K Silver
- Harvard Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA, USA.
| | - Laura E Flores
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
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3
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Manfredi C, Ditonno F, Franco A, Bologna E, Licari LC, Arcaniolo D, Tubaro A, De Nunzio C, Antonelli A, De Sio M, Cherullo EE, Autorino R. Prostate Cancer in Transgender Women: Epidemiology, Clinical Characteristics, and Management Challenges. Curr Oncol Rep 2023; 25:1431-1443. [PMID: 37910274 DOI: 10.1007/s11912-023-01470-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE OF REVIEW To systematically review the evidence on prostate cancer (PCa) in transgender women (TGW). RECENT FINDINGS A total of 25 studies were included. Fourteen articles were case reports or case series describing 21 TGW with PCa; 11 papers focused primarily on assessing the incidence or screening of PCa in TGW. The median (range) age of patients with PCa was 63 (45-78) years. Median (range) PSA at diagnosis was 7.5 (0.4-1710) ng/mL. Prostate biopsy detected ISUP 3-5 in 10 (67%) cases. T3-4 stages were described in 7 (64%) patients. Three (14.3%) cases of nodal involvement and 2 (9.5%) of metastases were reported at diagnosis. First-line therapy included radical prostatectomy or radiotherapy ± androgen deprivation therapy in 14 (74 %) subjects. Median (range) follow-up was 24 (2-120) months. A good response to first-line therapy was recorded in 8 (47.1%) cases. Median (range) incidence of PCa in TGW was 44.1 (4.34-140) cases per 100,000 person-years. PCa was significantly less frequent in TGW than in cisgender males (HR 0.4, 95% CI 0.2-0.9). Risk of death after PCa diagnosis was significantly higher in TGW compared to cisgender males (HR 1.91, 95% CI 1.06-3.45). TGW had lower lifetime PSA rates (48% vs. 64.6%, p = 0.048) than cisgender males. Few cases of PCa in TGW are currently reported. PCa seems significantly less frequent in TGW than in cisgender males; however, some data suggest a possible higher mortality in this cohort. TGW appear to have less access to PSA testing than cisgender men.
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Affiliation(s)
- Celeste Manfredi
- Department of Urology, Rush University Medical Center, 1725 W Harrison St, Professional Building - Suite 970, Chicago, IL, 60612, USA
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Ditonno
- Department of Urology, Rush University Medical Center, 1725 W Harrison St, Professional Building - Suite 970, Chicago, IL, 60612, USA
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Antonio Franco
- Department of Urology, Rush University Medical Center, 1725 W Harrison St, Professional Building - Suite 970, Chicago, IL, 60612, USA
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Eugenio Bologna
- Department of Urology, Rush University Medical Center, 1725 W Harrison St, Professional Building - Suite 970, Chicago, IL, 60612, USA
- Unit of Urology, Department of Maternal-Child and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Leslie Claire Licari
- Department of Urology, Rush University Medical Center, 1725 W Harrison St, Professional Building - Suite 970, Chicago, IL, 60612, USA
- Unit of Urology, Department of Maternal-Child and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Davide Arcaniolo
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Marco De Sio
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Edward E Cherullo
- Department of Urology, Rush University Medical Center, 1725 W Harrison St, Professional Building - Suite 970, Chicago, IL, 60612, USA
| | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, 1725 W Harrison St, Professional Building - Suite 970, Chicago, IL, 60612, USA.
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Mendes Wefelnberg M, Reimer N, Baumann FT. [Exercise therapy in prehabilitation : Current findings in urology]. UROLOGIE (HEIDELBERG, GERMANY) 2023; 62:1011-1016. [PMID: 37606656 DOI: 10.1007/s00120-023-02171-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Prehabilitation refers to interventions that take place before starting medical treatment. Prehabilitation exercise therapy aims to increase functional physical capacities to improve recovery and reduce side effects. OBJECTIVES To present the evidence and potential of prehabilitation exercise therapy in urological oncology. METHODS Compilation and explanation of study results. RESULTS Studies are limited and primarily focused on prostate and bladder cancer. Current data show positive effects on physical functioning and cardiorespiratory capacity. The majority of prehabilitation studies in prostate cancer focus on specific goals of physical functioning, particularly maintenance and recovery of urinary continence with inconsistent results. CONCLUSIONS There is preliminary evidence to improve cardiorespiratory fitness and overall physical functioning in urinary bladder and prostate cancer. Further in-depth research is needed to map the potential spectrum of prehabilitation exercise therapy in uro-oncology.
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Affiliation(s)
- Michael Mendes Wefelnberg
- Centrum für Integrierte Onkologie (CIO), Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - Nadine Reimer
- Centrum für Integrierte Onkologie (CIO), Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Freerk T Baumann
- Centrum für Integrierte Onkologie (CIO), Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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Bernal J, Venkatesan K, Martins FE. Erectile Dysfunction in Pelvic Cancer Survivors and Current Management Options. J Clin Med 2023; 12:jcm12072697. [PMID: 37048780 PMCID: PMC10095222 DOI: 10.3390/jcm12072697] [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: 01/17/2023] [Revised: 03/18/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023] Open
Abstract
Pelvic malignancies, including prostate, rectal, and bladder cancers, are among the most frequent malignancies found in the male population. These issues are most effectively and commonly treated with radiotherapy and/or surgery. However, these treatments can cause collateral damage, resulting in significant impacts on quality of life, with erectile dysfunction being one of the most frequent postoperative complications. Currently, there are several treatment options for erectile dysfunction, including oral phosphodiesterase type 5 inhibitors, vacuum erection devices, intracorporeal injections, and penile prosthesis. The latter has shown to be an effective and safe technique, with results comparable to those obtained by patients without pelvic surgery or radiotherapy. The results of early penile rehabilitation programs are promising and they have been incorporated into a greater proportion of treatment plans more recently, with varying degrees of success. In this narrative review, we summarize the literature on erectile dysfunction after pelvic cancer treatments and its management.
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Affiliation(s)
- Jose Bernal
- Department of Urology, Hospital Sotero del Rio/Clinica Indisa, Santiago 13123, Chile
| | - Krishnan Venkatesan
- Department of Urology, MedStar Washington Hospital Center, Washington, DC 20010, USA
| | - Francisco E Martins
- Department of Urology, School of Medicine, University of Lisbon, Hospital Santa Maria, 1649-035 Lisbon, Portugal
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6
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Di Mauro E, Di Bello F, Califano G, Morra S, Creta M, Celentano G, Abate M, Fraia A, Pezone G, Marino C, Cilio S, Capece M, La Rocca R, Imbimbo C, Longo N, Colla' Ruvolo C. Incidence and Predicting Factors of Histopathological Features at Robot-Assisted Radical Prostatectomy in the mpMRI Era: Results of a Single Tertiary Referral Center. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59030625. [PMID: 36984626 PMCID: PMC10057318 DOI: 10.3390/medicina59030625] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023]
Abstract
Background and Objectives: To describe the predictors of cribriform variant status and perineural invasion (PNI) in robot-assisted radical prostatectomy (RARP) histology. To define the rates of upgrading between biopsy specimens and final histology and their possible predictive factors in prostate cancer (PCa) patients undergoing RARP. Material and Methods: Within our institutional database, 265 PCa patients who underwent prostate biopsies and consecutive RARP at our center were enrolled (2018-2022). In the overall population, two independent multivariable logistic regression models (LRMs) predicting the presence of PNI or cribriform variant status at RARP were performed. In low- and intermediate-risk PCa patients according to D'Amico risk classification, three independent multivariable LRMs were fitted to predict upgrading. Results: Of all, 30.9% were low-risk, 18.9% were intermediate-risk and 50.2% were high-risk PCa patients. In the overall population, the rates of the cribriform variant and PNI at RARP were 55.8% and 71.1%, respectively. After multivariable LRMs predicting PNI, total tumor length in biopsy cores (>24 mm [OR: 2.37, p-value = 0.03], relative to <24 mm) was an independent predictor. After multivariable LRMs predicting cribriform variant status, PIRADS (3 [OR:15.37], 4 [OR: 13.57] or 5 [OR: 16.51] relative to PIRADS 2, all p = 0.01) and total tumor length in biopsy cores (>24 mm [OR: 2.47, p = 0.01], relative to <24 mm) were independent predicting factors. In low- and intermediate-risk PCa patients, the rate of upgrading was 74.4% and 78.0%, respectively. After multivariable LRMs predicting upgrading, PIRADS (PIRADS 3 [OR: 7.01], 4 [OR: 16.98] or 5 [OR: 20.96] relative to PIRADS 2, all p = 0.01) was an independent predicting factor. Conclusions: RARP represents a tailored and risk-adapted treatment strategy for PCa patients. The indication of RP progressively migrates to high-risk PCa after a pre-operative assessment. Specifically, the PIRADS score at mpMRI should guide the decision-making process of urologists for PCa patients.
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Affiliation(s)
- Ernesto Di Mauro
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Francesco Di Bello
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Gianluigi Califano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Simone Morra
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Massimiliano Creta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Giuseppe Celentano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Marco Abate
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Agostino Fraia
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Gabriele Pezone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Claudio Marino
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Simone Cilio
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Marco Capece
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Roberto La Rocca
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Ciro Imbimbo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Nicola Longo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Claudia Colla' Ruvolo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
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Penile Rehabilitation after Prostate Cancer Treatment: Which Is the Right Program? URO 2023. [DOI: 10.3390/uro3010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
The management of sexual complications after treatment of localized prostate cancer, such as erectile dysfunction, changes in the length of the penis, pain during sexual intercourse, and lack of orgasm, is still an unsolved problem with an important impact on patients’ quality of life. In this review, we summarize the current scientific literature about the rehabilitation of erectile dysfunction after prostate cancer treatment. The therapy for penile rehabilitation includes different types of treatments: the combination of phosphodiesterase type 5 inhibitors (PDE5-I) and the vacuum erectile device (VED) are considered first-line treatment options. When therapy begins, the duration of treatment, the dosage and the drug used all play very important roles in the treatment outcome. Intracavernous injection (ICI) therapy represents the second-line option for patients ineligible for PDE5-I therapy. Technological development has led to the emergence of devices for the stimulation of the penis without the use of drugs, such as penile vibratory stimulation (PVS) for stimulation of ejaculation in spinal cord injury and low-intensity extracorporeal shockwave therapy (LIESWT). The rapid diffusion of the latter, thanks to its easy use, attains good results without side effects. The panorama of penile rehabilitation after PC treatments is vast and many studies are needed, especially on new technologies, to find the best therapeutic regimen possible, personalized to the patient’s characteristics and the type of treatment for PC.
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8
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El-Osta A, Kerr G, Alaa A, El Asmar ML, Karki M, Webber I, Riboli Sasco E, Blume G, Beecken WD, Mummery D. Investigating self-reported efficacy of lifestyle medicine approaches to tackle erectile dysfunction: a cross-sectional eSurvey based study. BMC Urol 2023; 23:15. [PMID: 36740686 PMCID: PMC9901095 DOI: 10.1186/s12894-023-01180-2] [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: 08/03/2022] [Accepted: 01/27/2023] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Erectile dysfunction (ED) is the most common sexual dysfunction in men. Some types of ED are amenable to treatment using lifestyle medicine approaches with or without pharmacotherapy. AIM Investigate self-reported efficacy of lifestyle medicine approaches to tackle ED. METHODS A cross-sectional online survey of 1177 community dwelling adults explored the prevalence and methods used to tackle ED in the community setting. We examined differences between participants with and without ED. Variables associated with ED in univariable analyses were included in a multivariable logistic regression to identify variables independently associated with the condition. OUTCOMES Self-reported measure: perceived effectiveness of lifestyle medicine interventions to tackle ED. RESULTS Most respondents (76.5%) had experienced ED, and this was associated with having a long-term condition, taking anti-hypertensive medication, hypercholesterolaemia and obesity. Medication was the most common management strategy overall (65.9%), followed by stress management (43.5%) and weight loss (40.4%). Over half (53.9%) did not use any lifestyle modification strategies to tackle ED. Only 7.0% of ED sufferers received a mental health assessment and 29.2% received other tests (e.g., blood test, medical imaging) by GPs. Cardiovascular training was identified as the best rated strategy by its users (37.8%). Supplements (35.1%) and weight training/physical activity (32.6%) were also positively rated. CLINICAL IMPLICATIONS Structured education to general practitioners and community dwelling adults about the impact of lifestyle behaviour modification and how this could influence the appearance or trajectory of ED could help improve personal choice when tackling ED. STRENGTHS AND LIMITATIONS To our knowledge, this is the first study to collect eSurvey responses from community dwelling adults to gauge their reliance and perceived effectiveness of lifestyle medicine approaches to tackle ED. The principal limitation was the lack of follow-up, and not recording other information including lifestyle factors such as nutrition, smoking, and the use of alcohol and recreational drugs, which may have enabled a fuller exploration of the factors that could influence the primary outcome measures examined. CONCLUSION Despite the high prevalence of ED, there is not enough awareness in the community setting about effective and low-cost lifestyle medicine strategies, including cardiovascular training and the use of supplements and weight training, to help tackle this common condition.
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Affiliation(s)
- Austen El-Osta
- grid.7445.20000 0001 2113 8111Self-Care Academic Research Unit (SCARU), Department of Primary Care and Public Health, School of Public Health, Imperial College London, 323 Reynolds Building, Charing Cross Hospital, St Dunstan’s Road, London, W6 8RP UK
| | - Gabriele Kerr
- grid.7445.20000 0001 2113 8111Self-Care Academic Research Unit (SCARU), Department of Primary Care and Public Health, School of Public Health, Imperial College London, 323 Reynolds Building, Charing Cross Hospital, St Dunstan’s Road, London, W6 8RP UK
| | - Aos Alaa
- grid.7445.20000 0001 2113 8111Self-Care Academic Research Unit (SCARU), Department of Primary Care and Public Health, School of Public Health, Imperial College London, 323 Reynolds Building, Charing Cross Hospital, St Dunstan’s Road, London, W6 8RP UK
| | - Marie Line El Asmar
- grid.7445.20000 0001 2113 8111Self-Care Academic Research Unit (SCARU), Department of Primary Care and Public Health, School of Public Health, Imperial College London, 323 Reynolds Building, Charing Cross Hospital, St Dunstan’s Road, London, W6 8RP UK
| | - Manisha Karki
- grid.7445.20000 0001 2113 8111Self-Care Academic Research Unit (SCARU), Department of Primary Care and Public Health, School of Public Health, Imperial College London, 323 Reynolds Building, Charing Cross Hospital, St Dunstan’s Road, London, W6 8RP UK
| | - Iman Webber
- grid.7445.20000 0001 2113 8111Self-Care Academic Research Unit (SCARU), Department of Primary Care and Public Health, School of Public Health, Imperial College London, 323 Reynolds Building, Charing Cross Hospital, St Dunstan’s Road, London, W6 8RP UK
| | - Eva Riboli Sasco
- grid.7445.20000 0001 2113 8111Self-Care Academic Research Unit (SCARU), Department of Primary Care and Public Health, School of Public Health, Imperial College London, 323 Reynolds Building, Charing Cross Hospital, St Dunstan’s Road, London, W6 8RP UK
| | - Giordano Blume
- UroGate Praxisnetzwerk, Berliner Platz 2, 61476 Kronberg, Germany
| | - Wolf-D. Beecken
- UroGate Praxisnetzwerk, Berliner Platz 2, 61476 Kronberg, Germany
| | - David Mummery
- grid.7445.20000 0001 2113 8111Self-Care Academic Research Unit (SCARU), Department of Primary Care and Public Health, School of Public Health, Imperial College London, 323 Reynolds Building, Charing Cross Hospital, St Dunstan’s Road, London, W6 8RP UK
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Napolitano L, Barone B, Spirito L, Trama F, Pandolfo SD, Capece M, García-Rojo E, Fernández-Pascual E, Crocetto F, Fusco F, De Sio M, Arcaniolo D, Manfredi C. Voice Assistants as Consultants for Male Patients with Sexual Dysfunction: A Reliable Option? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2612. [PMID: 36767978 PMCID: PMC9914936 DOI: 10.3390/ijerph20032612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/26/2023] [Accepted: 01/28/2023] [Indexed: 06/18/2023]
Abstract
The aim of this study was to evaluate the ability of Google Assistant, Alexa, and Siri to recognize and answer questions about male sexual health. Each VA was tested on a smart speaker: Alexa on Amazon Echo Dot 4th Gen., Google Assistant on Google Home Mini, and Siri on Apple HomePod. A pool of patients' frequently asked questions regarding erectile dysfunction (ED), premature ejaculation (PE), Peyronie's disease (PD), male infertility, and other aspects of male sexual health were identified by authors. The recognition of question was evaluated ("yes" or "not"). For each recognized question, the response characteristics (domains) were rated on a scale from 0 to 10 (according to the quality). We chose the recognition rate of the questions as the primary outcome and the quality of the answers as the secondary outcome. Overall, the best VA in recognizing questions was Siri, with a total of 83.3% questions compared with 64.0% for Alexa (p = 0.024) and 74.0% for Google Assistant (p = 0.061). Siri was associated with a significantly higher recognition rate than Alexa for PE (80% vs. 40%; p = 0.002) and PD (66.7% vs. 33.3%; p = 0.010). The quality of the responses was classified as low in 57 out of 105 cases (54.3%), intermediate in 46 cases (43.8%), and high in only 2 cases (1.9%), highlighting an overall intermediate-low quality of the answers. Male infertility was the condition associated with the highest mean scores in "Targeted response to the problem" (7.32 ± 2.57), "Scientific correctness of the answer", (5.9 ± 2.76) "Completeness of the answer" (5.14 ± 2.56), and "Understandability of the response for a patient" (5.3 ± 2.51) domains. Siri was associated with significantly higher scores than Alexa (p < 0.05) in several domains of all conditions evaluated. The question recognition rate of VAs is quite high; however, the quality of the answers is still intermediate-low. Siri seems superior to Alexa in both question recognition and response quality. Male infertility appears to be the sexual dysfunction best addressed by VAs.
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Affiliation(s)
- Luigi Napolitano
- Unit of Urology, Department of Neurosciences, Reproductive Sciences, and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Biagio Barone
- Unit of Urology, Department of Neurosciences, Reproductive Sciences, and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Lorenzo Spirito
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Francesco Trama
- Urology Unit, “Santa Maria Delle Grazie” Hospital, 80078 Pozzuoli, Italy
| | - Savio Domenico Pandolfo
- Unit of Urology, Department of Neurosciences, Reproductive Sciences, and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Marco Capece
- Unit of Urology, Department of Neurosciences, Reproductive Sciences, and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Esther García-Rojo
- Department of Urology, Hospital Universitario HM Sanchinarro, 28050 Madrid, Spain
| | - Esaú Fernández-Pascual
- LYX Institute of Urology, Faculty of Medicine, Universidad Francisco de Vitoria, 28006 Madrid, Spain
| | - Felice Crocetto
- Unit of Urology, Department of Neurosciences, Reproductive Sciences, and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Ferdinando Fusco
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Marco De Sio
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Davide Arcaniolo
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Celeste Manfredi
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
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Molecular Regulation of Concomitant Lower Urinary Tract Symptoms and Erectile Dysfunction in Pelvic Ischemia. Int J Mol Sci 2022; 23:ijms232415988. [PMID: 36555629 PMCID: PMC9782153 DOI: 10.3390/ijms232415988] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/09/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022] Open
Abstract
Aging correlates with greater incidence of lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) in the male population where the pathophysiological link remains elusive. The incidence of LUTS and ED correlates with the prevalence of vascular risk factors, implying potential role of arterial disorders in concomitant development of the two conditions. Human studies have revealed lower bladder and prostate blood flow in patients with LUTS suggesting that the severity of LUTS and ED correlates with the severity of vascular disorders. A close link between increased prostatic vascular resistance and greater incidence of LUTS and ED has been documented. Experimental models of atherosclerosis-induced chronic pelvic ischemia (CPI) showed increased contractile reactivity of prostatic and bladder tissues, impairment of penile erectile tissue relaxation, and simultaneous development of detrusor overactivity and ED. In the bladder, short-term ischemia caused overactive contractions while prolonged ischemia provoked degenerative responses and led to underactivity. CPI compromised structural integrity of the bladder, prostatic, and penile erectile tissues. Downstream molecular mechanisms appear to involve cellular stress and survival signaling, receptor modifications, upregulation of cytokines, and impairment of the nitric oxide pathway in cavernosal tissue. These observations may suggest pelvic ischemia as an important contributing factor in LUTS-associated ED. The aim of this narrative review is to discuss the current evidence on CPI as a possible etiologic mechanism underlying LUTS-associated ED.
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11
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Calace FP, Napolitano L, Arcaniolo D, Stizzo M, Barone B, Crocetto F, Olivetta M, Amicuzi U, Cirillo L, Rubinacci A, Lecce A, Pandolfo SD, Langella NA, Persico F, Trama F, Quattrone C, Bottone F, Spirito L, De Sio M, Manfredi C. Micro-Ultrasound in the Diagnosis and Staging of Prostate and Bladder Cancer: A Comprehensive Review. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1624. [PMID: 36363581 PMCID: PMC9695797 DOI: 10.3390/medicina58111624] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/06/2022] [Accepted: 11/08/2022] [Indexed: 08/07/2023]
Abstract
Background and Objectives: Multiparametric magnetic resonance imaging (mpMRI) of the prostate and prostate-specific membrane antigen positron emission tomography (PSMA PET) are some examples of how the advancement of imaging techniques have revolutionized the diagnosis, staging, and consequently management of patients with prostate cancer (PCa). Although with less striking results, novel radiological modalities have also been proposed for bladder cancer (BCa) in recent years. Micro-ultrasound (MUS) is an imaging examination characterized by high real-time spatial resolution, recently introduced in the urological field. This article aimed to describe the current evidence regarding the application of MUS for the diagnosis and staging of PCa and BCa. Materials and Methods: We designed a narrative review. A comprehensive search in the MEDLINE, Scopus, and Cochrane Library databases was performed. Articles in English-language and published until July 2022 were deemed eligible. Retrospective and prospective primary clinical studies, as well as meta-analyses, were included. Results: MUS-guided prostate biopsy showed high sensitivity (0.91, 95% CI, 0.79-0.97) in the diagnosis of clinically significant PCa (csPCa). It was associated with a higher detection rate of csPCa than a systematic biopsy (1.18, 95% CI 0.83-1.68). No significant difference was found between MUS and mpMRI-guided biopsy in the total detection of PCa (p = 0.89) and in the detection of Grade Groups ≥ 2 (p = 0.92). The use of MUS to distinguish between non-muscle-invasive and muscle-invasive BCa was described, highlighting an up-staging with MUS only in a minority of cases (28.6%). Conclusions: Promising findings have emerged regarding the feasibility and accuracy of MUS in the diagnosis and staging of PCa and BCa. However, the available evidence is limited and should be considered preliminary.
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Affiliation(s)
- Francesco Paolo Calace
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Luigi Napolitano
- Unit of Urology, Department of Neurosciences, Reproductive Sciences, and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Davide Arcaniolo
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Marco Stizzo
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Biagio Barone
- Unit of Urology, Department of Neurosciences, Reproductive Sciences, and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Felice Crocetto
- Unit of Urology, Department of Neurosciences, Reproductive Sciences, and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Michelangelo Olivetta
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Ugo Amicuzi
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Luigi Cirillo
- Unit of Urology, Department of Neurosciences, Reproductive Sciences, and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Andrea Rubinacci
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Arturo Lecce
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Savio Domenico Pandolfo
- Unit of Urology, Department of Neurosciences, Reproductive Sciences, and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | | | | | - Francesco Trama
- Department of Surgical and Biomedical Science, Andrological and Urogynecological Clinic, Santa Maria Terni Hospital, University of Perugia, 05100 Terni, Italy
| | - Carmelo Quattrone
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Francesco Bottone
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Lorenzo Spirito
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Marco De Sio
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Celeste Manfredi
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
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Takada K, Shimokawa M, Mizuki F, Takamori S, Takenaka T, Miura N, Shikada Y, Yoshizumi T. Association between sex and outcomes in patients with non-small-cell lung cancer receiving combination chemoimmunotherapy as a first-line therapy: a systematic review and meta-analysis of randomized clinical trials. Eur J Med Res 2022; 27:157. [PMID: 35999618 PMCID: PMC9400263 DOI: 10.1186/s40001-022-00789-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/11/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Recently, several meta-analyses have investigated the association between sex and the efficacy of immune checkpoint inhibitors (ICIs) in non-small-cell lung cancer (NSCLC). However, this issue remains controversial, because the results have been inconsistent. Moreover, the effect of sex on outcomes in patients with NSCLC receiving combination chemoimmunotherapy as a first-line therapy is poorly understood. The aim of this study was to examine the association between sex and outcomes in patients with NSCLC receiving combination chemoimmunotherapy as a first-line therapy. METHODS We searched PubMed and Scopus from database inception to Feb 18, 2022 and performed a systematic review and meta-analysis of randomized and controlled clinical trials investigating ICI+non-ICI vs non-ICI as a first-line therapy in NSCLC. The pooled hazard ratios (HRs) and 95% confidence intervals (CIs) for overall survival (OS) and progression-free survival (PFS) in male and female patients were calculated using common and random-effects models. RESULTS We analyzed 5,830 patients, comprising 4,137 (71.0%) males and 1,693 (29.0%) females, from nine randomized clinical trials. The pooled HR (95%CI) for OS comparing ICI+non-ICI vs non-ICI was 0.80 (0.72-0.87) for males and 0.69 (0.54-0.89) for females. The pooled HR (95%CI) for PFS comparing ICI+non-ICI vs non-ICI was 0.60 (0.55-0.66) for males and 0.56 (0.44-0.70) for females. CONCLUSIONS In patients with NSCLC receiving combination chemoimmunotherapy as a first-line therapy, a greater improvement in OS and PFS was observed in female patients than in male patients.
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Affiliation(s)
- Kazuki Takada
- Department of Surgery, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Mototsugu Shimokawa
- Department of Biostatistics, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan. .,Cancer Biostatistics Laboratory, Clinical Research Institute, National Hospital Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka, 811-1395, Japan.
| | - Fumitaka Mizuki
- Center for Clinical Research, Yamaguchi University Hospital, Yamaguchi, Japan
| | - Shinkichi Takamori
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoyoshi Takenaka
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Naoko Miura
- Department of Surgery, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Yasunori Shikada
- Department of Surgery, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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13
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Machine Learning and Clinical-Radiological Characteristics for the Classification of Prostate Cancer in PI-RADS 3 Lesions. Diagnostics (Basel) 2022; 12:diagnostics12071565. [PMID: 35885471 PMCID: PMC9323238 DOI: 10.3390/diagnostics12071565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/24/2022] [Accepted: 06/25/2022] [Indexed: 11/17/2022] Open
Abstract
The Prostate Imaging Reporting and Data System (PI-RADS) classification is based on a scale of values from 1 to 5. The value is assigned according to the probability that a finding is a malignant tumor (prostate carcinoma) and is calculated by evaluating the signal behavior in morphological, diffusion, and post-contrastographic sequences. A PI-RADS score of 3 is recognized as the equivocal likelihood of clinically significant prostate cancer, making its diagnosis very challenging. While PI-RADS values of 4 and 5 make biopsy necessary, it is very hard to establish whether to perform a biopsy or not in patients with a PI-RADS score 3. In recent years, machine learning algorithms have been proposed for a wide range of applications in medical fields, thanks to their ability to extract hidden information and to learn from a set of data without previous specific programming. In this paper, we evaluate machine learning approaches in detecting prostate cancer in patients with PI-RADS score 3 lesions via considering clinical-radiological characteristics. A total of 109 patients were included in this study. We collected data on body mass index (BMI), location of suspicious PI-RADS 3 lesions, serum prostate-specific antigen (PSA) level, prostate volume, PSA density, and histopathology results. The implemented classifiers exploit a patient’s clinical and radiological information to generate a probability of malignancy that could help the physicians in diagnostic decisions, including the need for a biopsy.
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14
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Celentano G, Creta M, Napolitano L, Abate M, La Rocca R, Capece M, Mirone C, Morra S, Di Bello F, Cirillo L, Mangiapia F, Califano G, Collà Ruvolo C, Sagnelli C, Sica A, Calogero A, Iacono F, Fusco F, Mirone V, Longo N. Prostate Cancer Diagnosis, Treatment and Outcomes in Patients with Previous or Synchronous Colorectal Cancer: A Systematic Review of Published Evidence. Diagnostics (Basel) 2022; 12:diagnostics12061475. [PMID: 35741285 PMCID: PMC9221875 DOI: 10.3390/diagnostics12061475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/11/2022] [Accepted: 06/13/2022] [Indexed: 11/18/2022] Open
Abstract
The management of patients with prostate cancer (PCa) and previous or synchronous colorectal cancer (CRC) represents a challenging issue. A systematic review was performed in May 2022 to summarize available evidence about the diagnosis, management, and outcomes of these patients. Twenty-seven studies involving 252 patients were identified. Overall, 163 (64.7%) and 89 (35.3%) patients had synchronous and metachronous PCa and CRC, respectively. In patients with synchronous diseases, PCa treatment involved active surveillance in 1 patient, radical prostatectomy (RP) in 36 patients, radiotherapy (RT) in 60 patients, RP plus RT in 1 patient, proton beam therapy in 1 patient, and cryoablation in 1 patient. In patients with previous CRC treatment, prostate biopsy was mostly performed by transrectal approach (n = 24). The trans-perineal and suprapubic approaches were adopted in 12 and 6 cases, respectively. Surgical PCa treatment in these cases involved endoscopic extraperitoneal RP, robot-assisted RP, and not otherwise specified RP in 30, 15, and 2 cases, respectively. Biochemical recurrence rates ranged from 20% to 28%. Non-surgical PCa treatment options included brachytherapy, RT plus androgen deprivation therapy, and RT alone in 23, 2 and 4 patients, respectively. PCa specific survival was reported by one study and was 100%.
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Affiliation(s)
- Giuseppe Celentano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80130 Naples, Italy; (G.C.); (L.N.); (M.A.); (R.L.R.); (M.C.); (S.M.); (F.D.B.); (L.C.); (F.M.); (G.C.); (C.C.R.); (F.I.); (V.M.); (N.L.)
| | - Massimiliano Creta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80130 Naples, Italy; (G.C.); (L.N.); (M.A.); (R.L.R.); (M.C.); (S.M.); (F.D.B.); (L.C.); (F.M.); (G.C.); (C.C.R.); (F.I.); (V.M.); (N.L.)
- Correspondence: ; Tel./Fax: +39-081-7462-611
| | - Luigi Napolitano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80130 Naples, Italy; (G.C.); (L.N.); (M.A.); (R.L.R.); (M.C.); (S.M.); (F.D.B.); (L.C.); (F.M.); (G.C.); (C.C.R.); (F.I.); (V.M.); (N.L.)
| | - Marco Abate
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80130 Naples, Italy; (G.C.); (L.N.); (M.A.); (R.L.R.); (M.C.); (S.M.); (F.D.B.); (L.C.); (F.M.); (G.C.); (C.C.R.); (F.I.); (V.M.); (N.L.)
| | - Roberto La Rocca
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80130 Naples, Italy; (G.C.); (L.N.); (M.A.); (R.L.R.); (M.C.); (S.M.); (F.D.B.); (L.C.); (F.M.); (G.C.); (C.C.R.); (F.I.); (V.M.); (N.L.)
| | - Marco Capece
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80130 Naples, Italy; (G.C.); (L.N.); (M.A.); (R.L.R.); (M.C.); (S.M.); (F.D.B.); (L.C.); (F.M.); (G.C.); (C.C.R.); (F.I.); (V.M.); (N.L.)
| | - Claudia Mirone
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania “Luigi Vanvitelli”, 80123 Naples, Italy;
| | - Simone Morra
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80130 Naples, Italy; (G.C.); (L.N.); (M.A.); (R.L.R.); (M.C.); (S.M.); (F.D.B.); (L.C.); (F.M.); (G.C.); (C.C.R.); (F.I.); (V.M.); (N.L.)
| | - Francesco Di Bello
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80130 Naples, Italy; (G.C.); (L.N.); (M.A.); (R.L.R.); (M.C.); (S.M.); (F.D.B.); (L.C.); (F.M.); (G.C.); (C.C.R.); (F.I.); (V.M.); (N.L.)
| | - Luigi Cirillo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80130 Naples, Italy; (G.C.); (L.N.); (M.A.); (R.L.R.); (M.C.); (S.M.); (F.D.B.); (L.C.); (F.M.); (G.C.); (C.C.R.); (F.I.); (V.M.); (N.L.)
| | - Francesco Mangiapia
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80130 Naples, Italy; (G.C.); (L.N.); (M.A.); (R.L.R.); (M.C.); (S.M.); (F.D.B.); (L.C.); (F.M.); (G.C.); (C.C.R.); (F.I.); (V.M.); (N.L.)
| | - Gianluigi Califano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80130 Naples, Italy; (G.C.); (L.N.); (M.A.); (R.L.R.); (M.C.); (S.M.); (F.D.B.); (L.C.); (F.M.); (G.C.); (C.C.R.); (F.I.); (V.M.); (N.L.)
| | - Claudia Collà Ruvolo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80130 Naples, Italy; (G.C.); (L.N.); (M.A.); (R.L.R.); (M.C.); (S.M.); (F.D.B.); (L.C.); (F.M.); (G.C.); (C.C.R.); (F.I.); (V.M.); (N.L.)
| | - Caterina Sagnelli
- Department of Mental Health and Public Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
| | - Antonello Sica
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80123 Naples, Italy;
| | - Armando Calogero
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80130 Naples, Italy;
| | - Fabrizio Iacono
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80130 Naples, Italy; (G.C.); (L.N.); (M.A.); (R.L.R.); (M.C.); (S.M.); (F.D.B.); (L.C.); (F.M.); (G.C.); (C.C.R.); (F.I.); (V.M.); (N.L.)
| | - Ferdinando Fusco
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
| | - Vincenzo Mirone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80130 Naples, Italy; (G.C.); (L.N.); (M.A.); (R.L.R.); (M.C.); (S.M.); (F.D.B.); (L.C.); (F.M.); (G.C.); (C.C.R.); (F.I.); (V.M.); (N.L.)
| | - Nicola Longo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80130 Naples, Italy; (G.C.); (L.N.); (M.A.); (R.L.R.); (M.C.); (S.M.); (F.D.B.); (L.C.); (F.M.); (G.C.); (C.C.R.); (F.I.); (V.M.); (N.L.)
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Efficacy of Tadalafil in Penile Rehabilitation Started Before Nerve-Sparing Robot-Assisted Radical Prostatectomy: A Double-Blind Pilot Study. Sex Med 2022; 10:100508. [PMID: 35395569 PMCID: PMC9177888 DOI: 10.1016/j.esxm.2022.100508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/16/2022] [Accepted: 02/25/2022] [Indexed: 11/19/2022] Open
Abstract
Background Despite the widespread practice of nerve-sparing robot-assisted radical prostatectomy (nsRARP) for the treatment of localized prostate cancer (PCa), erectile dysfunction remains a significant sequela of radical prostatectomy. Aim This study aimed to compare the efficacy of tadalafil 5 mg once daily for erectile function recovery in patients who underwent nsRARP according to the timing of rehabilitation initiation. Methods In this double-blind, prospective pilot study, a total of 41 patients who underwent nsRARP were randomly assigned into 2 groups according to the timing of rehabilitation initiation. In the preRARP group (n = 20), tadalafil was started 2 weeks before nsRARP, and in the postRARP group (n = 21), it was started 4 weeks after nsRARP. Erectile function recovery after nsRARP was defined as an International Index of Erectile Function (IIEF-5) score of ≥17. Outcomes The measures of EF recovery were the changes in IIEF-5 score. Results The rate of erectile function recovery at 12-month follow-up was 80.0% and 71.4% in the preRARP and postRARP groups, respectively. The mean differences between baseline and postoperative IIEF-5 scores at 1-, 3-, 6-, and 12-month follow-up were −11.7 ± 3.2, −7.4 ± 3.2, −5.6 ± 1.5, and −4.1 ± 1.1 in the preRARP group and −14.7 ± 4.7, −12.0 ± 5.0, −9.7 ± 3.9, and −6.0 ± 3.1 in the postRARP group, respectively (1-month, P = .259; 3-months, P = .077; 6-months, P = .014; 12-months, P = .007). Clinical implications Preoperative tadalafil 5 mg once a day could be used effectively and safely as a strategy for penile rehabilitation after nsRARP. Strengths and Limitations This study is the first prospective trial of penile rehabilitation with tadalafil 5 mg once a day prior to nsRARP. This is a pilot study with the limitations of a small sample; further and large-scale studies with multiple cohorts, such as an untreated control group and an early immediate rehabilitation group for EF recovery, are needed. Conclusion This study suggests that preoperative penile rehabilitation using tadalafil may lead to better erectile function recovery than postoperative penile rehabilitation using tadalafil. Noh T, Shim JS, Kang SG, et al. Efficacy of Tadalafil in Penile Rehabilitation Started Before Nerve-Sparing Robot-Assisted Radical Prostatectomy: A Double-Blind Pilot Study. Sex Med 2022;10:100508.
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Terrier JE, Ruffion A, Hamant C, Rousset V, Kalecinski J, Baudot A, Dumas A, Chauvin F, Bourmaud A. Patient Education for Radical Prostatectomy: Development of a Program Tailored to the Needs of Prostate Cancer Patients. Am J Mens Health 2021; 15:15579883211063317. [PMID: 34923862 PMCID: PMC8721889 DOI: 10.1177/15579883211063317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/08/2021] [Accepted: 11/11/2021] [Indexed: 12/24/2022] Open
Abstract
In all, 30% to 90% of prostate cancer patients undergoing radical prostatectomy (RP) recover their erectile capacity. No effective post RP erectile rehabilitation program exists to date. The aim of this exploratory qualitative study is to explore the needs of these patients and to develop a patient education program (PEP) which meets these needs. Interviews were carried out by a socio-anthropologist with prostate cancer patients treated by RP within the 6 previous months. The needs and expectations identified led to the choice of a logical model of change for the construction of the PEP. Nineteen patients were included in the study; 17 of them were living with a partner. Two categories of patients appeared during the interviews: informed patients resigned to lose their sexuality and patients misinformed about the consequences of the surgery. The tailored program was built on the Health Belief Model and provides six individual sessions, including one with the partner, to meet the needs identified. This study designed the first program to target comprehensively the overall sexuality of the patient and his partner, and not only erection issues. To demonstrate the effectiveness of this program, a controlled, multicentric clinical trial is currently ongoing.
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Affiliation(s)
- Jean-Etienne Terrier
- Department of Urology, Centre Hospitalier Lyon Sud, Lyon, France
- Health Services and Performance Research Unit, EA 74 25, Lyon 1 University, Lyon, France
| | - Alain Ruffion
- Department of Urology, Centre Hospitalier Lyon Sud, Lyon, France
| | - Chloé Hamant
- Hygée Center, University Hospital of Saint Etienne, Saint Etienne, France
| | - Vanessa Rousset
- Hygée Center, University Hospital of Saint Etienne, Saint Etienne, France
| | - Julie Kalecinski
- Hygée Center, University Hospital of Saint Etienne, Saint Etienne, France
| | - Amandine Baudot
- Hygée Center, University Hospital of Saint Etienne, Saint Etienne, France
| | | | - Franck Chauvin
- Health Services and Performance Research Unit, EA 74 25, Lyon 1 University, Lyon, France
- Hygée Center, University Hospital of Saint Etienne, Saint Etienne, France
| | - Aurelie Bourmaud
- INSERM U1123 ECEVE, Paris, France
- Robert Debré University Hospital, Paris, France
- Université de Paris, Paris, France
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Reimer N, Zopf EM, Böwe R, Baumann FT. Effects of Exercise on Sexual Dysfunction in Patients With Prostate Cancer - A Systematic Review. J Sex Med 2021; 18:1899-1914. [PMID: 37057481 DOI: 10.1016/j.jsxm.2021.09.001] [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: 01/16/2021] [Revised: 08/27/2021] [Accepted: 09/02/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Emerging evidence suggests that exercise interventions may improve sexual dysfunction, one of the most common and distressing long-term adverse effects of cancer treatment. AIM The aim of this systematic review is to provide an overview of the effects of exercise on sexual dysfunction in prostate cancer patients. METHODS A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. The systematic literature search was performed on 13th July 2021 using CINAHL, Cochrane Central Register of Controlled Trials, Embase, Medline and Web of Science. Studies were included if they were randomized controlled trials (RCTs) assessing sexual function in prostate cancer patients conducting an exercise intervention alone or in combination with other supportive interventions. The methodological quality was assessed using the Physiotherapy Education Database Score and Jadad scale. Outcomes were reported as between-group differences. Intragroup differences were also reported if significant. OUTCOMES Positive intervention effects on sexual function were primarily observed in patients following prostatectomy and undergoing anti-hormone treatment and for pelvic floor muscle exercises as well as aerobic and resistance exercise. RESULTS 22 RCTs (n = 1.752 patients) met the eligibility criteria, conducting either an exercise-only intervention (n = 10), a multimodal (exercise plus other supportive therapy) intervention (n = 4), or pelvic floor muscle exercises (n = 8). 6 RCTs assessed sexual dysfunction as a primary endpoint and 8 RCTs used dedicated assessment methods. 9 of the 22 RCTs found significant between-group differences in favor of the intervention group. CLINICAL IMPLICATIONS The multifaceted etiology of sexual dysfunction provides a strong rationale to further investigate the effects of exercise on sexual dysfunction in prostate cancer patients and also to consider a multidisciplinary approach. STRENGTHS AND LIMITATIONS A strength is the comprehensive literature search to identify RCTs involving different exercise interventions and a wide range of sexual function assessments. Further, this is the first systematic review on this topic. The main limitations include the difficulty to compare studies due to the heterogeneity of exercise interventions and low questionnaire completion rates in some studies. CONCLUSION Preliminary data from a small number of studies suggest that certain exercise interventions may improve sexual dysfunction in prostate cancer patients, however further trials involving sexual dyfunction as a primary outcome and more comprehensive assessment tools are needed to confirm the rehabilitative and preventive effects of exercise on sexual dysfunction in prostate cancer patients. Nadine Reimer, Eva Maria Zopf, Rebecca Böwe, et al. Effects of Exercise on Sexual Dysfunction in Patients With Prostate Cancer - A Systematic Review. J Sex Med 2021;18:1899-1914.
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Affiliation(s)
- Nadine Reimer
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany.
| | - Eva Maria Zopf
- Australian Catholic University, Mary MacKillop Institute for Health Research, Melbourne, Australia
| | - Rebecca Böwe
- Hochschule Fresenius, University of Applied Sciences, Faculty of Health & Social Work, Cologne, Duesseldorf, Germany
| | - Freerk Theeagnus Baumann
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
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