Drinking More Water May Reduce Frequency of Urinary Tract Infections

MedicalResearch.com Interview with:
"Glass of Water" by Iwan Gabovitch is licensed under CC BY 2.0Professor Yair Lotan MD

Chief of Urologic Oncology
Holder of the Helen J. and Robert S. Strauss Professorship in Urology
UT Southwestern Medical Center at Dallas
Department of Urology
Dallas, Texas 75390-9110 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Urinary tract infections are extremely common in women and many women experience recurrent episodes which impact their quality of life.  There are also many women who do not drink as much water as is recommended.

This study found that in healthy women with recurrent UTIs who drink less than 1.5 liters per day, the additional intake of 1.5 liters of water daily reduced the risk of recurrent infections by nearly 50%.  Continue reading

Ultrasound Therapy Found To Be Effective Option For Prostate Cancer

MedicalResearch.com Interview with:

Prof. Hashim Ahmed Professor and Chair of Urology Imperial College London

Prof. Ahmed

Prof. Hashim Ahmed
Professor and Chair of Urology
Imperial College London

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Men with localised clinically significant prostate cancer currently undergo radical (whole gland) surgery or radiotherapy. These treatments are effective but can cause urine leakage in 5-30% and erectile dysfunction in 30-60%. Radiotherapy can cause rectal problems in 5%.

So, although there is benefit in treating the cancer in these men, the side effects significantly affect the quality of life. 

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Prostate Cancer: ERLEADA (apalutamide) Delayed Metastases While Not Reducing Quality of Life

MedicalResearch.com Interview with:

Dr. Fred Saad, MD FRCS Full Professor and Chief of Urologic Oncology, CHUM; Medical Director of Interdisciplinary Urologic Oncology Group, CHUM; Department of Surgery/Faculty of Medicine; Institut du cancer de Montréal/CRCHUM

Dr. Saad

Dr. Fred Saad, MD FRCS
Professor and Chief of Urology
Director of GU Oncology
Raymond Garneau Chair in Prostate Cancer
University of Montreal Hospital Center (CHUM)
Director, Prostate Cancer Research , Montreal Cancer Institute

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Patient Reported Outcomes (PRO) data from the Phase 3 SPARTAN study showed adding ERLEADA (apalutamide) to androgen deprivation therapy (ADT) for patients with nmCRPC who were asymptomatic and well, did not worsen or cause detriment to HRQoL when compared to the placebo.The percent of patients who felt “quite a bit” or “very much” bothered was low (<2–6 percent of patients in the apalutamide group and 0–6 percent of those in the placebo group), suggesting that ERLEADA treatment was generally well-tolerated. This outcome, coupled with the efficacy results seen in SPARTAN, suggest that apalutamide can be given to patients at risk of metastasis without worry about compounded side effects or negative HRQoL..

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Apalutamide (Erleada™) Extended Metastasis-Free Survival in Resistant Prostate Cancer

MedicalResearch.com Interview with:

Dr. Fred Saad, MD FRCS Full Professor and Chief of Urologic Oncology, CHUM; Medical Director of Interdisciplinary Urologic Oncology Group, CHUM; Department of Surgery/Faculty of Medicine; Institut du cancer de Montréal/CRCHUM

Dr. Saad

Dr. Fred Saad, MD FRCS
Full Professor and Chief of Urologic Oncology, CHUM;
Medical Director of Interdisciplinary Urologic Oncology Group, CHUM;
Department of Surgery/Faculty of Medicine;
Institut du cancer de Montréal/CRCHUM

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The SPARTAN study was a Phase 3, randomized, double-blind, placebo-controlled, multicenter study that evaluated ERLEADA (apalutamide), a next-generation androgen signaling inhibitor, in patients with non-metastatic castration-resistant prostate cancer (nmCRPC) who had a rapidly rising PSA (PSA doubling time ≤10 months). The post-hoc analysis presented at the American Urological Association (AUA) 2018 annual meeting showed in patients who received the treatment apalutamide while receiving continuous androgen deprivation therapy (ADT) significantly decreased the risk of PSA progression by 94 percent compared with the placebo group. Continue reading

Decreased Sleep Associated With Lower Testosterone Levels

MedicalResearch.com Interview with:
Kristen L. Knutson, PhD Associate Professor Center for Circadian and Sleep Medicine Department of Neurology Northwestern University Feinberg School of Medicine Chicago, IL  60611​Premal Patel, MD, PGY-5
Urology
University of Manitoba

MedicalResearch.com: What is the background for this study? What are the main findings? What should readers take away from your report?

Response: Within the literature there has only been small experimental studies which looked at impaired sleep and testosterone. To our knowledge, there has been no study that has evaluated sleep and testosterone using a population dataset. We utilized the National Health and Nutrition Examination Survey to assess the association of sleep with serum testosterone. NHANES examines a nationally representative sample of about ~5000 persons each year.

After performing a multivariate linear regression of numerous variables within the NHANES database (age, marital status, prior co-morbidities, number of hours of sleep, etc…) we found that a reduction in the number of hours slept, increasing body mass index and increasing age were associated with lower testosterone levels.

Given that this is a cross-sectional analysis, we are unable to provide causality of this relationship but we do feel it is important to counsel patients with low testosterone about the importance of living a healthy lifestyle which includes a well-balanced diet, exercise and sufficient sleep.

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Some Antibiotics Linked To Increased Risk of Kidney Stones

MedicalResearch.com Interview with:

A kidney stone (yellow) composed of calcium oxalate: Wikipedia Image

A kidney stone (yellow) composed of calcium oxalate: Wikipedia Image

Gregory Tasian MD, MSc, MSCE
Assistant Professor of Urology and Epidemiology
University of Pennsylvania Perelman School of Medicine
Division of Urology and Center for Pediatric Clinical Effectiveness
The Children’s Hospital of Philadelphia

MedicalResearch.com: What is the background for this study? What are the main findings?

Response:  We found that five classes of commonly prescribed antibiotics were associated with an increased risk of kidney stones. These classes were sulfa drugs (e.g. Bactrim), fluoroquinolones (e.g. Cipro), cephalosporins (e.g. cephalexin), nitrofurantoin, and broad-spectrum penicillins (e.g. augmentin).  For those five classes of antibiotics, the greatest risk was found among younger patients. However, the increased risk was still significant across all ages, including for older adults with the exception of broad-spectrum penicillins, which were not associated with an increased risk of kidney stones among patients >75 years of age.

We conducted this study because:

1) Prior investigations have demonstrated that changes in the gut microbiome were associated with kidney stones,

2) Antibiotics are prescribed frequently, and

3) The number of people affected by kidney stone disease has increased 70% over the last 30 years and the greatest increases have been found among children and adolescents.

Our results were consistent with these previous studies, so we were not surprised with the findings although we did not know which specific classes of antibiotics would be associated with an increased risk of stones and which ones would not.

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YONSA (abiraterone acetate) In Metastatic Castration-Resistant Prostate Cancer

MedicalResearch.com Interview with:

https://www.churchillpharma.com/

Paul Nemeth, Ph.D.
Sr. Vice President, Regulatory Affairs, Clinical Development & Quality Assurance
Churchill Pharmaceuticals LLC
King of Prussia, PA 19406


MedicalResearch.com: What is the background for this study?

Response: In the STAAR study, 53 patients with metastatic castration-resistant prostate cancer (mCRPC) were randomized to receive YONSA, an abiraterone acetate fine particle formulation 500 mg once daily in combination with 4 mg of methylpresnisolone twice daily or 1,000 mg daily of the originator abiraterone acetate (OAA) in combination with 5 mg of prednisone twice daily for a period of 84 days.  Previous studies in healthy volunteers under fasted conditions had shown that single oral doses of 500 mg of YONSA are bioequivalent to single oral doses of 1,000 mg OAA and that a background of 4 mg of methylprednisolone twice daily on a single oral dose of 500 mg of YONSA results in the same extent of absorption as a background of 5 mg of prednisone twice daily on a single oral dose of 1,000 mg of OAA.  Continue reading

Hematuria, and Early Cancer Detection, Not Uncommon With Anticoagulation Medications

MedicalResearch.com Interview with:

Robert Nam, MD, FRCSC Ajmera Family Chair in Urologic Oncology Professor of Surgery University of Toronto Head, Genitourinary Cancer Site Odette Cancer Centre Sunnybrook Health Sciences Centre

Dr. Nam

Robert Nam, MD, FRCSC
Ajmera Family Chair in Urologic Oncology
Professor of Surgery
University of Toronto
Head, Genitourinary Cancer Site
Odette Cancer Centre
Sunnybrook Health Sciences Centre 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The well known potentially lethal complications of anti-thrombotic medications of cerebral and gastrointestinal bleeding complications are well known.  However, more common bleeding related complications are not well described .  In particular, gross hematuria is a well known complication of these medications but its frequency and severity is unknown.  We sought to characterize this association among a large population-based cohort consisting of over 2.5 million patients from the Province of Ontario, Canada, using hematuria-related complications was endpoints.  These were defined as undergoing invasive urologic procedures, hospital admissions or emergency visits for gross hematuria.

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Pubic Hair Grooming–Related Injuries Surprisingly Common

MedicalResearch.com Interview with:

Thomas W. Gaither, BS
Department of Urology
University of California, San Francisco
General Hospital, San Francisco

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We study genitourinary trauma and reconstruction. This study was motivated from a previous study showing that Emergency Room visits due to grooming were increasing over the past nine year. We sought to better characterize who was at most risk for grooming injuries. We found that grooming is extremely common in both men and women and minor injuries occur in about 25% of groomers. Surprisingly, a little over one percent sought medical care due to their injury. Participants at most risk our those who remove all of their pubic hair frequently ( as opposed to those who just trim). We did not find any instruments that were necessarily putting participants at risk for injury.

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Electroacupuncture Reduced Leakage in Stress Urinary Incontinence

MedicalResearch.com Interview with:
Baoyan Liu, MD
Guang’an Men Hospital
China Academy of Chinese Medical Sciences
Beijing, China

Patient with Electroacupuncture

Patient with Electroacupuncture

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The prevalence of stress urinary incontinence(SUI) is as high as 49% and varies according to the population studied and the definition of stress urinary incontinence.

SUI causes psychological burden, affects relationships, lowers physical productivity, and decreases quality of life in women. Yet, few effective therapies are available for treating stress urinary incontinence.

In this randomized clinical trial that included 504 women, the mean decrease in urine leakage, measured by the 1-hour pad test from baseline to week 6, was 9.9 g with
electroacupuncture vs 2.6 g with sham electroacupuncture, a significant difference.

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MRI Guided Prostate Biopsies Can Improve Care and Reduce Costs

MedicalResearch.com Interview with:

Vikas Gulani, MD, PhD Director, MRI, UH Cleveland Medical Center Associate Professor, Radiology, CWRU School of Medicine

Dr. Gulani

Vikas Gulani, MD, PhD
Director, MRI, UH Cleveland Medical Center
Associate Professor, Radiology, CWRU School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We wanted to learn if performing MR before prostate biopsy, followed by MR guided strategies for biopsy, are cost effective for the diagnosis of prostate cancer in men who have not previously undergone a biopsy and who have a suspicion of prostate cancer.

The most significant findings are as follows:

We found that all three MR guided strategies for lesion targeting (cognitive targeting, MR-ultrasound fusion targeting, and in-gantry targeting) are cost effective, as the increase in net health benefits as measured by addition of quality adjusted life years (QALY), outweigh the additional costs according to commonly accepted willingness to pay thresholds in the United States.

Cognitive targeting was the most cost effective. In-gantry biopsy added the most health benefit, and this additional benefit was cost-effective as well.

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Minimally Invasive Rezum® Radiofrequency System Treats Obese Men With Lower Urinary Tract Symptoms Caused by BPH


MedicalResearch.com Interview with:
Dr. Nikhil K. Gupta
and
Kevin McVary, MD, FACS
Professor, Department of Surgery
Chair, Division of Urology
Southern Illinois University School of Medicine

MedicalResearch.com: What is the background for this study?

Pre Treatment.jpg: Benign prostatic hyperplasia (BPH) is an enlargement of the prostate gland, affecting 12 million men in the U.S., with nearly 800,000 newly diagnosed each year. An enlarged prostate squeezes down on the urethra causing lower urinary tract symptoms.

Pre Treatment.jpg: Benign prostatic hyperplasia (BPH) is an enlargement of the prostate gland, affecting 12 million men in the U.S., with nearly 800,000 newly diagnosed each year. An enlarged prostate squeezes down on the urethra causing lower urinary tract symptoms.

Response: Male lower urinary tract symptoms due to benign prostatic hyperplasia, or LUTS due to BPH, have most commonly been treated with a combination of medication, such as alpha-blockers and 5-alpha reductase inhibitors, and surgery, such as transurethral resection of prostate (TURP) and Greenlight photovaporization of prostate (PVP). These treatments, however, have potentially serious adverse and sexual side effects. Minimally invasive surgical therapies (MIST) for LUTS due to BPH have tried to thread the needle between medications and invasive surgery, giving effective relief of symptoms with minimal anesthetic need while preserving sexual function. Previously developed MISTs have been unable to provide durable relief of symptoms, causing patients to undergo multiple treatments in a short period of time, and have been limited by prostate size and conformation, e.g. the inability to treat a middle lobe or median bar. LUTS due to BPH is also very strongly and likely causally linked with obesity, and obesity seems to have an effect on the efficacy of treatment as well, as obesity affects response to medication and tends to dampen the treatment effect of TURP.

Convective Radiofrequency Water Vapor Energy ablation of the prostate, named Rezūm®, is a new MIST that uses radiofrequency to generate energy in the form of water vapor. The water vapor acts as a convective energy source and, once injected into the treatment area, distributes itself evenly within the treated tissue, causing uniform necrosis througout the treated area. This mechanism using convection is in contrast to previous technologies using conductive heat energy, which created a heat gradient with tissue closest to the heat source receiving the largest amount of energy and tissue farthest from the heat source receiving almost no energy. Thus conductive energy has a different effect on different parts of the treated area. With Rezūm, MRI studies have shown that the water vapor creates a uniform treatment effect while staying within collagen barriers, obeying natural tissue planes and affecting only the intended treatment areas.

The purpose of this study was to determine the efficacy of Rezūm in treatment of LUTS due to BPH, examine the treatment’s effect on sexual function, and to determine whether obesity affected treatment efficacy.

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Flibanserin- Addyi -Improved Sexual Health in Women With Hypoactive Sexual Desire Disorder

MedicalResearch.com Interview with:

Dr. Michael Krychman, MD Executive Director: The Southern California Center for Sexual Health and Survivorship, Medical Director: Sexual Medicine at Hoag Hospital Newport Beach CA Clinical faculty member University of Southern California Los Angeles, CA

Dr. Krychman

Dr. Michael Krychman, MD
Executive Director: The Southern California Center for Sexual Health and Survivorship,
Medical Director: Sexual Medicine at Hoag Hospital Newport Beach CA
Clinical faculty member
University of Southern California
Los Angeles, CA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This post hoc analysis pooled data from three 24-week, double-blind, placebo-controlled studies (VIOLET, DAISY, and BEGONIA) of flibanserin in premenopausal women with acquired, generalized HSDD5-7. Patients who received flibanserin 100 mg once daily at bedtime (qhs) or placebo were included in the analysis. The Female Sexual Function Index (FSFI) consists of 19 items across 6 domains. Scores range from 2 to 36. Higher scores indicate better sexual functioning. Scores under 26 indicate sexual dysfunction. Analysis of covariance was used to evaluate changes from the first week to week 24 in the FSFI domain and total scores were compared for flibanserin 100 mg qhs versus placebo. For patients who discontinued study participation prior to week 24, the last postbaseline observation was carried forward (LOCF).

Results found that treatment with flibanserin 100 mg qhs produced statistically significant improvement, relative to placebo, on all domains of the FSFI (desire, arousal, lubrication, orgasm, satisfaction and pain) in premenopausal women with acquired, generalized hypoactive sexual desire disorder (HSDD).

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Active Surveillance Can Be Expanded To Select Group of Younger Men With Prostate Cancer

MedicalResearch.com Interview with:

Keyan Salari, MD, PhD Resident in Urologic Surgery Keyan Salari is currently completing his residency in the Harvard Program in Urologic Surgery at the Massachusetts General Hospital, and is conducting post-doctoral research in cancer genomics in the Garraway Lab at the Dana-Farber Cancer Institute and the Broad Institute of Harvard and MI

Dr. Keyan Salari

Keyan Salari, MD, PhD
Resident in Urologic Surgery
Keyan Salari is currently completing his residency in the Harvard Program in Urologic Surgery at the Massachusetts General Hospital, and is conducting post-doctoral research in cancer genomics in the
Garraway Lab at the Dana-Farber Cancer Institute
and the Broad Institute of Harvard and MIT

MedicalResearch.com: What is the background for this study?

Response: Active surveillance is an effective strategy addressing the problem of over treatment of clinically indolent prostate cancer, but data on the role of active surveillance in younger men is limited. Younger men diagnosed with prostate cancer are typically counseled to undergo treatment as opposed to surveillance of their prostate cancer.

To potentially expand the role of active surveillance to younger patient populations, we undertook this study evaluating the outcomes of younger men under 60 years of age who elected to pursue active surveillance of their prostate cancer.

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New Prostate Cancer Specific Assay May Reduce Need For Biopsies

MedicalResearch.com Interview with:

Eric A. Klein, MD</strong> Chairman, Glickman Urological and Kidney Institute Cleveland Clinic

Dr. Klein

Eric A. Klein, MD
Chairman, Glickman Urological and Kidney Institute
Cleveland Clinic

MedicalResearch.com: Which of these results did you find most interesting or surprising?

Response: What’s most interesting is that the IsoPSA assay redefines how PSA is measured, which links it more closely to the underlying biology of cancer. Current assays measure only the concentration of PSA, which can be affected by conditions other than cancer – BPH most commonly, but also infection and inflammation – which limits its diagnostic accuracy for finding cancer. Its been known for several decades that PSA exists in multiple different forms in the bloodstream in patients with prostate cancer.

These novel molecules arise because cancer cells have deranged cellular metabolism that result in the generation of new species of PSA, making their measurement more tightly linked to the presence or absence of cancer and even the presence of high grade cancer (where cellular metabolism is even more disordered).

The IsoPSA assay is the first assay to measure all of these isoforms and thus has better diagnostic accuracy for cancer.

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Psychiatric Side Effects of 5 Alpha Reductase Inhibitors for BPH

MedicalResearch.com Interview with:

Blayne Welk, MD, FRCSC Assistant Professor of Surgery Western University

Dr. Blayne Welk

Blayne Welk, MD, FRCSC
Assistant Professor of Surgery
Western University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Concerns have been raised by regulatory agencies and patients about possible serious psychiatric side effects associated with the use of 5 alpha reductase inhibitors. These medications can be used for both enlarged prostates and alopecia.

We used administrative data to assess for potential psychiatric side effects associated with finasteride and dutasteride usage in older men with benign prostatic enlargement.

In our study we found that there was no increased risk of suicide associated with the use of these medications. However, there was a small increase in both self-harm and new onset depression associated with the use of 5 alpha reductase inhibitors.
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Prostate Artery Embolization Is Less Invasive Choice For BPH Treatment

MedicalResearch.com Interview with:

Dr. João Martins Pisco, MD PhD Hospital St. Louis, International Prostate Medical Center Lisbon, Portugal

Dr. João Martins Pisco

Dr. João Martins Pisco, MD PhD
Hospital St. Louis, International Prostate Medical Center
Lisbon, Portugal

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Enlarged prostate, also known as benign prostatic hyperplasia (BPH), is one of the most common prostate problems occurring in men older than 50. According to the National Institutes of Health, as many as 14 million men in the U.S. had symptoms suggestive of BPH, which can affect 50 percent of men between 51 and 60 years of age and up to 90 percent of men older than 80. A few years ago, Dr. João Martins Pisco developed the minimally invasive treatment, known as prostate artery embolization, to treat BPH. The study that Dr. Pisco presented at the Society of Interventional Radiology on March 8 is the first of its kind – a study with 1,000 patients with long-term efficacy data.

Between March 2007 and March 2016, Dr. Pisco and his team performed PAE on 1,000 men who averaged 67 years of age. All patients were evaluated in the short term (one, three, and six months), 807 patients were seen through the medium term (every six months between six months and three years), and 406 patients were evaluated long term (every year after three years).

During each evaluation, the men’s symptoms were measured by the International Prostate Symptom Score (IPSS), which tests for the blockage of urine flow, and the International Index of Erectile Function (IIEF), which assesses erectile dysfunction. Researchers also measured the size of the prostate and the amount of urine left in the bladder after urination. They also evaluated the peak urinary flow rate and the prostate-specific antigen (PSA) level, a test used to screen for prostate cancer.

MedicalResearch.com:  What are the main findings?

Response:  The data from these measures revealed at the short-term mark that the treatment had an 89 percent cumulative success rate—measuring the success across all variables through the given testing period. The 807 men evaluated at the medium-term mark had an 82 percent success rate. And of the 406 patients measured at the long-term mark, 78 percent were considered cumulative successes.

In an additional analysis, researchers found that among 112 patients who also suffered acute urinary retention (AUR) before undergoing PAE, 106 or 94.6 percent had their catheter removed between two days and three months after treatment. At medium-term and long-term follow up, 95 of the 112 (84.8 percent) and 89 of the 112 (78.5 percent) did not experience any recurrence of their AUR.

The team also performed PAE in 210 patients who had limited treatment options due to extreme enlargement of the prostate (larger than 100 cm³). Of these men, 84 percent experienced cumulative success at short-term evaluation and 76.2 percent at medium- and long-term. The normal size of a prostate is 15 cm3 to 30 cm3.

MedicalResearch.com: What should readers take away from your report?

Response:  Prostate artery embolization gives men with BPH a treatment option that is less invasive than other therapies and allows them to return to their normal lives sooner. Time and time again, Dr. Pisco has seen patients who are relieved to find out about PAE because they are not able to tolerate medications for BPH due to their side effects. These men also don’t want traditional surgery because it involves greater risks, has possible sexual side effects, and has a recovery time that is relatively long compared to PAE, which is generally performed under local anesthesia and on an outpatient basis.

Prostate artery embolization should also be presented to patients who are exploring options to resolve their BPH.

That said, PAE may not be appropriate for all patients, such as those with advanced arterial atherosclerosis that may be due to smoking or diabetes. Patients should speak with an interventional radiologist or other members of their care team to discuss treatment options.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: As a next step, Dr. Pisco and his team are now conducting a study comparing the effectiveness of PAE to a sham – or placebo—treatment to address any possible placebo effect that may have occurred during Pisco’s research with these 1,000 patients.

MedicalResearch.com: Is there anything else you would like to add?

Response: Prostate artery embolization is a safe and effective treatment and these data demonstrate the efficacy of the therapy in the long term. It’s important that patients know about this therapy as they explore how to resolve their BPH. 

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Society of Interventional Radiology abstract discussing:

Prostate artery embolization for BPH

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Clinical Outcomes Following a Low-Suspicion MRI for Prostate Cancer

MedicalResearch.com Interview with:

Lars Boesen MD PhD Department of Urology Herlev Gentofte University Hospital Herlev

Dr. Boessen

Lars Boesen MD PhD
Department of Urology
Herlev Gentofte University Hospital
Herlev

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Transrectal ultrasound-guided biopsies (TRUS-bx) traditionally used for detecting prostate cancer (PCa) are prone to sampling errors due to difficulties in target identification. Therefore, concerns about the possibility of missing significant prostate cancer result in men with negative biopsy results frequently undergo repeated biopsies, leading to increased medical costs, patient anxiety and morbidity.

Multiparametric MRI (mp-MRI) has become increasingly important in prostate cancer diagnosis. A suspicious lesion can be targeted by MRI-guided biopsies and improve diagnosis. Conversely, a normal mp-MRI may non-invasively exclude the possibility of an aggressive disease, avoiding the need for further biopsies. However, there are no current guidelines for clinicians whether standard repeated biopsies (TRUS-bx) should be performed in men with either a low-suspicion mp-MRI or benign MRI-targeted biopsies of a suspicious lesion and the clinical outcome and future risk of detecting significant prostate cancer following these findings is unknown.

Therefore, we assessed the risk of being diagnosed with prostate cancer after either a low-suspicion mp-MRI or benign targeted biopsies of a suspicious lesion in men with prior negative TRUS-bx, but a persistent clinical suspicion of missed significant cancer over a follow-up period of at least three years. Our results suggest that a low-suspicion MRI in men with prior negative TRUS-bx can be used non-invasively in ruling out longer term significant cancer and immediate repeated biopsies are of limited clinical value and might be avoided even if prostate-specific-antigen levels are persistently elevated.

MedicalResearch.com: What should readers take away from your report?

Response: A low-suspicion mp-MRI in a man with prior negative TRUS-bx has a high accuracy in ruling out a significant aggressive prostate cancer during follow-up of at least three years. Thus, immediate repeated biopsies rarely find significant disease and could be avoided even if the prostate-specific-antigen level is persistently elevated.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Our results should be verified in larger prospective studies with a longer follow-up period to assess other clinical endpoints that include disease progression, cancer specific mortality and associated costs with an mp-MRI approach.

There are no disclosures or conflicts of interest

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:
J Urol. 2017 Feb 21. pii: S0022-5347(17)30297-5. doi: 10.1016/j.juro.2017.02.073. [Epub ahead of print]
Clinical outcome following a low-suspicion multiparametric prostate MRI or benign MRI-guided biopsy to detect prostate cancer: A follow-up study in men with prior negative transrectal ultrasound-guided biopsies.
Boesen L1, Nørgaard N2, Løgager V3, Thomsen HS4.
Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Penile Length One Year After Radical Prostatectomy Not Statistically Different Than Pre-Op

MedicalResearch.com Interview with:
Yoshifumi Kadono, MD. PhD.
Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science,
Kanazawa, Ishikawa, Japan 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: I had experienced some patients who underwent radical prostatectomy (RP) complained penile shortening after RP. Once I checked that kind of reports, some reports mentioned the phenomenon of penile shortening (PS) after radical prostatectomy; however, the results were little bit different and the reasons of PS after RP were not well elucidated.

Therefore, we started our study to obtain our data. In our study, the penile length (PL) was measured before, 10 days after, and at 1, 3, 6, 9, 12, 18, and 24 months after RP. And the PL at 10 days after RP was shortest, and it gradually recovered thereafter. Penile length at 12 months after radical prostatectomy was not significantly different from preoperative penile length. Based on MRI investigation, slight vertical repositioning of the membranous urethra after radical prostatectomy caused chronological changes in penile length.

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Marked Increase in Number of US Patients With Kidney Stones

MedicalResearch.com Interview with:
Li Hao Richie Xu MD

Division of Mineral Metabolism
University of Texas Southwestern Medical Center
Dallas, Texas, United States

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Over the past three decades, the prevalence of the kidney stones has escalated in the United States. Changes in dietary patterns, increasing body weight and obesity likely contributed to this significantly higher prevalence of kidney stone. In this study, we explored temporal changes in stone composition, demographic characteristics, and in serum and urinary kidney stone risk profile in kidney stone forming population for the last 35 years.

The proportion of uric acid stones has been almost doubled during this period. Although age and body mass index (BMI) increased over time in both uric acid and calcium stone formers, uric acid stone formers were consistently older, had higher BMI, and lower urinary pH than calcium stone formers. In addition, over time, the proportion of female vs. male increased in calcium stone formers, but not in uric acid stone formers. The most significant urinary parameter differentiating uric acid stone formers from calcium stone formers is 24-hour urinary pH.

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Benefits and Harms of Duloxetine For Treatment of Stress Urinary Incontinence

MedicalResearch.com Interview with:
Emma Maund, MSc PhD
Nordic Cochrane Centre

MedicalResearch.com: What is the background for this study?

Response: Duloxetine has been approved in Europe for the treatment of stress urinary incontinence in women. It is not approved for this indication in the US and Canada. Currently, reasons why marketing authorization applications are withdrawn or denied are not published by either the Canadian or the US drug agency. However, the FDA has said that a higher-than-expected rate of suicide attempts – 2.6 timer higher – was observed in the open-label extensions of controlled trials of duloxetine for stress urinary incontinence. Given the FDA’s statement about the rate of suicide attempts, we wanted to determine whether duloxetine increased the risk of suicidality, violence or their possible precursors (drug induced akathisia, an extreme type of restlessness; activation, which consists of stimulating effects such as insomnia, anxiety and agitation; emotional disturbance, such as depersonalization and derealization; or psychotic events, such as delusions and hallucinations) in the randomized phases of the trials.

We therefore assessed the benefits and harms of duloxetine in stress urinary incontinence using clinical study reports, including individual patient data, of the 4 main trials submitted by Eli Lilly to the European Medicines Agency.
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Prostate Biopsies and Prostatectomies Drop After PSA Recommendation Changes

MedicalResearch.com Interview with:

Jim C. Hu, M.D., M.P.H. Ronald P. Lynch Professor of Urologic Oncology Director of the LeFrak Center for Robotic Surgery Weill Cornell Medicine Urology New York Presbyterian/Weill Cornell New York, NY 10065

Dr. Jim Hu

Jim C. Hu, M.D., M.P.H.
Ronald P. Lynch Professor of Urologic Oncology
Director of the LeFrak Center for Robotic Surgery
Weill Cornell Medicine
Urology
New York Presbyterian/Weill Cornell
New York, NY 10065

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The US Preventative Services Task Force (USPSTF) recommended against PSA testing in men older than 75 years in 2008 and more recently in all US men regardless of age in 2012. This was largely based on a faulty study, the prostate, lung, colo-rectal and ovarian screening study. We demonstrated in May 2016 that this randomized trial did not compare screening to no screening or apples to oranges, as it set out to do. It compared screening to screening. Although controversial, the guidelines were well-intentioned, as recognize that there is over-diagnosis and over-treatment of men with prostate cancer. Given this background, the goal of our study was to explore the downstream consequences of the recommendation against PSA screening. As such, we explored 3 separate databases to characterize national procedure volumes for prostate needle biopsy and radical prostatectomy, or surgery to cure prostate cancer.

The main finding was that prostate biopsy numbers decreased by 29% and radical prostatectomy surgeries decreased by 16% when comparing before to after USPSTF recommendations against PSA screening. Therefore practice patterns followed policy. Prostate biopsies are usually performed due to an elevated, abnormal screening PSA. However, it is also performed to monitor low-risk, slow growing prostate cancers. We also found that while the overall number of prostate biopsies decreased, there was a 29% increase in the proportion or percentage of biopsies performed due to active surveillance, or monitoring of low risk prostate cancers which should be done periodically. Therefore we provide the first national study to demonstrate that there is less over-diagnosis and over-treatment of prostate cancer.

However, the concern is that we also recently demonstrated that there is more aggressive prostate cancer on surgical pathology for men who go on to radical prostatectomy. They have high grade, higher stage cancers, which have a lower chance of cure. The link is:

http://www.prostatecancerreports.org/fulltext/2016/_Hu_JC160708.pdf

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No Link Found Between Vasectomy and Developing or Dying From Prostate Cancer

MedicalResearch.com Interview with:

Eric Jacobs, PHD | Strategic Director, Pharmacoepidemiology American Cancer Society, Inc. 250 Williams St. Atlanta, GA 30303

Dr. Eric Jacobs

Eric Jacobs, PHD
Strategic Director, Pharmacoepidemiology
American Cancer Society, Inc.
250 Williams St.
Atlanta, GA 30303

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Vasectomy is a common, inexpensive, and very effective method of long-term birth control. However, in 2014, an analysis from a large epidemiologic cohort study, the Health Professionals Follow-Up Study, found that vasectomy was associated with about 10% higher overall risk of prostate cancer and about 20% higher risk of fatal prostate cancer. Together with other researchers at the American Cancer Society, I analyzed the association between vasectomy and fatal prostate cancer among more than 363,000 men in the Cancer Prevention Study II (CPS-II) cohort, age 40 and older, who were followed for up to 30 years. This is the largest prospective analysis of vasectomy and fatal prostate cancer to date. We also examined vasectomy and prostate cancer in a subset of about 66,000 CPS-II study participants who were followed for new diagnoses of prostate cancer.

We found no link between having had a vasectomy and risk of either developing or dying from prostate cancer.

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Is Testosterone Therapy Safe in Patients with Treated and Untreated Prostate Cancer?

MedicalResearch.com Interview with:

Dr. Jesse Ory Department of Urology, Faculty of Medicine Dalhousie University, Halifax Nova Scotia, Canada

Dr. Jesse Ory

Dr. Jesse Ory
Department of Urology, Faculty of Medicine
Dalhousie University, Halifax
Nova Scotia, Canada 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The use of Testosterone Therapy (TT) in men diagnosed with and treated for prostate cancer (CaP) has been highly controversial for several decades. Unfortunately, this controversy is largely founded on the results of a single patient in a study by Huggins and Hodges in the 1940s [1]. This wasn’t challenged until recently, when Morgentaler reviewed the literature on the topic and found no scientific basis for the assumption that TT will act like fuel on the fire of prostate cancer [2]. He also proposed a mechanism, the “saturation hypothesis” that helps account for why TT may in fact be safe for men with prostate cancer. [3]. Over the past decade, retrospective evidence has been accumulating that supports the safety of Testosterone Therapy in hypogonadal men with CaP on Active Surveillance, or in those who have been definitively treated for prostate cancer..

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Digital Rectal Exam and PSA May Detect Distinct Subtypes of Prostate Cancer

MedicalResearch.com Interview with:

Jim C. Hu, MD Ronald Lynch Professor of Urologic Oncology Weill Cornell Medicine New York, NY 10065

Dr. Jim Hu

Jim C. Hu, MD
Ronald Lynch Professor of Urologic Oncology
Weill Cornell Medicine
New York, NY 10065

MedicalResearch.com: What is the background for this study?

Response: Initial results from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO), a large-scale randomized controlled trial of prostate cancer screening in the United States, radically changed the landscape of prostate cancer screening insofar as it led the United States Preventative Services Task Force (USPSTF) to recommend against routine screening with prostate-specific antigen (PSA). Though many subsequent studies have continued to investigate the role of PSA in screening, there is a paucity of data examining the use of digital rectal examination (DRE) for screening in the PSA era. Indeed, the USPSTF recommendation did not explicitly address DRE, calling for further research to evaluate the role of periodic DRE in prostate cancer screening. Likewise, while recent guidelines from the National Comprehensive Cancer Network (NCCN) recommend use of PSA in all men who elect screening, the role of digital rectal examination is equivocal.

We sought to evaluate the value of  digital rectal examination and PSA for detection of clinically significant prostate cancer and prostate cancer-specific (PCSM) and overall mortality in a secondary analysis of the PLCO.

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