Al Barqawi

The association of time of day and serum testosterone concentration in a large screening population.

Authors from the USA reviewed semen samples for their National Prostate Cancer Awareness screening programme. They evaluated semen testosterone levels at various times during the day, depending on when the person attended for screening. In this study, they found that testosterone levels in older men remain stable throughout the morning and early afternoon, and declined only moderately after that. Further case control studies have been suggested to confirm this finding.

The Current Use and Future Trends of Focal Surgical Therapy in the Management of Localized Prostate Cancer

The current treatment algorithms for management of localized prostate cancer are mainly extirpative in nature. Treatment varies from expectant management to radical prostatectomy or radiation therapy. However, the ever-increasing emphasis on achieving the best survival benefit while better preserving quality of life, coupled with the introduction of new, safer, and efficacious minimally invasive ablative technologies, has led to the increased popularity of minimally invasive treatment (MIT). MIT refers to the use of a wide range of techniques for local target ablation of the prostate gland with minimal damage to the surrounding tissue. Currently these include cryotherapy and high-intensity focused ultrasound. However, other experimental technologies such as photodynamic therapy, interstitial prostate brachytherapy, and microwave and radiofrequency interstitial tumor ablation are also currently under investigation in early clinical trials. To date, the overall interim results for these relatively new modalities of treatment appear comparable to those for surgical and radiation therapies. However, randomized, controlled studies are needed to support use of these modalities as an alternative to surgery and radiation. In this review, we will address the current rationale for and knowledge of MIT with regard to its safety and efficacy in the treatment of localized prostate cancer. In addition, we will discuss future promising tools in MIT such as photodynamic therapy and the target focal therapy approach as a new trend for the treatment of organ-confined low-volume disease.

The Effect of Short-term Dutasteride Intake in Early-stage Prostate Cancer: Analysis of 148 Patients Who Underwent Three-dimensional Prostate Mapping Biopsy

OBJECTIVES The effect of dutasteride on existing prostate cancer volume is largely unknown. In this study, we assessed the impact of dutasteride on tumor burden and Gleason score. METHODS A retrospective review of patients from our institution was performed, examining men interested in surveillance for prostate cancer, who underwent transperineal three-dimensional mapping (TP-3DM) biopsy within 3-6 months after their initial cancer diagnosis. The criteria to qualify for TP-3DM biopsy included prostate-specific antigen < 10 ng/mL, Gleason score ≤ 7, ≤ 2 positive cores out of 12. There were 2 cohorts of men--those who took dutasteride daily before the TP-3DM biopsy and those who did not receive any 5ARIs. Upstaging of prostate cancer diagnosis was defined as an increase in one or more positive cores or a change from unilateral to bilateral disease. RESULTS From 2006-2008, a cohort of 148 men underwent TP-3DM biopsy of the prostate. Ninety-one men received a treatment regime of dutasteride at least 3 months before TP-3DM biopsy. Fifty-seven men did not receive dutasteride or any other 5ARI. Approximately 74% of men who did not take dutasteride were upstaged and/or upgraded compared with 49.4% of men who received dutasteride (P = .0038). CONCLUSIONS We observed a 24.3% decrease in the proportion of upstaging and/or upgrading of prostate cancer in men who received dutasteride at least 3 months before 3D prostate TP-3DM biopsy. Thus, the effect of dutasteride on prostate cancer may have implications for its potential use as a secondary chemoprevention agent.

The current status of cryotherapy and high-intensity focused ultrasound in the treatment of low-grade prostate cancer.

As a result of widespread serum prostate-specific antigen (PSA) screening and prostate cancer awareness, the detection of low-grade prostate cancer has increased. At the moment, it is unclear how to treat patients in this population. Thus, we focused on reviewing therapies for patients in this low risk group. The purpose of this review paper is to present the status of emerging therapies of cryotherapy and high-intensity focused ultrasound (HIFU) in patients with low risk disease. Based on our review of the literature, there are several small-scale studies of these two therapies that have revealed favorable outcomes, but with complications of urinary incontinence and impotence. With further research, these therapies may develop into good alternatives for patients in this expanding group.

A REDUCED AMERICAN UROLOGICAL ASSOCIATION SYMPTOM SCORE

INTRODUCTION AND OBJECTIVES: Our study creates a shorter version of the American Urologic Association symptom score (AUA SS). Our instrument is called the UWIN symptom score (U=Urgency, W=weak stream, I=Incomplete emptying, N=Nocturia). METHODS: In this study, participants in the Prostate Cancer Awareness Week from 2006 and 2007 were administered both the regular AUA SS and the UWIN questionnaire. A total of 6,773 participants completed both the AUA SS and the UWIN questionnaire. The total score of each participant for the AUA SS (0-35) and the UWIN (0-12) were evaluated using Spearman’s correlation coefficients and Bland-Altman plots to determine the level of agreement between the two questionnaires. RESULTS: The correlation between the total AUA SS (0-35) and the total UWIN score (0-12) is 0.87 (<0.0001) and the correlation between the quality of life question in the AUA SS and the UWIN is 0.80 (<0.0001) using the Spearman correlation coefficient. The UWIN total value range can be grouped into: “Mild” (0-3), “Moderate” (4-7) and “Severe” (8-12) symptoms. A second analysis was performed using the Bland-Altman Plot to evaluate the agreement between the AUA SS and the UWIN. This evaluation method requires that the scores both be expressed on the same scale. Since the AUA SS is on a scale between 0-35 and the UWIN is on a scale between 0-12, each index was divided by its maximum obtainable value, thereby rescaling both indicies to between 0-1. There was good agreement between the two questionnaires (see graphs below). Overall, respondents tended to give a slightly higher UWIN total score compared to their AUA SS total. CONCLUSIONS: This study validates that the UWIN questionnaire can be used in the place of the AUA SS. The UWIN questionnaire will make collecting data for both clinicians and researchers as cost-effective and as efficient as possible while measuring the same information as the gold-standard AUA SS. Table 1: Reduced Symptom Questionnaire or UWIN