Lluis Cecchini

Bone Mineral Density Changes in Patients With Prostate Cancer During the First 2 Years of Androgen Suppression

PURPOSE We characterized bone mineral density changes in patients with prostate cancer on androgen deprivation therapy during the first 2 years of uninterrupted therapy, and identified which location most reflects bone mass loss. MATERIALS AND METHODS Using dual energy x-ray absorptiometry, bone mineral density was prospectively assessed in patients with nonmetastatic prostate cancer at the lumbar spine and femoral neck, Wards triangle, trochanter and total hip. Measurements were performed at baseline and yearly thereafter in patients on ADT, and at baseline and 1 year in controls (age matched patients with prostate cancer, free of biochemical progression after radical prostatectomy). RESULTS A total of 62 patients were included in the study, 31 in each group. Median age (70 and 69 years, respectively), mean Gleason score and mean baseline serum testosterone did not significantly differ. Patients receiving ADT experienced a significant bone mass loss at 12 months in all locations, ranging from 2.29% to 5.55% (p <0.001). In contrast, bone mineral density did not change significantly (0.64% to 1.68%) in patients not receiving ADT. In the 20 patients on ADT after 24 months, the second year decrease was not as severe, nor was it significant compared to first year values. The major bone mass loss occurred in Wards triangle, with decreases of 5.55% at 12 months and 7.05% at 24 months. CONCLUSIONS Bone mineral density decreases during the first 24 months of androgen suppression with the most relevant effect occurring in the first year. Wards triangle is the axial skeletal site that reflects the major bone mass loss. Because the deleterious impact of long-term androgen suppression on bone mineral density is inversely related to fracture risk and indirectly related to survival in patients with prostate cancer, early diagnosis and prevention of bone mass loss are warranted in these patients.

The relationship between daily calcium intake and bone mineral density in men with prostate cancer.

To analyse the relationship between daily calcium intake (DCI) and bone mineral density (BMD) in patients with prostate cancer, and to assess if DCI is a risk factor for osteoporosis in this group of patients.

Alendronate decreases the fracture risk in patients with prostate cancer on androgen-deprivation therapy and with severe osteopenia or osteoporosis

To evaluate changes in bone mass and fracture risk in patients with prostate cancer on androgen‐deprivation therapy (ADT) and with a basal T‐score of >−2.0, who were treated with an oral bisphosphonate, as such patients treated with ADT are at increased risk of bone loss and bone fracture.

Risk factors for positive findings in patients with high-grade T1 bladder cancer treated with transurethral resection of bladder tumour (TUR) and bacille Calmette-Guérin therapy and the decision for a repeat TUR

Study Type – Therapy (case series)

Preoperative Prediction of Pathologically Insignificant Prostate Cancer in Radical Prostatectomy Specimens: The Role of Prostate Volume and the Number of Positive Cores

Introduction: To determine clinical and biopsy features with predictive capacity to identify pathologically insignificant prostate cancer (pIPCa). Material and Methods: pIPCa was defined as cancer volume <0.5 cm3 and a Gleason score (GS) of ≤6 in radical prostatectomy (RP) specimens. Clinical and biopsy parameters were studied as predictors of pIPCa and validated by applying them to d’Amico’s low-risk cases: T1c-T2a, prostate-specific antigen (PSA) <10 and biopsy GS ≤6. Appropriate cut-offs were selected. Results: 280 patients were evaluated; 11.8% (33) had pIPCa, increasing to 23% in low-risk cases. In patients fulfilling d’Amico’s low-risk criteria, variables significantly different in pIPCa were: volume, number of positive cylinders (NPC), percentage of positive cylinders (%PC), percentage of the most affected cylinder (%MAC) and uni/bilaterality. In these cases, volume and the NPC increased as independent variables on logistic regression and when adding a volume threshold of 45 cm3 and 1 positive core, specificity reached 95.8%. Conclusions: The incidence of pIPCa in RP specimens is relevant, especially in low-risk cases. Prostate volume and NPC are independent predictors of pIPCa. We propose a simple predictive model by adding the features of 1 positive core and volume ≧45 cm3 to d’Amico’s criteria. This allows to preoperatively distinguish between patients that most probably would benefit from radical treatment and patients that might be offered active surveillance.

Mediterranean Dietary Pattern is Associated with Low Risk of Aggressive Prostate Cancer: MCC-Spain Study

Purpose: We explored the association of the previously described Western, prudent and Mediterranean dietary patterns with prostate cancer risk by tumor aggressiveness and extension. Materials and Methods: MCC‐Spain (Multicase‐Control Study on Common Tumors in Spain) is a population based, multicase‐control study that was done in 7 Spanish provinces between September 2008 and December 2013. It collected anthropometric, epidemiological and dietary information on 754 histologically confirmed incident cases of prostate cancer and 1,277 controls 38 to 85 years old. Three previously identified dietary patterns, including Western, prudent and Mediterranean, were reconstructed using MCC‐Spain data. The association of each pattern with prostate cancer risk was assessed by logistic regression models with random, province specific intercepts. Risk according to tumor aggressiveness (Gleason score 6 vs greater than 6) and extension (cT1‐cT2a vs cT2b‐cT4) was evaluated by multinomial regression models. Results: High adherence to a Mediterranean dietary pattern rich not only in fruits and vegetables but also in fish, legumes and olive oil was specifically associated with a lower risk of Gleason score greater than 6 prostate cancer (quartile 3 vs 1 relative RR 0.66, 95% CI 0.46–0.96 and quartile 4 vs 1 relative RR 0.68, 95% CI 0.46–1.01, p‐trend = 0.023) or with higher clinical stage (cT2b‐T4 quartile 4 vs 1 relative RR 0.49, 95% CI 0.25–0.96, p‐trend = 0.024). This association was not observed with the prudent pattern, which combines vegetables and fruits with low fat dairy products, whole grains and juices. The Western pattern did not show any association with prostate cancer risk. Conclusions: Nutritional recommendations for prostate cancer prevention should consider whole dietary patterns instead of individual foods. We found important differences between the Mediterranean dietary pattern, which was associated with a lower risk of aggressive prostate cancer, and Western and prudent dietary patterns, which had no relationship with prostate cancer risk.

Re: Marko Babjuk, Willem Oosterlinck, Richard Sylvester, et al. EAU Guidelines on Non-Muscle-Invasive Urothelial Carcinoma of the Bladder. Eur Urol 2008;54:303–14

The recently published guidelines on non-muscleinvasive urothelial carcinoma of the bladder by the European Association of Urology (EAU) [1] are not only a thorough and updated literature review but also an extremely useful tool for everyday decision making. The co-authors should, therefore, be congratulated for their work. As Dr. Soloway states in his editorial, the critical importance of risk stratification is extremely well illustrated in this guideline. We would, however, like to comment on the EAU recommendation policy on restaging transurethral resection (reTUR) for high-grade T1 (HGT1). The guidelines state: ‘‘A second TUR should be considered if there is a suspicion that the initial resection was incomplete . . . [and] when a highgrade non-muscle-invasive tumour or a T1 tumour was detected at the initial TUR. . . . It has been demonstrated that a second TUR can increase recurrence-free and progression-free survival [20] (level of evidence: 2a).’’ This statement is based on a report by Divrik et al [2] prospectively comparing two groups of ‘‘all grades’’ T1 tumors undergoing reTUR plus 6w mitomycin C (group 1, 74 patients) and mitomycin C alone (no reTUR; group 2, 68 patients). Even though nonsignificant, a bias for 11% more cases of high grade in group 2 should be pointed out. At 31.5-mo follow-up, a significant decrease in recurrence rate for group 1 was shown. At the same follow-up, however, progression was observed for three cases (4.05%) in group 1 and for eight cases (11.76%) in group 2 (six muscle-infiltrating tumors and two carcinoma in situ [CIS]), p = 0.097. Unfortunately, the report failed to show significant

Is there a relationship between prostate volume and Gleason score

To review the relationship between the Gleason grade and prostate volume in biopsy and radical prostatectomy (RP) specimens, and thus assess the hypothesis that smaller prostates have a greater incidence of high‐grade tumours.

Twelve Core Template Prostate Biopsy is an Unreliable Tool to Select Patients Eligible for Focal Therapy.

Introduction: To determine whether unilateral prostate cancer diagnosed at 12-core prostate biopsy harbours relevant prostate cancer foci in contralateral lobe in cases eligible for hemiablative focal therapy. Material and Methods: We analysed 112 radical prostatectomies of unilateral Gleason 6/7 prostate cancer based on prostate biopsy information. The presence of significant prostate cancer foci and/or the index lesion in the contralateral lobe is described. A subanalysis is performed in cases of Gleason score 6 and in cases of very-low-risk prostate cancer. Results: Contralateral prostate cancer was present in 69.6% of cases, fulfilling significant prostate cancer criteria in 33% and being the index lesion in 32%. No significant differences were found when analysing the Gleason 6 group (73% contralateral prostate cancer, 34% significant prostate cancer and 35% index lesion) or the very-low-risk prostate cancer group (80% contralateral prostate cancer, 29% significant prostate cancer and 45% index lesion). Conclusions: The assumption of unilateral prostate cancer based on 12-core template prostate biopsy information is unreliable. In about one third of the cases, there will be focus of significant prostate cancer or the index lesion in the contralateral lobe. This information should be taken into account when hemiablative focal therapies are considered.

Micronuclei frequency in urothelial cells of bladder cancer patients, as a biomarker of prognosis: Micronuclei frequency in urothelial cells of bladder cancer patients, as a biomarker of prognosis

It has been suggested that the frequency of micronuclei (MN) in defoliated urothelial cells could be used as a biomarker for both the potential risk of bladder cancer (BC) and its progression. To prove this we have carried out a large study evaluating the MN frequency in a group of 383 hospital patients submitted to cystoscopy. From them, 77 were negative in their first cystoscopy, and were considered as a reference group; 79 were positive and were classified as patients with tumor; and 227 with previous bladder cancer submitted to follow‐up monitoring were negative and classified as BC patients without tumor. Vesical washes were processed and the obtained cells were placed onto microscope slides for further scoring. To minimize scoring misinterpretations, cells were stained with DAPI, and observed in a fluorescence microscope. Results indicated that patients with BC presented higher incidence of MN than controls (18.29 ± 10.04 vs. 14.40 ± 8.49, P = 0.010, respectively). When individuals with BC were classified depending on whether the BC was a primary or a recidivated tumor, those patients with recurrent BC presented a higher frequency of MN than those where BC was detected for the first time (19.22 ± 9.59 vs. 16.60 ± 10.78, respectively); nevertheless, this increase did not reach statistical significance. Finally, a positive and significant correlation was observed between MN frequency and the degree of the tumor (P = 0.038). All this together would confirm the potentiality of the MN frequency in urothelial defoliated cells assay to be used, at least, in the follow‐up and surveillance of BC patients. Environ. Mol. Mutagen. 60: 168–173, 2019.