R. Lombardo

Metabolic Syndrome and Lower Urinary Tract Symptoms in Patients With Benign Prostatic Enlargement: A Possible Link to Storage Symptoms

OBJECTIVE To evaluate the association between metabolic syndrome (MetS) and lower urinary tract symptoms (LUTS) in patients with benign prostatic enlargement (BPE). MATERIALS AND METHODS From 2009 onward, a consecutive series of patients with LUTS-BPE were enrolled. Patients were evaluated using the International Prostate Symptom Score (IPSS) and ultrasonographic prostate volume. Body mass index, waist circumference, and blood pressure were measured. Blood samples were collected for prostate-specific antigen levels, fasting glucose levels, triglyceride levels, high-density lipoprotein levels, and testosterone levels. MetS was defined according to Adult Treatment Panel III (ATP III). The risk of detecting LUTS as a function of MetS was evaluated using the logistic regression analysis. RESULTS A total of 431 patients were enrolled with a median age and prostate-specific antigen level of 67 years (61-73 years) and 3 ng/mL (2.2-4.3 ng/mL), respectively; median body mass index was 27 kg/m2 (25-29 kg/m(2)); median testosterone was 3.9 ng/mL (3.1-4.7 ng/mL); median IPSS was 8 (4-14), median prostate volume was 43 mL (35-56 mL). One hundred three of 431 patients (23.8%) presented with a MetS. Patients with MetS presented a higher IPSS storage subscore (4; interquartile range, 2-7 vs 3; interquartile range 1-7; P = .002). On multivariate analysis, the presence of MetS was associated with an increased risk of an IPSS storage subscore ≥4 (odds ratio, 1.782; 95% confidence interval, 1.045-3.042; P = .030). CONCLUSION In our single-center study, MetS is associated with an increased risk of storage symptoms in patients with BPE. Although these results should be confirmed, and the pathophysiology is yet to be understood, it can be assumed that MetS and its metabolic components should be considered as possible factors involved in LUTS-BPE pathogenesis.

Physical activity as a risk factor for prostate cancer diagnosis: a prospective biopsy cohort analysis.

To assess the association between physical activity, evaluated by the Physical Activity Scale for the Elderly (PASE) questionnaire, and prostate cancer risk in a consecutive series of men undergoing prostate biopsy.

Serum levels of chromogranin A are not predictive of high-grade, poorly differentiated prostate cancer: results from an Italian biopsy cohort.

OBJECTIVES To explore the association of chromogranin A (CgA) levels and the risk of poorly differentiated prostate cancer (CaP) in men undergoing prostate biopsy. MATERIALS AND METHODS Between 2006 and 2012, we prospectively enrolled 1,018 men with no history of CaP undergoing prostate biopsy. The risk of detecting poorly differentiated CaP as a function of CgA concentration was evaluated using crude and adjusted logistic regressions. Further analyses were performed to determine whether CgA was a significant predictor of high-grade CaP in men with low PSA (<10 ng/ml). RESULTS We found a significantly higher level of CgA in men with poorly differentiated CaP. CgA was however co-linear with age, and serum CgA levels were not significantly associated with the overall risk of CaP, and the specific risk of poorly differentiated CaP (OR 1.001 95% CI 0.99-1.01, P = 0.74). Moreover, in men with low PSA levels (<10 ng/ml), CgA was not a significant predictor of high grade-disease on univariate (OR 1.00; 95% CI 0.99-1.01; P = 0.66) and multivariate analysis (P = 0.85). CONCLUSIONS In our cohort of patients, the serum level of CgA is not a significant predictor of poorly differentiated CaP on initial prostate biopsy, even in men with low PSA levels (<10 ng/ml). According to our experience, CgA should not be considered a reliable marker to predict poorly differentiate cancer in the setting of initial prostate biopsy.

Assessment of HPV-mRNA test to predict recurrent disease in patients previously treated for CIN 2/3

BACKGROUND The use of HPV-mRNA test in the follow-up after LEEP is still matter of debate, with regard to its capacity of prediction relapse. OBJECTIVE The aim of the present study is to evaluate the reliability of HPV-mRNA test to predict the residual and recurrent disease, and its accuracy in the follow-up of patients treated for CIN 2/3. STUDY DESIGN Multicenter prospective cohort study. Patients who underwent LEEP after a biopsy diagnosing CIN 2/3 were followed at 3, 6, 12, 24 and 36 months. Each check up included cytology, colposcopy, HPV-DNA test (LiPA) and HPV-mRNA test (PreTect HPV Proofer Kit NorChip). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), of HPV-DNA test and HPV-mRNA test to predict relapse, recurrent and residual disease. Using multiple logistic regression, the statistical significant variables as assessed in univariate analysis were entered and investigated as predictors of relapse disease. RESULTS The mRNA-test in predicting a residual disease had a sensitivity of 52% and a NPV of 91%, whereas DNA-test had 100% and 100%, respectively. On the contrary in the prediction of recurrent disease mRNA-test had a sensitivity and a NPV of 73.5% and 97%, whereas DNA-test had 44% and 93%. On the multivariate analysis, age, cytology, HPV DNA and mRNA test achieved the role of independent predictors of relapse. CONCLUSION HPV-mRNA test has a higher sensitivity and a higher NPV in predicting recurrent disease, for this reason it should be used in the follow-up of patients treated with LEEP for CIN 2/3 in order to individualize the timing of check up.

Transrectal-ultrasound prostatic biopsy preparation: rectal enema vs. mechanical bowel preparation.

Introduction Transrectal prostate biopsy (TRUSbx) is the standard for the diagnosis of prostate cancer. Different bowel preparations are used for patients undergoing TRUSbx. The aim of our study was to compare two different bowel preparations for TRUSbx. Material and methods From May 2012 and onwards, a selected group of men undergoing TRUS 12-core prostate biopsy were enrolled into a prospective database. Patients were randomized 1:1 to receive a rectal enema (Group A) the night before the procedure or polyethylene glycol 34.8 grams/4 liters of water the day before the procedure (Group B). A VAS scale to evaluate the patients’ discomfort according to the two preparations was collected. The same antibiotic prophylaxis was performed in both groups. All complications were prospectively recorded and graded according to the Clavien Classification System (CCS). Results A total of 198 patients were consecutively enrolled. Mean age was 67.5 ±7.9 years, mean body mass index (BMI) was 27.1 ±4.2 Kg/m2, mean PSA value was 9.3 ±12.6 ng/ml and the mean prostatic volume was 60.6 ±29 ml. 97 patients were enrolled in Group A and 101 in Group B. Overall post-biopsy morbidity rate was 60%. No significant differences for low-grade and high-grade complications was observed between the two groups. Patients receiving the rectal enema presented with a significantly lower VAS score (3.1 ±1.1 vs. 5.9 ±1.7; p = 0.02). Conclusions Our study confirmed that a rectal enema should be considered as the standard bowel preparation in patients undergoing a TRUS biopsy; it is as effective as PEG and associated with less discomfort.

The Diagnosis of Benign Prostatic Obstruction: Validation of the Young Academic Urologist Clinical Nomogram

OBJECTIVE To externally validate the Young Academic Urologist (YAU) nomogram for the prediction of benign prostatic obstruction (BPO) in patients with lower urinary tract symptoms and benign prostatic enlargement. MATERIALS AND METHODS Between January 2013 and September 2014, a consecutive series of patients with lower urinary tract symptoms and benign prostatic enlargement underwent standardized pressure flow studies (PFSs) in 2 tertiary Italian centers. Variables assessed were International Prostatic Symptom Score, Prostate Specific Antigen (PSA), prostate size, transitional zone volume, maximal urinary flow rate (Qmax), postvoid residual urine. BPO was defined as a Schäfer grade ≥ 3 at PFSs. Qmax and transitional zone volume were plotted on the YAU nomogram to predict the presence of BPO. Receiver operating characteristic curve analysis was used to evaluate predictive properties of the nomogram for the final diagnosis of BPO. RESULTS A total of 449 patients were consecutively enrolled. In those, 310 patients (69%) presented a BPO (Schäfer ≥ 3) at PFSs. The novel YAU nomogram presented an area under the curve of 0.76; 95% confidence interval: 0.72-0.82 for the diagnosis of BPO. At the best cutoff value of 80% (nomogram probability), the sensitivity was 74% and specificity was 79%, the positive predictive value was 89%, and the negative predictive value was 56%. CONCLUSION Although further studies are needed to confirm our results, the YAU nomogram was, in our experience, an excellent tool to predict the presence of BPO.

Prostate-specific Antigen Density Is a Good Predictor of Upstaging and Upgrading, According to the New Grading System: The Keys We Are Seeking May Be Already in Our Pocket

OBJECTIVE To analyze the performance of prostate-specific antigen density (PSAD) as a predictor of upstaging and prognostic grade group (PGG) upgrading. MATERIALS AND METHODS We retrospectively evaluated data on men with prostate cancer (PCa) treated with robot-assisted laparoscopic radical prostatectomy (RALP) at our center in 2014-2015. Preoperative PSAD was calculated. Bioptic and pathologic PGGs were also considered in the analysis. We defined upgrading as any increase in PGG after RALP; upstaging was the pathologic diagnosis of a clinically unsuspected stage ≥3a PCa. RESULTS Data on 379 patients were analyzed. Upgrading was found in 41.4% of the patients; 29% of the patients were upstaged. On multivariable analysis, core involvement and PSAD were found to be predictors of upgrading (odds ratio [OR] 1.017, 95% confidence interval [CI] 1.001-1.034, P = .039; and OR 3.638, 95% CI 1.084-12.207, P = .001, respectively). Furthermore, core involvement and PSAD were predictors of upstaging (OR 1.020, 95% CI 1.020-1.034, P = .003; and OR 5.656, 95% CI 1.285-24.894, P = .022, respectively). PSAD showed areas under the curve of 0.712 (95% CI 0.645-0.780, P = .000) and 0.628 (95% CI 0.566-0.689, P = .000) for the prediction of upgrading and upstaging, respectively. In a subpopulation of 90 patients theoretically eligible for active surveillance, 14% were found upstaged and 17% were upgraded. PSAD showed areas under the curve of 0.894 (95% CI 0.808-0.97, P = .000) and 0.689 (95% CI 0.539-0.840, P = .021) for the prediction of upgrading and upstaging, respectively. CONCLUSION PSAD is a valuable predictor of upgrading and upstaging in men with PCa who were candidates for surgery and is accurate in selecting patients for AS.

Metabolic Syndrome Does Not Increase the Risk of Ejaculatory Dysfunction in Patients With Lower Urinary Tract Symptoms and Benign Prostatic Enlargement: An Italian Single-center Cohort Study

OBJECTIVE To evaluate the relationship between metabolic syndrome (MetS) and ejaculatory dysfunction (EjD) in patients with lower urinary tract symptoms and benign prostatic enlargement. MATERIALS AND METHODS From 2012 to 2016, a consecutive series of men with lower urinary tract symptoms and benign prostatic enlargement who were attending our prostate clinic were evaluated using the International Prostate Symptom Score (IPSS) and were subsequently enrolled into a prospective database. All patients were assessed using the short form of the International Index of Erectile Function (IIEF-SF) and the Male Sexual Health Questionnaire ejaculatory dysfunction short form (MSHQ-EjD-SF) that evaluates the ability to ejaculate, the ejaculation force, the ejaculation volume, and subjective bother associated with EjD. MetS was defined according to the Adult Treatment Panel III criteria. RESULTS A total of 220 patients were enrolled; 48 of 220 patients (22%) presented a MetS. Mean age was 70 ± 8 years, mean IPSS was 8.3 ± 6.2, mean IIEF score was 17.3 ± 7.9, and mean MSHQ-EjD-SF was 9.9 ± 4.7. Overall, 109 of 220 patients (50%) were affected by a moderate or severe EjD. On multivariate analysis, age (odds ratio [OR]: 1.058, 95% confidence interval [CI]: 1.016-1.123; P = .007), IIEF score (OR: 0.899, 95% CI: 0.856-0.943; P = .000), and IPSS (OR: 1.065, 95% CI: 1.011-1.123; P = .018) were found to be predictors of EjD. In our series MetS was not found to be predictive of EjD. CONCLUSION In our single-center study, MetS has no influence on the EjD evaluated with the MSHQ-EjD-SF.

Detrusor overactivity increases bladder wall thickness in male patients: A urodynamic multicenter cohort study

To evaluate the role of Bladder wall thickness (BWT) as a predictor of Detrusor overactivity (DO) in patients with Lower urinary tract symptoms (LUTS)/Benign prostatic enlargement without Bladder Outlet Obstruction.

Serum levels of 17-β-estradiol are not predictive of prostate cancer diagnosis and aggressiveness: Results from an Italian biopsy cohort

OBJECTIVES To explore the association between serum levels of 17-β-estradiol (17BE) and prostate cancer (PCa) risk in men undergoing prostate biopsy. METHODS AND MATERIALS Between 2006 and 2012, we prospectively enrolled 894 patients, with no history of PCa, undergoing prostate biopsy. Before biopsy was performed, general data, digital rectal examination (DRE), body mass index, 17BE, and prostate-specific antigen (PSA) were recorded. The risk of detecting cancer and high-grade cancer was assessed as a function of 17BE using crude and adjusted logistic regressions. RESULTS Serum levels of 17BE were not associated with an increased risk of PCa or high-grade disease. Age (odds ratio [OR] 1.05; 95% confidence interval [CI]: 1.03-1.07; P = 0.000), DRE(OR 2.81; 95% CI: 1.98-4.00; P = 0.000), and PSA(OR 1.07; 95% CI: 1.04-1.10; P = 0.000) were found to be independent predictors of PCa risk. Age (OR 1.05; 95% CI: 1.01-1.09; P = 0.007), DRE (OR 3.04; 95% CI: 1.79-5.17; P = 0.000), body mass index (OR 1.07; 95% CI: 1.01-1.150; P = 0.040), and PSA (OR 1.08; 95% CI: 1.03-1.12; P = 0.000) were found to be independent predictors of high-grade disease. CONCLUSION In our cohort of patients, serum levels of 17BE are not predictive of PCa or high-grade disease. In patients at risk of PCa, 17BE should not be considered a reliable marker to predict poorly differentiated PCa in the setting of initial prostate biopsy.