Tiago Lopes

Can serum angiogenin be used to improve the diagnostic performance in prostate cancer screening

Several biomarkers have been studied to avoid unnecessary biopsies resulting from suboptimal performance of prostate-specific antigen (PSA) testing. We aimed to assess the use of serum angiogenin as a prostate cancer diagnostic tool among candidates for biopsy. We selected 252 patients referred for ultrasound-guided transrectal prostate biopsy on the basis of an abnormal digital rectal examination and/or elevated total PSA. Serum angiogenin was quantitatively analyzed by solid-phase enzyme-linked immunosorbent assay. Results of the prostatic pathology assessment (cancer vs. noncancer) were defined by biopsy. The median serum angiogenin levels were significantly higher in patients with prostate cancer (median: 487 500 vs. 414 800 pg/ml, P=0.008). Among patients with baseline tPSA of 4.0 ng/ml or less, 37.5% had serum angiogenin less than 389 000 pg/ml (sensitivity: 88.9%; specificity: 45.2%), and the probability of having prostate cancer varied from 22.5% before testing to 6.7% among those with low angiogenin levels. When further restricting the analyses to a group of patients with even lower probability of having cancer, on the basis of tPSA and f/t PSA values, the evaluation of serum angiogenin did not contribute toward a meaningful variation in the post-test probability of cancer. In conclusion, serum angiogenin levels may be useful to distinguish between cancer and noncancer patients among the candidates for prostatic biopsy in regular clinical practice. Further investigation is needed among patients with low PSA levels and to understand the relation between this biomarker and the long-term survival of prostate cancer patients.

Neurotrophins in the lower urinary tract: becoming of age.

The lower urinary tract (LUT) comprises a storage unit, the urinary bladder, and an outlet, the urethra. The coordination between the two structures is tightly controlled by the nervous system and, therefore, LUT function is highly susceptible to injuries to the neuronal pathways involved in micturition control. These injuries may include lesions to the spinal cord or to nerve fibres and result in micturition dysfunction. A common trait of micturition pathologies, irrespective of its origin, is an upregulation in synthesis and secretion of neurotrophins, most notably Nerve Growth Factor (NGF) and Brain Derived Neurotrophic Factor (BDNF). These neurotrophins are produced by neuronal and non-neuronal cells and exert their effects upon binding to their high-affinity receptors abundantly expressed in the neuronal circuits regulating LUT function. In addition, NGF and BDNF are present in detectable amounts in the urine of patients suffering from various LUT pathologies, suggesting that analysis of urinary NGF and BDNF may serve as likely biomarkers to be studied in tandem with other factors when diagnosing patients. Studies with experimental models of bladder dysfunction using antagonists of NGF and BDNF receptors as well as scavenging agents suggest that those NTs may be key elements in the pathophysiology of bladder dysfunctions. In addition, available data indicates that NGF and BDNF might constitute future targets for designing new drugs for better treatment of bladder dysfunction.

INTRA-TRIGONAL INJECTION OF BOTULINUM TOXIN A IN PATIENTS WITH BLADDER PAIN SYNDROME - RESULTS AT 9-MONTHS FOLLOW-UP

the number of associated conditions increased (i.e., localized, regional, to systemic), pain, stress, depression, and sleep disturbance increased while social support, sexual functioning and quality of life deteriorated. Anxiety and catastrophizing remained elevated in all groups. Symptom duration was associated with phenotypic progression. CONCLUSIONS: IC/PBS patients have significant biopsychosocial impairment compared to controls. IBS, FM and CFS are more prevalent in IC/PBS patients and result in significant impact. There is progression over time from an organ centric to regional and finally systemic pain syndrome with progression of symptom severity and deterioration of cognitive and psychosocial parameters associated with IC/PBS.

PD19-04 BLADDER SENSORY MECHANISM EARLY IMPAIRMENT INDUCES DETRUSOR UNDERACTIVITY (DU) FOLLOWING BLADDER OUTLET OBSTRUCTION (BOO)

OAB were EQUC positive more often than ASF with an OR of 3.9 (95% CI 1.6-9.5, p 1⁄4 0.003). OAB patients showed mixed microbial composition in 23.6% (13/55) of CUS, while BPH/LUTS patients were all dominated by a single genus (p 1⁄4 0.003). Lactobacillus dominated in 21.6% (35/162) of women, but was absent in men (p < 0.001). CONCLUSIONS: Male bladders are EQUC positive less often than their female counterparts, both in the presence and absence of LUTS. Males and females with LUTS are more likely to have bladder microbiota identifiable by EQUC than their asymptomatic counterparts. Mixed microbial composition is more common in symptomatic than asymptomatic female patients, while male patients are typically dominated by a single genus. Lactobacillus dominance was only identified in female patients.

Biomarkers in the Overactive Bladder Syndrome

Overactive bladder (OAB) is a symptomatic complex affecting both men and women. The overall incidence is above 10% but may exceed 40% in the elderly population (Irwin et al., 2006; Irwin et al., 2009; Sexton et al., 2009a). OAB is defined by the International Continence Society (ICS) as a clinical syndrome characterized by urinary urgency, with or without incontinence, usually with frequency and nocturia (Abrams et al., 2002, 2003; Hashim & Abrams, 2007). Urgency, which is a storage symptom defined as a sudden compelling desire to pass urine difficult to defer, is the hallmark symptom as it is the only one that must be present in order to establish the diagnosis of OAB (Abrams et al., 2002, 2003). Several comorbidities are very common among OAB patients, including depression, insomnia and fractures (Coyne et al., 2008; Sexton et al., 2009a; Sexton et al., 2009b). The economic costs of OAB, associated with medical consultations, therapy and diminished productivity at work, may reach billions of dollars (Irwin et al., 2009) and will certainly increase with the demographic shift of an ageing population.