The Current Status of Metastatic Castration-Naïve Prostate Cancer Management

During last many decades, androgen deprivation therapy (ADT) was the main treatment of choice for metastatic castration-naïve prostate cancer (mCNPC). However, there are now more possible treatment options for mCNPC. In CHAARTED, GETUG-AFU 15, and STAMPEDE trial, docetaxel added to ADT improved overall survival compared to ADT alone in mCNPC. Also, STAMPEDE and LATITUDE trial revealed that abiraterone added to ADT improved overall survival compared to ADT alone for mCNPC patient. Furthermore, ARCHES and ENZAMET trial showed that enzalutamide added to ADT also can be a treatment option for mCNPC. Apalutamide added to ADT also improved survival compared to ADT alone in castration resistant prostate cancer patient. The usefulness of radiation therapy to primary tumor in mCNPC has also been studied in HORRAD and STAMPEDE trial. There are many ongoing trials for mCNPC setting. The aim of this paper is to review the current status of mCNPC management options. (Korean J Urol Oncol 2020;18:11-17)

Relationship between Hypogonadal Symptoms, Sexual Dysfunction and Chronic Prostatitis in Middle-Aged Men by Self-Reported Questionnaires, even without Biochemical Testosterone Deficiency

PURPOSE: To investigate the association of erectile dysfunction (ED), premature ejaculation (PE), and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in men with late-onset hypogonadism (LOH).MATERIALS AND METHODS: We reviewed the data of 408 enrolled men between January 2014 and January 2019. All participants completed the Androgen Deficiency in the Aging Male (ADAM), international index of erectile function-5 (IIEF-5), National Institutes of Health chronic prostatitis symptom index (NIH-CPSI), and premature ejaculation diagnostic tool (PEDT) questionnaires. Participants were divided by ADAM positive (ADAM+: Group 1) and ADAM negative (ADAM−: Group 2).RESULTS: Total of 289 subjects were in Group 1 and 119 were in Group 2. The mean age was 53.8±7.8 years. The mean total testosterone was 4.8±1.2 ng/dL and showed no differences between the groups (p=0.839). In Groups 1 and 2, ED (IIEF≤21) was identified in 233 (80.6%) versus 37 (31.1%), respectively (p<0.001). The prevalence of PE (PEDT≥9) was 112 (38.7%) versus 13 (10.9%) in Groups 1 and 2, respectively (p<0.001). However, PE (intravaginal ejaculation latency time<5 minutes) showed no differences between the groups (p=0.863). The incidence of chronic prostatitis (NIH-CPSI pain score≥4) showed significant differences with 49 (17.0%) versus 8 (6.7%) in Groups 1 and 2, respectively (p=0.007). IIEF-5 total score showed the significantly highest negative correlation (r=−0.313, p<0.001).CONCLUSIONS: Those who complained of LOH symptoms and positive results in the ADAM questionnaire need to be assessed concurrently with the above questionnaires. This could aid useful to detect of ED, PE, and chronic prostatitis co-occurrence.

Metabolic Syndrome Is an Independent Risk Factor for Acquired Premature Ejaculation

PURPOSE: To determine the role of metabolic syndrome (MetS) as a risk factor for acquired premature ejaculation (PE) after considering the various risk factors, such as lower urinary tract symptoms, erectile dysfunction, hypogonadism, and prostatitis. MATERIALS AND METHODS: From January 2012 to January 2017, records of 1,029 men were analyzed. We performed multivariate analysis to identify risk factors for PE, including the covariate of age, marital status, International Prostate Symptom Score, International Index of Erectile Function (IIEF) score, National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) score, serum testosterone levels, and all components of MetS. Acquired PE was defined as self-reported intravaginal ejaculation latency time ≤3 minutes, and MetS was diagnosed using the modified National Cholesterol Education Program Adult Treatment Panel III criteria. RESULTS: Of 1,029 men, 74 subjects (7.2%) had acquired PE and 111 (10.8%) had MetS. Multivariate analysis showed that the IIEF overall satisfaction score (odds ratio [OR]=0.67, p<0.001), NIH-CPSI pain score (OR=1.07, p=0.035), NIH-CPSI voiding score (OR=1.17, p=0.032), and presence of MetS (OR=2.20, p=0.022) were significantly correlated with the prevalence of acquired PE. In addition, the Male Sexual Health Questionnaire for Ejaculatory Dysfunction scores and ejaculation anxiety scores progressively decreased as the number of components of MetS increased. CONCLUSIONS: MetS may be an independent predisposing factor for the development of acquired PE. Effective prevention and treatment of MetS could also be important for the prevention and treatment of acquired PE.

Unilateral Multifocal Type 2 Papillary Renal Cell Carcinoma in Adolescence. A Case Report

Papillary renal cell carcinomas (RCCs) can be classified into 2 subtypes (types 1 and 2), depending on their characteristic cytogenetics, immunostaining profiles, and gene-expression profiles. Compared with type 1 papillary RCCs, type 2 papillary RCCs are relatively rare and show more aggressive features. For those reasons, they are associated with a worse prognosis. A 13-year-old patient was admitted to the hospital with right kidney mass. A laparoscopic radical nephrectomy was performed, and results of the histopathologic examination confirmed it to be type 2 papillary RCC. Type 2 papillary RCCs are rarely found in unilateral and multifocal forms, especially in adolescence. Here, we report the unique case of papillary RCC at a young age.

The Correlation between Body Mass Index and Routine Parameters in Men Over Fifty

PURPOSE: This study aimed to investigate the relationships between body mass index (BMI) and prostate-specific antigen (PSA) levels, international prostate symptom score (IPSS), quality of life (QoL), and prostate volume (PV). MATERIALS AND METHODS: Height, weight, PSA levels, PV, and IPSS were analyzed in 15,435 patients who underwent a prostate examination between 2001 and 2014. Patients aged <50 years or with a PSA level ≥10 ng/mL were excluded. The relationships between BMI and PSA, IPSS, QoL, and PV were analyzed by a scatter plot, one-way analysis of variance, and the Pearson correlation coefficient. RESULTS: The mean age was 71.95±7.63 years, the mean BMI was 23.59±3.08 kg/m2, the mean PSA level was 1.45±1.45 ng/mL, the mean IPSS was 15.53±8.31, the mean QoL score was 3.48±1.25, and the mean PV was 29.72±14.02 mL. PSA, IPSS, and QoL showed a tendency to decrease with increasing BMI, and there were statistically significant differences for each parameter (p≤0.001). PV showed a significant tendency to increase with BMI (p < 0.001). In the correlation analysis, BMI showed a statistically significant correlation (p < 0.001) with PSA, IPSS, and QoL, although the correlations were very weak. In contrast, BMI showed a significant correlation with PV (p < 0.001), with a meaningful Pearson correlation coefficient of 0.124. CONCLUSIONS: Higher BMI was associated with lower PSA levels and higher IPSS and QoL scores. Meanwhile, PV increased with BMI. Although obese individuals had a greater PV, obesity did not aggravate lower urinary tract symptoms.

Efficacy of Long-Term Daily Dosage of Alfuzosin 10 mg upon Sexual Function of Benign Prostatic Hypertrophy Patients: Two-Year Prospective Observational Study

PURPOSE: To identify sexual function improvement associated with alfuzosin (10 mg daily for 2 years). MATERIALS AND METHODS: We enrolled 30 men with lower urinary tract symptom (LUTS) who visited Gyeongsang National University Hospital between 2010 and 2012. At first visit, urinalysis, prostate specific antigen, transrectal ultrasound, and uroflowmetry were performed. The nternational Prostate Symptom Score (IPSS), quality of life (QoL), International Index of Erectile Function (IIEF), and Male Sexual Health Questionnaire Ejaculation Function Domain (MSHQ-EjFD) questionnaires were administered, and the subjects answered the same questionnaires at 1 month, 6 months, 1 year, and 2 years of follow-up. RESULTS: Twelve men completed of the entire study. After administration of alfuzosin, the median IPSS at first visit, 1 month, 6 months, 1 year, and 2 years was 18.00 (interquatile range [IQR]: 14.00~29.75), 20.00 (IQR: 11.50~30.00), 15.50 (IQR: 8.50~25.25), 14.50 (IQR: 9.25~19.50), and 11.50 (IQR: 5.00~17.75), respectively, which showed an improvement. The median QoL at the same times was 4.50 (IQR: 4.00~5.00), 4.50 (IQR: 4.00~5.00), 3.00 (IQR: 2.00~4.00), 3.50 (IQR: 2.25~4.00), and 3.00 (IQR: 1.00~3.00), respectively, and also showed improvement. Likewise, the median IIEF was 36.50 (IQR: 24.50~46.75), 37.50 (IQR: 26.75~47.25), 45.50 (IQR: 35.00~59.75), 48.50 (IQR: 34.75~62.75), and 47.50 (IQR: 43.25~61.00), while the median MSHQ-EjFD was 19.00 (IQR: 12.0~24.75), 19.50 (IQR: 13.50~27.75), 23.00 (IQR: 19.25~32.25), 26.50 (IQR: 18.25~34.50), 27.00 (IQR: 21.50~32.50), respectively, with both showing improvement. CONCLUSIONS: After administration of alfuzosin (10 mg daily for 2 years), the IPSS, QoL, IIEF, and MSHQ-EjFD all improved significantly. This means long-term administration of 10 mg of alfuzosin daily would be effective not only for LUTS but also erectile function and ejaculation.

Effects of Tamsulosin on Premature Ejaculation in Men with Benign Prostatic Hyperplasia

PURPOSE: Previous studies have revealed that tamsulosin is effective in improving lower urinary tract symptoms (LUTS) and erectile functioning but has some inhibitory effects on ejaculation, including decreased ejaculatory volume. However, these inhibitory effects on ejaculation can be beneficial to patients with premature ejaculation (PE). Therefore, this study was conducted to understand the effect of tamsulosin on PE in men with benign prostatic hyperplasia. MATERIALS AND METHODS: Twenty-nine patients who visited with LUTS were categorized into 2 groups of LUTS-only patients (n=12) and LUTS combined with PE (LUTS+PE) patients (n=17), and 0.4 mg of tamsulosin was administered to the patients of both groups for 12 weeks. Comparative analyses of before and after the treatment were conducted for calculating the International Prostate Symptom Score (IPSS), International Index of Erectile Function-5 (IIEF-5), intravaginal ejaculatory latency time (IELT), premature ejaculation diagnostic tool (PEDT), and premature ejaculation profile (PEP). The patients with an IPSS score of 8 or higher were determined as LUTS patients, and the patients with IELT of less than 2 minutess and a PEDT score of 9 or higher were determined as PE patients. RESULTS: After treatment, the IPSS score significantly decreased in both groups. There was no statistically significant change in the PEDT for the LUTS group, but there was a significant decrease in PEDT (p=0.012; from 12.1+/-3.31 to 8.4+/-4.49) in the LUTS+PE group. CONCLUSIONS: Tamsulosin not only has a treatment effect for LUTS but also improves the PE of LUTS+PE patients. Therefore, further studies are needed to confirm the effects of tamsulosin on PE.

Effects of Tamsulosin on Premature Ejaculation in Men with Benign Prostatic Hyperplasia

PURPOSE: Previous studies have revealed that tamsulosin is effective in improving lower urinary tract symptoms (LUTS) and erectile functioning but has some inhibitory effects on ejaculation, including decreased ejaculatory volume. However, these inhibitory effects on ejaculation can be beneficial to patients with premature ejaculation (PE). Therefore, this study was conducted to understand the effect of tamsulosin on PE in men with benign prostatic hyperplasia. MATERIALS AND METHODS: Twenty-nine patients who visited with LUTS were categorized into 2 groups of LUTS-only patients (n=12) and LUTS combined with PE (LUTS+PE) patients (n=17), and 0.4 mg of tamsulosin was administered to the patients of both groups for 12 weeks. Comparative analyses of before and after the treatment were conducted for calculating the International Prostate Symptom Score (IPSS), International Index of Erectile Function-5 (IIEF-5), intravaginal ejaculatory latency time (IELT), premature ejaculation diagnostic tool (PEDT), and premature ejaculation profile (PEP). The patients with an IPSS score of 8 or higher were determined as LUTS patients, and the patients with IELT of less than 2 minutess and a PEDT score of 9 or higher were determined as PE patients. RESULTS: After treatment, the IPSS score significantly decreased in both groups. There was no statistically significant change in the PEDT for the LUTS group, but there was a significant decrease in PEDT (p=0.012; from 12.1+/-3.31 to 8.4+/-4.49) in the LUTS+PE group. CONCLUSIONS: Tamsulosin not only has a treatment effect for LUTS but also improves the PE of LUTS+PE patients. Therefore, further studies are needed to confirm the effects of tamsulosin on PE.