A novel screening strategy for clinically significant prostate cancer in elderly men over 75 years of age / 亚洲男科学杂志(英文版)

A standard modality for prostate cancer detection in men 75 years and older has not been established. A simple screening method for elderly patients is needed to avoid unnecessary biopsies and to effectively diagnose prostate cancer. A retrospective study was conducted on elderly patients who had prostate biopsy at Kanazawa University Hospital (Kanazawa, Japan) between 2000 and 2017. Of the 2251 patients who underwent prostate biopsy, 254 had clinically significant prostate cancer (CSPC) with a Gleason score (GS) of≥7 and 273 had a GS of <7 or no malignancy. In this study, patients aged 75 years or older were classified as elderly patients. GS ≥ 7 was characterized by a prostate-specific antigen (PSA) of the maximum area under the curve of 12 ng ml

Testosterone Replacement Therapy for Patients with Hypogonadism after High Dose-Rate Brachytherapy for High-Risk Prostate Cancer: A Report of Six Cases and Literature Review

Testosterone Deficiency and Nocturia: A Review

Nocturia causes lack of sleep and excessive daytime somnolence, reducing overall well-being, vitality, productivity, and mental health. Nocturia is significantly associated with testosterone deficiency, lower urinary tract symptoms (LUTS), and sleep disorders. The development of LUTS is commonly associated with testosterone deficiency in elderly men, and recent studies have suggested that testosterone has an ameliorative effect on nocturia. In hypogonadal men with nocturia, a negative feedback cycle can arise, in which testosterone deficiency leads to the development of nocturia, and nocturia contributes to the decline in testosterone levels. Therefore, patients with nocturia should receive appropriate treatment in order to improve their quality of life. Nocturia is generally treated by restricting nighttime water intake, as well as by the administration of medications, such as alpha-1 blockers, anticholinergic drugs, and desmopressin. Testosterone replacement therapy (TRT) is used worldwide as a treatment for many hypogonadal conditions. TRT represents an alternative treatment option for nocturia in hypogonadal men. However, limited information is currently available regarding the effects of TRT on nocturia in hypogonadal men, and further studies are required to reach more definitive conclusions.

Clinical Management of Priapism: A Review

Priapism is defined as a persistent and painful erection lasting longer than four hours without sexual stimulation. Based on episode history and pathophysiology, priapism is classified into three subtypes: ischemic (low-flow), non-ischemic (high-flow), and stuttering priapism. Ischemic priapism is characterized by a persistent, painful erection with remarkable rigidity of the corpora cavernosa caused by a disorder of venous blood outflow from this tissue mass, and is similar to penile compartment syndrome. Stuttering priapism is characterized by a self-limited, recurrent, and intermittent erection, frequently occurring in patients with sickle cell disease. Non-ischemic priapism is characterized by a painless, persistent nonsexual erection that is not fully rigid and is caused by excess arterial blood flow into the corpora cavernosa. Because ischemic and non-ischemic priapism differ based on emergency status and treatment options, appropriate discrimination of each type of priapism is required to initiate adequate clinical management. The goal of management of priapism is to achieve detumescence of the persistent penile erection and to preserve erectile function after resolution of the priapism. To achieve successful management, urologists should address this emergency clinical condition. In the present article, we review the diagnosis and clinical management of the three types of priapism.

Late-Onset Hypogonadism Syndrome and Lower Urinary Tract Symptoms

Androgen replacement therapy (ART) is a widely accepted form of treatment worldwide for aging men with late-onset hypogonadism (LOH) syndrome. Concurrent with the progressive decline in testosterone from middle age, there is a gradual increase in prostate volume, reflecting the development of benign prostatic hyperplasia (BPH). Prostate growth is dependent on the presence of androgens, and conversely, antiandrogen agents or orchidectomy can decrease prostate volume in patients with BPH. Thus, it is important to investigate whether ART could have any negative effects on prostatic disease or lower urinary tract symptoms (LUTS). Although only limited amounts of information on the correlations between androgen levels in aging men and clinical manifestations of LUTS are available, a few recent studies have suggested that testosterone levels may have some beneficial effects on various urinary functions in men. Androgen receptors are found in the urothelium, urinary bladder, prostate, and urethra, and testosterone could have an impact on the autonomic nervous system, bladder smooth muscle differentiation, nitric oxide synthase, phosphodiesterase-5 and Rho/Rho-kinase activities, and pelvic blood flow. In addition, some previous studies demonstrated that ART had little effect on LUTS or urinary function in aging men with LOH syndrome. Furthermore, some recent randomized controlled trials indicated that short-term ART may be effective in the improvement of LUTS in hypogonadal men with mild BPH. However, only limited information is available regarding the effects of longer-term ART or the safety of ART in men with severe BPH and LUTS, and further studies are required to reach more definitive conclusions.