Cardiovascular Risk Factors in Premature Ovarian Insufficiency using Hormonal Therapy / Fatores de risco cardiovascular na insuficiência ovariana prematura em uso de terapia hormonal

Abstract Objective Premature ovarian insufficiency (POI) is characterized by early hypoestrogenism. An increased risk of cardiovascular (CV) disease is a long-term consequence of POI. A challenge of hormone therapy (HT) is to reduce the CV risk. Methods Cross-sectional study with lipid profile analysis (total cholesterol, LDL-C, HDL-C, VLDL-C and triglycerides), blood glucose levels and arterial blood pressure of women with POI using HT, compared with age and BMI-matched women with normal ovarian function (controls). Results The mean age and BMI of 102 POI patients using HT and 102 controls were 37.2 ± 6.0 and 37.3 ± 5.9 years, respectively; 27.0 ± 5.2 and 27.1 ± 5.4 kg/m2. There wasn't difference between groups in arterial systolic and diastolic blood pressure, blood glucose levels, total cholesterol, LDL-C, VLDL-C and triglycerides. HDL-C levels were significantly higher in the POI group (56.3 ± 14.6 and 52 ± 13.9mg/dL; p = 0.03). Arterial hypertension was the most prevalent chronic disease (12% in the POI group, 19% in the control group, p = ns), followed by dyslipidemia (6 and 5%, in POI and control women). Conclusion Women with POI using HT have blood pressure levels, lipid and glycemic profile and prevalence of hypertension and dyslipidemia similar to women of the same age and BMI with preserved gonadal function, in addition to better HDL levels.

Resumo Objetivo A insuficiência ovariana prematura (IOP) é caracterizada pelo hipoestrogenismo precoce. Risco aumentado de doença cardiovascular (CV) é uma consequência a longo prazo da IOP e um desafio da terapia hormonal (TH) é reduzir o risco CV. Métodos Estudo transversal com análise do perfil lipídico (colesterol total, LDL-C, HDL-C, VLDL-C e triglicerídeos), glicemia e pressão arterial de mulheres com IOP em uso de TH, em comparação a mulheres com função ovariana normal (controles) pareadas por idade e IMC. Resultados A média de idade e IMC de 102 pacientes com IOP em uso de TH e 102 controles foi de 37,2 ± 6,0 e 37,3 ± 5,9 anos, respectivamente; 27,0 ± 5,2 e 27,1 ± 5,4 kg/m2. Não houve diferença entre os grupos na pressão arterial sistólica e diastólica, glicemia, colesterol total, LDL-C, VLDL-C e triglicerídeos. Os níveis de HDL-C foram significativamente maiores no grupo IOP (56,3 ± 14,6 e 52 ± 13,9mg/dL; p = 0,03). A hipertensão arterial foi a doença crônica mais prevalente (12% no grupo POI, 19% no grupo controle, p = ns), seguida da dislipidemia (6 e 5%, no grupo POI e controle). Conclusão Mulheres com IOP em uso de TH apresentam níveis pressóricos, perfil lipídico e glicêmico e prevalência de hipertensão e dislipidemia semelhantes às mulheres da mesma idade e IMC com função gonadal preservada, além de melhores níveis de HDL.

ENDOMETRIAL CARCINOMA: NARRATIVE REVIEW

Endometrial cancer is the most common gynecological malignancy in developed countries and its incidence has been increasing over recent years. Symptoms include postmenopausal bleeding, abnormal vaginal bleeding, pelvic pain, and dyspareunia. Risk factors include obesity, unopposed estrogen exposure, family history of endometrial or ovarian cancer, and Lynch syndrome. Diagnosis is con?rmed through endometrial biopsy, hysteroscopy, or dilation and curettage. Treatment options depend on the stage and grade of the cancer and may include surgery, radiation therapy, chemotherapy, or a combination. This review article summarizes the current state of knowledge on endometrial cancer, including its epidemiology, risk factors, clinical presentation, diagnostic methods, and treatment options. Recent advancements in the ?eld, including emerging biomarkers and targeted therapies, are highlighted. The authors conducted a systematic search of the literature on endometrial cancer, and the results were synthesized and presented using a narrative synthesis approach. The epidemiology of endometrial cancer underscores the importance of preventive measures, including regular gynecological checkups and lifestyle modi?cations to reduce obesity and improve reproductive health

Progress of neoadjuvant therapy for high-risk prostate cancer in the era of novel hormonal therapy / 现代泌尿外科杂志

In the past, the use of neoadjuvant androgen deprivation therapy (ADT) for prostate cancer did not exhibit survival benefits and was not recommended by the practicing guidelines. In recent years, with the emergence of novel hormonal therapeutics such as Abiraterone, Enzalutamide, Apalutamide and Darolutamide, the interest for neoadjuvant therapy has been reignited. Here, we summarize the four categories of neoadjuvant therapy with new hormonal agents, and discuss how to evaluate the efficacy and explore the molecular mechanism after neoadjuvant therapy.

Clinical factors of positive surgical margin after robot-assisted laparoscopic radical prostatectomy in patients with high-risk prostate cancer / 中华泌尿外科杂志

Objective:To investigate the relationship between the positive surgical margin and clinical factors such as neoadjuvant hormonal therapy after robot-assisted laparoscopic radical prostatectomy (RARP) in high-risk patients with prostate cancer.Methods:The clinical data of 164 patients with high-risk prostate cancer being performed RARP by one surgeon were analyzed retrospectively in our hospital from January 2016 to January 2022. The mean patient’s age was (65.3±6.2) years old, mean body mass index (BMI) was (25.6±3.0) kg/m 2, the median value of total prostate specific antigen (tPSA) before operation was 18.6(11.3, 31.3)ng/ml, the median value of Gleason score before operation was 7 (7, 8), the median value of prostate volume was 29.3 (22.4, 40.2) ml, and the clinical stage was T 2aN 0M 0-T 4N 0M 0. 80 patients with prostate cancer were treated with neoadjuvant endocrine therapy. All of them were treated with complete androgen blockade with a median course of 3 months. Univariate analysis was used to analyze the correlation between age, BMI, prostate volume, neoadjuvant hormonal therapy, preoperative tPSA, clinical stage, Gleason score before operation and positive surgical margin. Then multivariate logistic regression was used to further analyze the independent risk factor of positive surgical margin after RARP. Results:The postoperative pathological diagnosis included pT 2 stage in 111 cases (67.7%), pT 3a stage in 15 cases (9.1%), pT 3b stage in 25 cases (15.2%), pT 4 stage in 13 cases (7.9%). No lymph node metastasis was noticed in all patients. The Gleason scores included 6 in 11 cases (6.7%), 3+ 4 in 26 cases (15.9%), 4+ 3 in 36 cases (22.0%), 8 in 17 cases (10.4%), 9-10 in 24 cases (14.6%), un-evaluation due to endocrine therapy in 50 (30.5%). The positive surgical margin of high-risk patients with prostate cancer was 44.5% (73/164). Univariate analysis showed that the neoadjuvant hormonal therapy, tPSA and clinical stage were correlated with positive surgical margin ( P<0.05). Multivariate logistic regression analysis showed that non-neoadjuvant hormonal therapy, preoperative tPSA>20ng/ml and clinical stage>T 2b were independent risk factors for positive surgical margin of high-risk patients with prostate cancer. Stratified analysis showed that when the preoperative tPSA was 10-20 ng/ml(21.1% vs.55.9%, P=0.014), the clinical stage was T 2c(29.6% vs.49.1%, P=0.040), the Gleason score before operation was 7(19.4% vs.54.1%, P=0.003), the positive surgical margin of high-risk patients in the neoadjuvant hormonal therapy group was significantly lower than that in the non-neoadjuvant hormonal therapy group ( P<0.05). Conclusions:Non-neoadjuvant hormonal therapy, preoperative tPSA>20 ng/ml and clinical stage>T 2b were independent risk factors for positive surgical margin of RARP in the high-risk patients with prostate cancer. For high-risk patients with preoperative tPSA of 10-20 ng/ml, clinical stage of T 2c and Gleason score before operation of 7, neoadjuvant hormonal therapy has important clinical significance in reducing the positive surgical margin of RARP.

Clinical exploration of enzalumide as first-line neoadjuvant therapy for metastatic hormone sensitive prostate cancer / 中华泌尿外科杂志

Enzalumide has not been approved for therapy in metastatic hormone sensitive prostate cancer (mHSPC) patients in China. This study retrospectively analyzed the response to treatment of Enzalutamide as first-line neoadjuvant hormonal therapy for mHSPC. A 69-year-old man with prostate cancer characterized with clinical staging T 3bN 1M 1b, tPSA 240.69ng/ml and Gleason score 8, was administrated with Enzalumide as neoadjuvant hormonal therapy for 6 months. Re-examination for prostate MRI indicated the prostate, tumor lesion and the enlarged lymph nodes in the pelvic cavity were significantly smaller than before. Therefore, a robot-assisted laparoscopic radical prostatectomy was performed. Postoperative pathology showed resection margins were negative and no metastasis was observed in lymph nodes of pelvic cavity. After the operation, adjuvant hormonal therapy was performed. Blood tPSA was 0.016ng/ml at 6 weeks, and no tumor recurrence or enlarged lymph nodes were found in pelvic MRI at 6 months. Therefore, in this case, Enzalutamide as first-line neoadjuvant hormonal therapy can reduce the clinical staging of mHSPC, which may allow surgical resection of the tumor.

Male breast cancer: The Philippine General Hospital experience

RATIONALE/OBJECTIVE@#Breast cancer among males is often diagnosed at a later age and at an advanced stage. The study aimed to present the epidemiology, associated risk factors, clinical and pathological characteristics, treatment patterns and outcomes of male breast cancer patients treated at the Philippine General Hospital from January 2008- December 2017. Information from this study can provide for better understanding of the disease and basis for creating guidelines toward better outcomes. @*METHODS@#Retrospective study of medical records involving male breast cancer patients who underwent surgery and treatment at the Philippine General Hospital from January 2008- December 2017.@*RESULTS@#Male breast cancer accounted for 15 (0.26%) of 5,777 resected breast specimens for breast cancer patients with a 1:384 male to female ratio. The mean age of presentation was 60 years. The most common presentation was a retro-areolar mass, with 33% of patients presenting post-excision. Sixty-seven percent were at Stage II and 20% at Stage III. About 94% of patients have invasive ductal carcinoma, while the only other histology is papillary carcinoma at 13%. Majority of those tested were both estrogen receptor and progesterone receptor (ER/PR) positive (33% versus 1 %), and Her2neu negative. All patients underwent modified radical mastectomy. Only two patients were documented to have received adjuvant chemotherapy while one patient received neoadjuvant chemotherapy.@*CONCLUSION@#Breast cancer remains to be a rare disease among males, is often diagnosed at a later age and at an advanced stage. Because of its rarity, awareness is necessary not only in the community but also among healthcare providers to identify and treat the problem earlier. Further investigation and prospective studies are recommended.

Spontaneous membranous dysmenorrhea: a rare clinical entity

Membranous dysmenorrhea is a rare painful clinical condition associated with spontaneous expulsion of the endometrium as an entire piece, retaining the shape of the uterus. Authors report a case of membranous dysmenorrhea in a 36 year old multiparous woman, who was not on any hormonal therapy. She presented with history of menorrhagia for 20 days and severe dysmenorrhea for one day. During her second day of hospital admission, she expelled a fleshy mass resembling a decidual cast. Histopathological examination was consistent with diagnosis of membranous dysmenorrhea. The etiology of membranous dysmenorrhea is not very clear and hence reporting such rare cases may aid in understanding the etiology and pathophysiology of this rare condition.

A Clinical Study Of Estrogen And Progesterone Receptors Status And Clinical Stage Of Carcinoma Breast Patients In Upper Assam (a Prospective Study)

Introduction: Carcinoma breast is the most common cancer in women worldwide. But mortality is decreasing due to early detection by active screening program and better understanding of receptors status and treatment following results of receptors status. But in India patients usually presents in later stage due to lack of awareness and active screening program . so BCS is not possible and MRM is the treatment of choice along with neoadjuvant chemotherapy which cause more morbidity. Method and material: study was conducted in Assam medical college and hospital from june 2017 to January 2018 and patients followed by a variable period of 3 to 6 months. Cases was diagnosed and treated according to stage of their carcinoma. Results: mean age of presentation is 43.11 yrs. Most common stage at presentation stage 3a(38.24%) and stage 2b(35.29%). ER receptors positivity is 50%. HER-2/neu positivity is 47%. Triple positive 23.53% and triple negative 11.76%. Conclusion: Receptors status should be done in all cases then hormonal / targeted therapy should be started which improves survival . In India average age for presentation is a decade earlier then western countries so we should start an active screening program which should start at 35 yrs of age.

Current concepts and trends in the treatment of bone metastases in patients with advanced prostate cancer / 亚洲男科学杂志(英文版)

Bone metastases have a major impact on quality of life and survival of patients with advanced prostate cancer. In the last decade, the development and approval of substances inhibiting the vicious cycle of bone metastases have enabled the reduction of complications caused by bone metastases in patients with castration-resistant prostate cancer. These drugs have raised awareness of the importance of skeletal-related events which in the meantime represent an important end point also in trials using agents not specifically designed for bone lesions. Second-generation antihormonal drugs such as enzalutamide or abiraterone have been shown to have a positive impact on the incidence of skeletal complications and therefore provide an important tool in the armamentarium used for treating bone metastases. Radiopharmaceuticals such as radium-223 dichloride ([223Ra]) have been demonstrated not only to reduce skeletal-related events and bone-related pain, but also to prolong overall survival, thereby being the first bone-Targeting agent showing a survival benefit. As previous studies have not provided an obvious benefit of bone-Targeted lesions in castration-sensitive disease, the use of these agents is not recommended. In oligometastatic prostate cancer, the role of local treatment of metastases using stereotactic radiation or radiosurgery is a matter of intense debates and may play an increasing role in the future.

Knowledge, attitude and practice of Filipino Gynecologists on menopausal hormonal therapy: Where are we now? / Philippine Journal of Obstetrics and Gynecology

Objective@#This study evaluated the knowledge, attitude and practice of Filipino gynecologists towards hormonal therapy for menopausal symptoms. @*Methods@#This was a cross-sectional study carried out among practicing Filipino gynecologists in different regions of the Philippines from April to October 2018. A self-administered questionnaire was used to identify the current knowledge, attitude and practice of gynecologists regarding the use of hormonal replacement therapy. @*Results@#There were 369 respondents included in the study. Our findings indicate that the most common indication for MHT are vasomotor symptoms and vaginal dryness. Almost all Filipino gynecologists participating in this study were aware that MHT will improve vasomotor and urogenital symptoms, sexual dysfunction and mood. Majority of them correctly agreed that MHT will decrease the risk of osteoporosis and coronary artery disease. On the other hand, at least half of the respondents falsely believed that MHT can decrease the risk for cognitive dysfunction, cerebrovascular disease, Parkinson’s disease and vascular thrombosis. Only 68% of the respondents agreed that they have adequate knowledge about the treatment options for postmenopausal symptoms and as much as 32% of them are still not confident with their knowledge. Majority (65%) of Filipino gynecologists do not routinely recommend or offer the use of MHT to every postmenopausal woman. @*Conclusion@#The knowledge and attitude of gynecologists on hormonal therapy play an important role in the decision making of a woman during her climacteric period. Basic knowledge on menopausal symptoms and indications for hormonal therapy are known to the respondents but these knowledge do not translate to practice.

The retrospective analysis of clinical features, treatment and prognosis of incidental prostate cancer / 中华泌尿外科杂志

Objective To explore the clinical feature,treatment and prognosis of incidental prostate cancer(IPC) after transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH).Methods From January 2009 to April 2017,24 cases undergoing TURP for benign prostatic hyperplasia and being diagnosed with prostate cancer(T1a-T1b) was retrospectivey analysed,who aged from 62 to 84 years (mean 71.8 years).Digital rectal examination (DRE) showed prostate medium texture,smooth surface,and no nodules.Ultrasound presented no low echo nodules in the prostate.Prostate volumes were 19.2-93.4 ml,with median of 40.1 ml.PSA were 1.81-9.11 ng/ml,with median of 4.12 ng/ml.The patients with PSA between 6-10 ng/ml accepted prostate biopsy,and pathological results were negative.Results The The pathology of TURP specimens in 24 cases were diagnosed prostate cancer (21 cases of T1a,3 cases of T1b).According to the new WHO/ISUP classification group,there were 18 cases of hierarchical group 1,3 cases of hierarchical group 2,1 case of hierarchical group 3,2 cases in hierarchical group 4.All patients were treated with hormonal therapy,and 7 cases (5 cases of hierarchical group 1,and 2 cases of hierarchical group 2) underwent laparoscopic radical prostatectomy (LRP) after 3 months of hormonal therapy.The specimens of prostatectomy were examined by whole-mount serial,showing 3 cases of prostate cancer (T1a) with negative margin,and 4 cases of benign prostate cells.They were followed up for 5-82 months with median of 43.5 months.No biological progression or tumor progression was found,and,1 case died of colon cancer after 26 months of follow-up.The patients' age and Gleason score of stage T1b were higher than that of stage T1a.Prostate volume and preoperative PSA had no statistically significant difference between the two stages.Conclusions The patients' age and Gleason score of stage T1b were higher than that of stage T1b.The proportion of residual tumor following TURP was high.The prognosis of incidental prostate cancer was good by hormonal therapy or radical prostatectomy.

PHARMACOLOGICAL MANAGEMENT OF OSTEOPOROSIS

Osteoporosis is a common problem encountered inprimary care. Mortality and long-term morbidity isassociated with almost all types of symptomaticosteoporotic fractures. Local data suggests thatosteoporosis remains undiagnosed and undertreated.Primary care physicians play a central role in closing thegap for osteoporosis treatment with the opportunity todiagnose, investigate, and treat these patients effectively.In this article, we explore different pharmacologicaloptions in the treatment of osteoporosis, including therole of calcium and vitamin D, antiresorptive agents,hormonal therapy, and anabolic treatment options.

Treatment strategy for metastatic prostate cancer with extremely high PSA level: Reconsidering the value of vintage therapy / 亚洲男科学杂志(英文版)

The prognostic significance of initial prostate-specific antigen (PSA) level for metastatic prostate cancer remains uncertain. We investigated the differences in prognosis and response to hormonal therapies of metastatic prostate cancer patients according to initial PSA levels. We analyzed 184 patients diagnosed with metastatic prostate cancer and divided them into three PSA level groups as follows: low (<100 ng ml-1), intermediate (100-999 ng ml-1), and high (≥1000 ng ml-1). All patients received androgen deprivation therapy (ADT) immediately. We investigated PSA progression-free survival (PFS) for first-line ADT and overall survival (OS) within each of the three groups. Furthermore, we analyzed response to antiandrogen withdrawal (AW) and alternative antiandrogen (AA) therapies after development of castration-resistant prostate cancer (CRPC). No significant differences in OS were observed among the three groups (P = 0.654). Patients with high PSA levels had significantly short PFS for first-line ADT (P = 0.037). Conversely, patients in the high PSA level group had significantly longer PFS when treated with AW than those in the low PSA level group (P = 0.047). Furthermore, patients with high PSA levels had significantly longer PFS when provided with AA therapy (P = 0.049). PSA responders to AW and AA therapies had significantly longer survival after CRPC development than nonresponders (P = 0.011 and P < 0.001, respectively). Thus, extremely high PSA level predicted favorable response to vintage sequential ADT and AW. The current data suggest a novel aspect of extremely high PSA value as a favorable prognostic marker after development of CRPC.

Treatment strategy for metastatic prostate cancer with extremely high PSA level: reconsidering the value of vintage therapy / 亚洲男科学杂志(英文版)

The prognostic significance of initial prostate-specific antigen (PSA) level for metastatic prostate cancer remains uncertain. We investigated the differences in prognosis and response to hormonal therapies of metastatic prostate cancer patients according to initial PSA levels. We analyzed 184 patients diagnosed with metastatic prostate cancer and divided them into three PSA level groups as follows: low (<100 ng ml-1), intermediate (100-999 ng ml-1), and high (≥1000 ng ml-1). All patients received androgen deprivation therapy (ADT) immediately. We investigated PSA progression-free survival (PFS) for first-line ADT and overall survival (OS) within each of the three groups. Furthermore, we analyzed response to antiandrogen withdrawal (AW) and alternative antiandrogen (AA) therapies after development of castration-resistant prostate cancer (CRPC). No significant differences in OS were observed among the three groups (P = 0.654). Patients with high PSA levels had significantly short PFS for first-line ADT (P = 0.037). Conversely, patients in the high PSA level group had significantly longer PFS when treated with AW than those in the low PSA level group (P = 0.047). Furthermore, patients with high PSA levels had significantly longer PFS when provided with AA therapy (P = 0.049). PSA responders to AW and AA therapies had significantly longer survival after CRPC development than nonresponders (P = 0.011 and P < 0.001, respectively). Thus, extremely high PSA level predicted favorable response to vintage sequential ADT and AW. The current data suggest a novel aspect of extremely high PSA value as a favorable prognostic marker after development of CRPC.

Tiempo trascurrido a partir de la menopausia y su repercusión en el deterioro cognitivo / Time since menopause and its effect on cognitive deterioration

Resumen OBJETIVO Determinar si el tiempo trascurrido a partir de la menopausia repercute en el deterioro cognitivo y si la terapia hormonal tiene alguna influencia en éste. MATERIALES Y MÉTODOS Estudio observacional, transversal, prospectivo, comparativo y abierto en el que se estudiaron mujeres posmenopáusicas a quienes se aplicó el Mini Mental State Examination (MMSE) y la Menopause Rating Scale (MRS). Se analizaron las diferencias según el tiempo trascurrido a partir de la menopausia entre quienes recibían o no terapia hormonal. Se realizó prueba t de Student y análisis de correlación de Pearson. RESULTADOS Se estudiaron 94 mujeres que se dividieron en dos grupos; en el grupo I las que recibieron terapia hormonal (n = 46) y en el II, sin ésta (n = 48). La puntuación del MMSE fue mayor en el grupo I; la puntuación en orientación espacial, recuerdo diferido y lenguaje fue mayor en el grupo con 10 o menos años después del inicio de la menopausia, que quienes tenían más de ese tiempo y hasta 20 años; lo mismo ocurrió con la puntación de la MRS. En el grupo II la puntuación en orientación temporal fue mayor en el grupo con 10 o menos años de posmenopausia al compararlo con el de más de 10 y hasta 20 años y con el de más de 20 años. Lo mismo sucedió para fijación-recuerdo, cálculo, lenguaje y puntuación del MMSE. En el grupo I hubo correlación entre la puntuación del MMSE y la edad -0.746, p < 0.001 y el tiempo trascurrido a partir de la menopausia -0.722, p < 0.001. En el grupo II la hubo entre la puntuación en el MMSE y la edad -0.863, p < 0.001 y el tiempo desde la menopausia -0.873, p < 0.001. CONCLUSIÓN La edad es un factor que influye negativamente en la función cognitiva pero con menor afectación en las mujeres que recibieron terapia hormonal.

Abstract OBJECTIVE To determine if the time since menopause has effect on cognitive status and if hormone therapy (HT) influences it. MATERIALS AND METHODS Observational, cross-sectional, prospective, comparative, open study in which postmenopausal women were evaluated with the Mental Mini State Examination (MMSE) and the Menopause Rating Scale (MRS). The differences were analyzed according to time since menopause among those that received or non-HT. Student t test and Pearson's correlation analysis were done. RESULTS Ninety-four women were studied and divided in two groups: Group I, with HT (n =46) and Group II, without HT (n =48). The MMSE score was greater in group I, also space orientation, differed memory and language scores were greater in the group with 10 or less years since menopause when comparing it with those with more than 10 and up to 20 years and similar happened with the MRS score. In group II, the score in temporary orientation was greater in the group with 10 or less years, when compared with that with more than 10 and up to 20 years group; and with the group with more than 20 years similar happened for fixation-memory, calculation, language and MMSE score. In group I correlation was found between MMSE score and age -0.746, p < 0.001 and time since menopause -0.722, p < 0.001. In group II it was between MMSE score and age -0.863, p < 0.001 and time since menopause -0.873, p < 0.001. CONCLUSION Age negatively influenced the cognitive function, but this was greater in the group without HT.

Fertility preserving treatment with hysteroscopic resection followed by progestin therapy in young women with early endometrial cancer / 부인종양

OBJECTIVE: To report our 15-year institutional experience of fertility-sparing treatment in young patients with early endometrial cancer (EC) treated by combined hysteroscopic resection and progestin therapy. METHODS: Twenty-eight patients (stage IA, G1 and 2 endometrioid EC) wishing to preserve their fertility were enrolled into this prospective study. Hysteroscopic resection was used to resect the tumor, endometrium adjacent to the tumor and myometrium underlying the tumor. Adjuvant hormonal therapy consisted of oral megestrol acetate or levonorgestrel intrauterine device for 6 months or more. RESULTS: After 3 months from the progestin start date, 25 patients (89.3%) showed a complete regression (median time to complete regression, 3 months [range, 3-9 months]), two (7.1%) showed persistent disease, while one patient (3.6%) presented with progressive disease and underwent definitive surgery (stage IA, G3 endometrioid). At 6 months, one of the two patients with persistent disease underwent definitive surgery (stage IA, G1 endometrioid), while the other one was successfully re-treated. Two recurrences were observed (7.7%) both involving the endometrium and synchronous ovarian cancer. The median duration of complete response was 94.5 months (range, 8-175 months). More than half of the responders (57.7%) attempted to conceive with 93.3% and 86.6% pregnancy and live birth rates, respectively. CONCLUSION: The addition of a standardized three-step resectoscopy to progestin would seem to improve the efficacy of progestin alone. High pregnancy and live birth rates were observed in women attempting to conceive.

Value of hormonal therapy for congenital cryptorchidism / 中华实用儿科临床杂志

Congenital cryptorchidism is one of the most common congenital anomalies of the male genitalia.Early treatment for cryptorchidism can help to reduce the occurence of infertility,testicular cancer and torsion.Because the mechanism of testicular is very complex,the efficiency of drug treatment is only 20％,and the long-term impact has been uncertain.Thus hormonal therapy in cryptorchidism is still controversial.Some progresses in hormonal treatment of congenital cryptorchidism in recent years are reviewed is this article.

Value of hormonal therapy for congenital cryptorchidism / 中华实用儿科临床杂志

Congenital cryptorchidism is one of the most common congenital anomalies of the male genitalia.Early treatment for cryptorchidism can help to reduce the occurence of infertility,testicular cancer and torsion.Because the mechanism of testicular is very complex,the efficiency of drug treatment is only 20％,and the long-term impact has been uncertain.Thus hormonal therapy in cryptorchidism is still controversial.Some progresses in hormonal treatment of congenital cryptorchidism in recent years are reviewed is this article.

Combined brachytherapy with intermittent hormonal therapy in treating clinical moderate and high risk non-metastatic prostate cancer / 中华泌尿外科杂志

Objective To investigate the clinical value of 125I particle implantation brachytherapy combined with intermittent hormonal therapy for treating clinical moderate and high risk non-metastatic prostate cancer.Methods A prospective study was proceeded and 100 cases with moderate and high risk (cT≥T2b,Gleason score ≥ 7,pre-biopsy PSA ≥ 10 ng/ml)non-metastatic prostate cancer were included.The selected patients were divided into two group.In the study group,patients were treated with 125I particle implantation combined with intermittent hormonal therapy.In the control group,patients were treated with only intermittent hormonal therapy.Hormonal therapy was maximal androgen blockage for two groups,including bicalutamide 50 mg oral every day and Leuprorelin 3.75 mg subcutaneous injection every 28 days.There were 50 cases in each group and clinical trial agreements were signed.During follow-up,PSA were tested every month.Chest X-ray and whole-body hone scanning were checked every 6 months.Hormonal therapy was stopped when patient's PSA level fell to 0.2 ng/ml,and keep stabilized for 3 months.When PSA level elevated for 3 times continuously and over 1 ng/ml,hormonal therapy was initiated again.The IPSS scores were documented before treatment and every 3 months after treatment.Adverse reactions of urinary tract and rectum were assessed every 3 months after 125I particle implantation in study group.The ratio of the first time to stop hormonal therapy,the time duration of first hormonal therapy and stable phase,re-hormonal therapy free survival rate,bone metastasis free survival rate,castration resistance prostate cancer(CRPC) free survival rate,cancer-specific free survival rate and overall survival rate were compared.Results The 100 cases in this study were followed up for 24-40 months,with an average time of 31.6 months.In study group,the PSA level in all cases descended to the level of stopping hormonal therapy.The time duration of hormone therapy ranged from 4 to 12 months,with an average time of 6.3 months.21 (42％) cases had a PSA elevation again to restart hormonal therapy.In control group,the PSA level in 47 cases descended to the level of stopping hormonal therapy.The time duration of hormone therapy ranged from 5 to 15 months,with an average time of 7.2 months.34 (68％) cases had a PSA elevation again to restart hormonal therapy.There was no significant difference in percentage of cases of stopping hormone therapy and in time duration of hormonal therapy for the first cycle.Instead,there were significant differences in stable phase after first cycle hormonal therapy between two groups (27.2 months vs.17.7 months;P ＜ 0.001).When analyzed by Kaplan-Meier survival curve,there was no significant difference in cancer-specific survival rate and overall survival rate.There were significant differences in Re-hormonal therapy free survival (P =0.002),bone metastasis free survival (P =0.04) and CRPC free survival(P =0.005).Conclusions Compared with intermittent hormonal therapy alone,125I particle implantation brachytherapy combined with intermittent hormonal therapy could prolong the hormonal sensitive time in moderate and high risk nonmetastatic prostate cancer patients and control the progress of the prostate cancer.

Understanding prostate-specific antigen dynamics in monitoring metastatic castration-resistant prostate cancer: Implications for clinical practice / 亚洲男科学杂志(英文版)

Availability of novel hormonal therapies as well as docetaxel and cabazitaxel treatment for metastatic castration-resistant prostate cancer (CRPC) has changed the outlook for this group of patients with improvements in progression-free survival and overall survival. Physicians often diagnose the progression of prostate cancer using serum prostate-specific antigen (PSA). However, serum PSA is not always correlated with the clinical status in CRPC. To evaluate the PSA dynamics with greater precision, understanding of the control of PSA and of the mechanisms of development of CRPC is needed. Moreover, it is necessary to use new hormonal therapies with an appropriate timing to optimally improve the prognosis and the QOL of the patients. In the present review, we ascertain the PSA dynamics and the mechanisms of the development of CRPC to assist in optimal utilization of the new treatments for mCRPC.