A cross-sectional study on gut microbiota in prostate cancer patients with prostatectomy or androgen deprivation therapy.

BACKGROUND: Androgen deprivation therapy (ADT), either by medical or surgical castration, is the backbone for standard treatment of locally advanced or metastatic prostate cancer, yet it is also associated with various metabolic and cardiovascular complications. Recent evidence have shown that obesity, insulin resistance, or metabolic disturbances can be associated with changes in the gut microbiome, while animal studies also show that castration is associated with changes in the gut microbiome. This study aims to investigate whether the fecal microbiota in prostate cancer patients who had undergone prostatectomy or ADT are different, and explore changes in phylogeny and pathways that may lead to side effects from ADT. METHODS: A total of 86 prostate cancer patients (56 patients on ADT and 30 patients with prostatectomy) were recruited. The fecal microbiota was analyzed by the 16S rRNA gene for alpha- and beta-diversities by QIIME2, as well as the predicted metabolic pathways by Phylogenetic Investigation of Communities by Reconstruction of Unobserved States 2. RESULTS: The alpha-diversity was significantly lower in the ADT group. The beta-diversity was significantly different between the groups, in which Ruminococcus gnavus and Bacteroides spp were having higher relative abundance in the ADT group, whereas Lachnospira and Roseburia were reduced. The Firmicutes-to-Bacteroidetes ratio is noted to be lower in the ADT group as well. The functional pathway prediction showed that the biosynthesis of lipopolysaccharide (endotoxin) and propanoate was enriched in the ADT as well as the energy cycle pathways. This study is limited by the cross-sectional design and the clinical heterogeneity. CONCLUSIONS: There is a significant difference in gut microbiome between prostate cancer patients on ADT and prostatectomy. We theorize that this difference may contribute to the development of metabolic complications from ADT. Further longitudinal studies are awaited.

Simultaneous transurethral bipolar enucleation of the prostate, supine ultrasound-guided percutaneous nephrolithotomy and open cystolithotomy: A feasible and safe approach.

Management of the coexisting hard renal pelvic stone, large urinary bladder stone and benign prostatic hyperplasia is not common which can be difficult. Here we reported a case of a 70-year-old Asian male who presented with 1.5cm renal pelvic stone, 5cm large bladder stone and 96 cc benign enlarged prostate, which were managed by simultaneous transurethral bipolar enucleation of the prostate (BipoLEP), supine ultrasound-guided percutaneous nephrolithotomy (PCNL) and open cystolithotomy. Simultaneous transurethral BipoLEP, supine ultrasound-guided PCNL and open cystolithotomy are feasible and safe, with the advantage of minimizing the patient's operation and anesthesia time.

The impact of microbiome in urological diseases: a systematic review.

OBJECTIVE: The term microbiome is used to signify the ecological community of commensal, symbiotic, and pathogenic microorganisms that share our body space, in which there were increasing evidences to suggest that they might have potential roles in various medical conditions. While the study of microbiome in the urinary system is not as robust as the systems included in the Human Microbiome Project, there are still evidences in the literature showing that microbiome may have a role in urological diseases. Therefore, we would like to perform a systematic review on the topic and summarize the available evidence on the impact of microbiome on urological diseases. METHODOLOGY: This review was performed according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. After screening 589 abstracts and including additional studies (such as references from review papers), 76 studies were included for review and discussion. RESULTS: Studies had suggested that there were correlations of microbiome of different body cavities (e.g., fecal, urinary and seminal fluid) with urological diseases. Also, different diseases would have different microbiome profile in different body cavities. Unfortunately, the studies on the association of microbiome and urological diseases were still either weak or inconsistent. CONCLUSION: Studies suggested that there might be some relationship between microbiome and various urological diseases. However, further large-scale studies with control of confounding factors should be performed under a standardized methodology in order to have better understanding of the relationship. Also, more standardized reporting protocol for microbiome studies should be considered for better communications in future studies.

The prevalence of lower urinary tract symptoms in a Chinese population, and the correlation with uroflowmetry and disease perception.

OBJECTIVES: To evaluate the prevalence of lower urinary tract symptoms (LUTS) in a population of Chinese men, and its correlation with uroflowmetry and disease perception. MATERIALS AND METHODS: Male volunteers above 40-year old were recruited in the community. Assessment with International Prostatic Symptom Score (IPSS), uroflowmetry, and a quiz on prostatic disease knowledge with 12 true-false-type questions were performed. Correlation of IPSS with uroflowmetry results and prostatic disease knowledge was analyzed. RESULTS: A total of 319 men were recruited for the study, with a mean age of 62 ± 8 years. About 69.3 % of them had moderate-to-severe symptoms on IPSS. A statistically significant correlation was found between IPSS and Q max (r = -0.260, p < 0.001), IPSS and quality of life (r = -0.172, p = 0.002), and IPSS and post-void residuals (r = 0.223, p < 0.001). About 53.0 % of subjects had less than 4 correct answers for the 12 true-false questions. Negative correlation was noted between the number of correct answers and IPSS (r = -0.185, p = 0001). In other words, for the better knowledge on prostatic diseases, the lower IPSS was found. CONCLUSIONS: In a cohort of community-dwelling Chinese men, a significant portion of the population had moderate-to-severe LUTS. While uroflowmetry parameters were found to correlate with IPSS, the degree of knowledge on prostatic diseases also shared a statistically significant correlation with IPSS. This has an implication on the role of urological health education in the future.