Prostate Specific Antigen Nadir After Radical Cystoprostatectomy in Patients With Benign Prostatic Tissue: A Benchmark To Define Biochemical Recurrence after Radical Prostatectomy.

PURPOSE: Biochemical failure after radical prostatectomy has been defined based on retrospective studies in men who underwent RP for localized prostate cancer. Nevertheless, retrospective strategy and possibility of extra-prostatic extension overshadowed the accurateness of the aforementioned cut-off value. To define a more precise PSA nadir value, we estimated serum PSA after cystoprostatectomy in cases with bladder urothelial cancer and no evidence of prostate cancer. MATERIALS AND METHODS: Study population consists of 52 subsequent patients who underwent radical cystoprostatectomy for muscle-invasive bladder cancer between December 2010 and December 2013. Patients with prostate adenocarcinoma and/or high grade prostate intraepithelial neoplasia were excluded from enrollment. Other exclusion criteria were prostate involvement with urothelial carcinoma, neoadjuvant or adjuvant chemotherapy and radiation therapy. Between all cases, 41 were enrolled for study. Serum PSA level was measured using immunochemiluminescence method among 6 months to 3 years after operation in study participants. RESULTS: Forty-one patients with mean age of 66.4 ± 8.9 were assessed in this study. Average serum PSA level after radical cysto-prostatectomy was .037 ± .031 ng/mL (from .002 to .1). Serum PSA level was not impressed with type of diversion or interval between operation and PSA measurement. Average serum PSA level in this study was meaningfully lesser than .2 ng/mL which is contemplated as PSA nadir value after RP. CONCLUSION: Serum PSA level of 0.2 ng/mL as the definition for biochemical recurrence after RP may delay salvage treatment. Our results showed that cut off value of ?0.1 ng/mL may be more precise in the era of early salvage treatment.

Is active surveillance an appropriate approach to manage prostate cancer patients with Gleason Score 3+3 who met the criteria for active surveillance?

OBJECTIVE: Prostate cancer is one of the common malignant tumors in men worldwide. Nowadays it seems that Gleason Score 3+3 may not need definite treatment and some of the experts even ignore it as a cancer but we should be aware that in some patients with Gleason Score 3+3 there is a higher risk for harboring higher-grade cancer. We had done this study to evaluate patients with prostate cancer with Gleason Score 3+3 to determine the value of tumor volume in these cases. MATERIAL AND METHODS: From September 2010 to October 2017, radical prostatectomy was done for 123 sequential patients with localized prostate cancer in two referral centers of Shahid Beheshti Medical University, Tehran, Iran, and 42 cases with Gleason Scores 3+3 which who were candidates for active surveillance were included in the study. RESULTS: Thirty of 42 (71.4%) patients had significant tumor volumes (≥0/5 cm3). When tumor volume was less than 0.5 cm3, none of the patients had extra prostatic tumor extension. In patients with tumor volume greater than 0.5 cm3, two cases (6.6%) had extra prostatic extension, 4 cases (13.3%) had positive margins, four cases (13.3%) reactive lymph nodes and 16 cases (53.3%) perineural invasion. CONCLUSION: We suggest that some patients with Gleason Score 3+3 have tumor volume >0.5 cm3 who are considered having significant cancer pathology and active surveillance may not be appropriate approach to manage all cases with Gleason Score 3+3.

Spontaneous rupture of continent cutaneous urinary diversion after 25 years.

Spontaneous rupture of a continent cutaneous urinary diversion is uncommon and diagnosis of this situation requires a high degree of suspicion. In this paper we present a 66-year-old man with continent cutaneous pouch after radical cystoprostatectomy that presented with spontaneous perforation 25 years after surgery. Spontaneous pouch perforation in our case after 25 years emphasizes the need for long follow-up in patients with continent diversion.

Glutathione S-transferase polymorphisms (GSTM1, GSTT1, GSTP1) and male factor infertility risk: a pooled analysis of studies.

PURPOSE: To determine the role of glutathione S-transferases (GSTs; GSTM1, GSTT1, and GSTP1) gene polymorphisms in susceptibility to male factor infertility. MATERIALS AND METHODS: We report a pooled analysis of 11 studies on the association of GSTM1, GSTT1, and GSTP1 polymorphisms and male factor infertility, including 1323 cases and 1054 controls. RESULTS: An overall significant association was determined between the GSTM1 null genotype [odds ratio (OR), 2.74; 95% confidence interval (CI), 1.72 to 3.84; P = .003], GSTT1 null genotype (OR, 1.54; 95% CI, 1.43 to 3.47; P = .02), and male factor infertility. The GSTP1 Ile/Val genotype had overall protective effect against development of infertility (OR, 0.48; 95% CI, 0.27 to 0.77), while there was significant heterogeneity between studies. In sensitivity analysis, two studies were excluded; the association and direction between GSTM1 and GSTT1 null genotypes and GSTP1 Ile/Val genotype and male infertility remained unchanged. There was no significant interaction between smoking status and studied genotypes on male infertility risk (P = .26). CONCLUSION: These results demonstrated that amongst populations studied to date, GSTM1 and GSTT1 null genotypes are associated with strong and modest increase in the risk of male infertility, respectively. On the contrary, GSTP1 Ile/Val genotype has protective effect.

Influence of opioid consumption on serum prostate-specific antigen levels in men without clinical evidence of prostate cancer.

OBJECTIVE: To determine the effect of opioid consumption on the serum prostate-specific antigen (PSA) level. METHODS: From April 2009 to December 2011, 56 opioid users and 82 age-matched controls participated in the present study. The exclusion criteria were prostate cancer or other malignancies, serum PSA level ≥ 4 ng/dL, abnormal digital rectal examination findings, previous prostate surgery, pelvic radiotherapy, bladder stone, urinary tract infection, recent prostatic manipulation, and a history of taking drugs that alter the serum PSA level. The prostate volume and PSA, serum testosterone, and luteinizing and follicle-stimulating hormone levels were measured in the eligible participants and compared between the opioid users and control subjects. The study was conducted in accordance with the Declaration of Helsinki, and the institutional review board approved the study. RESULTS: The serum PSA level was significantly lower in opioid users compared with that in the control subjects (0.82 ± 0.77 vs 1.95 ± 1.00, P < .001). The testosterone level was also lower in the opioid users (339.08 ± 142.49 vs 396.71 ± 133.64, P = .008). The difference between the PSA levels remained significant when a comparison was performed between the eugonadal opioid users and eugonadal control subjects. Moreover, the effect of opioid consumption on the PSA level persisted on multivariate analysis, controlling for serum testosterone level. CONCLUSION: Opium consumption was associated with significant decline in the serum PSA level and warrants adjustment in the PSA cutpoints at which biopsy is recommended. Opioid-induced hypogonadism does not seem to account for the PSA decline, and additional studies are required to determine the involved mechanisms.

Prognostic Value of Promoter Hypermethylation of Retinoic Acid Receptor Beta (RARB) and CDKN2 (p16/MTS1) in Prostate Cancer.

OBJECTIVE: The molecular mechanism of prostate cancer is poorly understood. The aim of the study was to investigate the prevalence and prognostic value of promoter hypermethylation of retinoic acid receptor beta (RARB) and p16 among benign prostatic hyperplasia (BPH) and prostate cancer patients. METHODS: In this case-control study, 63 patients were included in three groups; 21 with BPH as the control group, 21 with prostate cancer and good prognostic factors (based on prostate-specific antigen, Gleason score and stage) as good prognosis group, and 21 with prostate cancer and poor prognostic features as poor prognosis group. The prostate biopsy specimen of each individual was examined for hypermethylation of RARB and p16 promoters by methylation specific PCR (MSPCR). RESULTS: Seven (33.3%) patients with good prognosis and 15 (71.4%) patients with poor prognosis were positive for RARB methylation, which were significantly higher than controls (P<0.0001). p16 promoter methylation was shown in 19.0% and 47.6% patients with good and poor prognosis, respectively. The RARB and p16 promoter methylation in the poor prognosis group was significantly higher than that in the good prognosis group (P =0.02 for RARB and P<0.0001 for p16). CONCLUSION: Hypermethylation of RARB and p16 promoters may predict prognosis in prostate cancer.

Prominent bladder cancer risk factors in Iran.

Several risk factors have been suggested for transitional cell carcinoma (TCC) of the bladder (BC). Since it seems that some factors have more prominent role over the others in our region, we conducted the present case-control study with 692 bladder cancer (BC) patients versus 692 healthy controls (262 women versus 1,122 men in total) matched on the basis of gender and age (± 5 years). The enrolled cases had confirmed TCC of bladder. To gather data, we exploited a questionnaire filled up in face-to-face interviews. We classified different factors in four categories as follows: 1-dietary factors; 2-history of underlying diseases; 3-lifestyle; and 4-occupational/chemical exposures. Among dietary factors, pickles (P= 0.04) and vegetables (P= 0.001) had protective effects. In the second group, histories of all evaluated diseases were accompanied by increased risks for BC. Among life style factors, cigarette smoking (P= 0.0001), opium use (P= 0.0001), history of excessive analgesic use (P= 0.0001) and hair dye use (P= 0.02) had significant correlations with BC. However, none of the occupational exposures was associated with BC. One may conclude that some factors such as opium use may have a more important role in developing BC in our region. Nonetheless, we should categorize occupations based on their definite exposure to chemicals for conducting further studies.