Androgen-deprivation therapy and cognitive decline in the NEON-PC prospective study during the COVID-19 pandemic.

BACKGROUND: Androgen-deprivation therapy (ADT) has been associated with cognitive decline, but results are conflicting. This study describes changes in cognitive performance in patients with prostate cancer, according to ADT, during the first year after prostate cancer diagnosis. PATIENTS AND METHODS: Patients with prostate cancer treated at the Portuguese Institute of Oncology of Porto (n = 366) were evaluated with the Montreal Cognitive Assessment (MoCA), before treatment and after 1 year. All baseline evaluations were performed before the coronavirus disease 2019 (COVID-19) pandemic and 69.7% of the 1-year assessments were completed after the first lockdown. Cognitive decline was defined as the decrease in MoCA from baseline to the 1-year evaluation below 1.5 standard deviations of the distribution of changes in the whole cohort. Participants scoring below age- and education-specific normative reference values in the MoCA were considered to have cognitive impairment. Age- and education-adjusted odds ratios (aORs) were computed for the association between ADT and cognitive outcomes. RESULTS: Mean MoCA scores increased from baseline to the 1-year evaluation (22.3 versus 22.8, P < 0.001). Cognitive decline was more frequent in the ADT group, and even more after the onset of the COVID-19 pandemic (aOR 6.81 versus 1.93, P for interaction = 0.233). The 1-year cumulative incidence of cognitive impairment was 6.9% (9.1% before and 3.7% after the pandemic onset), which was higher among patients receiving ADT, but only after the pandemic (aOR 5.53 versus 0.49, P for interaction = 0.044). CONCLUSIONS: ADT was associated with worse cognitive performance of patients with prostate cancer, mostly among those evaluated after the first COVID-19 lockdown.

La incidencia acumulada y los factores predictivos de la cistitis rádica en pacientes con cáncer de próstata localizado / Cumulative incidence and predictive factors of radiation cystitis in patients with localized prostate cancer

Objetivo: Determinar la incidencia acumulada de la cistitis rádica y la cistitis rádica severa en una cohorte de pacientes de alto volumen e investigar sus potenciales factores predictivos. Métodos: Hemos realizado un análisis retrospectivo de los datos clínicos de pacientes diagnosticados con cáncer de próstata localizado y tratados con radioterapia en nuestra institución (junio 2005-enero 2013), y cuantificado la incidencia acumulada de cistitis rádica. El análisis de regresión de Cox y las curvas de Kaplan-Meier se calcularon para evaluar los determinantes de la cistitis por radiación. Resultados: Se utilizaron datos de 783 pacientes (557 tratados con radioterapia primaria, 188 con adyuvante y 38 con rescate). El tiempo medio de seguimiento fue de 49 meses (P25-P75: 31,8-69,3). A los 5 años de seguimiento, la incidencia acumulada de cistitis rádica y cistitis rádica severa fue de 9,1 y 1,6%, respectivamente. No se encontró asociación entre la incidencia de cistitis rádica y la edad, el estadio T tumoral, el nivel de PSA basal, la puntuación de Gleason, la clasificación de riesgo de D’Amico, el ajuste de radioterapia (primario frente a adyuvante frente a rescate) o la dosis de radiación aplicada. Conclusiones: Dentro de nuestra cohorte, la cistitis rádica es una complicación poco frecuente del tratamiento de radioterapia prostática y los casos graves que requieren hospitalización son aún más infrecuentes. No se encontró asociación entre las características del tumor, el ajuste de la radioterapia o la dosis de radiación y la incidencia acumulada de cistitis rádica

Purpose: To determine the cumulative incidence of overall and severe radiation cystitis in a high volume cohort of patients and to investigate its potential predictive factors.Methods: We have performed a retrospective analysis of clinical data from patients diagnosed with localized prostate cancer and treated with radiotherapy at our institution (June 2005-January 2013), and quantified the cumulative incidence of radiation cystitis. Cox regression analysis and Kaplan-Meier curves were computed to evaluate the determinants of radiation cystitis. Results: Data from 783 patients was retrieved (557 treated with primary radiotherapy, 188 with adjuvant and 38 with salvage). Median follow-up time was 49 months (P25-P75: 31.8-69.3). At 5 years of follow-up, cumulative incidence of overall and severe radiation cystitis was 9.1 and 1.6%, respectively. No association was found between the incidence of radiation cystitis and age, tumor T stage, baseline PSA level, Gleason score, D’Amico risk classification, radiotherapy setting (primary versus adjuvant versus salvage) or radiation dose applied. Conclusions: Within our cohort, radiation cystitis is an uncommon complication of prostatic radiotherapy treatment, and severe cases requiring hospitalization are even more infrequent. We found no association between tumor characteristics, radiotherapy setting or radiation dose and the cumulative incidence of radiation cystitis

Cumulative incidence and predictive factors of radiation cystitis in patients with localized prostate cancer. / La incidencia acumulada y los factores predictivos de la cistitis rádica en pacientes con cáncer de próstata localizado.

PURPOSE: To determine the cumulative incidence of overall and severe radiation cystitis in a high volume cohort of patients and to investigate its potential predictive factors. METHODS: We have performed a retrospective analysis of clinical data from patients diagnosed with localized prostate cancer and treated with radiotherapy at our institution (June 2005-January 2013), and quantified the cumulative incidence of radiation cystitis. Cox regression analysis and Kaplan-Meier curves were computed to evaluate the determinants of radiation cystitis. RESULTS: Data from 783 patients was retrieved (557 treated with primary radiotherapy, 188 with adjuvant and 38 with salvage). Median follow-up time was 49 months (P25-P75: 31.8-69.3). At 5 years of follow-up, cumulative incidence of overall and severe radiation cystitis was 9.1 and 1.6%, respectively. No association was found between the incidence of radiation cystitis and age, tumor T stage, baseline PSA level, Gleason score, D'Amico risk classification, radiotherapy setting (primary versus adjuvant versus salvage) or radiation dose applied. CONCLUSIONS: Within our cohort, radiation cystitis is an uncommon complication of prostatic radiotherapy treatment, and severe cases requiring hospitalization are even more infrequent. We found no association between tumor characteristics, radiotherapy setting or radiation dose and the cumulative incidence of radiation cystitis.

Endothelial function in patients with metabolic syndrome and erectile dysfunction: a question of angiopoietin imbalance?

Erectile dysfunction (ED) is a highly prevalent disease whose aetiology is mostly vasculogenic. It is nowadays considered a marker of future cardiovascular events reflecting the underlying endothelial dysfunction, the common link with the metabolic syndrome (MetS). The recent association between MetS, endothelial dysfunction and peripheral artery disease, but not with coronary artery disease (CAD), suggests that the pathophysiologies of CAD and peripheral artery disease may be distinct. Moreover, several recent studies support an emerging role for an imbalance of angiogenic growth factor levels like Angiopoietin 1 and 2 in cardiovascular disease, considering its intimate association with chronic low-grade inflammation. We aim to find a correlation between Angiopoietins levels and systemic and local endothelial function in MetS and ED patients. Forty-five MetS patients with ED were enrolled. ED severity was assessed by International Index of Erectile Function questionnaire (IIEF5) and penile duplex Doppler ultrasound (PDDU). Endothelial function was assessed by Peripheral arterial tonometry (PAT), and serum asymmetric dimethylarginine (ADMA), Ang1 and Ang2 levels. Obesity and hypertension were the most frequent MetS parameters (91.1 and 88.9% respectively). Severe ED was present in 35.6% of patients. Penile haemodynamic was impaired in 77.5%. Endothelial dysfunction (PAT criteria) was present in 40.9% of patients. Ang2 levels were significantly higher in men with abdominal obesity. We observed an inverse correlation between Ang1 and peak systolic velocity, and in patients with penile arterial dysfunction, Ang1 levels were significantly higher and Ang2/Ang1 ratio significantly lower, than patients with normal arterial function. Neither ADMA nor PAT parameters were correlated with ED severity evaluated by IIEF5 or PDDU exam. In conclusion, there is an imbalance of angiopoietins in MetS and ED patients. The absence of correlation with PAT or ADMA levels suggests that angiopoietins may be early markers of endothelial dysfunction in this population of higher cardiovascular risk.

Avaliação dos resultados e da satisfação global após tratamento da disfunção eréctil com prótese peniana insuflável de três componentes: a nossa experiência / Outcome and satisfaction rates of three-piece penile prostheses implantation for treatment of erectile dysfunction: single center experience

Introdução e objectivos: A colocação de prótese peniana é a última opção no tratamento da disfunção eréctil orgânica, quando todos os tratamentos de primeira e segunda linha não estão indicados ou são ineficazes. O objectivo deste estudo foi a avaliação dos doentes tratados com prótese peniana insuflável de três componentes e o seu impacto de satisfação no doente-parceira no nosso serviço, nos últimos 10 anos. Material e métodos: Entre 2001 e 2010, foram colocadas quarenta e uma (41) próteses penianas insufláveis de 3 componentes em homens com disfunção eréctil. Dois doentes não foram localizados na altura do estudo. Os dados foram obtidos nos registos clínicos, avaliação médica e entrevista telefónica. O casal preencheu um questionário de avaliação da qualidade de vida e satisfação global. A idade média na altura da cirurgia foi de 59,6 anos (38-73 anos). O tempo médio de seguimento após a cirurgia foi de 18 meses (6-77 meses). Resultados: As principais causas da disfunção eréctil foram antecedente cirúrgico de prostatectomia radical (46,4%) e a diabetes mellitus (39%). Seis doentes (14,6%) tiveram complicações pós-operatórias minor precoces. Em 4 doentes (9,7%) a prótese foi removida por infecção e não reimplantada. Não foi constatada disfunção mecânica ou necessi-dade de revisão das próteses. Na maioria dos doentes (94,6%) houve melhoria da libido e no relacionamento com as parceiras. Conclusão: O grau de satisfação global dos doentes e das parceiras após a colocação da prótese foi elevado, tendo-se registado apenas um pequeno número de complicações. Estes resultados demonstram que a colocação de prótese peniana insuflável de três componentes continua a ser o tratamento de eleição da disfunção eréctil orgânica refractária ao tratamento de primeira linha (AU)

Introduction and objective: Three-piece inflatable penile prostheses are the last option in the treatment of organic erectile dysfunction, when conservative therapies are unsuccessful, contraindicated or rejected. Our objective was to investigate the ten year outcome of patients treated with three-piece inflatable implant and its impact on patient-partner satisfaction in our department. Material and methods: Since 2001 to 2010, 41 patients with erectile dysfunction received a three piece penile implant. Two patients were lost for follow-up. Data was obtained from medical records, clinical evaluation and telephone interview. All patients and partners were assessed with a questionnaire about life quality and satisfaction. Mean age at surgery was 59.6 years (38-73 yrs). Median follow-up time was of 18 months (6-77 months). Results: Radical prostatectomy (46.4%) and diabetes mellitus (39.0%) were the main reason for dysfunction in this patient group. Six patients (14.6%) had early postoperative minor complications. Four patients (9.7%) presented with penile implant infection and the prosthesis were removed and not re-implanted. There were no reports of mechanical failure or prosthesis revision. The majority of patients (94.6%) were satisfied after surgery, with significant improvement in libido and relationship with partners. Conclusion: The global satisfaction of the patients and their partners after three-piece penile inflatable implantation is high, with a low complication rate. These results confirmed that three-piece inflatable penile prostheses are the gold standard in treatment of organic erectile dysfunction when conservative therapies failed (AU)