Circulating Plasma microRNA to Differentiate Cushing's Disease From Ectopic ACTH Syndrome.

Corticotropinomas and adrenocorticotropic hormone (ACTH)-secreting neuroendocrine tumors exhibit differential levels of some microRNAs (miRs) compared to normal tissue. Because miRs can be released from tissues into circulation, they offer promise as novel disease biomarkers. Objective: To evaluate whether miRs are differentially detected in plasma samples of patients with ACTH-dependent Cushing's syndrome (CS). Design: Case-control study. Methods: Morning fasting plasma samples were collected from 41 consecutive patients with confirmed ACTH-dependent CS and 11 healthy subjects and stored at -80°C. Twenty-one miRs previously reported to be differentially expressed in ACTH-secreting tumors vs. healthy tissue samples were quantified in plasma by qPCR. Results: Among enrolled subjects, 28 were confirmed to have Cushing's disease (CD), 13 had ectopic ACTH secretion (EAS) and 11 were healthy controls. We found statistically significant differences in the circulating levels of miR-16-5p [45.04 (95% CI 28.77-61.31) in CD vs. 5.26 (2.65-7.87) in EAS, P < 0.001; q = 0.001], miR-145-5p [0.097 (0.027-0.167) in CD vs. undetectable levels in EAS, P = 0.008; q = 0.087] and differences in miR-7g-5p [1.842 (1.283-2.400) in CD vs. 0.847 (0.187-1.507) in EAS, P = 0.02; q = 0.14]. The area under the receiver-operator (ROC) curve was 0.879 (95% CI 0.770-0.987), p < 0.001, when using miR-16-5p to distinguish between CD and EAS. Circulating levels of miR-16-5p in the healthy control group differed from that of both the CD and EAS groups. Conclusions: Plasma miR levels differ in patients with CD and EAS. In particular, miR-16-5p, miR-145-5p and miR-7g-5p are promising biomarkers for further research to differentiate ACTH-dependent CS.

Prostatic Arterial Embolization vs Open Prostatectomy: A 1-Year Matched-pair Analysis of Functional Outcomes and Morbidities.

OBJECTIVE: To evaluate 1-year surgical and functional results and morbidities of prostatic artery embolization (PAE) vs open prostatectomy (OP). PATIENTS AND METHODS: We undertook 1:1 matched-pair analysis (International Prostate Symptom Score [IPSS], peak flow [PF], postvoid residual [PVR], and prostate volume) of 287 consecutive patients treated for benign prostatic obstruction, including 80 OP and 80 PAE. Inclusion criteria were as follows: lower urinary tract symptoms or benign prostatic obstruction, IPSS ≥12, prostate-specific antigen (PSA) <4 ng/mL, or PSA between 4 and 10 ng/mL but negative prostate biopsy, total prostate volume >80 cm(3), and PF <15 mL/s. Follow-up was performed at 1 month, 6 months, and 1 year at clinic. Primary end points of the study were the comparison regarding IPSS, International Index of Erectile Function-5, PF, PVR, and IPSS quality of life (IPSS-QoL) after 1 year of follow-up. RESULTS: Regarding primary end points, OP group had lower IPSS (4.31 vs 10.40; P <.05), 1-year PVR (6.15 vs 18.38; P <.05), 1-year PSA (1.33 vs 2.12; P <.05), IPSS-QoL (0.73 vs 2.78; P <.05), International Index of Erectile Function-5 (10.88 vs 15.13; P <.05), and greater PF (23.82 vs 16.89; P <.01). The matched-pair comparison showed higher value of postoperative hemoglobin level (mg/dL) and shorter hospitalization (days) and catheterization (days) for PAE group. At the multivariate logistic regression, PAE was associated with persistent symptoms (IPSS ≥8; odds ratio, 2.67; 95% confidence interval [CI], 0.96-7.4; P <.01) and persistent PF ≤15 mL/s (odds ratio, 4.95; 95% confidence interval, 1.73-14.15; P <.05) after 1 year. CONCLUSION: PAE could be considered a feasible minimally invasive technique but failed to demonstrate superiority to OP because of the increased risk of persistent symptoms and low PF after 1 year.

Prostatic artery embolization for prostate volume greater than 80 cm3: results from a single-center prospective study.

OBJECTIVE: To investigate clinical benefits and safety of prostatic artery embolization (PAE) in patients with prostate volume ≥80 cm(3) and Charlson comorbidity index (CCI) ≥2 and affected by benign prostatic obstruction (BPO). PATIENTS AND METHODS: From January 2009 to January 2012, PAE was performed in 88 consecutive patients affected by clinical BPO. Inclusion criteria were symptomatic BPO refractory to medical treatment, International Prostate Symptom Score (IPSS) ≥12, total prostate volume (TPV) ≥80 cm(3), Qmax <15 mL/s, and CCI ≥2. Primary end points were the reduction of 7 points of the IPSS and the increase of Qmax. Secondary end points were the reduction of TPV, postvoid residue (PVR), prostate-specific antigen (PSA), International Index of Erectile Function 5 score, and IPSS-quality of life (QoL). Follow-up was addressed at 3 months, 6 months, and at 1 year. RESULTS: The mean IPSS (10.40 vs 23.98; P <.05) and the mean Qmax (16.89 vs 7.28; P <.05) at 1 year were significantly different with respect to baseline. When considering secondary end points, we observed significant variation in terms of PVR (18.38 vs 75.25; P <.05), TPV (71.20 vs 129.31; P <.05), and PSA level (2.12 vs 3.67; P <.05) at 1 year compared with baseline. Finally, the mean IPSS-QoL significantly changed from baseline to 1 year after PAE (5.10 vs 2.20; P <.05). No minor or major complications were reported. CONCLUSION: We showed clinical benefits of PAE for the treatment of lower urinary tract symptoms and/or BPO by reducing IPSS, TPV, PSA, PVR, and improvement in urinary flow and QoL after 1 year in patients with prostate volume ≥80 cm(3) and CCI ≥2.