Faculty Bibliography

OBJECTIVE: The purpose of this study was to assess the possible clinical significance of bladder urine T1 hyperintensity based upon comparison with urinalysis findings, using a cohort of patients who underwent prostate MRI and urinalysis at a similar point in time during preoperative work-up. METHODS: We identified 56 patients who underwent prostatectomy at our institution who obtained prostate MRI and urinalysis within 1 day of each other preoperatively. A control group of 160 consecutive adult men who underwent pelvic MRI during the same time period for other indications was also identified. Two radiologists independently and in consensus reviewed the T1-weighted images to assess the frequency of bladder urine T1 hyperintensity in both groups. The urinalyses in the 56 men undergoing prostatectomy were reviewed, with the results compared between patients with and without bladder urine T1 hyperintensity. RESULTS: Four (7.1%) of 56 men with prostate cancer exhibited T1 hyperintense bladder urine, compared with six (3.8%) of 160 patients exhibiting this finding in the control group (P=.288). Of the four prostate cancer patients with this finding, all exhibited a normal urinalysis. An abnormal urinalysis was identified for four of the prostate cancer patients, all of whom exhibited normal urine T1 signal intensity. CONCLUSION: Bladder urine T1 hyperintensity may be seen occasionally in patients with prostate cancer but is not associated with abnormal urinalysis and therefore should not be regarded as a sign of acute urinary pathology

Medical therapy for the treatment of benign prostatic hyperplasia (BPH) became an accepted standard of care in the 1990s following the reports of randomized, double-blind, placebo-controlled studies showing that finasteride, a 5-alpha reductase inhibitor, and terazosin, an alpha-blocker, significantly improved lower urinary tract symptoms and increased peak urinary flow rates in men with BPH. This article reviews novel approaches to the pharmacological treatment of BPH

INTRODUCTION: It is believed that men diagnosed with prostate cancer and a low baseline serum testosterone (BST) may have more aggressive disease, and it is frequently recommended they forego testosterone replacement therapy. We used two large Phase III trials involving androgen deprivation therapy and external beam radiation therapy to assess the significance of a BST. METHODS AND MATERIALS: All patients with a BST and complete data (n = 2,478) were included in this analysis and divided into four categories: 'Very Low BST' (VLBST) </=16.5th percentile of BST (</=248 ng/dL; n = 408); 'Low BST' (LBST) >16.5th percentile and </=33rd percentile (>248 ng/dL but </=314 ng/dL; n = 415); 'Average BST' (ABST) >33rd percentile and </=67th percentile (314-437 ng/dL; n = 845); and 'High BST' (HBST) >67th percentile (>437 ng/dL; n = 810). Outcomes included overall survival, distant metastasis, biochemical failure, and cause-specific survival. All outcomes were adjusted for the following covariates: treatment arm, BST, age (<70 vs. >/=70), prostate-specific antigen (PSA; <10 vs. 10 </= PSA <20 vs. 20 </=), Gleason score (2-6 vs. 7 vs. 8-10); T stage (T1-T2 vs. T3-T4), and Karnofsky Performance Status (60-90 vs. 100). RESULTS: On multivariable analysis age, Gleason score, and PSA were independently associated with an increased risk of biochemical failure, distant metastasis and a reduced cause-specific and overall survival (p < 0.05), but BST was not. CONCLUSIONS: BST does not affect outcomes in men treated with external beam radiation therapy and androgen deprivation therapy for prostate cancer

Abstract Relief of benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms by alpha-blockers (alpha1-adrenoceptor antagonists) is mediated primarily through the blockade of alpha(1A)-receptors, leading to relaxation of smooth muscle in the prostate and bladder neck. Early alpha-blockers that were nonselective for adrenoceptor subtypes have been associated with blood pressure-related adverse effects, such as orthostatic hypotension, that may be attributed at least in part to the blockade of alpha(1B)-adrenoceptors in arterial vessels. Silodosin, a novel alpha-blocker with exceptionally high selectivity for alpha(1A-) versus alpha(1B)-adrenoceptors, was recently approved in the United States for the treatment of urinary symptoms related to BPH. The unique receptor selectivity profile likely accounts for some of the desirable clinical features of the drug. Silodosin possesses an excellent cardiac- and blood pressure-related safety profile, and data have demonstrated that it does not promote QT-interval prolongation. Therapeutic doses of silodosin are safe for men with mild-to-moderate liver dysfunction; dosage adjustment is recommended in those with moderate renal impairment. The drug should not be taken with potent cytochrome P450 3A4 inhibitors. Silodosin may be especially beneficial in patients who need to maximize cardiovascular tolerability

Study Type - Diagnostic (exploratory cohort)Level of Evidence 2b OBJECTIVE: To evaluate the role of magnetic resonance imaging (MRI) and up-standing ultrasonography (USUS) for the detection of inguinal hernias (IHs) before open radical retropubic prostatectomy (ORRP) and to assess factors associated with the presence of IHs in these men. PATIENTS AND METHODS: From 1 July 2007 to 1 February 2009, 164 men underwent preoperative evaluation for ORRP by one surgeon. Of these men 113 (69%) were evaluated for IHs by physical examination (PE), USUS and MRI. In all 226 groins were examined. Any IH diagnosed by any method was considered a true positive. The sensitivity, negative predictive value (NPV), and concordance were calculated for the three diagnostic methods. Possible predictive factors of IHs were evaluated. RESULTS: Of the 226 groins evaluated, 72 (32%) IHs were diagnosed. USUS had the greatest sensitivity (69.4%) and the highest NPV (87.5%). MRI had fair agreement with PE and USUS, while USUS and PE had moderate agreement with each other. No factor was associated with an increased likelihood of preoperative diagnosis of IH. CONCLUSIONS: This study was limited by the lack of a reference standard to diagnose IH. USUS was the most sensitive method for the detection of IH. We recommend that all men undergoing ORRP should be evaluated for IHs by PE and at least one imaging method and that IHs be repaired at the time of ORRP, obviating the need for a second surgical procedure

PURPOSE: Few groups have examined satisfaction after prostate cancer treatment. We determined 1) predictors of satisfaction between 3 months and 2 years after open radical retropubic prostatectomy, and 2) whether these factors are time dependent. MATERIALS AND METHODS: This prospective cohort study included 1,542 men who underwent radical retropubic prostatectomy from October 2000 to July 2008. The primary outcome was satisfaction self-assessed at 3, 6, 12 and 24 months. We used multivariate logistic regression and repeated measures analysis to determine predictors of satisfaction, adjusting for demographic and clinical characteristics. RESULTS: Median followup was 24 months. About 93% of the men were satisfied. On multivariate analysis men were significantly less satisfied at 3 months when the urinary catheter was indwelling for 3 weeks or greater (OR 0.23, 95% CI 0.10-0.54), or they required intervention for anastomotic stricture (OR 0.23, 95% CI 0.11-0.49) or experienced 4-point or greater worsening in American Urological Association symptom score (OR 0.26, 95% CI 0.13-0.49). At 6 months worsening urinary function (OR 0.34, 95% CI 0.13-0.88) and biochemical failure (OR 0.15, 95% CI 0.05-0.43) were significantly associated with satisfaction. Worsening sexual function became significant at 12 and 24 months. These associations were confirmed on repeated measures analysis. CONCLUSIONS: Most men were satisfied after radical retropubic prostatectomy. Satisfaction determinants showed a nonsignificant trend toward time dependence. Postoperative factors, such as the duration of indwelling Foley catheterization, were associated with short-term satisfaction while sexual and urinary function, and biochemical failure were associated with long-term satisfaction. Based on high satisfaction rates open radical retropubic prostatectomy is an excellent treatment for prostate cancer