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Background: Stress urinary incontinence (UI) is the most common presentation following robot-assisted radical prostatectomy (RARP), but a postoperative non-invasive and objective test is still lacking. To assess pelvic floor integrity after RARP, we recently proposed Uroflow Stop Test (UST) with surface electromyography (EMG)., Aim: Here we provide two new clinical parameters: the neurologic latency time (NLT) and the urologic latency time (ULT) derived from UST-EMG Test. Principal outcome was to evaluate their variation during one year follow-up and ULT ability to predict post-RARP UI., Design: Observational and longitudinal study., Setting: Interdivisional Urology Clinic (Perugia-Terni, Italy)., Population: Patients with prostate cancer treated with a full nerve-sparing RARP who underwent postoperative pelvic floor muscles training (PFMT): a diurnal functional home program and a weekly hospital program with the use of biofeedback, between 1 and 3 months postoperatively., Methods: All patients consecutively performed a UST-EMG test at one, three, six, and twelve months after surgery. At each follow-up visit we collected NLT values, ULT values, 5-item 26-Expanded Prostate Cancer Index (EPIC), Incontinence Developed on Incontinence Questionnaire (ICIQ-UI) Short Form and International Prostate Symptom Score (IPSS). We analysed statistically significant differences in NLT and ULT between continent and incontinent patients and we evaluate the diagnostic ability of 1-month post-surgery ULT value to diagnose the presence of postoperative UI., Results: Sixty patients were enrolled. The mean time to PFMT was 31.08 (range: 30-35) days. Overall IPSS, NLT and ULT had similar trends: progressive decrease until the six months after surgery (1-month vs. 3 months vs. 6 months, P<0.05) to plateau thereafter. When considering the two group of patients, IPSS and NLT were significantly higher in the incontinent group only one month after surgery, while ULT became similar between the two groups at 6 months after surgery. The best cut-off of 1-month ULT values that maximized the Youden function at 12-months resulted 3.13 second., Conclusions: NLT and ULT may respectively account for the nerve and the urethral closure system integrity post-RARP. In the first month after RARP, both NLT and ULT differs between incontinent vs. continent patients. NLT become similar between two group after one month, confirming the recovery from neuropraxia, but ULT remains statistically significant different until 3 months postoperatively. The value of 1-month ULT resulted a valid tool to predict incontinence status at 12 months., Clinical Rehabilitation Impact: ULT and NLT may be also useful tools to monitor the continence progressive recovery after RARP and they may help rehabilitation specialists to evaluate the ongoing results during postoperative follow-up.

Increased diagnoses of silent prostate cancer (PCa) have led to overtreatment and consequent functional side effects. Focal therapy (FT) applies energy to a prostatic index lesion treating only the clinically significant PCa focus. We analysed the potential predictive factors of FT failure. We collected data from patients who underwent robot-assisted radical prostatectomy (RARP) in two high-volume hospitals from January 2017 to January 2020. The inclusion criteria were: one MRI-detected lesion with a Gleason Score (GS) of ≤7, ≤cT2a, PSA of ≤10 ng/mL, and GS 6 on a random biopsy with ≤2 positive foci out of 12. Potential oncological safety of FT was defined as the respect of clinicopathological inclusion criteria on histology specimens, no extracapsular extension, and no biochemical, local, or metastatic recurrence within 12 months. To predict FT failure, we performed uni- and multivariate logistic regression. Sixty-seven patients were enrolled. The MRI index lesion median size was 11 mm; target lesions were ISUP grade 1 in 27 patients and ISUP grade 2 in 40. Potential FT failure occurred in 32 patients, and only the PSA value resulted as a predictive parameter ( p < 0.05). The main issue for FT is patient selection, mainly because of multifocal csPCa foci. Nevertheless, FT could represent a therapeutic alternative for highly selected low-risk PCa patients.

Many different genetic alterations, as well as complex epigenetic interactions, are the basis of the genesis and progression of prostate cancer (CaP). This is the reason why until now the molecular pathways related to development of this cancer were only partly known, and even less those that determine aggressive or indolent tumour behaviour. MicroRNAs (miRNAs) represent a class of about 22 nucleotides long, small non-coding RNAs, which are involved in gene expression regulation at the post-transcriptional level. MiRNAs play a crucial role in regulating several biological functions and preserving homeostasis, as they carry out a wide modulatory activity on various molecular signalling pathways. MiRNA genes are placed in cancer-related genomic regions or in fragile sites, and they have been proven to be involved in the main steps of carcinogenesis as oncogenes or oncosuppressors in many types of cancer, including CaP. We performed a narrative review to describe the relationship between miRNAs and the crucial steps of development and progression of CaP. The aims of this study were to improve the knowledge regarding the mechanisms underlying miRNA expression and their target genes, and to contribute to understanding the relationship between miRNA expression profiles and CaP., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Fournier's gangrene is a rare and potentially lethal condition. Previously described as an idiopathic process, this necrotising fasciitis is secondary to infection and in 95% of cases the cause arises from ano-rectum (30-50%), uro-genitalia (20-40%) or genital skin (20%). Cancer could lead to a Fournier's gangrene thanks a Romacompromised host immunity condition. In the past the rate of death was high ranging from 20% to 80%, while currently mortality is decreasing to 10%. We report a case of a 76-years-old man with Fournier's Gangrene due to locally advanced prostate cancer. The multimodal therapeutic management included broad-spectrum antibiotic therapy, intravenous fluid resuscitation and surgical debridement that was delayed by the will of the patient. To our knowledge, this is the first case of Fournier's gangrene caused by prostate cancer without common predisposing factors. In order to improve the knowledge about this rare disease, we performed a narrative review of the literature.

There is emerging evidence that microRNAs (miRNAs) dysregulation is involved in the genesis and the progression of Prostate Cancer (PCa), thus potentially increasing their use in urological clinical practice. This is the first pilot study which utilizes Illumina Deep Sequencing to examine the entire miRNAs spectrum existent in urine exfoliated prostate cells (UEPCs) of PCa patients. A total of 11 male patients with histological diagnosis of PCa were enrolled in the present study. First-catch urine (30 mL) was collected following a prostate massage. Total RNA was extracted from urine and sequenced using an HiSeq2500 System (Illumina). QPCR assay was used to validate the highest NGS results in PCA patients and in age-matched, caucasian men. Remarkably, PCA let-7 family was down-regulated (P < 0.01), compared to the controls. The results of our study support the notion of a relatively high diagnostic value of miRNA family for PCa detection, especially in the let-7 family. The present research confirmed the potential use of miRNAs as non-invasive biomarkers in the diagnosis of PCa, potentially reducing the invasiveness of actual clinical strategy.

Introduction: Primary aim of this study was to investigate the feasibility and the safety of PERUSIA (posterior, extraperitoneal, robotic, under santorini, intrafascial, anterograde) radical prostatectomy (RP). Secondary aim was to evaluate oncologic and functional results. The main intent of PERUSIA is to reduce injury of the Neuro-Vascular Bundles (NVB) and to preserve periurethral anterior structures. This is the first reported prospective cohort study about our technique., Materials and Methods: We collected prospective data of a cohort of 210 patients who had undergone PERUSIA RP between January 2013 and May 2015. Key points of this technique included the following: posterior approach to intrafascial plane, which was developed from the median to lateral side, anterograde preservation of the Veil of Aphrodite, and development of an anterior avascular plane to preserve the santorini plexus. We included only sexually potent patients with low-risk disease. Perioperative, oncologic, and functional outcomes were collected. Postoperative full continence was defined as no pad use. Patients were defined potent when International Index of Erectile Function (IIEF-5) score was >17. Median follow-up was 22 months., Results: Median operative time and median estimated blood loss were 120 minutes and 150 mL, respectively. 25 patients (11.9%) experienced a total of 36 complications overall with an overall complication rate of 17.1%. We reported 3 (8.3%) grade IIIb complications and no major ones. Overall positive surgical margin rate was 20% with biochemical recurrence occurring in 3.8% of patients at a median follow-up of 22 months. Immediate urinary continence rate (1 day after catheter removal) was 66.6%. At 3 and 12 months, the continence rate was 90.4% and 96.1%, respectively, while sexual potency rate was 70.4% and 80.9%., Conclusion: PERUSIA RP has proved to be safe and effective for low-risk prostate cancer with exciting functional outcomes in terms of early recovery of urinary continence and sexual potency.

We aimed at assessing the stability of candidate reference genes in urine sediments of men subjected to digital rectal examination for suspected prostate cancer (PCa). Two microRNAs (miR-191 and miR-25) and 1 small nucleolar RNA (SNORD48) were assayed in 35 post-DRE urine sediments of men with PCa and in 26 subjects with histologically confirmed benign prostatic hyperplasia (BPH). The stability of candidate reference genes was assessed through BestKeeper algorithm and equivalence test. miR-200b and miR-452 were used to test for the effect of normalization on target genes. Our results proved miR-191 to be the most stable gene, showing the lowest degree of variation and the highest stability value. miR-25 and SNORD48 values fell beyond the cutoff of acceptability. In conclusion, we recommend the use of miR-191 for normalization purposes in post-DRE urine sediments.

Glyoxalase 1 is a scavenging enzyme of potent precursors in reactive oxygen species formation and is involved in the occurrence and progression of human malignancies. Glyoxalase I A111E polymorphism has been suggested to influence its enzymatic activity. The present study was aimed at investigating the association of this polymorphism with oxidative stress and its implications in prostate cancer progression or survival. The polymorphism was genotyped in human differently aggressive and invasive prostate cancer cell lines, in 571 prostate cancer or 588 benign prostatic hyperplasia patients, and 580 healthy subjects by Polymerase Chain Reaction/Restriction Fragment Length Polymorphism. Glyoxalase 1 activity, the pro-oxidant Glyoxalase 1-related Argpyrimidine and oxidative stress biomarkers were evaluated by biochemical analyses. Glyoxalase 1 polymorphism was associated with an increase in Glyoxalase 1-related pro-oxidant Argpyrimidine and oxidative stress levels and cancer progression. The mutant A allele conferred a modest risk of prostate cancer, a marked risk of prostate cancer progression and a lower survival time, compared to the wild C allele. The results of our exploratory study point out a significant role for Glyoxalase 1 in prostate cancer progression, providing an additional candidate for risk assessment in prostate cancer patients and an independent prognostic factor for survival. Finally, we provided evidence of the biological plausibility of Glyoxalase 1 polymorphism, either alone or in combination with other ones, all related to oxidative stress control that represents a key event in PCa development and progression.

Background: Glyoxalase I (GLOI) detoxifies reactive dicarbonyls, as methylglyoxal (MG) that, directly or through the formation of MG-derived adducts, is a growth inhibitor and apoptosis inducer. GLOI has been considered a general marker of cell proliferation, but a direct link between the two has yet to be demonstrated. The aim of the present work was to clarify whether GLOI was involved in the proliferation control of LNCaP and PC3 human prostate cancer cells or might play a different role in the growth regulation of these cells., Methods: RNA interference was used to study the role of GLOI in cell proliferation or apoptosis. Cell proliferation was evaluated by [3H]thymidine incorporation assay and flow cytometry, that was also used to analyze apoptosis. Real-time TaqMan polymerase chain reaction and spectrophotometric analyses were used to study transcript levels or specific activity, respectively. Proteins levels were analyzed by Western blot. MG was measured by high-performance liquid chromatography., Results: We found that GLOI is not implicated in the proliferation control of LNCaP and PC3 cells but plays a role in the apoptosis of invasive prostate cancer PC3 cells, through a mechanism involving a specific MG-adduct and NF-kB signaling pathway., Conclusions: Our data represent the first systematic demonstration that GLOI cannot be considered a general marker of cell proliferation and that acts as a pro-survival factor in invasive PC3 cells by elusing apoptosis. GLOI may be involved in prostate cancer progression, via the control of key molecules in the mitochondrial apoptotic mechanism, through NF-kB signaling pathway., (Copyright © 2012 Wiley Periodicals, Inc.)

The aim of our study was to monitor serum levels of two miRNAs (miR-21 and miR-141) and three KLKs (hK3/PSA, hK11, and hK13) before and 1, 5, and 30 days after radical prostatectomy, in order to characterize their fluctuations after surgery. 38 patients with prostate cancer were included. miR-21 and miR-141 were quantified through real-time PCR, while ELISA assays were used to quantify hK3 (PSA), hK11, and hK13. Both miR-21 and miR-141 showed a significant increase at the 5th postoperative day, after which a gradual return to the preoperative levels was recorded. These findings suggest that miR-21 and miR-141 could be involved in postsurgical inflammatory processes and that radical prostatectomy does not seem to alter their circulating levels. Postoperative serum kallikreins showed a significant decrease, highlighting the potential usefulness of kallikreins apart from PSA as potential prostate cancer markers.

Prostate cancer has the highest tumour incidence in the male population and represents 9.2% of cancer-related deaths. The most commonly used screening technique up to the present has been serum measurement of PSA which has led to a marked increase in the number of prostate cancer cases diagnosed every year. Nevertheless PSA in the early diagnosis of prostate cancer has many limitations. It can lead to a very high number of unnecessary biopsies in patients with benign prostate hyperplasia and, in addition, may also lead to an overdiagnosis and overtreatment of clinically insignificant neoplasias. Moreover many neoplasias are already present with PSA within normal limits. It is clear, therefore, that new biomarkers for the diagnosis and follow-up of prostate cancer have to be developed. We present a review of the literature in which we have analysed the most promising biomarkers in terms of sensitivity and diagnostic specificity for prostate cancer and which are currently under study, analysing recent developments and future prospects.

Background: The localization of low affinity nerve growth factor receptor (p75) in prostate carcinogenesis is still unclear. Our aim was to reinvestigate the localization of p75 in normal and pathological prostate and to check a possible correlation to neoplastic grading., Methods: Specimens from 33 prostate cancers and from normal prostatic tissue were analyzed for p75 expression at light and ultrastructural levels., Results: In normal tissue p75-immunoreactivity was restricted to basal cells in the epithelial compartment and to nerves and blood vessel in stroma. During carcinogenesis, p75-immunoreactivity progressively decreased at the periphery of the foci according to the increase in malignancy. No p75-immunoreactivity was detected inside of the foci. On the contrary, in stroma we found a dramatic increase in p75-immunoreactivity correlated to an increase in malignancy. In this compartment, for the first time ultrastructural analysis identified p75-immunoreactivity in smooth muscle cells (SMC) that are p75-negative in normal conditions., Conclusion: The present study confirms at ultrastructural level a malignant-dependent p75 decrease in basal cells of neoplastic foci. Furthermore, we show a novel, malignant-dependent localization of p75 in SMC in the stroma around the neoplastic foci. Since p75 expression is present in muscle cells only during the earliest stages of differentiation and mature muscle cells lose this expression, we hypothesize that p75 re-expression in stromal SMC is a further mechanism related to the general de-differentiation of the stroma connected to the neoplastic invasion. According to this hypothesis, our results suggest that p75 analysis could be a novel prognostic marker for prostate cancer., ((c) 2009 Wiley-Liss, Inc.)

The identification of reliable molecular biomarkers in prostate cancer early diagnosis is clinically desirable. We quantitatively detected prostate cancer specifically overexpressed genes, DD3 and PSA, in urine sediments of men suffering from prostate cancer or benign prostate hyperplasia, after prostatic massage. As both genes are exclusively expressed in androgen receptor expressing human prostate carcinoma cell lines, we further investigated the possible effect of androgens on PSA and DD3 gene expression. DD3 and PSA mRNA levels were measured by real-time polymerase chain reaction. The combined markers test had a sensitivity of 80.2% and a specificity of 100%. Both gene transcripts were significantly upregulated by androgens. Results indicated the clinical usefulness of the combination of DD3 and PSA as molecular markers in the early diagnosis of prostate cancer and the need of combining as many as possible analytical data with the clinical and demographic ones to achieve the maximum level of diagnostic accuracy.

Prostate cancer (PCa) is a heterogeneous, multifactorial and multifocal disease. Therefore, the search for a combination of assays using a panel of tumor markers is fundamental for a more precise and reliable diagnosis. In the present study we investigated the diagnostic value of five different genes, associated with PCa carcinogenesis, encoding for prostate-specific membrane antigen (PSMA), serine protease Hepsin, PCa antigen 3 (PCA3), UDP-N-acetyl-alpha-D-galatosamine transferase (GalNAC-T3) and prostate-specific antigen (PSA). Forty-four patients, with previously untreated, histologically verified PCa and forty-six patients with benign prostatic hyperplasia (BPH) were enrolled in this study. Absolute concentration of the transcript levels of each gene was calculated by quantitative Real-Time PCR analysis in urine sediments of men suffering from PCa or BPH after prostatic massage. The diagnostic value of a concomitant examination of these markers was evaluated by logistic regression analysis. We demonstrated that the diagnostic potential of the combined urinary PSA and PSMA level was significantly better than that of each singularly considered marker, including total serum PSA, the present gold standard test for PCa diagnosis.

Objective: In a prospective study we analysed the 3-yr results of the effects of radical retropubic prostatectomy (RRP) on detrusor and sphincter function by comparing urodynamic status preoperatively with that during longitudinal follow-up., Methods: Fifty-four consecutive patients underwent urodynamics with pressure flow studies and Valsalva leak point pressure measurements 3-7 d before RRP (baseline), and then 8 mo after surgery. Thirty-two patients were studied again 3 yr later. We analysed bladder compliance, detrusor overactivity (DO), detrusor contractility, and intrinsic sphincter deficiency (ISD)., Results: There was a significant increase in the number of patients with reduced bladder compliance at the 8-mo follow-up. De novo reduced bladder compliance was detected in 32.3% of patients and persisted in 28.1% at the 36-mo follow-up. De novo detrusor hypocontractility was observed in 51% of patients at 8 mo (p<0.05) and persisted in 25% of cases 3 yr later. No patients showed any postvoid residual volume. The associations between detrusor hypocontractility with DO and between detrusor hypocontractility with ISD were detected in 76.2% and 44% of patients, respectively, at 8 mo, and in 25% and in 34% of cases, respectively, at 36 mo of follow-up (p<0.05 and p<0.001)., Conclusions: Following RRP detrusor hypocontractility, decreased bladder compliance, and ISD represent de novo dysfunction probably due to bladder denervation during surgery. They become established conditions over time in about 30% of patients. Nevertheless, they do not produce voiding symptoms because patients develop new voiding behaviours.

Introduction: Although hormones play fundamental roles in prostate growth, their clinical significance is not completely clear. In the present study we assessed whether serum hormone levels are markers of prostate disease., Patients and Methods: In 128 patients with benign prostatic hypertrophy or prostate cancer, testosterone, follicle-stimulating hormone, luteinizing hormone, and prolactin levels were correlated with disease. In patients with prostate cancer, the hormone levels were also correlated with prognostic factors. Predictive values were assessed for prostate-specific antigen and testosterone levels only, using multiple logistic regression analysis and receiver operating characteristic curves., Results: The testosterone concentrations were significantly lower in patients with prostate cancer than in those with benign prostatic hypertrophy and were also significantly lower in patients with advanced-stage disease than in patients with organ-confined disease. Testosterone appears to be an independent predictor of disease and enhances the predictive accuracy for benign prostatic hypertrophy and prostate cancer., Conclusions: This study supports experimental findings that prostate cancer is frequently associated with low testosterone concentrations. In the diagnostic workup for prostate cancer, associating prostate-specific antigen and testosterone levels may improve the predictive accuracy of prostate disease tests.

Objectives: An observational study was planned by the QuABIOS group, to survey the hormonal treatment administered to prostate cancer patients in Italy within a time window of 12 months. We report here a prospective quality of life (QOL) evaluation over time and by hormonal treatment modalities., Methods: Patients with diagnosis of prostate cancer and treated with hormonal therapy were eligible for this study. The EORTC QLQ-C30 v.3 questionnaire was administered at enrolment, after 6 months and after 12 months from enrolment., Results: 587 patients were enrolled by 33 urological centers. When 1518 visits were considered together independently of time, antiandrogen monotherapy was associated with a significantly better QOL than LHRH-analogue containing treatment modalities in almost all functional scales; cyproterone acetate demonstrated a better physical function and general health status than bicalutamide. When QOL was analyzed in a prospective 12-month window, a worsening of physical function and general health status was observed, notwithstanding, antiandrogens remained significantly associated to a better QOL than LHRH-analogue therapies also over time: a favourable physical function and general health status appeared again to be related to cyproterone acetate than bicalutamide., Conclusions: Androgen deprivation therapy is associated with decline in QOL, particularly in the domains of physical function, energy, and general health status. This survey demonstrated that antiandrogens had a better QOL profile than LHRH-analogue containing therapies;furthermore, a more favourable tolerability for cyproterone acetate as compared to bicalutamide is suggested.

Background: Prostasomes are secretory granules synthesized, stored and secreted by normal and neoplastic human prostate epithelial cells and by prostate cancer metastasis. Prostasomes are postulated to be shed into the blood circulation in prostate cancer patients, where they may cause an immune response., Materials and Methods: An antiprostasome antibody ELISA was developed and used to measure serum antibody titres in 81 males with prostate cancer or benign prostate hyperplasia., Results: Patients with biopsy-verified prostate cancer had significantly higher antibody titres [p = 0.019 for the dominant tumour expression (first Gleason parameter) and p = 0.022 for the dominant and non-dominant form (first and second Gleason parameters)] than individuals with benign prostate hyperplasia or other benign prostate disorders. No correlation existed between antibody titres and PSA values., Conclusion: These results indicate that the antiprostasome antibody titre in serum may be a novel prostate cancer marker not replacing, but rather supplementing, PSA.

Background: Dietary factors, life-style as well as environmental conditions may contribute to the risk of prostate tumor together with genetic susceptibility, that may be an important factor in determining who is more likely to develop prostate malignancy. We have undertaken a case-control study in order to elucidate the association between polymorphisms in some metabolizing genes with the risk of prostate cancer (PCa)., Methods: Polymorphisms of three xenobiotic genes (CYP17, GSTP1, PON1) were characterized in 384 patients with untreated PCa and 360 age-matched control patients with benign prostatic hyperplasia (BPH). All polymorphisms were investigated by PCR/RFLP methods using DNA from lymphocytes., Results: We found that men with the CYP17/A1A1-A1A2 genotypes, GSTP1/IleVal genotype, PON192/QR and PON55/LM-MM genotypes had a significantly higher risk of PCa compared with the others genotypes., Conclusions: The three polymorphisms appear to be common genetic traits that are associated with an increased risk for PCa: the analysis of them all in each single case may be a predictable factor, particularly among groups exposed to PCa-related carcinogens., ((c) 2004 Wiley-Liss, Inc.)

Objective: Accurate staging of prostatic cancer is important for planning an optimal treatment, such as radical prostatectomy in clinical stage T2. About 40-50% of patients operated for cT2 disease show a pathological stage T3 disease. In a prospective study we analysed accuracy of TRUS and endocoil MRI in a group of patients before radical prostatectomy., Materials and Methods: 33 consecutive patients suspicious of prostate neoplasms were studied and staged with TRUS and endocoil MRI before prostatic biopsy and before radical prostatectomy. One urologist trained in TRUS conducted the exam, while one radiologist interpreted the MRI studies in a blind mode. The criteria evaluated were accuracy of global staging, extracapsular extension (ECE) and seminal vesicle invasion (SVI). These results were correlated with the histopathological findings after radical prostatectomy., Results: The histopathological results showed 14 patients (42%) with pT2 disease, 18 patients (54%) with pT3 disease and 1 case (4%) of pT4 disease. TRUS showed a low sensitivity (38%) and a good specificity (78%), with an overall accuracy of 50%; the best result was 96% specificity for SVI. Endocoil MRI showed a good sensitivity (70%) and specificity (76%), with an overall accuracy of 73%. Endocoilc was also useful to stage T1c disease when TRUS is negative. TRUS tends to understage, whereas endocoil MRI over-stages prostate cancer., Conclusions: TRUS and endocoil MRI may help in decision making about the appropriate treatment of prostatic cancer, even if they have limited current value, due to understaging or overstaging.

Background: Nearly all cases of metastatic prostate carcinoma progress, after hormonal ablation, to a hormone refractory status. To the authors' knowledge no standard chemotherapy for patients with hormone refractory prostate carcinoma (HRPC) exists. In a prospective study, the efficacy and toxicity of an oral combination of estramustine and cyclophosphamide were evaluated., Methods: Between March 1996 and April 1998, 32 consecutive patients (median age 74 years; range, 53-84 years) with metastatic HRPC were treated with oral estramustine (10 mg/kg/day) and oral cyclophosphamide (2 mg/kg/day) for 14 days every 28 days. Inclusion criteria were previous complete androgen blockade, antiandrogen withdrawal evaluation, and clinical or biochemical disease progression. Response assessment was based on a decrease > or =50% in the prostate specific antigen (PSA) level associated with improvement (or no worsening) in Eastern Cooperative Oncology Group (ECOG) performance status (PS) and relief of bone pain (if present)., Results: All patients were evaluable for efficacy and toxicity. PSA levels decreased by at least 50% in 14 patients (43.7%) (95% confidence interval, 26.5-60.9), remained stable in 12 patients (37.5%), and rose in 6 patients (18.8%). ECOG PS was 0 in 5 of 14 patients, improved from 1 to 0 in 7 patients, and remained unchanged in 2 patients. Bone pain, present in 8 of 14 patients, disappeared in 7 and was partially relieved in 1. The median duration of response was 30 weeks (range, 8-88+ weeks). An objective partial response was obtained in two cases. Toxicity was mild and mainly gastrointestinal (World Health Organization [WHO] Grade 1). No cases of WHO Grade 3-4 hematologic toxicity occurred., Conclusions: The oral combination of estramustine and cyclophosphamide appears to be safe and effective in patients with HRPC. In responding patients its use shows a clinical benefit in terms of improvement of ECOG PS and pain control., (Copyright 2000 American Cancer Society.)

Background: Prostate cancer is in Italian men the second neoplasm for incidence. Transrectal ultrasonography (TRUS) is still today a cheap test, not very invasive, well accepted by the motivated patient and sufficiently accurate for the valuation of the local status disease. We proposed our data to verify if a careful local ultrasonographic study of prostatic carcinoma could or not predict its systemic course., Methods: We have valued 136 out patients affected by prostate cancer and treated with either palliative medical therapy or radiotherapy. The follow-up varies from 12 to 132 months. The local, evaluation of the disease done through TRUS in longitudinal and/or axial scan (the dimension of the gland, the volume and ultrasonographic characteristics of the lesion, capsular involvement and estimation of the surrounding structures: seminal vesicles, vesica, rectum)., Results: In the long run, considering the local and systemic course of the disease, we have noticed accordance globally in 116 patients (85.3%); 13 patients showed only systematic progression (9.5%) while in 7 patients, we have noticed a local but not a systemic variation., Conclusions: We can deduce that periodical carrying-out of the TRUS (twice a year) constitute a reliable index not only of local procedure of the pt. but also predicting the systemic course of the disease, making the routine carrying out of the other check-up unnecessary, that could be reserved for cases with precise clinical indication.

Management of prostate cancer requires considerable economic and social efforts and may causes some discomfort to patient. To attempt a simplification of the prostate cancer follow-up (dosage of PSA, ultrasound and abdominal and pelvic TC and/or RM, bone scan, X-ray chest and X-ray bone), Authors have review the patients with prostatic cancer who were undergone to a conservative treatment with hormonal and/or radiation therapy. From January 1984 to September 1995, 136 patients have been evaluated in the Urological Department of University of Perugia. Local staging cancer has been made according to TNM system. Ultrasound transrectal follow-up study (TRUS) we made through longitudinal and/or transversal scans. The echographic features have been evaluated are the prostate size, volume and echogenic pattern of cancer, extracapsular extention and, finally, the echographic appearance of surrounding tissues (seminal vesicles, rectum, bladder). In 116 patients (85.3%) Authors found a good correlation of clinical course and the results of the investigations whereas in 20 patients (14.7%) such correlation falls to be demonstrated. Although PSA level remains an important prognostic marker for monitoring patients with prostatic cancer, TRUS is useful to determinate not only the local status but also to predict the subsequent clinical course of these patients. The later could be performed at least twice a year whereas further investigations could be prescribed only in presence of clinical suspicious of metastasis. It can be concluded that TRUS and PSA levels are sufficiently safe indexes on follow-up of prostate cancer which can replace the most expensive examinations avoiding an unnecessary cost to the health care system. Furthermore TRUS can recognize patients with urine flow obstruction who may benefit by treatment with improvement of their quality of life.

In a group of 115 patients with prostatic cancer, the correlation between the local and systemic evolution of the neoplasm has been evaluated. In 80 patients non local and systemic up-staging of the tumor was observed. In further 18 patients both local and systemic staging uppers and in the remaining 17 patients no correlation between local and systemic evolution was observed. In conclusion, in this series, the prostatic cancer demonstrated an high concordance in both local and systemic evolution and then the modifications of local staging can be used as a predictive parameter of systemic evolution of the prostatic cancer.