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Simple Summary Previous studies have shown heavy intake of different alcoholic beverages affects prostate cancer (PCa) clinical outcomes differently. However, the intake patterns of specific alcoholic beverages for PCa status are understudied. The study's objective is to evaluate intake patterns of total alcohol and three types of alcoholic beverage (beer, wine, and spirits) by PCa risk and aggressiveness status. This study included 10,029 men with European ancestry (4676 non-PCa men and 5353 PCa patients). We found PCa patients had a similar total heavy alcohol intake compared with non-PCa men. However, PCa patients were likely to drink more wine and spirits than non-PCa men. Patients with aggressive PCa drank more beer but not wine and spirits. Interestingly, heavy wine intake was inversely associated with PCa aggressiveness. These findings suggest that the intake patterns of specific alcoholic beverages differ by PCa status, and this information might help develop personalized alcohol intervention for PCa patients. Background: Previous studies have shown that different alcoholic beverage types impact prostate cancer (PCa) clinical outcomes differently. However, intake patterns of specific alcoholic beverages for PCa status are understudied. The study's objective is to evaluate intake patterns of total alcohol and the three types of beverage (beer, wine, and spirits) by the PCa risk and aggressiveness status. Method: This is a cross-sectional study using 10,029 men (4676 non-PCa men and 5353 PCa patients) with European ancestry from the PCa consortium. Associations between PCa status and alcohol intake patterns (infrequent, light/moderate, and heavy) were tested using multinomial logistic regressions. Results: Intake frequency patterns of total alcohol were similar for non-PCa men and PCa patients after adjusting for demographic and other factors. However, PCa patients were more likely to drink wine (light/moderate, OR = 1.11, p = 0.018) and spirits (light/moderate, OR = 1.14, p = 0.003; and heavy, OR = 1.34, p = 0.04) than non-PCa men. Patients with aggressive PCa drank more beer than patients with non-aggressive PCa (heavy, OR = 1.48, p = 0.013). Interestingly, heavy wine intake was inversely associated with PCa aggressiveness (OR = 0.56, p = 0.009). Conclusions: The intake patterns of some alcoholic beverage types differed by PCa status. Our findings can provide valuable information for developing custom alcohol interventions for PCa patients.

Purpose: Incidence and mortality of prostate cancer (PCa) are still increasing in developing countries. Limited access to the health system or more aggressive disease are potential reasons for this. Ethnic and social differences in developed countries seem to make inappropriate to extrapolate data from other centers. We aim to report the epidemiological profile of a PSA-screened population from a cancer center in Brazil. Materials and Methods: We retrospectively selected 9.692 men enrolled in a PCa prevention program, comprising total PSA level and digital rectal examination at the first appointment, associated with complementary tests when necessary. Men aged over 40 years-old were included after shared decision-making process. Prostate biopsy (TRUS) was performed when clinically suspected for PCa. After the diagnosis, patients underwent appropriate treatment. Results: TRUS was performed in 5.5% of men and PCa incidence was 2.6%. Overall ratio between number of patients who needed to be screened in order to diagnose one cancer was 38.9 patients, with 2.1 biopsies performed to diagnose a cancer. Positive predictive value (PPV) of TRUS biopsy in this strategy was 47.2%, varying from 38.5% (80 years-old). We evidenced 70 patients (27.9%) classified as low risk tumors, 74 (29.5%) as intermediate risk, and 107 (42.6%) as high-risk disease. Conclusions: PSA-screening remains controversial in literature. In front of a huge miscegenated people and considering the big proportion of high-risk PCa, even in young men diagnosed with the disease, it is imperative to inform patients and health providers about these data particularities in Brazil.

Das zentrale Thema dieser Bachelorarbeit ist der Einfluss von Hüftprothesen auf die radioonkologische Behandlung des Prostatakarzinoms. Bei der Behandlung eines Prostatakarzinoms bei vorhandener Hüftprothese mittels Strahlentherapie muss der Bestrahlungsplan so erstellt werden, um mögliches Eindringen von Strahlung durch eine Metall-Hüftprothese zu vermeiden, da der Hüftkopf und der Schenkelhals zu den Risikoorganen zählen. Die Parameter des Bestrahlungsplans müssen somit so gewählt werden, dass die Metall-Hüftprothese ausgespart wird, die Behandlung aber trotzdem nicht an Effektivität verliert. Um relevante Studien einzugrenzen, wurde nach folgenden Suchbegriffen gesucht: „Dose perturbation ́ ́, ,,hip prostheses ́ ́, ,,Monte Carlo ́ ́, ,, radiotherapy ́ ́, ,,treatment planning ́ ́, ,,uniform scanning proton therapy ́ ́, ,,VMAT ́ ́, ,,metallic hip prosthesis ́ ́, ,,prostate cancer ́ ́. Zur Datenrecherche wurden Datenbanken wie zum Beispiel, PubMed, NCBI und Google Scholar verwendet. Weiters ist eine Statistik von statistik.at angeführt, um an allgemeine Informationen zu gelangen. Bei der Recherche der Literatur wurde besonderes Augenmerk auf die Aktualität der Studien gelegt, da es in diesem Bereich laufend Fortschritte gibt. Für die Beantwortung der Forschungsfragen wurde die recherchierte Literatur verglichen und nach Gemeinsamkeiten gesucht. Die VMAT- und IMRT-Technik stellten sich hierbei als gute Lösung dar, um eine homogene Dosisauslastung im PTV von mindestens 95% zu erreichen. Diese Arbeit ermöglicht einen Überblick über die aktuellen Behandlungsmethoden bei Prostatakrebs und dem Vorhandensein von Hüftprothesen. Es wird der Prostatakrebs und die Problematik der Metall-Hüftprothesen thematisiert. The central topic of this bachelor thesis is the influence of hip prostheses on the radiooncological treatment of prostate cancer. When treating a prostate carcinoma with an existing hip prosthesis by means of radiation therapy, the radiation plan must be drawn up in a way that preferably avoids the possible penetration of radiation by a metal hip prosthesis should be avoided, since the femoral head and neck are among the organs at risk. The parameters of the irradiation plan must therefore be selected in a way that does not expose the metal hip prosthesis, but ensures that the treatment still remains effective. To narrow down relevant studies, the following search terms were used: "can perturbation ́ ́, ,,hip prostheses ́ ́, ,,Monte Carlo ́ ́, ,,radiotherapy ́ ́, ,,treatment planning ́ ́, ,,uniform scanning proton therapy ́ ́, ,,VMAT ́ ́, ,,metallic hip prosthesis ́ ́, and ,,prostate cancer ́ ́. Databases such as PubMed, NCBI and Google Scholar were used for research. Furthermore, statistics from Statistik Austria were used to obtain general information. When researching the literature, special attention was paid to the topicality of the studies, as there is constant progress in this field. To answer the research questions, the researched literature was compared in order to search for and commonalities. The VMAT and IMRT techniques proved to be a good solution to achieve a homogeneous dose rate in PTV of at least 95%. This paper provides an overview of current treatment methods for prostate cancer and the presence of hip prostheses. Prostate cancer and the connected problems of metal hip prostheses are discussed.

Introduction: The use of pre- and post-surgery variables has been used to create nomograms in order to identify patients at high risk of treatment failure. The PRIX nomogram is one such device; we compare the PRIX nomogram with the presence of secondary circulating prostate cells to predict those men who will undergo treatment failure. Methods and Patients: Men who underwent radical prostatectomy for prostate cancer entered the study. The PRIX score was calculated from the total serum PSA pre-surgery, the biopsy Gleason score and clinical stage. Circulating prostate cells were detected from venous blood one month after surgery, using differential gel centrifugation and standard immunocytochemistry with anti-PSA. A test was considered positive when 1 CPC/blood sample was detected. Patients were followed up for five years and biochemical failure was defined as a serum PSA >0.2ng/ml. Kaplan-Meier and Cox proportional models were used to calculate survival curves. Results: 321 men participated, of whom 131 (40.8%) underwent biochemical failure within 5 years. A higher PRIX score was associated with increased failure risk, as was the presence of CPCs. The predictive power of CPCs was significantly higher than the PRIX score. Combining the two methods, for equal PRIX scores, scores but CPC positive had a worse biochemical failure free survival than men with high PRIX scores but CPC negative. For men with PRIX scores of ≥4 the use of CPC detection did not aid in the clinical decision making process. For those with PRIX scores of 0 and 1, CPC detection identified men with a high risk of treatment failure. Conclusions: The combined PRIX/CPC score improved the predictive values of men at high risk of biochemical failure. Both are simple systems that could be incorporated in a general hospital. Further multicenter studies are warranted to confirm these results.

Bone homeostasis is achieved through a continuous remodelling process on the bone surface of the balanced resorption of old bone by osteoclasts and the formation of new bone by osteoblasts. Local and systemic growth factors regulate the differentiation and activity of the osteoclasts and osteoblasts (and osteocytes). Maintenance and repair of normal bone result in the release of enzymes, peptides and mineral components that have been characterised as serum and urinary biochemical markers of bone remodelling [1]. High bone turnover in cancer patients is crucial for all the steps of bone metastatic disease, from the homing of circulating cancer cells into the bone (premetastatic niche) to the complication of bone metastasis (BMT) (skeletally related events [SREs]). Therefore, elevated bone turnover marker could predict bone metastasis, risk of bone progression and risk of SREs, potentially becoming a potent prognostic predictor (Fig. 2.1). For this reason, biochemical markers of bone remodelling are potentially an ideal tool for evaluating changes in bone turnover, such as those associated with malignant bone lesions and response to treatment. Osteoclast and osteoblast activity (and probably that of cancer cells) is associated with the release of distinct biochemical markers that are amenable to non-invasive measurements of the blood or urine.

Objectives: Predicting the value of screening tests in the detection of prostate cancer in Saudi men. Methods: The study was conducted in King Fahd Hospital of the University, Al-Khobar. Total, free and percent free serum prostate specific antigen (PSA) were measured in Saudi men above the age of 45 years. Transrectal ultrasonography (TRUS) and needle biopsy were performed on those with suspicious digital rectal examination (DRE) and or PSA >4ng/ml. A group of 849 Saudi men were with normal PSA levels and normal DRE were considered cancer free.. The remaining 151 patients with PSA >4ng/ml were suspicious for prostate cancer. Only 55 patients agreed to have TRUS and needle biopsy Results: PSA testing and DRE had the highest positive predictive value but this value dropped when TRUS was added. Conclusion: PSA and DRE are the main tests for the detection of prostate cancer, while TRUS is valuable when sample are taken of a wide area of prostate tissue in men at high risk of cancer.

Contexto: El tratamiento basado en deprivación androgénica es uno de los tratamientos estándar que reciben muchos pacientes con cáncer de próstata. Además, su utilización está aumentando debido a una clara expansión de las indicaciones de esta terapia hacia los pacientes con cáncer localizado. Resumen de evidencia: A pesar de que clásicamente se considera que es bien tolerada, la deprivación androgénica tiene efectos adversos. Entre estos cabe destacar la pérdida de masa mineral ósea, que puede conducir a osteoporosis y elevación del riesgo de fractura ósea. Algunas fracturas pueden tener graves consecuencias, como sucede con la fractura de cadera. Para realizar el diagnóstico de esta situación, existen procedimientos útiles como la densitometría ósea. Y una vez diagnosticada, la disminución de la masa mineral ósea puede ser manejada con recomendaciones dietéticas, cambios generales en el estilo de vida, o con fármacos como los bisfosfonatos o el recientemente aprobado denosumab. Conclusiones: Los urólogos, siguiendo las recomendaciones vigentes, deben llevar a cabo una cuidadosa vigilancia de la salud ósea de los pacientes con cáncer de próstata sometidos a deprivación androgénica, para poder obtener un diagnóstico precoz e instaurar las medidas generales y/o terapéuticas apropiadas, en caso necesario. Context: Treatment based on androgenic deprivation is one of the standard treatments that many prostate cancer patients receive. Moreover, its use is increasing due to a clear expansion of the indications of this therapy in patients with localized cancer. Summary of evidence: In spite of being classically considered that it is well tolerated, androgenic deprivation has adverse effects. Of these, it is worth mentioning the loss of mineral bone mass, which can lead to osteoporosis and increase the risk of bone fracture. Some fractures may have serious consequences, as occurs with hip fractures. To make a diagnosis in this situation, there are useful procedures such as bone densitometry. Once diagnosed, the decrease in mineral bone mass can be managed with dietary recommendations, general changes in lifestyle, or with drugs such as denosumab. Conclusions: Following applicable recommendations, urologists must carefully monitor the bone health of patients with prostate cancer subjected to androgenic deprivation, in order to obtain an early diagnosis and to apply the appropriate general and/or therapeutic measures, if necessary.

Introducción: En bien conocido que la prostatectomía radical (PR) es una opción excelente como tratamiento del cáncer de próstata localizado, desde el punto de vista de control oncológico. Desde hace décadas los esfuerzos de la comunidad urológica en este campo, se centran en intentar mejorar los resultados funcionales (morbilidad urinaria y sexual) tras este procedimiento. Desde el inicio de este siglo, conviven tres abordajes (abierto, robótico y laparoscópico) que hasta nuestros días pugnan por intentar alcanzar y demostrar los mejores resultados. El objetivo de esta revisión ha sido hacer una puesta al día lo más exhaustiva, rigurosa y objetiva posible, sobre los resultados oncológicos y funcionales que consiguen las tres técnicas (abordajes) de PR. Material y métodos: Hemos centrado la comparativa en cuatro apartados: resultados perioperatorios, resultados oncológicos, resultados funcionales y costes económicos. Para ellos se realizó unas búsqueda sistemática en los siguientes registros: PubMed, OVID, EMBASE y Cochrane Library, con los siguiente términos: PR Retropúbica, PR Abierta, PR Laparoscópica, PR Robótica, Función Sexual, Incontinencia Urinaria, Calidad de Vida, Costes Económicos. Se seleccionaron un total de 73 referencias, a criterio de los autores, que fueron analizadas individualmente. Resultados: La mortalidad relacionada con el procedimiento es extremadamente baja con cualquiera de las técnicas, con poco dolor postoperatorio y mínimos requerimientos analgésicos. Los resultados oncológicos, medidos en términos de márgenes quirúrgicos son comparables: PR Abierta (14-20%), PR Laparoscópica (7,4-21,9%) y PR Robótica (5,7-17,3%). En relación a resultados funcionales (función sexual y continencia urinaria) es difícil establecer comparaciones debidos a la multitud de sesgos existentes (estudios no randomizados, diferentes métodos y escalas de medida, diferentes definiciones, etc). En los estudios uni-institucionales, los resultados parecen ser equivalentes. Conclusiones: Las series de PR Laparoscópica y Robótica aún carecen de resultados maduros en términos de control bioquímico y resultados funcional a largo plazo. Parece que con estos abordajes la pérdida sanguínea y la necesidad de transfusión es menor que en cirugía abierta. La tecnología robótica aporta ventajas muy interesantes, que podrían tener un papel en homogeneizar los resultados del abordaje mínimamente invasivo, pero que aguardan validación a medio y largo plazo. Introduction: It is well known that radical prostatectomy (RP) is an excellent option in localized prostatic cancer especially from oncological control point of view. The efforts, during last decades, of the urological community in this field have been addressed in trying to improve functional outcomes (urinary and sexual morbidity) after the procedure. From the beginning of this century, three managements (open, robotic and laparoscopic) have been coexisting trying to get and prove the best results. The objective of this review has been to make the most exhaustive, rigorous and objective updating with the functional and oncological outcomes from the three (RP) techniques. Material and methods: We have centered the comparison in four sections: perioperative, oncological outcomes, functional results and economic costs. With this purpose a systematic search was made in the following registers: PubMed, OVID, EMBASE and Cochrane Library, with the following terms: Retropubic RP, open RP, laparoscopic RP, robotic RP, Sexual function, urinary incontinence, quality of life, economic costs. At author’s criteria, a total of 73 references were selected, that were individually analyzed. Results: Whatever the technique is, the mortality related to the procedure is extremely low, with little postoperative pain and minimum analgesic requirements. The oncological results are similar, measured in surgical margin terms: Open RP (14-20%), Laparoscopic RP (7.4-21.9%) and robotic RP (5.7-17.3%). Concerning functional results (sexual function and urinary continence), it is difficult to establish comparisons due to the multitude of existing byas (non randomized studies, different methods and measurement scales, differentdefinitions, etc.) In the uni-insitutional studies, results seem to be equivalent. Conclusions: Laparoscopic and robotic RP series are still pending of mature outcomes, related to long term biochemical control and functional results. It seems that with these managements, blood loss and transfusion needs are minor compared to open surgery. Robotic technology adds very interesting advantages that could have an important role in homogenize the minimally invasive management, but are still pending of validation at medium and long term.

Ziel dieser Arbeit war zum einen, das Prostatakarzinomvolumen (PC-Vol.) auf seine Unabhängigkeit als prognostischer Parameter (PP) zu prüfen, zum anderen die Erstellung eines neuen Risikoklassifikationssystems anhand des PC-Vol.. Obwohl sich in den univariaten Analysen eine deutliche Korrelation zwischen dem PC-Vol. und den gängigen Prognosefaktoren zeigte, war das PC-Vol. in der multivariaten Analyse (MA) kein unabhängiger PP hinsichtlich eines PSA-Progresses. Bei der durchgeführten Risikoklassifizierung ergab sich für ein PC-Vol. von 0.5ng/m, and then we defined cut-off-values for the PC-Vol. to seperate our large patient cohort into a low, intermediate and high-risk group for PSA-progression after radical prostatectomy. According to multivariate analysis (MA) PC-Vol. does not independently predict PSA failure after radical prostatectomy.In our analysis we identified as independent progression parameters tumour stage and gleason score of the prostatectomy specimen, as well as age of the patients. Separated as a low (4cm³) PC-Vol. shows significant differences concerning PSA progression. Using the relative risk factors of the MA a stratification into risk categories is easily achieved, so that time consuming PC-Vol. measurement is not necessary.