Hormonal therapy is one of the treatment options for prostate cancer patients. There are many hormonal treatments modality to block the testosterone effect on prostate cancer cell proliferation. Degarelix is an innovative molecule able to antagonize the GnRH receptor with comparable oncological results to GnRH agonist, but with less side effects, avoiding the flare up phase, and better efficacy in LUTS relief. These characteristics of degarelix can impact on the clinical decision making to choose a therapy instead of another.

OBJECTIVEProstate carcinoma (PCa) is one of the most frequent neoplasms, with more than 110.000 new cases/year in Europe. As PCa is not clearly demonstrable at transrectal ultrasound (TRUS), guidelines on TRUS guided biopsy suggest to perform a random tissue sampling (at least 8-12 "cores" depending on gland volume). Although accuracy grows with core number, patient discomfort and adverse event probability grow as well. Thus it would be worth to aim to reduce the number of prostate biopsy cores without loss of diagnostic accuracy.MATERIALS AND METHODSA retrospective study was performed to evaluate the feasibility of an improved version of a rtCAB tool developed at DEIS (University of Bologna) for the reduction of prostate biopsy cores. rtCAB is an innovative processing technique which enhances TRUS video stream by a live false color overlay image that helps the physician to perform the biopsy by guiding the sampling into target zones. In order to train rtCAB, a monocentric, single operator prostate gland adenocarcinoma database has been built. The database enlists 81 patients, for a total of 743 prostate byoptic (PBx) cores and 14860 ROI. For each patient we collected age, PSA levels, digital rectal examination (DRE) findings, presence or absence of focal lesions, and prostate volume. During TRUS, raw ultrasound data were acquired and associated to each PBx core. For each core we collected both the radio frequency (RF) signal and the histological outcome.RESULTSThe whole system was optimized for reducing the number of false positives while preserving an acceptable number of false negatives. Comparing to a classical PBx approach (8-12 cores), the estimated positive predictive value (PPV) of our method increased from 25% to 40%, with an overall sensitivity of 85%.CONCLUSIONSPreliminary results show that the proposed tool can provide real-time feedback to the operator during TRUS. Sensitivity and PPV values suggest that a reduction of almost 50% the number of biopsy cores without losing in diagnostic accuracy is feasible. A prospective study is needed to further confirm these preliminary retrospective results.

PURPOSE:radical prostatectomy (RP) is affected by urinary incontinence (UI) that, even if temporary, can severely impact patients quality of life. We investigated if a post surgery tutored and personal trained pelvic floor re-educational program improves continence recovery more than pelvic floor exercises performed by patients on their own.PATIENTS AND METHODS:332 incontinent (>1 pad/daily) patients (pts) submitted to RP between 2006 and 2008 were prospectively randomized in group A (166 pts) and group B (166 pts). The first group performed an intensive tutored pelvic training program and the second formed the control group. The follow-up was at one year and the self report of recovery of continence was measured every 3, 6 and 12 months.RESULTS:the median time of continence recovery in group A was 44+/-2 days, while in group B it was 76+/-4 days. Patients enrolled in the pelvic floor re-educational dedicated program (group A) achieved continence earlier than the control group (group B). In fact, the number of incontinent patients at the different follow-up intervals was higher for the control group than for the treatment group.CONCLUSION:We have demonstrated that a post RP personal training program of pelvic muscle re-education supported by a physician and nurses expert in continence disorders have a benefit in future continence.

OBJECTIVE Many authors have demonstrated that cardiovascular diseases (CVD) and their related risk factors can predict erectile dysfunction (ED). The penile Doppler ultrasonography is a method to evaluate the cavernous blood flow in people with suspected vasculogenic impotence. The goal of our study was to evaluate if erectile dysfunction is associated to a vascular disease and which is the role of penile Doppler investigation. MATERIAL AND METHODS 90 patients (group 1) complaining ED, but no symptoms of CVD were prospectively evaluated with penile Doppler ultrasound. The controls (group 2) were 45 apparently healthy subjects. Both groups were submitted to carotid and aortal-iliac Doppler ultrasonography. RESULTS 50 patients (mean age 60.5 +/- 4.6 years) in group 1 (IIEF < 15) and 45 subjects (mean age 59.5 +/- 4.6 years) in group 2 (IIEF > 15) were recruited. Mean age, height, LDL-cholesterol and blood pressure value were not statistically different (p = 0.417) between the two groups. Statistically significant differences were found in weight values (p = 0.016). Only 8 patients (4%) were affected by arterial insufficiency and 42.1% by veno-occlusive mechanism insufficiency (p > 0.05). The cavernosal artery diameters were within 0.7 +/- 0.2 and 1.2 +/- 0.1 mm. All patients with a diagnosis of vasculogenic impotence of either arterial or venous origin were found asymptomatically affected by both a diffuse thickenings > 1 mm or a non hemodynamic plaque in the other vessels examined (carotid arteries or aorta or iliac arteries). DISCUSSION Looking at our results, erectile dysfunction is associated to diffuse thickness > 1 mm or with a non hemodynamic plaque of atherosclerotic origin in other vessels. These data confirm the theory that impotence has to be considered as a risk marker for cardiovascular disease (CVD) in men with no cardiovascular symptoms. In our opinion, the penile echo Doppler is not able to show any endothelial dysfunction in terms of loss of mediator releasing. CONCLUSION In case of suspect vasculogenic impotence, even if penile Doppler is not pathological, it would be worth performing a systemic Doppler evaluation of main arteries in order to investigate the presence of atherosclerotic finding and institute a preventive therapy for CVD.

BACKGROUND Ghrelin is a natural growth hormone segretagogue (GHS), involved in the biology of a number of diseases such as lung cancer and prostate cancer. The aim of this study is to assess the relationship existing between ghrelin and testosterone, insulin, and PSA in prostate adenocarcinoma. PATIENTS AND METHODS A patient population and a control population were studied. The former consisted of 18 individuals, age range 50-75 years, with a primary histological diagnosis of prostate adenocarcinoma that were divided into two equal groups of 9 patients each. The control population consisted of 40 normogonadic healthy males aged between 23 and 77 years (average age 43). The first group was treated with oral bicalutamide with a daily dose of 150 mg, while the second group was treated with an intramuscular injection of 11.25 mg of leuprorelin every three months. Total ghrelin was measured with a radio immunological direct method using Phoenix's ghrelin human RIA kit. Intra-assay variance was 8.2% and inter-assay variance was 11.4% . Acylated-ghrelin was measured by applying an extraction method using C18 columns followed by radio immunological dosage with antibody and peninsula tracer. Intra-assay variance was 6.1% and inter-assay variance was 8.7% . All other blood parameters were analysed at the central laboratory of the S. Orsola-Malpighi Polyclinic in Bologna. PSA and testosterone were used to assess response to treatment. The PSA monitoring was achieved with a chemio-luminescence assay method (Roche Modular analytics E 170). Free T was also measured using a direct RIA kit (Diagnostic Systems Laboratories, Inc.). RESULTS In the four months during which patients underwent pharmacological treatment, testosterone values varied significantly (p<0.05) in both groups. No variations (p>0.05) were found for ghrelin, acylated-ghrelin and insulin. CONCLUSION It is concluded that in patients with prostate neoplasms there is no correlation between the variations of circulating levels of ghrelin and those of testosterone.

Literature reports intra-thyroid involvement of renal cell carcinoma (RCC) as a very rare and late event after kidney cancer diagnosis. Nevertheless, it must be investigated and differentiated from primary thyroid nodules. This is important in order to give the patient the best and earliest treatment. In fact the presence of thyroid metastasis of RCC is often the expression of a systemic disease and therefore the patient should have a complete total body examination in order to rule out any other organ involvement. In the case of a solitary metastasis, the therapeutic approach is thyroidectomy giving the patient a survival benefit. Here, a case report of a solitary RCC thyroid metastatic nodule associated with an omolateral internal jugular neoplastic thrombosis is presented together with a review of the literature on this matter.

BACKGROUND This study evaluated the accuracy of a new echographic method named RULES (radiofrequency ultrasonic local estimators) in the diagnosis of prostate cancer. PATIENTS AND METHODS A double-blind prospective study was carried out on 105 patients mean age 66.6 years, prostate specific antigen (PSA) >4 ng/ml with clinical and/or biochemical suspicious of prostate cancer. Patients were submitted to transrectal prostate biopsy (8 to 12 cores) using a traditional echograph connected to a new hardware/ software platform named FEMMINA (fast echographic multiparameter multi image novel apparatus) that processes the echo signal by a RULES (radiofrequency ultrasonic local estimators) algorithm. Histological findings were compared to B-mode and RULES modality. RESULTS Cancer was detected in 32/105 patients, of which 26/32 were determined as positive with the RULES method. RULES had better positive predictive value, negative predictive value, sensitivity, specificity and accuracy than B-mode. CONCLUSION Results obtained with RULES are encouraging and, if further confirmed, could help to reduce the number of unnecessary prostatic biopsies.

Small and large cell neuroendocrine carcinomas of the urinary bladder are rare and usually coexist with urothelial carcinoma in elderly patients. Here we report the clinical case of a young smoker who was referred to our institution for a primary pure neuroendocrine carcinoma of the bladder, and review the existing literature on small and large cell neuroendocrine carcinomas of the urinary bladder.

BACKGROUND: Prostate cancer (PCa) is the most common non-skin cancer among men in Western countries. Inflammation appears to be involved in the pathogenesis of PCa. Recent studies have shown that many inflammatory genes are associated with the risk of PCa. Alpha 1 antichymotrypsin (ACT) is an acute phase protein and it is part of the circulating prostate specific antigen (PSA). PATIENTS AND METHODS: Allele and genotype frequencies of a promoter single nucleotide polymorphism (SNP) in ACT gene were investigated in patients with benign prostate hypertrophy (BHP) or PCa and controls. RESULTS: The G allele was more represented in PCa patients (odds ratio = 2.349). The PSA levels and prostatic volume did not correlate with the ACT genotype. However, stratifying subjects by age, a correlation of PSA levels and the GG genotype in young PCa patients was found. CONCLUSION: Carriers of the ACT G allele are at risk of developing PCa and genotyping healthy subjects could be a new approach for early prevention.

BACKGROUND:"in vivo" application of a new echographic method able to better identify neoplastic tissue. The aim of this study was to evaluate its accuracy in the diagnosis of prostate cancer.MATERIALS AND METHODS:Double-blind prospective study on 60 patients (pts) submitted to both transrectal ultrasound (TRUS) of prostate with a traditional echograph connected to a new hardware/software platform named FEMMINA (Fast Echographic Multiparameter Multi Image Novel Apparatus) that processes the echo signal by RULES (Radiofrequency Ultrasonic Local EStimators) algorithm and to a prostatic biopsy (8 to 12 cores). Histological findings of biopsies were compared to B-mode and the new ultrasound method.RESULTS:Cancer was detected in 18/60 pts. 14 patients had positive images with RULES, 11 with B-mode modality. The positive predictive value (PPV) and negative predictive value (NPV) of B-mode were 42% and 79% while 77% and 90% of RULES. Sensitivity and specificity of B-mode were 61% and 79% while those of RULES were 77% and 90%. B-mode diagnostic accuracy was 63% and RULES accuracy was 86%.CONCLUSIONS:Results obtained with RULES are encouraging but they need further studies for its application in clinical practice.

Over the past ten years nephron sparing surgery for renal cancer has been compared to radical nephrectomy for what concern oncological results, even in elective situations but it is necessary to consider functional results (renal function) as well. Clamping renal artery, inducing a temporary renal ischemia that might represent the major known cause of permanent renal damage, is advised for both open and laparoscopic conservative approach. Data from literature show that before the clamping, the patient should be adequately hydrated and receive mannitol. Ischemia should last preferentially less than 30 minutes and kidney cooling should be advised in case of more prolonged ischemia. Artery reclamping should be avoided. Both in warm and cold ischemia, the renal tissue should be perfused by mannitol once the circulation is resumed.