Small non-coding RNAs (sncRNAs) can be found in circulation and may carry endocrine signals. Here, we analyse circulating sncRNAs before and after castration to identify sncRNAs that potentially could convey endocrine signals from the testis. In a previous randomized clinical trial, men with advanced prostate cancer (n = 57) were treated by either subcapsular orchiectomy (O-arm, n = 28) or GnRH-analogue (G-arm, n = 29). Blood samples were obtained at baseline (W0) and at 12 (W12) and 24 weeks (W24) post-intervention. Small non-coding RNAs from 169 longitudinally paired serum samples were sequenced using the RealSeq-Biofluids Small RNA kit. A joint analysis of sncRNA reads at W12 and W24 compared to W0 identified 81 and 175 circulating sncRNAs present at significantly (FDR < 0.05) different levels in the O-arm and G-arm, respectively. Most sncRNAs were found at lower levels after treatment (n = 67 (83%) and n = 150 (86%) in the O- and G-arm, respectively). The most prevalent type of sncRNA was piRNAs contributing to 44% (n = 36 piRNAs) in the O-arm and 58% (n = 101 piRNAs) in the G-arm. When the two treatment arms were analysed together, 16 sncRNAs were found to be consistently altered after castration. Of these sncRNAs, 8 were piRNAs and 4 have previously been reported in the testis, indicating a likely testicular origin. Using RT-qPCR and small RNA in situ hybridisation, we validated a testicular expression of miR-153 and SNORD38A. In conclusion, the circulating sncRNA profiles are altered after castration and with a substantial loss of piRNAs indicating lost secretion of testicular sncRNAs. However, we cannot deduce if these circulating piRNAs mediate an endocrine signal.

Penile vibratory stimulation (PVS) has shown promise in aiding recovery of erectile function after radical prostatectomy. This prospective cohort pilot study aimed to determine optimized settings in preparation of a randomized controlled trial to further asses its effects. Men without prior erectile dysfunction were instructed to use a mechanical medical vibrator daily for six months following surgery and to adjust settings according to preferences. The primary objective was the optimized parameters defined by the time spent using the vibrator, along with the most frequently used amplitude and frequency settings. Secondary outcomes included patient acceptance and settings most often inducing erections and orgasms. Twenty men were included, 19 of whom used the device on a median of 40.1% of days (IQR: 28,8–51,4%). PVS was most often performed for 5 min (IQR: 5–10 min) and the most frequently used amplitude and frequency were 1 mm and 90 Hz. These parameters were also the ones to induce erections and orgasms most often. At 6 months, 12/19 men were able to engage in penetrative sex. Fourteen patients reported satisfaction with the device, and no adverse effects were observed. Altogether, patient-optimized parameters consisting of 5 min daily stimulation at an amplitude of 1 mm and a frequency of 90 Hz were the most used and showed the strongest association with both erections and orgasms. These parameters will be used in a larger randomized trial.

BACKGROUND:Erectile dysfunction (ED) is recognized as an early marker of cardiovascular disease, but the specific clinical characteristics associated with cardiac dysfunction remain unclear. AIM:To identify risk factors for cardiac dysfunction in men with ED as assessed with echocardiography. METHODS:In this cross-sectional study, men with ED were recruited from a urology outpatient clinic and through invitations to randomly selected men >40 years. Echocardiography was used to assess left ventricular (LV) systolic and diastolic dysfunction. OUTCOMES:Associations between cardiac dysfunction and clinical variables-including age, body mass index (BMI), blood pressure, lipid profile, hemoglobin A1c (HbA1c), high-sensitivity C-reactive protein, and cardiovascular comorbidities-were examined. RESULTS:Among 398 men, univariable analyses showed that BMI, diastolic blood pressure, and high-sensitivity C-reactive protein were associated with increased odds of LV systolic dysfunction. In multivariable analysis, BMI (OR 1.08; 95% CI: 1.01-1.15), diastolic blood pressure (OR 1.04; 95% CI: 1.01-1.07), and HbA1c (OR 1.06; 95% CI: 1.01-1.12) remained significant. For LV diastolic dysfunction, BMI (OR 1.09; 95% CI: 1.00-1.19) and dyslipidemia (OR 2.54; 95% CI: 1.11-5.72) were associated with LV diastolic dysfunction. CLINICAL IMPLICATIONS:These findings support the importance of cardiovascular risk assessment and targeted prevention strategies in men with ED. STRENGTHS AND LIMITATIONS:A key strength of this study is the large, well-characterized cohort, enabling robust analyses of risk factors for cardiac dysfunction. Its cross-sectional design, however, precludes causal inference. CONCLUSION:Cardiometabolic risk factors are associated with echocardiographic signs of cardiac dysfunction in men with ED. Elevated BMI, diastolic blood pressure, and HbA1c are linked to LV systolic dysfunction, while BMI and dyslipidemia are associated with LV diastolic dysfunction. CLINICAL TRIAL REGISTRATION:The study was prospectively registered at ClinicalTrials.gov (NCT05285280).

AbstractExercise training reduces tumour growth by increasing tumour‐infiltrating T‐cell density in preclinical models. However, it remains unknown whether exercise training can modify intratumoural T cells in humans.The aim of this study was to compare the effects of an exercise training intervention versus control on human prostate intratumoural T‐cell density.This study is a secondary analysis of a randomized controlled trial. We randomly allocated men (age > 18 years) with treatment‐naive localized prostate cancer scheduled for radical prostatectomy 2:1 to exercise training intervention or control. The exercise intervention consisted of supervised, high‐intensity interval bicycling four times per week from the time of randomization until prostatectomy. Intratumoural CD3+ and CD8+ T‐cell densities in diagnostic biopsies and postsurgical prostatectomy specimens were quantified using immunohistochemistry. Between‐group differences in changes from baseline to follow‐up were estimated using constrained baseline linear mixed‐effect models.A total of 30 participants were included (exercise intervention, n = 20; control, n = 10). We found no between‐group differences in changes in CD3+ T cells [mean difference (95% confidence interval): −17 (−185; 150) cells/mm2] or CD8+ T cells [mean difference (95% confidence interval): −16 (−206; 172) cells/mm2]. Additionally, we found no statistically significant correlations between changes in T‐cell density and the number of exercise training sessions attended or changes in maximal oxygen consumption.In this secondary analysis of a randomized controlled trial, we found no impact of the exercise regimen on tumour‐infiltrating CD3+ and CD8+ T‐cell density in human prostate cancer.

BACKGROUND:Seminal phosphate concentrations are markedly higher than serum levels, suggesting a yet uncharacterised role of phosphate transporters in the male reproductive tract. METHODS:Analysis of type II and III phosphate co-transporter (SLC34A1-3/NPT2a-c, SLC20A1-2/PIT1-2) expression was conducted in prostate, seminal vesicle, and epididymis from wildtype mice fed normal or high-phosphate diet, mice treated with a NPT2a-inhibitor, Global Fgf23 knockout mice, and in human tissues. Seminal phosphate concentrations and semen quality were examined in 301 healthy men. FINDINGS:Phosphate transporters are expressed in a zone-specific manner in the mouse epididymis and prostate. Elevated serum phosphate increased the expression of Slc34a1 (466 ± 24 vs. 1 ± 0.3, p < 0.05), Slc34a2 (54 ± 26 vs. 1 ± 0.2, p < 0.05), Slc34a3 (5 ± 0.3 vs. 1 ± 0.8, p < 0.001) and Slc20a1 (37 ± 18 vs. 1 ± 0.3, p < 0.05) to maintain a stable epididymal phosphate concentration. In contrast, prostatic phosphate concentrations increased (6.0 ± 0.4 vs. 4.5 ± 0.4, p < 0.05) with no change in expression of phosphate transporters except for lower Slc34a3 (0.1 ± 0.04 vs. 1 ± 0.4, p < 0.05). Hyperphosphatemic Fgf23 knockout mice had higher Slc20a2 expression (5.1 ± 1.1 vs. 1 ± 0.4, p < 0.05), while inhibition of NPT2a reduced phosphate concentrations specifically in caput epididymis (15 ± 0.1 vs. 19 ± 0.7, p < 0.001). Human epididymis, prostate and seminal vesicle showed distinct region-specific expression of phosphate-transporters with an abundant SLC34A2 expression in seminal vesicle. In healthy men, high seminal phosphate was positively linked with sperm concentration, motile sperm count, morphologically normal sperm (all, p < 0.05) and serum testosterone (p < 0.01). INTERPRETATION:This study shows distinct expression and regulation of phosphate transporters in the epididymis, prostate and seminal vesicle. Moreover, both systemic and local phosphate concentrations may be of importance for reproductive organ function and semen quality. FUNDING:This study was supported by funding from the Novo Nordisk Foundation, Denmark; Independent Research Fund Denmark, Denmark; Cleveland Foundation, UK; Beckett-Fonden, Denmark; Brødrene Hartmanns Fond, Denmark; Innovation Fund Denmark, Denmark.

Androgen deprivation therapy (ADT) and androgen receptor pathway inhibitors (ARPIs) are cornerstones in the treatment of prostate cancer (PC), but are associated with adverse cardiovascular effects. The objective of this work was to systematically review and analyse cardiac structure and function in PC patients undergoing therapy with ADT or ARPIs as assessed with echocardiography. The work was pre-registered with Prospero (CRD42024539717). We searched PubMed/Medline, Ovid/Embase, Cochrane Library, and Google Scholar on January 7th, 2025. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 were followed. Studies with PC patients treated with ADT or ARPI, compared to baseline, and assessed with echocardiography were included. Quality was assessed using the Newcastle–Ottawa Scale and Risk of Bias 2. Mean differences in echocardiographic measurements during treatment compared to baseline were assessed in meta-analyses. Six studies (three prospective cohort studies, one retrospective cohort study, and two randomised trials) with 560 patients all examining the influence of ADT on echocardiographic parameters were included in the meta-analysis, which showed a reduction in left ventricular (LV) ejection fraction (− 2.32

BACKGROUND AND OBJECTIVE:Testosterone deficiency (TD) affects 18-38% of men undergoing radical prostatectomy (RP) for localised prostate cancer and may impair postoperative sexual rehabilitation. Testosterone replacement therapy (TRT) may improve sexual function and is assumed to be oncologically safe following RP, though evidence is based on nonrandomised, retrospective studies. The ENFORCE study evaluates the effects of TRT on sexual function recovery and on biochemical recurrence (BCR) following RP in men with TD. CLINICAL TRIAL DESIGN AND TIME FRAME:The ENFORCE study is a phase 3, multicentre, randomised, single-blind, placebo-controlled trial being conducted at ten Dutch centres. Eligible patients with TD (total testosterone <8 nmol/l, or total testosterone 8-12 nmol/l with free testosterone <225 pmol/l) and minimal preserved erectile function (Expanded Prostate Cancer Index Composite 26 [EPIC-26] sexual domain ≥40) undergoing RP are randomised to receive TRT or placebo from 6-12 wk after RP until 1 yr after RP. ENDPOINTS:The primary endpoint is sexual function at 12 mo (EPIC-26 sexual domain). The secondary endpoints include sexual function at 6 and 24 mo, and quality of life, and hormonal and urinary function at 12 and 24 mo, assessed by the EPIC-26 and Aging Males' Symptoms questionnaires. BCR is evaluated at 12, 24, and 60 mo. DATA SOURCES AND STATISTICAL ANALYSIS:Outcomes include patient-reported outcomes and laboratory results. Linear regression will assess the effect of TRT on sexual function, adjusting for baseline variability. STRENGTHS AND LIMITATIONS:Strengths include the randomised design and long-term follow-up. Limitations include potential recruitment challenges due to specific inclusion criteria, limited to men with TD and minimal preserved sexual function. FUNDING:This work was supported by KWF Dutch Cancer Society, Besins Healthcare, and Canisius Wilhelmina Hospital Research Fund. ETHICS AND TRIAL REGISTRATION:This trial was approved by the Medical Research Ethics Committee Oost-Nederland (ClinicalTrials.gov, NCT04833426). PATIENT SUMMARY:For men with low testosterone undergoing surgery for prostate cancer (radical prostatectomy), testosterone replacement therapy (TRT) may improve recovery of sexual function and general well-being. The ENFORCE trial investigates whether TRT indeed improves sexual recovery after prostate cancer surgery and whether it can be administered safely. Although TRT is generally believed to be safe, this is based on small or potentially biased studies, and has never been investigated in a large clinical trial. Some concerns remain that TRT increases the risk of prostate cancer recurrence. The results of this trial may provide answers about the benefits and safety of TRT after prostate cancer surgery.

Lower limb edema (LLE) is characterized by swelling due to fluid accumulation and is an under-recognized condition in men with prostate cancer. This study investigated the prevalence of LLE and explored its impact on daily living, depression, and health-related quality of life (HRQoL). This cross-sectional study included men with prostate cancer who attended follow-up at the Department of Urology, Rigshospitalet, Denmark, during a 3-month period. LLE was defined as an L-Dex ≥ 10, measured by using bioimpedance spectroscopy, combined with self-reported symptoms (≥ 2 of heaviness, swelling, or tightness) using items from European Organisation for Research and Treatment of Cancer Quality of Life (EORTC) QLQ-VU34. HRQoL, depression, and the impact of LLE on daily living were assessed using self-reported questionnaires. Among 401 patients, LLE was identified in 45 (11

BACKGROUND:Guidelines recommend biopsies for men <50 years with testicular microlithiasis and cancer risk factors to rule out germ cell neoplasia in situ. Limited data support this practice. OBJECTIVES:To clarify the significance of testicular microlithiasis by examining pathological findings in men with testicular microlithiasis. MATERIALS AND METHODS:We reviewed charts of men diagnosed with testicular microlithiasis at a tertiary referral center from 2013 to 2023. Patient characteristics, clinical findings, and cancer risk factors including testicular hypotrophy (volume ≤12 mL), infertility, and cryptorchidism were recorded. Men with unknown fertility were offered semen analyses. Histological findings from testicular biopsies and subsequent cancers were noted. Primary endpoints were rates of germ cell neoplasia in situ and testicular cancer diagnoses. RESULTS:We included 334 men (median age 33 years, range 16-73 years): 27 had testicular hypotrophy, 18 infertility, 25 cryptorchidism, and 56 multiple risk factors. The remaining 208 men had no apparent risk factors. Of these 36 were had reduced semen quality. Overall, 137 of 334 men (41%) underwent biopsies, with germ cell neoplasia in situ in 10 cases (7.3%, 95% confidence interval 3.6%-13%). Four had multiple risk factors (hypotrophy and infertility in two; hypotrophy, infertility, and cryptorchidism in two), three had hypotrophy alone, one had infertility, and two had reduced semen quality. Germ cell neoplasia in situ was unilateral in all cases and only found in testicles with testicular microlithiasis. Unilateral orchiectomy was performed in all germ cell neoplasia in situ cases, with hypotrophy found in all but one. Over a median follow-up of 4.7 years (range 1.16-11.49 years), testicular cancer developed in three men (0.9%, 95% confidence interval 0.19%-2.6%). DISCUSSION:Germ cell neoplasia in situ was only detected in cases with both testicular microlithiasis and testicular hypotrophy, and the rate of subsequent cancer development was low. This suggests that testicular microlithiasis alone does not increase cancer risk in otherwise morphologically normal testicles. CONCLUSION:Biopsies should only be considered in men with incidental testicular microlithiasis if the testicular size is reduced.

Erectile dysfunction (ED) is recognized as an early marker for cardiovascular disease yet the specific clinical characteristics that correlate with cardiac dysfunction remain unclear. We aimed to identify risk factors of cardiac dysfunction in men with ED. In this cross-sectional study, men with ED were included from a Urology outpatient clinic, and via invitations sent to randomly selected men >40 years. Echocardiography assessed left ventricular (LV) systolic and diastolic dysfunction. Data on age, body mass index (BMI), blood pressure, lipid profile, hemoglobin A1c (HbA1c), high-sensitivity C-reactive protein (hs-CRP), and cardiovascular comorbidities were analyzed for associations with cardiac dysfunction. Among 398 men, the univariable analysis showed that BMI, diastolic blood pressure, and hs-CRP were associated with increased odds of LV systolic dysfunction (OR per 1 kg/m2: 1.08, OR per 1 mmHg: 1.03, OR per 1 mmol/L: 1.28, respectively). In multivariable analysis, BMI, diastolic blood pressure, and HbA1c were independently associated with LV systolic dysfunction, with ORs of 1.08 (95% CI: 1.01-1.15), 1.04 (95% CI: 1.01-1.07), and 1.06 (95% CI: 1.01-1.12), respectively. Additionally, BMI and dyslipidemia were associated with LV diastolic dysfunction (OR: 1.09 [95% CI 1.00-1.19] and OR: 2.54 [95% CI: 1.11-5.72], respectively). Cardiometabolic factors contribute to cardiac dysfunction in men with erectile dysfunction. Elevated BMI, diastolic blood pressure, and HbA1c are associated with LV systolic dysfunction, while BMI and dyslipidemia are associated with LV diastolic dysfunction, possibly driven by chronic inflammation. This underscores the need for targeted management of cardiovascular risks in this high-risk population. The authors declare no conflicts of interest.

Men with metastatic prostate cancer are at an increased risk of metabolic syndrome, cardiovascular disease, and pathological fracture. The latter is both attributed to the cancer itself, bones are the most common site of metastases in prostate cancer, as well as the treatment with androgen deprivation therapy. Exercise therapy has been shown to be beneficial, but with uncertainty about its safety, applicability, and suitability for patients with prostate cancer and bone metastases. In these patients, we aim to investigate the safety and efficacy of exercise therapy that specifically targets bone in terms of bone density in the legs. This blinded, randomized, controlled trial will include 102 patients with prostate cancer and bone metastases. Participants will be assigned to a supervised 32-week high-intensity progressive resistance and impact training program (intervention group) or standard treatment including a municipal 12-week standard training program, if desired (control group). Primary outcomes are changes in physical capacity and lower extremity strength measured by the 30-s Chair Stand Test. Secondary outcomes include bone mineral density and body composition, physical function, quality of life, safety (i.e., adverse events and pain), hospitalizations, physical activity, falls, feasibility, and patient experiences. Data will be collected at baseline, midway intervention (16 weeks), post-intervention (32 weeks), and follow-up (44 weeks). This study is the first to examine a long-term high-intensity progressive resistance and impact training in patients with prostate cancer and bone metastases. While exercise recommendations for these patients have typically been cautious, high-intensity progressive resistance and impact training has demonstrated safety and benefit in patients with osteoporosis. This research will shed light on the efficacy and safety of progressive resistance and impact training in patients with prostate cancer and bone metastases, potentially improving treatment-related side effects and quality of life. This trial is approved by the Regional Ethics Committee for the Capital Region of Denmark (J.nr.:H-23015286) and by the Danish Data Protection Agency (j.nr.: P-2023–2018). The study was prospectively registered at ClinicalTrials.gov on February 24, 2024 (ID: NCT06259279).

OBJECTIVES:To assess the prevalence of myocardial impairment in men with erectile dysfunction (ED) as compared with the general population using conventional and two-dimensional speckle-tracking echocardiography. SUBJECTS AND METHODS:In this cross-sectional study, men with ED underwent clinical, electrocardiographic, and transthoracic echocardiographic evaluation including left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) according to a predefined protocol. All participants were matched 1:1 with controls from the general population on sex, age, and body mass index (BMI). RESULTS:In total, 796 people were included, 398 men with ED and 398 controls. The ED group had a median (interquartile range [IQR]) age of 61 (53-70) years and a median (IQR) BMI of 26.3 (24-29) kg/m2. Left ventricular (LV) systolic dysfunction was found in 232 (58.3%) men with ED compared to 102 (25.6%) controls (P < 0.001). Nineteen (4.8%) men with ED were referred for further cardiovascular evaluation. CONCLUSION:More than half of men with ED exhibited signs of cardiac dysfunction, particularly LV systolic dysfunction. Further research should explore the long-term prognostic implications of these findings.

Objective To explore how the use of the ProPep® Nerve Monitoring System (ProPep Surgical, Austin, TX, USA) for intraoperative specific sparing of the pudendal nerve fibres influences postoperative functional outcomes after unilateral nerve‐sparing (UNS) or non‐nerve‐sparing (NNS) robot‐assisted radical prostatectomy (RARP). Patients and methods We randomised 100 men undergoing UNS or NNS RARP to ProPep nerve monitoring during RARP (intervention) or standard of care RARP (control). Functional outcomes were assessed at 3, 6, and 12 months using the International Consultation on Incontinence Questionnaire Short Form (ICIQ‐SF), the International Prostate Symptom Score, the Danish Prostate Symptom Score, the International Index of Erectile Function, the Erection Hardness Scale, and 24‐h pad tests. The primary outcome was the difference in ICIQ‐SF score between the groups at 12 months. Secondary outcomes included differences in the remaining outcome measures and continence rates at all time points. Continence was defined as the use of no pads and the answer ‘Never’ to the question: ‘How often do you experience urinary incontinence?’ or a urine loss of <8 g on the 24‐h pad test. Results A total of 82 patients were included in the per‐protocol analysis at 12 months with 41 in each group. At 12 months the mean ICIQ‐SF scores were 5.37 (95% confidence interval [CI] 3.71–7.03) and 5.66 (95% CI 4.05–7.27) for the intervention and control groups, respectively ( P = 0.8). There were no statistically significant differences in any of the remaining outcomes. However, the continence rate was higher in the intervention group at 6 months (63% vs 44%, P = 0.09). Conclusions Intraoperative nerve monitoring did not result in better functional outcomes following UNS or NNS RARP. Larger studies are needed to explore if ProPep can reduce the time to continence after RARP.

Abstract Objectives Men with erectile dysfunction (ED) are at elevated risk of heart disease. However, data on the prevalence of abnormal cardiac structure and function in ED is scarce. We utilized echocardiography to assess cardiac characteristics in men with ED. Methods In this prospective cohort study of men with ED referred to a tertiary urology clinic, all participants underwent transthoracic echocardiography following a predefined protocol and electrocardiogram. Erectile function was graded according to the International Index of Erectile Function - Erectile Function (IIEF-EF) questionnaire. Participants with neurological disease, a medical history of pelvic surgery or trauma were excluded. Left ventricular (LV) structure was evaluated by ventricular mass index (LVMi). LV diastolic function was evaluated according to early diastolic mitral annular velocity (e'), ratio of early transmitral filling velocity to (E/e’) and left atrial volume index (LAVi). LV systolic function was evaluated by LV ejection fraction (LVEF), and global longitudinal strain (GLS). Results We included 100 patients with a median age of 61 yr (IQR 13) and median IIEF-EF was 15 (IQR 14). Comorbidities included hypertension (43%), dyslipidemia (41%), diabetes mellitus (29%), ischemic heart disease (12%), arrhythmia (12%), and heart failure (3%). Regarding cardiac structure, 25 patients had LV hypertrophy. Signs of LV diastolic dysfunction were a common observation; 21 patients had an E/e' ratio > 9, while 30 patients had reduced septal and/or lateral e' velocities with only 1 patient having left atrial dilation (LAVi > 34 ml/m2). Regarding LV systolic dysfunction, 83 patients had reduced GLS (< 16%) with 14 suffering reduced LVEF < 52%. 4 patients were referred for further evaluation, due to previously undiagnosed left bundle branch block, mitral valve regurgitation, aortic valve regurgitation, and incident heart failure, respectively. Conclusions A majority of patients with ED demonstrated impairment of cardiac structure and function assessed by measures of diastolic dysfunction and myocardial deformation. Conflicts of Interest The authors declare no conflict of interest.

AbstractBackgroundDue to increasing older populations worldwide, injuries, disabilities and deaths caused by falls among the elderly represent a growing human and societal problem. We aimed to improve health among men of at least 70 years of age with low‐normal to low testosterone and mobility problems by using testosterone undecanoate (TU) injections, progressive strength training, and oral supplements of vitamin D, calcium and protein.MethodsThis was a single‐centre, randomized, placebo‐controlled, double‐blind trial with 148 older men with a median age of 77 (73–81) years, testosterone levels at median 8 (5–9) nmol/L (full range from 1.1 to 12.9 nmol/L) and mobility problems, recruited at University Hospital of Copenhagen, Herlev Hospital, Denmark. Participants were randomized into four arms for 20 weeks: (1) TU therapy (n = 37); (2) progressive resistance training with supplements of calcium, vitamin D and protein (n = 36); (3) both interventions combined (n = 36); or (4) no intervention (n = 39). The main outcome measure was the 30‐s chair stand test, due to test performance correlating with the risk of serious fall injuries and lower extremity muscle strength. Outcome measurements were performed at baseline and after 20 weeks.ResultsAfter the intervention, the combination group receiving progressive resistance training, TU and supplements achieved a median score of 13 (11–15) compared to the control group at 10 (0–14) in the 30‐s chair stand test (P = 0.003). This median improvement of 3.0 was clinically important. Compared to the control group, participants in the combination group also increased quality of life (P < 0.05) and reduced both tiredness (P < 0.05) and leg fat (P < 0.05) and had higher variability in the RR interval (P < 0.01). The group receiving TU reduced gynoid and leg fat compared to the control group (both P < 0.05). Blood tests improved for several variables, especially in the combination group. There was no statistically significant increase in adverse effects from either the supplements or training.ConclusionsIn men ≥70 years old with low‐normal to low testosterone and mobility problems, supplements of testosterone, calcium, vitamin D and protein combined with progressive resistance training improved 30‐s chair stand test performance, muscle strength and quality of life. Both tiredness and leg fat were reduced, and RR interval variability was increased. Significant adverse effects were not observed.

OBJECTIVE:To investigate the association between pre- and postoperative magnetic resonance imaging (MRI) measurements of the membranous urethra and the prostate volume and continence following robot-assisted radical prostatectomy (RARP). PATIENTS AND METHODS:From December 2018 to June 2022, 100 continent patients undergoing unilateral nerve-sparing or non-nerve-sparing RARP were included in this cohort study. Bi-parametric MRI scans were performed before and 12 months after RARP and measurements included the membranous urethral length (MUL) measured in cm (mMUL) and in the number of image slices (sMUL; 3 mm/slice), the membranous urethral diameter (MUD), and the prostate volume. Urinary function was evaluated by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and continence, defined as the use of zero pads and the answer 'never' to the ICIQ-UI SF question regarding incontinence frequency or <8 g urine-loss per 24 h. Regression with robust variance estimates was used to analyse the association between measurements and outcomes. RESULTS:At 12 months, continence and MRI data were available for 82 patients. The continence rate was 63% and the median (interquartile range) ICIQ-UI SF score was 4 (0-9). Both preoperative MUL measurements were associated with continence at 12 months. Every extra 5 mm of MUL increased the likelihood of being continent by 13 percentage points (P = 0.03) and every additional slice of sMUL increased it by 6 percentage points (P = 0.05). Both postoperative MUL measurements were associated with better continence and lower ICIQ-UI SF scores (P < 0.01). A larger prostate volume was associated with urinary incontinence at 12 months, with a small effect size. The MUD was not associated with continence. CONCLUSION:Preoperative mMUL and sMUL are associated with continence at 12 months after RARP. The sMUL may be a useful measurement when only the axial plane is available, and the slice gap is known. Postoperative MUL measurements are strongly associated with continence, while MUD and prostate volume hold minimal prognostic value.