A case-control study of prostatic cancer with reference to dietary habits

A case-control study of prostatic cancer which consisted of 100 patients with prostatic cancer, matched for hospital, age (+/- 3 yr) and hospital admission date (+/- 3 months) to patients with benign prostatic hyperplasia (BPH) and hospital controls, was conducted from 1981 to 1984. Low daily intake of beta-carotene (RR = 2.13: 95% confidence interval, 1.20-3.77) and of vitamin A (RR = 1.94: 1.10-3.43), as compared to the intake of those substances by BPH controls, were factors significantly correlated with the development of prostatic cancer. Low daily intake of beta-carotene (RR = 2.13: 1.20-3.77), as compared with hospital controls, were significantly correlated with prostatic cancer development. Infrequent intake of bread (RR = 2.40: 1.31-4.38), intended to represent a westernized diet, and of spinach (RR = 1.96: 1.01-7.73), a typical green and yellow vegetable, as compared to BPH controls and infrequent intake of spinach (RR = 4.55: 1.82-11.11) as compared to by hospital controls, were significant risk factors for prostatic cancer. Intake of carbohydrates, protein, fat, total calories, fibers, vitamin B and vitamin C were not correlated with the development of prostatic cancer.     

A case-control study of prostatic cancer in Kyoto, Japan: sexual risk factors

A case-control study on prostatic cancer was conducted in Kyoto, Japan, from 1981-1984, including 100 patients with prostatic cancer (PC) and age, hospital, and date-of-admission matched controls of benign prostatic hyperplasia (BPH) patients and general hospital patients. Analysis of several sexual factors obtained through a self-administered questionnaire revealed the following observations: 1) cancer patients had fewer sex partners before marriage (relative risk, RR = 0.35; 95% confidence interval: 0.13-0.93) than the hospital controls; 2) they had more vigorous sexual activities in the third (RR = 2.89; 1.01-8.28) and fourth decades of life (RR = 2.26: 1.03-4.95) than hospital controls, but no significantly different sexual activities from controls in other decades; 3) they had less frequent orgasms (RR = 2.55; 1.11-5.83) than BPH controls or (RR = 4.96: 1.78-13.9) hospital controls, and sexual intercourse appeared to be less satisfactory (RR = 2.08: 1.05-4.13) than that of hospital controls; and 4) they had less frequent episodes of sexually transmitted diseases (RR = 0.36: 0.16-0.83) than BPH controls. Marital status, fertility, ejaculation, masturbation, nocturnal emission, contraceptive use, and wife's episodes of sexually transmitted disease were not linked to prostatic cancer risk.     

High-risk group for benign prostatic hypertrophy

A case control study was conducted on 100 patients with benign prostatic hypertrophy (BPH) and 100 controls matched by age and residence. Interviews were performed by well-trained urologists using an original questionnaire. Matched-pair analysis revealed the following characteristics and relative risks (RR) as being significantly (P less than 0.05) different among the BPH patients versus the controls: higher educational background (RR = 2.77); not engaged in farming, forestry, or fishing (RR = 4.82); no environmental pollution at work (RR = 2.90); a present annual income of more than 2,400,000 yen (RR = 3.84); a previous annual income of more than 2,400,000 yen (RR = 3.82); practice the highest standard of living (RR = 4.24); more than two children (RR = 2.67); experienced first nocturnal emission before reaching the age of 20 (RR = 3.11); expanding more than 10 min to complete one act of sexual intercourse (RR = 2.43); having no episode of sexual impotence that lasted more than 1 month (RR = 2.29); no family history of gastric ulcer (RR = 7.98); no family history of breast cancer (RR = 8.25); regular consumption of milk (RR = 2.25); irregular consumption of green and yellow vegetables (RR = 3.91); and pickles not consumed at every meal (RR = 1.99). Characteristics that did not achieve a high level of statistical significance (0.05 less than P less than 0.10) between cases and controls were as follows: past history of gonorrhea, urethritis, or prostatitis and syphilis (RR = 1.84, 2.76, and 4.26, respectively), and daily meat consumption (RR = 3.18). On the basis of interviews of the patients and cases reported in this study, we conclude that dietary and sexual habits may be important factors which place individuals at a higher risk for developing BPH.     

非那雄胺对前列腺癌发生率及病理分级的影响

目的:评估非那雄胺对中国人前列腺癌发病率及病理分级的影响.方法:将1 029例BPH患者根据其药物治疗的方法分为非那雄胺组、α-受体阻滞剂组、联合用药组及对照组(未治疗组).收集四组患者的穿刺病理资料,重新行Gleason评分.对四组患者前列腺癌发病率及前列腺癌病理分级的差异进行分析.结果:①前列腺癌总发病率为13.51%;应用非那雄胺组与未应用非那雄胺组比较差异有统计学意义(P<0.05),发病率相对下降40.63%(RR=0.59,95%CI:0.43～0.82).②前列腺癌患者病理分级为中高级(Gleason≥7分)者占58.27%,应用非那雄胺组与未应用非那雄胺组比较差异有统计学意义(P<0.05),中高级分化前列腺癌相对增多33.96%(RR=1.34,95%CI:1.01～1.76).结论:非那雄胺治疗BPH虽能降低前列腺癌的发病风险,但同时能使发生前列腺癌的病理级别增高.     

Insulin-like growth factors and risk of benign prostatic hyperplasia

BACKGROUND: Insulin-like growth factors (IGFs) have potent growth mitogenic and anti-apoptotic effects on prostate tissue, whereas IGF binding proteins (IGFBPs) inhibit growth of prostatic tissue. The IGF axis has been implicated in prostate cancer risk, but its role in benign prostatic hyperplasia (BPH) is unclear. METHODS: Plasma levels of IGF-I, IGF-II, IGFBP-1, and IGFBP-3 were determined from the fasting bloods of 206 BPH cases admitted for treatment and 306 randomly selected population controls in Shanghai, China. RESULTS: Relative to the lowest tertile, men in the highest tertile of IGF-I levels had a significantly elevated risk of BPH (odds ratio [OR] = 2.80, 95% confidence interval [95% CI] = 1.60-4.92; P(trend) < 0.001). Results for IGF-I were more pronounced after adjustment for serum androgens. In contrast, men in the highest IGFBP-3 tertile had a significantly reduced risk (OR = 0.40; 95% CI = 0.23-0.69; P(trend) < 0.001). No associations of BPH with IGF-II and IGFBP-1 were observed. CONCLUSION: As has been previously observed for prostate cancer, we found that IGF-I and IGFBP-3 are associated with BPH risk in China. Further investigation is needed to elucidate the role of the IGF axis in BPH etiology.     

Obesity in relation to prostate cancer risk: comparison with a population having benign prostatic hyperplasia

OBJECTIVE: To analyse the relationship between obesity and prostate cancer, when compared with men with benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: The records were reviewed of consecutive patients with histologically confirmed prostate cancer admitted for prostate surgery between January 1993 and February 1999. Controls were selected from patients who were hospitalized at the same time for the surgical treatment of BPH. One control was matched to each case by age. Obesity was defined as a body mass index (BMI) of> 29 kg/m2. RESULTS: The study included 194 cases and 194 controls; their median (range) age at operation was 69.5 (50-88) years in both groups, and the BMI 26.1 (16.6-38.1) kg/m2 in the cancer and 25.7 (15.1-36.8) kg/m2 in the BPH group. The difference between the groups was not significant (P = 0.06). Obesity was significantly associated with prostate cancer, with an odds ratio (95% confidence interval) of 2.47 (1.41-4.34). Cases with advanced disease had a higher BMI than those with localized disease, but when age was considered the difference was not significant. CONCLUSION: In general the BMI was not significantly associated with prostate cancer when compared with men having BPH. However, obese men had 2.5 times the risk of having prostate cancer.     

Treatment of benign prostatic hyperplasia and occurrence of prostatic surgery and acute urinary retention: a population-based cohort study in the Netherlands

OBJECTIVES: To assess and compare the risk of prostatic surgery in (subsets of) patients with a diagnosis of BPH. We sought to expand on data of an earlier pharmacy-based study by obtaining more information on BPH disease parameters by using a Dutch GP-based research database. METHODS: A retrospective cohort study (1994-mid-year 2002) was conducted among 1430 men aged > or =45 years with > or =6 months of registration with the GP. BPH case identification was based on review of medical records. RESULTS: Overall, we found that there was no difference in the risk of prostatic surgery between patients on medical treatment and watchful waiting. Patients using 5alpha-reductase inhibitors (5-ARIs) at any stage had a statistically significant reduced risk of surgery compared to patients using alpha-blockers only: adjusted hazard ratio 0.35 (95%CI: 0.13-0.96). The routine collection of BPH parameters were insufficient to be useful in the analysis. CONCLUSION: Patients using 5-ARIs seemed to have a reduced risk of prostatic surgery compared to patients using alpha-blockers. However, it was unknown whether the disease profile of 5-ARI users is different compare to non-5-ARI-treated and untreated patients with BPH, as detailed medical information necessary to characterise patients according to the BPH disease severity and development of disease parameters is not routinely recorded by GPs.     

Significance of vitamin D receptor gene polymorphism for risk and disease severity of prostate cancer and benign prostatic hyperplasia in Japanese

OBJECTIVE: Recent studies have demonstrated an association between vitamin D receptor (VDR) genotype and prostate cancer. Currently, there is a scarcity of data regarding the association of VDR genotype with benign prostatic hyperplasia (BPH). The purpose of this study was to investigate the TaqI VDR polymorphism in Japanese prostate cancer patients, Japanese BPH patients and Japanese controls in order to determine if an association exists between VDR genotype and the risk of developing prostate cancer and BPH as well as disease severity. METHODS: 110 prostate cancer patients, 83 BPH patients and 90 male age-matched controls were genotyped for a previously described TaqI restriction fragment length polymorphism at codon 352 in exon 9 of the VDR gene. Products were digested into T allele or t allele according to the absence or presence of a TaqI restriction site with individuals being classified as TT, Tt or tt. RESULTS: The frequency of the genotype tt was higher in the control group (6.7%) compared to patients with prostate cancer (1.8%) and BPH (3.6%) but this was not statistically significant. However, the frequency of the genotype TT was significantly higher among prostate cancer patients with locally advanced or metastatic disease (T3/ T4/N1/M1) compared to controls (p = 0.001). In addition, the genotype TT was significantly higher among prostate cancer patients with a high Gleason grade of tumor (grade 5) compared to controls (p = 0.0001). In addition, the genotype TT was statistically higher in BPH patients with high prostate volume (volume >50 cm(3)) compared to controls (p = 0.001). CONCLUSION: These data demonstrate that VDR genotype plays an important role in determining the risk of more advanced and aggressive prostate cancer as well as prostatic enlargement in Japanese men.     

机器人辅助腹腔镜与传统腹腔镜行胰腺癌手术的Meta分析

目的本研究旨在系统评价机器人辅助腹腔镜手术在胰腺癌手术治疗中应用的可行性与安全性,为临床研究与实践提供参考。 方法计算机检索PubMed、中国知网和万方,同时辅以其他检索,收集所有机器人辅助腹腔镜和传统腹腔镜应用于胰腺癌手术治疗的比较研究。按照Cochrane系统评价纳入文献的质量,利用Stata 12.0软件对提取的相关指标进行Meta分析。 结果8篇文献纳入Meta分析,包含682例胰腺癌患者,其中机器人辅助治疗组292例,传统腹腔镜组390例。Meta分析结果表明：与传统腹腔镜手术相比,机器人辅助腹腔镜手术能够减少术中出血量(SMD＝－0.670,95%CI＝－1.012,－0.329),降低输血率(RR＝0.457,95% CI＝0.245,0.854)和术中转开腹率(RR＝0.612,95%CI＝0.348,0.974),提高保脾率(RR＝2.331,95% CI＝1.599,3.398),缩短术后住院时间(SMD＝－0.230,95% CI＝－0.433,－0.027),并且能够减少术后并发症(RR＝0.643,95%CI＝0.451,0.917)和再次手术率(RR＝0.766,95%CI＝0.258,2.268)。但是,二者的手术时间和术后胰瘘率无显著性差异。 结论机器人辅助腹腔镜手术相对于传统腹腔镜手术,术中出血量少,转开腹率低,保脾率高,并发症少,再次手术率低,可以安全有效地治疗胰腺癌。     

Association of V89L SRD5A2 polymorphism with prostate cancer development in a Japanese population

PURPOSE: The SRD5A2 gene codes the steroid 5-reductase type II, a critical mediator of androgen action, and the V89L and A49T polymorphisms of this gene may be associated with a distinct enzyme activity. We explored the association among these polymorphisms and the risk of prostate cancer or benign prostatic hyperplasia (BPH) in a Japanese population. MATERIALS AND METHODS: This study included 302 patients with prostate cancer, 228 with BPH and 243 male controls. V89L and A49T polymorphisms were analyzed by the polymerase chain reaction restriction fragment length polymorphism method. Genotypes were evaluated by electrophoresis on agarose gel. RESULTS: For the V89L polymorphism there were no significant differences in genotype frequencies in patients with prostate cancer and controls (p = 0.071) or in patients with BPH and male controls (p = 0.219). However, males with the VV or VL genotype were at significantly increased risk for prostate cancer compared with those with the LL genotype (adjusted OR 1.69, 95% CI 1.07 to 2.65, p = 0.024). The risk of BPH in males with the VV or VL genotype was not significantly elevated in comparison with those with the LL genotype (adjusted OR 1.37, 95% CI 0.85 to 2.20, p = 0.194). The V89L variant was not associated with the grade or stage of prostate cancer, or with patient age. For the A49T polymorphism all subjects had the AA genotype. CONCLUSIONS: The V allele of the V89L polymorphism in the SRD5A2 gene may dominantly increase the risk of prostate cancer.     

Alfuzosin 10 mg once daily prevents overall clinical progression of benign prostatic hyperplasia but not acute urinary retention: results of a 2-year placebo-controlled study

OBJECTIVES: To evaluate the effect of alfuzosin 10 mg once daily administered for 2 years on progression events in men with lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH). PATIENTS AND METHODS: In all, 1522 men at risk of having progression events from LUTS/BPH were randomized to receive alfuzosin 10 mg once daily (759) or placebo (763) for 2 years. Endpoints assessed were the occurrence of a first episode of acute urinary retention (AUR; primary) and the need for BPH-related surgery. Post hoc analyses included a deterioration in the International Prostate Symptom Score (IPSS) of > or = 4 points and overall clinical progression of BPH (occurrence of AUR and/or surgery and/or symptom deterioration). RESULTS: Over 2 years, symptom deterioration was the most common progression event (14.3%), followed by BPH-related surgery (5.8%) and AUR (2.0%). Alfuzosin did not reduce the risk of AUR (alfuzosin 2.1% vs placebo 1.8%, P = 0.82) but tended to reduce the risk of surgery (5.1% vs 6.5%, P = 0.18); the reduction in risk (RR) and 95% confidence interval with alfuzosin was 22 (-18 to 48)%; and significantly reduced the risk of symptom deterioration (11.7% vs 16.8%; P = 0.0013); the RR was 30 (10-46)%. The overall clinical progression of BPH was significantly lower with alfuzosin than with placebo (16.3% vs 22.1%, P < 0.001); RR 26 (9-40)%. Alfuzosin also significantly improved the IPSS (P = 0.017), quality of life (P < 0.001) and peak flow rate (P = 0.001) compared with placebo. Baseline levels of prostate-specific antigen (PSA) predicted both AUR and BPH-related surgery events, while the baseline postvoid residual urine volume predicted symptom deterioration. The incidence of adverse events with alfuzosin was comparable to that with placebo. CONCLUSIONS: Alfuzosin 10 mg once daily prevents the overall clinical progression of BPH, defined by the occurrence of a deterioration in IPSS of > or = 4 points and/or AUR and/or BPH-related surgery, but does not reduce the primary occurrence of AUR. Alfuzosin significantly improves LUTS and quality of life over 2 years, and is well tolerated.     

Surgery for stomach cancer in a defined Swedish population: current practices and operative results. Swedish Gastric Cancer Study Group.

OBJECTIVE: To study routine surgical in-hospital care, and to relate postoperative morbidity and mortality to age, sex, tumour stage, operation done, and surgical workload of the hospital. DESIGN: Prospective population-based study. SETTING: All hospitals that diagnosed new cases of stomach cancer in five counties in central and northern Sweden, 1 February 1989-31 January 1995. PATIENTS: All 1024 patients diagnosed as having a new adenocarcinoma of the stomach. RESULTS: The stomach cancer was in such an advanced stage at diagnosis that only half of the patients could be offered a potentially curative operation. The tumour was resectable in 632 patients (62%). Distal gastric resection was done for 359 (57%) and total gastrectomy in 259 (41%) of all the resected cases. Postoperative complications occurred in 250 patients (31%). In multivariate analyses the relative risk (RR) for postoperative complications increased to 2.3 (95% confidence interval [CI] = 1.3 to 4.3) in patients over 79 years of age compared with those under 60. The corresponding RR for postoperative death was 5.1 (95% CI = 2.0 to 12.7) in patients over 79 years. Total gastrectomy combined with splenectomy and distal pancreatectomy carried the highest postoperative morbidity (RR = 3.3) and mortality (RR = 3.7) compared with distal gastrectomy. CONCLUSION: There was no difference in postoperative morbidity or mortality among different types of hospital categories. Surgical treatment of stomach cancer still carries a substantial morbidity and mortality in an unselected series of patients, particularly among elderly patients.     

Study of the association between ischemic heart disease and use of alpha-blockers and finasteride indicated for the treatment of benign prostatic hyperplasia

OBJECTIVE: Given the high possibility of co-occurrence of benign prostatic hyperplasia (BPH) and cardiovascular disease, we evaluated whether patients using BPH drugs are at an increased risk of acute hospital admission for ischemic heart disease (IHD). METHODS: A nested case control study within a cohort of 4414 men (aged > or =30 years) who had a history of using BPH products between 1992 and 1998 was conducted. Cases were defined as men with a first record of an acute hospital admission for IHD during the study period; three controls were matched to each case on year of birth, pharmacy and calendar time (index date). RESULTS: The study population comprised 220 cases and 515 controls. Current use of alpha-blockers (adjusted odds ratio 1.0, 95% confidence interval: 0.5-2.2) or finasteride (adjusted odds ratio 0.3, 95% CI: 0.1-1.4) was not associated with hospital admission for IHD. Furthermore, current use of BPH drugs was not associated with IHD in patient subgroups (age, history of cardiovascular disease, diabetes), nor with duration of use prior to hospitalization. CONCLUSION: Although the power of the study was low, we found no evidence for an association between current use of BPH drugs and hospital admission for IHD. Therefore, our study seems to confirm the good cardiovascular safety profile of modern BPH drugs.     

Polymorphisms in the vitamin D receptor gene and the androgen receptor gene and the risk of benign prostatic hyperplasia

OBJECTIVE: Little is known about risk factors for the development of benign prostatic hyperplasia (BPH). Recently, associations were observed between prostate cancer (CaP) risk and polymorphisms in the vitamin D receptor (VDR) gene and the androgen receptor (AR) gene. Since both receptors are relevant for prostate growth, the VDR and AR are also expected to be involved in the development of BPH. The objective of this study is to establish the relationship between the risk of BPH and a polymorphism in the number of CAG repeats in the AR gene and a TaqI restriction enzyme polymorphism in the VDR gene. METHODS: For this study, 98 patients who had been treated for BPH-related complaints and 61 convenience controls (predominantly bladder cancer patients) were recruited from the outpatient clinic. DNA was isolated from peripheral blood, and genotyping was performed with PCR-based methods. Means as well as odds ratios (ORs) with 95% confidence intervals (CI) were calculated using SPSS software. RESULTS: The mean number of CAG repeats in the AR gene in patients and controls was found to be similar: 21.8 (SD = 2.8) and 21.9 (SD = 2.9), respectively. In the subgroup of patients with a prostate volume of at least 50 cm(3), the mean number of repeats was 21.5 (SD = 2.6). The OR for BPH for individuals with homozygous presence of the VDR TaqI restriction fragment length polymorphism (RFLP) (tt) versus individuals with homozygous absence (TT) or heterozygotes (Tt) was found to be 1.0 (95% CI 0.4-2.4). For individuals with a prostate volume of at least 50 cm(3), the OR was 1.2 (95% CI 0.5-3. 2). CONCLUSION: Unlike earlier observations in prostate cancer, we did not find an association between the CAG repeat polymorphism in the AR gene and the TaqI RFLP polymorphism in the VDR gene and the risk of BPH.     

Treatment strategies, patterns of drug use and treatment discontinuation in men with LUTS suggestive of benign prostatic hyperplasia: the Triumph project

OBJECTIVES: We aimed to describe treatment strategies for lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH), adherence to and persistence with pharmacological treatment and the association between the type of LUTS/BPH complaints and early treatment discontinuation. METHODS: Within a large GP database (IPCI) in the Netherlands we identified all males > or =45 years newly diagnosed with LUTS/BPH during 1995-2000. Details on treatment were assessed from the electronic patient records. Logistic regression analysis was used to estimate the association between the type of main urinary complaints and early treatment discontinuation. RESULTS: Of the 2214 men with incident LUTS/BPH, 1075 received pharmacological treatment and 238 underwent prostate surgery. The average adherence differed slightly between drugs: 67% for alpha-blockers, 73% for 5alpha-reductase inhibitors and 71% for combination therapy. 26% of the treated patients discontinued treatment early. The probability of early discontinuation was higher if patients mainly expressed one type of complaint: voiding (OR(adj) 3.38; 95%CI: 1.89-6.04), post micturition (OR(adj) 2.37; 95%CI: 1.15-4.87) or storage symptoms (OR(adj) 1.85; 95%CI: 1.16-2.95) as compared to patients expressing a combination of symptoms. The risk of early discontinuation was higher if patients had a normal PSA measurement. Older age and a higher chronic disease score protected against early treatment discontinuation. CONCLUSIONS: Almost half of newly diagnosed LUTS/BPH patients are pharmacologically treated, and a quarter discontinues very rapidly. Stopping early is more frequent among younger persons, persons with only one type of main urinary complaint, no other co-morbidity and a normal PSA.     

The efficacy and safety of dutasteride and finasteride in patients with benign prostatic hyperplasia: a systematic review and meta-analysis

BackgroundAlthough the efficacy and safety of monotherapy in the treatment of benign prostatic hyperplasia (BPH) have been established clinically, the efficacy and safety of dutasteride and finasteride have not been compared. The aim was to systematically evaluate the efficacy and safety of the two drugs in the treatment of BPH to provide medical evidence for clinical treatment.MethodsA search of relevant articles was conducted using the electronic databases PubMed, Embase, Medline, Cochrane Library, China Academic Journals Full-text Database (CJFD), Chinese Science and Technology Journal Database (VIP) and Wanfang Database. Randomized controlled trials (RCTs) comparing the efficacy of finasteride (control group) with that of dutasteride (experimental group) in the treatment of BPH with respect to the International Prostate Symptom Score (IPSS), the maximum urinary flow rate (Qmax), prostate volume (PV), quality of life (QOL), serum prostate-specific antigen (PSA) level and adverse drug reactions (ADRs) after medication were strictly evaluated and considered for inclusion. Rev Man 5.4 software was used for the meta-analysis.ResultsA total of 8 RCTs were included, with a total of 2,116, patients. The meta-analysis showed that compared with finasteride, dutasteride can effectively improve the Qmax of patients with BPH [mean difference (MD) =0.32; 95% confidence interval (CI): (0.01, 0.63); P=0.04]. There was no significant difference in reducing IPSS [MD =0.13; 95% CI: (−0.55, 0.82); P=0.70], improving PV [MD =−1.25; 95% CI: (−3.30, 0.79); P=0.23], reducing QOL [MD =−0.44; 95% CI: (−0.93, 0.05); P=0.08] and serum PSA level [MD =−0.04; 95% CI: (−0.15, 0.07); P=0.50], and the occurrence of ADRs [relative risk (RR) =−0.01; 95% CI: (−0.05, 0.04); P=0.72], there was no significant difference.DiscussionDutasteride is better than finasteride in improving the Qmax of patients with BPH. There was no statistically significant difference in symptoms, PV, PSA, QOL, or adverse reactions. Dutasteride is an effective and safe treatment for BPH. Due to the limitations of the methodological quality and sample size of the included studies, this conclusion needs to be verified by stratified RCTS with high volumes and long follow-up times.     

Hormonal predictors of prostate cancer

INTRODUCTION: Androgens are necessary for the development and functioning of the prostate gland. The association of serum testosterone and pituitary hormone levels with prostate cancer development is not completely understood. In this clinical study, we evaluated the role of serum testosterone, free testosterone, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels in predicting prostate cancer risk in patients who had transrectal ultrasonography-guided prostate biopsy with the suspicion of prostate cancer. MATERIAL AND METHODS: A total of 211 patients who were selected to undergo prostatic biopsy due to abnormal digital rectal examination and/or a serum prostate-specific antigen (PSA) level >2.5 ng/ml were included in the study. The patient characteristics of total PSA, free/total PSA ratio, serum total testosterone, free testosterone, free/total testosterone ratio, FSH and LH levels were compared according to the pathological diagnosis. RESULTS: The mean age was 63.91 years (range 44-83) and the mean PSA level was 9.23 ng/ml (range 0.13-50.41) in the whole group. Of 211 patients, 69 (32.7%) were positive for prostate cancer. The patients who were positive for prostate cancer had statistically lower levels of serum total testosterone compared with the patients who were diagnosed as having benign prostatic hyperplasia (BPH; 405 vs. 450.5 ng/dl, respectively; p = 0.013). The serum FSH level was significantly higher in men with prostatic cancer than in men with BPH (7.56 vs. 6.06 mIU/ml, respectively; p = 0.029). No significant differences between men with prostatic cancer and those with BPH were found for serum LH levels. When normal ranges for serum free and total testosterone levels were defined as 9 pg/ml and 300 ng/dl, respectively, patients who had low free testosterone and total testosterone levels had significantly higher cancer detection rates than patients with high serum androgen levels: 40.8% (40/98) versus 25.6% (29/113) (p = 0.021), and 48.6% (18/37) versus 29.3% (51/174), respectively (p = 0.023). After logistic regression analysis, none of the hormones showed a significant difference in predicting the risk of prostate cancer in patients undergoing prostate biopsy with suspicion of the disease. CONCLUSION: Our data suggest that patients diagnosed with prostate cancer have low levels of serum testosterone and high levels of serum FSH compared with the patients with BPH. No support was found for the theory that high levels of testosterone increase prostate cancer risk. Further studies are needed to clarify the relationship between hormones and prostate cancer etiology.     

Prostatic hypertrophy and venereal disease as possible risk factors in the development of bladder cancer

In three urological predictors, nocturia, prostatic surgery for prostatic hypertrophy and a previous venereal disease, a significantly increased relative risk (RR) of developing bladder cancer was detected. An epidemiological case control investigation was performed on 165 male bladder cancer patients and an equal number of male controls matched concerning age and geographical area. The sample was obtained from a predominantly rural district. The theoretical individual risk factors were calculated by the aid of a multivariate logistic analysis. Twenty-four patients versus 11 controls had a history of prostatic surgery (RR = 2.38) for benign prostatic hypertrophy, 60 patients versus 36 controls complained of nocturia at least 2 years before presenting symptoms of bladder cancer (RR = 2.05), and 16 patients versus seven controls had a history of venereal disease (RR = 2.42). The results seems to indicate that prostatic hypertrophy and previous venereal disease may at least in part be factors of importance associated with bladder cancer.     

Incidence of hospital‐acquired pressure injury: A cohort study of adults admitted to public and private hospitals in Sao Paulo,Brazil

This study aimed to estimate the incidence of hospital‐acquired pressure injury (PI) and its risk factors in inpatient and intensive care units of five hospitals (two public and three private) in the city of Sao Paulo, Brazil. A 6‐month follow‐up prospective cohort study (n = 1937) was conducted from April to September 2013. Baseline and follow‐up measurements included demographic and care information, as well as risk assessments for both undernutrition (NRS‐2002) and PI (Braden scale). Poisson regression with robust variance was used for data analysis. A total of 633 patients (32.60%) showed risk for PI. The incidence rate of PI was of 5.9% (9.9% in public hospitals vs 4.1% in private hospitals) and was higher in intensive care units, compared to inpatient care units (10% vs 5.7%, respectively). Risk for PI increased with age (RR = 1.05; 95% CI 1.04‐1.07); was higher in in public hospitals, compared to private hospitals (RR = 4.39; 95% CI 2.92‐6.61); in patients admitted for non‐surgical reasons compared to those admitted for surgical reasons (RR = 1.91; 95% CI 1.12‐3.27); in patients with longer hospital stays (RR = 1.04; 95% CI 1.03‐1.06); high blood pressure (RR = 1.76; 95% CI 1.17‐2.64); or had a risk for undernutrition (RR = 3.51; 95% CI 1.71‐7.24). Higher scores in the Braden scale was associated with a decreased risk of PI (RR = 0.79; 95% CI 0.75‐0.83). The results of our study indicate that 5.9% of all patients developed PI and that the most important factors that nurses should consider are: patient age, care setting, length of hospitalization, comorbidities, reason for admission and nutrition when planning and implementing PI‐preventative actions.