Androgen deprivation therapy still remains the gold standard in the treatment of advanced prostate cancer. Unfortunately,
patients with metastatic prostate cancer treated with androgen deprivation ...therapy frequently develop androgen-independent
prostate cancer. Cytotoxic chemotherapy has not been used routinely and the current standard regimens have not demonstrated
any significant alteration in the development of hormone-refractory disease. Recent phase III randomized clinical trials have
suggested that docetaxel-based therapy, demonstrating a real increase of survival in treated patients, could represent the
new standard treatment for metastatic patients. There is also promising activity of new drug combinations, such as taxanes
plus vinca alkaloids, and of classic chemotherapeutic agents plus biological drugs. This review focuses on the current therapies
for the treatment of HRPC.
Estrogen receptor subtype β (ERβ) is highly expressed in rat prostate epithelium, but its presence in human prostate needs to be confirmed. Here we investigated the expression of ERβ in five benign ...(normal and/or hyperplastic) and 10 malignant (Gleasons’ score 2–7) prostate tissue specimens using immunohistochemistry. Immunohistochemistry was performed on formalin-fixed, paraffin-embedded tissue sections, using a commercially available ERβ polyclonal antibody developed against the C-terminal amino acid residue. Nuclear ERβ expression was found in the nuclei of glandular epithelium of benign prostate tissue specimens; faint nuclear ERβ positivity was also present in a few stromal cells around normal epithelium. Nuclear ERβ specific immunostaining was undetectable in all prostate cancer sections.
Owing to the existing controversy about the role of life-style in the pathogenesis of BPH, the possible associations of LUTS and prostate enlargement with alcohol intake, coffee consumption, smoking, ...physical activity, body mass index (BMI) and concomitant diseases were studied in the large series of patients of the QUIBUS study.
Among concomitant diseases, essential hypertension was the most represented. However no apparent additive or synergistic influence on symptoms was recorded in this subset of the population. Coffee consumption was not associated with prostate volume or LUTS. Alcohol consumption was associated with urgency and intermittence and with an overall higher IPSS. No major influence on symptoms was found in smokers. Physical activity was associated with a lower frequency of incomplete bladder emptying, repeated urination, intermittence and urgency. The postulated existence of an association between BMI and BPH was not confirmed in this study. When a prediction of the IPSS scores was tempted by entering the life-style factors in a multiple regression model, they were able to explain at best 5% of the variance of the dependent variable.
Life-style patterns bear a greater influence on individual symptoms than on total scores. This difference is sometimes high enough to recommend specific life-style measures to patients with LUTS and prostate enlargement.
Gynecomastia is an abnormal increase in the volume of the male breast that is generally considered to be due to an increased estrogen/androgen ratio. Pathological causes of gynecomastia include ...organic diseases and therapy, such as the administration of estrogens and antiandrogens, which alter the ratio of circulating hormones. Hormone therapy for prostate cancer is generally well tolerated but often accompanied by the occurrence of gynecomastia and breast pain or tenderness. The increased use of antiandrogens as monotherapy is leading to an increase in the number of patients affected by gynecomastia. Treatments are available to alleviate or prevent the development of gynecomastia, including medical treatment with antiestrogens and aromatase inhibitors. Alternatively, mastectomy with excision of the gland, liposuction or an association of the two techniques have proved to be effective. Radiation therapy may provide effective relief from the breast pain associated with gynecomastia. In this paper we show the good results of mastectomy performed with a lower semicircular periareolar incision in men suffering from gynecomastia due to antiandrogen therapy for inoperable prostate cancer. In addition, we present a review of the various techniques used for the treatment of gynecomastia.
During the period from September 1998 to May 2001, 10 patients receiving hormone treatment for metastatic or inoperable prostatic cancer were selected for the study if they had breast pain and bilateral gynecomastia. Five of these patients had been offered prophylactic radiotherapy before treatment but refused, while the remaining five patients had refused radiotherapy after hormone treatment. These patients were therefore given the option of surgical treatment. Before surgery all patients underwent clinical and ultrasound examination of the breast. All surgical samples were examined histopathologically. During follow-up clinical examinations were carried out one week, one month, six months, one year and two years after surgery.
The results were satisfactory in all patients especially from an aesthetic point of view. Moreover, breast pain disappeared about one week after surgery. After a follow-up of 6-36 months (average, 22.8 months) no recurrences were observed. Only a few immediate postoperative complications were recorded (hematoma in one case and seroma in another). Histological examination of the excised glands showed fibrosclerotic tissue and a small amount of fat.
Surgical liposuction can be considered an effective treatment for gynecomastia, in particular in the very early stages because the breast becomes irreversibly fibrous as the disease progresses. This surgical technique is simple and effective and is therefore to be considered favorable, especially because of the very short hospitalization and the absence of complications.
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