The 12-month follow-up of the low-intensity extracorporeal shockwave therapy in the treatment of patients with chronic pelvic pain syndrome refractory to 3-As medications

PURPOSE

Applying low-intensity extracorporeal shockwave therapy (LI-ESWT) has been reported to improve symptoms of refractory chronic pelvic pain syndrome (CPPS) in short-term follow-up. This study aims to demonstrate the effect of LI-ESWT on refractory CPPS over the span of a 12-month follow-up.

MATERIALS AND METHODS

This was an open-label, single-arm prospective study. LI-ESWT consisted of 3000 shock waves once weekly for 4 weeks (Duolith SD1 T-Top) were applied. Clinical symptoms were re-assessed at 1, 3, 6, and 12 months using NIH-CPSI score, visual analog scale, 5-item version of the International Index of Erectile Function and International Prostate Symptom Score.

RESULTS

Thirty-one of the 43 patients enrolled had a successful response at the 1-month follow up after the treatment. Twenty-six of the 31 patients who responded successfully to LI-ESWT at the 1-month follow-up, maintained their response at the 6- and 12-month follow-up. The existence of psychosocial disorder at the baseline characteristics analysis was the only potential factor that may hinder the effectiveness of LI-ESWT.

CONCLUSIONS

LI-ESWT has shown to be a safe and effective therapy for CPPS patients at the long-term follow-up. History of psychological disorders might be a significant predictor of a successful response.

New-onset diabetes after androgen-deprivation therapy for prostate cancer: A nationwide propensity score-matched four-year longitudinal cohort study

INTRODUCTION

Androgen-deprivation therapy (ADT) is important in the treatment of prostate cancer. However, the relationship between ADT and the risk of diabetes remains unclear, and the association between duration and types of ADT has not been fully investigated.

AIM

To examine the risk of developing type 2 diabetes mellitus (T2DM) in men who underwent ADT for prostate cancer.

METHODS

Data were collected retrospectively from the Longitudinal Health Insurance Database of Taiwan. In total, 4604 prostate cancer patients ≥40 years old who underwent ADT were included in the study cohort, and 4604 prostate cancer patients without ADT were included as controls, after adjusting for age and other comorbidities.

RESULTS

During the four-year follow-up period, the incidence of new-onset T2DM was 27.49 and 11.13 per 1000 person-years in the ADT and ADT-never cohorts, respectively. The ADT cohort was 2.19 times more likely to develop T2DM than the control group (95% CI 1.90-2.53, P < 0.001). Furthermore, the association was particularly striking in the subgroup of patients receiving complete androgen blockade (adjusted HR 2.33, 95% CI 1.96-2.78, P < 0.001).

CONCLUSIONS

Men with prostate cancer who received ADT are at risk for developing diabetes.

Efficacy of Low-Intensity Extracorporeal Shock Wave Therapy on Men With Chronic Pelvic Pain Syndrome Refractory to 3-As Therapy

Managing patients with chronic pelvic pain syndrome (CPPS) refractory to the traditional 3-As therapy (antibiotics, alpha-blockers, and anti-inflammatories) is a challenging task. Low-intensity extracorporeal shock wave therapy (LI-ESWT) was recently reported to be able to improve pain, urinary symptoms, and even sexual function by inducing neovascularization and anti-inflammation, reducing muscle tone, and influencing nerve impulses. This study evaluates whether combined treatment with LI-ESWT can restore clinical ability and quality of life (QoL) in patients refractory to 3-As therapy. This was an open-label, single-arm prospective study. Patients with CPPS without more than a 6-point decrease in the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) total score under the maximal dosage of 3-As therapy were enrolled. LI-ESWT treatment consisted of 3,000 shock waves administered once weekly for 4 weeks. The NIH-CPSI, visual analog scale (VAS) score, International Prostate Symptom Score (IPSS), and the five-item version of the International Index of Erectile Function (IIEF-5) were used to evaluate efficacy at 1, 4, and 12 weeks after LI-ESWT. Thirty-three patients were enrolled in this study. After LI-ESWT treatment, 27 of the 33 patients (81.82%) had a successful response to LI-ESWT, with a decrease of 3.29 and 5.97 in the VAS score and total IPSS at the 3-month follow-up. Waist circumference was the only significant predictor of a successful response to LI-ESWT. LI-ESWT can serve as a salvage therapy for patients with CPPS refractory to traditional 3-As therapy. Further studies are needed to determine an adequate therapeutic protocol and important predictors in patients with different CPPS etiologies.

Hormone therapy for prostate cancer increases the risk of Alzheimer's disease: a nationwide 4-year longitudinal cohort study

INTRODUCTION

Androgen-deprivation therapy (ADT) is recognized to be the preferred first-line treatment for advanced prostate cancer. However, the risk-benefit ratio of ADT remains poorly defined and the relationship between androgen depletion and dementia is not clear.

AIM

To investigate the risk of developing Alzheimer's disease (AD) in patients undergoing ADT for prostate cancer.

METHODS

Data from 24 360 prostate cancer patients were collected from the Longitudinal Health Insurance Database of Taiwan. In total, 15 959 patients who underwent ADT were included in the study cohort, and another 8401 patients who did not receive ADT were included as a non-ADT cohort.

RESULTS

During the average 4-year follow-up period, the incidence of AD was 2.78 per 1000 person-years in the non-ADT cohort and 5.66 per 1000 person-years in the ADT cohort. After adjusting for age and all comorbidities, the combined ADT cohort was found to be 1.84 times more likely to develop AD than the non-ADT control group (95%CI 1.33-2.55, p < 0.001).

CONCLUSIONS

The present results suggest that ADT use is associated with an increased risk of developing AD.