Lo Giudice A, et al. World J Mens Health. 2024 Jan;42:e9. https://doi.org/10.5534/wjmh.230106

Prostate Cancer (PCa) is still ranked as the first cancer in the male population and evidences have suggested an alteration of glycemic and lipidic metabolism that are related to its progression and prognosis. The aim of the study is to investigate associations between enzymes’ expression, especially involved in the lipidic pathway, and PCa aggressiveness. We retrospectively analyzed data from 390 patients with PCa or benign prostatic hyperplasia (BPH) at the Department of Urology, University of Catania. Immunohistochemical slides were evaluated for the expression of proteins related to glucose and lipidic metabolism. A total of 286 were affected by PCa while 104 by BPH. We demonstrated that ATP-lyase (odds ratio [OR]: 1.71; p < 0.01), fatty acid synthase (OR: 4.82; p < 0.01), carnitine palmitoyl transferase-1a (OR: 2.27; p < 0.05) were associated with androgen receptor (AR) expression. We found that steaoryl Co-A desaturase expression in PCa patients with total cholesterol ≥ 200 mg/dL was independently associated with ISUP ≥4 (OR: 4.22; p = 0.049). We found that CPT-1a+ was associated with biochemical recurrence (hazard ratio: 1.94; p = 0.03]). Our results support the evidence that the manipulation of lipidic metabolism could serve in the future to contrast PCa progression.

Background: Prostate cancer (PCa) is a disease with a wide range of clinical manifestations. Up to the present date, the genetic understanding of patients with favorable or unfavorable prognosis is gaining interest for giving the appropriate tailored treatment. We aimed to investigate genetic changes associated with lymph node metastasis in a cohort of hormone-naïve Pca patients. Methods: We retrospectively analyzed data from 470 patients who underwent surgery for PCa between 2010 and 2020 at the Department of Urology, University of Catania. Inclusion criteria were patients with lymph node metastasis and patients with PCa with extra capsular extension (pT3) and negative lymph node metastasis. The final cohort consisted of 17 different patients (11 PCa with lymph node metastasis and 6 PCa without lymph node metastasis). Through the cBioPortal online tool, we analyzed gene alterations and their correlations with clinical factors. Results: A total of 688 intronic, synonym and nonsynonym mutations were sequenced. The gene with the most sequenced mutations was ERBB4 (83 mutations, 12% of 688 total), while the ones with the lower percentage of mutations were AKT1, FGFR2 and MLH1 (1 mutation alone, 0.14%). Conclusion: In the present study we found mostly concordance concerning the ERBB4 mutation between both primary PCa samples and matched lymph node metastasis, underlining that the identification of alterations in the primary tumor is extremely important for cancer prognosis prediction.

The relationship between varicocele and hypogonadism becomes clearer everyday thanks to the most recent literature, particularly with regards to the impact of varicocele repair on serum testosterone level improvement in hypogonadal patients. We selected English articles published from 1964 to September 2021. The search terms “varicocele” and “hypogonadism” were used as filters. A total of 102 studies have been obtained. For the meta-analysis, the pooled mean differences (MDs) for continuous variables and the ln(OR) were used for data pooling observational studies. A total of 15 articles have been finally included: nine retrospective and six observational. Testosterone levels pre- and after surgery were reported in four studies. There was statistically significant heterogeneity in these studies (chi² = 267.09, I² = 72%; p = 0.01). Mean differences of total testosterone was statistically different in men pre- and after-surgery (mean difference = 106.76; p < 0.0001). It is indeed established that altered environments caused by varicocele cause pantesticular insult, but it has not been unequivocally determined whether men with varicocele are at increased risk for the development of clinical hypogonadal symptoms.

Background: Non‐obstructive azoospermia (NOA) affects approximately 10% of infertile men and represents a major challenge in assisted reproductive technology (ART). A model that includes histological variants could be helpful in predicting sperm retrieval rate (SRR) after microdissection testicular sperm extraction (mTESE) in patients affected by NOA and without genetic abnormalities Objectives: To develop and validate a predictive nomogram integrating clinical and histopathological variables to estimate SRR in NOA patients undergoing microTESE. Material and Methods: A multi‐center retrospective/prospective cohort study was conducted between 2022 and 2024, enrolling 333 men diagnosed with NOA across six academic centers. Preoperative data, including age, body mass index (BMI), hormonal profile (follicle‐stimulating hormone [FSH], luteinizing hormone [LH], testosterone), genetic analysis, and ultrasound‐measured testicular volume, were collected. MicroTESE was performed under microscopic guidance with histopathological evaluation. Predictive factors for successful sperm retrieval were analyzed through logistic regression, and a predictive nomogram was constructed and internally validated using bootstrapping techniques. Multi‐variate logistic regression was performed to identify independent variables associated with SRR in patients with available final pathology. Therefore, a predictive nomogram was developed and validated using 1000 bootstrap samples. Results: The overall SRR was 52.55%. Multi‐variate analysis identified FSH levels (odds ratio [OR]: 0.97; p = 0.049), maturation arrest (OR: 0.04; p < 0.01), and Sertoli cell‐only syndrome (SCOS; OR: 0.03; p < 0.01) as independent predictors of SRR. The predictive nomogram demonstrated good accuracy, with a C ‐index of 0.75, sensitivity of 73%, specificity of 82%, and overall accuracy of 77% at a cutoff of 0.33. Discussion: Using preoperative and histology data, we developed a nomogram to predict SR outcomes in patients with NOA undergoing mTESE. Our findings demonstrate that integrating hormonal and histopathological data enhances predictive accuracy of the model, thus providing a valuable tool for preoperative counseling and clinical decision‐making in couples presenting with infertility. Conclusion: This validated nomogram effectively predicts sperm retrieval outcomes in NOA patients undergoing microTESE, facilitating improved patient counseling, informed clinical decisions, and optimized patient selection. Prospective external validation and further model refinement are recommended to enhance generalizability and clinical applicability.

Background: The level of food processing has gained interest as a potential determinant of human health. The aim of this study was to assess the relationship between the level of food processing and prostate cancer severity. Methods: A sample of 120 consecutive patients were examined for the following: their dietary habits, assessed through validated food frequency questionnaires; their dietary intake of food groups, categorized according to the NOVA classification; and their severity of prostate cancer, categorized into risk groups according to European Association of Urology (EAU) guidelines. Uni- and multivariate logistic regression analyses were performed to test the association between the variables of interest. Results: Individuals reporting a higher consumption of unprocessed/minimally processed foods were less likely to have greater prostate cancer severity than those who consumed less of them in the energy-adjusted model (odds ratio (OR) = 0.38, 95% confidence interval (CI): 1.17–0.84, p = 0.017 and OR = 0.33, 95% CI: 0.12–0.91, p = 0.032 for medium/high vs. low grade and high vs. medium/low grade prostate cancers, respectively); however, after adjusting for potential confounding factors, the association was not significant anymore. A borderline association was also found between a higher consumption of ultra-processed foods and greater prostate cancer severity in the energy-adjusted model (OR = 2.11, 95% CI: 0.998–4.44; p = 0.051), but again the association was not significant anymore after adjusting for the other covariates. Conclusions: The level of food processing seems not to be independently associated with prostate cancer severity, while potentially related to other factors that need further investigation.