Introduction: Patients with localized prostate cancer (PCa) are active participants in the choice of treatment. Objectives: To access the effects of social and demographic factors in the choice of treatment in cases of localized PCa, in a Portuguese population. Methods: Identification of all patients with the diagnosis of localized PCa in the last four years in an oncological centre. Evaluation of the effects of sociodemographic factors (age, profession, literacy, marital status, district and number of inhabitants of the place of residence) in the choice of treatment. Results: 300 patients with localized PCa were evaluated: 17.3% (n = 52) opted for radical prostatectomy (RP); 39,3% had (n = 118) external radiotherapy; brachytherapy in 29.3% (n = 88) and other options (active surveillance, cryotherapy and hormonal therapy) in 14.1% (n = 42). In relation to surgical treatment (RP) the following results were obtained: a) > 70 years: 3.9% (n = 5); ≤ 70 years: 27.5% (n = 47), p < 0.001; b) primary sector: 10.3% (n = 3); secondary sector: 16.2% (n = 27); tertiary sector: 24.1% (n = 21); quaternary sector: 8.3% (n = 1), p = 0.296; c) marital status married: 17.9% (n = 47); single: 0% (n = 0); divorced: 25.0% (n = 5); widow: 0% (n = 0), p = 0.734; d) residency in a city: 14.1% (n = 13); city > 4000 habitants: 22.7% (n = 15); city ≤ 4000 habitants: 16.9% (n = 24), p = 0.701. Using multinomial regression with age (p = 0.001), district (p = 0.035), marital status (p = 0.027) and profession (0.179), this model explained 17.2%-28.4% of therapeutic choices (p < 0.001). Conclusions: The main socioeconomical factor that influence treatment choice was age. Unmarried patients over 70 years choose less radical prostatectomy. Other sociodemographic factors have minor influence in the choice of the treatment.

Background: Most men diagnosed with prostate cancer will be candidates for active treatment and 20 to 50% of patients treated with organ preserving strategies recur within the prostate. Optimal treatment of recurrence is controversial. Prostate cryosurgery has been increasingly used as primary, recurrence and focal treatment for prostate cancer. Methods: We analysed 55 patients submitted to cryotherapy as salvage treatment after recurrence. Results: Study population presented with a mean age of 70.9 ± 6.2 years, mean initial PSA of 7.6 ng/ml and average prostate volume by ultrasound of 43.2 ± 14.7 grams. Mean follow-up was of 18.0 months. Biochemical free survival at one year of follow-up was of 85%. Conclusions: Cryotherapy can be an effective and safe treatment for recurrence after primary curative treatment failure.

Introduction: Cycling is a popular means of transport and recreational activity; bicycles are also a source of genitourinary injuries and there is the idea that cycling may have a significant impact on sexual function. The objective of this study was to evaluate the effect of amateur cycling on erectile function. Methods: We used a questionnaire comparing amateur cyclists (n = 199) and footballers (n = 43), regarding sexual related comorbidities and hours of practice per week. The cyclists were also characterized in terms of road vs cross-country, breaks during cycling, saddle, and shorts. To evaluate erectile function, the International Index of Erectile Function questionnaire was applied. Results: there was no difference in International Index of Erectile Function total score between groups. Age and presence of erectile dysfunction associated comorbidity were negative factors in the International Index of Erectile Function score in cyclists but not in the footballers. Conclusions: Cycling is usually associated with perineal numbness, but that numbness did not lead to lower International Index of Erectile Function scores. In conclusion amateur cycling has no effect on EF.

Background: Periprostatic adipose tissue (PPAT) has been shown to play a significant role in prostate cancer (PCa) development and progression. This relationship is further exacerbated by obesity, as PPAT-secreted factors increase PCa aggressiveness and have also been implicated in chemotherapy resistance. Therefore, identifying the molecular mediators of PPAT–prostate interorgan communication and the factors that disrupt this crosstalk is pivotal for better disease management. Obesogens, i.e., endocrine-disrupting chemicals that dysregulate adipose tissue towards an “obese” phenotype, have recently been implicated in disrupting this crosstalk, with an impact on prostate cell fate. Objectives: This study aimed to investigate whether obesogenic dysregulation of human PPAT secretory activity affects PCa cell viability and their response to docetaxel and cabazitaxel. Methods/Results: Through ex vivo culture of human PPAT and conditioned medium assays, we demonstrated that exposure to the model obesogen tributyltin (TBT) induced an “obese” phenotype in human PPAT, characterised by adipocyte enlargement and increased secretion of leptin and C-C motif chemokine ligand 7. The TBT-treated PPAT secretome enhanced cell viability and decreased the sensitivity of PCa cells to taxanes. Conclusions: This study provides preliminary evidence that lays the groundwork for future investigations, dissecting the molecular pathways underpinning prostate carcinogenesis and resistance to chemotherapy induced by obesogen-dysregulated PPAT.

Background/Objectives: Prostate cancer is one of the most common malignancies diagnosed in men worldwide. Brachytherapy (BT), particularly low-dose rate (LDR)-BT, has been shown to be a successful treatment. The aim of this study was to evaluate the effectiveness of BT treatment in localized prostate cancer patients from a single-center Portuguese cohort. Methods: This was a retrospective study that evaluated prostate cancer patients followed up at the Center for the Treatment of Urological Diseases, Coimbra, Portugal, who underwent LDR-BT between November 2007 and March 2024. Overall survival (OS), biochemical recurrence-free survival (BRFS) and complications post-LDR BT treatment were evaluated during patients’ follow-up time. Results: A total of 1343 patients treated with LDR-BT were recruited. Global OS and BRFS rates were 98.4% and 87.7%, respectively. A reduced frequency of complications such as lower urinary tract symptoms, erectile dysfunction, acute urinary retention, radiation proctitis and stress urinary incontinence were described. High OS (>98%) and BRFS rates were observed particularly in low and intermediate disease risk. Prostate-specific antigen (PSA) serum levels > 20 ng/mL, Gleason score (GS) ≥ 8 and clinical tumor stage (cT) ≥ T2c were identified as the strongest predictors of death and/or biochemical recurrence. Conclusions: BT is an effective treatment in localized prostate cancer patients, with comparable outcomes and consistent with the OS and BRFS rates reported in the current literature for radical prostatectomy and external beam radiotherapy approaches, and with a reduced frequency of complications. PSA serum levels > 20 ng/mL, GS ≥ 8 and cT stage ≥ T2c can be used as strong predictors of death and/or biochemical recurrence during patients’ follow-up.

Introduction: Hemorrhagic cystitis is defined by the presence of hematuria, lower urinary tract symptoms and cystoscopy findings indicative of underlying urothelial damage. It is common in patients with prior radiotherapy for pelvic malignancies. The severity of the bleeding can vary from mild to severe hematuria refractory to conservative therapy and with a continuous need for transfusions. Treatment can be challenging not only by the lack of clear guidelines but also the multiple comorbidities of these patients. Urinary diversion with or without cystectomy should be reserved for those who have failed all the previously available therapy, because of the morbidity/mortality associated with this type of procedure. Supratrigonal cystectomy can be an option in patients with intense fibrosis of the pelvic region. The purpose of this article is to present the results of our institution with supratrigonal cystectomy with urinary diversion as a last line treatment for radiation-induced hemorrhagic cystitis. Materials and methods: We retrospectively analyzed 17 patients who underwent supratrigonal cystectomy and bladder mucosa fulguration with urinary diversion for refractory radiation-induced hemorrhagic cystitis in our institution from January 2010 to December 2020. Results and discussion: Median patient age at time of cystectomy was 69 years and 64.7% (11) were females. The most common etiology was prior radiation therapy for gynecologic malignancies (11-64.7%). All the patients had prior therapy with bladder irrigation and fulguration. Besides that, 29.4% (n=5) received intravesical therapy with formalin, 11.8% (n=2) hyperbaric oxygen therapy and 5.9% (n=1) prior urinary diversion. Median time between radiation therapy and cystectomy was 65 months. Median ASA score of 3, median preoperative hemoglobin was 9,6mg/dl and 10.5 mg/dl at time of discharge after surgery. Ileal conduit was used in 52.9% (9), cutaneous ureterostomy in 41.2% (7) and ureterosigmoidostomy in 5.9% (1). Majority of patients (10-58.8%) did not require any blood transfusion during surgery or during their stay. Clavien-Dindo complications grade III or higher occurred in 29,4% (5). Median hospital stay postoperative was 12 days. No mortality was reported in the 30 days after surgery. Median follow-up after cystectomy was 28 months, with a 1-year survival of 93.3% (14 of 15) and 3-year survival of 83.3% (10 of 13). There was no difference in the presence of postoperative complications or overall survival between the types of urinary diversion. Conclusions: This represents one of the largest series on cystectomy in hemorrhagic cystitis, that we found to this date. Supratrigonal cystectomy is a valid option as a last line treatment for radiation-induced hemorrhagic cystitis, reducing the risks associated with simple cystectomy in patients with prior pelvic radiation.