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SSD is an easily measured parameter on NCCT that independently correlates with SWL efficacy in treating stones in all locations.

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PurposeThe analysis of exosome/microvesicle (extracellular vesicles (EVs)) and the RNA packaged within them (exoRNA) has the potential to provide a non-invasive platform to detect and monitor disease related gene expression potentially in lieu of more invasive procedures such as biopsy. However, few studies have tested the diagnostic potential of EV analysis in humans.Experimental DesignThe ability of EV analysis to accurately reflect prostate tissue mRNA expression was examined by comparing urinary EV TMPRSS2:ERG exoRNA from pre-radical prostatectomy (RP) patients versus corresponding RP tissue in 21 patients. To examine the differential expression of TMPRSS2:ERG across patient groups a random urine sample was taken without prostate massage from a cohort of 207 men including prostate biopsy negative (Bx Neg, n = 39), prostate biopsy positive (Bx Pos, n = 47), post-radical prostatectomy (post-RP, n = 37), un-biopsied healthy age-matched men (No Bx, n = 44), and young male controls (Cont, n = 40). The use of EVs was also examined as a potential platform to non-invasively differentiate Bx Pos versus Bx Neg patients via the detection of known prostate cancer genes TMPRSS2:ERG, BIRC5, ERG, PCA3 and TMPRSS2.ResultsIn this technical pilot study urinary EVs had a sensitivity: 81% (13/16), specificity: 80% (4/5) and an overall accuracy: 81% (17/21) for non-invasive detection of TMPRSS2:ERG versus RP tissue. The rate of TMPRSS2:ERG exoRNA detection was found to increase with age and the expression level correlated with Bx Pos status. Receiver operator characteristic analyses demonstrated that various cancer-related genes could differentiate Bx Pos from Bx Neg patients using exoRNA isolated from urinary EVs: BIRC5 (AUC 0.674 (CI:0.560–0.788), ERG (AUC 0.785 (CI:0.680–0.890), PCA3 (AUC 0.681 (CI:0.567–0.795), TMPRSS2:ERG (AUC 0.744 (CI:0.600–0.888), and TMPRSS2 (AUC 0.637 (CI:0.519–0.754).ConclusionThis pilot study suggests that urinary EVs have the potential to be used as a platform to non-invasively differentiate patients with prostate cancer with very good accuracy. Larger studies are needed to confirm the potential for clinical utility.

Study Type – Prognosis (retrospective cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? Statin use may reduce the risk of developing prostate cancer. Studies also suggest that the protective effect of statins may be beneficial for prostate cancer patients following treatment. Statin users may also have lower PSA than non‐users. Our study agrees with the findings that statin users may have lower PSA than non‐users. Contrary to the findings that statins are protective in prostate cancer this study shows no benefit and possible worse biochemical outcome after radical prostatectomy. OBJECTIVE • To determine the relationship between statin use and biochemical recurrence (BCR) following radical prostatectomy (RP). PATIENTS AND METHODS • A retrospective analysis was performed on 3198 RP patients between 1990 and 2008. • Exclusion criteria were neo‐adjuvant or adjuvant therapy, follow‐up <2 years, and insufficient pathological or prostate‐specific antigen (PSA) data. • Statin use was determined from the patient’s record. Clinical and pathological variables were compared between statin users and non‐users. • Kaplan–Meier and multivariate Cox regression analyses were performed to determine the effect of statin use on BCR. RESULTS • A total of 1261 patients fit criteria for analysis. There were 281 (22%) statin users. Mean age was 60 years and median follow‐up was 36 months (mean 43 months). • Statin users had a lower median preoperative PSA (6.4) compared with non‐users (7.1) (P < 0.05). In all, 80% of statin users had a pathological Gleason sum ≥7 compared with 67% of non‐users (P < 0.05). • On multivariate analysis, statin use was an independent predictor of BCR (hazard ratio 1.54, P < 0.05). Statin users had a lower 5‐year BCR‐free survival compared with non‐users (75% vs 84%, P < 0.05). CONCLUSIONS • Statin users are at an increased risk for BCR following RP. This finding may be due to the reduction in preoperative PSA potentially delaying diagnosis and/or masking aggressive disease. • Further studies are necessary to elucidate the impact of statin medications following prostate cancer therapy.