BackgroundNeuroendocrine tumors (NETs) are rare neoplasms, with an estimated annual incidence of ~ 6.9/100,000. NETs arise throughout the body from cells of the diffuse endocrine system. More than half originate from endocrine cells of the gastrointestinal tract and the pancreas, thus being referred to as gastroenteropancreatic NETs (GEP NETs). The only treatment that offers a cure is surgery, however most patients are diagnosed with metastatic disease, and curative surgery is usually not an option.Since the majority of patients are not candidate for curative surgery, they can be offered long-term systemic treatment, for both symptomatic relief and tumor growth suppression. Evidence based treatment options include somatostatin analogues, everolimus (an mTOR inhibitor), sunitinib (a tyrosine kinase inhibitor), peptide receptor radionuclide therapy (PRRT), chemotherapy, etc., alone or combined with cytoreductive procedures (surgery or liver directed procedures). However, there is an increasing need for novel therapies. Other treatment options being investigated are immunotherapy and epigenetic assessment that may lead to more personalized interventions. Following first line therapy with somatostatin analogues, there is no clear information to date indicating a preferred treatment sequence, and therefore the treatment approach should be individualized based on each NET patient characteristics.ConclusionsNET patients are increasingly diagnosed throughout the world, usually with metastatic disease and requiring systemic therapy. We believe that each patient should be therefore thoroughly evaluated and individually discussed by a multidisciplinary and dedicated NET-expert team, updated with all treatment options including ongoing clinical trials, and before selecting the proper treatment sequence.

Introduction Although erectile dysfunction (ED) might be associated with coronary heart disease (CHD), there is no evidence it predicts poor cardiovascular prognosis. On the other hand, an abnormal heart rate profile during exercise stress testing predicts poor cardiovascular prognosis in high-risk patients, such as diabetic men, even in the absence of CHD. Aim In order to study if ED predicts poor cardiovascular prognosis in high-risk patients, we examined the association between ED and heart rate profile during exercise stress testing in diabetic men with no CHD. Main Outcome Measures Erectile dysfunction severity, exercise capacity during exercise stress testing, and heart rate decrease after exercise stress testing. Methods A retrospective study. The medical charts of diabetic men with vascular ED from a single-sex clinic were reviewed, as well as the medical charts of body mass index (BMI)- and age-matched diabetic men without ED going through routine check-ups. All men underwent routine treadmill stress testing according to the Bruce protocol in order to characterize heart rate profile during exercise. The Sexual Health Inventory for Men (SHIM) questionnaire was used to characterize ED. Results Included were 18 diabetic men with ED (SHIM questionnaire scores 5–21) and 18 diabetic men without ED (SHIM questionnaire scores 22–25), 40 years of age or older. None of the men had signs of coronary insufficiency during exercise treadmill stress testing. Although the two groups did not statistically differ with respect to the mean age, the mean BMI, the prevalence of cardiovascular risk factors, and the mean exercise treadmill stress testing findings, the SHIM questionnaire scores were significantly associated with low metabolic equivalents (r = 0.51, P = 0.03) and delayed heart rate recovery during the first 2 minutes after exercise (r = 0.55, P = 0.018) only among diabetic men with ED. Conclusion Erectile dysfunction severity might be associated with poor cardiovascular prognosis in adult diabetic men with no CHD.

Neuroendocrine tumors (NETs) are rare neoplasms, with an estimated annual incidence of ~ 6.9/100,000. NETs arise throughout the body from cells of the diffuse endocrine system. More than half originate from endocrine cells of the gastrointestinal tract and the pancreas, thus being referred to as gastroenteropancreatic NETs (GEP-NETs). The only treatment that offers a cure is surgery; however, most patients are diagnosed with metastatic disease, and curative surgery is usually not an option. These patients can be offered long-term systemic treatment, for both symptomatic relief and tumor growth suppression. Evidence-based treatment options include somatostatin analogs, everolimus (a mTOR inhibitor), sunitinib (a tyrosine kinase inhibitor), and peptide receptor radionuclide therapy, alone or combined with cytoreductive procedures (surgery or liver-directed procedures). Other treatment options being investigated are immunotherapy and epigenetic assessment that may lead to more personalized interventions. We believe that each patient should be thoroughly evaluated and their case discussed by a multidisciplinary team that is up-to-date with all treatment modalities including ongoing clinical trials, before selecting the proper treatment option.

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Hepatic intra-arterial therapies are well tolerated in the majority of patients with NETs and liver metastases and associated with both clinical improvement and tumor stabilization for prolonged periods. These therapies should be always considered, irrespective of the presence of extrahepatic metastasis.