Objectives: We evaluated the relationship between penile curvature and testosterone in Peyronie's disease patients treated in Japan. Methods: Data were obtained from 109 patients with Peyronie's disease treated with surgery at our hospital between April 2004 and December 2019. Penile deformity assessment was based on findings of a rigid erection induced by intracavernosal injection. Low total testosterone level was defined as <300 ng/dl. Patients were divided into two groups according to curvature severity (I, <60°; II ≥60°), then clinical factors including total testosterone were compared. Uni-and multivariate logistic regression analyses were performed to identify factors predicting severe penile deformity (≥60°).Results: For all patients, mean total testosterone was 469 ng/dl and median curvature was 50°, with a significant inverse correlation found between curvature and testosterone level (p < 0.0001). Group I and II patients numbered 55 and 54, respectively. Mean total testosterone for Group II was 397 ng/dl, significantly lower than Group I (539 ng/dl). Median curvature in 15 patients with a low testosterone level was 80°, significantly higher than those with a normal testosterone range (50°). Univariable and multivariable logistic regression analysis indicated total testosterone, follicle stimulating hormone, and C-reactive protein as significant factors correlated with severe penile deformity, among which total testosterone was most relevant. Conclusion:The present findings confirmed that penile deformity severity is correlated with testosterone level in Japanese males with Peyronie's disease.

Azoospermia is a severe problem that prevents couples from having their own children through natural pregnancy. To obtain sperm from patients with azoospermia testicular sperm extraction (TESE) is required. In non-obstructive azoospermia (NOA), a particularly severe type of male infertility, patients need to undergo microdissection testicular sperm extraction (micro TESE) to collect sperm and, at 40 to 60%, the sperm retrieval success rate is not very high. Therefore, our objective in the present study was to make a model for predicting the possibility of sperm retrieval in patients with NOA before performing micro TESE, using machine learning. We retrospectively obtained data from the medical records of 430 patients who underwent micro TESE from 2011 to 2020, and used Prediction One, which does not require coding, to create the model. We successfully achieved our objective. The AUC for the AI model was 0.7246, which is acceptable. In addition, among the variables, we found that T/E2 ratios contributed most to predicting whether sperm retrieval was possible or not. T/E2 ratios have potential as a clinical predictor of sperm retrieval in NOA.

We investigated whether aspartate transaminase (AST)-to-alanine aminotransferase (ALT) ratio and its change during the course of treatment in castration-resistant prostate cancer (CRPC) patients is associated with tumor condition and lethality. Clinical data from 130 CRPC patients were retrospectively evaluated. AST/ALT ratios at the time of prostate cancer (PC) diagnosis, androgen deprivation therapy (ADT), CRPC diagnosis, and the final follow-up examination after CRPC treatment were calculated for each. The prognostic capabilities of the AST/ALT ratio for overall survival (OS) were analyzed by the Kaplan-Meier method and Cox hazard models. The median AST/ALT ratio at the PC diagnosis was 1.517 and the optimal value predicting lethality defined by the receiver operating curve was 1.467. The AST/ALT ratio decreased once during ADT and then elevated in a stepwise manner with cancer progression. The median AST/ALT ratio at the PC diagnosis in surviving patients was 1.423, which did not change longitudinally, whereas that of in deceased patient was significantly higher (1.620) and further elevated after CRPC diagnosis. Kaplan-Meier curves indicated significantly worse OS in patients with the AST/ALT ratio ≥ 1.467, which was confirmed by multivariate analysis. We identified the AST/ALT ratio as a prognostic biomarker for CRPC that changed longitudinally reflecting tumor progression.

ObjectiveThis study aimed to identify the prediction accuracy of the combination of C-reactive protein (CRP) albumin ratio (CAR) and time to castration resistance (TTCR) for overall survival (OS) following development of metastatic castration-resistant prostate cancer (mCRPC).MethodsClinical data from 98 mCRPC patients treated at our institution from 2009 to 2021 were retrospectively evaluated. Optimal cutoff values for CAR and TTCR to predict lethality were generated by use of a receiver operating curve and Youden’s index. The Kaplan–Meier method and Cox proportional hazard regression models for OS were used to analyze the prognostic capabilities of CAR and TTCR. Multiple multivariate Cox models were then constructed based on univariate analysis and their accuracy was validated using the concordance index.ResultsThe optimal cutoff values for CAR at the time of mCRPC diagnosis and TTCR were 0.48 and 12 months, respectively. Kaplan–Meier curves indicated that patients with CAR &gt;0.48 or TTCR &lt;12 months had a significantly worse OS (both p &lt; 0.005). Univariate analysis also identified age, hemoglobin, CRP, and performance status as candidate prognostic factors. Furthermore, a multivariate analysis model incorporating those factors and excluding CRP showed CAR and TTCR to be independent prognostic factors. This model had better prognostic accuracy as compared with that containing CRP instead of CAR. The results showed effective stratification of mCRPC patients in terms of OS based on CAR and TTCR (p &lt; 0.0001).ConclusionAlthough further investigation is required, CAR and TTCR used in combination may more accurately predict mCRPC patient prognosis.

Background Few investigations regarding hematospermia duration have been reported thus far. The aim of this study was to identify clinical factors associated with the duration of hematospermia. Methods Clinical data of 198 patients with hematospermia treated at Toho University Omori Medical Center from 2007 to 2022 were retrospectively evaluated. To identify independent predictors of hematospermia duration, uni- and multivariate Cox analyses were performed. Receiver operating characteristic analysis, Kaplan-Meier survival curves, and propensity score matching were applied for statistical evaluations. Results Multivariate analysis of all 198 patients showed urine pH (UpH) level and any abnormal imaging finding of the prostate to be independent predictors of hematospermia duration. Based on the receiver-operating curve of UpH level for hematospermia improvement, the patients were divided into two groups using a threshold of 6.0 (Low-UpH 5.0–6.0, n=128; High-UpH 7.0–9.0, n=70). Kaplan-Meier curves indicated that patients in the High-UpH group or with any abnormal imaging finding had a higher rate of hematospermia persistence (both P<0.05). Even after matching between the groups classified by UpH (n=60 each), multivariate analysis showed that UpH level (hazard ratio 0.75, 95% CI: 0.61–0.92; P=0.006) and any abnormal imaging finding (hazard ratio 1.55, 95% CI: 1.04–2.31; P=0.033) were independent predictors of hematospermia duration. In Kaplan-Meier analysis findings of matched cohorts, High-UpH and presence of any abnormal imaging findings remained significantly correlated with higher rate of hematospermia persistence, while further stratification using a combination of these two factors identified a stepwise reduction in that rate (P=0.019). In addition, the proportion of patients with these two factors present simultaneously was significantly higher in the group with hematospermia for two months or more, and especially with a duration of greater than six months, than in the group with a duration of less than two months. Conclusions Although further research is needed, both UpH level and imaging findings of the prostate are considered useful biomarkers for predicting prolonged hematospermia.