case report E544Cite as: Can Urol Assoc J 2013;7(7-8):e544-6. http://dx.doi.org/10.5489/cuaj.175 Published online August 19, 2013. AbstractThe incidence of prostate cancer in transsexual patients is very low with only few reported cases. Many years before presenting with prostate cancer, these patients receive hormone ablation as a part of their gender therapy. Their disease is already defined as castrate resistant, and the treatment and follow-up of such patients remains a challenge. We report a case of a male-to-female transgender woman who was diagnosed with metastatic prostate cancer, 31 years post-feminization. Case reportIn 1970, a 45-year-old woman underwent male-to-female sex reassignment surgery, including bilateral orchidectomy. Since then she had started feminizing estrogen therapy, which included conjugated estrogen tablets 1.25 mg daily with no other hormone manipulation therapy. She had no documented family history of prostate cancer.At the age of 75, she presented with obstructive voiding urinary symptoms and was found to have a serum prostatespecific antigen (PSA) level of 13.5 ng/mL; no previous PSA level had been measured (Fig. 1). Her testosterone value was in the castrate range. She underwent a transurethral resection of the prostate and the histology revealed a Gleason 7 prostatic adenocarcinoma. Staging scans did not reveal any evidence of gross metastatic disease. In July 2000, the patient completed a course of external beam radiotherapy (20 fractions of 55.00 Gy) with curative intent. Treatment was well-tolerated. For 18 months following radiotherapy, her PSA values stabilized to about 20 ng/mL. Two years later, her PSA has risen to 37 ng/mL, at which time antiandrogen therapy was initiated (flutamide 250 mg, three times a day) and her estrogen replacement therapy was converted to diethylstilboestrol (1 mg once a day). Four months later, her repeat PSA value decreased to 20 ng/mL. At the end of the same year, diethylstilboestrol had been replaced with ethinyl estradiol (150 mcg once a day), which did not seem to have an effect on future PSA values. At that time a restaging bone scan was done which revealed a suspicion of single metastasis in the proximal femur. She remained asymptomatic. Fourteen months later, her PSA level increased to 40 ng/mL and a repeat bone scan demonstrated significant progression of osseous metastatic disease. At that time palliative chemotherapy was initiated. The patient was treated with mitoxatrone every 21 days and with prednisone 5 mg orally twice daily. She was given 6 cycles of chemotherapy with no toxic side effects. Her PSA initially rose from 53 ng/mL at the start of chemotherapy to 75 at the third cycle and reached plateau at 78 ng/mL after the sixth cycle. Repeated bone and computed tomography scan during chemotherapy showed stable appearances. On August 27, 2005, she was admitted to hospital with general deterioration in health. The next day, the patient died of thromboembolic event. DiscussionThe development of prostate adenocarcinoma in feminized tr...

The aim of this review was to discuss the most recent data from current trials of diethylstilboestrol (DES) to identify its present role in advanced prostate cancer treatment as new hormonal therapies emerge. The most relevant clinical studies using DES in castration-refractory prostate cancer (CRPC) were identified from the literature. The safety, efficacy, outcomes and mechanisms of action are summarized. In the age of chemotherapy this review highlights the efficacy of oestrogen therapy in CRPC. The optimal point in the therapeutic pathway at which DES should be prescribed remains to be established.

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The role of a bladder neck sparing (BNS) technique in radical prostatectomy (RP) remains controversial. The potential advantages of improved functional recovery must be weighed against oncological outcomes. We performed a literature review to evaluate the current knowledge regarding oncological and functional outcomes of BNS and bladder neck reconstruction (BNr) in RP. A systematic literature review using on-line medical databases was performed. A total of 33 papers were identified evaluating the use of BNS in open, laparoscopic and robotic-assisted RP. The majority were retrospective case series, with only one prospective, randomised, blinded study identified. The majority of papers reported no significant difference in oncological outcomes using a BNS or BNr technique, regardless of the surgical technique employed. Quoted positive surgical margin rates ranged from 6% to 32%. Early urinary continence (UC) rates were ranged from 36% to 100% at 1 month, with long-term UC rate reported at 84-100% at 12 months if the bladder neck (BN) was spared. BNS has been shown to improve early return of UC and long-term UC without compromising oncological outcomes. Anastomotic stricture rate is also lower when using a BNS technique.

printing of pelvic fracture urethral injuries-fusion of technology and urethroplasty.