Prostatic Neoplasms: Morales A

Wang C, Nieschlag E, Swerdloff RS, Behre H, Hellstrom WJ, Gooren LJ, Kaufman JM, Legros JJ, Lunenfeld B, Morales A, Morley JE, Schulman C, Thompson IM, Weidner W, Wu FC. · Division of Endocrinology, Department of Medicine, Harbor-UCLA Medical Center and Los Angeles BioMedical Research Institute, Torrance, CA 90509, USA. · Aging Male. · Pubmed #18763169 No free full text.

This publication has no abstract.

Morales A. · No affiliation provided · Eur Urol. · Pubmed #16920252 No free full text.

This publication has no abstract.

Morales A. · Department of Urology and Centre for Advanced Urological Research, Queen's University, Kingston, Canada. · J Endocrinol Invest. · Pubmed #16042371 No free full text.

Abstract: The aging of the world population has brought to the forefront of medical practice the diagnosis and treatment of hypogonadism in adult men. There is an increasing interest on the use of testosterone (T) and other androgens to manage men with clinical and biochemical evidence of hypogonadism. Although treatment with T has been used for 70 yr and it is, generally, safe and effective, there are a number of safety issues--ranging from cardiovascular and lipid alterations to hematological changes--that the physician needs to be aware of. Unquestionably, prostate safety constitutes the most important one. No evidence exists that appropriate androgen administration with knowledgeable monitoring carries significant or potentially serious adverse effects on the prostate gland. Men with symptomatic lower urinary obstruction need to be assessed carefully prior to androgen administration. The suspicion of prostate cancer is an absolute contraindication for T use. Recommendations are available for the judicious and safe use of T in aging men.

Ebert T, Jockenhövel F, Morales A, Shabsigh R. · Department of Urology, Euromed Clinic, Europa-Allee 1, D-90763 Fürth, Germany. · Eur Urol. · Pubmed #15661407 No free full text.

Abstract: For over 50 years, testosterone therapy has been used for the treatment of hypogonadism. In recent years, there has been an increase in the use of testosterone therapy for men with late-onset hypogonadism, as more convenient and effective modes of application are developed. Testosterone therapy in these men can significantly improve their sense of well-being, and lead to increases in muscle and bone mass, upper body strength, virility and libido [Gruenewald, Matsumoto. J Am Geriatr Soc 2003;51:101; Morales. Aging Male 2004; in press]. However, ensuring that optimal testosterone therapy is achieved in men with hypogonadism remains challenging. Oral delivery of unmodified testosterone is not possible, due to rapid first-pass metabolism and its short half-life. Therefore, different derivatives and formulations of testosterone have been developed to enhance potency, prolong duration of action or improve bioavailability. In addition, several different routes of administration have now been evaluated, including intramuscular injections, oral formulations, transdermal patches, transbuccal systems and transdermal testosterone gel. Despite the broad range of testosterone therapy on offer, each form has its benefits and limitations, and some will suit one patient more than another. An important concern among clinicians is that testosterone therapy may cause or promote prostate cancer. While current evidence supports the safety of testosterone therapy, androgens are growth factors for pre-existing prostate cancer. Therefore, before therapy is initiated, careful digital rectal examination and determination of prostate-specific antigen (PSA) in serum should be performed, in order to exclude evident or suspected prostate cancer. The first 3-6 months after initiating testosterone therapy is the most critical time for monitoring effects on the prostate. Therefore, it is important to monitor PSA levels every 3 months for the first year of treatment; thereafter, regular monitoring (mostly for prostate safety but also for cardiovascular and haematological safety) during therapy is mandatory.

Morales A. · Department of Urology, Queen's University, Kingston General Hospital, Ont., Canada. · Eur Urol. · Pubmed #12074396 No free full text.

Abstract: Progress in the understanding of the action of exogenous testosterone has diminished many of the concerns that existed regarding its safety. The major interest is now focused on the effects of androgen supplementation on the prostate gland. Many such concerns have been addressed but others remain to be fully elucidated. It is well established that hypogonadal men receiving adequate androgen therapy develop a prostate with a volume similar to what would be expected from their eugonadal counterparts. Androgen therapy results in modest elevations in the PSA and minor changes in flow parameters. Prostate cancer, on the other hand, remains the most prominent of the safety concerns. Although there is no evidence that normal levels of testosterone promote the development of cancer of the prostate, it is clear that the administration of testosterone enhances a pre-existing prostatic malignancy. Androgen supplementation studies have been, in most cases, of short duration and lacked a control cohort. The current evidence does not support the view that appropriate treatment of hypogonadal elderly men with androgens has a causal relationship with prostate cancer. Larger experience, however, is needed. The same criteria applies to the use of other hormones such as dehydrotestosterone, dehydroepiandrosterone follicle stimulating and growth hormone. A set of recommendations regarding androgen replacement therapy and prostate safety is proposed.

Morales A, Black AM, Emerson LE. · Centre for Applied Urological Research, Queen's University, Kingston, Ontario, Canada. · BJU Int. · Pubmed #18671790 No free full text.

Abstract: OBJECTIVE: To assess the effects of testosterone supplementation in men with testosterone deficiency syndrome (TDS) after external beam radiotherapy (EBRT) for localized prostate cancer. PATIENTS AND METHODS: Five men with significant signs of TDS after treatment for localized prostate cancer with EBRT were treated with testosterone once their prostate-specific antigen (PSA) level had reached the nadir. RESULTS The mean (range) level of testosterone before supplementation was 5.2 (1.1-9.2) nmol/L and the duration of follow-up while on supplementation was 14.5 (6-27) months. At the last visit, the testosterone levels were 17.6 (8.5-32.4) nmol/L. One of the five patients had a transitory increase in PSA level but none had levels of >1.5 ng/mL. All patients reported a marked response in the manifestations of TDS, i.e. four each reported decreased hot flushes, decreased fatigue and improved libido, and two reported improved erectile function. CONCLUSION: Men with TDS after EBRT for localised prostate cancer are candidates for testosterone therapy. The patients must be aware of the advantages and disadvantages of the treatment. PSA levels must have reached a nadir before starting treatment and the follow-up must be particularly close. In these few patients there were no adverse effects from testosterone supplementation. There is a need for more information about the safety and efficacy of testosterone therapy in men successfully treated for localized prostate cancer, because there is evidence indicating hypogonadism in these patients, compromising their quality of life and longevity, independent of the cancer.

Walker M, Aronson KJ, King W, Wilson JW, Fan W, Heaton JP, MacNeily A, Nickel JC, Morales A. · Division of Cancer Care and Epidemiology, Department of Community Health and Epidemiology, Cancer Research Institute, Queen's University, Kingston, Onatrio, Canada. · Int J Cancer. · Pubmed #15825170 No free full text.

Abstract: Dietary patterns reflect combinations of dietary exposures, and here we examine these in relation to prostate cancer risk. In a case-control study, 80 incident primary prostate cancer cases and 334 urology clinic controls were enrolled from 1997 through 1999 in Kingston, Ontario, Canada. Food-frequency questionnaires were completed prior to diagnosis and assessed intake in the 1-year period 2-3 years prior to enrollment. Among controls, dietary intake was used in principal components analyses to identify patterns that were then evaluated with all subjects in relation to prostate cancer risk using unconditional logistic regression, controlling for age. Four dietary patterns were identified: Healthy Living, Traditional Western, Processed and Beverages. Increased prostate cancer risk is apparent in relation to the Processed pattern, composed of processed meats, red meats, organ meats, refined grains, white bread, onions and tomatoes, vegetable oil and juice, soft drinks and bottled water. The OR for the highest tertile compared to baseline is 2.75 (95% CI 1.40-5.39), with a dose-response pattern (trend test p < 0.0035). Our results suggest that a dietary pattern including refined grain products, processed meats and red and organ meats contributes to increased prostate cancer risk. Since dietary information was collected before subjects knew their diagnosis, recall bias was avoided.

Jorda M, Morales A, Ghorab Z, Fernandez G, Nadji M, Block N. · Department ofpathology, University of Miami-Jackson Memorial Medical Center, Miami, Florida, USA. · J Urol. · Pubmed #12352406 No free full text.

Abstract: PURPOSE: There is growing interest in HER2 and its downstream signaling pathway molecules as treatment targets in human malignancies, including prostatic carcinoma. We used a standard Food and Drug Administration approved HER2 immunohistochemical kit to study HER2 expression in prostate cancer. We compared the results with those reported for mammary carcinoma. MATERIALS AND METHODS: For this study we selected 216 specimens obtained from patients who underwent radical prostatectomy for primary untreated prostatic carcinoma. Immunohistochemical staining was performed using the HercepTest kit (Dako Corp., Carpinteria, California) in strict fashion according to the technical and analytical protocols outlined in the kit. RESULTS: Of the tumors 33 (15%) were positive for HER2, including 31 (94%) that were only weakly positive (2+). Of the HER2 positive tumors 97% were Gleason grade 7 or higher. Of the 33 positive cases 22 (67%) showed only a focal positive reaction for HER2 in discrete tumor areas. CONCLUSIONS: HER2 is expressed in a minority of untreated primary prostatic carcinomas. Unlike in mammary carcinoma, HER2 positivity in prostatic cancer is usually weak in intensity and focal in distribution. While the former casts doubt on the usefulness of HER2 as a potential treatment target for most primary untreated prostatic cancer, the latter phenomenon may lead to false-negative results if the test is performed in small biopsies. Furthermore, HER2 staining of prostatic carcinoma can be technically and analytically reproducible provided that there is strict adherence to the outlined methodologies and interpretation.

Morales A. · No affiliation provided · J Urol. · Pubmed #17085212 No free full text.

This publication has no abstract.