Purpose: Perineural invasion is the only interaction between cancer cells and nerves studied to date. It is a symbiotic relationship between cancer and nerves that results in growth advantage for both. In this article, we present data on a novel biological phenomenon, cancer-related axonogenesis and neurogenesis. Experimental Design: We identify spatial and temporal associations between increased nerve density and preneoplastic and neoplastic lesions of the human prostate. Results: Nerve density was increasedin cancer areas as well as in preneoplastic lesions compared with controls. Two-and three-dimensional reconstructions of entire prostates confirmed axonogenesis in human tumors. Furthermore, patients with prostate cancer had increased numbers of neurons in their prostatic ganglia compared with controls, corroborating neurogenesis. Finally, two in vitro models confirmed that cancer cells, particularly when interacting with nerves in perineural invasion, induce neurite outgrowth in prostate cancer. Neurogenesis is correlated with features of aggressive prostate cancer and with recurrence in prostate cancer.We also present a putative regulatory mechanism based on semaphorin 4F (S4F). S4F is overexpressed in cancers cells in the perineural in vitro model. Overexpression of S4F in prostate cancer cells induces neurogenesis in the N1E-115 neurogenesis assay and S4F inhibition by small interfering RNA blocks this effect. Conclusions: This is the first description of cancer-related neurogenesis and its putative regulatory mechanism.Nerves play a fundamental role not only in the biology of prostate cancer but also in the normal prostate epithelium. The prostate is thoroughly innervated and receives autonomic innervation through the hypogastric and pelvic nerves (1). Our studies of prostate nerve density in a group of cancer-free patients have shown that nerve density of the peripheral zone, where prostate cancer is more frequent, is significantly greater than that of the transition zone. Both overall nerve density and peripheral zone nerve density decrease with increasing age.Nerves have numerous interactions with the epithelial and stromal components of the prostate. Nerves are involved in prostate development and maintenance of the adult phenotype. Several reports have shown that mechanical and/or chemical denervation of the pelvic plexus of Sprague-Dawley and Wistar rats and dogs causes morphologic and functional changes in the prostate (2 -6). Denervated prostates have an overall decrease in cell height and secretory reduction (3). In humans and rats, the embryologic formation of the prostate requires intact innervation. Maturation of the prostate during adolescence also requires the presence of nerves. These findings strongly suggest that prostate function not only is regulated by androgens but also is subject to the trophic influences of nerves (5,7,8).The best-known interaction between nerves and cancer in prostate cancer is perineural invasion (PNI), the process by which cancer cells invade around ne...

The Global Evaluative Assessment of Robotic Skills is simple to administer and able to differentiate levels of robotic surgical expertise. This standardized assessment tool shows excellent consistency, reliability and validity. Further study is warranted to evaluate its usefulness for surgical education and the establishment of competency in robotic surgery.

Objective-To evaluate an entertainment-based patient decision aid for prostate cancer screening among patients with low or high health literacy.Methods-Male primary care patients from two clinical sites, one characterized as serving patients with low health literacy (n=149) and the second as serving patients with high health literacy (n=301), were randomized to receive an entertainment-based decision aid for prostate cancer screening or an audiobooklet-control aid with the same learner content but without the entertainment features. Postintervention and 2-week follow-up assessments were conducted.Results-Patients at the low-literacy site were more engaged with the entertainment-based aid than patients at the high-literacy site. Overall, knowledge improved for all patients. Among patients at the low-literacy site, the entertainment-based aid was associated with lower decisional conflict and © 2008 Elsevier Ireland Ltd. All rights reserved. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.Conflict of Interest None. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript greater self-advocacy (i.e., mastering and obtaining information about screening) when compared to patients given the audiobooklet. No differences between the aids were observed for patients at the high-literacy site.Conclusions-Entertainment education may be an effective strategy for promoting informed decision making about prostate cancer screening among patients with lower health literacy.Practice Implications-As barriers to implementing computer-based patient decision support programs decrease, alternative models for delivering these programs should be explored.

This study identified a pharmacologically optimized intravesical mitomycin C treatment with statistically significantly enhanced efficacy.

Purpose Testosterone replacement therapy in men with prostate cancer is controversial, with concern that testosterone can stimulate cancer growth. We evaluated the safety and efficacy of testosterone in hypogonadal men with prostate cancer treated with radical prostatectomy. Materials and Methods We performed a review of 103 hypogonadal men with prostate cancer treated with testosterone after prostatectomy (treatment group) and 49 nonhypogonadal men with cancer treated with prostatectomy (reference group). There were 77 men with low/intermediate (nonhigh) risk cancer and 26 with high risk cancer included in the analysis. All men were treated with transdermal testosterone, and serum hormone, hemoglobin, hematocrit and prostate specific antigen were evaluated for more than 36 months. Results Median (IQR) patient age in the treatment group was 61.0 years (55.0–67.0), and initial laboratory results included testosterone 261.0 ng/dl (213.0–302.0), prostate specific antigen 0.004 ng/ml (0.002–0.007), hemoglobin 14.7 gm/dl (13.3–15.5) and hematocrit 45.2% (40.4–46.1). Median followup was 27.5 months, at which time a significant increase in testosterone was observed in the treatment group. A significant increase in prostate specific antigen was observed in the high risk and nonhigh risk treatment groups with no increase in the reference group. Overall 4 and 8 cases of cancer recurrence were observed in treatment and reference groups, respectively. Conclusions Thus, testosterone therapy is effective and, while followed by an increase in prostate specific antigen, does not appear to increase cancer recurrence rates, even in men with high risk prostate cancer. However, given the retrospective nature of this and prior studies, testosterone therapy in men with history of prostate cancer should be performed with a vigorous surveillance protocol.