(Objective) Enzalutamide is an oral androgen-receptor inhibitor that prolongs survival in men with castration-resistant prostate cancer (CRPC). We retrospectively evaluated clinical efficacy and safety of enzalutamide in CRPC. (Patients and methods) We reviewed clinical records of 73 patients who had received enzalutamide for the CRPC at Showa University and affiliated 7 hospitals. Enzalutamide was given at a dose of 160 mg/day, but some patients were treated at lower dose because of there age or poor performance status. Prostrate-specific antigen (PSA) response, prior docetaxel use and the previously administered agents were evaluated retrospectively. (Results) The median patients age was 77 years, the median Gleason score was 9 and the median PSA level at baseline was 26.9 ng/ml. The patients who had prior docetaxel use were 29 (39.7%) and the median of total docetaxel dose was 460 mg/body. The median number of total prior treatments (anti-androgens, Estramustine and steroid) was 3. Twenty seven (61.4%) patients with docetaxel-naïve achieved over 50% reduction of PSA level from baseline, but only 7 (24.1%) in patients previously treated with docetaxel. The most common adverse events included fatigue (24.7%), anorexia (24.7%) and the nausea (16.4%). We found a small proportion of responders to enzalutamide experienced a PSA flare. (Conclusion) Our results of the use of Enzaltamide for CRPC were similar with previous reports. PSA flare was found in some patients with CRPC who responded to enzaltamide. It should be noted that this possible PSA flare phenomenon.
Objectives To investigate the correlation between the Erection Hardness Score and both erectile function and metabolic and lifestyle factors. Methods This study included 548 men who underwent a complete standard medical checkup at Yokohama Shin‐midori General Hospital between 1 July 2016 and 31 August 2018, and answered the question about erectile hardness. The following variables were evaluated: age, erectile hardness on the Erection Hardness Score, erectile function on the Sexual Health Inventory for Men, current medical history (diabetes, hypertension, dyslipidemia, heart disease, stroke), metabolic risk factors (abdominal circumference, hyperglycemia, high blood pressure, lipid abnormality) and lifestyle factors. First, to examine the correlation between erectile hardness and erectile function, the mean Sexual Health Inventory for Men score by Erection Hardness Score grade was determined for each age group. Then, an analysis was carried out to examine the association between erectile hardness and age, current medical history, metabolic risk factors, and lifestyle factors. Results In each age group, a lower Erection Hardness Score grade was associated with a lower mean Sexual Health Inventory for Men score. Lipid abnormality, diabetes and age were independent risk factors for decreased erectile hardness. Conclusions Erection Hardness Score is a useful tool that can easily and accurately assess erectile function in the settings of medical checkups and clinical practice. Diabetes and lipid abnormality affect erectile hardness.
VIAGRA was first placed on the Japanese market in 1999. Since then, PDE5 inhibitors, such as VIAGRA, have been widely used as the first alternative therapeutic medication to treat erectile dysfunction (ED). A new form of VIAGRA called VIAGRA OD Film was launched in the Japanese market on October 21st, 2016. OD film is taken orally without water and is fast dissolving. It is therefore expected to be easier to consume. Moreover, this medication is packaged in thin aluminum sheets to improve portability compared to the original tablets. For this study, we surveyed 25 patients to analyze the OD film formulation. These patients desired ED treatment and used the VIAGRA OD Film. All the participants answered our survey. They were aged between 21 and 79. Thirteen patients switched from the tablets to the OD film and 12 patients only used the OD film. The survey items included: 1) portability, 2) storage, 3) ease of consumption, 4) comfortableness, 5) level of self-consciousness with their partner, 6) thoughts on taking the film formulation, 7) comparison with the tablets, and 8) efficacy and adverse reaction. We observed that 61.5% of the patients who switched from tablets to film found that storage and portability were improved. Additionally, 61.5% of the patients who switched from tablets to film and 75.0% of the patients who were prescribed film only were able to comfortably swallow them. We also found that 69.2% who switched from tablets to film and 75.0% who were prescribed film only felt more at ease using it and 61.5% who switched from tablets to film and 66.7% who were prescribed film only felt more comfortable with the film. Finally, 28.0% of the individuals stated a negative opinion on the ease of consuming the OD film. The efficacy of the film was the same as the tablets. We identified two cases of adverse reactions with mild hot flashes and headache but no severe adverse reaction. This survey indicates that the ease of intake and portability was improved with OD film. Disclosure Work supported by industry: no.
Objective: Many erectile dysfunction (ED) cases are attributed to vascular endothelial dysfunction and impaired blood flow due to arteriosclerotic changes. In this study, we examined the association among the erection hardness score (EHS), pulse wave velocity (PWV), and the presence of carotid artery plaques. Subjects and Methods: The study enrolled 67 patients who visited our hospital with the chief complaint of ED. Based on the history at the first visit, 28 of the 67 patients were categorized into the EHS 3–4 group and the remaining 39 into the EHS 0–2 group. The two groups were retrospectively analyzed. Results: The PWV points were significantly higher in the EHS 0–2 group than in the EHS 3–4 group (P = 0.047). In consideration for error in age, the modified points (PWV at the first visit – reference PWV by age) were significantly higher in the EHS 0–2 group than in the EHS 3–4 group (P = 0.026). This group also showed a higher detection rate of plaques by carotid ultrasound (66.7%). Conclusion: This study showed that patients with lower points of EHS had higher PWV and were more likely to have carotid artery plaques. While ED has occasionally been considered as an early risk marker for the onset of cardiovascular events; this study suggests that the hardness of the penis can be an easier-to-measure and more sensitive index.
In recent years, awareness of erectile dysfunction and the demand for treatment have been increasing even among young men. We investigated the status of young patients 40 years of age or younger with erectile dysfunction. The subjects were 208 patients who visited the urology departments of Showa University Fujigaoka Hospital and affiliated hospitals with a chief complaint of erectile dysfunction. The erectile function was assessed with the Sexual Health Inventory for Men (SHIM), diary questions on sexual intercourse from the Sexual Encounter Profile, and the Erection Hardness Score, which measures the hardness of erection. The treatment was monotherapy with sildenafil (25 or 50 mg), vardenafil (10 or 20 mg), or tadalafil (10 or 20 mg) or a combination of multiple phosphodiesterase 5 (PDE5) inhibitors. To investigate the cause, blood tests including free testosterone and the Self-rating Depression Scale questionnaire were conducted, and Pulse Wave Velocity (PWV) was measured. The median age of the patients was 36 years. As for the cause of erectile dysfunction, psychogenic erectile dysfunction was observed in 141 patients, accounting for 67.7% of the patients. However, 82.1% of patients who underwent PWV measurement showed measurements suggestive of organic changes. The efficacy rates of PDE5 inhibitors were 77% for sildenafil, 73% for vardenafil, and 85% for tadalafil. This study showed that psychogenic erectile dysfunction was common in young patients, and that PDE5 inhibitors were effective for them. In addition, the study suggested the presence of organic changes as a risk factor for erectile dysfunction even in young patients. Disclosure Work supported by industry: no.
Objectives The Erection Hardness Score (EHS) can assess erectile hardness with a single question and is readily used in routine clinical practice. We investigated the correlation between EHS and both erectile function and metabolic risk, lifestyle, and other factors. Methods This study included 548 men who underwent a complete standard medical checkup at our hospital between July 1, 2016, and August 31, 2018, and answered the question about erectile hardness. The following variables were evaluated: age, erectile hardness on the EHS, erectile function on the Sexual Health Inventory for Men (SHIM), current medical history (diabetes, hypertension, dyslipidemia, heart disease, stroke), metabolic risk factors (abdominal circumference, hyperglycemia, high blood pressure, lipid abnormality), and lifestyle factors. First, to examine the correlation between erectile hardness and erectile function, the mean SHIM score by EHS grade was determined for each age group. Then, an analyses was performed to examine the association between erectile hardness and age, current medical history, metabolic risk factors, and lifestyle factors. Results In each age group, a lower EHS grade was associated with a lower mean SHIM score. Lipid abnormality, diabetes, and age were independent risk factors for decreased erectile hardness. Conclusion The EHS as a measure of erectile hardness was correlated with erectile functional as assessed using the SHIM, and current diabetes and lipid abnormality were independent risk factors for decreased erectile hardness. However, neither dyslipidemia nor lipid abnormality is listed as a risk factor in the ED guidelines. Traditionally, lipid abnormality was assessed based mainly on the presence or absence of current hyper-lipidemia and serum total cholesterol level. Today, the diagnostic criteria for metabolic syndrome proposed by the World Health Organization, International Diabetes Federation, and Japanese Society of Internal Medicine also recommend the use of serum triglyceride and HDL cholesterol levels, instead of total cholesterol level, for evaluating lipid abnormality. I think the assessment of lipid abnormality should be used triglyceride and HDL cholesterol levels, instead of total cholesterol level. Disclosure Work supported by industry: no.
Objective: Demand for erectile dysfunction treatments has increased not only in elderly patients but also in young patients. Reports indicate that frequent causes of erectile dysfunction in Japan are organic disorders in elderly patients and psychogenetic disorders in young patients. Methods: We defined patients under the age of 40 as young erectile dysfunction patients, and those over 65 as elderly erectile dysfunction patients. We divided these two groups and conducted a retrospective comparative study based on medical questionnaires. We selected 215 cases of patients under the age of 40, and 176 cases of patients over the age of 65, and created a group of young patients and a group of elderly patients. We implemented the erectile hardness score, Sexual Health Inventory for Men, and sexual encounter profile questions 2 and 3 as the patient's daily clinical journal. Results: The median age of young patients was 36 years, and that of elderly patients was 70 years. With respect to Sexual Health Inventory for Men, the average score was a significantly higher score in the young patients (9.26 vs 7.10, P < 0.001). Concerning erectile hardness score, young patients showed significantly higher scores in erectile hardness score (3.15 vs 2.06, P < 0.001). In terms of sexual encounter profile question 2, 50.9% of young patients responded "yes," but 24.3% of elderly patients responded, thus indicating a significantly higher score in young patients. In terms of sexual encounter profile question 3, 6.1% of young patients responded "yes," and 0.7% of elderly patients responded "yes," indicating a significantly higher in young patients. Conclusions: The results showed that many young patients with erectile dysfunction were able to perform insertion, but were unable to maintain erection.
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