Aging Male最新文献

Introduction: Functional hypogonadism, a manifestation of testosterone deficiency in simultaneously present comorbidities, profoundly impairs quality of life in men with overweight and obesity - yet remains persistently under-recognized in clinical practice.

Findings: Lifestyle modification constitutes first-line therapy, while pharmacological and surgical interventions increasingly complement it. Both promote substantial weight loss and may reverse obesity-related hypogonadism; bariatric surgery, in particular, elicits marked rises in circulating testosterone but entails risks of bone demineralization and uncertain long-term reproductive sequelae. Notwithstanding, testosterone deficiency itself represents a key driver of secondary osteoporosis, insulin resistance, anemia, fatigue, and depression as well as sexual symptoms. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have redefined obesity therapy through profound weight reduction and cardiometabolic benefit, yet concomitant losses of lean mass raise concern over sarcopenia and skeletal fragility.

Conclusion: This focused review article aims to present a comprehensive update on the latest data concerning combining testosterone therapy with contemporary anti-obesity pharmacotherapy as a new standard of care for obese men with functional hypogonadism, uniting metabolic, vascular, sexual, cognitive, and skeletal benefits within a comprehensive strategy to fortify corporeal resilience and enhance quality of life.

Background: The monocyte-to-high-density lipoprotein cholesterol ratio (MHR), an indicator of inflammation and lipid metabolism, has demonstrated significant clinical potential. The study aims to investigate the association between the MHR and total testosterone (TT) levels, as well as testosterone deficiency (TD) risk, utilizing data from the NHANES.

Methods: We analyzed data from 6,194 adult men from NHANES 2011-2016. Multivariate linear and logistic regression analyses were conducted to evaluate associations of MHR with TT levels and TD risk, respectively. Restricted cubic spline (RCS) analyses and subgroup analyses further assessed the robustness of our findings.

Results: In the fully adjusted model, each unit increase in log-transformed MHR was associated with a decrease in TT (β = -47.91, 95% CI: -62.39, -33.43, P < 0.001) and an increase in TD risk (OR = 1.81, 95% CI: 1.46, 2.24, P < 0.001). RCS analysis confirmed a linear relationship, and the findings were consistent across subgroup analyses.

Conclusions: This study showed that in the United States (US) adult men, a high MHR is linked to low TT levels and a higher TD risk. These findings suggest MHR could be a useful marker for early detection of low testosterone and TD risk, warranting further prospective research for confirmation.

Introduction: Corporoplasty is typically accompanied by circumcision to prevent complications such as phimosis, foreskin edema, and necrosis, yet supporting evidence is limited. We reassessed the need for concomitant circumcision by quantifying postoperative phimosis and exploring associated comorbidities.

Methods: In this single-centre retrospective cohort study, 69 of 191 men who underwent corporoplasty between 2010 and 2023 met predefined criteria. Patients with incomplete records, refusal to participate, or loss to follow-up were excluded. Data collection involved the administration of a questionnaire to patients, supplemented by data retrieved from medical databases. The median age was 55 years (range 17-70 years).

Results: 48 of 69 patients did not undergo circumcision either before or during the corporoplasty. Only 3 out of the 48 patients (6.25%) developed post-surgical phimosis. No post-surgical foreskin necrosis were reported. A relevant finding was type2 diabetes mellitus as a significant risk factor for post-surgical phimosis (p < 0.0038). Additionally, the negative impact of the degree of curvature on post-surgical glans penis sensitivity was identified (p = 0.027).

Conclusion: Our findings advocate against the obligatory practice of circumcision performing corporoplasty. Nonetheless, our results emphasize the importance of counseling patients with type2 diabetes mellitus due to their heightened susceptibility to post-surgical phimosis development.

Background: The extent to which male hypogonadism is diagnosed and treated remains ambiguous. This study scrutinizes the respective medical framework in Germany.

Materials and methods: This observational study retrospectively analyzes data from four million male state insurance clients, aged 30 to 80, from 2014 to 2021. It evaluates diagnostics related to hypogonadism prevalence, incidence, comorbidities, testosterone therapy (TTh) implementation, type 2 diabetes incidence, and work incapacity rates.

Results: According to the diagnoses, the prevalence of primary hypogonadism (0.62%) exceeded that of secondary (0.16%) and functional hypogonadism (0.09%), with both incidence and prevalence rising from 2015 to 2021. Common comorbidities included primary hypertension, back pain, and dyslipidemia. Within the first year post-diagnosis, TTh (via transdermal or intramuscular administration) was initiated in 35.22%, 36.60%, and 59.55% of patients with primary, secondary, and functional hypogonadism, respectively. Untreated primary hypogonadism patients had higher work incapacity rates compared to treated patients (17.1% vs. 9.71%; p < 0.001). Conversely, treated patients had a higher incidence of newly diagnosed type 2 diabetes (24.0% vs. 17.7%; p < 0.001).

Conclusion: Optimizing the diagnosis, treatment, and monitoring of male hypogonadism in clinical practice could enhance the quality of life for affected individuals and reduce societal costs.

Background: Prostate cancer most commonly metastasizes to bones and lymph nodes; visceral metastases are uncommon. Central nervous system involvement is exceedingly rare. Here, we report a case of prostate cancer with brain metastasis initially presenting as a lesion occupying the sellar and suprasellar regions and discuss its management.

Case presentation: An 80-year-old male presented with diplopia for two months. Brain MRI showed an occupying lesion in the sellar and suprasellar regions. He also reported urinary difficulty and constipation. Laboratory tests showed elevated TPSA (367.000 ng/mL) and FPSA (40.300 ng/mL) levels. Imaging supported prostate cancer with a suprasellar metastatic lesion. Transurethral prostate resection confirmed prostate adenocarcinoma. He was diagnosed with mHSPC (T4N1M1) and received endocrine therapy.

Conclusions: Brain metastasis from prostate cancer is rare. This case demonstrated a significant reduction in both primary and metastatic lesions following ADT-based endocrine therapy, with no significant adverse effects.

Objective: To systematically compare the efficacy and safety of medications in elderly with overactive bladder.

Methods: Pubmed, Embase, Web of Science, and the Cochrane Register of Clinical Trials databases were systematically searched from database inception to July 25, 2023, and randomized, controlled, double-blind trials for overactive bladder in the elderly were screened according to the protocol. Data were analyzed using Stata17.0.

Results: In terms of reducing Micturitions, the interventions were ranked: trospium chloride (TRO), fesoterodine (FES) 4/8 mg, vibegron (VIB), mirabegron (MIR) 25/50 mg, tolterodine ER (TOL) 4 mg, placebo (PBO), of which only TOL showed no significant difference compared to placebo; Forsafety, the TEAE of TOL 4/8 mg had the highest incidence and was significantly different from others; MIR, VIB, and FES 4mg were well-tolerated regarding dry mouth and constipation; TOL 4 mg, FES 4/8 mg, and VIB showed a statistically increase from placebo for headache and FES 4/8mg and MIR 25 mg showed a statistically increase for dizziness.

Conclusions: TRO 60 mg has the best efficacy in reducing micturitions, but increases the incidence of dry mouth and constipation; VIB and MIR are well tolerated in dry mouth and constipation, but may increase the risk of headache or dizziness.

Background and objective: This meta-analysis compared the efficacy and safety of degarelix and GnRH agonists in prostate cancer treatment.

Methods: A comprehensive literature search was carried out using PubMed, Web of Science, Cochrane Library, and Scopus. RevMan 5.3 software was applied to conduct the meta-analysis.

Results: Degarelix resulted in a higher frequency of adverse events compared to GnRH agonists (59.7% vs 48.4%; RR: 1.07, 95%CI: 1.02-1.13, p < 0.001). However, these events did not translate into a higher rate of severe complications (10.8% vs 11.8%; RR: 0.89, 95%CI: 0.66-1.19, p = 0.43), treatment discontinuation (5.5% vs 5.5%; RR:1.00, 95%CI: 0.67-1.50, p = 0.99) or death (2.5% vs 3.9%; RR: 0.64, 95%CI: 0.34-1.19, p = 0.16). Degarelix triggered higher incidence of injection site reaction (45.3%vs 4.4%; RR: 19.17, 95%CI: 5.51-66.74, p < 0.00001), but contributed to lower rates of cardiovascular events (6.1% vs 7.8%; RR: 0.7, 95%CI: 0.51-0.96, p = 0.03), musculoskeletal events (12.7% vs 15.2%; RR: 0.79, 95%CI: 0.65-0.95, p = 0.01) and urinary adverse effects (AEs) (6.4% vs 14.1%; RR: 0.46, 95%CI: 0.33-0.63, p < 0.00001). Degarelix provided better relief of IPSS (MD -1.85, 95%CI: -2.97- -0.72, P = 0.001) and was linked to reduced prostate volume (MD -1.4, 95%CI: -4.83-2.02, P = 0.42). There was no significant difference in PSA progression at 12 months (13.3% vs 14%; RR: 0.88, 95%CI: 0.73-1.06, p = 0.17). However, degarelix achieved significantly higher castration rates at day 3 (96.5% vs 0%; RR: 356.05, 95%CI: 87.57-1447.68, p < 0.00001) and more sustained testosterone suppression at 12 months (96.1% vs 74.3%; RR: 1.3, 95%CI: 1.02-1.66, p = 0.03).

Conclusions and clinical implications: While degarelix is associated with higher overall AE rates, it provides significant benefits in terms of cardiovascular and musculoskeletal safety, rapid testosterone suppression, and lower urinary AEs.

Background: Prostate diseases, comprising prostatitis, benign prostatic hyperplasia (BPH), and prostate cancer (PCA), represent substantial public health burdens. This study aimed to clarify biomarker-disease relationships and identify potential therapeutic targets for prostate disorders using a Mendelian Randomization (MR) framework.

Methods: We conducted two-sample MR analyses using genome-wide association data. Causal effects were estimated using complementary MR methods. To identify therapeutic targets, MR findings were integrated with DrugBank, protein-protein interaction networks, bulk RNA sequencing, and molecular docking.

Results: Six biomarkers showed causal effects on prostate diseases: URK on prostatitis; GGT and TBIL on BPH; and UCR, PHOS, and BUN on PCA. Functional integration highlighted MPO and TUBB as drug targets for BPH, while docking implicated MET and ATP8B1 in BPH and GATA3 and ENPP3 in PCA. Drug repurposing suggested dexamethasone for BPH and colchicine and metformin for PCA.

Conclusion: This study provides genetic evidence linking biomarkers to prostate diseases and identifies novel druggable targets and repurposing opportunities, offering mechanistic insights and prospects for precision therapy.

Background: The causal relationship and mechanisms connecting Vitamin B12 (VB12) deficiency anemia, red cell distribution width (RDW), and prostate cancer (PCa) remain unclear due to small, methodologically limited studies.

Methods: We performed bidirectional two-sample Mendelian randomization (2SMR) using GWAS to test the causal effects of VB12 deficiency anemia and RDW on PCa. VB12-deprivation cell assays assessed γ-H2AX, cell-cycle distribution, and EMT markers. Mechanistic follow-up used SMR with HEIDI, enrichment, and colocalization analyses.

Results: Both VB12 deficiency anemia (OR_IVW = 1.054, 95% CI: 1.018-1.090) and higher RDW (OR_IVW = 1.095, 95% CI: 1.040-1.153) showed modest positive associations with PCa risk by 2SMR. Multiple sensitivity analyses supported robustness, bidirectional tests found no evidence of reverse causation, and VB12-deprivation cell assays further corroborated the MR signals. In multivariable MR, the positive RDW-PCa association persisted after conditioning on CRP and ferritin. SMR identified 68 genes shared between VB12 deficiency anemia and PCa. Colocalization highlighted two priority loci: B3GAT1 (PP4 = 0.94) and SIK2 (PP4 = 0.78), suggesting that expression changes at these genes may mediate prostate cancer susceptibility.

Conclusion: Genetic liability to VB12 deficiency anemia and higher RDW showed modest, directionally consistent associations with increased PCa risk. This risk may be mediated through B3GAT1 and SIK2.