1. Cardiovascular risks are a better indicator of high-grade prostate cancer than metabolic syndrome

Evaluating Metabolic Syndrome (MS) as a single condition may be an inappropriate approach to investigating prostate cancer risk. This study aimed to evaluate the strength of association between individual cardiovascular risks (CVR) and prostate cancer diagnosis at biopsy by correlating the histological characteristics (Gleason score) with the grading of CVR. This may be a more appropriate method to define the metabolic profile of patients since CVR status includes several possible risk factors such as age, smoking status and personal and family history of renal/cardiovascular disease, which are not included in the definition of MS. According to the study by Nunzio et al, moderate/high CVR was associated with a 2.5 times increased risk of high-grade prostate cancer. Further studies in a large patient population across multiple institutions and countries are needed to confirm the results of the research and to better understand which molecular pathway is responsible for the observed results.

2. ACE inhibitors reduce incidence, severity and duration of radiation proctitis

Proctitis is one of the complications of prostatic radiotherapy and can have a profound negative effect on a patient’s overall quality of life. It can lead to the clinical manifestations of rectal bleeding, tenesmus, diarrhoea and strictures. Previous studies have shown that ACE inhibitors (ACEIs) may prevent development of radiation-induced injuries in certain tissue types. Research conducted at the University of Dundee with the participation of 817 patients suggests that the use of ACEIs during prostate radical radiotherapy is significantly associated with a low grade proctitis. These findings suggest that ACEIs help to reduce the incidence of proctitis after radical radiotherapy as well as accelerating the resolution of proctitis. The mechanism of action of ACEIs in reducing severity, incidence and resolution time of radiation induced proctitis is still unknown.

3. Family history of prostate cancer increases risk of low grade, but not high grade, prostate cancer

Current urological guidelines consider family history of prostate cancer as a strong risk factor for prostate cancer, particularly in men who have first-degree relatives with prostate cancer. A study using patients from the Swiss arm of the European Randomised Study of Screening for Prostate Cancer (ERSPC), on which patients had systematic PSA level tests done every 4 years, concluded that men with a family history of prostate cancer are at an increased risk of low-grade but not aggressive (high grade) prostate cancer. While family history should still be considered as a risk factor in daily practice, the assessment should become much more sophisticated and detailed, including the exact origins of diagnosis that is whether prostate cancer in relatives has been detected by PSA screening or clinically.

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