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In recent years, new therapeutic options have brought improvements in the treatment of metastatic, castration-resistant prostate cancer. Targeted Hormone Therapy (THT) represents a novel therapeutic component for which recent studies have shown a maximum benefit in the time between failure of androgen deprivation therapy (patient is metastatic and still pain-free) and prior to chemotherapy. Prostate cancer experts of the Austrian Society of Urology and Andrology (OGU), the Working Group for Urologic Oncology as part of the OGU, and the Professional Association of Austrian Urologists (BvU) have developed recommendations for the treatment of patients with asymptomatic or mildly symptomatic metastatic, castration-resistant prostate cancer. The definition of failure of classical hormonal therapy has been based on the guidelines of the German Society of Urology (Deutsche Gesellschaft fur Urologie, DGU) and the European Association of Urology (EAU). Criteria for the initiation of treatment with hormonal or chemotherapy include: Treatment should only be initiated when all of these four criteria are applicable, with the age of the patient being no exclusion criterion. First-line therapies for these patients include abiraterone, enzalutamide, and docetaxel as well as radium-223. The manuscript refers only to treatment regimens available in Austria. Selection of the initial treatment option—starting with THT or chemotherapy—should be determined based on the individual patient characteristics. When using abiraterone or enzalutamide, re-staging within 3–6 months is recommended.

Active surveillance (AS) is a well-recognized strategy to reduce the risk of overtreatment in men with low-risk prostate cancer. No data on this approach are available from Austria.The Qualitätspartnerschaft Urologie (QuapU) developed an online database for patients managed with AS in Austria. Principal inclusion/exclusion criteria corresponded to those of the S3 prostate cancer guideline of German urologists: prostate-specific antigen (PSA)10 ng/ml, Gleason score7 (maximum 20% of biopsies being positive). Control visits were scheduled at 3‑month intervals, control biopsies were scheduled at 12 and 36 months.To date 131 patients have been entered into this data base. Mean patient age is 64 years, 6% were younger than 50 years, two thirds of patients were aged 50-70 years and 25% were older than 70 years. Mean PSA value was 5.9 ng/ml (PSA 0-4 ng/ml: 15%; PSA4-10 ng/ml: 85%). The prostate volume averaged 39 ml. The mean time under AS was 17.5 months (12 months: 60%;12 months: 40%). The AS adherence at 12 months was 85% and at 24 months 76%. To date, a total of 23 patients (17.6%) stopped AS. The most frequent reasons for discontinuing AS were patient wish for active treatment (43.5%) and PSA progression (30.4%). A histological progression was rarely seen (6.1%) and the control biopsy rate was low (19.8%).This study is the first description of AS in Austria and documents the feasibility of an online registry for AS. The data confirm the international experience with this approach with acceptable adherence rates.

The aim of this study was to determine prevalence and risk factors for erectile dysfunction (ED) in men undergoing a health investigation.Men aged 30-69 yrs participating in a health screening project in the area of Vienna completed a 11-item questionnaire on ED which was extracted from the international index of erectile function (IIEF). In parallel, all men underwent a detailed health examination including physical assessment, evaluation of various life-style factors and a blood analysis with 14 parameters.Within the total study population (n = 832; 45.3 +/- 9.8 yrs), 8.2% reported no sexual intercourse during the previous four weeks, 5.1% reported moderate/severe ED, 13.1% mild and 73.6% no ED. ED, defined as any problem in maintaining erection until the end of sexual intercourse, increased from 12.5% in those aged 30-39 yrs to 15.3% at 40-49 yrs, 27.4% at 50-59 yrs and 45.2% in men 60-69 yrs. In parallel, the percentage of men without sexual intercourse during the previous four weeks increased from 7.4% at 30-39 yrs to 8.8% at 50-59 yrs and 17.0% at 60-69 yrs. By far the strongest correlate for ED was age; other factors were cardiovascular diseases, physical activity and diabetes mellitus.This study provides the first estimate of the prevalence of ED in different life decades of men in Vienna, and identifies a number of risk factors for this highly prevalent disorder in ageing men.