Duration Of Hormonal Treatment Research Articles

Quality of Life of Prostate Cancer Patients Treated with Androgen Deprivation Therapy in Ain Shams University Hospital

Abstract Background Prostate cancer is the second most common cancer in men worldwide, according to data from the World Health Organization (WHO) GLOBOCAN Database. The current lifetime risk of prostate cancer for men living in the United States is estimated to be approximately one in eight. In Egypt according to GLOBOCAN number of new cases of prostate cancer 4767 (7.2%), while 5-syear survival 97.5%. Aim of the Work In this study, we aimed to evaluate the impact of treatment with Androgen Deprivation Therapy on quality of life for prostate cancer patient treated in Ain Shams University Hospital using a questionnaire from European organization of research and treatment -quality of life for cancer patient – prostate (PR 25) on prostate patient an Arabic index validated. Patients and Methods This Cross-sectional study was conducted at tertiary care hospital at Ain Shams University hospitals from August 2022 to February 2023 and performed on a total of 45 prostate cancer patients who attended the outpatient clinic at oncology department at Ain Shams University for hormonal therapy that were diagnosed before 2021. Results Our study results revealed that there was no statistically significant correlation between the quality-of-life (QOL) scores and both age of patient and duration of hormonal treatment. In correlation with the demographic characteristics, our study results revealed that the symptom scale score and Functional scale score showed no statistically significant differences with the medical, surgical history of the patient, history of chemotherapy and radiotherapy, ECOG and Metastasis. Conclusion The quality-of-life scores (QLQ-PR25) revealed that the mean symptom scale was 41.11 (SD ± 10.94) and the functional scale was 67.22 (SD ± 13.86) with no significant correlation with both age of patient and duration of hormonal treatment. However, the study was single arm and lack the control group which may underestimate the sexual and urinary changes or outcomes due to the intervention by ADT in patients with prostate cancer. Consequently, the present study can burden the knowledge and shed some light on future prospective studies with larger sample sizes and control group demonstrating the long-term outcomes of ADT in patients with prostate cancer regarding the HR-QOL.

Gender affirming hormone therapy and transgender women fertility: Histologic predictors of germ cell presence.

Evaluate histological changes in testicular parameters after hormone treatment in transgender women. Cross-section study with patients who underwent gonadectomy at Hospital de Clínicas de Porto Alegre from 2011 to 2019. Hormone treatment type, route of administration, age at initiation and duration were recorded. Atrophy parameters were observed: testicular volume, tubular diameter, basal membrane length, presence of spermatogonia and spermatids (diploid and haploid spermatozoid precursors). Eighty-six patients were included. Duration of hormone treatment is associated with testicular atrophy and spermatogenesis arrest. Other characteristics of hormone treatment such as age of initiation, route of administration and type of treatment were not associated with testicular histological changes. Testicular volume may predict spermatogenesis arrest. Basal membrane length and tubular diameter ratio is an interesting predictor of germ cell presence. Cross-sex hormone treatment affects testicular germ cell presence. Basal membrane length and tubular diameter ratio reduces inter variability of measurements and better exemplify how atrophic seminiferous tubules are. Fertility preservation should be addressed by healthcare providers in order to recognize gender affirming treatment impact on transgender health.

Adjuvant Ovarian Function Suppression in Premenopausal Hormone Receptor–Positive Breast Cancer

Few oncology studies have assessed the effectiveness of adjuvant ovarian function suppression (OFS) in observational settings for premenopausal hormone receptor-positive breast cancer. Target trial emulation is increasingly used for estimating treatment outcomes in observational cohorts. To describe hormone therapy and OFS treatment patterns (aim 1), examine the association between adding OFS to tamoxifen (TAM) or aromatase inhibitor (AI) and survival (aim 2), and examine the association between duration of hormone treatment (TAM or AI) plus OFS (H-OFS) and survival (aim 3). This population-based cohort study included all premenopausal, early-stage breast cancer diagnoses between 2010 and 2020 in Alberta, Canada. Target trial emulation was conducted. Eligibility criteria were directly modeled after the Suppression of Ovarian Function Trial (SOFT) and Tamoxifen and Exemestane Trial (TEXT). Participants were followed up for a maximum of 5 years. Data were analyzed from July 2022 through March 2023. For aim 2, exposures were receiving the following baseline treatments for 2 years: AI + OFS (AI-OFS), TAM + OFS (T-OFS), and TAM alone. For aim 3, exposures were a 2-year or greater and a less than 2-year duration of H-OFS. Recurrence-free survival was the primary outcome of interest. Marginal structural Cox models with inverse probability treatment and censoring weights were used to estimate hazard ratios (HRs), adjusted for baseline and time-varying confounding variables. Among 3434 female patients with premenopausal, early-stage breast cancer diagnoses (median [IQR] age, 45 [40-48] years), 2647 individuals satisfied SOFT and TEXT eligibility criteria. There were 2260 patients who initiated TAM, 232 patients who initiated T-OFS, and 155 patients who initiated AI-OFS; 192 patients received H-OFS for 2 or more years, and 195 patients received H-OFS for less than 2 years. The 5-year recurrence risks were not significantly lower in AI-OFS vs TAM (HR, 0.76; 95% CI, 0.38-1.33) or T-OFS vs TAM (HR, 0.87; 95% CI, 0.50-1.45) groups. Patients receiving H-OFS for 2 or more years had significantly better 5-year recurrence-free survival compared with those receiving H-OFS for less than 2 years (HR, 0.69; 95% CI, 0.54-0.90). This study found no significant reductions in recurrence risk for AI-OFS and T-OFS compared with TAM alone. H-OFS duration for at least 2 years was associated with significantly improved recurrence-free survival.

Impact of the preoperative hormone therapy duration on the satisfaction of transgender men after chest masculinization surgery

Introduction Chest masculinization is currently the most commonly performed gender-affirming surgery. It is often preceded by testosterone replacement therapy, whose duration is not agreed upon before surgery. Our study evaluates the postoperative satisfaction of transgender men who have undergone chest masculinization surgery according to their preoperative hormonal treatment duration. Material and methods We conducted a single-center prospective study conducted from 2021 to 2022. All transgender men older than 18 years who had chest masculinization surgery were included. Demographic data, medical history, operative data, and duration of preoperative hormone therapy were collected. Participants completed the BREAST-Q© and BODY-Q© questionnaires pre- and postoperatively. Results Forty-six patients were included, with a median age of 21 years (18–45 years). The median preoperative testosterone duration was 596 days (186–4479 days). A significant improvement was found in BREAST-Q© (psychosocial, sexual and physical well-being; satisfaction with chest) and BODY-Q© (satisfaction with chest and nipples) parameters (p < 0.01). There was no significant correlation between preoperative hormone therapy time and chest satisfaction of BREAST-Q© (ρ = 0.069; R2 = 0.002; p = 0.647) and BODY-Q© (ρ = –0.114; R2 = 0.007; p = 0.450). Conclusion All patients in our study were exposed to exogenous testosterone for at least six months. Our study suggests that satisfaction remains unchanged with a longer duration of usage, indicating that an extended period of hormone impregnation may not be necessary before performing chest masculinization surgery in transgender men. Furthermore, the findings confirm a significantly high post-operative satisfaction rate among participants, emphasizing the positive impact of this type of surgery.

In vivo induction of male sexual behavior in zebrafish by adding agents to water.

Successful fertilization in fish mating occurs when egg maturation in the ovary of the female, ovulation, sperm maturation in the testis of the male, and reproductive behaviors in both sexes are triggered in synchrony. The male sexual behavior of fish is induced by hormones and pheromones. In a previous study, we demonstrated that externally applied hormones added to the water can induce oocyte maturation and ovulation in female zebrafish. Here, we attempted to establish a similar method to induce the sexual behavior of male zebrafish. The male sex steroid testosterone (Tes) triggered sexual behavior within several hours in vivo when administered directly into the surrounding water. A selective agonist for membrane progesterone receptor (mPR), Org OD-02 (Org), also induced sexual behavior. Through trials of various combinations of compounds, we found that the most effective conditions were achieved by treatment with a mixture of testosterone (Tes) and Org. The effect of treatment was evaluated by the number of fertilized eggs obtained by pairing with females with induced ovulation in vivo. The period necessary for the induction of male sexual behavior was evaluated by time course experiments. The success rate of mating and the number of fertilized eggs reached the maximum level at 3-4 hours of treatment. The duration of hormonal treatment was confirmed by counting the number of hooking occurrences, which is the final cue to induce spawning by females. In summary, we have established a method to induce male sexual behavior in zebrafish in vivo. The method can be used to obtain fertilized eggs in zebrafish by simply adding agents into the water.

Fertility-Sparing Management of Early Stage Endometrial Cancer: A Narrative Review of the Literature

Objectives: The incidence of endometrial cancer (EC) is rising largely due to the increasing levels of obesity along with an ageing population. This has led to an increase in the incidence of premenopausal women with EC. 5% of cases are in patients less than 40 years old, 70% of which are nulliparous at diagnosis. Therefore, fertility considerations must be taken into account when managing these patients. The objectives of this review are to present the fertility-sparing management options available. Mechanism: A detailed computerized literature search of PubMed and MEDLINE up to 1st June 2022 was carried out in order to survey the evidence for fertility-sparing treatment. Studies including patients with endometrial hyperplasia and early-stage EC undergoing fertility-sparing management were included. Findings in Brief: Progestin acts by downregulating oestrogen receptors, thereby suppressing endometrial growth. Oral progestins and the levonorgestrel-releasing intrauterine system (IUS) have therefore been used as non-surgical hormonal treatment for EC. Megestrol acetate (MA) has been shown to produce the highest remission rates compared to other progestins in a systematic review and meta-analysis, but medroxyprogesterone acetate exhibited lower recurrence rates. The IUS for atypical hyperplasia (AH) and EC showed that the majority of patients responded by 3 months’ use. A minimum duration of hormonal treatment for AH and EC of 6 months has been advocated, based on randomised studies showing greater efficacy when compared to 3 months treatment. A meta-analysis and systematic review assessing the efficacy of both oral and intra-uterine progestins showed a higher pooled complete response (CR) than with IUS alone. Metformin, gonadotrophin-releasing hormone agonists and weight loss have also been added to progestin regimes with variable results on EC regression. Hysteroscopic resection allows for targeted excision of early-stage EC, but with the risk of perforation and so this has not been recommended by the British Gynaecological Cancer Society or the European Society of Gynaecological Oncology. Assisted reproduction treatment (ART) may be the quickest way to achieve pregnancy once CR is achieved. Pregnancy rates have varied from 32–100%, with live birth rates varying from 17.9–43.8%. Conclusions: EC incidence is on the increase in the premenopausal population along with obesity rates and the average first age of parenthood. Fertility-sparing management of EC should be considered for women where fertility is desired.

The Effects of an In Vitro Oocyte Maturation System and Chlorogenic Acid Supplementation during Embryo Culture on the Development of Porcine Cloned Embryos Derived from Native Vietnamese Ban Pigs

The aim of this study was to improve the production efficiency of Vietnamese native Ban pig embryos using somatic cell nuclear transfer (SCNT). Fibroblast cells from Ban pigs were injected into the enucleated cytoplasts of crossbred gilts, and the reconstructed embryos were subsequently cultured. In the first experiment, cytoplasts were isolated from oocytes matured in either a defined porcine oocyte medium (POM) or in TCM199 medium supplemented with porcine follicular fluid. Both media were supplemented with gonadotropic hormones, either for the first 22 h of in vitro maturation (IVM) or for the entire 44 h of IVM. In the second experiment, the reconstructed SCNT embryos were cultured with or without 50 μM chlorogenic acid (CGA). Furthermore, this study examined parthenogenetic embryos. The IVM medium and duration of hormone treatment did not affect embryo development. CGA supplementation to the culture medium significantly increased blastocyst formation rates in parthenogenetic embryos but not in SCNT embryos. However, CGA supplementation significantly reduced the apoptotic index in blastocysts regardless of embryo source. In conclusion, the IVM method did not affect SCNT embryo production, while CGA supplementation during embryo culture improved the quality of SCNT embryos in indigenous pig breeds.

Pregnancy After Breast Cancer - Prognostic Safety and Pregnancy Outcomes According to Oestrogen Receptor Status: A Systematic Review.

Breast cancer is the primary cause of cancer-related death in women. Women diagnosed with estrogen receptor (ER)-positive breast cancer have prolonged treatment durations. Owing to the paucity of research and lack of consensus regarding conception planning and pregnancy for patients with ER-positive breast cancer, we aimed to assess pregnancy and survival outcomes in women with ER-positive breast cancer during and after treatment. We conducted a systematic review of the available studies on pregnancy after ER-positive breast cancer. The assessed outcomes included overall survival (OS), disease-free survival (DFS), hormonal therapy duration, and pregnancy outcomes. Ultimately, 2,669 patients from five studies were included in this study. When all breast cancer receptor subtypes were included in the analysis, pregnancy after breast cancer was associated with a time-dependent protective effect on both DFS and OS. This protective effect was not evident when examining ER-positive patients with subsequent pregnancies, and no significant differences in DFS were observed. ER-positive patients who became pregnant received significantly lower rates of hormonal therapy. Hormonal treatment at the time of pregnancy was correlated with increased rates of termination owing to concerns about teratogenic effects. Pregnancy after breast cancer did not significantly affect DFS in ER-positive patients over a follow-up period of 5-10 years from diagnosis, although did significantly affect hormonal treatment duration in the reviewed studies. Further analysis and in-depth studies are required to assess the effects of altered hormonal treatment times, as well as patient management related to pregnancy planning after breast cancer.

Histological study on the influence of puberty suppression and hormonal treatment on developing germ cells in transgender women.

STUDY QUESTIONCan transgender women cryopreserve germ cells obtained from their orchiectomy specimen for fertility preservation, after having used puberty suppression and/or hormonal treatment?SUMMARY ANSWERIn the vast majority of transgender women, there were still immature germ cells present in the orchiectomy specimen, and in 4.7% of transgender women—who all initiated medical treatment in Tanner stage 4 or higher—mature spermatozoa were found, which would enable cryopreservation of spermatozoa or testicular tissue after having used puberty suppression and/or hormonal treatment.WHAT IS KNOWN ALREADYGender affirming treatment (i.e. puberty suppression, hormonal treatment, and subsequent orchiectomy) impairs reproductive function in transgender women. Although semen cryopreservation is generally offered during the transition process, this option is not feasible for all transgender women (e.g. due to incomplete spermatogenesis when initiating treatment in early puberty, in case of inability to masturbate, or when temporary cessation of hormonal treatment is too disruptive). Harvesting mature spermatozoa, or testicular tissue harboring immature germ cells, from orchiectomy specimens obtained during genital gender-affirming surgery (gGAS) might give this group a chance of having biological children later in life. Previous studies on spermatogenesis in orchiectomy specimens showed conflicting results, ranging from complete absence of germ cells to full spermatogenesis, and did not involve transgender women who initiated medical treatment in early- or late puberty.STUDY DESIGN, SIZE, DURATIONHistological and immunohistochemical analyses were performed on orchiectomy specimens from 214 transgender women who underwent gGAS between 2006 and 2018. Six subgroups were identified, depending on pubertal stage at initiation of medical treatment (Tanner stage 2-3, Tanner stage 4-5, adult), and whether hormonal treatment was continued or temporarily stopped prior to gGAS in each of these groups.PARTICIPANTS/MATERIALS, SETTING, METHODSAll transgender women used a combination of estrogens and testosterone suppressing therapy. Orchiectomy specimen sections were stained with Mayer’s hematoxylin and eosin and histologically analyzed to assess the Johnsen score and the ratio of most advanced germ cell types in at least 50 seminiferous tubular cross-sections. Subsequently, immunohistochemistry was used to validate these findings using spermatogonia, spermatocytes or spermatids markers (MAGE-A3/A4, γH2AX, Acrosin, respectively). Possibilities for fertility preservation were defined as: preservation of spermatozoa, preservation of spermatogonial stem cells or no possibilities (in case no germ cells were found). Outcomes were compared between subgroups and logistic regression analyses were used to assess the association between the duration of hormonal treatment and the possibilities for fertility preservation.MAIN RESULTS AND THE ROLE OF CHANCEMature spermatozoa were encountered in 4.7% of orchiectomy specimens, all from transgender women who had initiated medical treatment in Tanner stage 4 or higher. In 88.3% of the study sample orchiectomy specimens only contained immature germ cells (round spermatids, spermatocytes or spermatogonia, as most advanced germ cell type). In 7.0%, a complete absence of germ cells was observed, all these samples were from transgender women who had initiated medical treatment in adulthood. Cessation of hormonal treatment prior to gGAS did not affect the presence of germ cells or their maturation stage, nor was there an effect of the duration of hormonal treatment prior to gGAS.LIMITATIONS, REASONS FOR CAUTIONSince data on serum hormone levels on the day of gGAS were not available, we were unable to verify if the transgender women who were asked to temporarily stop hormonal treatment 4 weeks prior to surgery actually did so, and if people with full spermatogenesis were compliant to treatment.WIDER IMPLICATIONS OF THE FINDINGSThere may still be options for fertility preservation in orchiectomy specimens obtained during gGAS since a small percentage of transgender women had full spermatogenesis, which could enable cryopreservation of mature spermatozoa via a testicular sperm extraction procedure. Furthermore, the vast majority still had immature germ cells, which could enable cryopreservation of testicular tissue harboring spermatogonial stem cells. If maturation techniques like in vitro spermatogenesis become available in the future, harvesting germ cells from orchiectomy specimens might be a promising option for those who are otherwise unable to have biological children.STUDY FUNDING/COMPETING INTERESTNone.TRIAL REGISTRATION NUMBERN/A.

Prospective Patient-reported Psychosocial Outcomes of Facial Feminization Surgery

PURPOSE: Gender affirming surgery is an essential component in the treatment of gender dysphoria. While health insurance plans have deemed several gender-affirming surgeries as medically necessary, facial reconstructive procedures continue to be debated due to a deficiency of high-level evidence for quality-of-life improvements. As face perception neural networks allow for immediate gender identification, facial gender-affirming surgery is frequently the first and most important surgery for many patients with gender dysphoria, particularly in the transfeminine population. In this work, we administer a battery of validated, quantitative patient-reported outcomes measures examining the psychosocial functioning of a cross-section of transgender patients who have or have not received facial feminization surgery (FFS). METHODS: In total, 96 patients (age 33.07 ± 10.60 years) receiving an FFS consultation at the University of California, Los Angeles were prospectively enrolled from 2019 to 2021 and administered 11 adult Patient-Reported Outcomes Measurement Information System item banks, including version 1.0 anxiety short form 8a, version 1.1 anger short form 5a, version 1.0 depression short form 8b, version 1.2 global health form, version 2.0 satisfaction with sex life form, version 1.0 positive affect short form 15a, version 1.0 meaning and purpose short form 4a, version 2.0 emotional support short form 4a, version 2.0 companionship short form 4a, and version 2.0 social isolation short form 4a. Descriptive statistics and linear regression analyses were performed. RESULTS: Patients who received FFS (assessed 236.35 ± 143.30 days postoperatively) demonstrated improvements in anxiety, anger, depressive symptoms, sex life, positive affect, emotional support, and meaning and purpose instrument scores. Because psychosocial functioning is likely to be influenced by multiple factors, we developed a linear regression model to understand whether FFS would be an independent predictor of psychosocial scores. Other predictors included were the presence or absence of other gender affirming surgery, binary or non-binary gender identity, duration of hormone treatment, age at the time of assessment, and global health scores as a measure of baseline health. For anxiety scores, this model accounted for 36.6% of the variance [F(6,78) = 7.512, P < 0.001], and for anger scores, this model accounted for 23.2% of the variance [F(6,78) = 3.919, P = 0.02]. The completion of FFS independently predicted lower anxiety scores (beta = −0.197, P = 0.04) and lower anger scores (beta = −0.219, P = 0.04). With the exception of global health, no other variables were significantly predictive of either anxiety or anger scores. CONCLUSIONS: Our prospective, cross-sectional assessment of psychosocial outcomes demonstrated a global improvement in psychosocial functioning in patients who have received FFS. The linear regression model that includes other potential predictors of variance in scores such as other gender affirming surgery, age, and duration of hormone therapy demonstrated that completion of FFS was an independent predictor of lower anxiety and anger scores. This work is the first Level II evidence study in quality of life of outcomes for patients who have undergone FFS and it is also the first study utilizing robust, validated instruments for assessment. Future directions of this work include longitudinal analyses of patient outcomes after FFS.

SC197 - What is the optimal duration of hormonal treatment during salvage radiotherapy in men with pN1 prostate cancer? Results form a large multi-institutional series

SC197 - What is the optimal duration of hormonal treatment during salvage radiotherapy in men with pN1 prostate cancer? Results form a large multi-institutional series

P1220 - What is the optimal duration of hormonal treatment during salvage radiotherapy in men with pN1 Prostate Cancer? Results form a large Multi-Institutional series

P1220 - What is the optimal duration of hormonal treatment during salvage radiotherapy in men with pN1 Prostate Cancer? Results form a large Multi-Institutional series

Long-term recurrence risk after a first venous thromboembolism in men and women under 50 years old: A French prospective cohort

BackgroundData on long-term venous thromboembolism (VTE) recurrence risk according to gender are conflicting. ObjectiveTo evaluate long-term VTE recurrence risk after a first VTE in men and women under 50 years old. MethodsSince May 2000, 875 consecutive patients (315 men, 560 women) with a first symptomatic VTE under 50 years old were enrolled in a French prospective multicentre cohort study and were followed up as long as possible. The primary outcome was symptomatic recurrent VTE during follow-up. ResultsAt baseline, men were older and had more comorbidities than women. First VTE was mainly unprovoked in men (80.6%) and hormone-related in women (84.3%). During a median follow-up of 7.0 years (inter-quartile range, 5.0–11.0), recurrent VTE occurred in 97 men (30.8%) and in 72 women (12.9%) (annual incidence rates of recurrent VTE of 4.8% versus 1.8%-person-years, P<0.001). However, there was no difference according to gender in subgroups of patients with a first unprovoked VTE (5.8% versus 3.8%-person-years, P = 0.09). In women, duration of hormonal treatment before first VTE did not influence recurrence risk. In multivariable analysis, unprovoked VTE and family history of VTE were independently associated with recurrence (hazard ratio of 2.50 (95% confidence interval, 1.61 to 3.85) and 1.52 (1.11 to 2.09) respectively). LimitationsNumber of women with unprovoked VTE was low. ConclusionsIn patients with a first VTE under 50 years old, a first unprovoked episode and a family history of VTE, but not gender, were associated with a high risk of long-term recurrence.

Clinical Outcomes of High-Dose Palliative Radiotherapy for Elderly Patients with Localized Prostate Cancer

While men may live for many years with prostate cancer, symptoms associated with local extension and metastatic disease limit quality of life. Radical treatment for localized prostate cancer in elderly patients, age greater than 70, can sometimes lead to morbidity with less survival benefit. To mitigate this risk, androgen deprivation therapy-based approaches are often employed. At the study institution, a common clinical practice over the study period (>10 years) was to offer these patients palliative radiotherapy (RT) with doses up to 5000cGy in an attempt to control local disease, delay progression, and delay subsequent use of hormonal therapy. This study aimed to report on the benefits and toxicities associated with this RT treatment and whether it interrupted use of hormonal therapy. Using a patient information system, patients were identified with birthdate(s) on or before September 1, 1948, and having received radiotherapy treatment to the prostate with doses between 4000cGy and 5000cGy. Ethics approval was obtained and chart review performed to determine duration of hormonal treatment, radiation-related toxicity, PSA kinetics, and overall survival. 54 patients meeting the inclusion criteria for the study were identified. 53 (98%) had a pathologic confirmation of prostate cancer. Median time from pathologic diagnosis to administration of radiotherapy was 13 (13-31) months. Of the cohort, 36 (67%) patients did not receive continuous hormonal therapy. These patients had a median duration of combined neoadjuvant and adjuvant hormonal therapy of 18 months and a median time to re-initiation of hormonal therapy after radiotherapy of 20 months. No patients encountered CTCAE Grade 3 toxicities. There were no reported skin toxicities; 13 (24%) reported CTCAE Grade 1 Genitourinary (GU) toxicity, 3 (6%) CTCAE Grade 2 GU toxicity; and 9 (17%) reported CTCAE Grade 1 Gastrointestinal (GI) toxicity and 0% CTCAE Grade 2 GI toxicity. Kaplan-Meier estimated 5-year metastasis-free survival was 56%, and 5-year overall survival was 78%. Palliative radiotherapy to the prostate of up to 5000cGy was well tolerated in this cohort of elderly patients. In several patients, treatment breaks from androgen deprivation were achieved.

Risk of bipolar disorder in patients with endometriosis: A nationwide population-based cohort study

BackgroundWomen with endometriosis (EM) have increased vulnerability to certain psychiatric disorders, including depression and anxiety, as well as bipolar disorder (BD). This study investigates the risk of BD development in EM patients. Also, the impact of EM treatment on the risk of developing BD is examined. MethodsA total of 17,832 EM patients and 17,832 non-EM controls matched by age, index year, and Charlson Comorbidity Index (CCI) score were included between 2000–2012 and followed to the end of 2013. Participants newly diagnosed as BD by board-certified psychiatrist were defined as incidents. Cox regression analysis was used to calculate the hazard ratio (HR) with 95% confidence interval (CI) of the BD incidence rate between two studied groups. ResultsEM patients were associated with an increased risk of BD development compared with non-EM controls after adjusting for age, CCI score, and different treatment options (1.04 versus 0.56 per 1,000 person-years, HR: 2.34, 95% CI: 1.75–3.12). Also, there was no significant difference in the risk estimate between different hormonal or surgical treatment groups, suggesting a limited impact of EM treatment on the risk of BD development. LimitationsThis study deals with the duration of hormonal treatment, whether operated or not, which reduces the chances of showing the effect of individual EM treatment on the risk of BD development. ConclusionThis study shows that EM patients are associated with an increased risk of BD development. Further studies would be needed to elucidate the mechanism linking the EM and BD.

Female obesity does not impact live birth rate after frozen-thawed blastocyst transfer.

Does female obesity affect live birth rate after frozen-thawed blastocyst transfer? Live birth rate was not statistically different between obese and normal weight patients after frozen-thawed blastocyst transfer (FBT). Obesity is a major health problem across the world, especially in women of reproductive age. It impacts both spontaneous fertility and clinical outcomes after assisted reproductive technology. However, the respective impact of female obesity on oocyte quality and endometrial receptivity remains unclear. While several studies showed that live birth rate was decreased in obese women after fresh embryo transfer in IVF cycle, only two studies have evaluated the effects of female body mass index (BMI) on pregnancy outcomes after frozen-thawed blastocyst transfer (FBT), reporting conflicting data. This retrospective case control study was conducted in all consecutive frozen-thawed autologous blastocyst transfer (FBT) cycles conducted between 2012 and 2017 in a single university-based centre. A total of 1415 FBT cycles performed in normal weight women (BMI = 18.5-24.9kg/m2) and 252 FBT cycles performed in obese women (BMI ≥ 30kg/m2) were included in the analysis. Endometrial preparation was standard and based on hormonal replacement therapy. One or two blastocysts were transferred according to couple's history and embryo quality. Female and male age, smoking status, basal AMH level and type of infertility were comparable in obese and normal weight groups. Concerning FBT cycles, the duration of hormonal treatment, the stage and number of embryos (84% single blastocyst transfer and 16% double blastocysts transfer) used for transfer were comparable between both groups. Mean endometrium thickness was significantly higher in obese than in normal weight group (8.7 ± 1.8 vs 8.1 ± 1.6mm, P< 0.0001). Concerning FBT cycle outcomes, implantation rate, clinical pregnancy rate and live birth rate were comparable in obese and in normal weight groups. Odds ratio (OR) demonstrated no association between live birth rate after FBT and female BMI (OR = 0.92, CI 0.61-1.38, P= 0.68). Anthropometric parameters such as hip to waist ratio were not used. Polycystic ovarian syndrome status was not included in the analysis. Our study showed that live birth rate after frozen-thawed blastocyst transfer was not statistically different in obese and in normal-weight women. Although this needs confirmation, this suggests that the impairment of uterine receptivity observed in obese women after fresh embryo transfer might be associated with ovarian stimulation and its hormonal perturbations rather than with oocyte/embryo quality. No external funding was received. There are no competing interests. N/A.

Breast cancer risk in transgender people receiving hormone treatment: nationwide cohort study in the Netherlands

ObjectiveTo investigate the incidence and characteristics of breast cancer in transgender people in the Netherlands compared with the general Dutch population.DesignRetrospective, nationwide cohort study.SettingSpecialised tertiary gender clinic in Amsterdam, the...

Clinical progression at initiation of a life-extending therapy (LET) in metastatic castration-resistant prostate cancer (mCRPC) is associated with a poor prognosis, whatever the treatment-line: Results of the CATS retrospective registry.

189 Background: We previously reported that cancer pain was associated with a poor prognosis in mCRPC patients (pts) treated with docetaxel (D) ( Oudard, BJU Int 2009). Asymptomatic chemo-naive pts treated with novel androgen receptor targeted agent (H) have a greater overall survival (OS) than those with mild symptoms ( Miller, Eur Urol 2018). We thus investigated the impact on OS of progression type at initiation of first-, second- and third-line of LET in a large cohort of mCRPC pts (CATS registry) treated with D, cabazitaxel (C) and H. Methods: 669 consecutive mCRPC pts treated with 3 LETs (DCH, n= 158; DHC, n=456; HDC, n=55) were retrospectively reviewed. Type of progression: PSA alone, radiographic ± PSA, clinical ± PSA ± radiographic at initiation of each LET was evaluable in 661 pts. Clinical progression was defined by worsening of cancer-related pain or symptoms as per physician judgment. Results: Clinical progression at initiation of LET increased with the number of treatment lines and was consistently associated with a worse outcome. Clinical progression was associated with a significantly shorter duration of treatment with H but had no influence on duration of taxanes. Conclusions: In pts treated with 3 LTEs (D, C and H) clinical progression at sequence initiation is associated with a poor OS and a shorter duration of hormonal treatment. These data may help guide treatment decisions.[Table: see text]

Assessing the Role and Optimal Duration of Hormonal Treatment in Association with Salvage Radiation Therapy After Radical Prostatectomy: Results from a Multi-Institutional Study

BackgroundThe optimal duration of hormonal therapy (HT) when associated with postprostatectomy radiation therapy (RT) remains controversial. ObjectiveTo test the impact of HT duration among patients treated with postprostatectomy RT, stratified by clinical and pathologic characteristics. Design, setting, and participantsThe study included 1264 patients who received salvage RT (SRT) to the prostatic and seminal vesicle bed at eight referral centers after radical prostatectomy (RP). Patients received SRT for either rising prostate-specific antigen (PSA) or PSA persistence after RP, defined as PSA ≥0.1ng/ml at 1mo after surgery. Administration of concomitant HT was at the discretion of the treating physician. Outcome measurements and statistical analysisThe outcome of interest was clinical recurrence (CR) after SRT, as identified by imaging. Multivariable Cox regression analysis was used to test the association between CR and HT duration. We applied an interaction test between HT duration and baseline risk factors to assess the hypothesis that CR-free survival differed by HT duration according to patient profile. Three risk factors were prespecified for evaluation: pT stage ≥pT3b, pathologic Gleason ≥8, and PSA level at SRT >0.5 ng/ml. The relationship between HT duration and CR-free survival rate at 8yr was graphically explored according to the number of risk factors (0 vs 1 vs ≥2). Results and limitationsOverall, 1125 men (89%) received SRT for rising PSA and 139 (11%) were treated for PSA persistence. Concomitant HT was administered to 363 patients (29%), with a median HT duration of 9mo. At median follow-up of 93mo after surgery, 182 patients developed CR. The 8-yr CR-free survival was 92%. On multivariable analysis, HT duration was inversely associated with the risk of CR (hazard ratio 0.95; p=0.022). A total of 531 (42%) patients had none of the prespecified risk factors, while 507 (40%) had one and 226 (18%) had two or more risk factors. The association between HT duration and CR was significantly different by risk factors (0 vs 1, p=0.001; 0 vs ≥2, p<0.0001). We observed a significant effect of HT duration for patients with two or more risk factors, for whom HT administration was beneficial when given for up to 36mo. This effect was attenuated among patients with one risk factor, with concomitant HT slightly beneficial when administered for a shorter time (<12mo). Conversely, for patients with no risk factors, the risk of CR remained low and constant regardless of HT duration. ConclusionsThe oncologic benefit of HT duration among men receiving SRT for increasing PSA after RP depends on their clinical and pathologic characteristics. Our data suggested a significant effect of long-term HT for patients with two or more adverse features. Conversely, short-term HT was sufficient for patients with a single risk factor, whereas patients without any risk factors did not show a significant benefit from concomitant HT. Patient summaryWe tested the impact of hormonal therapy (HT) duration during radiation therapy after radical prostatectomy. We identified three risk factors and observed a different impact of HT duration by clinical and pathologic characteristics. Patients with more adverse features benefit from long-term concomitant HT. On the contrary, for patients with a single risk factor, short-term HT may be reasonable. Patients without any risk factors did not show a significant benefit from concomitant HT.

Pregnancy and oncologic outcomes after fertility-sparing management for early stage endometrioid endometrial cancer.

Hormonal management is an alternative treatment for preserving fertility in patients with presumed early stage endometrioid endometrial cancer. This study aimed to define the pregnancy and oncologic outcomes and factors of successful conception after hormone therapy for endometrioid endometrial cancer. We retrospectively analyzed patients presumed to have stage IA, grade 1-2 endometrioid endometrial cancer who underwent fertility-sparing treatment. Concurrent medroxyprogesterone and levonorgestrel-release intra-uterine devices were used for treatment. The pregnancy outcomes and oncologic outcomes were compared between the pregnant and non-pregnant groups. Seventy-one patients presumed to have stage IA, grade 1-2 endometrioid endometrial cancer had complete remission, and 49 of them tried to conceive. Twenty-two (44.9%) patients became pregnant; the total number of pregnancies was 30. These pregnancies resulted in seven abortions (23.3%), one pre-term birth (3.3%), and 20 full-term births (66.6%). The total live birth rate was 66.6 % (20/30). The median duration of hormonal treatment was 11.9 months (range 4-49) and 12.0 months (range 3-35) in the pregnant and non-pregnant groups, respectively. On multivariate analysis, age, body mass index, treatment duration, medroxyprogesterone dose, and number of dilatation and curettage biopsies were not significantly associated with pregnancy failure, but the association with grade (OR 6.2, 95% CI 1.0 to 38.9; P<0.05) was statistically significant. The median disease-free survival duration was 26 months (range 20-38) and 12 months (range 4-48) in the pregnant and non-pregnant groups, respectively (P<0.05, log-rank test). A lower grade might be a positive factor for future pregnancy. Moreover, successful pregnancy might be a factor in preventing recurrence.