Long-term Follow-up In Men Research Articles

MP26-06 EFFECTS OF MAGNETIC RESONANCE IMAGING TARGETING ON OVERDIAGNOSIS AND OVERTREATMENT OF PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Detection & Screening II (MP26)1 Sep 2021MP26-06 EFFECTS OF MAGNETIC RESONANCE IMAGING TARGETING ON OVERDIAGNOSIS AND OVERTREATMENT OF PROSTATE CANCER Andrew Vickers Andrew VickersAndrew Vickers More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002023.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: It has been suggested that targeting prostate lesions identified on magnetic resonance imaging (MRI) will improve the sensitivity of prostate biopsy for high-grade disease. The clinical significance of high-grade tumors found by MRI-targeting in men with benign systematic biopsy findings is open to question. We compared data from the National Cancer Institute (NCI) study of MRI-targeted biopsy with results from long-term follow-up of men who had negative sextant biopsy in the European Randomized trial of Screening for Prostate Cancer (ERSPC) METHODS: The NCI study included finding from MRI-targeted biopsy for 999 men with negative systematic biopsy. For ERSPC, 3,056 men who had negative sextant biopsy were followed for 11 years. We calculated the number of patients needing to be diagnosed (NND) and treated (NNT) following targeted biopsy in order to prevent one prostate cancer death at 11 years. We used a simple modelling approach that involved several assumptions, such as the proportion of the deaths in the ERSPC would have been prevented by earlier diagnosis had the initial biopsy been MRI-guided. We then varied these assumptions to assess the effects on the results. RESULTS: In the base scenario, which involved assumptions favorable to MRI, NND and NNT were 89 and 57 (table). Results were only more encouraging for MRI-targeting under unlikely scenarios, such as 100% sensitivity for MRI and 100% cure rates for treatment. CONCLUSIONS: Although MRI may be of benefit overall, considering decreases in overdiagnosis resulting from avoidance of biopsy in men with negative scans, targeting biopsy needles to MRI-detected lesions results in a large number of men diagnosed and treated per death prevented. Consideration should be given to changing guidelines on grading of MRI cores and those regarding treatment of high-grade prostate cancer. Source of Funding: This work was supported in part by the National Institutes of Health/National Cancer Institute (NIH/NCI) with a Cancer Center Support Grant to Memorial Sloan Kettering Cancer Center [P30 CA008748], a SPORE grant in Prostate Cancer to Dr. H. Scher [P50-CA92629], the Sidney Kimmel Center for Prostate and Urologic Cancers and David H. Koch through the Prostate Cancer Foundation. © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e464-e464 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrew Vickers More articles by this author Expand All Advertisement Loading ...

Greater body mass index is a better predictor of subclinical cardiac damage at long-term follow-up in men than is insulin sensitivity: a prospective, population-based cohort study.

BackgroundTo examine whether lower insulin sensitivity as determined by homeostatic model assessment (HOMA-%S) was associated with increased left ventricular mass (LVM) and presence of LV diastolic dysfunction at long-term follow-up, independently of body mass index (BMI), in middle-aged, otherwise healthy males.MethodsProspective population-based cohort study with a median (IQR) follow-up time of 28 (27–28) years, in which traditional cardiovascular risk factors, including HOMA-%S and BMI, were assessed at baseline, and echocardiographic determination of LVM and LV diastolic function was performed at follow-up. Associations between risk factors and echocardiographic variables were tested using multivariable linear and binary logistic regression.ResultsThe study population comprised 247 men with a median (IQR) age of 47 (47–48) years. Mean (SD) BMI was 25.1 +/− 3.0 kg/m2, and median (IQR) HOMA-%S was 113.0 (68.3–284.6). Subjects with low insulin sensitivity (lowest HOMA-%S quartile (Q1)) had significantly greater BMI, fasting plasma insulin, and higher fasting blood glucose (FBG) (p <0.02 for all). BMI and HOMA-%S were significantly correlated (r = −0.383, p <0.0001). At follow-up, mean (SD) LVM and LVMI were 202 +/− 61 g and 103 +/− 31 g/m2, respectively, whereas median (IQR) E/é was 10 (8–12). Moreover, 36 % had grade 2 or 3 diastolic dysfunction. In multivariable analyses, greater BMI, but not low insulin sensitivity was independently associated with later detection of increased LVM and diastolic dysfunction.ConclusionGreater baseline BMI, but not lower insulin sensitivity was independently associated with greater LVM and diastolic dysfunction at long-term follow-up.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-015-0165-3) contains supplementary material, which is available to authorized users.

AB141. Changes of sexual function after photoselective vaporization of the prostate by 120 W GreenLight High Performance System Laser: long-term follow-up

ObjectiveTo evaluate the impact of 120 W GreenLight High Performancer System photoselective vaporization of the prostate (HPS-PVP) on erectile function at long-term follow-up in men with LUTS due to benign prostatic hyperplasia (BPH).MethodsThree hundred and fifty-one consecutive patients who underwent HPS-PVP during 2008-2012 were analyzed retrospectively. We divided all patients into three groups: group I [International Index of Erectile Function (IIEF-5) ≤7, n=202], group II (8≤ IIEF-5 ≤16, n=90) and group III (IIEF-5 ≥17, n=59) according to the preoperative IIEF-5. The patients were assessed before surgery and at 3, 12 and 24 months after HPS-PVP. We measured IPSS, QoL, Qmax, post void residual volume and IIEF-5 at each visit. The risk factors were evaluated for over three IIEF-5 points decrease at postoperative 3 months.ResultsThe mean age, presence of hypertension, prostate volume, IPSS and QoL were significantly different among three groups. Perioperative parameters such as operative time, applied energy, catheterization time and postoperative complication rates showed no statistical differences. In all groups, main parameters following operation such as IPSS, QoL, Qmax, and post void residual volume had significant improved compared to baseline. Whereas, the IIEF-5 was significant decrease in group II and group III. On the contrary, group I was increased. In group II and III, multivariate analysis showed that the age, BMI, and prostate volume were significantly related to a diminution of erectile function after HPS-PVP.ConclusionsSexual function was significantly deceased after HPS-PVP except patients with preoperative severe erectile dysfunction (IIEF-5 ≤7). The age, BMI, and prostate volume were the independent risk factors for erectile function decline after HPS-PVP.

Naltrexone Reduction of Long-Term Smoking Cessation Weight Gain in Women But Not Men: A Randomized Controlled Trial

The opioid antagonist naltrexone has shown promise to reduce weight gain during active treatment, but longer-term studies have not been conducted. The goal was to examine effects of naltrexone on weight gain over long-term follow-up in men and women who quit smoking. Weight was examined at baseline and 6- and 12-month follow-up in the two largest randomized, double-blind, placebo-controlled trials of naltrexone in nicotine dependence. For 6-12 weeks after the quit date, participants were randomly assigned to receive naltrexone or placebo. Behavioral counseling and open-label nicotine patch were also included for the first 4-6 weeks. Of the 700 participants in the combined intent-to-treat sample, there were 159 (77 women) biochemically verified abstinent smokers at 6 months, and 115 (57 women) of them remained abstinent at 12 months. Changes in weight (in kilograms or in percentage) and body mass index from baseline to the follow-ups were assessed for these participants. Weight gain was significantly lower for women treated with naltrexone compared with placebo (6 months, 3.3 vs. 5.5 kg; 12 months, 5.9 vs. 7.4 kg, respectively). Increases in body mass index and percentage body weight gain were also significantly lower in women treated with naltrexone versus placebo. These effects were not observed in men. The results provide evidence for naltrexone as the first pharmacotherapy to reduce postsmoking cessation weight gain among women.

Association Between Family History and Coronary Heart Disease Death Across Long-Term Follow-Up in Men

Background— Family history of coronary heart disease (CHD) has been well studied as an independent risk factor for CHD events in the short term (&lt;10 years). However, data are sparse on the association between family history and risk for CHD across long-term follow-up. Methods and Results— We included 49 255 men from the Cooper Center Longitudinal Study. Premature family history of CHD was defined as the presence of angina, myocardial infarction, angioplasty, or bypass surgery in a relative &lt;50 years of age. Cause-specific mortality was obtained from the National Death Index. The association between premature family history and cardiovascular disease (CVD) or CHD death was compared across 3 unique follow-up periods (0–10, &gt;10–20, and &gt;20 years). Lifetime risk was estimated by use of a modified survival analytic technique adjusted for competing risk with non-CVD death as the competing event. After 811 708 person-years of follow-up, there were 919 CHD deaths and 1456 CVD deaths. After adjustment for traditional risk factors, premature family history was associated with CHD mortality &gt;10 to 20 years (1.59; 95% confidence interval, 1.14–2.22) and &gt;20 years (1.43; 95% confidence interval, 1.05–1.95) with wider confidence intervals at 0 to 10 years (1.32; 95% confidence interval, 0.76–2.31). Similar findings were observed for CVD mortality. Compared with men without a family history of coronary artery disease, premature family history was associated with an ≈50% higher lifetime risk for both CHD and CVD mortality (13.7% versus 8.9% and 21% versus 14.1%, respectively). Conclusion— Premature family history was associated with a persistent increase in both CHD and CVD mortality risk across long-term follow-up, resulting in significantly higher lifetime risk estimates.

Circulation: Clinical Summaries

<i>Circulation:</i> Clinical Summaries

Occupational and Other Predictors of Herniated Lumbar Disc Disease—A 33-Year Follow-up in The Copenhagen Male Study

Cohort study. To examine the association between self-reported physical workload and risk of herniated lumbar disc disease (HLDD) in a long-term follow-up of men without a history of back disorders at baseline. Heavy physical workload is considered a risk factor for HLDD, but the issue is not definitively settled. The Copenhagen Male Study is a prospective cohort study established in 1970 to 1971. At baseline, 5245 men answered a questionnaire about history of back disease and physical workload. Psychosocial working conditions, lifestyle, social class, and measured height and weight were included as potential confounders. Information about hospitalization due to HLDD was obtained from the National Hospital Register covering the period from 1977 to 2003. Hazard ratios were calculated by Cox proportional hazard regression model. Among 3833 men without back disease history at baseline, the strongest predictor of hospitalization for HLDD was frequent strenuous physical activity at work; compared with unexposed, the hazard ratio with 95% confidence interval was 3.90 (1.82-8.38). Also, body height was a significant predictor, whereas body weight was only insignificantly associated with HLDD. Among men without history of back disease reporting of frequent exposure to strenuous physical activity at work was a strong risk factor for later hospitalization due to HLDD.

Long-term Follow-up of Men With Isolated High-grade Prostatic Intra-epithelial Neoplasia Followed by Serial Delayed Interval Biopsy

To analyze the outcomes of serial delayed interval biopsy (DIBx) in men with isolated high-grade prostatic intraepithelial neoplasia (HGPIN). The natural history of isolated HGPIN is poorly defined. Since January 2000, we have monitored men with isolated HGPIN using DIBx every 3 years, regardless of the change in prostate-specific antigen (PSA) level. The institutional biopsy records from 1996 onward were reviewed to identify the men with isolated HGPIN found on 12-core needle biopsy specimens who had undergone a minimum of 1 DIBx in our follow-up strategy. Patient age, biopsy and prostatectomy pathologic outcomes, and longitudinal PSA measurements were recorded. A total of 112 men had undergone a first DIBx and 47 had undergone a second DIBx at the last follow-up examination at a mean of 34.4 and 66.2 months after the HGPIN diagnosis, respectively. Prostate cancer was found in 25 (22.3%) of 112 men and 11 (23.4%) of 47 men at DIBx-1 and DIBx-2, respectively. The PSA velocity was not predictive of cancer during short-term follow-up. Of the men diagnosed with cancer, 63.6% had a Gleason score of ≥7, and 9 (81.8%) of 11 men had clinically significant disease (Gleason score of ≥7 and/or >5% cancer volume) at surgery. All cancers were organ confined at and surgery. Men with isolated HGPIN have a continued risk of developing prostate cancer during long-term follow-up, regardless of the changes in the serum PSA level. Collectively, the relatively high likelihood of organ confinement and clinically significant cancer suggest empiric DIBx every 2-3 years could be a valuable tool in the follow-up of men with isolated HGPIN found by extended core biopsy.

A further meta-analysis of population-based screening for abdominal aortic aneurysm

It remains unclear whether population-based screening for abdominal aortic aneurysm (AAA) in men reduces all-cause long-term mortality. We performed an updated meta-analysis of randomized controlled trials of AAA screening for prevention of long-term mortality in men. To identify all randomized controlled trials of population-based AAA screening with long-term (≥ 10 year) follow-up in men, MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials were searched through June 2009. Data regarding AAA-related and all-cause mortality (including Cox regression hazard ratios [HRs] and 95% confidence intervals [CIs]) were abstracted from each individual study. For each study, data regarding mortality in both the screening and control groups were used to generate odds ratios (ORs) and 95% CIs. Study-specific estimates were combined using inverse variance-weighted averages of logarithmic ORs or HRs (or risk ratios where no HR was reported) in both fixed- and random-effects models. Our search identified four randomized controlled trials of population-based AAA screening with long-term follow-up in men aged ≥ 65 years. Pooled analysis demonstrated a statistically significant reduction in AAA-related mortality (random-effects OR, 0.55; 95% CI, 0.36 to 0.86; P = .008; P for heterogeneity = .01; absolute risk reduction [ARR], 4 per 1000; number needed to screen [NNS], 238; random-effects HR, 0.55; 95% CI, 0.35 to 0.86; P = .009; P for heterogeneity = .009) and revealed a statistically nonsignificant reduction (but a strong trend toward a significant reduction) in all-cause mortality (fixed-effects OR, 0.98; 95% CI, 0.95 to 1.00 [1.001]; P = .06; P for heterogeneity = .93; ARR, 5 per 1000; NNS, 217; fixed-effects HR, 0.98; 95% CI, 0.96 to 1.00 [1.0001]; P ≥ .05 [P = .052]; P for heterogeneity = .74) with AAA screening relative to control. The results of our analysis suggest that population-based screening for AAA reduces AAA-related long-term mortality by 4 per 1000 over control in men aged ≥ 65 years. Whereas, screening for AAA shows a strong trend toward a significant reduction in all-cause long-term mortality by 5 per 1000, which does not narrowly reach statistical significance.

Influence of Photoselective Vaporization of the Prostate on Sexual Function: Results of a Prospective Analysis of 149 Patients with Long-Term Follow-Up

BackgroundEven though transurethral resection of the prostate remains the gold standard treatment for lower urinary tract symptoms (LUTS) refractory to medical therapy, photoselective vaporization of the prostate (PVP) has become a popular alternative. Early PVP studies seem encouraging, but few data exist regarding the effect of PVP on sexual function at long-term follow-up. ObjectiveOur aim was to evaluate the impact of PVP on erectile function (EF) at long-term follow-up in men with LUTS due to benign prostatic hyperplasia (BPH). Design, setting, and participantsOne hundred forty-nine consecutive patients who underwent a prostate vaporization with the GreenLight laser performed by a single surgeon (FB) were prospectively enrolled in this study. InterventionAll patients underwent PVP with the GreenLight laser performed by one experienced surgeon. MeasurementsAll patients were evaluated by International Index of Erectile Function (IIEF-5) preoperatively and at 1, 3, 6, and 12 mo and then once a year. At each visit, the questionnaires were collected, and each patient’s maximum flow rate and postvoid residual volume were measured with ultrasound. Biologic data were also collected at each visit, including prostate-specific antigen, creatinine, and bacterial urine culture. Results and limitationsOne hundred forty-nine patients were enrolled in the study. Median patient age was 74 yr. Urinary function was significantly improved over baseline in both men with normal or abnormal preoperative erectile function. Energy used was 255±129kJ. Hospitalization stay was 2.2±3.1 d. Other than a temporary difference at 1 yr, IIEF-5 scores were comparable preoperatively and postoperatively if we consider all the population. However, considering patients with preoperative IIEF-5 >19, the postoperative IIEF-5 scores were significantly decreased at 6, 12, and 24 mo. ConclusionsSexual function appears to be maintained after PVP; however, in patients with normal preoperative EF, we showed a significant decrease in EF after PVP.

Explaining the obesity paradox: cardiovascular risk, weight change, and mortality during long-term follow-up in men

To examine life-long weight trajectories behind the 'obesity paradox', and whether cardiovascular disease (CVD) risk contributes. Cardiovascular disease risk and body mass index (BMI) at mean ages of 25, 47 (year 1974), and 73 years (year 2000) were available of a socioeconomically homogenous sample of 1114 men, without chronic diseases and diabetes in 1974. Overweight was defined as BMI > 25 kg/m(2), and 7-year mortality (2000-06) from the mean age of 73 years determined (188 deaths). Between 1974 and 2000, 44.3% (n = 494) were constantly overweight, 31.0% (n = 345) constantly normal weight, 12.2% (n = 136) moved from normal to overweight, and 12.5% (n = 139) moved from overweight to normal. The last group had highest CVD risk in midlife, and in late life more co-morbidities and greatest total mortality (P < 0.001). Adjusted mortality hazard ratio was 2.0 (95% confidence interval, CI 1.3-3.0; constantly normal weight group as referent). The hazard ratio remained similar (1.9, 95% CI 1.2-3.0) after adjustment for prevalent diseases in 2000. In old age, both normal weight and overweight men are a mixture of individuals with different weight trajectories during their life course. Overweight and high-CVD risk in midlife with subsequent weight decrease predict the worst prognosis in late life.

8: Predictors of HRQOL Duirng Long-Term Follow-Up of Men Treated for Prostate Cancer

8: Predictors of HRQOL Duirng Long-Term Follow-Up of Men Treated for Prostate Cancer

Selecting a healthy diet score: lessons from a study of diet and health in early old age (the Boyd Orr cohort)

To describe the selection and modification of an appropriate diet score to assess diet quality in early old age. Cross-sectional analyses of the Boyd Orr cohort - a long-term follow-up of men and women whose families took part in a survey of diet and health in pre-war Britain. Dietary data were obtained from a 113-item food-frequency questionnaire. A nine-item Healthy Diet Indicator (HDI) developed by Huijbregts and colleagues was identified from the literature and modified because some dietary variables were unavailable and to accord more closely with recommendations of the UK Committee on Medical Aspects of Food Policy. In total, 1475 traced, surviving cohort members aged 60 years and over. Modification resulted in a 12-item Healthy Diet Score (HDS). We found that about half the variation in the HDS was explained by variation in the HDI (r=0.71). There was, however, little misclassification of subjects (<10%) into extreme thirds of the distribution by the HDS compared with the HDI. Items of the score most strongly correlated with overall score were saturated fat (r=-0.57), red meat (r=-0.46), dietary fibre (r=0.58), fruit and vegetables (r=0.54) and percentage energy from carbohydrates (r=0.51). Modifying existing items had greater impact on agreement between HDI and HDS than the addition of new items. The selection and modification of diet scores is more complicated than often assumed. Furthermore, modest changes to an existing score can produce a score that is different from the original, and although it was not possible to test this issue, it may no longer predict subsequent health experience.

ISOLATED LOCAL RECURRENCE IS RARE AFTER RADICAL PROSTATECTOMY IN MEN WITH GLEASON 7 PROSTATE CANCER AND POSITIVE SURGICAL MARGINS: THERAPEUTIC IMPLICATIONS

We determined whether the high biochemical failure rate in men with Gleason score 7 disease and positive surgical margins after radical retropubic prostatectomy is secondary to distant metastasis or to local tumor recurrence that could be eliminated by immediate adjuvant radiation therapy. Between 1982 and 1997, 112 men with Gleason score 7 disease and positive surgical margins but no seminal vesicle or lymph node involvement underwent radical retropubic prostatectomy without immediate adjuvant radiation or hormonal therapy. Median followup was 8 years (range 1 to 16) and 45 men (40%) were followed 10 years or more. Kaplan-Meier actuarial survival estimates were used to determine the actuarial 5 and 10-year post-prostatectomy, and 5-year post-radiation recurrence rates. The actuarial 5 and 10-year post-prostatectomy biochemical, local and distant recurrence rates were 40% and 52%, 6% and 6%, and 7% and 16%, respectively. For 20 men who received radiation therapy for isolated prostate specific antigen elevation actuarial 5-year post-radiation biochemical recurrence-free rate was 34%. For 5 men who received radiation therapy for local recurrence actuarial 5-year post-radiation biochemical recurrence-free rate was 20%. Isolated clinical local recurrence is rare during long-term followup of men with Gleason score 7 disease and positive surgical margins at radical prostatectomy. Radiation therapy given at prostate specific antigen elevation poorly controlled the disease. Because patients with biochemical failure rarely had local recurrence at long-term followup, they most likely harbored subclinical distant metastasis. These data suggest that immediate adjuvant radiation therapy will not have a major impact on outcome because most men with Gleason score 7 disease and positive surgical margins in whom treatment fails most likely had distant metastasis at surgery. To improve the outcome in cases of Gleason score 7 disease and positive surgical margins a systemic approach to adjuvant therapy is necessary.

516 - Long Term Follow-Up of Men with a Penile Prosthesis and Their Sexual Partners

No AccessJournal of Urology1 Jun 1987Long Term Follow-Up of Men with a Penile Prosthesis and Their Sexual Partners Beth L. Pedersen, Leonore Tiefer, and Arnold Melman Beth L. PedersenBeth L. Pedersen More articles by this author , Leonore TieferLeonore Tiefer More articles by this author , and Arnold MelmanArnold Melman More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)75666-2AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Long Term Follow-Up of Men with a Penile Prosthesis and Their Sexual Partners." The Journal of Urology, 137(6), p. 232A © 1987 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 137Issue 6June 1987Page: 232A Advertisement Copyright & Permissions© 1987 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Beth L. Pedersen More articles by this author Leonore Tiefer More articles by this author Arnold Melman More articles by this author Expand All Advertisement PDF DownloadLoading ...

Long-term follow-up of men with male pattern baldness treated with topical minoxidil

Forty-one men with male pattern baldness completed 132 study weeks (2 years 9 months) with topical minoxidil and had follow-up 1-inch target-area vertex scalp hair counts. Initially these men were treated with either twice-daily 2% topical minoxidil for 12 months or 3% topical minoxidil for 8 to 12 months (one third of the subjects received placebo for the first 4 months). After 12 months all subjects continued to apply 3% topical minoxidil twice daily for 1 more year, after which they were randomized to once- versus twice-daily topical minoxidil for an additional 9 months. Those subjects who changed to once-daily application of topical minoxidil at 2 years had a mean change from baseline nonvellus hair count at 1 year of 291.2 (range of hairs four to 553) and at 2 years 9 months of 235 (two to 592 hairs). Those subjects who continued with twice-daily application of topical minoxidil throughout the study had a mean change from baseline nonvellus hair count at 1 year of 323 (15 to 589 hairs) and 335 (13 to 808 hairs) at 2 years 9 months with maintenance topical minoxidil. There were subjects on both maintenance schedules of topical minoxidil who lost some of the nonvellus hair they had initially gained with topical minoxidil; however, there was a greater mean loss in those patients following the once-daily versus twice-daily topical minoxidil regimen (p = 0.05). No subject lost nonvellus target hair as compared with baseline.(ABSTRACT TRUNCATED AT 250 WORDS)