Population-based Cohort Of Men Research Articles

MP72-04 ASSOCIATION OF CLINICAL TRIAL ENROLLMENT AND MORTALITY AMONGST PATIENTS WITH ADVANCED PROSTATE CANCER

You have accessJournal of UrologyCME1 Apr 2023MP72-04 ASSOCIATION OF CLINICAL TRIAL ENROLLMENT AND MORTALITY AMONGST PATIENTS WITH ADVANCED PROSTATE CANCER Rodrigo R Pessoa, Thomas Flaig, Tyler Robin, BORIS Gershman, Michael Bronsert, Kayvon Kiani, Eric Ballon-Landa, Corbin Eule, Elizabeth Kessler, Marc C Smaldone, and Simon P Kim Rodrigo R PessoaRodrigo R Pessoa More articles by this author , Thomas FlaigThomas Flaig More articles by this author , Tyler RobinTyler Robin More articles by this author , BORIS GershmanBORIS Gershman More articles by this author , Michael BronsertMichael Bronsert More articles by this author , Kayvon KianiKayvon Kiani More articles by this author , Eric Ballon-LandaEric Ballon-Landa More articles by this author , Corbin EuleCorbin Eule More articles by this author , Elizabeth KesslerElizabeth Kessler More articles by this author , Marc C SmaldoneMarc C Smaldone More articles by this author , and Simon P KimSimon P Kim More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003340.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Publication bias has been raised as concern in reporting clinical trials with negative results. However, little is known about the degree of publication bias from clinical trials with negative results for prostate cancer. Thus, we sought to elucidate the association of enrollment into a clinical trial and all-cause mortality from a population-based cohort of men with advanced prostate cancer in the U.S. METHODS: From CancerLinQ, a large national database of community oncology practices, all men with N1 and/or M1 advanced prostate cancer were identified from 2011 to 2021. The primary outcome was all-cause mortality. Multivariable Cox Proportional Hazards were used to test the association of overall survival and clinical covariates including clinical trial enrollment. RESULTS: During the study interval, we identified 139,971 men diagnosed with advanced prostate cancer. With a median follow-up of 58 months, only 2.3% of patients were enrolled into a clinical trial (n=3,269). On multivariable analysis adjusting for disease features, Asian (HR: 0.61; p<0.001) race and Hispanic/Latino origin (HR: 0.68; p<0.001) were associated with lower risk of all-cause mortality. Higher ECOG performance status also correlated with higher risk of all-cause mortality (all p<0.001). However, patients enrolled into clinical trials had higher risk of all-cause mortality compared to those patients who were not enrolled (HR: 1.18; p<0.001). CONCLUSIONS: In this population-based cohort of advanced prostate cancer patients, clinical trial enrollment was associated with a higher risk of all-cause mortality. We controlled for pertinent prognostic variables, but it remains possible that poorer prognosis patients are triaged to clinical trials. However, an alternate explanation is that some trials do have worse outcomes than standard of care and these findings raise concern that negative clinical trial results are rarely disseminated. Source of Funding: Schramm Foundation © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1025 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rodrigo R Pessoa More articles by this author Thomas Flaig More articles by this author Tyler Robin More articles by this author BORIS Gershman More articles by this author Michael Bronsert More articles by this author Kayvon Kiani More articles by this author Eric Ballon-Landa More articles by this author Corbin Eule More articles by this author Elizabeth Kessler More articles by this author Marc C Smaldone More articles by this author Simon P Kim More articles by this author Expand All Advertisement PDF downloadLoading ...

Androgen Receptor Gene CAG Repeat Length Varies and Affects Semen Quality in an Ethnic-Specific Fashion in Young Men from Russia.

Male infertility is a multi-factorial and multi-genetic disorder, and the prevalence of male infertility in the world is estimated at 5–35%. The search for the causes of male infertility allowed for identifying a number of genetic factors including a single X-linked gene of the androgen receptor (AR), and some of its alleles are assumed to negatively affect male fertility. Our aim was (1) to study the variability of the length of CAG repeats of the AR gene and possible associations in the AR CAG genetic variants with semen quality and reproductive hormone levels in a population-based cohort of men and (2) to estimate distributions of AR CAG repeat alleles and associations with semen parameters in different ethnic subgroups. The cohort of 1324 young male volunteers of different ethnicities (median age 23.0 years) was recruited from the general population of five cities of the Russian Federation, regardless of their fertility status. Semen quality (sperm concentration, motility and morphology), reproductive hormone levels (testosterone, estradiol, LH, FSH and inhibin B) and trinucleotide (CAG) n repeat polymorphism in exon 1 of the AR gene were evaluated. The semen samples were analyzed according to the WHO laboratory manual (WHO, 2010), serum hormones were measured by enzyme immunoassay, and the AR CAG repeat length was analyzed by direct sequencing of leukocyte DNA. The median AR CAG repeat length in men of our multi-ethnic population was 23 (range 6–39). In the entire study population, a significant difference (p ≤ 0.05) was found in the frequency distribution and the mean values for the CAG repeat length between the groups with normal (23.2 ± 3.3) and impaired semen quality (23.9 ± 3.2). Additionally, we demonstrated that the total sperm count, sperm concentration, progressive motility and normal morphology were lower in the category of long CAG repeats (CAG ≥ 25) compared with those in the category of short CAG repeats (CAG ≤ 19); however, hormonal parameters did not differ between the long and short CAG categories, with the exception of estradiol. Significant differences were observed in the AR CAG repeat length between the most common ethnic cohorts of Slavs (Caucasians), Buryats (Asians), and Yakuts (Asians). The Buryats and Yakuts had a higher number of CAG repeats than the Slavs (medians: Slavs—23; Buryats—24; Yakuts—25). The range of alleles differed among ethnicities, with the Slavs having the largest range (7–36 repeats, 24 alleles total), the Yakuts having the smallest range (18–32 repeats, 14 alleles total) and the Buryats having the middle range (11–39 repeats, 20 alleles total). The longer CAG repeats were associated with an impaired semen quality within the Slavic (CAG ≥ 25) and Buryat (CAG ≥ 28) groups, but this effect was not found in Yakuts. Hormonal parameters did not differ between the three CAG repeat categories in men of all ethnic groups. This is the largest Russian study of the distribution of AR CAG repeats and the search for association between length of AR CAG repeat tract and impaired spermatogenesis in men from the general population. Our results confirmed the association of longer CAG repeats with a risk of impaired semen quality, but this association can be modified by ethnic origin. Identification of the number of AR CAG repeats can be an effective tool to assess the risk of male subfertility and the control of androgen hormone therapy of reproductive diseases.

Real-world utilisation of brachytherapy boost and patient-reported functional outcomes in men who had external beam radiation therapy for prostate cancer in Australia

Background and purposeWe aimed to evaluate utilisation of brachytherapy (BT) boost in men who had external beam radiation therapy (EBRT) for prostate cancer, and to compare patient-reported functional outcomes (PRO) following each approach in a population-based setting in Australia. Materials and methodsThis is a population-based cohort of men with localised prostate cancer enrolled in the Victorian Prostate Cancer Outcomes Registry, who had EBRT between 2015 and 2020. Primary outcomes were proportion who had BT-boost, and PRO (assessed using the EPIC-26 questionnaires) 12 months post-treatment. Multivariable logistic regressions were used to evaluate factors associated with BT-boost, and linear regressions were used to estimate differences in EPIC-26 domain scores between EBRT alone and EBRT + BT. ResultsOf the 1,626 men in the study, 88 (5.4 %) had BT-boost. Factors independently associated with BT-boost were younger age, higher socioeconomic status, and treatment in public institutions. 1,555 men completed EPIC-26 questionnaires. No statistically or clinically significant differences in EPIC-26 urinary, sexual and bowel functional domain scores were observed between men who had EBRT + BT vs EBRT alone, with adjusted mean differences in urinary incontinence, urinary irritative/ obstruction, sexual, and bowel domain of 1.28 (95 %CI = −3.23 to 5.79), −2.87 (95 %CI = −6.46 to 0.73), 0.49 (95 %CI = −4.78 to 5.76), and 2.89 (95 %CI = −0.83 to 6.61) respectively. Conclusion1-in-20 men who had EBRT for prostate cancer had BT-boost. This is the first time that PRO following EBRT+/-BT is reported at a population-based level in Australia, with no evidence to suggest worse PRO with addition of BT-boost 12 months post-treatment.

Associations of specific types of fruit and vegetables with perceived stress in adults: the AusDiab study

PurposeHigher total fruit and vegetable (FV) intakes have been associated with lower perceived stress. The relationship between specific types of FV and perceived stress remains uncertain. The aims of this cross-sectional study were to explore the relationship between consumption of specific types of FV with perceived stress in a population-based cohort of men and women aged ≥ 25 years from the Australian Diabetes, Obesity and Lifestyle (AusDiab) Study.MethodsDietary intake was assessed using a validated Food Frequency Questionnaire (n = 8,640). Perceived stress was evaluated using a validated Perceived Stress Questionnaire, with values ranging 0–1 (lowest to highest). High perceived stress cut-offs of ≥0.34 for men and ≥0.39 for women were obtained from the highest quartile of the perceived stress score for each sex. Multivariable-adjusted logistic regression was performed to investigate the associations.ResultsThe mean age of participants (50.1% females) was 47.8 (SD 15) years. Persons in the highest, versus lowest, quartiles of apples and pears, orange and other citrus, and banana intakes had a significantly lower odds (24–31%) of having high perceived stress. Similarly, persons with higher intakes of cruciferous, yellow/orange/red, and legume vegetables had significantly lower odds (25–27%) of having high perceived stress.ConclusionIn Australian adults, a higher consumption of apples and pears, oranges and other citrus, and bananas, as well as cruciferous, yellow/orange/red, and legume vegetables were associated with lower odds of having high perceived stress. The recommendations of “eating a rainbow” of colours may assist in preventing and/or reducing perceived stress.

Fine Particulate Matter and Dementia Incidence in the Adult Changes in Thought Study.

Background:Air pollution may be associated with elevated dementia risk. Prior research has limitations that may affect reliability, and no studies have evaluated this question in a population-based cohort of men and women in the United States.Objectives:We evaluated the association between time-varying, 10-y average fine particulate matter () exposure and hazard of all-cause dementia. An additional goal was to understand how to adequately control for age and calendar-time-related confounding through choice of the time axis and covariate adjustment.Methods:Using the Adult Changes in Thought (ACT) population-based prospective cohort study in Seattle, we linked spatiotemporal model-based exposures to participant addresses from 1978 to 2018. Dementia diagnoses were made using high-quality, standardized, consensus-based protocols at biennial follow-ups. We conducted multivariable Cox proportional hazards regression to evaluate the association between time-varying, 10-y average exposure and time to event in a model with age as the time axis, stratified by apolipoprotein E (APOE) genotype, and adjusted for sex, education, race, neighborhood median household income, and calendar time. Alternative models used calendar time as the time axis.Results:We report 1,136 cases of incident dementia among 4,166 individuals with nonmissing APOE status. Mean [mean ± standard deviation (SD)] 10-y average was . Each increase in the moving average of 10-y was associated with a 16% greater hazard of all-cause dementia [1.16 (95% confidence interval: 1.03, 1.31)]. Results using calendar time as the time axis were similar.Discussion:In this prospective cohort study with extensive exposure data and consensus-based outcome ascertainment, elevated long-term exposure to was associated with increased hazard of all-cause dementia. We found that optimal control of age and time confounding could be achieved through use of either age or calendar time as the time axis in our study. Our results strengthen evidence on the neurodegenerative effects of . https://doi.org/10.1289/EHP9018

Sexual function outcomes of radiation and androgen deprivation therapy for localized prostate cancer in men with good baseline function.

Sexual dysfunction, including erectile dysfunction and loss of libido, are common among men undergoing treatment for localized prostate cancer. Both local treatments and systemic androgen deprivation therapy may contribute to these outcomes and are differentially indicated based on disease characteristics. We sought to compare sexual function through 5 years after radiation treatment with and without androgen deprivation therapy in men with good baseline sexual function to better understand long-term effects in this understudied subset of patients. We retrospectively reviewed a prospectively assembled population-based cohort of men who underwent radiation with and without androgen deprivation therapy for intermediate or high-risk localized prostate cancer. Sexual function was assessed longitudinally over 5 years. Men with erections sufficient for intercourse at baseline were selected for inclusion. Out of 167 patients included, 73 underwent radiation alone and 94 received androgen deprivation therapy plus radiation (51 with intermediate and 43 with high-risk disease). Androgen deprivation therapy use was associated with worse sexual function through 1 year regardless of disease risk. This difference was no longer statistically significant at 3 years in the intermediate-risk group. Compared to radiation alone, androgen deprivation therapy in high-risk disease was associated with worse sexual function at 3 years (effect: -20.3 points, CI [-31.8, -8.8], p < 0.001) but not at 5 years (effect: -3.4, CI [-17.2, 10.5], p = 0.63). Androgen deprivation therapy plus radiation is associated with worse sexual function through 3-years follow-up in men with high-risk prostate cancer compared to radiation alone. The addition of androgen deprivation therapy in the treatment of intermediate-risk disease does not appear to result in worse sexual function at 3 or 5-year follow-up compared to radiation alone.

Association between urinary arsenic, blood cadmium, blood lead, and blood mercury levels and serum prostate-specific antigen in a population-based cohort of men in the United States.

Exposures to heavy metals have been linked to prostate cancer risk. The relationship of these exposures with serum prostate-specific antigen (PSA), a marker used for prostate cancer screening, is unknown. We examined whether total urinary arsenic, urinary dimethylarsonic acid, blood cadmium, blood lead, and total blood mercury levels are associated with elevated PSA among presumably healthy U.S. men. Prostate cancer-free men, aged ≥40 years, were identified from the 2003–2010 National Health and Nutrition Examination Survey. Logistic regression analyses with survey sample weights were used to examine the association between heavy metal levels and elevated PSA for the total population and stratified by black and white race, after adjusting for confounders. There were 5,477 men included. Approximately 7% had elevated PSA. Men with an elevated PSA had statistically significantly higher levels of blood cadmium and blood lead compared to men with a normal PSA (p-values ≤ 0.02), with black men having higher levels. After adjusting for age, race/ethnicity, body mass index, smoking, and education, there was no association found between any of the heavy metal levels and elevated PSA for the total population. In addition, there was no association found when stratified by black and white race. Further investigation is warranted in a larger cohort of men who persistently are exposed to these heavy metals.

Fruit and vegetable intake is inversely associated with perceived stress across the adult lifespan

Poor nutritional habits are linked to higher perceived stress, but the relationship between fruit and vegetable (FV) intake and stress is uncertain. The primary aim of this cross-sectional study was to explore the relationship between FV intake and perceived stress in a population-based cohort of men and women aged ≥25 years from the Australian Diabetes, Obesity and Lifestyle (AusDiab) Study. A secondary aim was to investigate the relationship between serum carotenoids, biomarkers of FV intake, and perceived stress. In Australian men and women, dietary intake was assessed using a Food Frequency Questionnaire in 1999-2000 (n=8689). Perceived stress was assessed using a validated Perceived Stress Questionnaire [PSQ index values ranging from 0 (lowest) to 1 (highest)]. Serum carotenoids were measured in a subset of participants (n=1187) using high-performance liquid chromatography. Multivariable-adjusted linear and logistic regression were performed to investigate the associations between FV intake and perceived stress. Mean age of participants was 47.4 (SD 14.1) years (49.8% females). Participants with the highest intakes of FV had 10% lower PSQ index values than those with the lowest intake [Q4: 0.27±0.004 vs. Q1: 0.30±0.004 (mean±SE), p=0.004]. Similar associations were found for fruits and vegetables, analysed separately. In subgroup analyses higher FV intake was associated with lower perceived stress in the middle-aged adults [≥45-<65 years (p=0.004)], but not in the younger (<45 years) and older participants (≥65 years). Higher FV intake was also significantly associated with lower perceived stress in men (p=0.009) and women (p=0.012), separately. Serum carotenoid levels were inversely associated with perceived stress before, but not after adjusting for age and other confounding factors. In Australian adults, higher FV intake was associated with lower perceived stress, particularly in the middle-aged adults. These findings support current recommendations that fruit and vegetables are essential for health and well-being.

Current Mental Distress Among Men With a History of Radical Prostatectomy and Related Adverse Correlates.

Recent reviews and observational studies have reported that patients with prostate cancer (PCa) are at increased risk of mental health issues, which in turn negatively affects oncological outcomes. Here, we examine possible explanatory variables of mental distress in a population-based cohort of men who have undergone radical prostatectomy (RP). Data were derived from a Maritimes-Canada online survey assessing patient-reported quality of life outcomes between 2017 and 2019 administered to 136 men (47–88 years old, currently in a relationship) who have undergone RP for their PCa diagnosis. The primary outcome was a validated assessment of mental distress, the Kessler Psychological Distress Scale (K10). Urinary function was assessed using the International Prostate Symptom Score, and relationship satisfaction was assessed using the Dyadic Assessment Scale. A multivariate logistic regression assessed the contribution of urinary function, relationship satisfaction, age, multimorbidity, additional treatments, medication for depression and/or anxiety, and survivorship time. A total of 16.2% men in this sample screened positive for mental distress. The severity of urinary problems was positively associated with increased mental distress (OR = 4.79, 95% CI [1.04, 22.03]), while increased age (OR = 0.87, 95% CI [0.78, 0.97]), relationship satisfaction (OR = 0.14, 95% CI [0.3, .077]), and current medication for anxiety, depression, or both (OR = 0.09, 95% CI [0.02, 0.62]) were protective factors. Survivorship time, the presence of additional comorbidities, or PCa treatments were not identified to be statistically significant contributions to the fitted model. Here, we report that RP survivors are prone to presenting with increased mental distress long after treatment. Screening for mental distress during RP survivorship is recommended.

Patient-reported outcomes and localized prostate cancer management.

A new study reports the 5-year patient-reported outcome data from a population-based cohort of men with localized prostate cancer. These findings in conjunction with data on survival, treatment burden and treatment cost can assist clinicians in explaining to newly diagnosed patients the likely effects of modern management options on quality of life.

Osteoclast inhibitor treatment among men with metastatic castration-resistant prostate cancer.

Background:National Comprehensive Cancer Network guidelines recommend monthly osteoclast inhibitor treatment (OIT) in men with metastatic castration-resistant prostate cancer (mCRPC) to prevent skeletal related events (SREs). We assessed adherence to guidelines by quantifying treatment for SRE prevention in a population-based cohort of men with mCRPC.Methods:Using Surveillance, Epidemiology, and End Results-Medicare data, we identified men aged >65 with prostate cancer as a primary cause of death during 2006–2010. We assessed OIT during a 12-month period between 15 and 3 months before death and used multivariable negative binomial regression to identify factors associated with treatment.Results:Among 9,634 men who died of prostate cancer, 22% received ≥ 1 OIT, and use increased slightly over time. Men age 75–84 and ≥ 85 were less likely than younger men to be treated (IRR 0.63, 95% CI 0.49–0.78 and IRR 0.34, 95% CI 0.17–0.50, respectively). African American men were less likely than white men to receive OIT (IRR 0.75, 95% CI 0.54–0.95), as were men from areas with lower median income (P=0.014). Compared with men seeing a urologist only, men seeing a medical oncologist and a urologist (IRR 2.52, 95% CI 2.36–2.68) or a medical oncologist alone (IRR 3.82, 95% CI 3.54–4.09) had higher incidence rates of treatment.Conclusions:Fewer than a quarter of American men dying of prostate cancer received recommended treatment to prevent SREs within the final year of their lives, with particularly low rates of treatment among older men, African American men, and those living in areas with low median income. Visits with a medical oncologist were associated with increased use. Further evaluation of these disparities by age, race and socioeconomic status are necessary to identify interventions to reduce them.

Lifetime Pattern of Atrial Fibrillation and the Risks of Stroke and Death in a Population-based Cohort of Men (from The Manitoba Follow-Up Study)

Atrial fibrillation (AF) is associated with stroke and mortality. The arrhythmia can be sustained or intermittent. Previous studies that have used fixed covariates and short-time horizons to examine the relation between the pattern of AF and the occurrence of events have produced conflicting results. The Manitoba Follow-Up Study includes 3,983 originally healthy men who have been followed with routine examinations since 1948. AF status during each visit was classified into the following patterns: free of AF, newly diagnosed; intermittent AF-in sinus;intermittent AF-in AF; sustained AF. We created adjusted Cox proportional hazards models with time-dependent covariates to estimate risks for stroke and death according to AF pattern. After 167,982 person-years of follow-up and 66,297 electrocardiograms (ECGs), 548 men had at least 1 ECG documenting AF, 799 had a stroke, and 3173 died. Relative to men free of AF, sustained and newly diagnosed AF were associated with stroke (hazard ratio [HR] 1.85, 95% confidence interval [CI] 1.33 to 2.59 and HR 1.71, 95% CI 1.10 to 2.66, respectively) and death (HR 2.48, 95% CI 2.11 to 2.92 and HR 2.03, 95% CI 1.64 to 2.52, respectively). Intermittent AF was associated with death (HR 2.41 95% CI 1.58 to 3.68 in AF and HR 1.71 95% CI 1.44 to 2.03 in sinus), but not with stroke (HR 0.68, 95% CI 0.22 to 2.13 in AF and HR 1.02 95% CI 0.72 to 1.45 in sinus). Antithrombotic therapy was associated with a reduced risk of the outcomes. In conclusion, longitudinal analysis of patterns of AF evolving over time provided evidence that the associated risks of stroke and death vary considerably with rhythm classification on serial ECGs.

Genitourinary Prosthetic Use Among Prostate Cancer Survivors Treated with Radical Prostatectomy

ObjectiveErectile dysfunction and urinary incontinence are well-known side effects of radical prostatectomy that, when refractory to medical therapy, can be addressed by major genitourinary prosthetic surgery (urethral slings, artificial urinary sphincters (AUS), penile prostheses (PP)). Though these procedures have been evaluated in single institution studies, population-based analyses regarding their utilization have been sporadic. Thus, we sought to characterize post-prostatectomy genitourinary prosthetic surgery in a contemporary, population-based cohort of men with private insurance. Material and MethodsUsing MarketScan Commercial Claims data, we identified men undergoing RP between 2009-2010 based on coding. Our primary outcome was receipt of genitourinary prosthetic device based on codes documented in claims from 2009 through 2015. Other factors of interest included patient age, comorbidity, and geographic region. ResultsWe identified 23,813 men who underwent radical prostatectomy in 2009 and 2010 (mean age (SD) = 55.5 years (9.1)). Overall, 731 men (3.07%) underwent genitourinary prosthetic surgery, including 243 (1.0%) male slings, 111 (0.5%) AUS, and 377 (1.6%) PP. Median time to the first prosthetic surgery was 21.7 months (SD 12.9; range = 1.2-54.5). Men undergoing prosthetic surgery for post-prostatectomy complications were older (57.1 vs. 55.5y, p=0.001), and more likely to be diabetic (31.9 vs. 22.6%, p<0.001) than the remainder of the cohort. There was no significant difference in receipt of surgery based on overall comorbidity or geographic region (all p>0.05). ConclusionsOverall, receipt of genitourinary prosthetic surgery for incontinence (1.5%) or erectile dysfunction (1.6%) was rare following radical prostatectomy. However, diabetic and older men demonstrated a greater likelihood of device placement.

MP22-09 ASSOCIATION BETWEEN ANDROGEN-DEPRIVATION THERAPY AND NON-PROSTATE CANCER MORTALITY AMONG MEN WITH NON-METASTATIC PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Localized: Radiation Therapy1 Apr 2018MP22-09 ASSOCIATION BETWEEN ANDROGEN-DEPRIVATION THERAPY AND NON-PROSTATE CANCER MORTALITY AMONG MEN WITH NON-METASTATIC PROSTATE CANCER Christopher Wallis, Raj Satkunasivam, Sender Herschorn, Calvin Law, Arun Seth, Ronald Kodama, Girish Kulkarni, and Robert Nam Christopher WallisChristopher Wallis More articles by this author , Raj SatkunasivamRaj Satkunasivam More articles by this author , Sender HerschornSender Herschorn More articles by this author , Calvin LawCalvin Law More articles by this author , Arun SethArun Seth More articles by this author , Ronald KodamaRonald Kodama More articles by this author , Girish KulkarniGirish Kulkarni More articles by this author , and Robert NamRobert Nam More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.720AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Androgen deprivation therapy (ADT) has been associated with cardiovascular risk factors and the development of cardiovascular disease in men with metastatic prostate cancer. The effect of ADT on non-prostate cancer mortality is unknown among patients with non-metastatic prostate cancer. METHODS We performed a population-based, retrospective cohort study of men treated with surgery or radiotherapy for non-metastatic prostate cancer in Ontario, Canada from 2002-2009. ADT exposure was operationalized as a time-varying binary and cumulative dose exposure. Primary and secondary outcomes were non-prostate cancer mortality and cardiovascular mortality, respectively. The Fine & Gray sub-distribution method with generalized estimating equations was used to calculate sub-distribution hazard ratios (sdHR), while accounting for competing risks. RESULTS We examined 20,651 men treated for non-metastatic prostate cancer. Median follow-up was 7.4 years. Androgen deprivation therapy was not significantly associated with non-prostate cancer mortality (sdHR 0.75, 95% CI 0.37-1.50) or cardiovascular mortality (sdHR 1.16, 95% CI 0.37-3.63) when operationalized as a binary time-varying exposure. Similar results were obtained when we examined ADT cumulative dose exposure. CONCLUSIONS Androgen deprivation therapy is not associated with non-prostate cancer mortality or cardiovascular mortality in a large, population-based cohort of men with localized prostate cancer treated by surgery or radiation therapy. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e274-e275 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Christopher Wallis More articles by this author Raj Satkunasivam More articles by this author Sender Herschorn More articles by this author Calvin Law More articles by this author Arun Seth More articles by this author Ronald Kodama More articles by this author Girish Kulkarni More articles by this author Robert Nam More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

336 Nationwide Utilization of Reconstructive Urological Procedures to Mitigate Sexual and Urinary Complications Following Radical Prostatectomy

Erectile dysfunction (ED) and urinary incontinence are well-known side effects of radical prostatectomy (RP) that, when refractory to medical therapy, can be addressed by major genitourinary reconstructive surgery (GURS) (e.g., urethral slings, artificial urinary sphincters (AUS), penile prostheses (PP)). Though these procedures have been evaluated in single institution studies, population-based analyses regarding their utilization have been sporadic. Thus, we sought to characterize post-RP GURS in a contemporary, population-based cohort of men with private insurance. Using MarketScan Commercial Claims data, we identified men undergoing RP in 2009 based on CPT coding. Our primary outcome was receipt of GURS (i.e., slings, AUS, PP) based on procedure codes documented in claims from 2009 through 2013. Other factors of interest included patient age, comorbidity, and geographic region. Associations between factors of interest and receipt of GURS were investigated using two-sided unpaired t and χ-squared tests, for continuous and categorical variables, respectively.

Prostate Cancer Patient Characteristics Associated With a Strong Preference to Preserve Sexual Function and Receipt of Active Surveillance.

Men with early-stage prostate cancer have multiple options that have similar oncologic efficacy but vary in terms of their impact on quality of life. In low-risk cancer, active surveillance is the option that best preserves patients' sexual function, but it is unknown if patient preference affects treatment selection. Our objectives were to identify patient characteristics associated with a strong preference to preserve sexual function and to determine whether patient preference and baseline sexual function level are associated with receipt of active surveillance in low-risk cancer. In this population-based cohort of men with localized prostate cancer, baseline patient-reported sexual function was assessed using a validated instrument. Patients were also asked whether preservation of sexual function was very, somewhat, or not important. Prostate cancer disease characteristics and treatments received were abstracted from medical records. A modified Poisson regression model with robust standard errors was used to compute adjusted risk ratio (aRR) estimates. All statistical tests were two-sided. Among 1194 men, 52.6% indicated a strong preference for preserving sexual function. Older men were less likely to have a strong preference (aRR = 0.98 per year, 95% confidence interval [CI] = 0.97 to 0.99), while men with normal sexual function were more likely (vs poor function, aRR = 1.59, 95% CI = 1.39 to 1.82). Among 568 men with low-risk cancer, there was no clear association between baseline sexual function or strong preference to preserve function with receipt of active surveillance. However, strong preference may differnetially impact those with intermediate baseline function vs poor function (Pinteraction = .02). Treatment choice may not always align with patients' preferences. These findings demonstrate opportunities to improve delivery of patient-centered care in early prostate cancer.

Large institutional variations in use of androgen deprivation therapy with definitive radiotherapy in a population-based cohort of men with intermediate- and high-risk prostate cancer.

To evaluate the pattern of use of androgen deprivation therapy (ADT) with definitive radiotherapy (RT) in men with prostate cancer (PCa) in a population-based study in Australia. This is a prospective cohort of men with intermediate- and high-risk PCa, captured in the population-based Prostate Cancer Outcome Registry Victoria, who were treated with definitive prostate RT between January 2010 and December 2015. The primary outcome of interest was ADT utilization. Chi-squared test for trend was used to evaluate the temporal trend in the use of ADT over the study period. Multivariate logistic regressions were used to evaluate the effects of patient-, tumour- and treatment-related factors, and treatment institutions (public/ private and metropolitan/ regional) on the likelihood of ADT utilization. A total of 1806 men were included in the study, 199 of whom (11%) had favourable National Comprehensive Cancer Network (NCCN) intermediate-risk disease (i.e. only one intermediate-risk feature, primary Gleason grade 3, and <50% biopsy core involved), 687 (38%) had unfavourable NCCN intermediate-risk disease, and 920 (51%) had high-risk disease. Of the 1806 men, 1155 (64%) received ADT with RT. Men with NCCN high-risk PCa (84%) were more likely to have ADT than men with favourable NCCN intermediate-risk (32%) and unfavourable NCCN intermediate-risk (46%) PCa (P < 0.001). Men treated in public institutions (66%, vs 47% in private institutions; P < 0.001) and regional centres (78%, vs 59% in metropolitan institutions; P < 0.001) were more likely to receive ADT. There was a trend towards an increase in ADT utilization from 50% in 2010 to 64% in 2015 (P < 0.001). In multivariate analyses (adjusting for age, tumour-related factors, year of treatment and use of brachytherapy boost), treatment institution (public and regional) remained independently associated with increased likelihood of ADT utilization. Men with intermediate-risk PCa treated in regional and public institutions were 2.7 times (95% confidence interval [CI] 1.9-3.9; P < 0.001) and 2.8 times (95% CI 1.4-5.3; P = 0.002), more likely to receive ADT with RT, respectively, while men with high-risk PCa treated in regional and public institutions were 3.1 times (95% CI 1.7-5.7; P < 0.001) and 3.0 times (95% CI 1.7-5.4; P < 0.001), more likely to receive ADT with RT, respectively. This is the largest Australasian contemporary series reporting on the pattern of use of ADT with definitive prostate RT. While there was an increasing trend towards use of ADT over time, ADT still appeared to be underutilized in certain groups of patients who may benefit from ADT, with approximately one in five men with high-risk and one in two with unfavourable intermediate-risk PCa not receiving ADT with RT. There was notable variation in the use of ADT between public vs private and metropolitan vs regional institutions.

Population-based Semen Analysis Results and Fertility Among Patients With Inflammatory Bowel Disease: Results From Subfertility Health Assisted Reproduction and the Environment (SHARE) Study

To evaluate male fertility in Crohn disease (CD) and ulcerative colitis (UC) by examining semen analysis results and paternity from the SHARE study (Subfertility Health Assisted Reproduction and the Environment), a population-based cohort of semen analysis results from Utah men. A population-based cohort of men with CD or UC was identified using the Utah Population Database (contains person-level linked demographic, genealogical, and medical record information for 85% of Utahans) from 1996 to 2014, and validated by clinical chart review. This cohort was then cross-linked (n = 55) to the SHARE population dataset of semen analysis results. Men with CD or UC were compared with population-based, age-matched, paired (1:1) controls (n = 47). Paternity was evaluated though presence and number of linked offspring and inter-birth interval. Offspring were identified in 71% of UC patients (mean of 1.8 children) and 61% of CD patients (mean of 1.2 children). Compared with matched controls, there were no differences in number of offspring, mean inter-birth interval, or any of the evaluated semen analysis parameters among either men with CD or UC. Fertility and semen analysis values among men with UC or CD are not significantly impacted compared with population-based, age-matched controls.

Outcomes following percutaneous coronary revascularization among South Asian and Chinese Canadians

BackgroundPrevious data suggest significant ethnic differences in outcomes following percutaneous coronary revascularization (PCI), though previous studies have focused on subgroups of PCI patients or used administrative data only. We sought to compare outcomes in a population-based cohort of men and women of South Asian (SA), Chinese and “Other” ethnicity.MethodsUsing a population-based registry, we identified 41,792 patients who underwent first revascularization via PCI in British Columbia, Canada, between 2001 and 2010. We defined three ethnic groups (SA, 3904 [9.3%]; Chinese, 1345 [3.2%]; and all “Others” 36,543 [87.4%]). Differences in mortality, repeat revascularization (RRV) and target vessel revascularization (TVR), at 30 days and from 31 days to 2 years were examined.ResultsAdjusted mortality from 31 days to 2 years was lower in Chinese patients than in “Others” (hazard ratio [HR] 0.72; 95% confidence interval [CI] 0.53-0.97), but not different between SAs and “Others”. SA patients had higher RRV at 30 days (adjusted odds ratio [OR] 1.30; 95% CI: 1.12-1.51) and from 31 days to 2 years (adjusted hazard ratio [HR] 1.17; 95% CI: 1.06-1.30) compared to “Others”. In contrast, Chinese patients had a lower rate of RRV from 31 days to 2 years (adjusted HR 0.79; 95% CI: 0.64-0.96) versus “Others”. SA patients also had higher rates of TVR at 30 days (adjusted OR 1.35; 95% CI: 1.10-1.66) and from 31 days to 2 years (adjusted HR 1.19; 95% CI: 1.06-1.34) compared to “Others”. Chinese patients had a lower rate of TVR from 31 days to 2 years (adjusted HR 0.76; 95% CI: 0.60-0.96).ConclusionsSA had higher RRV and TVR rates while Chinese Canadians had lower rates of long-term RRV, compared to those of “Other” ethnicity. Further research to elucidate the reasons for these differences could inform targeted strategies to improve outcomes.

Abstract PR04: Ethnic heterogeneity and prostate cancer mortality in Hispanic/Latino men

Abstract Purpose: Few studies have focused on the rapidly growing and extremely diverse Hispanic/Latino population in regards to prostate cancer outcomes. Our study explores whether heterogeneity between Hispanic/Latino men of diverse ancestry potentially contributes to unexplored disparities in five-year prostate cancer-specific mortality and all-cause mortality. Patients and Methods: From the Surveillance, Epidemiology, and End Results program (SEER), we designed a population-based cohort of men diagnosed with local-regional prostate cancer (n= 432,356) from 2000-2012. Five-year cumulative incidence of prostate cancer-specific mortality was obtained using competing risks analysis and all-cause mortality was determined by using one minus the Kaplan-Meier survival estimate of overall survival. This was examined for different racial and/or ethnic groups: Non-Hispanic White (n= 313,514), Non-Hispanic Black (n= 62,346), Hispanic/Latino (n= 36,407), and Asian American/Pacific Islander (n= 20,089). We also measured prostate cancer-specific and all-cause mortalities in Hispanic/Latino subgroups: Mexican (n= 7,273), Puerto Rican (n= 1,174), South or Central American (n= 2,666), Cuban (n= 747), and Dominican (n= 292). Results: In all racial/ethnic groups, five-year cumulative incidence rates were highest for Non-Hispanic Black men at 15.96% (95% CI: 15.6 - 16.3) and were lowest in Hispanic/Latino men at 13.08% (95% CI: 12.6 - 13.5) and Asian American/Pacific Islander men at 13.33% (95% CI: 12.7 - 13.9). Within ethnic subgroups, Puerto Rican men at 22.06% (95% CI: 19.4 - 25.1) and Cuban men 20.91% (95% CI: 17.8 - 24.5) showed significantly higher five-year all-cause mortality than all other groups. Mexican men showed the third highest rate of all groups with 16.47% (95% CI: 15.4 - 17.6). For five-year prostate cancer-specific mortality, both Non-Hispanic Black and Hispanic/Latino men showed similar rates that were higher than other racial/ethnic groups with 3.39% (95% CI: 3.22 - 3.57) and 3.29% (95% CI: 3.07 - 3.52), respectively. For ethnic subgroups, Puerto Rican men at 5.26% (95% CI: 3.88 - 6.92) and Mexican men at 4.77% (95% CI: 4.19 - 5.40) showed significantly higher five-year prostate cancer-specific mortality than all other groups. Cuban and Dominican men showed high rates of both five-year all-cause and prostate cancer-specific mortality, but without significance. Conclusions: Our findings indicate previously unknown disparities in five-year prostate cancer-specific mortality in Mexican and Puerto Rican men. We also note the increased all-cause mortality within Puerto Rican men diagnosed with prostate cancer, of which may be influenced by comorbid disease. These findings should be further explored and considered in screening and management guidelines. Citation Format: Felix M. Chinea, Vivek N. Patel, Deukwoo Kwon, Chris J. Lopez, Narottam Lamichhane, Sanoj Punnen, Erin Kobetz, Matthew C. Abramowitz, Alan Pollack. Ethnic heterogeneity and prostate cancer mortality in Hispanic/Latino men. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr PR04.