Risk Of Prostate Cancer Detection Research Articles

PCaGuard: A Software Platform to Support Optimal Management of Prostate Cancer.

Background and Objective Prostate cancer (PCa) is a severe public health issue and the most common cancer worldwide in men. Early diagnosis can lead to early treatment and long-term survival. The addition of the multiparametric magnetic resonance imaging in combination with ultrasound (mpMRI-U/S fusion) biopsy to the existing diagnostic tools improved prostate cancer detection. Use of both tools gradually increases in every day urological practice. Furthermore, advances in the area of information technology and artificial intelligence have led to the development of software platforms able to support clinical diagnosis and decision-making using patient data from personalized medicine. Methods We investigated the current aspects of implementation, architecture, and design of a health care information system able to handle and store a large number of clinical examination data along with medical images, and produce a risk calculator in a seamless and secure manner complying with data security/accuracy and personal data protection directives and standards simultaneously. Furthermore, we took into account interoperability support and connectivity to legacy and other information management systems. The platform was implemented using open source, modern frameworks, and development tools. Results The application showed that software platforms supporting patient follow-up monitoring can be effective, productive, and of extreme value, while at the same time, aiding toward the betterment medicine clinical workflows. Furthermore, it removes access barriers and restrictions to specialized care, especially for rural areas, providing the exchange of medical images and patient data, among hospitals and physicians. Conclusion This platform handles data to estimate the risk of prostate cancer detection using current state-of-the-art in eHealth systems and services while fusing emerging multidisciplinary and intersectoral approaches. This work offers the research community an open architecture framework that encourages the broader adoption of more robust and comprehensive systems in standard clinical practice.

African American Men have Increased Risk of Prostate Cancer Detection Despite Similar Rates of Anterior Prostatic Lesions and PI-RADS Grade on Multiparametric Magnetic Resonance Imaging

To determine whether the frequency of anterior prostate lesions (APL) on multiparametric magnetic resonance imaging (mpMRI) prior to biopsy differed between African American (AA) and non-AA men and evaluate implications of race and tumor location for prostate cancer (PCa) detection. Patients from the Prospective Loyola University mpMRI (PLUM) Prostate Biopsy Cohort (January 2015-December 2020) without prior diagnosis of PCa were evaluated for APLs by race. Multivariable logistic regression models evaluated predictors of APLs and associations of APLs and race with detection of any PCa (grade group 1+) and clinically significant PCa (csPCa; grade group 2+). Additional stratified and propensity score matched analyses were conducted. Of 1,239 men included, 190 (15.3%) were AA and 302 (24.4%) had at least one APL with no differences by race on multivariable analysis. While men with APLs were twice as likely to harbor PCa or csPCa, the unadjusted proportion of targeted biopsy-confirmed APL PCa (12.6% vs 12.0%) or csPCa (8.4% vs 8.9%) were similar for AA and non-AA men. AA men had higher risk of prostate cancer on targeted cores (OR 1.66 (95%CI 1.06 - 2.61), P=0.026) which was independent of lesion location or PI-RADS. AA men were found to have similar rates of APLs on mpMRI to non-AA men indicating access to mpMRI may mitigate some of the historical racial disparity based on lesion location. AA men have increased risk of PCa detection compared to non-AA men independent of anterior location or lesion grade on mpMRI reinforcing the importance of identifying genetic, biologic, and socioeconomic drivers.

Abstract 4347: Differentially expressed genes and molecular pathways in an autochthonous mouse prostate cancer model

Abstract Prostate cancer remains a major public health problem and second leading cause of cancer-related deaths in men in the United States. Despite widespread screening efforts and advancement in therapeutic regimens, incidence of prostate cancer remains steady in the past two decades. Although serum prostate-specific antigen (PSA) has been used as a screening test for prostate cancer for over two decades, the practice remains controversial. As a screening test for prostate cancer, PSA lacks sensitivity and specificity as early detection marker. Furthermore, screening may lead to unnecessary biopsies, over-detection, and overtreatment. There is a need for specific and sensitive biomarker(s) which can differentiate between cancer and non-cancer utilized for screening and early detection. The present study aims to comprehend the molecular pathways of prostate cancer which is essential for early detection and treatment. Dorso-lateral prostate from 20 week transgenic adenocarcinoma of the mouse prostate (TRAMP) mice, which spontaneously develops prostate cancer and recapitulates human disease and age-matched non-transgenic littermates were utilized for microarray analysis. Network and pathway analyses were mapped using the Ingenuity Pathway Analysis (IPA), and the database for annotation, visualization and integrated discovery. In total, 136 differentially expressed genes, including 32 downregulated genes and 104 upregulated genes were identified in the dorso-lateral prostate of TRAMP mice, compared to non-transgenic. A subset of differentially expressed genes were validated by QRT-PCR. Among these genes, 36% genes were connected to the nucleic acid binding especially ribosomal proteins which play important roles in protein synthesis, and is the most enriched pathway in the development of prostate cancer. Moreover, the results also suggest deregulation of the metabolic process and an imbalance between extracellular matrix components and adherens junction proteins could induce cancer progression. Taken together, the present study evaluated the underlying pathways and its connection to human cancer, which may further help to assess the risk of prostate cancer detection and its progression to identify potential targets of adjuvant treatment. Citation Format: Shiv Verma, Sanjeev Shukla, Mitali Pandey, Gregory T. MacLennan, Sanjay Gupta. Differentially expressed genes and molecular pathways in an autochthonous mouse prostate cancer model [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4347.

Long-Term Outcome of a Single Intervention Population Based Prostate Cancer Screening Study

We evaluated the long-term effect of screening for prostate cancer. In 1988 we randomly selected 2,400 men from a background population of 27,464 men. The 2,400 men were invited to undergo screening, of whom 1,779 (74%) accepted and were examined with digital rectal examination, ultrasound and prostate specific antigen measurement. Biopsy was performed if there were suspicious findings on ultrasound or digital rectal examination, or prostate specific antigen was greater than 10 ng/ml. The subpopulations have now been reassessed after 20 years. Participants had a decreased overall mortality rate compared to the source population (IRR 0.93, 95% CI 0.86-0.98). Nonparticipants had an increased overall mortality rate (IRR 1.25, 95% CI 1.14-1.37). There was no difference between the groups in prostate cancer specific survival. The incidence of prostate cancer remained higher in the screened population throughout followup. A single screening intervention in men 50 to 75 years old using prostate specific antigen, digital rectal examination and transrectal ultrasound, and a prostate specific antigen cutoff of 10 ng/ml for biopsy carried a significant risk of prostate cancer detection without a concomitant reduction in prostate cancer specific mortality after 20 years. This intervention should not be considered for public screening. Nonparticipants were at greater risk for death of all causes. In addition to being a single intervention trial, the limitations of this study include an outdated prostate specific antigen cutoff for biopsy. Despite the outdated screening method the source population failed to reach the same level of prostate cancer incidence as the screened population even after 20 years.

Chronic Inflammation in Prostate Biopsy Cores is an Independent Factor that Lowers the Risk of Prostate Cancer Detection and is Inversely Associated with the Number of Positive Cores in Patients Elected to a First Biopsy

Objectives: To investigate associations of chronic inflammatory infiltrate (CII) with prostate cancer (PCa) risk and the number of positive cores in patients elected to a first set of biopsies. Materials and Methods: Excluding criteria were as follows: active surveillance, prostate specific antigen (PSA) ≥ 30 ng/l, re-biopsies, incidental PCa, less than 14 cores, metastases, or 5-alpha reductase inhibitors. The cohort study was classified as negative (control group) and positive cores between 1 and 2 or > 2. Results: The cohort included 421 cases who did not meet the exclusion criteria. PCa was detected in 192 cases (45.6%) of which the number of positive cores was between 1 and 2 in 77 (40.1%) cases. The median PSA was 6.05 ng/ml (range 0.3-29 ng/ml). Linear regression models showed that CII was an independent predictor inversely associated with the risk of PCa. Multinomial logistic regression models showed that CII was an independent factor that was inversely associated with PCa risk in cases with positive cores between 1 and 2 (OR = 0.338; p = 0.004) or more than 2 (OR = 0.076; p < 0.0001) when compared to the control group. Conclusion: In a cohort of men undergoing the first biopsy set after prostate assessment, the presence of CII in the biopsy core was an independent factor inversely associated with PCa risk as well as with the number of positive biopsy cores (tumor extension). Clinically, the detection of CII in negative biopsy cores might reduce the risk of PCa in repeat biopsies as well as the probability of detecting multiple positive cores.

Prospective Quality of Life in Men Choosing Active Surveillance Compared to Those Biopsied but not Diagnosed with Prostate Cancer

Active surveillance is an important alternative to definitive therapy for men with low risk prostate cancer. However, the impact of active surveillance on health related quality of life compared to that in men without cancer remains unknown. In this study we evaluated health related quality of life outcomes in men on active surveillance compared to men followed after negative prostate needle biopsy. A prospective study was conducted on men who were enrolled into the Center for Prostate Disease Research Multicenter National Database and underwent prostate needle biopsy for suspicion of prostate cancer between 2007 and 2014. Health related quality of life was assessed at biopsy (baseline) and annually for up to 3years using SF-36 and EPIC questionnaires. Health related quality of life scores were modeled using generalized estimating equations, adjusting for baseline health related quality of life, and demographic and clinical characteristics. Of the 1,204 men who met the initial eligibility criteria 420 had a negative prostate needle biopsy (noncancer comparison group). Among the 411 men diagnosed with low risk prostate cancer 89 were on active surveillance. Longitudinal analysis revealed that for most health related quality of life subscales there were no significant differences between the groups in adjusted health related quality of life score trends over time. In this study most health related quality of life outcomes in patients with low risk prostate cancer on active surveillance did not differ significantly from those of men without prostate cancer. A comparison group of men with a similar risk of prostate cancer detection is critical to clarify the psychological and physical impact of active surveillance.

Prostate cancer detection: The impact of obesity on Asian men

ObjectiveTo evaluate the impact of body mass index (BMI) on prostate cancer detection in biopsy-naive men presenting to a single tertiary hospital in Singapore. Materials and methodsWe retrospectively examined 458 men who underwent initial prostate biopsies between January 2012 and April 2014. Indications for biopsy were serum prostate-specific antigen level≥4.0ng/ml, or digital rectal examination findings suspicious for malignancy, or both. Only men with serum prostate-specific antigen level <20ng/ml were included. BMI categories were based on the World Health Organization recommendations (normal:<25.0, overweight: 25.0–29.9, and obese: ≥30). ResultsOf the 458 men included in our cohort, 125 (27.3%) men were positive for prostate cancer on biopsy, with 69 (15.1%) being clinically significant (Gleason≥7). Men with BMI≥25kg/m2 (41.7%) were younger (67.2 vs. 68.8y, P = 0.030), had larger prostates (45.5 vs. 40.1g, P = 0.014), and were more likely to have a positive biopsy finding (34.6% vs. 22.1%, P = 0.003). On multivariate analysis, being overweight or obese was associated with increased risk of having prostate cancer on biopsy (odds ratio [OR] = 2.61, 95% CI: 1.58–4.30, P<0.001 and OR = 3.26, 95% CI: 1.37–7.73 P = 0.007, respectively). The same trend was observed for clinically significant cancers but not for clinically insignificant cancers (OR = 3.57, 95% CI: 1.87–6.82, P<0.001 and OR = 3.86, 95% CI: 1.33–11.21, P = 0.013 for being overweight and obese, respectively). ConclusionAsian men with BMI≥25kg/m2 are at greater risk of having a positive initial biopsy result. The BMI threshold (BMI≥25kg/m2) for Asian men to be at increased risk of prostate cancer detection on initial biopsy is lower than that of Western populations (BMI≥30kg/m2).

Prostate cancer detection upon transrectal ultrasound-guided biopsy in relation to digital rectal examination and prostate-specific antigen level: what to expect in the Chinese population?

We investigated the prostate cancer detection rates upon transrectal ultrasound (TRUS)-guided biopsy in relation to digital rectal examination (DRE) and prostate-specific antigen (PSA), and risk factors of prostate cancer detection in the Chinese population. Data from all consecutive Chinese men who underwent first TRUS-guided prostate biopsy from year 2000 to 2013 was retrieved from our database. The prostate cancer detection rates with reference to DRE finding and PSA level of < 4, 4–10, 10.1–20, 20.1–50 and > 50 ng ml−1 were investigated. Multivariate logistic regression analyses were performed to investigate for potential risk factors of prostate cancer detection. A total of 2606 Chinese men were included. In patients with normal DRE, the cancer detection rates were 8.6%, 13.4%, 21.8%, 41.7% and 85.2% in patients with PSA < 4, 4–10, 10.1–20, 20.1–50 and > 50 ng ml−1 respectively. In patients with abnormal DRE, the cancer detection rates were 12.4%, 30.2%, 52.7%, 80.6% and 96.4% in patients with PSA < 4, 4–10, 10.1–20, 20.1–50 and > 50 ng ml−1 respectively. Older age, smaller prostate volume, larger number of biopsy cores, presence of abnormal DRE finding and higher PSA level were associated with increased risk of prostate cancer detection upon multivariate logistic regression analyses (P < 0.001). Chinese men appeared to have lower prostate cancer detection rates when compared to the Western population. Taking the different risk factors into account, an individualized approach to the decision of TRUS-guided biopsy can be adopted.

Simultaneous treatment with statins and aspirin reduces the risk of prostate cancer detection and tumorigenic properties in prostate cancer cell lines.

Nowadays prostate cancer is the most common solid tumor in men from industrialized countries and the second leading cause of death. At the ages when PCa is usually diagnosed, mortality related to cardiovascular morbidity is high; therefore, men at risk for PCa frequently receive chronic lipid-lowering and antiplatelet treatment. The aim of this study was to analyze how chronic treatment with statins, aspirin, and their combination influenced the risk of PCa detection. The tumorigenic properties of these treatments were evaluated by proliferation, colony formation, invasion, and migration assays using different PCa cell lines, in order to assess how these treatments act at molecular level. The results showed that a combination of statins and aspirin enhances the effect of individual treatments and seems to reduce the risk of PCa detection (OR: 0.616 (95% CI: 0.467–0.812), P < 0.001). However, if treatments are maintained, aspirin (OR: 1.835 (95% CI: 1.068–3.155), P = 0.028) or the combination of both drugs (OR: 3.059 (95% CI: 1.894–4.939), P < 0.001) represents an increased risk of HGPCa. As observed at clinical level, these beneficial effects in vitro are enhanced when both treatments are administered simultaneously, suggesting that chronic, concomitant treatment with statins and aspirin has a protective effect on PCa incidence.

Editorial comment.

Evidence from both observational (case-control or prospective cohort) studies and randomized clinical trials (primarily focused on vascular events) suggests that regular use of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce the risk of a number of epithelial cancers, including prostate cancer. The magnitude of the prostate cancer risk reduction associated with aspirin is modest, with pooled estimates from meta-analyses suggesting reductions on the order of 10%-20% compared to nonusers. 1 Algra A.M. Rothwell P.M. Effects of regular aspirin on long-term cancer incidence and metastasis: a systematic comparison of evidence from observational studies versus randomized trials. Lancet Oncol. 2012; 13: 518-527 Abstract Full Text Full Text PDF PubMed Scopus (605) Google Scholar , 2 Bosetti C. Rosato V. Gallus S. et al. Aspirin and prostate cancer prevention. Recent Results Cancer Res. 2014; 202: 93-100 Crossref PubMed Scopus (11) Google Scholar , 3 Huang T.B. Yan Y. Guo Z.F. et al. Aspirin use and the risk of prostate cancer: a meta-analysis of 24 epidemiologic studies. Int Urol Nephrol. 2014; 46: 1715-1728 Crossref PubMed Scopus (40) Google Scholar A number of recent studies also suggest that aspirin or other NSAIDs are associated with a decrease in serum prostate-specific antigen (PSA) of approximately 10%. 4 Chang S.L. Harshman L.C. Presti Jr., J.C. Impact of common medications on serum total prostate-specific antigen levels: analysis of the National Health and Nutrition Examination Survey. J Clin Oncol. 2010; 28: 3951-3957 Crossref PubMed Scopus (97) Google Scholar , 5 Nieder C. Norum J. Geinitz H. Impact of common medications on serum total prostate-specific antigen levels and risk group assignment in patients with prostate cancer. Anticancer Res. 2011; 31: 1735-1740 PubMed Google Scholar , 6 Fowke J.H. Motley S.S. Smith Jr., J.A. et al. Association of nonsteroidal anti-inflammatory drugs, prostate specific antigen and prostate volume. J Urol. 2009; 181: 2064-2070 Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar These results raise the question of whether aspirin OR NSAID use may lower PSA level to a degree that reduces the likelihood of being referred for biopsy. If true, this would be a significant clinical problem given that approximately 30% of men aged ≥50 years are reported to regularly use aspirin. 7 Brasky T.M. Velicer C.M. Kristal A.R. Nonsteroidal anti-inflammatory drugs and prostate cancer risk in the VITamins And Lifestyle (VITAL) Cohort. Cancer Epidemiol Biomarkers Prev. 2010; 19: 3185-3188 Crossref PubMed Scopus (29) Google Scholar The Impact of the Use of Aspirin and Other Nonsteroidal Anti-inflammatory Drugs on the Risk of Prostate Cancer Detection on BiopsyUrologyVol. 84Issue 5PreviewTo evaluate the association between nonsteroidal anti-inflammatory drug (NSAID) use and the risk of prostate cancer (PC) detection in men undergoing biopsy. Full-Text PDF ReplyUrologyVol. 84Issue 5PreviewWe would like to thank Dr. Bruce J. Trock for his insightful editorial and thoughtful commentary. Full-Text PDF

The impact of the use of aspirin and other nonsteroidal anti-inflammatory drugs on the risk of prostate cancer detection on biopsy.

To evaluate the association between nonsteroidal anti-inflammatory drug (NSAID) use and the risk of prostate cancer (PC) detection in men undergoing biopsy. Men were identified using our academic institution's prospectively maintained prostate biopsy database. Patients were classified as aspirin (ASA) users, users of other NSAIDs, or nonusers. The primary outcome was any PC on biopsy, and the secondary outcome was clinically significant PC (CSPC; Gleason sum ≥7). Multivariate logistic regression analyses were performed to adjust for a priori defined clinical confounders. Of 839 patients, 408 (48.6%) were diagnosed with PC and 201 (24.0%) had CSPC. A higher proportion of ASA users (63.5%) and other NSAID users (61.2%) had PC compared with nonusers (41.9%; P <.001). CSPC was more common among ASA users (34.9%; P <.001) compared with other NSAID users (20.0%) and nonusers (20.9%). In multivariate regression analyses, ASA use (odds ratio [OR] = 2.04; 95% confidence interval [CI] = 1.32-3.13; P = .001) and other NSAID use (OR = 2.42; 95% CI = 1.36-431; P = .003) were associated with higher odds of PC detection, whereas ASA use was associated with higher odds of CSPC (OR = 1.62; 95% CI = 1.00-2.62; P = .048). In men undergoing biopsy, ASA and other NSAID use were associated with increased probability of detecting PC, whereas ASA use was associated with the risk of detecting CSPC. Although NSAID use might have a protective biological effect against PC, men who develop elevated prostate-specific antigen levels while on NSAIDs may nonetheless be less likely to have an inflammatory etiology and more likely to harbor PC. It may be warranted for clinicians to consider the influence of NSAIDs when evaluating patients being considered for biopsy.

Obesity is associated with higher risk of prostate cancer detection in a biopsy population in Korea

To evaluate the impact of obesity on prostate cancer detection, as measured by the body mass index (BMI) in a Korean biopsy population. We retrospectively reviewed the records of 1213 men who underwent transrectal ultrasonography-guided prostate biopsy at our institution. Biopsy outcomes were analysed with respect to various variables, including patient age, prostate-specific antigen (PSA), prostate volume, digital rectal examination (DRE) findings and obesity, defined as BMI ≥25 kg/m(2) , an Asian BMI category. Among 1213 men, 408 (33.6%) were obese and 344 (28.4%) had a positive biopsy. Obese men were younger (65.5 vs 67.1 years, P = 0.003), had a larger prostate (49.2 vs 42.9 mL, P < 0.001) and were less likely to have any abnormality on DRE (8.1 vs 15.9% P < 0.001) than non-obese men. In the multivariate analysis, obesity was significantly associated with a higher risk of prostate cancer detection in men undergoing biopsy (odds ratio [OR] = 1.446, P = 0.024). In addition, obesity was significantly associated with a higher rate of biopsy-detected high grade (Gleason score ≥4 + 3) disease, and this association remained after multivariate adjustment (OR = 1.498, P = 0.039). Obese men were younger, had a larger prostate, and had less tendency to have an abnormality on DRE than non-obese men. Obesity was associated with a higher risk of prostate cancer detection as an independent factor, including high grade prostate cancer in a Korean biopsy population.

Poor glycemic control of diabetes mellitus is associated with higher risk of prostate cancer detection in a biopsy population.

ObjectivesTo evaluate the impact of glycemic control of diabetes mellitus (DM) on prostate cancer detection in a biopsy population.Patients and MethodsWe retrospectively reviewed the records of 1,368 men who underwent prostate biopsy at our institution. We divided our biopsy population into three groups according to their history of DM, and their Hemoglobin A1c (HbA1c) level: a no-DM (DM−) group; a good glycemic control (DM+GC) group (HbA1c <6.5%); and a poor glycemic control (DM+PC) group (HbA1c ≥6.5%). For sub-analyses, the DM+PC group was divided into a moderately poor glycemic control (DM+mPC) group (6.5≤ HbA1c <7.5%) and a severely poor glycemic control (DM+sPC) group (HbA1c ≥7.5%).ResultsAmong 1,368 men, 338 (24.7%) had a history of DM, and 393 (28.7%) had a positive biopsy. There was a significant difference in prostatic specific antigen density (PSAD) (P = 0.037) and the frequency of abnormal DRE findings (P = 0.031) among three groups. The occurrence rate of overall prostate cancer (P<0.001) and high-grade prostate cancer (P = 0.016) also presented with a significantly difference. In the multivariate analysis, the DM+PC group was significantly associated with a higher rate of overall prostate cancer detection in biopsy subjects compared to the DM− group (OR = 2.313, P = 0.001) but the DM+PC group was not associated with a higher rate of high-grade (Gleason score ≥7) diseases detected during the biopsy (OR = 1.297, P = 0.376). However, in subgroup analysis, DM+sPC group was significantly related to a higher risk of high-grade diseases compared to the DM− group (OR = 2.446, P = 0.048).ConclusionsPoor glycemic control of DM was associated with a higher risk of prostate cancer detection, including high-grade disease, in the biopsy population.

Obesity affects the biopsy-mediated detection of prostate cancer, particularly high-grade prostate cancer: a dose-response meta-analysis of 29,464 patients.

Background and ObjectivesIn previous studies, obesity (measured according to the body mass index) has correlated inconsistently with the risk of biopsy-measured prostate cancer, and specifically high-grade prostate cancer. This meta-analysis aimed to clarify these correlations.MethodsA comprehensive literature search of the MEDLINE and EMBASE databases was conducted for relevant studies published through January 2014. The pooled estimates of odds ratios (OR) and confidence intervals (CI) were computed, and the meta-analysis was performed with the STATA software according to a random effects approach.ResultsA total of 11 studies that included 29,464 individuals were identified. A 5-kg/m2 increase in body mass index was associated with a 15% (OR, 1.15; 95% CI, 0.98–1.34) higher risk of prostate cancer detection and a 37% (OR, 1.37; 95% CI, 1.19–1.57) higher risk of high-grade prostate cancer detection at biopsy. There were no differences among the results of studies conducted in the USA, Europe or Asia. We also found that studies that had adjusted for prostate-specific antigen levels, digital rectal examination results, and prostate volumes obtained positive significant outcomes (OR, 1.27; 95% CI, 1.12–1.44), whereas studies that did not adjust for the above-mentioned confounding variables obtained negative results (OR, 0.92; 95% CI, 0.68–1.25). Moreover, the positive correlation between body mass index and the detection of both prostate cancer and high-grade diseases tended to be stronger as the number of biopsy cores increased.ConclusionThe present meta-analysis demonstrated that a high body mass index correlated positively with prostate cancer detection, especially high-grade prostate cancer detection. The adoption of a modified and possibly more aggressive biopsy strategy was suggested for obese populations.

Role of serum cholesterol and statin use in the risk of prostate cancer detection and tumor aggressiveness.

The aim of this study was to analyze the relationship between statin use along with serum cholesterol levels and prostate cancer (PCa) detection and aggressiveness. Statin users of three years or more and serum cholesterol levels (SC) were assessed in 2408 men scheduled for prostate biopsy. SC was classified as normal (NSC: <200 mg/dL) or high (HSC: >200 mg/dL). High-grade PCa (HGPCa) was considered if the Gleason score was greater than 7. Statin users comprised 30.9% of those studied. The PCa detection rate was 31.2% of men on statins and 37% of non-statin users (p < 0.006). The PCa detection rate was 26.3% in men with NSC and 40.6% in those with HSC (p < 0.001). In the subset of NSC men, the PCa rate was 26.5% for statin users and 26.2% for non-users (p = 0.939), while in men with HSC, the PCa rate was 36.4% for statin users and 42.0% for non-statin users (p = 0.063). The HGPCa rate was 41.8% for statin users and 32.5% for non-users (p = 0.012). NSC men had a 53.8% rate of HGPCa, while the rate was only 27.6% in HSC men (p < 0.001). NSC men on statins had an HGPCa rate of 70.2%, while non-statin users had a rate of 41.2% (p < 0.001). The HGPCa rate for HSC men on statins was 18.8%, while the rate was 30.0% (p = 0.011) for non-users. Logistic regression analysis suggested that serum cholesterol levels could serve as an independent predictor of PCa risk, OR 1.87 (95% CI 1.56–2.24) and HGPCa risk, OR 0.31 (95% CI 0.23–0.44), while statin usage could not. Statin treatment may prevent PCa detection through serum cholesterol-mediated mechanisms. A disturbing increase in the HGPCa rate was observed in statin users who normalized their serum cholesterol.

Sedentarism and overweight as risk factors for the detection of prostate cancer and its aggressiveness

ObjectiveTo analyze the influence of sedentary (SE) and overweight (OW) in the risk of prostate cancer detection (CP) and aggressiveness. Materials and methodsWe performed prostate biopsy (PB) to 2408 consecutive male, 5 ARIs untreated, because of elevated serum PSA above 4.0ng/mL (91%) or suspicious digital rectal examination (9%). In all ultrasound guided PB, 10 cores were obtained plus 2–8 additionals, according to age and prostate volume. Physical activity was assessed using a survey (SE vs. non-SE) and calculated body mass index (normal vs. OW>25kg/cm2). The tumor aggressiveness was evaluated according to the Gleason score (high grade «HG»: Gleason>7) and D’Amico risk (high risk «HR»: T>3a or PSA>20 or Gleason score>7). ResultsWe found a significant association between SE (52.5%) and OW (72.9%); p<0.001. The overall PC detection rate was 35.2%. In men with SE it was 36.7% and non-SE 33.6%, p=0.048. The overall rate of AG tumors was 28.3%, 29.2% in men with SE and 27.1 in non-SE, p=0.261. The overall rate of AR tumors was 35%, 39.7% in men with SE and 29.4% non-SE, p<0.001. CP was detected in 38.1% of men with normal BMI and 34.3% in men with OW, p=0.065. HG tumor rates were 18.1% and 31.4%, respectively, p<0.001 and AR tumor rates were 22.6% and 39.2%, respectively, p<0.001. Binary logistic regression showed that SE was an independent predictor of CP, OR 0.791 (95% CI: 0.625–0.989); p=0.030. SE and OW were independent predictors of HG: OR 0.517 (95% CI: 0.356–0.752); p=0.001, and OR 1.635 (95% CI: 1070–2497); p=0.023. SE and OW were also independent predictors of HR: OR 0.519 (95% CI: 0.349–0.771); p=0.001, and OR 1.998 (95% CI: 1.281–3.115); p=0.002. ConclusionsIn men who met criteria for prostate biopsy an association between sedentary and overweight exist. A sedentary lifestyle is associated with increased risk of PC detection while sedentary and overweight were associated with more aggressive tumors.

Sedentarismo y sobrepeso como factores de riesgo en la detección del cáncer de próstata y su agresividad

ObjectiveTo analyze the influence of sedentary (SE) and overweight (OW) in the risk of prostate cancer detection (CP) and aggressiveness. Material and methodWe performed prostate biopsy (PB) to 2,408 consecutive male, 5ARIs untreated, because of elevated serum PSA above 4.0ng/mL (91%) or suspicious digital rectal examination (9%). In all ultrasound guided PB, 10 cores were obtained plus 2 to 8 additionals, according to age and prostate volume. Physical activity was assessed using a survey (SE vs non-SE) and calculated body mass index (normal vs OW> 25kg/cm2). The tumor aggressiveness was evaluated according to the Gleason score (high grade «HG»: Gleason> 7) and D’Amico risk (high risk «HR»: T>3a or PSA>20 or Gleason score>7). ResultsWe found a significant association between SE (52.5%) and OW (72.9%), P<.001. The overall PC detection rate was 35.2%. In men with SE it was 36.7% and non-SE 33.6%, P=.048. The overall rate of AG tumors was 28.3%, 29.2% in men with SE and 27.1 in non-SE, P=.261. The overall rate of AR tumors was 35%, 39.7% in men with SE and 29.4% non-SE, P<.001. CP was detected in 38.1% of men with normal BMI and 34.3% in men with OW, P=.065. HG tumor rates were 18.1% and 31.4% respectively, P<.001 and AR tumor rates were 22.6% and 39.2% respectively, P<.001. Binary logistic regression showed that SE was an independent predictor of CP, OR .791 (95% CI: .625-.989), P=.030. SE and OW were independent predictors of HG: OR .517 (95% CI: .356-.752), P=.001, and OR 1.635 (95% CI: 1070-2497), p=0.023. SE and OW were also independent predictors of HR: OR .519 (95% CI .349-.771), P=.001, and OR 1.998 (95% CI 1.281-3.115), P=.002. ConclusionsIn men who met criteria for prostate biopsy an association between sedentary and overweight exist. A sedentary lifestyle is associated with increased risk of PC detection while sedentary and overweight were associated with more aggressive tumors.

Dietary habits and prostate cancer detection: a case–control study

Many studies have suggested that nutritional factors may affect prostate cancer development. The aim of our study was to evaluate the relationship between dietary habits and prostate cancer detection. We studied 917 patients who planned to have transrectal ultrasonography-guided prostatic biopsy based on an elevated serum prostate-specific antigen (PSA) level, a rising serum PSA level or an abnormal digital rectal examination. Before receiving the results of their biopsy, all patients answered a self-administered food frequency questionnaire. In combination with pathology data we performed univariable and multivariable logistic regression analyses for the predictors of cancer and its aggressiveness. Prostate cancer was found in 42% (386/917) of patients. The mean patient age was 64.5 (standard deviation [SD] 8.3) years and the mean serum PSA level for prostate cancer and benign cases, respectively, was 13.4 (SD 28.2) mug/L and 7.3 (SD 4.9) mug/L. Multivariable analysis revealed that a meat diet (e.g., red meat, ham, sausages) was associated with an increased risk of prostate cancer (odds ratio [OR] 2.91, 95% confidence interval [CI] 1.55-4.87, p = 0.027) and a fish diet was associated with less prostate cancer (OR 0.54, 95% CI 0.32-0.89, p = 0.017). Aggressive tumours were defined by Gleason score (>/= 7), serum PSA level (>/= 10 mug/L) and the number of positive cancer cores (>/= 3). None of the tested dietary components were found to be associated with prostate cancer aggressivity. Fish diets appear to be associated with less risk of prostate cancer detection, and meat diets appear to be associated with a 3-fold increased risk of prostate cancer. These observations add to the growing body of evidence suggesting a relationship between diet and prostate cancer risk.

The influence of metabolic syndrome on prostate cancer risk detection and its aggressiveness.

226 Background: Metabolic syndrome (MS) is a frequent pathological condition that increase cardiovascular risk and mortality. MS is frequently diagnosed in adult men who are at risk of prostate cancer (PC). Some studies have postulated a relationship between MS and overall oncogenesis, however no information exist in relation to PC. The objective of this study was to analyze the impact of MS on PC detection risk and PC aggressiveness. Methods: A group of 2408 men were consecutively subjected to prostate biopsy for cause, PSA &gt;4 ng/mL (64.4%), abnormal DRE (9%) or both (26.6%). Median PSA was 7.0 ng/mL (0.7-1279) and median age 68 years (46–86). MS was evaluated according to the ATPIII criteria (three or more conditions: waist circumference &gt;102 cm, triglyceride level &gt;150 mg/dL, high density lipoprotein level &lt;40 mg/dL, fasting glucosa level &gt;110 ng/dL and blood pressure &gt;130/85 mmHg. Men on lipid-lowering medications, hypoglicemiants and antihypertensives were classified as positive for the respective criterion. We took at least 10 cores in PB, plus 1 to 8 additional cores depending on age and prostate volume according to a modified Vienna’s nomogram. Overall PC detection rate was 35.2% and high grade (HG) rate (Gleason score &gt;7) 28.3%. Binary logistic regression and contingence analysis were performed and odds ratios (OR) calculated to analyze the strength of relationships. Results: The overall prevalence of MS was 61.5% (1480/2408). Multivariate analysis showed that MS was not an independent predictor of PC however MS was an independent predictor of HGPC. The rate of PC was 34.3% in men with MS (508 of 1480) and 36.6% in men without MS (340/928), p=0.255. OR: 0.904 (95%CI 0.762-1.073). The rate of HGPC was 33.1% among the PCs detected in men with MS and 21.2% among the PCs detected in men without MS, p &lt;0.001, OR 1.839 (95%IC 1.337-2.531). Conclusions: MS does not seem to increase the risk of prostate cancer detection in men subjected to PB for cause. However, we have detected an increase of the aggressiveness among PCs detected in men with MS.

Effect of chronic treatment of combined statins and aspirin on the risk of prostate cancer detection.

185 Background: The role of chronic treatment (ChT) with statins and aspirin on prostate cancer (PC) carcinogenesis is controversial. Both drugs are frequently used in adult men who are at risk of PC, and many of them receive both drugs simultaneously. The impact of the combined treatment (CT) with statins and aspirin on PC risk has never been reported. We proposed to explore the influence of ChT with statins and aspirin in the PC risk detection and their aggressiveness. Methods: 2408 men were consecutively biopsied for cause: PSA &gt; 4 ng/mL (64.4%), abnormal DRE (9%) or both (26.6%). ChT with statins and aspirin (&gt;1 year) was controlled. Median age was 68 years (46–86) and median PSA 7.0 ng/mL (0.7-1279). At least 10 cores, plus 1 to 8 additional cores, were obtained. The PC detection rate was 35.2% and the Gleason score was &lt; 7 in 20.8%, 7 in 50.9% and &gt; 7 (HGPC) in 28.3%. Multivariate and univariate analysis were done and OR calculated to analyze the strength of the relationships. Results: 440 men (18.3%) were receiving statins alone (SA), 160 (6.6%) aspirin alone (AA), and 304 (12.6%) both drugs simultaneously. Multivariate analysis showed that CT was the only independent predictor of a reduced risk of PC detection, p=0.025, (OR 0.589, 95%CI 0.370-0-936). PC was detected in 552 of 1502 men (36.7%) not receiving statins or aspirin, 34.5% (152/440) receiving SA, 40% (64/160) receiving AA, and in 26.3% (80/304) receiving statins and aspirin simultaneously. Related to cancer aggressiveness, multivariate analysis showed that combined treatment predicted significantly an increased risk of HGPC, p=0.013, (OR 2.672, 95%CI 1.226-5.825). HGPC was detected in 136 of 552 (24.6%) PCs detected in men not receiving statins or aspirin, in 40 of 152 (26.3%) PCs detected in men receiving SA, in 24 of 64 (37.7%) PCs detected in men receiving AA, and in 40 of 80 (50%) PCs detected in men receiving statins and aspirin simultaneously. Conclusions: This study suggests that ChT with the combination of statins and aspirin reduce significantly the risk of PC detection in men subjected to prostate biopsy for cause. However, this reduction of PC detection is accompanied by a significant increase of PC aggressiveness.