Use Of Hormone Therapy Research Articles

Perceptions, Benefits, and Use of Complementary and Integrative Therapies to Treat Menopausal Symptoms: A Pilot Study.

Menopause symptoms can be debilitating, and the use of menopausal hormone therapy (MHT) has declined significantly since the Women's Health Initiative. We surveyed 508 peri- and postmenopausal females to determine (1) the use of complementary and integrative therapies (CIT), MHT; and pharmacotherapies; (2) the perceptions, perceived benefits/risks of CIT, MHT; and pharmacotherapy use; and (3) factors associated with CIT and MHT use for menopause symptom treatment. The majority of respondents used CIT to treat menopause symptoms based on physician recommendation and research studies. Treatments that were perceived as most beneficial included exercise, mind-body therapies, diet, and spiritual practices, with exercise and mind-body therapies chosen to treat the most common symptoms of sleep disturbances, depressive mood, and anxiety. Higher education level was the main predictive variable for choosing exercise (odds ratio [OR] = 1.27, p = 0.02) and mind-body therapies (OR = 1.57, p = 0.02) to treat menopausal symptoms. Perceptions, beliefs, and use of different CIT by primarily white, affluent, and educated peri- and postmenopausal females to treat menopause symptoms, including sleep disturbances, depression, and anxiety, are driven by conversations with physicians and evidence-based research. These findings reinforce the necessity for both additional research in more diverse populations, as well as comprehensive, individualized personalized care from an interdisciplinary team that considers the best options available for all female patients.

105P Real-world systemic treatment choices and survival outcomes of patients diagnosed with non-metastatic high-risk HR+/HER2- breast cancer in the Netherlands

This study determines the proportion of patients with high-risk hormone receptor-positive human epidermal growth factor receptor-2-negative (HR+/HER2-) breast cancer (BC) within the total cohort of patients with non-metastatic HR+/HER2- BC and compares their systemic treatments and survival rates with those of patients with low- and intermediate-risk HR+/HER2- BC and triple-negative (TN) BC. All women (≥18 years) diagnosed with non-metastatic invasive HR+/HER2- BC or TNBC in the Netherlands between 2011 and 2019 were identified from the Netherlands Cancer Registry. Patients with HR+/HER2- BC were classified as low-, intermediate-, or high-risk, based on the number of positive lymph nodes, tumour size, and histological grade. Overall survival (OS) was evaluated using Kaplan-Meier survival analyses. Relative survival (RS) was estimated with the Pohar Perme method and defined as the ratio between OS and the expected survival of the Dutch population, using data from Statistics Netherlands. Survival data were available up to January 31, 2022. This study included 86,522 patients with HR+/HER2- BC. Of these, 51% had low-risk, 32% had intermediate-risk, and 13% had high-risk disease. In 4% of patients, the risk profile could not be defined. Endocrine therapy and chemotherapy use increased with an increasing risk classification: from 38% and 7% in low-risk, and 90% and 47% in intermediate-risk patients to 94% and 73% in high-risk patients. The 10-year OS and RS (95% confidence interval) were 84.2% (83.6-84.7) and 97.7% (96.8-98.4) in low-risk, 75.4% (74.5-76.2) and 92.4% (90.9-93.6) in intermediate-risk, and 64.4% (63.0-65.7) and 72.6% (70.8-74.3) in high-risk patients. The 10-year OS and RS of 12,448 patients with TNBC were 70.5% (69.4-71.6) and 78.3% (76.7-79.8), respectively. This study shows that 13% of patients with non-metastatic HR+/HER2- BC had high-risk disease. Although the majority of these patients received endocrine therapy and chemotherapy, the 10-year OS and RS rates were low and even worse than those of patients with TNBC. These data indicate an unmet medical need for modification of systemic treatment in this subgroup of patients.

Adjuvant treatment decisions among adults aged 65 years and older with early-stage hormone receptor positive breast cancer seen in a simple multidisciplinary clinic versus standard consultation

IntroductionRandomized studies support de-escalation of adjuvant therapy for a target population of older adults ≥65 years with stage I, estrogen-receptor (ER) positive breast cancer after breast conserving surgery. We sought to evaluate the impact of a simplified multidisciplinary clinic (s-MDC) in this population by comparing treatment patterns and patient perceptions of adjuvant radiation therapy (RT) and hormone therapy (HT) between patients seen in s-MDC vs. standard consultations. Materials and MethodsMedical records were retrospectively reviewed for patients in the above target population who underwent surgery between August 2020 and May 2022 at our institution. Two cohorts were included: (1) patients seen in s-MDC, and (2) patients seen in standard clinic separately by medical and radiation oncology (non-s-MDC cohort). The non-s-MDC patients declined, could not attend, and/or were not referred to the s-MDC. Patients in the s-MDC cohort were prospectively administered validated questionnaires to evaluate patient reported data including the Decision Autonomy Preference Scale (DAPS), e-Prognosis, and Medical Maximizing-Minimizing Scale (MMS). Chi square, t-tests, and non-parametric equivalents compared demographics, and logistic regression evaluated RT and HT use and survey score outcomes between cohorts. ResultsA total of 127 patients met inclusion criteria, with 33 s-MDC and 94 non-s-MDC patients. There was no difference between the cohorts in age, margin status, histology, grade, or focality. In the s-MDC cohort there were significantly more patients without sentinel lymph node biopsy (71.3% vs 42.4%, p = 0.003) and mean tumor size was smaller (0.69 vs. 0.96 cm, p < 0.003), and Charlson comborbidity index (CCI) was higher (5.21 vs 4.96, p = 0.038). There was no significant difference in receipt of RT (65% s-MDC vs 77% standard; odds ratio [OR] = 0.55, p = 0.189), HT (78% ss-MDC vs 72% standard; OR = 1.36, p = 0.513), or both (50% s-MDC vs 59% standard; OR = 0.7, p = 0.429). The s-MDC cohort was significantly more likely to undergo accelerated (vs. standard hypofractionated) RT (70% vs 39%; OR = 3.59, p = 0.020). In s-MDC patients with completed questionnaires (n = 33), all whose selected “mostly patient (n=6)” based decision making by DAPS chose RT while all “mostly doctor (n=1)” chose no RT. Based on e-Prognosis, there were lower odds of RT for increasing Schonberg score/ higher 10 yr mortality risk (OR 0.600, p = 0.048). MMS score ≥ 40 (“maximizer”) was strongly linked with the use of RT (OR 18.57, p = 0.011). DiscussionFor adults ≥65 years with early stage, ER positive breast cancer, s-MDC participation was not significantly associated with lower use of adjuvant RT or HT versus standard consultation but was significantly associated with shorter RT courses. DAPS and MMS results indicate that patient treatment preference may be predictable, highlighting an opportunity to tailor consultation discussions and recommendations based on intrinsic patient preferences and individual goals.

The etiopathogenesis of uterine leiomyomas: A review

Background. The most frequent female reproductive system tumors are uterine leiomyoma (UL). They are benign monoclonal tumors of uterine smooth muscle. They affect reproductive-age women with a lifetime prevalence of 3070%. UL is a disease with complex etiology determined by many genetic and environmental factors. Despite the frequency of UL, there is no long-term, cost-effective or fertility-preserving therapy option for it.&#x0D; Aim. To summarize the available literature data on the etiopathogenesis of uterine fibroids as well as the risk factors for the development of this disease.&#x0D; Materials and methods. The PubMed, Scopus, and Web of science literature databases were searched for relevant articles using such keywords as uterine fibroids, UL, association, genetic and hormonal factors, gene, etiology in various combinations.&#x0D; Results. Genetic disorders and hormonal and growth factors all have a part in the etiology of UL, and studies have resulted to the use of hormone therapy for fibroids, with varying results. Recent findings on the etiopathogenesis of UL, as well as the introduction of relevant genetically modified mouse models of UL, have rekindled interest in the disease. In this review, the basic features of fibroids are discussed, as well as the primary contributors to UL etiopathogenesis, including as genetic, hormonal, and growth causes. Besides the risk factors that contribute to the development of UL.&#x0D; Conclusion. Many questions about the causes and mechanisms of development factors that predispose remain unanswered, necessitating the continuation of these studies in order to obtain new information. Prospective studies are needed to better understand the biology and epidemiological associations, both to better understand modifiable risk factors and to shed light on the etiopathogenesis of this disease.

Adverse childhood experiences and sexual dysfunction in midlife women: Is there a link?

One in 3 children has had at least 1 adverse childhood experience (ACE), and ACEs have been associated with multiple medical and psychiatric morbidities in women later in life, including greater menopause symptom burden. To evaluate the association between ACEs and female sexual dysfunction (FSD) in midlife women. A cross-sectional analysis from DREAMS-the Data Registry on Experiences of Aging, Menopause, and Sexuality-was conducted with questionnaires completed by women aged 40 to 65years who presented to a women's health clinic at Mayo Clinic in Rochester, Minnesota, from May 2015 to December 2016. History of ACEs was obtained with the validated ACE questionnaire. FSD was assessed by the Female Sexual Function Index and the Female Sexual Distress Scale-Revised. The association between ACEs and FSD (defined as Female Sexual Function Index score ≤26.55 and Female Sexual Distress Scale-Revised score ≥11) was evaluated via a multivariable logistic regression model, adjusting for age, menopause status, hormone therapy use, anxiety, depression, relationship satisfaction, hot flash severity, and history of abuse in the past year. Women (N = 1572) had a mean age of 53.2years. Overall 59% reported having at least 1 ACE. When compared with no ACEs, a history of ≥4 ACEs significantly increased the odds of not being sexually active (odds ratio, 1.83; 95% CI, 1.30-2.57; P < .001). Among sexually active women, the proportion of women with FSD increased sequentially as the number of ACEs increased. In the univariate analysis, a history of ≥4 ACEs significantly increased the odds of FSD as compared with no ACEs (odds ratio, 2.12; 95% CI, 1.50-2.99; P < .001). The association remained statistically significant in the multivariable analysis after adjusting for confounders (odds ratio, 1.75; 95% CI, 1.15-2.68; P = .009). The findings highlight an opportunity for clinicians to screen for ACEs in women with sexual dysfunction and offer appropriate treatment and counseling as indicated. Strengths of the study include the large cohort, the use of validated tools for assessment of ACEs and FSD, and the adjustment for multiple potential confounding factors. Limitations include the cross-sectional study design, recall bias in reporting ACEs and recent abuse, and the low representation of racially and ethnically diverse women in the cohort. The study demonstrates an increased risk of sexual inactivity and sexual dysfunction in midlife women who experienced childhood adversity. The sexual dysfunction in women with ACEs seems to be independent of other factors that potentially affect female sexual function in midlife.

The estriol use in the perioperative period by patients with genital prolapse

Introduction. Postmenopausal women in a state of oestrogen deficiency often experience pelvic prolapse with underlying genitourinary menopausal syndrome, when the progression of atrophic processes in the vaginal mucosa comes to the forefront.Aim. To evaluate the results of the use of topical hormonal therapy in the perioperative period to improve the vaginal epithelial surface appearance in postmenopausal women who need surgical treatment of pelvic prolapse.Materials and methods. A comparative prospective randomized clinical trial included 60 postmenopausal patients aged 60 to 69 years with a postmenopausal period of 10 to 20 years, suffering from POP-Q stage II–IV pelvic prolapse (ICS, 1996). All patients were recommended surgical treatment using vaginal approach. The treatment group (Group 1) included 30 patients who received topical hormonal therapy with an estriol drug (Ovestin cream, 1 mg/g) within 1 month before reconstructive plastic surgery. The comparison group (Group 2) included 30 patients who did not receive hormonal treatment in the perioperative period.Results. No complications were observed in the treatment group after reconstructive plastic surgery in the early and late postoperative periods. In the comparison group, natural urination was not achieved in 9 of 30 (35.0%) women on Day 2 after surgery, in 4 of 30 (13.3%) patients on Day 3. Also in that group, 4 of 30 (13.3%) patients experienced infectious and inflammatory complications in the postoperative period, the mucous membrane healing in 5/30 (16.6%) patients took a long time, over 1 month.Conclusions. The use of topical hormonal therapy with an estriol drug in the perioperative period in patients who require surgical treatment of pelvic prolapse results in the relief of vulvovaginal atrophy symptoms and adequate regeneration of the vaginal mucosa, which helps reduce the likelihood of complications in both early and late postoperative periods.

Ten-year distant-recurrence risk prediction in breast cancer by CanAssist Breast (CAB) in Dutch sub-cohort of the randomized TEAM trial

BackgroundHormone receptor (HR)-positive, HER2/neu-negative breast cancers have a sustained risk of recurrence up to 20 years from diagnosis. TEAM (Tamoxifen, Exemestane Adjuvant Multinational) is a large, multi-country, phase III trial that randomized 9776 women for the use of hormonal therapy. Of these 2754 were Dutch patients. The current study aims for the first time to correlate the ten-year clinical outcomes with predictions by CanAssist Breast (CAB)—a prognostic test developed in South East Asia, on a Dutch sub-cohort that participated in the TEAM. The total Dutch TEAM cohort and the current Dutch sub-cohort were almost similar with respect to patient age and tumor anatomical features.MethodsOf the 2754 patients from the Netherlands, which are part of the original TEAM trial, 592 patients’ samples were available with Leiden University Medical Center (LUMC). The risk stratification of CAB was correlated with outcomes of patients using logistic regression approaches entailing Kaplan–Meier survival curves, univariate and multivariate cox-regression hazards model. We used hazard ratios (HRs), the cumulative incidence of distant metastasis/death due to breast cancer (DM), and distant recurrence-free interval (DRFi) for assessment.ResultsOut of 433 patients finally included, the majority, 68.4% had lymph node-positive disease, while only a minority received chemotherapy (20.8%) in addition to endocrine therapy. CAB stratified 67.5% of the total cohort as low-risk [DM = 11.5% (95% CI, 7.6–15.2)] and 32.5% as high-risk [DM = 30.2% (95% CI, 21.9–37.6)] with an HR of 2.90 (95% CI, 1.75–4.80; P < 0.001) at ten years. CAB risk score was an independent prognostic factor in the consideration of clinical parameters in multivariate analysis. At ten years, CAB high-risk had the worst DRFi of 69.8%, CAB low-risk in the exemestane monotherapy arm had the best DRFi of 92.7% [vs CAB high-risk, HR, 0.21 (95% CI, 0.11–0.43), P < 0.001], and CAB low-risk in the sequential arm had a DRFi of 84.2% [vs CAB high-risk, HR, 0.48 (95% CI, 0.28–0.82), P = 0.009].ConclusionsCost-effective CAB is a statistically robust prognostic and predictive tool for ten-year DM for postmenopausal women with HR+/HER2−, early breast cancer. CAB low-risk patients who received exemestane monotherapy had an excellent ten-year DRFi.

Hysterectomy and risk of epithelial ovarian cancer by histologic type, endometriosis, and menopausal hormone therapy

BackgroundThis nationwide, register-based case-control study investigated the association between hysterectomy and risk of epithelial ovarian cancer according to histology and by history of endometriosis and menopausal hormone therapy (MHT) use. MethodsFrom the Danish Cancer Registry, all women registered with epithelial ovarian cancer at age 40–79 years during 1998–2016 were identified (n = 6738). Each case was sex- and age-matched to 15 population controls using risk-set sampling. Information on previous hysterectomy on benign indication and potential confounders was retrieved from nationwide registers. Conditional logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) for the association between hysterectomy and ovarian cancer according to histology, endometriosis, and use of MHT. ResultsHysterectomy was not associated with risk of epithelial ovarian cancer overall (OR=0.99; 95% CI 0.91 –1.09) but was associated with reduced risk of clear cell ovarian cancer (OR=0.46; 95% CI 0.28–0.78). In stratified analyses, decreased ORs associated with hysterectomy were seen in women with endometriosis (OR=0.74; 95% CI 0.50–1.10) and in non-users of MHT (OR=0.87; 95% CI 0.76–1.01). In contrast, among long-term MHT users, hysterectomy was associated with increased odds for ovarian cancer (OR=1.20; 95% CI 1.03–1.39). ConclusionHysterectomy was not associated with epithelial ovarian cancer overall but with reduced risk of clear cell ovarian cancer. Our findings may suggest a reduced risk of ovarian cancer after hysterectomy in women with endometriosis and in MHT non-users. Interestingly our data pointed to an increased ovarian cancer risk associated with hysterectomy among long-term users of MHT.

Health-related quality of life of women with breast cancer being treated with hormone therapy: A scoping review.

To map the evidence available in the literature on the health-related quality of life of women with breast cancer using hormone therapy. This review followed the Joanna Briggs Institute methodological recommendations and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews reporting guidelines. Searches were performed in nine databases using descriptors, synonyms and keywords; grey literature was also included. The review protocol was registered with the Open Science Framework under doi: http://doi.org/10.17605/OSF.IO/347FM. Inclusion criteria were established according to the Population, Concept, and Context strategy. The selection of studies was performed by two independent reviewers with the aid of RAYYAN software and disagreements were resolved by a third reviewer. The main information from the included articles was grouped into textual categories and presented by means of a narrative synthesis. A total of 5419 records were identified, of which 42 studies fully met the eligibility criteria. Most were multicenter studies (42.9%) and randomized controlled trials (62%). Most studies addressed anastrozole (39.5%), letrozole (34.2%), and tamoxifen (26.3%), which were studied alone or in combination. The most widely used health-related quality-of-life assessment tool was the EORTC-QLQ-C30. The concomitant use of hormone therapy and cyclin-dependent kinase inhibitors 4 and 6 showed improvement in health-related quality of life. In recent years there has been an increase in studies focused on health-related quality of life, and the evidence pointed to relevant information on health-related quality of life and the use of endocrine therapy, tamoxifen in combination with aromatase inhibitors, as well as aromatase inhibitor alone and the use of cyclin-dependent kinase 4 and 6.

Ages at menarche and menopause, hormone therapy, and the risk of depression

ObjectiveTo examine the association between female reproductive factors and the risk of depression. MethodA retrospective cohort study was performed using a national database in South Korea. Among 945,729 eligible postmenopausal women, the associations between female reproductive factors including the age at menarche, age at menopause, parity, duration of oral contraceptive (OC) use, duration of breastfeeding, and use of menopausal hormone therapy (MHT), and the occurrence of depression were investigated. ResultsCompared to women with menarche at the age of ≤12 years, those with menarche at the age of ≥15 showed an increased risk of depression [adjusted hazard ratio (aHR) of 1.09 for 15–16 years and 1.18 for ≥17 years]. Compared to women with menopause at the age of 50–54, those with menopause at an earlier age showed an increased risk of depression (aHR of 1.20 for <40 years), and those with menopause at a later age showed a decreased risk of depression (aHR of 0.94 for ≥55 years). Use of MHT was associated with an increased risk of depression (aHR of 1.30 for ≥5 years). Duration of breastfeeding and duration of OC use had U-shaped but weak associations with depression. Whereas parity did not show a significant association with depression. ConclusionLate menarche, early menopause, and the use of MHT were associated with an increased risk of depression in postmenopausal women.

Real-World Treatment Patterns Among Patients With Metastatic Castration-Resistant Prostate Cancer: Results From an International Study.

There is limited real-world evidence on how increasing use of treatment intensification in metastatic castration-sensitive prostate cancer (mCSPC) has influenced treatment decisions in metastatic castration-resistant prostate cancer (mCRPC). The study objective was to evaluate the impact of novel hormonal therapy (NHT) and docetaxel use in mCSPC on first-line treatment patterns among patients with mCRPC in 5 European countries and the United States (US). Physician-reported data on patients with mCRPC from the Adelphi Prostate Cancer Disease Specific Program were descriptively analyzed. A total of 215 physicians provided data on 722 patients with mCRPC. Across 5 European countries and the US, 65% and 75% of patients, respectively, received NHT, and 28% and 9% of patients, respectively, received taxane chemotherapy as first-line mCRPC treatment. In Europe, patients who had received NHT in mCSPC (n = 76) mostly received taxane chemotherapy in mCRPC (55%). Patients who had received taxane chemotherapy, or who did not receive taxane chemotherapy or NHT in mCSPC (n = 98 and 434, respectively) mostly received NHT in mCRPC (62% and 73%, respectively). In the US, patients who had received NHT, taxane chemotherapy, or neither in mCSPC (n = 32, 12, and 72, respectively) mostly received NHT in mCRPC (53%, 83%, and 83%, respectively). Two patients in Europe were rechallenged with the same NHT. These findings suggest that physicians consider mCSPC treatment history when making first-line treatment decisions in mCRPC. Further studies are needed to better understand optimal treatment sequencing, especially as new treatments emerge.

Association of Age at Menopause and Hormone Therapy Use With Tau and β-Amyloid Positron Emission Tomography

Postmenopausal females represent around 70% of all individuals with Alzheimer disease. Previous literature shows elevated levels of tau in cognitively unimpaired postmenopausal females compared with age-matched males, particularly in the setting of high β-amyloid (Aβ). The biological mechanisms associated with higher tau deposition in female individuals remain elusive. To examine the extent to which sex, age at menopause, and hormone therapy (HT) use are associated with regional tau at a given level of Aβ, both measured with positron emission tomography (PET). This cross-sectional study included participants enrolled in the Wisconsin Registry for Alzheimer Prevention. Cognitively unimpaired males and females with at least 1 18F-MK-6240 and 11C-Pittsburgh compound B PET scan were analyzed. Data were collected between November 2006 and May 2021. Premature menopause (menopause at younger than 40 years), early menopause (menopause at age 40-45 years), and regular menopause (menopause at older than 45 years) and HT user (current/past use) and HT nonuser (no current/past use). Exposures were self-reported. Seven tau PET regions that show sex differences across temporal, parietal, and occipital lobes. Primary analyses examined the interaction of sex, age at menopause or HT, and Aβ PET on regional tau PET in a series of linear regressions. Secondary analyses investigated the influence of HT timing in association with age at menopause on regional tau PET. Of 292 cognitively unimpaired individuals, there were 193 females (66.1%) and 99 males (33.9%). The mean (range) age at tau scan was 67 (49-80) years, 52 (19%) had abnormal Aβ, and 106 (36.3%) were APOEε4 carriers. There were 98 female HT users (52.2%) (past/current). Female sex (standardized β = -0.41; 95% CI, -0.97 to -0.32; P < .001), earlier age at menopause (standardized β = -0.38; 95% CI, -0.14 to -0.09; P < .001), and HT use (standardized β = 0.31; 95% CI, 0.40-1.20; P = .008) were associated with higher regional tau PET in individuals with elevated Aβ compared with male sex, later age at menopause, and HT nonuse. Affected regions included medial and lateral regions of the temporal and occipital lobes. Late initiation of HT (>5 years following age at menopause) was associated with higher tau PET compared with early initiation (β = 0.49; 95% CI, 0.27-0.43; P = .001). In this study, females exhibited higher tau compared with age-matched males, particularly in the setting of elevated Aβ. In females, earlier age at menopause and late initiation of HT were associated with increased tau vulnerability especially when neocortical Aβ elevated. These observational findings suggest that subgroups of female individuals may be at higher risk of pathological burden.

PD15-03 RADIATION DOSE REQUIRED TO CONTROL PROSTATE CANCER AS DETERMINED BY POST-TREATMENT BIOPSY: LONG TERM RESULTS

You have accessJournal of UrologyCME1 Apr 2023PD15-03 RADIATION DOSE REQUIRED TO CONTROL PROSTATE CANCER AS DETERMINED BY POST-TREATMENT BIOPSY: LONG TERM RESULTS Nelson Stone, Rendi Shue, Barry Rosenstein, and Richard Stock Nelson StoneNelson Stone More articles by this author , Rendi ShueRendi Shue More articles by this author , Barry RosensteinBarry Rosenstein More articles by this author , and Richard StockRichard Stock More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003262.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radiation therapy for prostate cancer is typically prescribed at a standard dose, 79-81 Gy for external beam irradiation (EBRT) and 145 Gy for iodine-125 brachytherapy (BT). Unlike prostatectomy where the gland is removed at the time of treatment successful radiation treatment relies on the death of all cancer cells in situ. However, the dose requirement for different Gleason grade groups or NCCN risk groups may also differ. We investigated the relationship between the biological effective dose (BED) and local control as determined by post-treatment biopsy (PB) in a large cohort of men who had BT +EBRT. METHODS: 545 men who had BT were followed a median of 11 years (range 2-26) and had PB a mean of 3.2 years (2-17) post-treatment. All PB were performed by one investigator (NNS) and routinely performed at 2 years or later for a rising PSA. Median age, PSA and BED were 66 years (41-85), 7.0 ng/ml (1-189) and 185.5 Gy (15-282). 295 (54.1%) received hormone therapy (HT) for a median of 6 months. Radiation doses were converted post-implant to the BED using an ꭤ/β of 2. Associations with grade, stage, PSA, NCCN status, HT use, BED were compared to the PB results and prostate cancer survival (PCS) using ANOVA, chi-square, linear regression, Kaplan Meier estimates with comparisons by log rank and Cox proportion hazards. RESULTS: 34 (6.2%) of the 545 men had a positive PB which occurred a mean of 5.9 years (range 2-17) after all treatment. BED (p<0.001), stage (p=0.004), PSA (p=0.038) and HT use (p=0.019) were associated with a positive PB but only BED (p<0.001) remained significant on regression analysis. Dichotomizing BED to <140, 160, 180, 200, 220 or greater yielded optimal local control (positive biopsy rate 2% or less) at 180 Gy for all 3 NCCN risk groups (Table). Men with a positive PB had a mean BED of 136.8 vs. 181.3 Gy for negative PB (p<0.001). At <180 Gy 24/229 (10.5%) had local failure compared to 5/392 (1.7%) for higher doses (p<0.001, OR 6.7, 95% CI 2.5-17.9). PCS at 15 and 20 years for negative PB was 94.5 and 94.5% vs. 74.4 and 46.5% for a positive one (p<0.001). PCS was associated with BED (p<0.001), PSA (p=0.028) and stage (p=0.018). CONCLUSIONS: This long-term investigation defined the radiation dose necessary to eradicate prostate cancer and should be considered as the minimal requirement when prescribing and delivering this treatment option. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e419 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nelson Stone More articles by this author Rendi Shue More articles by this author Barry Rosenstein More articles by this author Richard Stock More articles by this author Expand All Advertisement PDF downloadLoading ...

MP37-11 SEXUAL, URINARY AND PELVIC ORGAN PROLAPSE FUNCTION AMONG OBESE WOMEN FOLLOWING BARIATRIC SURGERY

You have accessJournal of UrologyCME1 Apr 2023MP37-11 SEXUAL, URINARY AND PELVIC ORGAN PROLAPSE FUNCTION AMONG OBESE WOMEN FOLLOWING BARIATRIC SURGERY Alejandro Lopez, Nathan Shaw, Rachel Rubin, Jonathan Carter, and Lindsay Hampson Alejandro LopezAlejandro Lopez More articles by this author , Nathan ShawNathan Shaw More articles by this author , Rachel RubinRachel Rubin More articles by this author , Jonathan CarterJonathan Carter More articles by this author , and Lindsay HampsonLindsay Hampson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003275.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Obese women are more likely to experience bothersome urinary and sexual symptoms but the effect of bariatric surgery on these outcomes is poorly understood. We aim to describe how bariatric surgery impacts women’s urinary, sexual, and pelvic organ prolapse (POP) outcomes. METHODS: Bariatric surgery patients at University of California, San Francisco between 2009 and 2021 participated in a survey examining pelvic organ prolapse, sexual, and urinary health. Validated questionnaires measured each outcome: a modified version of the Female Sexual Function Index (FSFI), Pelvic Organ Prolapse Distress Inventory 6 (POPDI-6), and Urinary Distress Inventory 6 (UDI-6). All questions asked referenced three time points: before surgery, “at best” 4 weeks after surgery, and at the time of survey. Uni- and multivariate analyses were used to report the odds of patient factors associated with changes in outcomes of interest. RESULTS: Of 539 potential participants, 463 were women and 116 (25%) had complete survey data. The mean UDI-6 score was 24.5 prior to weight loss surgery, 20.6 after surgery, and 24 at the time of survey. Predictors of improvement of UDI-6 from pre- to best included no past use of hormone therapy (OR=1.6, p=.069) and better UDI score prior to surgery (OR=1.036, p=.004). The mean score for the FSFI component "satisfaction" was 3.14 prior to surgery, 3.63 after surgery, and 3.1 at the time of survey. Women who were post-menopausal were more likely to improve in FSFI from pre- to best (OR=3.99, p=.012). The mean POPDI-6 score was 12.9 prior to surgery, 9.9 after surgery, and 8.9 at the time of survey administration. A predictor of POPDI-6 improvement from pre- to best was better prior POPDI score (OR=1.33, p<.001). CONCLUSIONS: Women who undergo weight loss surgery experience benefits in urinary, sexual, and prolapse outcomes immediately following surgery, with a trend toward a return to pre-operative baseline function thereafter. Those with worse pre-operative function across all measures showed the least benefit from weight loss surgery. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e518 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alejandro Lopez More articles by this author Nathan Shaw More articles by this author Rachel Rubin More articles by this author Jonathan Carter More articles by this author Lindsay Hampson More articles by this author Expand All Advertisement PDF downloadLoading ...

MP67-14 VARIATION OF HORMONAL AGENT USAGE WITH POSTOPERATIVE RADIATION THERAPY: RESULTS FROM A POPULATION BASED COHORT OF PROSTATE CANCER PATIENTS IN COMMUNITY ONCOLOGY PRACTICES

You have accessJournal of UrologyCME1 Apr 2023MP67-14 VARIATION OF HORMONAL AGENT USAGE WITH POSTOPERATIVE RADIATION THERAPY: RESULTS FROM A POPULATION BASED COHORT OF PROSTATE CANCER PATIENTS IN COMMUNITY ONCOLOGY PRACTICES Rodrigo R Pessoa, Tyler Robin, Thomas Flaig, Elizabeth Molina, Boris Gershman, Eric Ballon-Landa, Corbin Eule, Elizabeth Kessler, Brian Chapin, Marc C Smaldone, and Simon P Kim Rodrigo R PessoaRodrigo R Pessoa More articles by this author , Tyler RobinTyler Robin More articles by this author , Thomas FlaigThomas Flaig More articles by this author , Elizabeth MolinaElizabeth Molina More articles by this author , Boris GershmanBoris Gershman 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 , Brian ChapinBrian Chapin 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.0000000000003330.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The optimal hormonal agent for postoperative radiation therapy remains to be defined with either LH-RH agents or androgen receptor blockers. Androgen deprivation therapy appears to be important for some patients receiving postoperative radiation therapy but there are differences in side effects and quality of life. Thus, we used a large national database of community practices to identify practice patterns with hormonal agents in the postoperative radiation therapy settings. METHODS: From the CancerLinQ database, which represents more than a 100 community oncology practices in the U.S., we included all men who underwent radical prostatectomy and then received adjuvant or salvage radiation therapy from 2000 to 2021. The primary outcome was concomitant use of hormonal therapy including luteinizing hormone – releasing hormone (LH-RH) agents or androgen receptor blockers. Multivariable logistic regression analyses were used to elucidate patient characteristics associated with use of each class of hormonal agents. RESULTS: Among the 390 surgically treated patients receiving postoperative radiation therapy, 50.7%(n=198) received no hormonal agents, 23.6 % (n=92) received LH-RH agents, and 22.82% (n=89) received both LH-RH agents and androgen receptor blocker. Only 2.8% (n=11) received androgen receptor blocker alone. Among patients with salvage radiation therapy at PSA>0.7 ng/dl, 51.6% did not receive any form of hormonal therapy. On multivariable analysis, patients with pN1+ compared with pN0 had higher odds of receiving LH-RH agents (OR: 3.21; p=0.01) during postoperative radiation therapy. Conversely, African American men were less likely to receive androgen receptor blockers compared to white men (OR: 0.24; p=0.004). Use of hormonal agents were not associated with postoperative radiation therapy intent. CONCLUSIONS: Among patients treated in community-based oncology practices in the U.S., most are not receiving any form of hormonal agents with postoperative radiation therapy. Racial disparities also exist in the use of androgen receptor blockers during post-prostatectomy radiation therapy. Increased attention is needed to disseminate evidence into clinical practice. Source of Funding: Schramm Foundation © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e948 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rodrigo R Pessoa More articles by this author Tyler Robin More articles by this author Thomas Flaig More articles by this author Elizabeth Molina More articles by this author Boris Gershman 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 Brian Chapin 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 ...

MP11-06 THE PROGNOSTIC ROLE OF 68Ga-PSMA PET/CT AND THE IMPACT OF METASTASIS-DIRECTED THERAPY ON CANCER PROGRESSION IN MEN WITH BIOCHEMICAL RECURRENCE FROM PROSTATE CANCER. RESULTS FROM A LARGE, SINGLE INSTITUTION SERIES

MP11-06 THE PROGNOSTIC ROLE OF 68Ga-PSMA PET/CT AND THE IMPACT OF METASTASIS-DIRECTED THERAPY ON CANCER PROGRESSION IN MEN WITH BIOCHEMICAL RECURRENCE FROM PROSTATE CANCER. RESULTS FROM A LARGE, SINGLE INSTITUTION SERIES

MP79-08 EFFECT OF HORMONE THERAPY ON SEMEN ANALYSIS PARAMETERS IN ADOLESCENT TRANSGENDER FEMALES

You have accessJournal of UrologyCME1 Apr 2023MP79-08 EFFECT OF HORMONE THERAPY ON SEMEN ANALYSIS PARAMETERS IN ADOLESCENT TRANSGENDER FEMALES Sai Allu, Sreeya Komaravolu, Mark Sigman, Gabriella Avellino, and Sarah Moore Sai AlluSai Allu More articles by this author , Sreeya KomaravoluSreeya Komaravolu More articles by this author , Mark SigmanMark Sigman More articles by this author , Gabriella AvellinoGabriella Avellino More articles by this author , and Sarah MooreSarah Moore More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003356.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Feminizing transgender patients represent an important urological patient population with unique healthcare needs. Although not every patient chooses to cryopreserve, everyone should be given the option. Hormone therapy (HT) is often started prior to proceeding with surgical orchiectomy. Research has suggested that transgender females on HT have reduced semen analysis (SA) parameters compared to cisgender patients, including reduced sperm concentration and motility. [1,2] There is limited information regarding fertility preservation by transgender patients on HT. The goal of this study is to report cryopreservation outcomes by adolescent feminizing transgender patients who are currently on HT. METHODS: We retrospectively reviewed charts of donors with our Men’s Health Center for direct donations to the sperm bank between 01/2011 to 07/2022. Inclusion criteria included adolescent age (16–24 years old) and the use of HT within three months of cryopreservation. Patient data collected included patient demographics, type of hormone therapy, and SA parameters. RESULTS: Five transgender patients were found who were on HT within three months prior to their semen cryopreservation and analysis. Their median age was 18 (range 16–22). Three patients were on spironolactone, one patient was on estradiol, and one patient was on a combination of both medications. All four patients on single-medication HT had normal concentration and motility on their semen analysis, as defined by the WHO Laboratory Manual for the Examination and Process of Human Semen (Table 1). Three of four patients on single HT had normal volume. The patient on combination HT demonstrated lowered overall SA parameters. CONCLUSIONS: This is the largest cohort of adolescent feminizing transgender patients on hormone therapy in which fertility preservation has been described. Semen cryopreservation could be a viable method for fertility preservation among this patient population who have already initiated hormonal therapies, specifically spironolactone or estradiol. Patients on single HT appear to have improved semen analysis parameters compared to patients on combination HT. Future studies are needed to further characterize fertility preservation with specific information on duration and dosage of HT, as well as outcomes of cryopreservation. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1144 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sai Allu More articles by this author Sreeya Komaravolu More articles by this author Mark Sigman More articles by this author Gabriella Avellino More articles by this author Sarah Moore More articles by this author Expand All Advertisement PDF downloadLoading ...

MP72-05 COMPLIANCE WITH RECOMMENDATIONS FOR NOVEL SECONDARY HORMONE THERAPY USE IN ADVANCED PROSTATE CANCER

You have accessJournal of UrologyCME1 Apr 2023MP72-05 COMPLIANCE WITH RECOMMENDATIONS FOR NOVEL SECONDARY HORMONE THERAPY USE IN ADVANCED PROSTATE CANCER Jared Faith and Michael Feuerstein Jared FaithJared Faith More articles by this author and Michael FeuersteinMichael Feuerstein More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003340.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Adding novel secondary hormone therapy to standard luteinizing hormone therapy is a Category 1 recommendation for treating metastatic castrate-sensitive prostate cancer (mCSPC), non-metastatic castrate-resistant prostate cancer (M0 CRPC), and metastatic castrate-resistant prostate cancer (M1 CRPC) set forth by the National Comprehensive Cancer Network (NCCN). Secondary hormone therapy is a Category 2A recommendation for treating high-risk localized prostate cancer (N0M0 PC), lymph node positive non-metastatic prostate cancer (N1M0 PC), and recurrent non-metastatic prostate cancer. The purpose of this study is part of a quality initiative to evaluate compliance in our academic practice with NCCN guidelines to optimize therapy. METHODS: This is a retrospective chart review of all patients receiving leuprolide for androgen deprivation therapy (ADT) from 2021 through June 2022. Patients with intermediate risk prostate cancer on leuprolide were excluded from the study. The number of patients within each category receiving novel secondary hormone therapies was quantified. RESULTS: Overall, of 139 patients who met our criteria, 29% received novel secondary hormone therapy. Compliance with NCCN Category 1 recommendations in terms of novel secondary hormone therapy was 68% overall, including 62% for mCSPC patients, 83% for M0 CRPC patients, and 70% for M1 CRPC. Compliance with Category 2A recommendations for adding novel hormone therapy was 16% overall. When we examined the compliance for individual practitioners, the compliance for the 5 highest-volume urologists ranged from 26-50% overall and 45-100% for Category 1 recommendations. CONCLUSIONS: Our findings demonstrate relatively low compliance with Category 1 and 2A recommendations for adding novel secondary hormone therapy in patients with advanced prostate cancer. There is an opportunity to immediately optimize treatment for these patients and future patients with quality improvement initiatives. Source of Funding: None. © 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 Jared Faith More articles by this author Michael Feuerstein More articles by this author Expand All Advertisement PDF downloadLoading ...

Ovarian Function Suppression in Premenopausal Women With Concurrent Endocrine Therapy Use

IntroductionAlmost 20% of patients receiving ovarian function suppression (OFS) and endocrine therapy (ET) for breast cancer treatment had inadequate OFS within the first year of treatment. Few studies have explored the long-term effectiveness of OFS to maintain estrogen suppression. Patients and MethodsThis retrospective, single institution study examined premenopausal women with early-stage breast cancer undergoing treatment with OFS and ET. The primary endpoint was the percentage of patients with inadequate ovarian suppression (estradiol ≥10 pg/mL) during OFS cycle 2 or later. The secondary endpoint was the percentage of patients with inadequate ovarian suppression within the first cycle after OFS initiation. Differences in age, body mass index (BMI), and previous chemotherapy use were summarized via multivariable logistic regression. ResultsOf the 131 patients included in the analysis, 35 (26.7%) lacked adequate suppression during OFS cycle 2 or later cycles. Patients with adequate suppression throughout treatment were more likely to be older (odds ratio [OR] 1.12 [95% CI, 1.05-1.22], P = .02), have a lower BMI (OR 0.88 [95% CI, 0.82-0.94], P < .001), and have received chemotherapy (OR 6.30 [95% CI, 2.06-20.8], P = .002). A total of 20 of 83 patients (24.1%) had an inadequately suppressed estradiol level within 35 days of OFS initiation. ConclusionThis “real world” cohort demonstrates that estradiol concentrations above the postmenopausal range of the assay are frequently detected, including more than 1 year after the start of OFS. Additional research is needed to establish estradiol monitoring guidelines and optimal degree of ovarian suppression.

Association of Accelerometer-Measured Physical Activity and Sedentary Behavior With Incident Cardiovascular Disease, Myocardial Infarction, and Ischemic Stroke: The Women's Health Study.

Background Few studies have investigated associations of acclerometer-based assessments of physical activity (PA) and sedentary behavior (SB) with incidence of cardiovascular disease (CVD) and its components. This prospective cohort study assessed the associations of accelerometer-measured PA and SB with total CVD, myocardial infarction, and ischemic stroke (IS). Methods and Results The authors included 16 031 women aged 62 years and older, free of CVD, with adherent accelerometer wear (≥10 hours/day for ≥4 days) from the Women's Health Study (mean age, 71.4 years [SD, 5.6 years]). Hip-worn ActiGraph GT3X+ accelerometers measured total volume of PA (total average daily vector magnitude), minutes per day of high-light PA and moderate to vigorous PA (MVPA), and SB. Women reported diagnoses of CVD, which were adjudicated using medical records and death certificates. Hazard ratios (HRs) were estimated for each exposure, and 95% CIsusing Cox proportional hazards models were adjusted for accelerometer wear time, age, self-reported general health, postmenopausal hormone therapy, smoking status, and alcohol use. The hypothetical effect of replacing 10 minutes/day of SB or high-light PA with MVPA on CVD incidence was assessed using adjusted isotemporal substitution Cox models. Over a mean of 7.1 years (SD, 1.6 years) of follow-up, 482 total CVD cases, 107 myocardial infarction cases, and 181 IS cases were diagnosed. Compared with the lowest quartiles of total average daily vector magnitude and MVPA (≤60 minutes), women who were in the highest quartiles (>120 minutes of MVPA) had a 43% (95% CI, 24%-58%) and 38% (95% CI, 18%-54%) lower hazard of total CVD, respectively. Estimates were similar for total average daily vector magnitude and MVPA with IS, but PA was not associated with myocardial infarction overall. High-light PA was not associated with any CVD outcomes. Women who spent <7.4 hours sedentary per day had a 33% (95% CI,11%-49%) lower hazard of total CVD compared with those who spent ≥9.5 hours sedentary. Replacing 10 minutes of SB with MVPA was associated with a 4% lower incidence of total CVD (HR, 0.96 [95% CI, 0.93-0.99]). Conclusions Accelerometer-assessed total PA and MVPA were inversely associated with total CVD and IS incidence, and SB was directly associated with total CVD; high-light PA was not related to CVD.