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Sood A, Cole D, Abdollah F, Eilender B, Roumayah Z, Deebajah M, Dabaja A, Alanee S. Endocrine, Sexual Function, and Infertility Side Effects of Immune Checkpoint Inhibitor Therapy for Genitourinary Cancers. Curr Urol Rep 2018; 19:68. [PMID: 29971696 DOI: 10.1007/s11934-018-0819-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW Immune checkpoint therapy has grown in prominence in the last few decades and is being increasingly utilized in treatment of advanced cancers. Although information on toxicities of these drugs is forthcoming, not much is known regarding the toxicity profile of these drugs from a sexual function standpoint. We undertook the current review to appraise the literature for endocrine/sexual side effects of anti-PD-1/PD-L1 and anti-CTLA-4 therapy. RECENT FINDINGS Our review included 32 articles and focused primarily on the programmed death (PD) pathway. We found that endocrine side effects after anti-PD-1/PD-L1 therapy are relatively rare, with hypothyroidism (range < 1 to 40%) and hypophysitis (range < 1 to 10%) being the two most common. None of the studies specifically commented on the infertility or sexual side effects of these drugs. However, two studies evaluating biochemical profiles of patients undergoing therapy with ipilimumab (a CTLA-4 inhibitor) or combination therapy (CTLA-4 + PD-1/PD-L1 inhibitors) noted that about < 1 to ~ 60% of the patients developed hypogonadotropic hypogonadism. None of the studies provided information regarding clinically meaningful sexual health endpoints such as libido, erectile function assessments, or sexual function-related quality of life. Endocrine side effects, although uncommon, are important and unique side effects of immune checkpoint therapy because they are often complex and can be life threatening. While side effects on sexual health may not be life threatening, they are lifestyle limiting. Thus, long-term follow-up, post-marketing surveillance, and future studies will need to elucidate the true rates of endocrine/sexual side effects and the mechanisms underlying them. This will aid in better counseling of the patients, as more of them undergo these novel immune checkpoint inhibitor therapies.
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Alanee S, El-Zawahry A, Karr M, Deebajah M, Dabaja A, Dynda D, Mcvary K, Braundmeier-Fleming A. MP15-13 EXAMINING CHANGES IN THE URINARY MICROBIOME INDUCED BY TRANSRECTAL ULTRASOUND GUIDED BIOPSY OF THE PROSTATE USING 16SRNA ANALYSIS. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Thompson R, Deebajah M, Yaguchi G, Walton E, Bazzi M, Peabody J, Menon M, Alanee S, Dabaja A. MP14-16 THE CHARACTERISTICS OF PROSTATE CANCER ON FINAL PATHOLOGY IN MEN UNDERGO RADICAL PROSTATECTOMY WITH A NEGATIVE MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Borchert A, Deebajah M, Bazzi M, Diaz-Insua M, Chick J, Bandari M, Peabody J, Menon M, Alanee S, Dabaja A. MP67-13 INCIDENCE OF PEYRONIE'S DISEASE AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY IN MEN WITH POST-OPERATIVE SUPRAPUBIC CATHETERS AND NO URETHRAL FOLEY CATHETERS. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sood A, Abdollah F, keeley J, Dabaja A, Peabody J, Menon M, Alanee S. MP87-16 EFFECT OF RACE ON THE RISK OF METASTASIS AND MORTALITY IN PATIENTS EXPERIENCING EARLY BIOCHEMICAL RECURRENCE FOLLOWING ROBOTIC RADICAL PROSTATECTOMY. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Deebajah M, Thompson R, Yaguchi G, Pantelic M, Peabody J, Menon M, Dabaja A, Alanee S. MP14-14 PROPENSITY SCORE MATCHED STUDY TO EXAMINE THE EFFECT OF RACE ON THE NUMBER OF LESIONS SUSPICIOUS FOR PROSTATE CANCER DETECTED THROUGH MAGNETIC RESONANCE IMAGING OF THE PROSTATE. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Alanee S, El-Zawahry A, Karr M, Deebajah M, Dabaja A, Dynda D, Mcvary K, Braundmeier-Fleming A. MP15-11 A PROSPECTIVE STUDY TO EXAMINE THE ASSOCIATION OF THE URINARY AND FECAL MICROBIOME WITH PROSTATE CANCER AND BENIGN PROSTATIC HYPERPLASIA USING 16SRNA ANALYSIS. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kachroo N, Diaz M, Menon M, Dabaja A. PD03-10 APPLICABILITY OF EPSTEIN’S CRITERIA FOR ACTIVE SURVEILLANCE IN A CONTEMPORARY US COHORT UNDERGOING ROBOTIC PROSTATECTOMY. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.2098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Moustafa S, Duke C, Sood A, Dun E, Dabaja A. 30-Day postoperative outcomes of minimally invasive versus abdominal myomectomy: an analysis of the National Surgical Quality Improvement Program (NSQIP) Database 2005-2013. Fertil Steril 2015. [DOI: 10.1016/j.fertnstert.2015.07.557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Sood A, Kapoor V, Abdollah F, Sammon J, Rogers C, Klett D, Jeong W, Dabaja A, Schmid M, Kibel A, Peabody J, Menon M, Trinh QD. MP59-03 AN EVALUATION OF THE TIMING OF SURGICAL COMPLICATIONS FOLLOWING NEPHRECTOMY. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.2163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dabaja A, Goldstein M. Microsurgical Hydrocelectomy: Rationale and Technique. UROLOGY PRACTICE 2014. [DOI: 10.1016/j.urpr.2014.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Wosnitzer MS, Mielnik A, Dabaja A, Robinson B, Schlegel PN, Paduch DA. Ubiquitin Specific Protease 26 (USP26) expression analysis in human testicular and extragonadal tissues indicates diverse action of USP26 in cell differentiation and tumorigenesis. PLoS One 2014; 9:e98638. [PMID: 24922532 PMCID: PMC4055479 DOI: 10.1371/journal.pone.0098638] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 05/06/2014] [Indexed: 02/03/2023] Open
Abstract
Ubiquitin specific protease 26 (USP26), a deubiquitinating enzyme, is highly expressed early during murine spermatogenesis, in round spermatids, and at the blood-testis barrier. USP26 has also been recognized as a regulator of androgen receptor (AR) hormone-induced action involved in spermatogenesis and steroid production in in vitro studies. Prior mutation screening of USP26 demonstrated an association with human male infertility and low testosterone production, but protein localization and expression in the human testis has not been characterized previously. USP26 expression analysis of mRNA and protein was completed using murine and human testis tissue and human tissue arrays. USP26 and AR mRNA levels in human testis were quantitated using multiplex qRT-PCR. Immunofluorescence colocalization studies were performed with formalin-fixed/paraffin-embedded and frozen tissues using primary and secondary antibodies to detect USP26 and AR protein expression. Human microarray dot blots were used to identify protein expression in extra-gonadal tissues. For the first time, expression of USP26 and colocalization of USP26 with androgen receptor in human testis has been confirmed predominantly in Leydig cell nuclei, with less in Leydig cell cytoplasm, spermatogonia, primary spermatocytes, round spermatids, and Sertoli cells. USP26 likely affects regulatory proteins of early spermatogenesis, including androgen receptor with additional activity in round spermatids. This X-linked gene is not testis-specific, with USP26 mRNA and protein expression identified in multiple other human organ tissues (benign and malignant) including androgen-dependent tissues such as breast (myoepithelial cells and secretory luminal cells) and thyroid tissue (follicular cells). USP26/AR expression and interaction in spermatogenesis and androgen-dependent cancer warrants additional study and may prove useful in diagnosis and management of male infertility.
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Herati A, Bolyakov A, Dabaja A, Wosnitzer M, Schlegel P, Paduch D. MP32-03 ASSESSMENT OF SPINAL CORD MOTOR GENERATOR FOR EJACULATION USING TRANSPERINEAL ULTRASOUND IN HEALTHY MEN WITH NORMAL SEXUAL FUNCTION. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Wosnitzer M, Dabaja A, Bolyakov A, Mielnik A, Schlegel P, Paduch D. Role of estradiol, prolactin, and inhibin B in normal male ejaculation. Fertil Steril 2013. [DOI: 10.1016/j.fertnstert.2013.07.1293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ghani KR, Trinh QD, Sammon JD, Jeong W, Simone A, Dabaja A, Dusik S, Peabody JO, Menon M. Percutaneous suprapubic tube bladder drainage after robot-assisted radical prostatectomy: a step-by-step guide. BJU Int 2013; 112:703-5. [DOI: 10.1111/bju.12071] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kovacevic L, Jurewicz M, Dabaja A, Thomas R, Diaz M, Madgy DN, Lakshmanan Y. Enuretic children with obstructive sleep apnea syndrome: should they see otolaryngology first? J Pediatr Urol 2013; 9:145-50. [PMID: 22285485 DOI: 10.1016/j.jpurol.2011.12.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 12/28/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVES To study: (1) the prevalence of diurnal urinary incontinence (DI) and nocturnal enuresis (NE) in children with obstructive sleep apnea syndrome (OSAS) who underwent surgery for their upper airway symptoms, (2) the postoperative rate of enuresis resolution, and (3) factors that may predict lack of improvement post surgery. PATIENTS AND METHODS An observational, pilot study of children 5-18 years of age with OSAS and NE who underwent tonsillectomy and/or adenoidectomy (T&A) between 2008 and 2010 was performed. Study consisted of a phone interview and chart review. Severity of NE and DI, frequency, arousal and sleeping disturbances were assessed pre and post T&A. Factors associated with failure to respond were analyzed using a logistic regression model. RESULTS Among the 417 children who underwent T&A, 101 (24%) had NE (61 males, mean age 7.8 ± 2.5 years), and of these 24 had associated DI (6%). Mean postoperative follow-up was 11.7 months. Of the 49 whose NE responded to T&A (49%), 30 resolved within 1 month postoperatively. DI resolved in 4 children (17%). There was a statistically significant difference between responders and non-responders regarding the presence of prematurity, obesity, family history of NE, type of enuresis, enuresis severity, and ability to be easily aroused. CONCLUSION NE was present in about one fourth of children with OSAS undergoing surgery, and resolved in about half. Lower response rate was associated with prematurity, obesity, family history of NE, presence of non-monosymptomatic NE, severe NE preoperatively, and arousal difficulties.
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Wosnitzer M, Dabaja A, Bolyakov A, Mielnik A, Schlegel P, Paduch D. 1394 TESTOSTERONE, LH, FSH, AND SHBG IN NORMAL MALE EJACULATORY FUNCTION. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.2748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Jeong W, Trinh QD, Ghani KR, Sammon JD, Jhaveri J, Sukumar S, Dabaja A, Kheterpal E, Muhletaler F, Menon M, Agarwal PK. V1890 ROBOT-ASSISTED PARTIAL CYSTECTOMY FOR BLADDER CANCER OF A BLADDER DIVERTICULUM. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.2045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jhaveri J, Trinh QD, Ghani KR, Fitzgerald C, Sammon JD, Jeong W, Sukumar S, Ehlert M, Dabaja A, Rivers K, Rogers CG, Menon M. V242 ROBOT-ASSISTED REPAIR OF RECURRENT VESICOVAGINAL FISTULA. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Trinh QD, Sammon JD, Sun M, Ravi P, Ghani KR, Jeong W, Bianchi M, Jhaveri J, Sukumar S, Dabaja A, Hansen J, Friedman A, Ehlert M, Muhletaler F, Agarwal PK, Peabody JO, Rogers CG, Shariat SF, Menon M, Karakiewicz PI. 1103 ROBOT-ASSISTED VS. LAPAROSCOPIC PARTIAL NEPHRECTOMY UTILIZATION PATTERNS AND PERIOPERATIVE OUTCOMES IN THE UNITED STATES. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.1211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Ghani KR, Trinh QD, Sammon J, Jeong W, Dabaja A, Menon M. Robot-assisted urological surgery: Current status and future perspectives. Arab J Urol 2012; 10:17-22. [PMID: 26558000 PMCID: PMC4442903 DOI: 10.1016/j.aju.2011.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 12/14/2011] [Accepted: 12/14/2011] [Indexed: 11/29/2022] Open
Abstract
Objectives To discuss the current status of robot-assisted urological surgery. Methods We searched PubMed for articles published from 2008 using the search terms ‘advances’, ‘robotic surgery equipment’ and ‘instrumentation’. We also searched PubMed for articles describing the latest developments in reconstructive techniques for lower and upper urinary tract procedures. Finally, we searched PubMed for original articles containing the terms ‘robotic surgery training’ and ‘credentialing’. Results With each release of hardware or ancillary instrumentation, the reconstructive abilities of the da Vinci surgical system (Intuitive Surgical, Sunnyvale, CA, USA) improve. Recent developments in reconstructive capabilities of robotic urological surgery include posterior reconstruction during robot-assisted radical prostatectomy, barbed sutures for urethrovesical anastomosis, sliding-clip renorrhaphy for robot-assisted partial nephrectomy, and repair of pelvic organ prolapse. The safe implementation of robotic surgery is aided by new guidelines in credentialing and proctoring, and the introduction of virtual reality simulators for training. Conclusion Robotic urological surgery is rapidly developing and expanding globally. To achieve the highest levels of safety for patients, surgeons must ensure that the implementation of robotic surgery is an integrative and effective process.
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Trinh QD, Sun M, Sammon J, Bianchi M, Sukumar S, Ghani KR, Jeong W, Dabaja A, Shariat SF, Perrotte P, Agarwal PK, Rogers CG, Peabody JO, Menon M, Karakiewicz PI. Disparities in access to care at high-volume institutions for uro-oncologic procedures. Cancer 2012; 118:4421-6. [DOI: 10.1002/cncr.27440] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 11/02/2011] [Accepted: 12/13/2011] [Indexed: 11/09/2022]
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Kovacevic L, Dabaja A, Jurewicz M, Renolds B, Rutt A, Madgi D, Lakshmanan Y. 827 ENURETIC CHILDREN WITH OBSTRUCTIVE SLEEP APNEA SYNDROME (OSAS): SHOULD THEY SEE OTOLARYNGOLOGY FIRST? J Urol 2011. [DOI: 10.1016/j.juro.2011.02.646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Farhat MH, Dabaja A, Agarwal P. Does increasing number of core biopsies change the results of needle biospy in prostate cancer? J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
113 Background: The superiority of extended sampling of the prostate compared to standard sextant biopsy in predicting the final Gleason score has been controversial. In the literature, sextant biopsies have a match rate between 28–68% and an upgrading rate of 25–57%. Consequently, multiple studies recommend that extended biopsies should be the standard of care. This study examines the effect of greater core biopsy number on upgrading GS and predicting surgical pathology. Methods: Prostate biopsies of 984 patients who underwent RP between 2001 and 2008 were retrospectively reviewed. The GS of the biopsies was compared to the pathological specimens using the Chi-square test. Further adjusted comparison was performed using logistic regression. A clinical significant upgrade was defined as increase of the total GS or the primary GS. Results: The majority of the upgrading occurred in biopsy Gleason 3+3 and 3+4 cases. Upgrading was seen in 35.1% of patients with 6 cores or less, 34.5% with 7–12 cores, and 45.5% with 13+ cores (p=0.061). Number of cores, BMI, or prostate size did not affect upgrading, while perineural invasion, cancer volume on a biopsy, and D'Amico risk criteria increased the likelihood of upgrading. Conclusions: The extended core biopsy does not seem to correlate with higher gleason score or to better predict the final pathologic gleason score compared to standard sextant biopsies in prostate cancer. D'Amico risk factors, perineural invasion, and cancer volume can be viewed as risk factors for upgrading especially in GS 3+3. No significant financial relationships to disclose.
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Dabaja A, Menon M, Agarwal P. Prognostic indicators of aggressive disease in patients with locally advanced or metastatic prostate cancer: A focus on neutrophil to lymphocyte and platelet to lymphocyte ratios. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
62 Background: Prostate specific antigen (PSA) and Gleason Score (GS) are helpful in predicting aggressive disease. Recently, the neutrophil:lymphocyte ratio (NLR) and platlet:lymphocyte ratio (PLR) were identified as prognostic indicators in gastric cancer which has an inflammatory pathogenesis. We hypothesized that these indicators may be prognostic in prostate cancer which is also postulated to have an inflammatory mechanism of carcinogenesis. Our goal was to assess if NLR and PLR is predictive of aggressive prostate cancer, which will be measured by metastasis and overall survival in patients on hormonal therapy as treatment. Methods: We performed a retrospective analysis of 246 patients that were being treated with hormone therapy for either locally advanced or metastatic disease, or who were not surgical candidates or refused surgery. A logistic regression model was used to analyze various prognostic factors including total GS, pre-biopsy PSA, perineural invasion, % of core biopsies positive, NLR, and PLR. Endpoints studied were overall survival and metastasis. Results: The logistic regression showed only pre biopsy PSA as a predictor of metastasis (n=82). The increased risk when measured continuously was 0.6% increase in odds ratio (p<0.015). When PSA was measured categorically the % biopsy cores positive were predictive of increased risk of metastatic disease with a 2.9% increase in odds ratio (p<0.002). The % biopsy cores positive were predictive of a 3.7% increased odds ratio in cancer-specific mortality (p<0.002). These results were controlled for age, which gave a 7% increase in odds ratio of overall survival (p<0.049). Conclusions: Despite the thought that prostate cancer has an inflammatory pathogenesis, no correlation was found between N:L and P:L ratios and overall survival or bone metastasis in patients on hormone therapy for locally advanced disease. There was a negative correlation between increased % positive biopsy cores a decreased risk of survival. Further investigation is necessary to investigate the role of NLR and PLR as prognostic indicators in organ confined prostate cancer. No significant financial relationships to disclose.
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