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Wang A, Lazo M, Lu J, Couper DJ, Prizment AE, Vitolins MZ, Denmeade SR, Joshu CE, Platz EA. Liver Fibrosis Scores and Prostate Cancer Risk and Mortality in the Atherosclerosis Risk in Communities Study. Cancer Prev Res (Phila) 2023; 16:523-530. [PMID: 37339266 PMCID: PMC10527661 DOI: 10.1158/1940-6207.capr-23-0168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/06/2023] [Accepted: 06/15/2023] [Indexed: 06/22/2023]
Abstract
Subclinical liver impairment due to fibrosis could influence the development and detectability of prostate cancer. To investigate the association between liver fibrosis and prostate cancer incidence and mortality, we included 5,284 men (mean age: 57.6 years, 20.1% Black) without cancer or liver disease at Visit 2 in the Atherosclerosis Risk in Communities study. Liver fibrosis was assessed using the aspartate aminotransferase to platelet ratio index, fibrosis 4 index (FIB-4), and nonalcoholic fatty liver disease fibrosis score (NFS). Over 25 years, 215 Black and 511 White men were diagnosed with prostate cancer, and 26 Black and 51 White men died from the disease. We estimated HRs for total and fatal prostate cancer using Cox regression. FIB-4 [quintile 5 vs. 1: HR = 0.47, 95% confidence interval (CI): 0.29-0.77, Ptrend = 0.004] and NFS (HR = 0.56, 95% CI: 0.33-0.97, Ptrend = 0.03) were inversely associated with prostate cancer risk in Black men. Compared with no abnormal score, men with ≥1 abnormal score had a lower prostate cancer risk if they were Black (HR = 0.46, 95% CI: 0.24-0.89), but not White (HR = 1.04, 95% CI: 0.69-1.58). Liver fibrosis scores did not appear to be associated with fatal prostate cancer in Black or White men. Among men without a clinical diagnosis of liver disease, higher liver fibrosis scores were associated with lower incidence of prostate cancer in Black men, but not in White men, and not with fatal prostate cancer in either race. Further research is needed to understand the influence of subclinical liver disease on prostate cancer development versus detectability and the racial differences observed. PREVENTION RELEVANCE Investigating the link between liver fibrosis and prostate cancer risk and mortality, our study reveals the potential influence of liver health on prostate cancer development and on detection using PSA test, urging further research to understand the differential findings by race and to optimize prevention and intervention strategies.
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Affiliation(s)
- Anqi Wang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Public and Population Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Mariana Lazo
- Department of Community Health and Prevention and the Urban Health Collaborative, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Jiayun Lu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - David J. Couper
- Department of Biostatistics, University of North Carolina at Chapel Gillings Hill School of Global Public Health, Chapel Hill, North Carolina
| | - Anna E. Prizment
- Division of Hematology, Oncology and Transplantation, Medical School, University of Minnesota and the Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Mara Z. Vitolins
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Samuel R. Denmeade
- Department of Oncology, Johns Hopkins University School of Medicine, and the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
- Department of Urology and the James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Corinne E. Joshu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Oncology, Johns Hopkins University School of Medicine, and the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Elizabeth A. Platz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Oncology, Johns Hopkins University School of Medicine, and the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
- Department of Urology and the James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Ioannidou A, Watts EL, Perez-Cornago A, Platz EA, Mills IG, Key TJ, Travis RC, Tsilidis KK, Zuber V. The relationship between lipoprotein A and other lipids with prostate cancer risk: A multivariable Mendelian randomisation study. PLoS Med 2022; 19:e1003859. [PMID: 35085228 PMCID: PMC8794090 DOI: 10.1371/journal.pmed.1003859] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 11/03/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Numerous epidemiological studies have investigated the role of blood lipids in prostate cancer (PCa) risk, though findings remain inconclusive to date. The ongoing research has mainly involved observational studies, which are often prone to confounding. This study aimed to identify the relationship between genetically predicted blood lipid concentrations and PCa. METHODS AND FINDINGS Data for low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides (TG), apolipoprotein A (apoA) and B (apoB), lipoprotein A (Lp(a)), and PCa were acquired from genome-wide association studies in UK Biobank and the PRACTICAL consortium, respectively. We used a two-sample summary-level Mendelian randomisation (MR) approach with both univariable and multivariable (MVMR) models and utilised a variety of robust methods and sensitivity analyses to assess the possibility of MR assumptions violation. No association was observed between genetically predicted concentrations of HDL, TG, apoA and apoB, and PCa risk. Genetically predicted LDL concentration was positively associated with total PCa in the univariable analysis, but adjustment for HDL, TG, and Lp(a) led to a null association. Genetically predicted concentration of Lp(a) was associated with higher total PCa risk in the univariable (ORweighted median per standard deviation (SD) = 1.091; 95% CI 1.028 to 1.157; P = 0.004) and MVMR analyses after adjustment for the other lipid traits (ORIVW per SD = 1.068; 95% CI 1.005 to 1.134; P = 0.034). Genetically predicted Lp(a) was also associated with advanced (MVMR ORIVW per SD = 1.078; 95% CI 0.999 to 1.163; P = 0.055) and early age onset PCa (MVMR ORIVW per SD = 1.150; 95% CI 1.015,1.303; P = 0.028). Although multiple estimation methods were utilised to minimise the effect of pleiotropy, the presence of any unmeasured pleiotropy cannot be excluded and may limit our findings. CONCLUSIONS We observed that genetically predicted Lp(a) concentrations were associated with an increased PCa risk. Future studies are required to understand the underlying biological pathways of this finding, as it may inform PCa prevention through Lp(a)-lowering strategies.
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Affiliation(s)
- Anna Ioannidou
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Eleanor L. Watts
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Aurora Perez-Cornago
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Elizabeth A. Platz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, United States of America
- Department of Urology and the James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Ian G. Mills
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
- Patrick G Johnston Centre for Cancer Research (PGJCCR), Queen’s University Belfast, Belfast, United Kingdom
- Centre for Cancer Biomarkers (CCBIO), University of Bergen, Bergen, Norway
| | - Timothy J. Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Ruth C. Travis
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | | | - Konstantinos K. Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Verena Zuber
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
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3
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Yang S, Song J, Yang H, Liu W, Jiang Y, Sun X, Ye D, Xu S, Mao Y. Genetically Predicted Circulating Concentrations of Alanine and Alanine Aminotransferase Were Associated with Prostate Cancer Risk. Clin Epidemiol 2022; 14:1255-1264. [PMID: 36330075 PMCID: PMC9624164 DOI: 10.2147/clep.s382116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/07/2022] [Indexed: 11/30/2022] Open
Abstract
Object Prostate cancer is one of the leading malignancies in men worldwide. Previous observational studies have linked amino acids and transaminase with altered risk of prostate cancer. However, whether these associations were causal remained unclear. Therefore, we conducted a Mendelian randomization (MR) to assess their potential causal associations. Methods Summary-level data for prostate cancer were obtained from a meta-analysis of genome-wide association studies (GWAS) including 79,148 prostate cancer cases and 61,106 controls of European descent. Instrumental variables (IVs) of amino acids and alanine aminotransferase (ALT) were obtained from a GWAS of 86,507 European individuals and a GWAS of 312,572 participants from the UK Biobank, respectively. MR analyses were performed using inverse-variance-weighted (IVW), likelihood-based, MR Pleiotropy RESidual Sum and Outlier (MR-PRESSO) test and MR-Egger regression. Results Genetically predicted circulating concentrations of alanine were associated with an increased risk of prostate cancer (odds ratio (OR): 1.16, 95% confidence interval (CI): 1.01-1.33, P=0.037 by IVW). Consistently, genetically predicted ALT was inversely associated with the risk of prostate cancer (OR: 0.43, 95% CI: 0.27-0.68, P=3.28×10-4 by IVW). MR-Egger regression did not indicate evidence of directional pleiotropy and sensitivity analyses yielded consistent associations. Conclusion Our study revealed that genetically predicted circulating alanine and ALT levels were associated with an altered risk of prostate cancer, suggesting their potential roles in the development of prostate cancer. Whether targeting alanine, ALT or its downstream effectors are helpful in reducing prostate cancer incidence warrants further investigation.
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Affiliation(s)
- Shaoxue Yang
- The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Hangzhou, 310022, People’s Republic of China
| | - Jie Song
- Department of Epidemiology, Zhejiang Chinese Medical University School of Public Health, Hangzhou, 310053, People’s Republic of China
| | - Hong Yang
- Department of Epidemiology, Zhejiang Chinese Medical University School of Public Health, Hangzhou, 310053, People’s Republic of China
| | - Wei Liu
- Department of Epidemiology, Zhejiang Chinese Medical University School of Public Health, Hangzhou, 310053, People’s Republic of China
| | - Yuqing Jiang
- Department of Epidemiology, Zhejiang Chinese Medical University School of Public Health, Hangzhou, 310053, People’s Republic of China
| | - Xiaohui Sun
- Department of Epidemiology, Zhejiang Chinese Medical University School of Public Health, Hangzhou, 310053, People’s Republic of China
| | - Ding Ye
- Department of Epidemiology, Zhejiang Chinese Medical University School of Public Health, Hangzhou, 310053, People’s Republic of China
| | - Songxiao Xu
- The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Hangzhou, 310022, People’s Republic of China
- Songxiao Xu, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Hangzhou, 310022, People’s Republic of China, Email
| | - Yingying Mao
- Department of Epidemiology, Zhejiang Chinese Medical University School of Public Health, Hangzhou, 310053, People’s Republic of China
- Correspondence: Yingying Mao, Department of Epidemiology, Zhejiang Chinese Medical University School of Public Health, 548 Binwen Road, Hangzhou, 310053, People’s Republic of China, Email
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Nascimento-Gonçalves E, Seixas F, Silva M, Fardilha M, Ferreira R, Neuparth MJ, Faustino-Rocha AI, Colaço B, Venâncio C, Barros L, Ferreira ICFR, Oliveira MM, Peixoto F, Rosa E, Oliveira PA. The influence of Castanea sativa Mill. flower extract on hormonally and chemically induced prostate cancer in a rat model. Food Funct 2021; 12:2631-2643. [PMID: 33645604 DOI: 10.1039/d1fo00029b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Prostate cancer (PCa) is one of the most common cancers in men, with a huge impact on their health. The use of Castanea sativa Mill. flowers (CFs) in beverages has been reported, through ancestral claims, as having health benefits. In vitro research has evidenced the properties of CFs, such as antitumor and antioxidant activities. This study aimed to evaluate the effects of CF extract in an animal model of PCa. Forty male Wistar Unilever rats were randomly assigned to four groups: control, induced, control + CF, and induced + CF groups. Animals from the induced groups were exposed to a multistep protocol for PCa induction. The CF extract, rich in trigalloyl-HHDP-glucoside and obtained via decoction, was administered to the CF groups in drinking water (3 mg per animal per day) for 49 weeks. Animals were sacrificed at 61 weeks of age. Regarding the effects of CFs on dorsolateral prostate tumorigenesis, no significant differences were observed between the induced and induced + CF groups. However, animals exposed to the CF extract showed fewer inflammation areas on the dorsolateral prostate lobe than those not exposed to CF. Moreover, the CF extract alleviated the hepatic oxidative stress associated with the multistep protocol, resulting in lower levels of lipid peroxidation. These results suggest that CF extract has antioxidant and anti-inflammatory properties.
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Affiliation(s)
- E Nascimento-Gonçalves
- Centre for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB), University of Trás-os-Montes and Alto Douro (UTAD), 5000-801 Vila Real, Portugal.
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Zhou J, He Z, Ma S, Liu R. AST/ALT ratio as a significant predictor of the incidence risk of prostate cancer. Cancer Med 2020; 9:5672-5677. [PMID: 32562455 PMCID: PMC7402847 DOI: 10.1002/cam4.3086] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/03/2020] [Accepted: 04/04/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND To investigate the effect of serum aspartate transaminase/alanine transaminase (AST/ALT) on the risk of prostate cancer. METHODS A total of 404 patients undergoing prostate biopsy from April 2016 to July 2019 were enrolled. One hundred and ninety-four patients with prostatic cancer (PCa) were diagnosed by pathology. Two hundred and ten patients were diagnosed with benign prostatic hyperplasia (BPH). Multivariate logistic regression was used to analyze the effect of AST/ALT ratio and other factors on the incidence of PCa. RESULT AST/ALT ratio was significantly higher in PCa than in BPH patients (OR 2.313, 95%CI 1.337-4.003, P = .002). ROC curve indicated that the best cutoff was 1.155 in predicting the incidence risk of PCa. The age of PCa patients is higher than BPH patients (OR 1.054, 95%CI 1.027-1.082, P < .001). We also found that platelets were lower in PCa than in BPH patients. Multivariate analysis showed that AST/ALT ratio could be used as an independent predictor to assess the incident risk of PCa(OR 1.043, 95%CI 1.014-1.072, P = .003). However, AST/ALT ratio did not predict the incidence in high-risk or low-risk PCa. CONCLUSION AST/ALT ratio was an independent factor in predicting the incidence of PCa. When the level of AST/ALT ratio in serum raised, the incidence risk of PCa was significantly increased, which was helpful for the clinical diagnosis of PCa. We still needed a multicenter study to verify the role of AST/ALT ratio in the development of PCa.
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Affiliation(s)
- Jiatong Zhou
- Department of UrologyThe Second Hospital of Tianjin Medical UniversityTianjinChina
| | - Zhaowei He
- Department of UrologyThe Second Hospital of Tianjin Medical UniversityTianjinChina
| | - Shenfei Ma
- Department of UrologyThe Second Hospital of Tianjin Medical UniversityTianjinChina
| | - Ranlu Liu
- Department of UrologyThe Second Hospital of Tianjin Medical UniversityTianjinChina
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6
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Ha H, Chung JW, Ha YS, Choi SH, Lee JN, Kim BS, Kim HT, Kim TH, Yoon GS, Kwon TG, Chung SK, Yoo ES. Clinical significance of the De Ritis ratio for detecting prostate cancer in a repeat prostate biopsy. Investig Clin Urol 2019; 60:447-453. [PMID: 31692969 PMCID: PMC6821984 DOI: 10.4111/icu.2019.60.6.447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 06/30/2019] [Indexed: 01/19/2023] Open
Abstract
Purpose We evaluated factors predicting a positive repeat biopsy result in patients with an initial negative prostate biopsy result. Materials and Methods This study included 124 patients in whom prostate cancer (PCa) was not detected in the initial transrectal ultrasound-guided prostate biopsy and who underwent repeat biopsy from January 2011 to December 2017. Patients without PCa in both initial and repeat prostate biopsies were designated as group 1 (n=82), and those in whom PCa was detected on a repeat prostate biopsy were designated as group 2 (n=42). Among group 2 patients, 6 had insignificant PCa according to the Epstein criteria and were combined with group 1 patients to make up group A (n=88). Patients with significant PCa were categorized as group B (n=36). We compared clinicopathologic characteristics between the groups. Results Multivariate analysis showed that age (p=0.018) and detection of atypical small acinar proliferation (ASAP) or ≥3 cores of high-grade prostatic intraepithelial neoplasia (HGPIN) (p=0.011) on the initial biopsy were predictive factors for a positive result on a repeat biopsy. When we compared group A and group B, age (p=0.004) and the De Ritis ratio (p=0.024) were significantly higher in group B in the multivariate analysis. Conclusions Age and the detection of ASAP or ≥3 cores of HGPIN on the initial biopsy were associated with detection of PCa on a repeat biopsy. Age and the De Ritis ratio were found to be predictive factors for the detection of clinically significant PCa on a repeat biopsy.
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Affiliation(s)
- Heon Ha
- Department of Urology, Kyungpook National University Hospital, Daegu, Korea
| | - Jae-Wook Chung
- Department of Urology, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Yun-Sok Ha
- Department of Urology, Kyungpook National University Hospital, Daegu, Korea.,Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Seock Hwan Choi
- Department of Urology, Kyungpook National University Hospital, Daegu, Korea.,Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jun Nyung Lee
- Department of Urology, Kyungpook National University Chilgok Hospital, Daegu, Korea.,Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Bum Soo Kim
- Department of Urology, Kyungpook National University Hospital, Daegu, Korea.,Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyun Tae Kim
- Department of Urology, Kyungpook National University Chilgok Hospital, Daegu, Korea.,Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Tae-Hwan Kim
- Department of Urology, Kyungpook National University Chilgok Hospital, Daegu, Korea.,Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ghil Suk Yoon
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea.,Department of Pathology, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Tae Gyun Kwon
- Department of Urology, Kyungpook National University Chilgok Hospital, Daegu, Korea.,Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sung Kwang Chung
- Department of Urology, Kyungpook National University Hospital, Daegu, Korea.,Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Eun Sang Yoo
- Department of Urology, Kyungpook National University Hospital, Daegu, Korea.,Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
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7
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Wang A, Lazo M, Carter HB, Groopman JD, Nelson WG, Platz EA. Association between Liver Fibrosis and Serum PSA among U.S. Men: National Health and Nutrition Examination Survey (NHANES), 2001-2010. Cancer Epidemiol Biomarkers Prev 2019; 28:1331-1338. [PMID: 31160348 DOI: 10.1158/1055-9965.epi-19-0145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/09/2019] [Accepted: 05/28/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To evaluate the association of liver fibrosis scores with PSA level among U.S. adult men overall and by race/ethnicity. METHODS Data from the National Health and Nutrition Examination Survey (NHANES), 2001-2010, were used. Males ages ≥40 years without a prostate cancer diagnosis and who had serum PSA, liver enzymes, albumin, and platelet counts measured as part of NHANES protocol were included. Liver fibrosis was measured using three scores: aspartate aminotransferase to platelet ratio index (APRI), fibrosis 4 index (FIB-4), and NAFLD fibrosis score (NFS). We assessed overall and race/ethnicity-stratified geometric mean PSA by fibrosis score using predictive margins by linear regression, and the association of abnormal fibrosis scores (APRI > 1, FIB-4 > 2.67, NFS > 0.676) and elevated PSA (>4 ng/mL) by logistic regression. RESULTS A total of 6,705 men were included. Abnormal liver fibrosis scores were present in 2.1% (APRI), 3.6% (FIB-4), and 5.6% (NFS). Men with higher fibrosis scores had lower geometric mean PSA (all P trend < 0.02). Men with abnormal APRI had a lower odds of PSA > 4 ng/mL [adjusted OR (aOR) = 0.33; 95% confidence interval (CI), 0.11-0.96]. Compared with men with 0 abnormal scores, those with 2 or 3 abnormal fibrosis scores had a lower odds of PSA > 4 ng/mL (aOR = 0.55; 95% CI, 0.33-0.91). The patterns were similar by race/ethnicity. CONCLUSIONS Men of all race/ethnicities with higher liver fibrosis scores had lower serum PSA, and men with advanced fibrosis scores had a lower odds of an elevated PSA. IMPACT These findings support further research to inform the likelihood of delay in prostate cancer detection in men with abnormal liver function.
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Affiliation(s)
- Anqi Wang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. .,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Mariana Lazo
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland
| | - H Ballentine Carter
- Department of Urology and the James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - John D Groopman
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland.,Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - William G Nelson
- Department of Urology and the James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland.,Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Elizabeth A Platz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland.,Department of Urology and the James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
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8
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Affiliation(s)
- Mark S Litwin
- Department of Urology, David Geffen School of Medicine at UCLA, Department of Health Policy & Management, UCLA Fielding School of Public Health and UCLA School of Nursing, Los Angeles, CA, USA.
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9
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Wang H, Fang K, Zhang J, Jiang Y, Wang G, Zhang H, Chen T, Shi X, Li Y, Duan F, Liu J. The significance of De Ritis (aspartate transaminase/alanine transaminase) ratio in predicting pathological outcomes and prognosis in localized prostate cancer patients. Int Urol Nephrol 2017; 49:1391-1398. [PMID: 28550473 DOI: 10.1007/s11255-017-1618-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 05/12/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE To illustrate whether De Ritis (aspartate transaminase-AST/alanine transaminase-ALT) ratio is useful in risk stratification of localized prostate cancer and propose an easy predictive model for biochemical recurrence-free survival (BCRFS). METHODS In total, 438 patients who underwent radical prostatectomy were included in this study. Blood samples including AST and ALT were collected 1-7 days before surgery. An elevated AST and ALT value was defined as over 40 or 56 IU/L. RESULTS The median AST and ALT value was 18.5 (16-22) and 14 (11-18) IU/L. In total, 15 patients (3.4%) and 9 patients (2.1%) exhibited elevated AST value and ALT value. The median De Ritis ratio was 1.33 (1.11-1.60), and ROC curve indicated the best cutoff of 1.325 in predicting the occurrence of biochemical recurrence. Higher De Ritis ratio was found to be related to older age (p < 0.001), higher tumor stages (p < 0.001) and Gleason Score (p < 0.001), presence of seminal invasion (p < 0.001), positive surgical margin (p < 0.001) and lymph node metastasis (p = 0.003). Multivariate logistic regression confirmed that De Ritis ratio was an independent predictor for final Gleason Score (p < 0.001), and multivariate Cox regression demonstrated De Ritis ratio as an independent risk factor for BCRFS. A simple predictive model which incorporated De Ritis ratio, pathological tumor stage and final Gleason Score could help risk stratification for BCRFS. CONCLUSION Higher De Ritis ratio could be predictive for worse pathological outcomes and higher BCR in localized prostate cancer patients. A predictive model which incorporates De Ritis ratio, Gleason Score and pathological tumor stage could help risk stratification for BCRFS.
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Affiliation(s)
- Huitao Wang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, No. 374, Dianmian Dadao Road, Kunming, 650101, Yunnan, People's Republic of China
| | - Kewei Fang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, No. 374, Dianmian Dadao Road, Kunming, 650101, Yunnan, People's Republic of China
| | - Jinsong Zhang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, No. 374, Dianmian Dadao Road, Kunming, 650101, Yunnan, People's Republic of China
| | - Yongming Jiang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, No. 374, Dianmian Dadao Road, Kunming, 650101, Yunnan, People's Republic of China
| | - Guang Wang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, No. 374, Dianmian Dadao Road, Kunming, 650101, Yunnan, People's Republic of China
| | - Haiyan Zhang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, No. 374, Dianmian Dadao Road, Kunming, 650101, Yunnan, People's Republic of China
| | - Tao Chen
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, No. 374, Dianmian Dadao Road, Kunming, 650101, Yunnan, People's Republic of China
| | - Xin Shi
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, No. 374, Dianmian Dadao Road, Kunming, 650101, Yunnan, People's Republic of China
| | - Yuhang Li
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, No. 374, Dianmian Dadao Road, Kunming, 650101, Yunnan, People's Republic of China
| | - Fei Duan
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, No. 374, Dianmian Dadao Road, Kunming, 650101, Yunnan, People's Republic of China
| | - Jianhe Liu
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, No. 374, Dianmian Dadao Road, Kunming, 650101, Yunnan, People's Republic of China.
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Long-term allopurinol use decreases the risk of prostate cancer in patients with gout: a population-based study. Prostate Cancer Prostatic Dis 2017; 20:328-333. [PMID: 28398294 DOI: 10.1038/pcan.2017.14] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 02/10/2017] [Accepted: 03/04/2017] [Indexed: 01/29/2023]
Abstract
BACKGROUND Clinical observations indicated an increased risk of developing prostate cancer in gout patients. Chronic inflammation is postulated to be one crucial mechanism for prostate carcinogenesis. Allopurinol, a widely used antigout agent, possesses potent anti-inflammation capacity. We elucidated whether allopurinol decreases the risk of prostate cancer in gout patients. METHODS We analyzed data retrieved from Taiwan National Health Insurance Database between January 2000 and December 2012. Patients diagnosed with gout during the study period with no history of prostate cancer and who had never used allopurinol were selected. Four allopurinol use cohorts (that is, allopurinol use (>365 days), allopurinol use (181-365 days), allopurinol use (91-180 days) and allopurinol use (31-90 days)) and one cohort without using allopurinol (that is, allopurinol use (No)) were included. The study end point was the diagnosis of new-onset prostate cancer. Multivariable Cox proportional hazards regression and propensity score-adjusted Cox regression models were used to estimate the association between the risk of prostate cancer and allopurinol treatment in gout patients after adjusting for potential confounders. RESULTS A total of 25 770 gout patients (aged between 40 and 100 years) were included. Multivariable Cox regression analyses revealed that the risk of developing prostate cancer in the allopurinol use (>365 days) cohort was significantly lower than the allopurinol use (No) cohort (adjusted hazard ratio (HR)=0.64, 95% confidence interval (CI)=0.45-0.9, P=0.011). After propensity score adjustment, the trend remained the same (adjusted HR=0.66, 95% CI=0.46-0.93, P=0.019). CONCLUSIONS Long-term (more than 1 year) allopurinol use may associate with a decreased risk of prostate cancer in gout patients.
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Urologische Aspekte bei Patienten mit Leberzirrhose. Urologe A 2016; 55:63-7. [DOI: 10.1007/s00120-015-3978-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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12
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Moreira DM, Bañez LL, Presti JC, Aronson WJ, Terris MK, Kane CJ, Amling CL, Freedland SJ. High serum folate is associated with reduced biochemical recurrence after radical prostatectomy: results from the SEARCH Database. Int Braz J Urol 2014; 39:312-8; discussion 319. [PMID: 23849564 DOI: 10.1590/s1677-5538.ibju.2013.03.03] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 04/02/2013] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION To analyze the association between serum levels of folate and risk of biochemical recurrence after radical prostatectomy among men from the Shared Equal Access Regional Cancer Hospital (SEARCH) database. MATERIALS AND METHODS Retrospective analysis of 135 subjects from the SEARCH database treated between 1991-2009 with available preoperative serum folate levels. Patients' characteristics at the time of the surgery were analyzed with ranksum and linear regression. Uni- and multivariable analyses of folate levels (log-transformed) and time to biochemical recurrence were performed with Cox proportional hazards. RESULTS The median preoperative folate level was 11.6 ng/mL (reference = 1.5-20.0 ng/mL). Folate levels were significantly lower among African-American men than Caucasians (P = 0.003). In univariable analysis, higher folate levels were associated with more recent year of surgery (P < 0.001) and lower preoperative PSA (P = 0.003). In univariable analysis, there was a trend towards lower risk of biochemical recurrence among men with high folate levels (HR = 0.61, 95 %CI = 0.37-1.03, P = 0.064). After adjustments for patients characteristics' and pre- and post-operative clinical and pathological findings, higher serum levels of folate were independently associated with lower risk for biochemical recurrence (HR = 0.42, 95 %CI = 0.20-0.89, P = 0.023). CONCLUSION In a cohort of men undergoing radical prostatectomy at several VAs across the country, higher serum folate levels were associated with lower PSA and lower risk for biochemical failure. While the source of the folate in the serum in this study is unknown (i.e. diet vs. supplement), these findings, if confirmed, suggest a potential role of folic acid supplementation or increased consumption of folate rich foods to reduce the risk of recurrence.
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Affiliation(s)
- Daniel M Moreira
- Division of Urologic Surgery, Department of Surgery, Duke Prostate Center, Duke University School of Medicine, Durham, NC 27710, USA.
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Teeter AE, Presti JC, Aronson WJ, Terris MK, Kane CJ, Amling CL, Freedland SJ. Do nomograms designed to predict biochemical recurrence (BCR) do a better job of predicting more clinically relevant prostate cancer outcomes than BCR? A report from the SEARCH database group. Urology 2013; 82:53-8. [PMID: 23806388 DOI: 10.1016/j.urology.2012.10.090] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 10/11/2012] [Accepted: 10/15/2012] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To examine the ability of various postoperative nomograms to predict prostate cancer-specific mortality (PCSM) and to validate that they could predict aggressive biochemical recurrence (BCR). Prostate-specific antigen (PSA), grade, and stage are the classic triad used to predict BCR after radical prostatectomy (RP). Multiple nomograms use these to predict risk of BCR. A previous study showed that several nomograms could predict aggressive BCR (prostate-specific antigen doubling time [PSADT] <9 months) more accurately than BCR. However, it remains unknown if they can predict more definitive endpoints, such as PCSM. METHODS We performed Cox analyses to examine the ability of 4 postoperative nomograms, the Duke Prostate Center (DPC) nomogram, the Kattan postoperative nomogram, the Johns Hopkins Hospital (JHH) nomogram, and the joint Center for Prostate Disease Research(CPDR)/Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) nomogram to predict BCR and PCSM among 1778 men in the Shared Equal Access Regional Cancer Hospital (SEARCH) database who underwent RP between 1990 and 2009. We also compared their ability to predict BCR and aggressive BCR in a subset of men. We calculated the c-index for each nomogram to determine its predictive accuracy for estimating actual outcomes. RESULTS We found that each nomogram could predict aggressive BCR and PCSM in a statistically significant manner and that they all predicted PCSM more accurately than they predicted BCR (ie, with higher c-index values). CONCLUSION Currently available nomograms used to predict BCR accurately predict PCSM and other more clinically relevant endpoints. Moreover, not only do they significantly predict PCSM, but do so with generally greater accuracy than BCR.
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Affiliation(s)
- Anna E Teeter
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
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Wu C, Aronson WJ, Terris MK, Presti JC, Kane CJ, Amling CL, Freedland SJ. Diabetes predicts metastasis after radical prostatectomy in obese men: results from the SEARCH database. BJU Int 2013; 111:E310-8. [PMID: 23305170 DOI: 10.1111/j.1464-410x.2012.11687.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To examine the association between diabetes and metastasis risk after radical prostatectomy (RP) and to determine if race or obesity modifies this relationship. PATIENTS AND METHODS Patients comprised 2058 US veterans with prostate cancer (PCa) enrolled in the Shared Equal-Access Regional Cancer Hospital (SEARCH) database and treated with RP between 1988 and 2010. The association of diabetes with metastasis risk or secondary treatment rates was examined using Cox proportional hazards, adjusting for preoperative and, separately, clinical and postoperative findings. The effect modification by race (black vs white) and obesity (body mass index [BMI] ≥30 vs <30 kg/m(2) ) was tested via interaction terms. RESULTS Men with diabetes had higher BMIs and were more likely to be non-white (all P ≤ 0.001). On multivariable analysis, diabetes was not associated with metastasis risk (P ≥ 0.45), but, among men with diabetes, longer diabetes duration was associated with higher metastasis risk (P ≤ 0.035). When stratified by obesity, diabetes was linked with higher metastasis risk in obese but not in non-obese men (P-interaction ≤ 0.037), but there was no significant interaction with race (P-interaction ≥ 0.56). Diabetes also predicted more aggressive secondary treatment among obese men but less aggressive treatment among non-obese men (hazard ratio 1.39 vs 0.63, P-interaction = 0.006). Where applicable, results were similar for both pre- and postoperative models. CONCLUSIONS Diabetes was not associated with metastasis risk overall. Stratification by obesity yielded significant differences, with diabetes linked to a fourfold higher metastasis risk in obese men, despite predicting more aggressive secondary treatment. Longer diabetes duration was also associated with increased metastasis risk.
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Affiliation(s)
- Chenwei Wu
- Duke University School of Medicine, Durham, NC, USA
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Keto CJ, Aronson WJ, Terris MK, Presti JC, Kane CJ, Amling CL, Freedland SJ. Detectable prostate-specific antigen Nadir during androgen-deprivation therapy predicts adverse prostate cancer-specific outcomes: results from the SEARCH database. Eur Urol 2012; 65:620-7. [PMID: 23245686 DOI: 10.1016/j.eururo.2012.11.052] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 11/27/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND A prostate-specific antigen (PSA) level <0.2 ng/ml 8 mo after starting on androgen-deprivation therapy (ADT) is correlated with better outcomes. However, not all men reach a nadir PSA level within 8 mo. Whether the lowest PSA on ADT-specifically, <0.2 ng/ml-can be used for risk stratification is untested. OBJECTIVE We examined the predictive value of small but detectable PSA nadir values on prostate cancer (PCa)-specific outcomes in men treated with early ADT after radical prostatectomy (RP). DESIGN, SETTING, AND PARTICIPANTS We performed a retrospective review of men treated with ADT after RP before metastases from the SEARCH database. We identified 402 men treated with ADT for elevated PSA following RP, of whom 294 men had complete data. Median follow-up after PSA nadir was 49 mo. All men had a PSA nadir <4 ng/ml; 223 men (76%) had an undetectable nadir. INTERVENTION ADT for an elevated PSA following RP with no radiographic evidence of metastatic disease. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS PSA nadir on ADT was defined as the lowest PSA value during ADT. Proportional hazards models and the C index were used to test the association and predictive accuracy, respectively, between PSA nadir and PCa-specific outcomes. RESULTS AND LIMITATIONS Men with a PSA nadir between 0.01 and 0.2 ng/ml had a greater risk of progression to castration-resistant PCa (CRPC) (hazard ratio [HR]: 5.14; p<0.001), metastases (HR: 3.98; p=0.006), and PCa-specific mortality (PCSM) (HR: 5.33; p=0.003) than men with an undetectable nadir. When data were restricted to men followed with ultrasensitive PSA values (sensitivity of 0.01 ng/ml), the C index of PSA nadir alone for predicting CRPC, metastases, and PCSM was 0.88, 0.91, and 0.96, respectively. CONCLUSIONS A PSA nadir on ADT, even at a very low level, strongly predicts progression to CRPC, metastases, and PCSM. Men with a detectable PSA nadir during ADT should be considered for clinical trials.
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Affiliation(s)
- Christopher J Keto
- Duke University School of Medicine, Durham, NC, USA; Veterans Affairs Medical Center, Durham, NC, USA
| | - William J Aronson
- University of California at Los Angeles Medical Center, Los Angeles, CA, USA; Veterans Affairs Medical Center, Greater Los Angeles, Los Angeles, CA, USA
| | - Martha K Terris
- Medical College of Georgia, Augusta, GA, USA; Veterans Affairs Medical Center, Augusta, GA, USA
| | - Joseph C Presti
- Stanford University Medical Center, Palo Alto, CA, USA; Veterans Affairs Medical Center, Palo Alto, CA, USA
| | | | | | - Stephen J Freedland
- Duke University School of Medicine, Durham, NC, USA; Veterans Affairs Medical Center, Durham, NC, USA.
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Are repeat prostate biopsies safe? A cohort analysis from the SEARCH database. J Urol 2012; 187:2056-60. [PMID: 22498218 DOI: 10.1016/j.juro.2012.01.083] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Indexed: 11/23/2022]
Abstract
PURPOSE Patients question whether multiple biopsy sessions cause worse prostate cancer outcomes. Therefore, we investigated whether there is an association between the number of prior biopsy sessions and biochemical recurrence after radical prostatectomy. MATERIALS AND METHODS Men in the SEARCH (Shared Equal Access Regional Cancer Hospital) database who underwent radical prostatectomy between 1988 and 2010 after a known number of prior biopsies were included in the analysis. Number of biopsy sessions (range 1 to 8) was examined as a continuous and categorical (1, 2 and 3 to 8) variable. Biochemical recurrence was defined as a prostate specific antigen greater than 0.2 ng/ml, 2 values at 0.2 ng/ml or secondary treatment for an increased prostate specific antigen. The association between number of prior biopsy sessions and biochemical recurrence was analyzed using the Cox proportional hazards model. Kaplan-Meier estimates of freedom from biochemical recurrence were compared among the groups. RESULTS Of the 2,739 men in the SEARCH database who met the inclusion criteria 2,251 (82%) had only 1 biopsy, 365(13%) had 2 biopsies and 123 (5%) had 3 or more biopsies. More biopsy sessions were associated with higher prostate specific antigen (p<0.001), greater prostate weight (p<0.001), lower biopsy Gleason sum (p=0.01) and more organ confined (pT2) disease (p=0.017). The Cox proportional hazards model demonstrated no association between number of biopsy sessions as a continuous or categorical variable and biochemical recurrence. Kaplan-Meier estimates of freedom from biochemical recurrence were similar across biopsy groups (log rank p=0.211). CONCLUSIONS Multiple biopsy sessions are not associated with an increased risk of biochemical recurrence in men undergoing radical prostatectomy. Multiple biopsy sessions appear to select for a low risk cohort.
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Muller RL, Presti JC, Aronson WJ, Terris MK, Kane CJ, Amling CL, Freedland SJ. Does salvage radiation therapy change the biology of recurrent prostate cancer based on PSA doubling times? Results from the SEARCH database. Urology 2012; 79:1105-10. [PMID: 22446345 DOI: 10.1016/j.urology.2012.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 01/13/2012] [Accepted: 01/20/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To investigate whether salvage radiation therapy (SRT) may promote prostate cancer (PCa) transformation to more aggressive phenotypes. To accomplish that, we identified men who underwent SRT after radical prostatectomy for PCa and failed SRT. PSA doubling time (PSADT) was used as a surrogate endpoint for cancer aggressiveness. We compared PSADT calculated before start of SRT and after SRT failure. METHODS Of 287 men in the SEARCH database since 1988 who underwent SRT, we detected 78 with SRT failure defined as PSA ≥ 0.2 ng/mL above the post-SRT nadir. Of these, 39 had PSADT available before and after SRT, which was compared using Wilcoxon's paired test with men serving as their own controls. We tested predictors of PSADT change using multivariable logistic regression. RESULTS There were no differences in PSADT before and after SRT (10.2 vs 12.6 months; P = .46). However, in some individual cases, large changes were observed. Only seminal vesicle invasion showed a trend towards an association with a shorter post-SRT PSADT relative to the pre-SRT PSADT (P = .13). CONCLUSION Overall, the PSADT after and before SRT were statistically identical, suggesting that after SRT failure, PCa does not emerge with more aggressive biological features. Further studies are needed to identify predictors and the clinical relevance of individual PSADT changes noted in our study.
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Affiliation(s)
- Roberto L Muller
- Division of Urologic Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC 27710, USA.
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Keto CJ, Aronson WJ, Terris MK, Presti JC, Kane CJ, Amling CL, Freedland SJ. Obesity is associated with castration-resistant disease and metastasis in men treated with androgen deprivation therapy after radical prostatectomy: results from the SEARCH database. BJU Int 2011; 110:492-8. [PMID: 22094083 DOI: 10.1111/j.1464-410x.2011.10754.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
UNLABELLED Study Type - Prognosis (cohort series). Level of Evidence 2a. What's known on the subject? and What does the study add? The incidence and prevalence of obesity in the USA and Europe is increasing. Higher body mass index is associated with a lower risk of overall prostate cancer diagnosis but also with an increased risk of high grade prostate cancer. Obese men undergoing primary therapy with radical prostatectomy or external beam radiation are more likely to experience a biochemical recurrence after treatment compared with normal weight men. Finally, obesity is associated with increased prostate-cancer-specific mortality. We hypothesized that obese men on androgen deprivation therapy may be at increased risk for prostate cancer progression. Previous studies have shown that obese men have lower levels of testosterone compared with normal weight men. Additionally, one previous study found that obese men have higher levels of testosterone on androgen deprivation therapy. Men with higher levels of testosterone on androgen deprivation therapy are at increased risk of prostate cancer progression. We found that men with higher body mass index were at increased risk of progression to castration-resistant prostate cancer, development of metastases and prostate-cancer-specific mortality. When we adjusted for various clinicopathological characteristics, obese men were at increased risk of progression to castration-resistant prostate cancer and development of metastases. The results of our study help generate hypotheses for further study regarding the mechanisms between obesity and aggressive prostate cancer. OBJECTIVE • To investigate whether obesity predicts poor outcomes in men starting androgen deprivation therapy (ADT) before metastasis, since previous studies found worse outcomes after surgery and radiation for obese men. METHODS • A retrospective review was carried out of 287 men in the SEARCH database treated with radical prostatectomy between 1988 and 2009. • Body mass index (BMI) was categorized to <25, 25-29.9 and ≥ 30 kg/m2. • Proportional hazards models were used to test the association between BMI and time to castration-resistant prostate cancer (PC), metastases and PC-specific mortality adjusting for demographic and clinicopathological data. RESULTS • During a median 73-month follow-up after radical prostatectomy, 403 men (14%) received early ADT. • Among 287 men with complete data, median BMI was 28.3 kg/m2. • Median follow-up from the start of ADT was 52 months during which 44 men developed castration-resistant PC, 34 developed metastases and 24 died from PC. • In multivariate analysis, higher BMI was associated with a trend for greater risk of progression to castration-resistant PC (P= 0.063), a more than threefold increased risk of developing metastases (P= 0.027) and a trend toward worse PC-specific mortality (P= 0.119). • Prognostic biomarkers did not differ between BMI groups. CONCLUSIONS • Among men treated with early ADT, our results suggest that obese men may have increased risk of PC progression. • These data support the general hypothesis that obesity is associated with aggressive PC, although validation of these findings and further study of the mechanisms linking obesity and poor PC outcomes are required.
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Affiliation(s)
- Christopher J Keto
- Duke University School of Medicine and Veterans Affairs Medical Center, Durham, NC 27710, USA
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Whitley BM, Moreira DM, Thomas JA, Aronson WJ, Terris MK, Presti JC, Kane CJ, Amling CL, Freedland SJ. Preoperative weight change and risk of adverse outcome following radical prostatectomy: results from the Shared Equal Access Regional Cancer Hospital database. Prostate Cancer Prostatic Dis 2011; 14:361-6. [PMID: 21894174 DOI: 10.1038/pcan.2011.42] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND We examined the relationship between weight change in the year before radical prostatectomy (RP) and biochemical recurrence (BCR) and adverse pathology. METHODS We abstracted data from 359 men undergoing RP in the SEARCH (Shared Equal Access Regional Cancer Hospital) database between 2001-2007. Logistic regression and Cox proportional hazards models were used to test the association between weight change in the year before surgery and adverse pathology and BCR, respectively. RESULTS In all, 152 (42%) men gained weight, 193 (54%) lost weight and 14 (4%) had the same weight. Among weight gainers, median gain was 2.4 kg and among weight losers, median loss was 2.7 kg. As a continuous variable, weight change was not associated with adverse pathology or BCR (all P>0.05). In secondary analysis, on multivariate analysis, men gaining ≥ 2.5 kg were at higher BCR risk (hazards ratio=1.65, 95% confidence interval (CI): 1.03-2.64, P=0.04) while weight loss ≥ 2.5 kg was not associated with BCR (hazards ratio=0.83, 95% CI: 0.54-1.29, P=0.41). CONCLUSIONS As a continuous variable, weight change was not associated with outcome. In secondary hypothesis-generating analyses, weight gain ≥ 2.5 kg in the year before surgery, regardless of final body mass index, was associated with increased BCR following RP. If validated, these data suggest weight gain ≥ 2.5 kg may promote prostate cancer progression.
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Affiliation(s)
- B M Whitley
- Duke Prostate Center, Division of Urologic Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC 27710, USA
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