Prostate cancer (PCa) incidence and severity in 821 hypogonadal men with and without testosterone therapy (TTh) in a controlled, observational registry implying more than 7,000 patient-years.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 304-304
Author(s):  
Ahmad Haider ◽  
Karim Sultan Haider

304 Background: Guidelines by AUA and EAU state that there is no evidence for an increased PCa risk for testosterone (T) treatment in hypogonadal men. Methods: In a registry study initiated in 2004 in a urology practice, 428 hypogonadal men (T≤350 ng/dL) received T undecanoate 1000 mg every 3 months following an initial 6-month interval for up to 13 years (T-group). 393 hypogonadal men (age range 51-74) opted against TTh (CTRL). Suspicion of or active PCa was excluded by transrectal ultrasound, digital rectal examination and PSA before treatment/observation initiation. Examinations were repeated between one and four times per year. Biopsies were performed when indicated according to EAU Guidelines. Results: In the T-group, 12 (2.8%) , in CTRL, 42 men (10.9%) were diagnosed with PCa. The mean baseline age of PCa patients was 64.9 years in the T-group and 64 in CTRL.In the T-group, the average time span between day of first injection and positive biopsy was 14.2 months (range: 5-18). No patient was diagnosed with PCa beyond 18 months of TTh. In CTRL, PCa was diagnosed at any time during the observation time. In the T-group, radical prostatectomy (RP) was performed in all men. All but 3 patients had Gleason score (GS) ≤6, and all but 1 had a primary GS of 3. Tumor grade was G2 in all 12 (100%), tumor stage T2a in 7 (58%), T2b in 3 (25%), and T2c in 2 (17%) patients. All but 2 patients are back on TTh after an average time of 25 months. In CTRL, RP was performed in all but 6 patients who received radiation therapy (RT). GS was ≤6 in 2 patients, 7 men had a GS of 7, 21 a GS of 8, and 12 a GS of 9. 4 men had a primary Gleason score of 3, 29 had 4, and 9 had 5. Tumor grade was G2 in 9 (21%) and G3 in 33 (79%) patients, tumor stage T2a in 2 (5%), T2c in 1 (2%), T3b in 15 (36%) and T3c in 24 (57%) patients. In CTRL, biochemical recurrence occurred in 11 (26%) patients. These patients received androgen deprivation therapy (ADT). 12 (34%) patients died of whom 7 were on ADT. In the T-group, no biochemical recurrences or deaths occurred during the observation time. Conclusions: Less PCa occurred and severity was lower in testosterone-treated hypogonadal patients compared to untreated hypogonadal controls.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 167-167
Author(s):  
Ahmad Haider ◽  
Karim Sultan Haider

167 Background: There is no evidence that TTh in hypogonadal men increases PCa incidence or severity. A US-Scandinavian group recently found that men receiving TTh had lower risk of aggressive PCa (Loeb S et al., J Clin Oncol 2017; 35:1430-6). Methods: 412 men with testosterone ≤350 ng/dL and symptoms received testosterone undecanoate 1000 mg every 3 months for up to 12 years. 380 hypogonadal men (57-74) opted against TTh. Median follow-up: 9 years. Total observation time covered approximately 6,400 patient-years. Prostate volume (PV) and PSA were measured and digital rectal examination/transrectal ultrasound performed before treatment/observation initiation and then every 3-6 months (T-group) or once or twice per year (CTRL). Biopsies were performed when indicated according to EAU guidelines. Results: In the T-group, 11 men (2.7%) were diagnosed with PCa. In CTRL, 34 (8.9%) were diagnosed with PCa. The incidence per 10,000 years was 33 in the T-group and 108 in CTRL. The mean baseline age of PCa patients was 65.2 years in the T-group and 64.3 in CTRL. All PCa diagnoses in the T-group were made within the first 18 months of treatment initiation. In CTRL, PCa was diagnosed at any time during the observation time. In the T-group, radical prostatectomy was performed in all men. All but 1 patient had a Gleason score (GS) ≤6, and all but 1 a predominant GS of 3. Tumor grade was G2 in all 11 (100%), tumor stage T2a in 7 (64%), T2b in 3 (27%), and T2c in 1 (9%) patient(s). In CTRL, radical prostatectomy was performed in all but 6 patients. GS was > 6 in all 34 patients. 7 men had a GS of 7, 17 a GS of 8, and 10 a GS of 9. 2 men had a predominant Gleason score of 3, 22 had 4, and 10 had 5. Tumor grade was G2 in 6 (17.6%) and G3 in 28 (82.4%) patients, tumor stage T2c in 1 (0.3%), T3a in 3 (8.8%), T3b in 13 (38.2%) and T3c in 17 (50%) patients. In CTRL, biochemical recurrence occurred in 8 (23.5%) patients. These patients received androgen deprivation therapy (ADT). 10 (29.4%) patients died of whom 5 were on ADT. In the T-group, there were no biochemical recurrences or deaths during the observation time. Conclusions: In hypogonadal men, TTh may decrease PCa incidence compared to CTRL. PCa was less severe in the T-group.


2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 5085-5085
Author(s):  
Ahmad Haider ◽  
Karim Sultan Haider

5085 Background: There is no evidence that TTh in men with hypogonadism increases PCa incidence or severity. A Canadian group recently found that long-term TTh decreased the risk of PCa diagnosis (Wallis et al., Lancet Diab Endocrinol 2016; 4:498). We assessed incidence and severity of PCa in hypogonadal men on long-term TTh (T-group) in comparison to an untreated hypogonadal control group (CTRL). Methods: 400 men with testosterone ≤350 ng/dL and symptoms received testosterone undecanoate 1000 mg every 3 months for up to 10 years. 296 hypogonadal men (57-74) opted against TTh. Median follow-up: 8 years. Total observation time covered more than 5,000 patient-years. Prostate volume (PV), PSA, weight and C-reactive protein (CRP) were measured and digital rectal examination/transrectal ultrasound performed before treatment initiation and then every 6-12 months. Biopsies were performed when indicated according to EAU guidelines. Results: In the T-group, PV increased slightly but significantly by 2.41 mL (p < 0.0001), PSA by 0.22 (NS). In CTRL, PV decreased slightly but significantly by -1.20 mL (p < 0.005), PSA by -0.38 (p < 0.0001). Weight dropped by 18.23% in the T-group and increased by 1.78% in CTRL, CRP decreased significantly in the T-group and remained unchanged in CTRL. In the T-group, 9 men (2.3%) were diagnosed with PCa. In CTRL, 15 (5.1%) were diagnosed with PCa. The incidence per 10,000 years was 29 in the T-group and 102 in CTRL. The mean baseline age of PCa patients was 65 years in the T-group and 65.5 in CTRL. Prostatectomy was performed in all men. In the T-group, all but 1 patient had a Gleason score ≤6, and all a predominant Gleason score of 3. Tumor grade was G2 in all 9 (100%), tumor stage T2a in 7 (78%) and T2b in 2 (22%) patients. In CTRL, Gleason score was > 6 in all 15 patients. 4 men had a predominant Gleason score of 3, 10 had 4, and 1 had 5. Tumor grade was G2 in 7 (46.7%) and G3 in 8 (53.3%) patients, tumor stage T2b in 1 (6.7%), T2c in 1 (6.7%), T3a in 1 (6.7%), T3b in 7 (46.7%) and T3c in 6 (50%) patients. Conclusions: In hypogonadal men, TTh may decrease PCa incidence compared to CTRL. PCa was less severe in the T-group. Weight loss and reduced inflammation by TTh may have contributed to our findings.


2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 33-33
Author(s):  
Ahmad Haider ◽  
Karim Sultan Haider

33 Background: Despite persisting concerns, there is no evidence that TTh in men with hypogonadism increases PCa incidence or severity. Rather, a Canadian group recently found that long-term TTh decreased the risk of PCa diagnosis (Wallis et al., Lancet Diab Endocrinol 2016; 4:498). We assessed incidence and severity of PCa in hypogonadal men on long-term TTh (T-group) in comparison to an untreated hypogonadal control group (CTRL). Methods: 375 men (age range: 33-70) with testosterone ≤ 350 ng/dL and symptoms received testosterone undecanoate 1000 mg every 3 months for up to 10 years. 296 hypogonadal men (57-74) opted against TTh. Median follow-up: 7 years. Prostate volume (PV), PSA, weight and C-reactive protein (CRP) were measured and digital rectal examination/transrectal ultrasound performed before treatment initiation and then regularly every 3-6 months. Biopsies were performed when indicated according to EAU guidelines. Results: In the T-group, PV increased slightly but significantly by 2.41 mL (p < 0.0001), PSA by 0.22 (NS). In CTRL, PV decreased slightly but significantly by -1.20 mL (p < 0.005), PSA by -0.38 (p < 0.0001). Weight dropped by 18.23% in the T-group and increased by 1.78% in CTRL, CRP decreased significantly in the T-group and remained unchanged in CTRL. In the T-group, 8 men (2.1%) were diagnosed with PCa. In CTRL, 12 (4.1%) were diagnosed with PCa. The incidence per 10,000 years was 32 in the T-group and 64 in CTRL. The mean baseline age of PCa patients was 65 years in both groups. Prostatectomy was performed in all men. In the T-group, all patients had a Gleason score ≤ 6 and a predominant Gleason score of 3. Tumor grade was G2 in all 8 (100%), tumor stage T2a in 6 (75%) and T2b in 2 (25%) patients. In CTRL, Gleason score was > 6 in all 12 patients. Three men had a predominant Gleason score of 3, 8 had 4, and 1 had 5. Tumor grade was G2 in 5 (41.7%) and G3 in 7 (58.3%) patients, tumor stage T2b in 1 (8.3%), T2c in 1 (8.3%), T3b in 4 (33.3%) and T3c in 6 (50%) patients. Conclusions: TTh in hypogonadal men regularly monitored may decrease incidence of PCa compared to hypogonadal CTRL. PCa was less severe in the T-group. Weight loss and reduced inflammation by TTh may have contributed to our findings.


2020 ◽  
pp. 205141582097042
Author(s):  
Pooja Suteri ◽  
Arvind Ahuja ◽  
Achin K Sen ◽  
Hemant Goel ◽  
Minakshi Bhardwaj ◽  
...  

Objectives: This study aimed to assess the incidence and discern the histomorphological spectrum of granulomatous prostatitis. Methods: A retrospective analysis of histopathological records of 1773 prostatic specimens received in the pathology department was done over a period of seven years. All histologically proven cases of granulomatous prostatitis were retrieved, the relevant clinical data were collected from patient records and the lesions were categorized accordingly. Results: Out of 1773 cases, 27 cases of granulomatous prostatitis were identified. The age range of these patients was between 50 and 89 years. Among the patients, non-specific granulomatous prostatitis (NSGP) was the most common followed by tubercular prostatitis, post-surgical prostatitis and xanthogranulomatous prostatitis. Three cases of post-surgical prostatitis were associated with malignancy. Serum prostate-specific antigen (PSA) levels ranged between 0.8 and 20.94 ng/mL (median 10.78 ng/mL). The diagnosis was made by histopathological examination of transrectal ultrasound (TRUS)-guided core biopsies, Trucut biopsies, transuretheral resection of prostate chips, prostatectomy and cystoprostatectomy specimens. Conclusion: In the present study, the incidence of granulomatous prostatitis was 1.5%. The patients usually present as hard nodules on digital rectal examination along with raised serum PSA levels. Carcinoma or benign prostatic hyperplasia was kept as a clinical diagnosis in these cases. Since the diagnosis of granulomatous prostatitis is made on histopathological examination only, meticulous histomorphological assessment is therefore required to reach a definitive diagnosis of granulomatous prostatitis.


2009 ◽  
Vol 56 (2) ◽  
pp. 17-21 ◽  
Author(s):  
T. Pejcic ◽  
J. Hadzi-Djokic ◽  
B. Markovic ◽  
D. Dragicevic ◽  
B. Glisic ◽  
...  

Objectives: To estimate the ratio between urinary prostate specific antigen (uPSA) and tumor volume after prostate biopsy. Methods: From 2000 to July 2008, uPSA concentration was determined in 60 patients with clinically organ-confined prostate cancer (PCa). All patients underwent six-area transrectal ultrasound (TRUS) - guided biopsy, with at least 12 biopsy cores. Single pathologist determined tumor grade (G), Gleason score (GS), the percentage of tumor infiltration (% TI) and the percentage of positive cores (% PC) in all biopsy cores. Additionally, relative tumor-biopsy volume (RTV) was calculated by multiplying % PC, % TI and prostate ultrasound- derived volume (Vol). Forty-one patients underwent retropubic radical prostatectomy (RRP), while 19 patients underwent radiation therapy. Results: Average uPSA was 308.6+311.9 ng/ml (range 0.06-988 ng/ml), average PSA was 9.7+ 5.5 ng/ml (range 1.2-24.3 ng/ml), tumor grade 1.7+ 0.8, Gleason score 5.2 + 1.3, the percentage of tumor infiltration 27.6+21.8 %, and the percentage of positive cores, 52.2+30.7 %. Average RTV was 6.3+ 8.4 ml (0.29-56 ml). All patients were divided in two groups: I, with RTV 4 ml and II, with RTV = 4 ml. The patients with RTV 4 ml had lower G (1.4 0.6 vs. 2.1+0.8, p=0.0002), lower GS (4.5+1 vs. 5.8+1.3, p=0.003) and higher uPSA (389.4+340.8 vs. 193.1 +229.7, p=0.014). There were no differences in serum PSA levels between the groups. Conclusion: Relative tumor-biopsy volume (RTV) is useful parameter in the preoperative assessment of tumor volume. Patients with higher RTV had significantly higher G and GS. However, these patients had significantly lower uPSA. This phenomenon could be the consequence of compromised PSA drainage from the peripheral zone of the prostate, caused by the tumor.


2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 8-8 ◽  
Author(s):  
G. L. Lu-Yao ◽  
D. Moore ◽  
W. Shih ◽  
Y. Lin ◽  
H. Li ◽  
...  

8 Background: To provide patients and clinicians more accurate estimates of co-morbidity specific survival stratified by patient age, tumor stage and tumor grade. Methods: We conducted a ten year competing risk analysis of 19,639 men age 66 years and older identified by the Surveillance, Epidemiology and End Results (SEER) program linked to Medicare program files. All men were diagnosed with localized prostate cancer and received no surgery or radiation within 180 days of diagnosis. The analysis was stratified by tumor grade and stage and by age and co-morbidity at diagnosis classified using the Charlson co-morbidity index. Underlying causes of death were obtained from SEER. Results: During the first ten years following diagnosis men with moderately and poorly differentiated prostate cancer were more likely to die from causes other than their disease. For men age 66-74 years with stage T1c Gleason score 5-7 disease at diagnosis, ten year overall mortality rates and prostate cancer specific rates were 28.8%, 50.5%, 83.1% and 4.8%, 2.0%, 5.3% respectively for men with Charlson scores 0, 1 and > 2. For men age 66-74 years with T1c Gleason score 8-10 disease at diagnosis, the corresponding rates were 55.0%, 52.0%, 64.3% and 25.7%, 20.2%, 13.7% respectively for men with Charlson scores 0, 1, > 2. Death from competing medical hazards was roughly comparable for men with stage T2 disease and higher for all men over age 75. Conclusions: Patients and clinicians should consider using co-morbidity specific data to estimate the threat posed by localized prostate cancer. No significant financial relationships to disclose.


1999 ◽  
Vol 17 (1) ◽  
pp. 253-253 ◽  
Author(s):  
Jon Håvard Loge ◽  
Arne Foss Abrahamsen ◽  
Øivind Ekeberg ◽  
Stein Kaasa

PURPOSE: To estimate the level of fatigue and frequency of fatigue cases among Hodgkin's disease survivors (HDS) and compare them with normative data from the general population. PATIENTS AND METHODS: A cross-sectional follow-up study was done of 557 HDS (age range, 19 to 74 years) treated at the Norwegian Radium Hospital from 1971 to 1991. The sample was approached by mail, and their data were compared with normative data from 2,214 controls (age range, 19 to 74 years) representative of the general Norwegian population. Of the 557 HDS, 459 (82%) responded. The mean age (± SD) at the time of study was 44 ± 12 years, and the mean observation time was 12 ± 6 years. The Fatigue Questionnaire (11 items) measures physical and mental fatigue. Two systems of scoring were used, dichotomized (0, 0, 1, and 1) and Likert (0, 1, 2, and 3). Total fatigue (TF) constitutes the sum of all the Likert scores. Caseness was defined as a total dichotomized score of ≥4 and fatigue that lasted 6 months or longer. RESULTS: The HDS had significantly higher levels of TF than the controls (14.3 v 12.2) (P < .001). Fatigue among the HDS equaled that of the controls in poorest health. More HDS (61%) than controls (31%) reported fatigue symptoms lasting 6 months or longer (P < .001). Fatigue cases were more frequent among HDS (men, 24%; women, 27%) than among the controls (men, 9%; women, 12%) (P < .001). Disease stage/substage IB/IIB predicted fatigue caseness (P = .03). No significant associations were found between treatment characteristics and fatigue. CONCLUSION: Hodgkin's disease survivors are considerably more fatigued than the general population and report fatigue of a substantially longer duration.


2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Oluwatobi Ayodeji Fasola ◽  
Augustine Oghenewyin Takure ◽  
Olayiwola B. Shittu

Abstract Background Transrectal ultrasound (TRUS)-guided prostate biopsy is a potentially painful procedure, due to the insertion of the TRUS probe in the anus and multiple passes of the biopsy needle through the rectum and prostate. Several methods of reducing pain and discomfort have been described. These include intra-rectal local anaesthetic gel (IRLA) instillation, periprostatic nerve block (PPNB), caudal block (CB) and oral analgesics. CB has potential complications of dural puncture and anaesthetic failure, while PPNB may be complicated by intravascular injection with systemic local anaesthetic toxicity. Only few studies have compared transrectal PPNB with CB with equivocal results. This study compared transrectal PPNB to CB in terms of efficacy of analgesia and incidence of complications. Methods A prospective randomized clinical trial was carried out among 80 consenting patients with an indication for TRUS-guided prostate biopsy in the Urology division of [BLINDED FOR PEER REVIEW]. Eighty participants were each randomized to either of Group A (CB with 10 ml of 2% lidocaine) or Group B (PPNB with a total of 20 ml of 1% lidocaine). Pain was assessed using an 11-point numerical rating scale (NRS), and questions on satisfaction with the procedure and willingness for a repeat procedure were asked. The incidence of complications was also recorded. Results There were no significant differences in the mean ages, body mass indices (BMIs), prostate-specific antigen (PSA) levels, digital rectal examination (DRE) findings and prostate sizes between the two groups. The mean NRS scores at administration of block, insertion of TRUS probe, prostate biopsy, 30 min and 1 day after biopsy were 2.9 ± 2.3, 2.1 ± 2.2, 3.1 ± 2.6, 1.4 ± 2.2 and 0.2 ± 0.4 respectively for CB and 3.1 ± 2.2, 2.3 ± 1.2, 2.8 ± 2.7, 1.4 ± 1.7 and 0.3 ± 0.5, respectively, for the PPNB group. There were no significant differences between the mean scores in both groups. There were also no statistically significant differences in the incidences of complications in both groups. Conclusion The two methods of analgesia are similar in efficacy and are equally safe to employ in the performance of TRUS-guided prostate biopsy. Both methods can be learned to increase the repertoire of the urologist when faced with a TRUS-guided prostate biopsy. Trial registration PACTR, PACTR202012779661309. Registered 11th December 2020—Retrospectively registered, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=14564.


2015 ◽  
Vol 30 (4) ◽  
pp. 401-406 ◽  
Author(s):  
Wiktor Dariusz Sroka ◽  
Marek Adamowski ◽  
Piotr Słupski ◽  
Joanna Siódmiak ◽  
Piotr Jarzemski ◽  
...  

Background Because of the numerous limitations of prostate-specific antigen (PSA), α-methylacyl-CoA racemase (AMACR) and hepsin have recently been suggested as potential biomarkers in prostate cancer (PC). This report presents a comparison study of the presence of AMACR and hepsin in urine collected before and after digital rectal examination (DRE) as a previously suggested diagnostic marker for PC. Methods Seventy-six urine samples (38 before and 38 after prostate massage) from patients with benign prostate hyperplasia (BPH) and 66 urine samples (33 before and 33 after prostate massage) from patients with PC were analyzed. PC was confirmed by prostate biopsy. Urinary levels of AMACR and hepsin were determined by ELISA and related to the tumor stage, Gleason score and PSA level. Results AMACR and hepsin levels in urine collected after prostate massage were higher only in the PC group. There were no correlations between AMACR levels, hepsin levels, tumor stage and Gleason score. AMACR and hepsin did not differentiate between BPH and PC with better true positive and false negative rates than serum PSA. Conclusions AMACR and hepsin were unable to diagnose PC with better true positive and false negative rates than PSA. An additional procedure combined with other markers should be applied for the reliable diagnosis of PC.


2019 ◽  
pp. 243-248
Author(s):  
PE Ngwu ◽  
GO Achor ◽  
VU Eziefule ◽  
JI Orji ◽  
FT Alozie

Background: Prostate Specific Antigen (PSA) is a commonly used marker in prostate cancer management. Gleason grading is one of the most powerful predictors of prostatic biological behaviour. PSA, when combined with the Gleason score and clinical stage, improves the prediction of the pathological stage for prostate cancer. Objectives: To assess the degree of correlation between PSA level and Gleason score as well as determine the likelihood of aggressiveness of prostate cancer using Gleason score as a parameter. Methods: A cross-sectional prospective study was conducted among 234 consecutive consenting patients presenting to the Urology Out-Patient Clinic between April 2015 and March 2018. Serum PSA was done and patients with values above 4ng/ml and/or abnormal Digital Rectal Examination (DRE) were selected to have a prostate biopsy. The sample was histologically analysed with Gleason score recorded for those with prostate cancer. Gleason score was then correlated with PSA levels. Results: The mean age for prostate cancer patients was 71.3±8.7 years. The mean PSA for patients with prostate cancer was 52.3±37.5ng/ml (Confidence Interval = 46.1-58.6) with p<0.001. About 18.2% of histologically confirmed prostate cancer cases had Gleason score 8-10 implying a high level of tumour aggressiveness. There is a positive correlation between PSA and Gleason score with R-value 0.590 indicating a good degree of correlation. Conclusion: There is a good degree of a positive correlation between PSA level and Gleason score, as well as a high level of aggressiveness of prostate cancer in Umuahia.


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