Prostate Cancer

Discussion in 'Men's Health Forum' started by Michael Scally MD, Sep 22, 2010.

  1. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    testosterone Replacement Therapy and the Risk of Prostate Cancer

    The association between the use of testosterone replacement therapy (TRT) and prostate cancer remains uncertain. Thus, we investigated whether TRT is associated with an increased risk of prostate cancer in men with late-onset hypogonadism.

    We used the United Kingdom Clinical Practice Research Datalink to assemble a cohort of 12,779 men newly-diagnosed with hypogonadism between 1 January 1995 and 31 August 2016, with follow-up until 31 August 2017. Exposure to TRT was treated as a time-varying variable and lagged by 1 year to account for cancer latency, with non-use as the reference category. During 58,224 person-years of follow-up, a total of 215 patients were newly-diagnosed with prostate cancer, generating an incidence rate of 3.7 per 1,000 person-years.

    In time-dependent Cox proportional hazards models, use of TRT was not associated with an overall increased risk of prostate cancer (hazard ratio = 0.97; 95% confidence interval: 0.71, 1.32), compared with non-use. Results remained consistent in secondary and sensitivity analyses, as well as in a propensity score-matched cohort analysis that further assessed the impact of residual confounding. Overall, the use of TRT was not associated with an increased risk of prostate cancer in men with late-onset hypogonadism.

    Santella C, Renoux C, Yin H, Yu OHY, Azoulay L. Testosterone Replacement Therapy and the Risk of Prostate Cancer in Men with Late-Onset Hypogonadism. American journal of epidemiology 2019. Testosterone Replacement Therapy and the Risk of Prostate Cancer in Men with Late-Onset Hypogonadism
     
  2. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    When Fat Goes Down, Prostate Cancer Is On The Ropes

    Reprogrammed lipid metabolism and persistent androgen receptor signaling commonly mark aggressive prostate cancer.

    We describe that targeting de-novo lipogenesis deprives prostate cancer cells of substrates and fuel, while inhibiting androgen receptor signaling.

    Our study uncovers the interplay between lipogenesis and androgen receptor and proposes novel combinatorial therapeutic approaches.

    Zadra G, Loda M. When fat goes down, prostate cancer is on the ropes. Molecular & cellular oncology 2019;6:1595308. https://www.tandfonline.com/doi/full/10.1080/23723556.2019.1595308
     

    Attached Files:

  3. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Holt JD, Gerayli F. Prostate Cancer Screening. Primary care 2019;46:257-63. Prostate Cancer Screening - ScienceDirect

    KEY POINTS

    · The benefits of prostate-specific antigen (PSA) screening in men aged 55 to 69 at average risk for prostate cancer are small: reduced risk for prostate cancer deaths and metastatic disease, but no decrease in overall mortality.

    · To realize the benefits from PSA screening in men at average risk for prostate cancer, PSA thresholds must be low enough that many false positives, many biopsies, and overdiagnosis of indolent cancers will occur.

    · The harms of PSA screening for prostate cancer are significant: anxiety, complications from biopsy, and morbidity from overly aggressive treatment.

    · There is little evidence evaluating benefits of PSA screening in populations at increased risk for prostate cancer, such as men with a positive family history or African American men.

    · Men 70 and older experience less benefit and more harm from PSA screening for prostate cancer. PSA screening is not recommended for them.

    Whether to screen for prostate cancer in aging men is a topic that is fairly well researched, but recommendations are controversial, because the evidence supporting any recommendation is equivocal. The evidence clearly does not support routine screening of all average-risk men, but for men aged 55 to 69 years, either not routinely screening, or engaging each man in shared decision making for his individual preference on screening, is reasonable and consistent with the evidence. Many organizations, including the American Cancer Society, have not yet reassessed their guidelines, in response to the US Preventative Services Task Force revised guideline.
     

    Attached Files:

  4. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Negative Predictive Value of Prostate Multi-Parametric Magnetic Resonance Imaging Among Men with Negative Prostate Biopsy and Elevated PSA

    PURPOSE: To estimate the negative predictive value (NPV) of prostate mpMRI in the detection of clinically significant (Gleason >/=7) prostate cancer (csPCa) at long-term follow-up (median 6.7 years, range 2.6-10.7 years), in men with negative pre-MRI biopsy and to assess the diagnostic performance of mpMRI in detecting csPCa over this time.

    MATERIALS AND METHODS: Following Institutional REB-approval, men with prostate mpMRI following a biopsy between 2004-2009 were identified retrospectively from a cancer registry database and MRI reports. The mpMRI sequences comprised T2-weighted and dynamic contrast-enhanced series (2004-2005) with diffusion-weighted imaging 2006 onwards.

    Clinical outcomes were assessed up to July 2015 by review of subsequent pathology results, PSA levels and review of electronic patient records. The primary outcome was csPCa diagnosis by follow-up. We also estimated the sensitivity, specificity, PPV and NPV of all prostate mpMRI during the period.

    RESULTS: 502 mpMRI with a prior biopsy were included. 121 were in men with a prior negative systematic biopsy for cancer (median PSA 9.5; median age 60 years). Of these, 96% (70/73) of men with negative mpMRI remained free of csPCa at median follow-up of 6.7 years (range 2.6-10.7 years). The overall NPV and PPV of mpMRI in the entire cohort regardless of pre-MRI biopsy status was 86% (80-91%) and 54% (52-57%) respectively, in the time period.

    CONCLUSION: Prostate mpMRI has high clinical NPV. In men with pre-MRI negative biopsy and a negative MRI, the risk of developing clinically significant prostate cancer at median 6.7 years is extremely low.

    Lo G, Burton KR, Haider MA, Fleshner N, Finelli A, Ghai S. Negative predictive value of prostate multi-parametric magnetic resonance imaging among men with negative prostate biopsy and elevated PSA - a clinical outcome retrospective cohort study. The Journal of urology 2019:101097ju0000000000000388. American Urological Association