BACKGROUND: Five-alpha reductase inhibitors (5aRIs) are used to treat benign prostatic hyperplasia (BPH). However, the cardiovascular effects of 5aRIs remain poorly understood. The study objective was to compare the rate of hospitalization for heart failure among men with BPH prescribed 5aRIs to that of men with BPH not prescribed BPH medications.METHODS: Using the Clinical Practice Research Datalink linked with hospitalization and vital statistics data, we conducted a population-based cohort study among patients newly diagnosed with BPH. We defined expo-sure as the current use of 5aRIs, current use of alpha-blockers, and no current use of BPH medications in a time-varying approach. The primary endpoint was hospitalization for heart failure, and secondary endpoints were myocardial infarction, stroke, and cardiovascular death. We used time-dependent Cox-proportional haz-ards models to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs).RESULTS: Our cohort included 94,440 men with incident BPH. A total of 3893 hospitalizations for heart failure occurred over 527,660 person-years of follow-up (incidence rate 7.38; 95% CI, 7.15-7.61, per 1000 person-years). Compared with no current use of BPH medications, current use of 5aRIs was not associated with an increased risk of hospitalization for heart failure (HR 0.94; 95% CI, 0.86-1.03), myocardial infarction (HR 0.92; 95% CI, 0.81-1.05), stroke (HR 0.94; 95% CI, 0.85-1.05), or cardiovascular death (HR 0.89; 95% CI, 0.80-0.99).CONCLUSIONS: The use of 5aRIs was not associated with an increased risk of hospitalization for heart fail-ure, myocardial infarction, stroke, or cardiovascular death compared with non-use. (c) 2023 Elsevier Inc. All rights reserved. center dot The American Journal of Medicine (2023) 136:1000-1010

To describe trends in the pharmacological treatment of BPH in the United Kingdom (UK) from 1998 to 2016. We created a cohort of men with a diagnosis of BPH between 1998 and 2016 using the Clinical Practice Research Datalink. Using Poisson regression, we estimated annual prescription rates of 5αRIs, α-blockers, and combination therapy (5αRIs + α-blockers). Adherence was defined by a proportion of days covered > 80%. Our cohort included 192,640 men with BPH who generated 1,176,264 person-years (PYs) of follow-up. The mean age was 68.0 (standard deviation: 10.7) years. The prescription rate of all BPH medications during the study period was 347.6 per 100 PYs (95% CI 347.2–347.9). α-Blockers had the highest prescription rate (222.9 per 100 PYs, 95% CI 222.7–223.2); prescription rates of 5αRIs and combination therapy were 69.1 per 100 PYs (95% CI 69.0–69.3) and 55.5 per 100 PYs (95% CI 55.4–55.7), respectively. The prescription rate for combination therapy was 19 times greater in 2013–2016 than in 1998–2000 (rate ratio: 19.2, 95% CI 18.6–19.7), while the prescription rates for 5αRIs and α-blockers each doubled during this period (rate ratio: 1.86, 95% CI 1.84–1.88 and rate ratio: 2.02, 95% CI 2.01–2.04, respectively). The proportion of patients who were adherent at 1 year to 5αRIs (32.3%), α-blockers (44.0%), and combination therapy (45.6%) was low. The prescription rate of BPH medications increased substantially between 1998 and 2016 in the UK, with the greatest relative increase observed with combination therapy. Adherence to BPH medications was low in this population-based study.

Introduction: To evaluate erectile function recovery following robotic-assisted radical prostatectomy (RARP) according to preoperative sexual health inventory for men (SHIM) score stratification.Materials and methods: We prospectively collected data on 250 consecutive patients who underwent RARP by a single surgeon between October 2006 and October 2012. Thirty-six patients were excluded because of lack of preoperative SHIM score. All patients had a minimum follow up of 2 years. Patients were divided into four groups according to their preoperative SHIM score: group 1 with normal potency (SHIM 22-25), group 2 with mild ED (SHIM 17-21), group 3 with mild-moderate ED (SHIM 12-16) and group 4 with moderate-severe ED (SHIM 1-11). Patients were followed at 3, 6, 9, 12, 18, 24 months intervals and twice yearly thereafter. SHIM questionnaire and erection hardness scale (EHS) score were collected at each visit. Potency was defined as successful penetration during intercourse (EHS score 3-4) with or without phosphodiesterase type 5-inhibitor (PDE5-I).Results: After exclusion, 214 patients were evaluated. The number of patients in group 1, 2, 3 and 4 were 95, 59, 26 and 34, respectively. At 3, 6, 9,12,18, 24 months, SHIM scores and potency rates were statistically different between groups 1 versus 2 versus 3 versus 4 (p < 0.01, at each time point). Patients in each group 1, 2 and 3 showed a statistically significant improvement in potency rates and SHIM scores at consecutive follow up visits up to 24 months (p < 0.01, for each potency group). Potency rates at 24 months for groups 1 to 4 were 83.3%, 54.5%, 50.0%, and 20.7%, respectively (p < 0.001).Conclusion: For proper patient counseling and better prediction of erectile function recovery after RARP, it is important to stratify patients according to preoperative SHIM scores. Setting realistic expectations may increase patient satisfaction.

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Evaluation I1 Apr 2015MP43-04 UROFLOW STOP TEST AT TIME OF CATHETER REMOVAL IS A NOVEL AND STRONG PREDICTOR OF EARLY RECOVERY OF ERECTILE FUNCTION FOLLOWING ROBOTIC-ASSISTED RADICAL PROSTATECTOMY (RARP): A PILOT STUDY Abdullah Alenizi, Marc Bienz, Anwar Alesawi, Naif Al-Hathal, Serge Benayoun, Thierry Lebeau, Kevin c Zorn, and Assaad El-Hakim Abdullah AleniziAbdullah Alenizi More articles by this author , Marc BienzMarc Bienz More articles by this author , Anwar AlesawiAnwar Alesawi More articles by this author , Naif Al-HathalNaif Al-Hathal More articles by this author , Serge BenayounSerge Benayoun More articles by this author , Thierry LebeauThierry Lebeau More articles by this author , Kevin c ZornKevin c Zorn More articles by this author , and Assaad El-HakimAssaad El-Hakim More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1611AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Potency recovery post robot-assisted radical prostatectomy (RARP) remains difficult to predict despite growing knowledge about risk factors. We recently showed that the ability to completely stop urine flow at time of catheter removal (uroflow Stop Test) post RARP is a strong independent predictor of early 3-months urinary continence recovery. The aim of this study is to evaluate whether uroflow Stop Test following RARP, can predict early recovery of potency METHODS In this study, data was collected prospectively on 108 RARP patients operated by a single surgeon (AEH). Prior to catheter removal on postoperative day 7, 150 ml of normal saline was instilled intravesically. Patients were subjected to an uroflowmetry and instructed to stop flow during voiding. Eighty patients had a positive uroflow Stop Test (group one) and 28 had a negative Stop Test (group two). Potency was defined as successful penetration during intercourse and/or erection hardness scale (EHS) score of ≥3/4, with or without PDE5-I. RESULTS Preoperative characteristics were comparable between both groups except nerve sparing and PSA, which were statistically higher in group one (p<0.05). 3- and 6-months potency recovery was significantly higher in group one. Potency rates in group one and two at 1, 3, 6, 9, 12, 18 and 24 months were 25% vs. 14.3% (p0.241), 42.6% vs. 14.8% (p0.010), 54.5% vs. 18.5% (p0.001), 56.4% vs. 36% (p0.084), 66.6% vs. 50% (p0.141), 65.5% vs. 56% (p0.404) and 73.2% vs. 57.7% (p0.160) respectively. Uroflow Stop Test was the strongest independent predictor of early potency recovery on multivariate analysis at 3 and 6 months [OR 6.70 (95%CI: 1.36-32.97, p0.019) and OR 5.46 (95%CI: 1.84-16.20, p0.025), respectively]. CONCLUSIONS Novel use of uroflowmetry at the time of urethral catheter removal is a simple, non-invasive study with strong and independent ability to predict early potency recovery following RARP. Table I. analysis at 3 months Significant predictive variables of potency ODDS RATIO (OR) 95.0% Confidence Interval for OR (lower) 95.0% Confidence Interval for OR (upper) Age 0.869 0.776 0.973 BMI 0.741 0.583 0.942 Uroflow Stop Test 6.698 1.361 32.968 As shown in table I, Uroflow Stop Test was the strongest independent predictor of early potency recovery on multivariate regression analysis at 3 months with an odds ratio (OR) of 6.70 (95%CI: 1.36-32.97, p 0.019).This indicated that respondents who had a positive Stop Test were 6.7 times more likely to report 3-months potency. Similarly, age and BMI were also significant contributors to the model at 3 months with an OR of 0.87 (95%CI: 0.78-0.97, p 0.015) and OR 0.74 (95%CI: 0.58-0.94, p 0.014), respectively. Table II. analysis at 6 months Significant predictive variables of potency ODDS RATIO (OR) 95.0% Confidence Interval for OR (Lower) 95.0% Confidence Interval for OR (upper) BMI 0.799 0.658 0.971 Uroflow Stop Test 5.462 1.842 16.201 At 6 months, uroflow Stop Test was again the strongest predictor of early potency recovery on multivariate regression analysis with an odds ratio (OR) of 5.46 (95%CI: 1.84-16.20, p 0.025). in addition, BMI was also found to be a significant predictor with an OR of 0.80 (95%CI: 0.66-0.97, p 0.024). © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e519 Peer Review Report Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Abdullah Alenizi More articles by this author Marc Bienz More articles by this author Anwar Alesawi More articles by this author Naif Al-Hathal More articles by this author Serge Benayoun More articles by this author Thierry Lebeau More articles by this author Kevin c Zorn More articles by this author Assaad El-Hakim More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

OBJECTIVE:To study the relation between uroflow Stop Test and early recovery of potency following robot-assisted radical prostatectomy (RARP). We recently showed that the ability to completely stop urine flow during voiding, measured objectively by uroflowmetry at the time of catheter removal (uroflow Stop Test) can predict early urinary continence recovery following RARP.MATERIALS AND METHODS:In this prospective observational cohort, data were collected on 108 patients operated by a single surgeon (AEH). Eighty patients had a positive uroflow Stop Test (group one) and 28 had a negative Stop Test (group two). Patients were followed for a minimum of 2 years. Covariates included age, body mass index, international prostate symptom score and sexual health inventory for men scores, prostate-specific antigen, tumor stage, prostate volume, nerve sparing status, and estimated blood loss.RESULTS:Preoperative characteristics were comparable between both groups except nerve sparing and prostate-specific antigen which were statistically higher in group one (P <.05). Early 3- and 6-months recovery of erectile function was significantly higher in group one. Potency rates in group one and two at 1, 3, 6, 9, 12, 18, and 24 months were 25% vs 14.3% (P = .241), 54.5% vs 18.5% (P = .001), 55.4% vs 18.5% (P = .001), 56.4% vs 36% (P = .084), 66.6% vs 50% (P = .141), 65.5% vs 56% (P = .404) and 73.2% vs 57.7% (P = .160) respectively. Uroflow Stop Test was independent predictor of early potency recovery on multivariate regression analysis at 6 months [odds ratio 6.042 (confidence interval 95% 1.496-24.413) P = .012].CONCLUSION:Uroflow Stop Test is simple and can help predict early potency recovery following RARP.

IMPORTANCE:5α-Reductase inhibitors (5-ARIs) are widely used in the treatment of benign prostatic hyperplasia. However, randomized clinical trials have raised concerns that their use may be associated with an increased risk of high-grade prostate cancer tumors that would ultimately lead to worse prostate cancer outcomes. To date, few observational studies have addressed this important safety concern.OBJECTIVE:To determine whether the use of 5-ARIs before prostate cancer diagnosis is associated with an increased risk of cancer-specific and all-cause mortality in men with a new diagnosis of prostate cancer in the real-world setting.DESIGN, SETTING, AND PARTICIPANTS:A retrospective cohort study was conducted in a cohort of 13,892 men with a new diagnosis of prostate cancer between January 1, 1999, and December 31, 2009, who were followed up until October 1, 2012. Patients were individually linked across 4 databases from the United Kingdom: National Cancer Data Repository, Clinical Practice Research Datalink, Hospital Episodes Statistics database, and Office for National Statistics database.MAIN OUTCOMES AND MEASURES:Cox proportional hazards models were used to estimate hazard ratios (HRs) with 95% CIs of prostate cancer-specific and all-cause mortality associated with prediagnostic use of 5-ARIs. For each outcome, 2 models were constructed, one adjusted for predefined covariates (conventional model) and another adjusted for high-dimensional propensity score (HD-PS) deciles.RESULTS:During a mean (SD) of 4.5 (3.1) years, 5001 deaths occurred, including 2429 from prostate cancer (crude incidence rate of 3.86 per 100 person-years [95% CI, 3.71-4.02]). In the conventional model, use of 5-ARIs before prostate cancer diagnosis was not associated with an increased risk of prostate cancer-specific mortality (crude incidence rates, 3.76 [95% CI, 3.04-4.59] [use] vs 3.87 [95% CI, 3.71-4.03] [nonuse] per 100 person-years; adjusted hazard ratio [aHR], 0.86 [95% CI, 0.69-1.06]) and all-cause mortality (crude incidence rates, 8.42 [95% CI, 7.32-9.64] [use] vs 7.93 [95% CI, 7.71-8.16] [nonuse] per 100 person-years; aHR, 0.87; 95% CI, 0.75-1.00). Similar results were observed with the HD-PS adjusted model (prostate cancer-specific mortality: aHR, 0.90 [95% CI, 0.73-1.13]; and all-cause mortality: aHR, 0.92 [95% CI, 0.80-1.07]).CONCLUSIONS AND RELEVANCE:The use of 5-ARIs was not associated with an increased risk of prostate cancer-specific and all-cause mortality in men with a new diagnosis of prostate cancer. While these results provide reassurance, additional studies are needed to replicate these findings.

PURPOSE:To determine whether the use of statins after prostate cancer diagnosis is associated with a decreased risk of cancer-related mortality and all-cause mortality and to assess whether this association is modified by prediagnostic use of statins.PATIENTS AND METHODS:A cohort of 11,772 men newly diagnosed with nonmetastatic prostate cancer between April 1, 1998, and December 31, 2009, followed until October 1, 2012, was identified using a large population-based electronic database from the United Kingdom. Time-dependent Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) with 95% CIs of mortality outcomes associated with postdiagnostic use of statins, lagged by 1 year to account for latency considerations and to minimize reverse causality, and considering effect modification by prediagnostic use of statins.RESULTS:During a mean follow-up time of 4.4 years (standard deviation, 2.9 years), 3,499 deaths occurred, including 1,791 from prostate cancer. Postdiagnostic use of statins was associated with a decreased risk of prostate cancer mortality (HR, 0.76; 95% CI, 0.66 to 0.88) and all-cause mortality (HR, 0.86; 95% CI, 0.78 to 0.95). These decreased risks of prostate cancer mortality and all-cause mortality were more pronounced in patients who also used statins before diagnosis (HR, 0.55; 95% CI, 0.41 to 0.74; and HR, 0.66; 95% CI, 0.53 to 0.81, respectively), with weaker effects in patients who initiated the treatment only after diagnosis (HR, 0.82; 95% CI, 0.71 to 0.96; and HR, 0.91; 95% CI, 0.82 to 1.01, respectively).CONCLUSION:Overall, the use of statins after diagnosis was associated with a decreased risk in prostate cancer mortality. However, this effect was stronger in patients who also used statins before diagnosis.

INTRODUCTION:While RARP (robotic-assisted radical prostatectomy) has become the predominant surgical approach to treat localized prostate cancer, there is little Canadian data on its oncological and functional outcomes. We describe the largest RARP experience in Canada.METHODS:Data from 722 patients who underwent RARP performed by 7 surgeons (AEH performed 288, TH 69, JBL 23, SB 17, HW 15, QT 7, and KCZ 303 patients) were collected prospectively from October 2006 to December 2013. Preoperative characteristics, as well as postoperative surgical and pathological outcomes, were collected. Functional and oncological outcomes were also assessed up to 72 months postoperative.RESULTS:The median follow-up (Q1-Q3) was 18 months (9-36). The D'Amico risk stratification distribution was 31% low, 58% intermediate and 11% high-risk. The median operative time was 178 minutes (142-205), blood loss was 200 mL (150-300) and the postoperative hospital stay was 1 day (1-23). The transfusion rate was only 1.0%. There were 0.7% major (Clavien III-IV) and 10.1% minor (Clavien I-II) postoperative complications, with no mortality. Pathologically, 445 men (70%) were stage pT2, of which 81 (18%) had a positive surgical margin (PSM). In addition, 189 patients (30%) were stage pT3 and 87 (46%) with PSM. Urinary continence (0-pads/day) returned at 3, 6, and 12 months for 68%, 80%, and 90% of patients, respectively. Overall, the potency rates (successful penetration) for all men at 6, 12, and 24 months were 37%, 52%, and 59%, respectively. Biochemical recurrence was observed in 28 patients (4.9%), and 14 patients (2.4%) were referred for early salvage radiotherapy. In total, 49 patients (8.4%) underwent radio-therapy and/or hormonal therapy.CONCLUSIONS:This study shows similar results compared to other high-volume RARP programs. Being the largest RARP experience in Canada, we report that RARP is safe with acceptable oncologic outcomes in a Canadian setting.

Importance The use of androgen deprivation therapy (ADT) in the treatment of advanced prostate cancer has been shown to delay the clinical progression of the disease. However, the testosterone suppression associated with this therapy may lead to a hypogonadal condition that can have detrimental effects on renal function, thus raising the hypothesis that ADT-induced hypogonadism could potentially lead to acute kidney injury (AKI). Objective To determine whether the use of ADT is associated with an increased risk of AKI in patients newly diagnosed with prostate cancer. Design and Setting A nested case-control analysis using medical information extracted from the UK Clinical Practice Research Datalink linked to the Hospital Episodes Statistics database. Participants Men newly diagnosed with nonmetastatic prostate cancer between January 1, 1997, and December 31, 2008, were selected and followed up until December 31, 2009. Cases were patients with incident AKI during follow-up who were randomly matched with up to 20 controls on age, calendar year of prostate cancer diagnosis, and duration of follow-up. Main Outcomes and Measures Conditional logistic regression was used to estimate odds ratios (ORs) with 95% CIs of AKI associated with the use of ADT. ADT was categorized into 1 of 6 mutually exclusive groups: gonadotropin-releasing hormone agonists, oral antiandrogens, combined androgen blockade, bilateral orchiectomy, estrogens, and combination of the above. Results A total of 10 250 patients met the study inclusion criteria. During a mean follow-up of 4.1 (SD, 2.9) years, 232 incident cases of AKI were identified (rate, 5.5/1000 person-years). Overall, current use of any ADT was associated with an increased risk of AKI when compared with never use (OR, 2.48 [95% CI, 1.61-3.82]), generating a rate difference of 4.43/1000 persons per year (95% CI, 1.54-7.33). This association was mainly driven by a combined androgen blockade consisting of gonadotropin-releasing hormone agonists with oral antiandrogens (OR, 4.50 [95% CI, 2.61-7.78]), estrogens (OR, 4.00 [95% CI, 1.06-15.03]), other combination therapies (OR, 4.04 [95% CI, 1.88-8.69]), and gonadotropin-releasing hormone agonists (OR, 1.93 [95% CI, 1.20-3.10]). Conclusions and Relevance In a cohort of patients with newly diagnosed nonmetastatic prostate cancer, the use of ADT was significantly associated with an increased risk of AKI. These findings require replication in other well-designed studies as well as further investigation of their clinical importance.

Androgens are known to play an important protective role on colorectal carcinogenesis, and thus the objective of this study was to determine whether androgen deprivation therapy (ADT) is associated with an increased risk of incident colorectal cancer in patients with prostate cancer.

You have accessJournal of UrologyModerated Poster 46, Tuesday, May 22, 2007, 1:00 - 3:00 pm1 Apr 20071495: Stress Urinary Incontinence and Erectile Dsyfunction in a Prostate Cancer Screening Cohort Felix K.-H. Chun, Jochen Walz, Andrea Gallina, Georg C. Hutterer, Alberto Briganti, Paul Perrotte, Claudio Jeldres, Serge Benayoun, Alvaro Ramirez, Francois Benard, Michael Mc Cormack, Luc Valiquette, and Pierre I. Karakiewicz Felix K.-H. ChunFelix K.-H. Chun More articles by this author , Jochen WalzJochen Walz More articles by this author , Andrea GallinaAndrea Gallina More articles by this author , Georg C. HuttererGeorg C. Hutterer More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Paul PerrottePaul Perrotte More articles by this author , Claudio JeldresClaudio Jeldres More articles by this author , Serge BenayounSerge Benayoun More articles by this author , Alvaro RamirezAlvaro Ramirez More articles by this author , Francois BenardFrancois Benard More articles by this author , Michael Mc CormackMichael Mc Cormack More articles by this author , Luc ValiquetteLuc Valiquette More articles by this author , and Pierre I. KarakiewiczPierre I. Karakiewicz More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)31696-3AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1495: Stress Urinary Incontinence and Erectile Dsyfunction in a Prostate Cancer Screening Cohort." The Journal of Urology, 177(4S), p. 493 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 177Issue 4SApril 2007Page: 493 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Felix K.-H. Chun More articles by this author Jochen Walz More articles by this author Andrea Gallina More articles by this author Georg C. Hutterer More articles by this author Alberto Briganti More articles by this author Paul Perrotte More articles by this author Claudio Jeldres More articles by this author Serge Benayoun More articles by this author Alvaro Ramirez More articles by this author Francois Benard More articles by this author Michael Mc Cormack More articles by this author Luc Valiquette More articles by this author Pierre I. Karakiewicz More articles by this author Expand All Advertisement PDF downloadLoading ...

Tissue inflammation has been linked to cancer in several disease models. We tested the association between chronic inflammation and prostate cancer (PCa), as well as high-grade prostatic intraepithelial neoplasia (HGPIN), in prostatic needle biopsy specimens. Tissues from 4526 men, who underwent systematic ultrasound-guided sextant needle biopsies of the prostate, were classified in the following order as PCa, or HGPIN, or chronic inflammation or benign. PCa was diagnosed in 1633 (36.1%), HGPIN in 535 (11.8%) and chronic inflammation in 347 (7.7%). Chronic inflammation conferred a protective effect from PCa: odds ratio (OR) = 0.20, 95% confidence interval (CI) = 0.15-0.28. Chronic inflammation was also inversely associated with HGPIN: OR = 0.11, 95% CI = 0.05-0.22. The ORs remained virtually unchanged after adjustment for age, serum prostate-specific antigen (PSA), digital rectal examination (DRE) and gland volume. Chronic inflammation is more frequent in the presence of benign histology than it is in the presence of PCa or HGPIN.

INTRODUCTION:Controversy persists about whether men should be screened for prostate cancer. On the other hand, the benefit of colorectal cancer screening has been proven for men starting at age 50. We aimed to examine the rate of exposure to previous screening tests for prostate cancer and colorectal cancer in a cohort of men living in Quebec. MATERIALS AND METHODS:As part of an event promoting early prostate cancer detection, 347 men aged 50 to 69 without an established diagnosis of prostate cancer agreed to reply to questions in a previously validated questionnaire. The self-administered questionnaire, which asked about previous screening tests for prostate cancer and colorectal cancer, was completed on-site. RESULTS:Among men aged 50 to 69, previous exposure to a digital rectal examination (DRE), a prostate-specific antigen (PSA) test, a fecal occult blood test (FOBT), and sigmoidoscopy were reported by 132 men (62.9%), 73 men (34.8%), 37 men (17.6%), and 39 men (18.6%) , respectively. Across all age strata (< 50, 50-69, > or = 70 years), PSA and DRE testing were highest in men aged 50 to 69 and were 2- to 3-fold higher than screening tests for colorectal cancer. CONCLUSIONS:In this cohort of asymptomatic Canadian men, overall and age-stratified exposure to tests to detect colon cancer early is far from ideal. Conversely, far more men have been subjected to PSA testing and DRE. Patients should be informed of the benefits and risks of colorectal cancer screening and PSA testing.

OBJECTIVE:To examine prostate specific-antigen (PSA) levels and percentage free/total PSA (f/tPSA) distributions as well as digital rectal examination (DRE) profiles in asymptomatic Canadian men with no established prostate cancer diagnosis, as recent data indicate that a man's risk of developing prostate cancer is higher if his baseline PSA level is above the median for his age group. SUBJECTS AND METHODS:We used data obtained during an early prostate cancer-detection event. An invitation to an onsite DRE, PSA level and f/tPSA assessment was accepted by 313 men. Serum PSA level and f/tPSA were measured before the DRE. A suspicious DRE and/or PSA level of > or = 2.5 ng/mL or f/tPSA of < or = 15% represented indications for a systematic 12-core ultrasonography-guided prostate biopsy. RESULTS:Of all the 313 men, most (235, 75%) had PSA levels of 0.01-1.53 ng/mL and an f/tPSA of >15% (285, 91.1%). The median (range) PSA level was 0.8 (0-34.2) ng/mL and f/tPSA was 27.4 (6.7-100)%. Age-specific median PSA levels and f/tPSA were, respectively, 0.7, 0.9, 1.0, 1.5 ng/mL and 31%, 27%, 26%, 25% for men aged 40-49, 50-59, 60-69 and 70-79 years. A suspicious DRE was recorded in 55 (17.6%) men, with eight (8.8%), 26 (20.0%), 14 (20.6%), and seven (28.9%) having suspicious DRE findings according to above age categories. Overall, seven (2.2%) prostate cancers were detected. CONCLUSION:The median age-specific baseline PSA levels and f/tPSA represent valuable indicators of prostate cancer risk. The population-specific baseline median PSA level should not be >1.0 ng/mL and the baseline f/tPSA should be >30%. Men with values outside of these ranges should be considered at greater risk of prostate cancer.

OBJECTIVE:Bacillus Calmette-Guerin (BCG) has shown promise in large scale studies. We assessed recurrence-free survival in patients treated with intravesical BCG/Interferon (IFN) for non-muscle invasive, BCG refractory, transitional cell carcinoma (TCC) of the urinary bladder at our local institution.METHODS:Cancer control data were gathered for patients enrolled in a BCG/Interferon protocol at the University of Montreal. The main inclusion criteria consisted of pathologically proven evidence of intravesical BCG failure, and of complete transurethral resection of latest post BCG recurrence. Induction consisted of eight intravesical BCG/Interferon instillations. Select patients were treated with BCG/Interferon maintenance therapy.RESULTS:Thirteen patients aged from 45 to 81 years (mean: 65) were included. Stages at TCC diagnosis were distributed as follows: 6 (46%) CIS, 3 (23%) Ta, and 4 (31%) T1. Induction BCG consisted of an average of 11 weekly instillations (range 3-24). Prior to BCG/Interferon stage distribution was as follows: 9 (69%) CIS, and 4 (31%) T1. BCG/Interferon maintenance was administered to 5 (38%) patients. Follow-up ranged from 1.5 to 32 months (mean=15, median=12). Recurrence was diagnosed in 5 patients (38%). Recurrence free survival (RFS) at 24 months was 66%. When stratified according to T stage prior to BCG/IFN, patients with CIS fared worse than T1 patients (50% versus 100%). Maintenance had no effect on RFS (75% versus 69%).CONCLUSIONS:Our results corroborate previous BCG/IFN reports. In selected patients, intravesical BCG/IFN offers a valid alternative to definitive therapy.