Several studies have reported associations between vascular calcifications and urinary stone disease (USD). However, results have been inconsistent and the majority of studies did not report on race/ethnicity. We examined the association between vascular calcifications and USD in a large, racially/ethnically diverse patient population. We identified 672 USD cases and 672 controls (i.e., patients without a history of USD) from patients who underwent non-contrast CT imaging at Montefiore Medical Center in Bronx, New York between 2004 and 2013. Controls were matched to cases on age, sex and race/ethnicity. The non-contrast CT imaging was used to measure abdominal aortic calcification (AAC) and calculate the AAC severity score. Logistic regression models were used to examine associations of AAC presence and severity score with risks of USD and stone types. Cases and controls had similar AAC prevalence (45.2% vs. 44.8%, p = 0.87), and AAC severity score (median 10 vs. 9.3, p = 0.47). The presence of AAC (OR = 0.98, 95% CI 0.78–1.23; p = 0.86) or AAC severity score were not associated with risk of USD: ORs of 0.96, 0.87, 1.07 and 1.03 for increasing AAC quartiles (p-trend = 0.54). There were also no associations in the stratified analyses by race/ethnicity or by sex. However, when USD patients were stratified by stone type, brushite/apatite stone formers had an inverse association with the lowest quartile of AAC severity score (OR = 0.35, 95% CI 0.11–0.84, p = 0.04) in comparison to patients without AAC. Overall, we found no association between vascular calcifications and risk of urinary stone disease in this large, hospital-based, case–control study.

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance II (MP62)1 Sep 2021MP62-18 ATENOLOL IS ASSOCIATED WITH REDUCED RISK OF PROSTATE CANCER UPGRADING: A MULTICENTER RETROSPECTIVE STUDY Ali Zahalka, Ethan Fram, Lauren Howard, Evan Garden, Larkin Mohn, Jay Annam, Allison Reagan, Benjamin Eilender, Amanda Dehoedt, Emily Wiggins, Ilir Agalliu, Stephen Freedland, Ash Tewari, and Kara Watts Ali ZahalkaAli Zahalka More articles by this author , Ethan FramEthan Fram More articles by this author , Lauren HowardLauren Howard More articles by this author , Evan GardenEvan Garden More articles by this author , Larkin MohnLarkin Mohn More articles by this author , Jay AnnamJay Annam More articles by this author , Allison ReaganAllison Reagan More articles by this author , Benjamin EilenderBenjamin Eilender More articles by this author , Amanda DehoedtAmanda Dehoedt More articles by this author , Emily WigginsEmily Wiggins More articles by this author , Ilir AgalliuIlir Agalliu More articles by this author , Stephen FreedlandStephen Freedland More articles by this author , Ash TewariAsh Tewari More articles by this author , and Kara WattsKara Watts More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002102.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Increased adrenergic innervation is observed in prostate cancer (PC) and is associated with aggressive disease. This is mediated by beta-adrenergic receptors in the tumor microenvironment. Among beta-blocker types, use of Atenolol was previously shown to reduce incident risk of clinically significant PC. However, it is unknown whether continued Atenolol use is associated with a sustained protective effect on PC progression. We therefore examined the association of Atenolol use on the risk of PC upgrading on repeat biopsy in a multicenter analysis. METHODS: A retrospective review of men who underwent initial biopsy for suspicion of PC and received at least one additional prostate biopsy (eg. active surveillance) between 2006 and 2019 across three diverse urban hospitals was performed. Active Atenolol users were those with at least two prescription refills within the year preceding initial biopsy, and duration of use calculated from medication initiation to last refill prior to repeat biopsy. Patient demographics, pre-biopsy PSA, and biopsy pathology were collected. Multivariable logistic regression analysis was performed to evaluate the association between Atenolol use and risk of upgrading, defined as any increase in primary or secondary Gleason grade on repeat biopsy. RESULTS: Among 1,779 men analyzed, 37% self-reported as Black, and 43% had an initial biopsy positive for PC (PC+), 33% of which had upgrading on repeat biopsy. Of men who had an initial negative biopsy (PC-), 44% had disease upgrading. On multivariable analysis, Atenolol use was associated with decreased odds of upgrading on repeat biopsy (PC- OR 0.70, CI 0.45-0.94, p=0.03; PC+ OR 0.63, CI 0.39-0.86, p=0.02). In a dose-dependent manner, greater duration of Atenolol exposure (>3 years) was associated with the greatest decreased odds of upgrading (PC- OR 0.51, CI 0.24-0.85, p=0.04; PC+ OR 0.53, CI 0.37-0.65, p=0.01). CONCLUSIONS: Use of the beta-blocker Atenolol is associated with a reduced odd of PC upgrading on repeat biopsy in our large multicenter population, and greater duration of Atenolol use was associated with a dose dependent decrease in upgrading. Future studies should test whether Atenolol can prevent PC progression in a post-PC diagnosis cohort (eg. active surveillance) as a novel therapeutic strategy. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1099-e1100 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ali Zahalka More articles by this author Ethan Fram More articles by this author Lauren Howard More articles by this author Evan Garden More articles by this author Larkin Mohn More articles by this author Jay Annam More articles by this author Allison Reagan More articles by this author Benjamin Eilender More articles by this author Amanda Dehoedt More articles by this author Emily Wiggins More articles by this author Ilir Agalliu More articles by this author Stephen Freedland More articles by this author Ash Tewari More articles by this author Kara Watts More articles by this author Expand All Advertisement PDF downloadLoading ...

Purpose: Increased adrenergic innervation is observed in prostate cancer (CaP) and is associated with aggressive disease. Emerging evidence suggests that beta-adrenergic blockade inhibits CaP progression. However, the association between type of beta-blocker use and risk of incident CaP on initial prostate biopsy has not been investigated in multiethnic populations. Materials and methods: A retrospective study of racially/ethnically diverse men (64% African-American and Hispanic), who underwent initial prostate biopsy between 2006 and 2016 in a large healthcare system was performed. Oral use of beta-blocker type was assessed by reviewing active prescriptions within the 5-year period preceding initial biopsy. Patient demographics and clinical factors were collected. Results: Of 4,607 men who underwent initial prostate biopsy, 4,516 met criteria and 2,128 had a biopsy positive for CaP; 20% high-risk, 41% intermediate-risk, and 39% low or very-low risk (National Comprehensive Cancer Network classification). Overall, 15% of patients were taking a beta-blocker prior to initial biopsy, with Metoprolol, Atenolol, and Carvedilol accounting for the majority. Of beta-blocker types, Atenolol alone was associated with a 38% reduction in odds of incident CaP (P= 0.01), with a 40% and 54% reduction in risks of National Comprehensive Cancer Network intermediate and high-risk CaP (P = 0.03 and P = 0.03, respectively) compared to men not taking a beta-blocker. Furthermore, longer duration of Atenolol use (3-5 years) was associated with a 54% and 72% reduction in intermediate and high-risk disease, (P = 0.03 and P = 0.03, respectively). Conclusions: Among beta blocker types, long-term Atenolol use is associated with a significant reduction in incident CaP risk on initial prostate biopsy for clinically-significant intermediate and high-risk disease compared to men not taking a beta-blocker. (C) 2020 Elsevier Inc. All rights reserved.

To determine whether patients with ureteral stones received different standard of care in the emergency department (ED) according to various sociodemographic factors. We conducted a retrospective study of patients presenting to EDs in a large tertiary-care hospital in the Bronx, New York with a diagnosis of ureteral stones. Electronic chart review was used to assess each patient’s ED course and to gather socio-demographic information. The primary outcomes of interest were administration of pain medication, prescription of alpha-1 antagonists to facilitate stone passage, and whether or not patients received CT scan or ultrasound. Associations of these outcomes with age categories, sex, race/ethnicity, BMI category, socioeconomic status and insurance status were examined using multivariate logistic regression models. 1200 patients were included in this analysis of which 616 (51%) were women. A large proportion of patients were minorities: 40% Hispanic, 15% non-Hispanic Black, and 20% other/multiracial. Patients aged 55–64 years and those 65 or older were less likely to receive pain medication compared to patients < 35 years (OR = 0.48, 95% CI 0.27–0.86, p = 0.01 and OR = 0.46, 95% CI 0.21–1.00, p = 0.05, respectively). Women were less likely than men to undergo any form of diagnostic imaging (OR = 0.52, 95% CI 0.35–0.76, p = 0.001). Similarly, patients in the lowest quintile of SES received less imaging than patients in the highest SES group (OR = 0.50, 95% CI 0.27–0.90, p = 0.02). Finally, women were less likely to receive alpha blockade compared to men (OR = 0.68, 95% CI 0.49–0.92, p = 0.014). Multiple disparities exist among patients presenting to the emergency department for ureteral stones.

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance I (MP48)1 Apr 2019MP48-16 ATENOLOL REDUCES INCIDENT LOW AND INTERMEDIATE RISK PROSTATE CANCER Ali Zahalka*, Ethan Fram, Wilson Lin, Larkin Mohn, Paul Frenette, Ilir Agalliu, and Kara Watts Ali Zahalka*Ali Zahalka* More articles by this author , Ethan FramEthan Fram More articles by this author , Wilson LinWilson Lin More articles by this author , Larkin MohnLarkin Mohn More articles by this author , Paul FrenettePaul Frenette More articles by this author , Ilir AgalliuIlir Agalliu More articles by this author , and Kara WattsKara Watts More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000556400.17034.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Recent evidence from pre-clinical models of prostate cancer (PCa) suggests that disruption of adrenergic signaling by beta-adrenergic receptor blockade inhibits PCa progression to more aggressive pathology. We examined the in vivo association between use of oral beta-blockers and incident PCa on initial prostate biopsy in a diverse, urban academic center. METHODS: A retrospective review of men who underwent initial prostate biopsy for any clinical indication between 2006-2016 at a large urban academic center was performed. The oral use of a Beta-blocker — Atenolol, Metoprolol, or Carvedilol — was assessed by reviewing patients’ active prescriptions (determined by prescription refill history) within one year preceding their corresponding biopsy. Patient demographics, pre-biopsy prostate specific antigen (PSA), biopsy pathology, and clinical stage were collected. Multinomial logistic regression analysis was used to evaluate the association of Beta-blocker use with subsequent incident PCa risk group (controls were used as reference category). RESULTS: 4,182 men underwent initial prostate biopsy during the study period and were included in the study. 64% self-identified as Black or Hispanic. 669 (16%) men were included in the B-blocker cohort based on preceding prescription refill history, of which 350 (17.7%) had benign pathology and 319 (14.5%) with PCa. Of all men with PCa on biopsy, risk groups (NCCN criteria) were as follows: 337 (8.1%) high risk, 1,029 (25.0%) intermediate risk, 169 (4%) low risk, and 671 (16.0%) very low risk PCa. On multivariate analysis, the beta-blocker, Atenolol, displayed a significant protective effect on both incident low risk and intermediate risk PCa (OR 0.55, P=0.02; OR 0.11, P=0.03, respectively) after adjusting for age, PSA, BMI, socioeconomic status (SES), cardiovascular disease, and race (presented in the Table). CONCLUSIONS: The oral beta-blocker, Atenolol, showed an approximately 50% reduction in incident intermediate risk PCa compared to men not taking a beta-blocker, as well as a dramatic reduction in incident low risk disease on prostate biopsy. Our results, combined with recent results from pre-clinical models of PCa, provide preliminary support for further research into the use of Atenolol as a potential protective pharmacologic agent against de novo PCa or PCa disease progression. Source of Funding: NIH National Cancer Institute F30CA203446 and T32 NS007098 Bronx, NY© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e703-e703 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ali Zahalka* More articles by this author Ethan Fram More articles by this author Wilson Lin More articles by this author Larkin Mohn More articles by this author Paul Frenette More articles by this author Ilir Agalliu More articles by this author Kara Watts More articles by this author Expand All Advertisement PDF downloadLoading ...

OBJECTIVES/SPECIFIC AIMS: The prevalence of kidney stone disease has increased significantly in the United States in the last 2 decades. While several studies have reported that disparities in access to and quality of medical care exist, there is a need for a more thorough investigation of factors that negatively impact patients seeking care specifically for kidney stone disease. We sought to examine whether kidney stone patients received different standard of care in the emergency department (ED) according to their race/ethnicity, gender, age, body mass index, socioeconomic status (SES), and insurance status. METHODS/STUDY POPULATION: We conducted a retrospective study of patients presenting to the ED at Montefiore Medical Center between January 1, 2014 and December 31, 2016. Patients with a diagnosis of nephrolithiasis were identified using ICD-9/10 codes and electronic chart review was used to assess each patient’s ED course as well as to gather sociodemographic information. The primary outcomes of interest were administration of pain medication, prescription of alpha-1 antagonists to facilitate stone passage and whether or not patients received CT scan or ultrasound. Associations of these outcomes with age categories, sex, race/ethnicity, body mass index category, SES and insurance status were examined using multivariate logistic regression models. RESULTS/ANTICIPATED RESULTS: A total of 1200 patients were included in this analysis of which 616 (51%) were women. A large proportion of patients were minorities (40% Hispanic and 15% non-Hispanic African-American), whereas 21% were Caucasian and 24% declined to report race/ethnicity. Patients between the ages of 55–64 and those older than 65 were less likely to receive pain medication compared to younger patients aged <35 years (OR=0.48, 95% CI: 0.27–0.86 and OR=0.46, 95% CI: 0.21–1.00, respectively). Women were less likely than men to undergo any form of diagnostic imaging (OR=0.52, 95% CI: 0.35–0.76) including CT scan (OR=0.50, 95% CI: 0.35–0.72). Similarly, patients in the lowest quintile of SES received less imaging than patients in higher SES categories (OR=0.50; 95% CI: 0.27–0.90). Furthermore, African Americans (both genders) and women were less likely to be prescribed an alpha antagonist medication (e.g., tamsulosin) to facilitate stone passage compared with White patients (OR=0.61, 95% CI 0.36–1.03) and men (OR=0.68, 95% CI: 0.49–0.92), respectively. DISCUSSION/SIGNIFICANCE OF IMPACT: We found that multiple disparities exist among patients presenting to the ED for nephrolithiasis. A more thorough investigation into the causes of these disparities is warranted to limit their impact on patient care.