Subsequent risk of acute urinary retention and androgen deprivation therapy in patients with prostate cancer

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Abstract

Acute urinary retention (AUR) is associated with hormone imbalance in men. However, limited studies focused on exploring the complications of AUR in patients with prostate cancer (PC) who receive androgen deprivation therapy (ADT). Therefore, we aim to evaluate the subsequent risk of AUR in ADT-treated PC patients. We collected data from 24,464 male patients who were newly diagnosed with prostate malignancy from a longitudinal health insurance database of catastrophic illness in 2000 to 2008. All PC patients were categorized into 2 cohorts, namely, ADT cohort and non-ADT cohort, based on whether or not the patient receives ADT. The patients were followed up until the occurrence of AUR. Multivariate Cox proportional hazard regression and Kaplan–Meier analysis were performed. After a 12-year follow-up, the incidence rates of AUR were 12.49 and 9.86 per 1000 person-years in ADT and non-ADT cohorts, respectively. Compared with the non-ADT cohort, the ADT cohort had a 1.21-fold increase in AUR risk based on the adjusted model (95% CI = 1.03–1.43). In addition, PC patients receiving early ADT treatment within 6 months or receiving only luteinizing hormone-releasing hormone treatment also had significantly increased risk of AUR. ADT was positively associated with AUR risk. PC patients receiving ADT should be informed about the risks of bladder outlet obstruction and AUR, and they may benefit from screening for related risk factors. New guidelines and treatments should be proposed in the future to manage ADT-related lower urinary tract symptoms and reduce the risk of AUR.

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Estimating measures of interaction on an additive scale for preventive exposures

Mirjam J Knol, Tyler J. VanderWeele, Rolf H. H. Groenwold … (2011)

Measures of interaction on an additive scale (relative excess risk due to interaction [RERI], attributable proportion [AP], synergy index [S]), were developed for risk factors rather than preventive factors. It has been suggested that preventive factors should be recoded to risk factors before calculating these measures. We aimed to show that these measures are problematic with preventive factors prior to recoding, and to clarify the recoding method to be used to circumvent these problems. Recoding of preventive factors should be done such that the stratum with the lowest risk becomes the reference category when both factors are considered jointly (rather than one at a time). We used data from a case-control study on the interaction between ACE inhibitors and the ACE gene on incident diabetes. Use of ACE inhibitors was a preventive factor and DD ACE genotype was a risk factor. Before recoding, the RERI, AP and S showed inconsistent results (RERI = 0.26 [95%CI: −0.30; 0.82], AP = 0.30 [95%CI: −0.28; 0.88], S = 0.35 [95%CI: 0.02; 7.38]), with the first two measures suggesting positive interaction and the third negative interaction. After recoding the use of ACE inhibitors, they showed consistent results (RERI = −0.37 [95%CI: −1.23; 0.49], AP = −0.29 [95%CI: −0.98; 0.40], S = 0.43 [95%CI: 0.07; 2.60]), all indicating negative interaction. Preventive factors should not be used to calculate measures of interaction on an additive scale without recoding.

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Efficacy and safety of enzalutamide versus bicalutamide for patients with metastatic prostate cancer (TERRAIN): a randomised, double-blind, phase 2 study.

Neal Shore, Simon Chowdhury, Arnauld Villers … (2016)

Enzalutamide is an oral androgen-receptor inhibitor that has been shown to improve survival in two placebo-controlled phase 3 trials, and is approved for patients with metastatic castration-resistant prostate cancer. The objective of the TERRAIN study was to compare the efficacy and safety of enzalutamide with bicalutamide in patients with metastatic castration-resistant prostate cancer.

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Testosterone suppression in men with prostate cancer leads to an increase in arterial stiffness and hyperinsulinaemia.

C Bulpitt, Chakravarthi Rajkumar, Sanjiv Agarwal … (2003)

The role of androgens in cardiovascular disease is uncertain. We aimed to determine the vascular effects of androgen suppression in men with prostate cancer. Arterial stiffness (or 'compliance') was measured in 16 men (71+/-9 years, mean+/-S.D.) prior to, and 3 months after, complete androgen suppression with gonadotrophin-releasing hormone analogues as treatment for prostate cancer. Fifteen control men (70+/-7 years) also had arterial stiffness studies at baseline and 3 months later. Two measures of arterial stiffness were employed: systemic arterial compliance (SAC) was measured by simultaneous recording of aortic flow and carotid artery pressure ('area method'), and pulse wave velocities (PWVs) were recorded with the 'Complior' system. The 16 cases underwent glucose-tolerance and fasting-lipids tests on both visits. After 3 months of testosterone suppression, there was a significant fall in SAC, which was not seen in the controls [mean change+/-S.E.M., -0.26+/-0.09 a.c.u. (arbitrary compliance unit) in the cases versus +0.06+/-0.11 in the controls; P =0.03). Central, but not peripheral, PWVs tended to increase in the cases (mean change+/-S.E.M. for aorto-femoral PWV, +0.5+/-0.4 m/s for cases versus -0.3+/-0.3 m/s for controls; P =0.08). After testosterone suppression, fasting insulin levels increased from 6.89+/-4.84 m-units/l to 11.34+/-8.16 m-units/l (mean+/-S.D.), total cholesterol increased from 5.32+/-0.77 mmol/l to 5.71+/-0.82 mmol/l and high-density lipoprotein cholesterol increased from 1.05+/-0.24 mmol/l to 1.26+/-0.36 mmol/l; P <0.005 for all. No significant change occurred in body-mass index, serum glucose, low-density lipoprotein cholesterol or triacylglycerol (triglyceride) levels. Our results indicate that loss of androgens in men leads to an increase in aortic stiffness and serum insulin levels, and may therefore adversely affect cardiovascular risk.

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Author and article information

Journal

Journal ID (nlm-ta): Medicine (Baltimore)

Journal ID (iso-abbrev): Medicine (Baltimore)

Journal ID (publisher-id): MEDI

Title: Medicine

Publisher: Wolters Kluwer Health

ISSN (Print): 0025-7974

ISSN (Electronic): 1536-5964

Publication date Collection: February 2020

Publication date (Electronic): 14 February 2020

Volume: 99

Issue: 7

Electronic Location Identifier: e18842

Affiliations

[a ]Department of Surgery, Yonghe Cardinal Hospital

[b ]School of Medicine, College of Medicine, Fu-Jen Catholic University

[c ]Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University

[d ]Department of Urology, Shuang-Ho Hospital

[e ]Department of Urology, School of Medicine, College of Medicine, Taipei Medical University

[f ]Department of Urology

[g ]Department of Medicine

[h ]Management Office for Health Data

[i ]Department of Urology, Taipei

[j ]Department of Urology, National Taiwan University Hospital, Hsin Chu Branch, Hsin Chu City

[k ]Department of Public Health, College of Public Health, China Medical University

[l ]Department of Medical Research, China Medical University and Hospital, Taichung, Taiwan.

Author notes

[∗ ]Correspondence: Chi-Jung Chung, Department of Public Health, College of Public Health, China Medical University, No. 91 Hsueh-Shih Road, Taichung 40402, Taiwan (e-mail: cjchung1010@ 123456gmail.com ).

Article

Publisher ID: MD-D-19-07272 Accession ID: 18842

DOI: 10.1097/MD.0000000000018842

PMC ID: 7035125

PubMed ID: 32049786

SO-VID: 7ec30433-6956-4bfd-99e4-e47552389a8a

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This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0

History

Date received : 20 September 2019

Date revision received : 13 December 2019

Date accepted : 20 December 2019

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Keywords: acute urinary retention,androgen deprivation therapy,luteinizing hormone-releasing hormone,orchiectomy,prostate cancer

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Keywords: acute urinary retention, androgen deprivation therapy, luteinizing hormone-releasing hormone, orchiectomy, prostate cancer

Subsequent risk of acute urinary retention and androgen deprivation therapy in patients with prostate cancer : A population-based retrospective cohort study

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Most cited references 30

Estimating measures of interaction on an additive scale for preventive exposures

Efficacy and safety of enzalutamide versus bicalutamide for patients with metastatic prostate cancer (TERRAIN): a randomised, double-blind, phase 2 study.

Testosterone suppression in men with prostate cancer leads to an increase in arterial stiffness and hyperinsulinaemia.

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