Ohio University Eastern

The purpose of this investigation was to examine the effect of caffeine (an adenosine receptor antagonist) on whole-body insulin-mediated glucose disposal in resting humans. We hypothesized that glucose disposal would be lower after the administration of caffeine compared with placebo. Healthy, lean, sedentary (n = 9) men underwent two trial sessions, one after caffeine administration (5 mg/kg body wt) and one after placebo administration (dextrose) in a double-blind randomized design. Glucose disposal was assessed using a hyperinsulinemic-euglycemic clamp. Before the clamp, there were no differences in circulating levels of methylxanthines, catecholamines, or glucose. Euglycemia was maintained throughout the clamp with no difference in plasma glucose concentrations between trials. The insulin concentrations were also similar in the caffeine and placebo trials. After caffeine administration, glucose disposal was 6.38 +/- 0.76 mg/kg body wt compared with 8.42 +/- 0.63 mg/kg body wt after the placebo trial. This represents a significant (P < 0.05) decrease (24%) in glucose disposal after caffeine ingestion. In addition, carbohydrate storage was 35% lower (P < 0.05) in the caffeine trial than in the placebo trial. Furthermore, even when the difference in glucose disposal was normalized between the trials, there was a 23% difference in the amount of carbohydrate stored after caffeine administration compared with placebo administration. Caffeine ingestion also resulted in higher plasma epinephrine levels than placebo ingestion (P < 0.05). These data support our hypothesis that caffeine ingestion decreases glucose disposal and suggests that adenosine plays a role in regulating glucose disposal in resting humans.

PURPOSE: We identified clinical, treatment and dosimetric parameters associated with the development of urethral strictures following permanent prostate brachytherapy. MATERIALS AND METHODS: From April 1995 through April 2003, 1,186 consecutive patients underwent prostate brachytherapy for clinical stage T1b-T3a NxM0 (2002 American Joint Committee on Cancer) prostate cancer. The treatment plan included supplemental XRT in 625 patients (52.7%) and androgen deprivation therapy in 465 (39.2%). Median followup was 4.3 years. Multiple clinical, treatment and dosimetric parameters were evaluated in univariate and multivariate analyses to identify independent predictors for urethral stricture disease. RESULTS: A total of 29 patients had brachytherapy related urethral strictures. All strictures involved the BM urethra with a 9-year actuarial risk of 3.6% and a median time to development of 2.4 years. The mean radiation dose to the BM urethra was significantly greater in patients with vs without stricture (p = 0.002). On multivariate analysis the BM urethral dose and supplemental XRT predicted urethral stricture. All except 3 patients were successfully treated with urethral dilation or internal optical urethrotomy. CONCLUSIONS: Brachytherapy related urethral stricture disease correlates highly with the radiation dose to the BM urethra. Careful attention to brachytherapy preplanning and intraoperative execution along with the judicious use of supplemental XRT is essential to minimize the incidence of stricture disease.

OBJECTIVE: To determine if the International Prostate Symptom Score (IPSS) before seed implantation, stratified into mild (0-7), moderate (8-19) and severe (>20) categories, predicts brachytherapy-related morbidity in terms of IPSS resolution, catheter dependency and the need for surgical intervention after brachytherapy. PATIENTS AND METHODS: From January 1998 to September 2003, 1034 consecutive patients had permanent interstitial brachytherapy for clinical stage T1b-T3a NXM0 (2002 system) prostate cancer. Of the 1034 patients, 739 (71.5%) presented with an IPSS of 0-7, 287 (27.7%) of 8-19, and eight (0.8%) of > or = 20. The IPSS 8-19 cohort was further stratified into 8-14 (237 men) and 15-19 (50 men) subgroups. The median follow-up was 38.2 months. In all patients, an alpha-blocker was initiated before brachytherapy and continued at least until the IPSS normalized, the latter defined as a return to within 1 point of that before implantation. A median of 21 IPSS questionnaires were obtained per patient. Several clinical, treatment and dosimetric variables were evaluated as predictors of urinary morbidity. RESULTS: For the entire cohort, the IPSS peaked at a mean of 0.5 months after implantation and resolved at a mean of 1.7 months. At 5 years after brachytherapy, 90.1% of patients at risk (88.8%, 95.5%, and four of eight patients with a pre-implant IPSS of 0-7, 8-19 and > or = 20, respectively) were within the IPSS 0-7 category. Compared to the pre-implant IPSS, 13 patients (8%) were assigned to a higher IPSS severity category. Neither prolonged urinary catheter dependency (>5 days; 16 patients, 1.5%) or transurethral resection of the prostate (TURP, 17 patients, 1.6%) depended on the pre-implant IPSS subgroup. In Cox regression analysis, IPSS resolution was best predicted by pre-implant IPSS, prolonged catheter dependency by patient age, and TURP by any catheter dependency, the maximum IPSS increase and the maximum urethral dose. CONCLUSIONS: The IPSS before implantation predicted the resolution of IPSS after brachytherapy, but did not correlate with substantial urinary morbidity, including catheter dependency or the need for TURP. At 5 years after brachytherapy, 90.1% of patients at risk were assigned to the IPSS 0-7 category.

The objective of this study was to investigate graduate students' perceptions of their graduate advisors' communication (competence, credibility, and nonverbal immediacy), and how these perceptions impact advisees' perceptions of learning, effectiveness of the advisee‐advisor relationship, and advisors' degrees of mentoring. Advisee perceptions of her or his advisor's competence and caring/goodwill accounted for 43% of the variance in advisee cognitive learning. Advisee perceptions of her or his advisor's caring/ goodwill accounted for 39% of the variance in advisee perceptions of the effectiveness of the advisee‐advisor relationship. Lastly, this study noted that the linear combination of advisee perceptions of advisor credibility and communication competence accounted for 55% of the variance in an advisee's perception of the amount of mentoring an advisee received from her or his graduate advisor.

Students who lack academic maturity can sometimes feel overwhelmed in a fully flipped classroom. Here an alternative, the Semi-Flipped method, is discussed. Rural students, who face unique challenges in transitioning from high school learning to college-level learning, can particularly profit from the use of the Semi-Flipped method in the General Chemistry classroom. This method brings together preparation before class, active learning in class, and a supportive homework system, and it appears to have significant benefits both for students and for the instructor.

OBJECTIVE: To report the biochemical progression-free survival (BPFS) in hormone-naive men aged < or = 54 years who underwent brachytherapy with or without supplemental external beam radiation therapy (EBRT), as despite favourable biochemical control rates with brachytherapy, there remains a reluctance to recommend non-extirpative approaches for young men with clinically localized prostate cancer. PATIENTS AND METHODS: From April 1995 to October 2002, 108 hormone-naive patients aged < or = 54 years (median 52 years, range 45-54) had permanent interstitial brachytherapy for clinical stage T1c-T2c NXM0 (2002 American Joint Committee on Cancer staging) prostate cancer. No patient had a seminal vesicle biopsy or pathological lymph node staging. The mean (sd, median) follow-up was 5.3 (1.8, 4.8) years. BPFS was defined by a prostate-specific antigen (PSA) level of < or = 0.40 ng/mL after the nadir. Risk groups were assigned using the Memorial Sloan-Kettering Cancer Center criteria. Several clinical, treatment and dosimetric variables were evaluated for their effect on BPFS. RESULTS: For the entire group, the actuarial 8-year BPFS was 96%; for low- (57 men), intermediate- (47) and high- (four) risk patients, the BPFS rates were 96%, 100% and three of four, respectively. For biochemically disease-free patients, the median PSA level after treatment was 0.05 ng/mL. In a multivariate analysis, only pretreatment PSA level predicted biochemical control, while dosimetry variables after treatment were almost statistically significant. CONCLUSIONS: Hormone-naive patients aged < or = 54 years have a high probability of a good 8-year BPFS after permanent interstitial brachytherapy with or without supplemental EBRT.

BACKGROUND: The impact of primary Gleason pattern was determined on cause-specific (CSS), biochemical progression-free (bPFS), and overall survival (OS) after brachytherapy for Gleason score 7 prostate cancer. METHODS: From April 1995 to October 2003, 530 patients underwent brachytherapy for Gleason score 3+4 (n = 300) or Gleason 4+3 (n = 230) prostate cancer. All patients underwent brachytherapy more than 3 years before analysis. The median follow-up was 5.7 years. Of the 530 patients, 412 (77.7%) received supplemental external beam radiation therapy (XRT) and 177 (33.4%) received androgen deprivation therapy. bPFS was defined by a prostate-specific antigen (PSA) </=0.40 ng/mL after nadir. Multiple parameters were evaluated as predictors of CSS, bPFS, and OS. RESULTS: At 10 years, Gleason 3+4 versus 4+3 did not predict for CSS (96.7% vs 93.3%, P = .506), bPFS (97.0% vs 92.9%, P = .085), or OS (77.0% vs 78.0%, P = .933). Cox linear regression analysis demonstrated that clinical stage and radiation dose (D90) predicted for CSS, whereas pretreatment PSA, clinical stage, and prostate size predicted for bPFS. Patient age, diabetes, and tobacco were the strongest predictors for OS. To date, 57 patients have died, with 80.7% due to cardiovascular/pulmonary events or secondary malignancies. Five patients have died of prostate cancer. CONCLUSIONS: The primary Gleason pattern did not impact CSS, bPFS, or OS in Gleason score 7 prostate cancer. Deaths from cardiovascular/pulmonary disease and second malignancies were 9.6 times more common than death from prostate cancer.

The purpose of this study was to examine the psychometric properties of the newly developed Humor Assessment (HA) instrument. Previous research (Wrench & McCroskey, 2001) noted a construct validity problem with the Humor Orientation (HO) scale created by M. Booth‐Butterfield and S. Booth‐Butterfield (1991). This study examined the relationships between the HA, which corrects the construct validity problem seen in the HO, and affective learning, nonverbal immediacy, cognitive learning, learning loss, student motivation, and teacher credibility.

PURPOSE: To evaluate the impact of obesity on cause-specific (CSS), biochemical progression-free (bPFS), and overall survival (OS) following prostate brachytherapy. MATERIALS AND METHODS: From April 1995 through March 2003, 1093 consecutive patients underwent brachytherapy for clinical T1b-T3a (2002 AJCC) prostate cancer. The median follow-up was 5.6 years. Evaluated body mass index (BMI) subgroups were < 25 (n = 258), 25.0 to 29.9 (n = 547), 30.0 to 34.9 (n = 214), and > or = 35 (n = 74) kg/m2, respectively. A total of 430 (39.9%) and 589 (53.9%) of the patients received androgen deprivation therapy or supplemental external beam radiation therapy, respectively. Multiple clinical, treatment, and dosimetric parameters were evaluated as predictors of CSS, bPFS, and OS. RESULTS: The 11-year CSS, bPFS, and OS for the entire cohort were 97.5%, 95.6%, and 77.6%, respectively. BMI did not impact CSS or bPFS for any of the BMI cohorts. However, OS was statistically lower in patients with a BMI < 25 kg/m2 (P = 0.014). A Cox linear regression analysis demonstrated that Gleason score was the best predictor of CSS while percent-positive biopsies, risk group, V100 and hypertension predicted for bPFS. Patient age and tobacco use were the strongest predictors of OS. A total of 128 patients have died with 108 (84.4%) of the deaths the result of cardiovascular/pulmonary disease (73) and second malignancies (35). To date, 12 patients have died of metastatic prostate cancer. CONCLUSION: Obesity did not impact CSS, bPFS, or OS in patients treated with permanent prostate brachytherapy. Cardiovascular or pulmonary disease and second malignancies substantially outweighed prostate cancer as competing causes of death.

OBJECTIVE: To evaluate the incidence and temporal resolution of dysuria after permanent prostate brachytherapy, and to identify predictors of brachytherapy-related dysuria. PATIENTS AND METHODS: The study included 130 patients with no history of transurethral resection of the prostate before treatment, who had brachytherapy on one of two prospective randomized trials, with explicitly planned and executed urethral-sparing techniques (100-150% minimum peripheral dose) using either 103Pd or 125I for clinical T1c-T2c prostate cancer. The median follow-up was 22.6 months. An alpha-blocker was initiated either prophylactically 2 weeks before implantation and continued at least until the International Prostate Symptom Score (IPSS) returned to normal, or withheld until the onset of significant brachytherapy-related urinary morbidity. Dysuria was evaluated on a 0-10 scale, before brachytherapy and then at 1, 3, 6 and 12 months afterward, with a median of four dysuria questionnaires per patient. Clinical, treatment and dosimetric variables evaluated included alpha-blocker, age, IPSS before and the maximum after treatment, prostate volume on ultrasonography, hormonal status, supplemental radiotherapy, isotope, urethral dose, V(100/200), D90, and time to obtaining a normal IPSS. RESULTS: The maximum incidence of dysuria was 85% at 1 month after brachytherapy, with subsequent resolution over time. The use of prophylactic tamsulosin resulted in a statistically lower dysuria severity score (difference of 2.7 vs 4.2, P < 0.005) at 1 month, with no discernible differences at 3, 6, 12 and 18 months. Patients with dysuria had a statistically higher IPSS. The dysuria resolved faster in patients implanted with 103Pd but was unaffected by the use of supplemental radiotherapy and/or androgen deprivation therapy. In multivariate analysis, prophylactic alpha-blockers resulted in statistically lower maximum dysuria scores, while the maximum IPSS after implantation and isotope type (but only at 6 months) were the best predictors of the resolution of dysuria. CONCLUSIONS: Dysuria is common after brachytherapy but is typically mild. Prophylactic alpha-blockers gave significantly lower maximum dysuria scores but did not affect the time to the resolution of dysuria. The maximum IPSS after the implant was the best predictor of the resolution of dysuria.

It is well-known that when searching one out of four, the original Grover's search algorithm is exact; that is, it succeeds with certainty. It is natural to ask the inverse question: If we are not searching one out of four, is Grover's algorithm definitely not exact? In this article we give a complete answer to this question through some rationality results of trigonometric functions.

PURPOSE: To evaluate the effect of prostate brachytherapy with or without supplemental therapies on long-term rectal function by means of a patient-administered quality-of-life instrument. MATERIALS AND METHODS: As part of an ongoing prospective evaluation, 164 of an initial 209 patients who remain alive were mailed the Rectal Function Assessment Score (R-FAS) with a prestamped return envelope. R-FAS range from 0 to 27 with lower scores being indicative of better bowel function. Of the 162 eligible patients, 161 (99.4%) returned the survey. Median follow-up was 9.0 years (range 8.2-11.2 years). Clinical, treatment, and dosimetric parameters evaluated for bowel function included patient age, diabetes, hypertension, tobacco consumption, clinical T stage, elapsed time since brachytherapy, ultrasound volume, planning target volume, androgen deprivation therapy, supplemental external beam radiation, isotope, rectal dose, prostate D100/D150/D200, and prostate D90. RESULTS: For the entire cohort, the current R-FAS was 3.59, which represented a nonstatistical improvement from prior surveys in 1999 (4.29) and 2002 (3.92) (P=0.134). Only 16 patients (9.9%) reported bowel function to be worse after brachytherapy. Of the clinical, treatment, and dosimetric parameters evaluated, only the number of preimplant bowel movements, tobacco use, and diabetes correlated with R-FAS. Despite lower rectal doses with Pd, isotope did not predict for bowel function. Consistent with prior surveys, patient perception of overall rectal quality of life was inversely related to supplemental external beam radiation (P=0.027). CONCLUSION: Prostate brachytherapy adversely affects bowel function. However, in most patients the changes are minimal and slowly resolve with time. Overall rectal quality of life is inversely related to supplemental external beam radiation.

OBJECTIVES: To determine the location and grade of prostate cancer diagnosed by transperineal template-guided mapping (TTMB) after negative transrectal ultrasound-guided (TRUS) biopsy. MATERIALS AND METHODS: This analysis consisted of 1118 consecutive patients who underwent TTMB from January 2005 to August 2015. Eight hundred thirty-five underwent TTMB after at least 1 negative TRUS biopsy and 283 underwent TTMB as the first biopsy procedure. The study population was divided into cohorts based on the number of prior TRUS biopsy sessions (0, 1, 2, and ≥3). No patient underwent multiparametric magnetic resonance imaging. Differences in location and cancer grade detected on TTMB were evaluated as a function of the number of prior TRUS biopsies. RESULTS: Of the 1118 patients, 679 were diagnosed with prostate cancer. This included 208, 325, 104, and 42 patients who underwent 0, 1, 2, and ≥3 prior TRUS biopsies. The incidence of cancer detection on TTMB decreased as the number of prior TRUS biopsies increased (73.5% vs. 62.4% vs. 51.7% vs. 37.2%, P<0.001); however, it became increasingly likely that TTMB would detect anterior prostate only as the number of prior TRUS biopsies increased (P=0.007). Moreover, the incidence of high grade cancer (Gleason score ≥7) in the anterior gland increased with the number of previous TRUS biopsies. CONCLUSIONS: TTMB detected prostate cancer in over half of the patients with one or more negative TRUS biopsies. The majority of TTMB detected cancers were Gleason score ≥7. As the number of prior TRUS biopsies increased, there was a commensurate increase in the proportion of high-grade, anterior only disease.

PURPOSE: Recent studies have suggested that extracapsular brachytherapy treatment margins correlate with biochemical control. It is likely that volumetric geographic dosimetric parameters will be more robust than selected radial measurements. Accordingly, we evaluated extracapsular volumetric dosimetric parameters in low-risk patients. MATERIALS AND METHODS: A total of 263 low-risk prostate cancer patients randomized to Pd-103 versus I-125 were implanted with a brachytherapy target volume consisting of the prostate with a 5-mm periprostatic margin. The median follow-up was 4.2 years. All patients were implanted at least 3 years prior to analysis. Within 2 hours of implantation, an axial CT was obtained for postimplant dosimetry. A 5-mm three-dimensional periprostatic anulus was constructed around the prostate and evaluated in its entirety and in 90 degrees segments. Prostate and anular dosimetric parameters consisted of V100/V150/V200 and D90. Biochemical progression-free survival (bPFS) was defined as a PSA < or =0.50 ng/mL after nadir. RESULTS: The Pd-103 and I-125 arms were well-matched in terms of clinical, biochemical, and pathologic presentation. Six-year bPFS was 96.8% versus 99.2% for I-125 versus Pd-103 (P = 0.149). The most recent median posttreatment PSA was <0.04 ng/mL for both isotopes. No significant differences in postoperative anular doses were discerned between bPFS and failed patients. CONCLUSIONS: A postimplant 5-mm, three-dimensional periprostatic anulus provides substantial information regarding dosimetric coverage. However, with a median follow-up of 4.2 years, such volumetric and geographic parameters have not proven useful in predicting biochemical outcome in low-risk patients.

No AccessJournal of UrologyUrological survey1 Mar 2006Erectile Function After Prostate Brachytherapy G.S. Merrick, W.M. Butler, K.E. Wallner, R.W. Galbreath, R.L. Anderson, B.S. Kurko, J.H. Lief, and Z.A. Allen G.S. MerrickG.S. Merrick More articles by this author , W.M. ButlerW.M. Butler More articles by this author , K.E. WallnerK.E. Wallner More articles by this author , R.W. GalbreathR.W. Galbreath More articles by this author , R.L. AndersonR.L. Anderson More articles by this author , B.S. KurkoB.S. Kurko More articles by this author , J.H. LiefJ.H. Lief More articles by this author , and Z.A. AllenZ.A. Allen More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)00590-2AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Erectile Function After Prostate Brachytherapy." The Journal of Urology, 175(3), pp. 959–960 Schiffler Cancer Center and Wheeling Jesuit University, Wheeling, West Virginia, Puget Sound Healthcare Corporation, Group Health Cooperative and University of Washington, Seattle, Washington, and Ohio University Eastern, St. Clairsville, Ohio© 2006 by American Urological AssociationFiguresReferencesRelatedDetails Volume 175Issue 3March 2006Page: 959-960 Advertisement Copyright & Permissions© 2006 by American Urological AssociationMetricsAuthor Information G.S. Merrick More articles by this author W.M. Butler More articles by this author K.E. Wallner More articles by this author R.W. Galbreath More articles by this author R.L. Anderson More articles by this author B.S. Kurko More articles by this author J.H. Lief More articles by this author Z.A. Allen More articles by this author Expand All Advertisement PDF DownloadLoading ...

PURPOSE: Although the perception exists that biochemical outcome in patients with a Gleason score of 7 with dominant pattern 4 histology is inferior to that of patients with a Gleason score of 7 with a primary Gleason grade of 3, conflicting conclusions have been reported for radical prostatectomy and brachytherapy. In this study, we evaluate the effect of the dominant histologic pattern in Gleason score 7 prostate cancer on biochemical progression-free survival after brachytherapy. MATERIAL AND METHODS: Between April 1995 and October 2001, 273 consecutive patients underwent permanent interstitial brachytherapy without androgen deprivation therapy for clinical T1c-T3a NxM0 (2002 American Joint Committee on Cancer) prostate cancer. No patient underwent seminal vesicle biopsy or pathological lymph node staging. All patients underwent brachytherapy more than 3 years before analysis. Biochemical progression-free survival was defined by a prostate specific antigen (PSA) cut point < or = 0.4 ng/mL after nadir or by the American Society for Therapeutic Radiology and Oncology (ASTRO) consensus definition. The median follow-up was 4.7 years. Clinical, treatment, and dosimetric parameters evaluated for biochemical progression-free survival included primary Gleason grade; clinical T stage; pretreatment PSA level; risk group; percent positive biopsy results; perineural invasion; patient age; isotope; supplemental external-beam radiation therapy; prostate volume; brachytherapy planning volume; percent of the target volume receiving 100%, 150%, and 200% of the prescribed dose (V100/150/200); minimum percent of the prescribed dose covering 90% of the target volume (D90); tobacco consumption; hypertension; and diabetes. RESULTS: For the entire cohort, the actuarial 8-year biochemical progression-free survival rate was 94.5% and 94.8% using a PSA cut point < or = 0.4 ng/mL after nadir and the ASTRO consensus definition, respectively. For biochemically disease free patients, the median posttreatment PSA level was < 0.1 ng/mL. When the group was stratified by the dominant histologic pattern, no statistical difference in outcome was noted for any of the evaluated parameters. In forward conditional Cox regression analysis, pretreatment PSA level and percent positive biopsy results were statistically significant predictors of biochemical outcome. CONCLUSIONS: In hormone-naive patients with a Gleason score of 7, prostate brachytherapy results in a high probability of 8-year biochemical progression-free survival and is independent of Gleason 3 + 4 versus 4 + 3 histology.

OBJECTIVES: Despite favorable long-term prostate brachytherapy outcomes, there remains a bias to recommend radical prostatectomy for young patients. Herein, we report cause-specific survival, biochemical progression-free survival (bPFS), overall survival and functional outcomes in men < or =50 years of age who underwent brachytherapy with or without supplemental therapies. METHODS: From October 1995 to November 2004, 42 consecutive patients < or =50 years of age underwent permanent interstitial brachytherapy. No patient underwent seminal vesicle biopsy or pathologic lymph node staging. The mean and median follow-up was 5.6 and 5.1 year. bPFS was defined as a prostate-specific antigen < or =0.40 ng/mL after nadir. Functional outcome determinations included urinary, bowel and erectile function evaluations. Multiple clinical, treatment and dosimetric parameters were evaluated for impact on survival. RESULTS: Cause-specific survival, bPFS, and overall survival for the entire cohort were 100%, 97.7%, and 100%, respectively. To date, only one patient has failed biochemically. Median time to International Prostate Symptom Score resolution was 3 months. No patient required a postimplant transurethral resection of the prostate or developed urinary incontinence. Two patients developed bulbomembtranous urethral strictures. The overall potency preservation rate was 75.6% (International Index of Erectile Function-6 >13 without mechanical or pharmacologic support). Bowel habits were reported to be the same or better than prior to treatment in 92.5% patients. No severe rectal complications requiring therapeutic intervention occurred. CONCLUSIONS: Men < or =50 years of age have favorable biochemical and functional outcomes following brachytherapy. Depending on risk group assignment, brachytherapy with or without supplemental therapies should be considered a viable option for all healthy men regardless of age.

OBJECTIVES: To evaluate whether the use of androgen deprivation therapy (ADT) in prostate brachytherapy patients impacts overall mortality (OM) in patients with lower pretreatment serum testosterone levels compared with those with normal or high baseline serum testosterone. MATERIALS AND METHODS: From October 2001 to May 2014, 1916 patients underwent brachytherapy and had a pretreatment serum testosterone. Baseline serum testosterone values were collected prospectively before initiation of therapy. Median follow-up was 7.2 years. In total, 26% of the patients received ADT, primarily men with higher risk disease. OM and prostate cancer-specific mortality were examined to determine whether men with lower baseline serum testosterone were at increased risk of mortality when ADT was used, compared with men with baseline normal or higher testosterone. RESULTS: Prostate cancer-specific mortality and OM at 10 years was 0.8% and 22.0%. Age, tobacco use, diabetes, cardiovascular disease, and percent positive biopsies were the strongest predictors of OM. ADT use by itself was not associated with an increased risk of OM on multivariate analysis (P=0.695). However, ADT use in men with lower baseline testosterone was associated with a significantly higher risk of OM (P<0.01). ADT use in men with normal or higher baseline testosterone was not associated with an increased OM risk (P=0.924). CONCLUSIONS: Men with lower baseline testosterone may be at increased risk of premature death when ADT is utilized compared with men with baseline normal or higher testosterone. Further analysis of this potential risk factor is warranted to further identify subsets of men who may be at higher risk of long-term adverse sequelae from ADT.

OBJECTIVES: Previous studies have evaluated whether metformin is associated with prostate cancer incidence and outcomes with conflicting conclusions. In this study, we evaluate the incidence of prostate cancer in diabetic patients treated with and without metformin compared with nondiabetic patients. MATERIALS AND METHODS: One thousand thirty-four patients underwent transperineal template-guided mapping biopsy secondary to either an elevated prostate-specific antigen (PSA) or a prior biopsy finding of atypical small acinar proliferation/prostatic intraepithelial neoplasia. The cohort included 881 nondiabetic men, 65 diabetic men treated with metformin, and 88 diabetic men not receiving metformin. In metformin-treated patients, the median duration of usage was 6.0 years. Differences in prostate cancer diagnosis, histologic grade, and tumor volume were compared across the 3 cohorts. RESULTS: There was no statistically significant differences discerned between the 3 cohorts in patient age, prebiopsy PSA, prostate volume, PSA density, PSA doubling time, PSA velocity, or the total number of prior transrectal ultrasound biopsy sessions. Five hundred eighty-four patients were diagnosed with prostate cancer. There was no difference in prostate cancer diagnosis (P=0.153), Gleason score (P=0.960), the number of positive biopsy cores (P=0.764), or risk group stratification (P=0.877) between the 3 cohorts. In multivariate analysis, only older age predicted for prostate cancer diagnosis. In terms of Gleason score ≥7, patient age, PSA velocity, and body mass index predicted for more aggressive histology. Neither diabetes, metformin use or duration was of statistical consequence. CONCLUSION: Metformin did not impact incidence of prostate cancer diagnosis, Gleason score distribution, or volume of disease.

Abstract Objectives To evaluate the impact of age on overall survival (OS), freedom from distant metastasis (FDM), rates of therapeutic intervention (TI), and quality of life (QOL) in active surveillance (AS) prostate cancer patients. Materials and methods Three hundred and five consecutive, prospectively evaluated AS patients who underwent a staging transperineal template‐guided mapping biopsy (TTMB) prior to enrollment on AS were evaluated and stratified by age. Evaluated outcomes included OS, FDM, TI, and QOL to include urinary, bowel, sexual function, and depression. Post void residual (PVR) urine measurements were also followed. Repeat biopsy was based on PSA kinetics, abnormal digital rectal examination or patient preference. Results Of the 305 patients, 290 (95.1%) were Gleason 3 + 3 and 15 patients (4.9%) were Gleason 3 + 4. The median follow‐up was 5.5 years (range 1‐14 years). At 10 years, TI was 0%, 1.0%, and 11.4% for patients ≤59, 60‐69, and ≥70 years of age ( P &lt; .001). No patient has developed distant metastasis. The median time to TI was 4.71 years. No statistical differences in urinary function, bowel function, or depression were noted. Potency preservation was dependent on patient age. Conclusion Within the confines of the follow‐up of our series, younger patients were less likely to proceed to therapeutic intervention. In addition, patient age did not adversely impact QOL outcomes.