Prostate Cancer Risk Among Men with Diabetes Mellitus (Spain)

Objective: Observational studies have associated diabetes with a decreased risk of prostate cancer. We aimed to evaluate this association using the General Practitioner Research Database in the UK. Methods: Population based case–control study nested in a cohort. Results: We identified 2,183 incident cases of prostate cancer between January 1995 and December 2001. We found that diabetic patients had a decreased risk of prostate cancer (OR = 0.72; 95% CI: 0.59–0.87). This association was observed among treated diabetics (OR = 0.63; 95% CI: 0.50–0.80) but not among untreated diabetics (OR = 1.01; 95% CI: 0.73–1.40). Our results suggest that the observed reduced risk could be restricted to users of insulin or sulphonylureas. Conclusion: Patients with diabetes have a decreased risk of prostate cancer. The role of antidiabetic treatment in this association warrants further research.     

Association of diabetes mellitus with prostate cancer: Nested case–control study (Prostate testing for cancer and Treatment study)

Observational studies suggest that diabetes is associated with a decreased risk of prostate cancer, but few are population based or have investigated associations with cancer stage or duration of diabetes. We report a case–control study nested within the population‐based Prostate testing for cancer and Treatment (ProtecT) study ISRCTN20141297. Men aged 50–69 years based around 9 UK cities were invited for a prostate‐specific antigen (PSA) test between June 2002 and November 2006. Amongst 55,215 PSA‐tested men, 1,966 had histologically confirmed prostate cancer; of these, 1,422 (72.3%) completed the questionnaire and 1,291 (65.7%) had complete data for analysis. We randomly selected 6,479 age‐ (within 5 years) and general practice‐matched controls. The prevalence of diabetes was 89/1,291 (6.9%) in cases and 555/6,479 (8.6%) in controls. Diabetes was associated with a reduced risk of prostate cancer (odds ratio = 0.78; 95% confidence interval: 0.61–0.99). There was weak evidence that the inverse association was greater for well‐ versus poorly differentiated cancers (p = 0.07). The magnitude of the inverse association did not change with increasing duration of diabetes (p for trend = 0.95). Diabetes is associated with a decreased risk of PSA‐detected prostate cancer. These data add to the evidence of the association of diabetes with prostate cancer in the PSA era.     

Association of Vasectomy and Prostate Cancer Among Men in a Maryland Cohort

Objectives To evaluate the association of vasectomy with prostate cancer. Methods Participants were male members of the CLUE II cohort followed since 1989. On a questionnaire mailed in 1996, the men were asked if they had had a vasectomy and their age at vasectomy. Between 1996 and April 2004, 78 prostate cancer cases were confirmed among the 3373 men who were at least 35 years old at baseline and who completed the questions about vasectomy. Cox proportional hazards regression was used to estimate age-adjusted hazard ratios (HR) of prostate cancer. Results The HR for prostate cancer for men who had had a vasectomy was 2.03 (95% CI: 1.24–3.32). Risk of low-grade disease (HR=2.87; 95% CI 1.49–5.54), but not high-grade disease (HR=0.99; 95% CI 0.36–2.76), was higher in men who had had a vasectomy. No statistically significant associations were observed for low- or high-stage disease. The association for vasectomy was more pronounced in men who were 40 years at the time of vasectomy (HR=2.63; 95% CI 1.40–4.94) than in men who were younger at vasectomy. Conclusions The results from this prospective study suggest a positive association between vasectomy and prostate cancer, especially low-grade disease. Supported by National Cancer Institute Grant CA 08030, National Institute of Aging Grant AG18033, and Department of Defense Grant DAMD17-94-J-4265. Dr. Rohrmann is supported by the Fund for Research and Progress in Urology, Johns Hopkins Medical Institutions. Dr. Paltoo was supported by the Cancer Prevention Fellowship Program, Office of Preventive Oncology, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD 20892, during the time she was working on this project. Dr. Comstock was partially supported by Research Career Award HL 21670 from the National Heart, Lung, and Blood Institute. These data were supplied in part by the Maryland Cancer Registry, the Department of Mental Hygiene, Baltimore, Maryland. The Department of Health and Mental Hygiene specifically disclaims responsibility for any analyses, interpretations or conclusions.     

Menopausal hormone therapy use and breast cancer risk in Australia: Findings from the New South Wales Cancer,Lifestyle and Evaluation of Risk study

Randomised controlled trials and large‐scale observational studies have found that current use of menopausal hormone therapy (MHT) is associated with an increased risk of breast cancer; this risk is higher for oestrogen–progestagen combination therapy than for oestrogen‐only therapy. Our study was designed to estimate MHT‐associated breast cancer risk in a population of Australian women. Data were analysed for postmenopausal women with self‐reported incident invasive breast cancer (n = 1,236) and cancer‐free controls (n = 862), recruited between 2006 and 2014 into a large case–control study for all cancer types, the NSW CLEAR study. Information on past and current MHT use was collected from all participants, along with other lifestyle and demographic factors, using a self‐administered questionnaire. Unmatched multivariable logistic regression was performed, adjusting for socio‐demographic, reproductive and health behaviour variables, body mass index and breast screening history. Compared to never users of MHT, the adjusted odds ratio (aOR) for breast cancer in current users of any type of MHT was 2.09 (95% CI: 1.57–2.78; p < 0.0001) and for past users of any type of MHT was 1.03 (0.82–1.28; p = 0.8243). For current users of oestrogen‐only and oestrogen–progestagen therapy, aORs were 1.80 (1.21–2.68; p = 0.0039) and 2.62 (1.56–4.38; p = 0.0003), respectively. These findings are consistent with those from other international observational studies, that current, but not past, use of MHT is associated with a substantially increased risk of breast cancer.     

Social Support and Adjustment Among Wives of Men with Prostate Cancer

This study aims to understand how wives’ mental health and life enjoyment are affected by their perceptions of the sufficiency of the support they render to their husbands who have prostate cancer. Its specific purpose is to determine whether these outcomes accrue more strongly to wives who perceive their husbands coping in avoidant ways. Drawing on data from an interview study of 51 wives of men diagnosed with prostate cancer, the authors employ heiarchical regression analysis to examine the wives’ adjustment in relation to their provision of support to their husbands. Our findings reveal a significant moderating effect of the husbands’ avoidant coping; consistent with cognitive dissonance theory, wives who provided sufficient support to more avoidant husbands demonstrated better mental health and life enjoyment than wives of men who were less avoidant. In addition, the perceived sufficiency of the support provided by the wives’ social networks had a stronger bearing on their adjustment than the support provided by their husbands. These findings add to our understanding of the psychological benefits that support providers derive when they communicate support in ways that suit the recipient's style of managing threat.     

Prostate cancer screening and mortality: A case-control study (United States)

OBJECTIVE: We performed a case-control study at Kaiser Permanente Northwest to assess the association between digital rectal examination (DRE) and prostate-specific antigen (PSA) testing, separately and together, and prostate cancer mortality. METHODS: We identified 171 KPNW members who died as a result of prostate cancer from 1992 to 1999 and 342 randomly-selected KPNW members matched to the cases on age, sex, and length of plan membership. History of screening was determined from medical records and laboratory databases for cases and controls. RESULTS: DRE and/or PSA screening at any time up to and including the case diagnosis date had taken place among 69.0% of cases and 74.6% of controls. After using logistic regression analysis to adjust for matching variables and a provider diagnosis of benign prostatic hypertrophy (BPH), we found an inverse association between receipt of a prostate cancer screening test and prostate cancer mortality (odds ratio (OR): 0.70, 95% confidence interval (CI): 0.46 - 1.1). Most of the screening tests were DREs, and it was not possible to assess the separate influence of PSA screening. CONCLUSIONS: The results of this study suggest that men who have been screened for prostate cancer have a reduced risk of dying as a result of this disease.     

Fatherhood status and risk of prostate cancer: Nationwide,population‐based case–control study

Previous studies have shown a decreased risk of prostate cancer for childless men; however, the cause of the association remains to be elucidated. The aim of our study was to assess the risk of prostate cancer by fatherhood status, also considering potential confounding factors. In a case–control study in Prostate Cancer data Base Sweden 2.0, a nationwide, population‐based cohort, data on number of children, marital status, education, comorbidity and tumor characteristics obtained through nationwide healthcare registers and demographic databases for 117,328 prostate cancer cases and 562,644 controls, matched on birth year and county of residence, were analyzed. Conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for prostate cancer overall and by risk category, adjusting for marital status and education. Childless men had a decreased risk of prostate cancer compared to fathers, OR = 0.83 (95% CI = 0.82–0.84), and risk was lower for low‐risk prostate cancer, OR = 0.74 (95% CI = 0.72–0.77), than for metastatic prostate cancer, OR = 0.93 (95% CI = 0.90–0.97). Adjustment for marital status and education attenuated the association in the low‐risk category, adjusted OR = 0.87 (95% CI = 0.84–0.91), whereas OR for metastatic cancer remained virtually unchanged, adjusted OR = 0.92 (95% CI = 0.88–0.96). Our data indicate that the association between fatherhood status and prostate cancer to a large part is due to socioeconomic factors influencing healthcare‐seeking behavior including testing of prostate‐specific antigen levels.     

Religiousness and Prostate Cancer Screening in African American Men

This study was designed to examine the relationship between religiousness (organized, nonorganized, and intrinsic) and religious problem solving (collaborative, deferring, and self-directing) in prostate cancer screening (PCS) attitudes and behavior. Men (N = 481) of African descent between the ages of 40 and 70 participated. Hierarchical regression analyses revealed that religiousness and self-directed problem solving were associated with PCS attitudes. Intrinsic religiousness was associated with PCS attitudes after controlling for health and organized religiousness. Religiousness was not associated with PCS behavior. Intrinsic religiousness may be an important dimension of religiousness to be considered in tailoring cancer interventions for individuals from faith-based communities.     

Relation of serum insulin-like growth factor-I (IGF-I) and IGF binding protein-3 to risk of prostate cancer (United States)

Objective: Insulin-like growth factor I (IGF-I) exerts potent mitogenic and antiapoptotic effects on prostatic epithelial cells. Insulin-like growth factor binding protein-3 (IGFBP-3) modulates the effects of IGF-I, and independently induces apoptosis and inhibits cell growth. Previous studies have inconsistently associated IGF-I and IGFBP-3 with prostate cancer. To try and further clarify these potential associations, we undertook a sibling-matched case–control study. Methods: Serum IGF-I and IGFBP-3 were determined for 845 men (408 cases and 437 sibling controls). Conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between the serum IGF levels and prostate cancer. Results: Among all study subjects, only the molar ratio of IGF-I to IGFBP-3 was associated with prostate cancer: comparing those in the highest to lowest quartiles gave an OR = 1.62 (95% CI = 1.02–2.57, trend-p = 0.04). Among men with clinically less aggressive disease, we observed positive associations between prostate cancer and high levels of IGF-I (OR = 2.78, 95% CI = 1.06–6.80, trend-p = 0.03), and IGFBP-3 (OR = 2.68, 95% CI = 1.08–6.80, trend-p = 0.04). Simultaneously modeling both left the IGF-I result essentially unchanged, while substantially weakening the IGFBP-3 association. Conclusions: We found that a high IGF-I to IGFBP-3 molar ratio was associated with an increased risk of prostate cancer. Furthermore, high IGF-I was associated with increased risk of prostate cancer among men with less advanced disease at diagnosis. These results lend support to the hypothesis that IGF-I, or the IGF-I to IGFBP-3 molar ratio, is an important risk factor for prostate cancer.     

Lifestyle factors and the risk of adult leukemia in Canada

Objectives: To evaluate the impact of active smoking, obesity, and dietary intakes on the risk of adult leukemia.Methods: We analysed data obtained from a population-based case–control study conducted in eight Canadian provinces. Risk estimates were generated by applying multivariate logistic regression methods to 1068 incident histologically confirmed leukemia cases and 5039 controls aged 20–74.Results: We found a statistically significant increased risk for acute myeloid leukemia (AML) associated with active smoking, with a clear dose–response relationship and an adjusted odds ratio (OR) of 1.5 (95% confidence interval [CI]=1.1–2.0) for heavy smokers reporting more than 20 pack-years of cigarette smoking. We also observed positive associations with the highest body mass index (BMI) for AML, chronic myeloid leukemia, and chronic lymphoid leukemia with a significant dose–response relationship. No association with leukemia was observed for the intake of fruits and vegetables, and the effect of active smoking on adult leukemia risk was not modified by fruits and/or vegetables consumption or obesity. However, the positive risk for AML associated with active smoking disappeared among subjects with high BMI (≥30 kg/m²).Conclusions: Our study contributes to the accumulating evidence linking AML and active smoking, and provides some evidence that obesity increases the risk of most of the adult leukemia subtypes.     

Alcohol consumption and PSA‐detected prostate cancer risk—A case‐control nested in the ProtecT study

Alcohol is an established carcinogen but not an established risk factor for prostate cancer, despite some recent prospective studies suggesting increased risk among heavy drinkers. The aim of this study was to investigate the role of alcohol on prostate‐specific antigen (PSA) levels and prostate cancer risk. Two thousand four hundred PSA detected prostate cancer cases and 12,700 controls matched on age and general practice were identified through a case‐control study nested in the PSA‐testing phase of a large UK‐based randomized controlled trial for prostate cancer treatment (ProtecT). Linear and multinomial logistic regression models were used to estimate ratios of geometric means (RGMs) of PSA and relative risk ratios (RRRs) of prostate cancer by stage and grade, with 95% confidence intervals (CIs), associated with weekly alcohol intake and drinking patterns. We found evidence of lower PSA (RGM 0.98, 95% CI: 0.98–0.99) and decreased risk of low Gleason‐grade (RRR 0.96; 95%CI 0.93–0.99) but increased risk of high‐grade prostate cancer (RRR 1.04; 95%CI 0.99–1.08; p_difference=0.004) per 10 units/week increase in alcohol consumption, not explained by current BMI, blood pressure, comorbidities, or reverse causation. This is the first large population‐based study to find evidence of lower PSA levels for increasing alcohol consumption, with potential public health implications for the detection of prostate cancer. Our results also support a modestly higher risk of high‐grade disease for heavy drinkers, but require independent replication to establish the nature of the association of alcohol with low‐grade disease, preferably in cohorts with a heterogeneous case‐mix.     

Lifestyle Components and Primary Breast Cancer Prevention

Breast cancer primary prevention is a high research priority due to the high psychological and economic costs.The disease is a multistep process and several risk factors have been recognized. Over the past three decadesnumerous studies have investigated the association of lifestyle with breast cancer, showing independent effects ofvarious factors. We report here a summary of the present state of knowledge on the role of lifestyle patterns, suchas physical activity, diet, smoking, hormone therapy, and experience of psychological stress in the modulation ofbreast cancer in women, and discuss commonly accepted biological mechanisms hypothesized as responsible forthe associations. The findings indicate that regular physical activity of moderate to vigorous intensity is probablylinked with the decreased breast cancer risk among postmenopausal females and suggestive for a decrease of therisk in premenopausal women. In contrast, the consumption of high-fat diet, alcohol intake, and use of combinedestrogen and synthetic progestagen hormonal therapy may increase the risk. Epidemiological findings dealingwith a role of smoking and experience of psychological stress are conflicting.     

Measuring Decisional Control Preferences in Men Newly Diagnosed with Prostate Cancer

The Control Preferences Scale is widely used in decision research to measure patient preferences for participation in treatment decision making with health care providers. Following anecdotal reports of confusion with the scale the authors conducted an exploratory interview study to examine perceptions of the meaning and applicability of the Control Preferences Scale for men with localized prostate cancer seeking treatment in a multidisciplinary urology clinic. The preliminary data suggest potential validity challenges when the Control Preferences Scale is used in a multidisciplinary prostate cancer care setting, including the clinical context of localized prostate cancer and the meaning of shared decision making.     

Systemic Therapy in Men with Metastatic Castration-resistant Prostate Cancer: A Systematic Review

AimsSince 2004, docetaxel-based chemotherapy has been the standard of care for men with metastatic castration-resistant prostate cancer (mCRPC), but recently randomised controlled trials (RCTs) of novel agents have shown promise in extending overall survival. These trials have evaluated agents delivered before chemotherapy, to replace or supplement docetaxel, or addressed treatment options for men who have progressed on docetaxel therapy. This review was undertaken to determine which systemic therapies improve cancer- or patient-related outcomes in men with mCRPC.Materials and methodsSearches were carried out in MEDLINE, EMBASE, the Cochrane Library and relevant conference proceedings. Eligible articles included RCTs comparing systemic therapy or combination (excluding primary or secondary androgen deprivation therapy, bone protective agents or radionuclides) with placebo or other agents in men with mCRPC.ResultsTwenty-five RCTs met the selection criteria. In chemotherapy-naive patients, targeted therapy with tasquinimod conferred a benefit in progression-free survival. Immunotherapy with sipuleucel-T extended overall survival and was well tolerated, but had no effect on the time to disease progression. Hypercastration with abiraterone extended progression-free survival, whereas overall survival was improved but not statistically proven. In the chemotherapy setting, updated and new trials of docetaxel alone confirmed the survival benefit seen in previous studies. A survival benefit with the addition of estramustine to docetaxel shown in a previous study did not lead to an improvement in pain palliation or quality of life. Trials of combining targeted therapies with docetaxel generally did not extend survival. The addition of bevacizumab improved progression-free survival, but not overall survival. The addition of GVAX immunotherapy or calcitriol was harmful. In the post-chemotherapy setting, progression-free and overall survival benefits were detected with cabazitaxel, abiraterone and enzalutamide. Cabazitaxel was associated with greater toxicity, whereas abiraterone and enzalutamide had less severe adverse effects. Satraplatin and sunitinib both extended progression-free survival, but did not improve overall survival.ConclusionDocetaxel-based chemotherapy remains the standard of care in men with mCRPC who are candidates for palliative systemic therapy. Promising results are emerging with sipuleucel-T and abiraterone in the pre-docetaxel setting and cabazitaxel, abiraterone and enzalutamide in patients who progress on or after docetaxel. Further research to determine the optimal choice, sequence or even the combination of these agents is necessary.     

Olive oil,seed oils and other added fats in relation to ovarian cancer (Italy)

Objective: This study investigates the potential role of olive oil and other added fats used for seasoning or cooking on ovarian carcinogenesis. Methods: We analyzed data from a multicentre case–control study conducted between 1992 and 1999 in Italy, including a total of 1031 incident with a first diagnosis, histologically confirmed epithelial ovarian cancer cases and 2411 hospital controls with acute, non-malignant and non-gynecological conditions. The subjects' usual diet was investigated through a validated food-frequency questionnaire, including specific questions aimed at assessing added fat intake patterns. Results: After allowance for study centre, year at interview, age, education, parity, oral contraceptive use, and total energy intake, a reduced risk of ovarian cancer was observed for high intake of olive oil (odds ratio (OR) = 0.68, 95% confidence interval (CI) 0.50–0.93 for the highest quintile of intake, compared to the lowest one) and for a group of specific seed oils (i.e. sunflower, maize, peanut, and soya) (OR = 0.59, 95% CI 0.46–0.76). No significant associations were observed for mixed seed oils, butter, and margarine. Conclusions: The present study suggests a favorable effect of olive oil and other vegetable oils on ovarian cancer in this Italian population.     

Healthy Lifestyle Changes During the Period Before and After Cancer Diagnosis Among Breast Cancer Survivors

Aims: The purpose of the present study was to investigate healthy lifestyle changes during the period beforeand after breast cancer diagnosis in Taiwan. Materials and Method: Lifestyle changes during the period beforeand after cancer diagnosis were assessed by convenience sampling with a structured questionnaire for breastcancer survivors. Results: A total of 235 breast cancer survivors completed the healthy lifestyle scale. The meanvalues before and after breast cancer diagnosis of the participants were 3.27 and 3.73. The final five dimensionsfor the period before breast cancer diagnosis were: had not experienced stress; had exercised; had maintainedsleep quality; had maintained body weight; and had maintained relationships. The final five dimensions for theperiod after breast cancer diagnosis were: sleep quality; had not experienced stress; relationship; had exercised;and had maintained body weight. A paired-t test was applied to examine the differences before and after cancerdiagnosis, revealing that the total average scores of the participants on the healthy lifestyle scale clearly differedstatistically (t= -17.20, p<0.01); and the nine dimensions before and after testing also demonstrate a markedstatistical difference (p<0.01). Conclusions: These findings are helpful in understanding the healthy lifestylechanges during the period before and after cancer diagnosis among breast cancer survivors. It is expected thatthese results can offer references of self-care for this group of patients.     

Prospective study of plasma enterolactone and prostate cancer risk (Sweden)

Objectives: Enterolactone, a phytoestrogen produced by the intestinal microflora from precursors in plant foods, has been postulated to protect against hormone-dependent cancers. We studied the association between plasma enterolactone and risk of prostate cancer. Methods: In the Northern Sweden Health and Disease Cohort, enterolactone concentrations were measured by time-resolved fluoroimmunoassay in plasma taken from 265 men who were diagnosed with prostate cancer at a mean time of 5 years after blood collection, and in plasma from 525 control men, matched for age and date of blood collection. Results: There was no significant association between quartiles of plasma enterolactone and risk of prostate cancer. Odds ratios for prostate cancer, estimated by conditional logistic regression for increasing concentrations of enterolactone in quartiles were 1.00 (referent), 0.81 (95% confidence interval 0.52–1.27), 1.03 (0.67–1.58), and 1.22 (0.80–1.86). Adjustments for body mass index (BMI), smoking status and stratification for age, lag time, storage time and tumour characteristics did not materially alter risk estimates. Men with very low enterolactone levels, however, had significantly higher risk of prostate cancer, odds ratio for bottom decile versus all other deciles was 1.68 (1.03–2.74). Conclusions: Our results do not support the hypothesis that enterolactone formed from dietary lignans protects against prostate cancer.     

The Role of Inflammation in Breast Cancer and Prostate Cancer

Inflammatory conditions increase the risk of cancer. Strong evidences showed that inflammation contributes to breast cancer and prostate cancer in different ways such as inflammationinduced DNA or RNA damage, overexpression cytokines, chemokines etc. Recent studies have begun to unravel molecular pathways linking inflammation and cancer. Some possible mechanisms by which inflammation can contribute to carcinogenesis have been found. These mechanisms by which inflammation contributes to cancer give broader views of cancer development. These insights are fostering new antiinflammatory therapeutic approaches to cancer development.     

Prognostic Impact of the Neutrophil-to-Lymphocyte Ratio in Men With Metastatic Castration-Resistant Prostate Cancer

BackgroundWe retrospectively evaluated the prognostic impact of neutrophil-lymphocyte ratio (NLR) as a marker for inflammatory and immune state in men with progressive metastatic castration resistant prostate cancer (mCRPC) following docetaxel.MethodsThe SUN-1120 phase III trial comparing prednisone combined with sunitinib (n = 584) or placebo (n = 289) for mCRPC following docetaxel-based chemotherapy was evaluated. The arms were combined for analysis, since no difference was observed in the primary endpoint of overall survival (OS). A logarithmic transformation was applied to non-normal factors. The Kaplan-Meier method was used for OS estimation. To identify an optimal prognostic model for survival, we used a Cox proportional hazards regression method with forward stepwise selection, stratifying for ECOG PS, progression type (prostate specific antigen [PSA] or radiographic) and treatment group. Patients were categorized into risk groups.ResultsComplete data was evaluable for 784 men. The factors used in the model that remained individually significant for OS in multivariable analysis were: log-lactate dehydrogenase level (LDH) level (HR 2.86 [95% CI = 2.29, 3.56], P < .001), hemoglobin (0.80 [0.74, 0.85], P < .001), > 1 organ involved by metastatic disease (1.49 [1.21, 1.84], P < .001), log-alkaline phosphatase (1.13 [0.99, 1.28], P = .074), log-number of prior cycles of docetaxel (0.84 [0.71, 0.98], P = .031), progression on docetaxel (1.35 [1.00, 1.81], P = .049), log-PSA (1.06 [1.00, 1.12], P = .075) and log-NLR (1.55 [1.32, 1.83], P < .001). NLR increased the c-statistic of the prognostic model from 0.703 to 0.715.ConclusionHigh NLR may be associated with an independent poor prognostic impact in post-docetaxel patients with mCRPC. These data warrant external validation.