HOSPITAL DISCHARGES INDICATE MORE MEN MAY REQUIRE SURGERY FOR BPH
Rising numbers of acute renal failure cases in BPH patients suggests more need full workup, possible intervention
Press Release: Edited for style and dates by Vibrance
May 17, 2011 — Despite an increased use of oral therapies to treat benign prostatic hyperplasia (BPH), some men may not be receiving treatment at the extent to which it is needed and may still suffer severe adverse complications as a result, according to new data from the University of California, San Diego (UCSD) presented at the Annual Meeting of the American Urological Association in Washington, DC.
BPH, or non-cancerous enlargement of the prostate, is a common condition that affects millions of men in the United States each year, and can lead to serious lower urinary tract symptoms, ranging from frequent or painful urination to urinary retention (which can lead to renal failure if left untreated). Numerous treatments, including oral therapies and minimally invasive surgical procedures, such as a transurethral resection of the prostate (TURP), are available for men with BPH.
UCSD researchers examined a 20 percent data sample from the Nationwide Inpatient Sample between 1998 and 2007 and identified 6,409,576 (5.3 percent) discharges with primary or secondary diagnoses of BPH. Age-adjusted prevalence for BPH increased from 4.2 percent to 7.4 percent over the 10 year period in this group, irrespective of primary diagnosis; however, discharges for primary BPH decreased from 0.86 percent to 0.47 percent. BPH surgery discharges decreased by 51 percent and those for primary BPH with acute renal failure increased more than 300 percent. Discharges for primary BPH with urinary retention, stones or infection remained static without significant change.
These data suggest that, while the prevalence of BPH is increasing, fewer men are receiving surgical treatment and an increasing number are presenting with acute renal failure.
“Oral therapies for BPH are a common first-line treatment that can be effective in many men,” Dr. Kwevin McVary said. “However, it is imperative that patients be treated promptly if the drugs aren’t working.
“In many cases, surgical treatment for BPH can help prevent urinary retention, which can ultimately lead to acute renal failure that can be life-threatening.”
About the American Urological Association: Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association is the pre-eminent professional organization for urologists, with more than 17,000 members throughout the world. An educational nonprofit organization, the AUA pursues its mission of fostering the highest standards of urologic care by carrying out a wide variety of programs for members and their patients.
HPV, VIRUS THAT CAUSES CERVICAL CANCER, FOUND PREVALENT IN MALES IN STUDY THAT SUGGESTS VACCINATIONS FOR BOYS AS WELL AS GIRLS
High-risk human papillomavirus (HPV) found in 10 percent of men and boys in study
Press Release: Edited for style and dates by Vibrance
May 14, 2011 – The male foreskin may be a reservoir for human papillomavirus (HPV), the virus that can lead to cervical cancer and genital warts, suggesting that boys – in addition to girls – should consider vaccination to prevent later transfer through sexual contact, according to researchers from Innsbruck Medical University in Austria. The study was presented during the 2011 Annual Meeting of the American Urological Association. AUA Spokesperson Kevin McVary, MD will moderate the session for media.
There are many types of HPV, which are classified as either at low- or high-risk of causing diseases, such as cancer of the cervix and other areas of the body. HPV is one of the most common sexually transmitted infections.
Researchers in Austria examined anonymized foreskins of 133 males – between seven months and 82 years old without clinical HPV-associated warts – who had undergone radical circumcision for phimosis. Researchers extracted DNA from 40 tissue sections to assess the prevalence of HPV and found low-risk HPV genotypes in 18.8 percent of the examined foreskins and high-risk HPV in 9.77 percent. None of the patients had clinical symptoms of disease.
“While vaccinations in girls for HPV is now accepted medical practice to prevent HPV infection, this study suggests the novel of idea of vaccinating boys prior to puberty as well,” Dr. McVary said. “The presence of subclinical HPV in boys and men suggests this may be an effective way to help prevent HPV transmitted by sexual contact.”
About the American Urological Association: Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association is the pre-eminent professional organization for urologists, with more than 17,000 members throughout the world. An educational nonprofit organization, the AUA pursues its mission of fostering the highest standards of urologic care by carrying out a wide variety of programs for members and their patients.
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ABIRATERONE DEMONSTRATES EFFECTIVE RESULTS WITH FAVORABLE SAFETY PROFILE IN MEN WITH CASTRATION-RESISTANT ADVANCED PROSTATE CANCER
Press Release: Edited for style and dates by Vibrance
May 16, 2011—Abiraterone acetate (AA) with low-dose prednisone (P) extended overall survival with favorable PSA and radiographic responses in patients with castration-resistant prostate cancer progressing after docetaxel-based chemotherapy, according to updated data from COU-AA-301, a multi-institutional, randomized, double-blind, placebo-controlled, phase III study from researchers at 147 institutions across 13 countries. AA is a selective androgen biosynthesis inhibitor that blocks the action of the CYP17 gene, which plays a vital role in androgen and estrogen biosynthesis.
Data was presented to the media during a special press during the 2011 Annual Meeting of the American Urological Association (AUA). The session was moderated by Christopher Amling, MD.
The study included 1,195 patients with castration-resistant prostate cancer who had previously undergone chemotherapy with docetaxel. Patients were randomized 2:1 to receive 1,000 mg AA plus 5 mg P twice daily, or placebo. Patients were assessed using prostate-specific antigen (PSA) scores and radiographic tests.
The study, of which the primary endpoint was overall survival, demonstrated:
- An increase in overall survival by a median of 14.8 months, compared to 10.9 with placebo.
- An improved time to PSA progression of 10.2 months
- That AA+P reduced the risk of death by 35 percent (HR=0.65) compared with placebo.
AA+P demonstrated a favorable safety profile compared to placebo, with patients experiencing less fatigue (8 percent vs. 10 percent), back pain (6 percent vs. 10 percent) and spinal cord compression (3 percent vs. 5 percent). The most common grade 3/4 adverse events were decreased lymphocyte levels (21 percent vs. 23 percent), fluid retention (2.3 percent vs. 1 percent), hypokalemia (3.9 percent vs. 0.8 percent), liver function test abnormalities (3.5 percent vs. 3.0 percent), hypertension (1.3 percent vs. 0.3 percent) and cardiac disorders (4.1 percent vs. 2.3 percent).
“In men with metastatic prostate cancer, hormone therapy typically slows disease progression for a substantial time. Chemotherapy becomes an option when the disease no longer responds to standard hormone therapy,” Dr. Amling said. “But what happens when prostate cancer progresses after chemotherapy? By targeting persistent androgen synthesis, these data suggest that abiraterone, combined with low-dose prednisone, may be an option.”
About the American Urological Association: Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association is the pre-eminent professional organization for urologists, with more than 17,000 members throughout the world. An educational nonprofit organization, the AUA pursues its mission of fostering the highest standards of urologic care by carrying out a wide variety of programs for members and their patients.
PROSTATE CANCER: TO TREAT, NOT TO TREAT AND WHEN TO TREAT?
Panel to Address Key Questions about Low-Risk Prostate Tumor Management
FOR BLADDER AND PROSTATE CANCERS
Press Release: Edited for style and dates by Vibrance
May 16, 2011 — As physicians and researchers debate the merit of the prostate-specific antigen (PSA) test, questions have arisen about the test’s ability to accurately identify the presence of prostate cancer, as well as how the test may be interpreted and better used to determine which prostate cancers require treatment and which do not. New research presented at the 2011 AUA Annual Meeting brought to light to the innovative possibilities for the use of PSA.:
A single blood test before the age of 50 could predict a man’s long-term risk of prostate cancer death, according to research from Memorial Sloan-Kettering Cancer Center in New York and Lund University in Malmo, Sweden. Using data from the Preventive Project, a cardiovascular study enrolling men ages 33 to 50 between 1974 and 1986, and a combination of case-note review or death certificate data, researchers identified 141 men in the study who had subsequently died of prostate cancer. Nearly half (44 percent) of the deaths occurred in men whose PSA score fell in the top 10 percent (≥1.5 ng/ml). Researchers expanded their analysis to the top quartile of men, measuring free PSA and human glandular kallikrein 2 (hK2), and found that these markers helped to identify an additional 2.4 percent of deaths in the top 10 percent of risk. These data suggest that early analysis of PSA, free PSA and hK2 may provide critical insight into a man’s risk of developing aggressive, life-threatening disease, enabling urologists to better assess when early intervention may be necessary.
Eliminating prostate cancer testing after the age of 60 may be an option for some men, but others could benefit from continued testing, according to new data being presented by Johns Hopkins researchers. Using data from the Baltimore Longitudinal Study of Aging, researchers identified 448 men with PSA measurements between the ages of 60 and 70, including 199 with a PSA less than 1 ng/ml. They reviewed PSA trajectory and its relationship to later diagnosis of prostate cancer (including high-risk disease, defined by PSA greater or equal to 20 ng/ml, Gleason 8-10 or confirmed prostate cancer death). In the 199 men with low PSA (median age of 61.9 at time of test), 13 were later diagnosed – four with significant disease. These data indicate that it may not be advisable to apply a universal cut-off point for PSA testing.
Prostate-specific antigen velocity (PSAV) can be a strong derivative in improving the performance of the PSA blood test as a marker for prostate cancer but has limited sensitivity and specificity, according to new data from researchers at Northwestern University. Researchers examined patients in two categories: those with elevated PSAV and no cancer on biopsy, and those with low PSAV with biopsy-detected cancer. Of those patients with low PSAV with biopsy-detected disease, 4.6 percent had a Gleason 8-10 tumor, 30 percent had slow-growing tumors with a Gleason score less than 6 and 54 percent had Gleason 7 tumors. Of those patients with elevated PSAV and negative biopsy, 58 percent were later diagnosed with biopsy-detected disease, suggesting a need to closely follow a patient’s PSA despite an initial negative biopsy.
PSAV and its rate of increase over time may be a key marker in identifying aggressive disease and could provide valuable insight in how to interpret the PSA test, according to researchers from Medical University Innsbruck in Austria and the University of California, San Francisco. Study authors analyzed pre-diagnosis PSA history from 94 prostate cancer patients who, following surgical treatment, suffered extra-capsular extension (EE) or recurrence, and calculated annual growth rate in cancer PSA for each. Of the men with EE or recurrence, 98.9 percent had an increasing or constant PSAV and 95 percent had a PSA annual growth rate of 10 percent or more, suggesting that, in men with a current PSA less than 4.0 ng/ml, increased scrutiny of annual growth rates of 1.0 ng/ml or more may be warranted.
“Debate has been ongoing about the use of the PSA test in the detection of prostate cancer but the question may not be whether we use the test but, rather, how we use it,” said Christopher Amling, MD, who moderated the briefing for media. “These studies shed important light on how we might refine our use and interpretation of the PSA test.”
About the American Urological Association: Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association is the pre-eminent professional organization for urologists, with more than 17,000 members throughout the world. An educational nonprofit organization, the AUA pursues its mission of fostering the highest standards of urologic care by carrying out a wide variety of programs for members and their patients.
BUILDING A BETTER CANCER TEST: UPDATES ON NEW BIOMARKERS AND GENETIC ASSAYS FOR BLADDER AND PROSTATE CANCERS
Press Release: Edited for style and dates by Vibrance
May 16, 2010 — Clinicians treating bladder and prostate cancers face significant challenges not only in treating, but also diagnosing these diseases. Diagnostic tests are limited, and, in some cases, the tests’ ability to distinguish indolent vs. aggressive disease is questionable. New research on genetic tests and biomarkers for disease, being presented during the 2011 Annual Meeting of the American Urological Association (AUA), holds the promise for newer, better tests for these cancers. The studies were presented to the press during a special session. The session was moderated by AUA Public Media Committee Chair Anthony Y. Smith, MD.
Studies being presented include:
· Certain genetic alleles associated with prostate cancer risk may also be connected to aggressive pathology features and may predict higher Gleason-grade disease in some men, according to researchers at Northwestern University. Genotypes for certain previously reported risk alleles were determined for more than 900 men with Gleason 6 prostate cancers who had undergone radical prostatectomy, and authors compared allele frequency for men whose tumors were ultimately upgraded to a pathologic Gleason 7 and those whose final pathologic Gleason was 6. Those with risk alleles on chromosomes 8q24 and 19q13 were 1.7 and 2.7 times more likely to be upgraded in the final pathology tumor specimen, suggesting that certain genotypes may be a strong predictor of aggressive pathology features.
· According to new data from Radboud University Nijmegen Medical Center in the Netherlands, measuring TMPRSS2:ERG expression in addition to PCA3 may improve the sensitivity and accuracy of the PCA3 test for prostate cancer. Using tissue samples for benign prostatic hyperplasia (48 samples) and prostate cancer (48 samples), as well as normal prostate tissue (32 samples), authors measured PCA3 and TMPRSS2:ERG expression. The PCA3 test had a sensitivity of 84.4 for prostate cancer, but included one false-positive and seven false-negative samples. The TMPRSS2:ERG gene fusion test was positive in 8.3 percent of the BPH samples, 15.6 percent of the normal tissue samples and half the prostate cancer samples. However, combining both tests resulted in the highest sensitivity and diagnostic accuracy. Using TMPRSS2:ERG in addition to PCA3 added only one false positive, and eliminated four of the seven false negatives seen with PCA3 alone.
· Certain genetic polymorphic variations may allow physicians to predict a patient’s sensitivity to hormonal therapy to treat prostate cancer, according to new researchers in Japan, who examined a possible correlation between certain single nucleotide polymorphisms (SNPs) from eight genes involved in androgen synthesis and metabolism and a man’s progression to castration-resistant disease. The period from diagnosis to data collection was 43 months. In this study, which included 214 patients, researchers compared the association of genotypes to the efficacy of androgen deprivation therapy, and found that patients with SNP rs6162 on the CYP17A1 gene were more likely to experience cancer progression following androgen deprivation therapy.
· Researchers in Germany and the United States will present data on a new quantitative TMPRSS2:ERG gene fusion urine assay to predict outcomes in men with prostate cancer scheduled for radical prostatectomy. Researchers obtained urine specimens from men to assess TMPRSS2:ERG levels prior to surgery, and compared these levels with post-surgery pathologic findings. Of the 74 men, 28 had non-organ confined disease, and 69 had a Gleason score of 7 or greater. 21 patients with biopsy Gleason 6 disease were upgraded to a pathologic Gleason grade of 7 or greater. Median TMPRSS2:ERG score was significantly higher in men with non-organ confined disease compared to those who had organ-confined disease (80 vs. 9). Median TMPRSS2:ERG scores for patients with pathological upgrading was 32, compared to 2 for those whose Gleason scores were not upgraded.
· A common criticism of the prostate-specific antigen (PSA) test is its lack of specificity in differentiating between benign prostatic hyperplasia (BPH) and prostate cancer. Through the use of a customized array platform, researchers at Brigham and Women’s Hospital and Northeastern University have identified five autoantibody signatures to specific cancer targets that, when the antigens were combined, were more effective than the PSA test in distinguishing between benign and malignant disease.
· Micro ribonucleic acid (miRNA) molecules, previously shown to play a key role in tumorigenesis, can play a promising role in diagnosing and treating cancers. Researchers from the Lahey Clinic in Boston examined the role that miRNA might play in diagnosing bladder cancer. Using urine from patients with confirmed bladder cancer and control patients with no history of cancer, authors isolated cell-free RNA from 35 healthy control patients and 142 patients with bladder cancer, and profiled 730 miRNAs. Disease progression correlated with the number of miRNAs expressed, with healthy controls expressing 8 miRNAs and patients with >T2 carcinoma expressing 228 miRNAs. Individual samples revealed an increase with some miRNA as disease progressed, suggesting that miRNA profiling could be of future clinical value in the treatment of bladder cancer.
· PCA3 has demonstrated success in identifying patients with prostate cancer; however, new data from the Medical University of Graz in Austria suggests that the test may be a valuable predictor of low-volume disease and may have a future role in managing patients on active surveillance protocols. Using pre-operative PCA3 scores and tumor volume data from 160 patients, authors used logistic regression models to identify endpoints for low-volume disease (less than 0.5 ml) and insignificant disease (using Epstein criteria). Low tumor volume and pathologically insignificant prostate cancer were present in 21.2 percent (n=34) and 10 percent (n=16) of patients. In those patients with low-volume and/or insignificant disease, PCA3 scores were significantly lower.
“The critical piece of the puzzle that is missing right now for treatment of a number of urologic cancers, but particularly for prostate cancer, are biomarkers that can be used to tell us prior to treatment which patients harbor slow growing indolent cancers, which harbor cancers that we might have a shot at curing and which harbor cancers that are so aggressive that they require a systemic approach,” Dr. Smith said.
About the American Urological Association: Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association is the pre-eminent professional organization for urologists, with more than 17,000 members throughout the world. An educational nonprofit organization, the AUA pursues its mission of fostering the highest standards of urologic care by carrying out a wide variety of programs for members and their patients.
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EXTENDED SAMPLING BIOPSIES, MRI SHOW PROMISE IN MANAGING LOW-RISK PROSTATE CANCER
Methods May Alleviate Uncertainties in Cases of Active Surveillance, “Watchful Waiting”
Press Release: Edited for style and dates by Vibrance
May 16, 2011 – Prostate cancer can be a slow-growing, low-risk disease that prompts cases of active surveillance (AS) or “watchful waiting,” which may be anxiety-producing for the patient. But according to two new studies – one dealing with MRI and the other with extended sampling biopsies – may give new direction on how to manage cases of low-risk prostate cancers. The studies will be presented to the media during a special press conference on Monday, May 16, 2011 at 2 p.m. during the 106th Annual Scientific Meeting of the American Urological Association (AUA).
Men Selected For Repeat Biopsy After Initial Negative Biopsy Often Undergo Multiple Biopsies Prior to Cancer Diagnosis (#2127): Doctors are not certain about when to repeat a biopsy in men who have elevated PSA levels with initial negative biopsies, or when to perform extended sampling, in which more than one sample is taken from the prostate in a single procedure, according to new data from researchers at the New York University School of Medicine.
Researchers identified 1,213 men who had an initial negative biopsy. 803 repeat biopsies were performed on 274 men. 16 percent of the men had as many as five repeat biopsies. An increasing proportion of men were diagnosed with prostate cancer on repeat biopsies: 10 percent on the second; 10 percent on the third; 11 percent on the fourth and 27 percent on the fifth. More than 50 percent of repeat biopsies included more than 12 cores, and 25 percent of men undergoing repeat biopsy were found to have prostate cancer. Authors conclude that, given the continued likelihood of cancer detection by the fifth biopsy, early consideration of extended sampling biopsies might be warranted and could improve detection and prevent men from undergoing repeat procedures.
Prostate MRI Findings Prior To Commencing Active Surveillance Among Men With Low Risk Prostate Cancer (#1292): Failure to fully recognize the amount of disease at baseline may be cause for active surveillance (AS) failure, according to new data from researchers at Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, who found that magnetic resonance imaging (MRI) discovered large volume disease in up to 22 percent of patients with low-risk prostate cancer who are managed with active surveillance. The researchers concluded that MRI prior to AS should be strongly considered as part of standard patient care, and particularly among patients with elevated PSA density.
Men were studied who had low-grade, low-risk localized prostate cancer. The study cohort was 60 patients. MRI did not detect any cancer in 23 patients (38 percent), while MRI and initial biopsy were consistent in 24 patients (40 percent).
However, MRI identified 13 patients (22 percent) with troubling discrepant findings (TDF). In 10 cases, a biopsy confirmed the presence of cancer. The average unidimensional size of these tumors was 1.5 cm and 50 percent of them had Gleason sum upgrading. Only PSA density was significantly elevated among those patients identified through MRI compared to those with no MRI-detected cancer.
“The slow growth of many prostate cancers is one of the most vexing areas that we deal with in treating this disease and knowing when active surveillance is the best solution,” said AUA spokesperson Joseph Presti, MD. “MRI and extended sampling biopsies may be a solution to this problem.”
About the American Urological Association: Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association is the pre-eminent professional organization for urologists, with more than 17,000 members throughout the world. An educational nonprofit organization, the AUA pursues its mission of fostering the highest standards of urologic care by carrying out a wide variety of programs for members and their patients.
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SMOKING LINKED TO BIOCHEMICAL RECCURENCE OF PROSTATE CANCER
Press Release: Edited for style and dates by Vibrance
May 16, 2010 – Men who smoke are more likely to have adverse pathology findings and a higher risk that PSA levels will elevate following radical prostatectomy for prostate cancer, according to a new study presented during the 106th Annual Scientific Meeting of the American Urological Association (AUA). The study was presented to the media during a press at the Walter E. Washington Convention Center.
Researchers from the Stanford University School of Medicine, Stanford, CA, identified 630 men with detailed smoking histories who underwent radical prostatectomy between 1989 and 2005. There were 321 smokers and 309 non-smokers in the study. Pathologic outcomes included prostate weight, volume of cancer, volume of high-grade cancer, margin status, seminal vesicle involvement, extraprostatic extension, perineural invasion, angiolymphatic invasion and the presence of nodal metastasis. Biochemical recurrence – a rise in PSA level following radical prostatectomy – was measured at PSA 0.2ng/ml. Various analyses were used to compare the smokers and the non-smokers.
Smokers had higher cancer volume compared to non-smokers (2.54 vs. 2.16 mL, p-0.016) and greater volume of high-grade cancer (0.58 vs. 0.28 mL, p-0.004). Heavy smokers (defined as those with a 20 pack-year history) had a greater risk of biochemical recurrence on univariate survival analysis; smoking also predicted a greater risk of recurrence on Cox regression, with roughly a 1 percent increase in PSA level per pack-year smoked.
“These data indicate that smoking history could provide valuable insight and should be included in risk-assessment models for prostate cancer,” said Joseph C. Presti, MD, who presented the study to the media. “The study also presents a strong message to men: quitting smoking now could impact your ability to survive prostate cancer later.”
About the American Urological Association: Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association is the pre-eminent professional organization for urologists, with more than 17,000 members throughout the world. An educational nonprofit organization, the AUA pursues its mission of fostering the highest standards of urologic care by carrying out a wide variety of programs for members and their patients.
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GAY MEN MORE VULNERABLE TO QUALITY OF LIFE IMPACTS FOLLOWING PROSTATE CANCER
Survey data on health-related quality of life reveal lower than average scores for gay men who have had prostate cancer
Press Release: Edited for style and dates by Vibrance
May 14, 2011 – Gay men who have undergone treatment for prostate cancer reported lower health-related quality of life scores compared to data from more generalized populations in other published research, according to a new study presented during the 106th Annual Scientific Meeting of the American Urological Association (AUA).
The study, which is among the first to quantitatively examine the impact of prostate cancer on gay men, was presented to reporters during a special press conference at the Walter E. Washington Convention Center in Washington, DC.
In the study, 92 gay men from both the United States and Canada completed a cross-sectional Internet-based survey that included the Expanded Prostate Cancer Index (EPIC) and the Male Sexual Health Questionnaire Short-Form, as well as questions relating to fear of cancer recurrence. Gay men, compared to normative data from more generalized populations, reported statistically significant worse functioning and more severe bother scores on the EPIC urinary, bowel, and hormonal symptom scales, and also reported worse EPIC sexual and ejaculatory functioning scores, as well as significantly worse mental health functioning and higher fear of cancer recurrence.
“This is one of the early studies demonstrating that quality of life is more significantly impacted by prostate cancer in the gay population,” said Tomas L. Griebling, MD, MPH, the AUA spokesman who moderated the briefing. “More research is needed to determine what steps we can take to diminish these impacts.”
About the American Urological Association: Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association is the pre-eminent professional organization for urologists, with more than 17,000 members throughout the world. An educational nonprofit organization, the AUA pursues its mission of fostering the highest standards of urologic care by carrying out a wide variety of programs for members and their patients.
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STUDIES LINK QUALITY OF SLEEP TO ERECTILE DYSFUNCTION, OTHER UROLOGIC CONDITIONS
Press Release: Edited for style and dates by Vibrance
May 14, 2011 – Two studies that link the quality of sleep to the occurrence of erectile dysfunction (ED) and other urologic conditions were reported during the 2011 Annual Meeting of the American Urological Association (AUA). The session was moderated by Kevin McVary, MD.
In the largest study to date demonstrating the relationship between obstructive sleep apnea (OSA) and erectile dysfunction, researchers from Mount Sinai Medical Center in New York evaluated 870 consecutively enrolled men in the ongoing Law Enforcement Cardiac Screening program (LECS), a subset of the World Trade Center Medical Monitoring and Treatment Program. Patients who scored positive on the Berlin Questionnaire (a widely used survey for OSA) were defined to be at high risk for OSA. ED was assessed by use of the International Index of Erectile Function -5 (IIEF-5), and was defined as IIEF of less than 22. A multivariate, binary logistic regression was performed to adjust for age, history of cardiovascular disease, systolic blood pressure, diabetes, smoking and body mass index (BMI).
The mean age of the patients in the study population was 47.3 years, with a mean BMI of 30.2. Sixty-three percent of the patients screened positive for OSA, 5.6 percent had a history of diabetes, and 29 percent had a smoking history. After adjusting for age and comorbidities, the patients with ED were more than twice more likely to have OSA than their normal counterparts. The likelihood of having OSA increased as the severity of erectile dysfunction increased, suggesting that men with this condition should also be screened for OSA.
Sleep is a modifiable risk factor that precedes certain urologic conditions (urinary incontinence [UI], lower urinary tract symptoms [LUTS] and nocturia) in men and women, perhaps operating through inflammatory and other pathways, according to a study by researchers at New England Research Institutes Inc. in Watertown, MA.
In the prospective cohort analyses of 1,610 men and 2, 535 women who completed the baseline and follow-up phases of the Boston Area Community Health (BACH) survey, researchers followed the subjects for five years, assessing sleep disturbance and the development of urologic symptoms. Baseline short sleep duration (men only) was defined as sleeping fewer than five hours per night, and sleep quality was defined as having restless sleep in the past week. LUTS were assessed using the AUA Symptom Index, urinary incontinence was defined as weekly urine leakage, and nocturia was defined as needing to urinate more than two times per night after falling asleep.
Incidence of LUTS among men (8 percent) and women (13 percent) was strongly related to short sleep duration among men and restless sleep among men and women. Incidences of UI and nocturia were associated with restless sleep among women but not men.
“We know that proper amounts of sleep and quality of sleep can impact a wide range of health conditions including erectile function and lower urinary tract symptoms,” said AUA spokesperson Kevin T. McVary, MD. “These data may help us better assess how helping patients modify their sleep patterns may help improve their health and overall quality of life.”
About the American Urological Association: Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association is the pre-eminent professional organization for urologists, with more than 17,000 members throughout the world. An educational nonprofit organization, the AUA pursues its mission of fostering the highest standards of urologic care by carrying out a wide variety of programs for members and their patients.
