Waist circumference is an independent risk factor for prostatic hyperplasia in Taiwanese males.

PURPOSE: Benign prostatic hyperplasia is a common disease affecting older males. As obesity becomes an increasing problem worldwide, its role in prostatic hypertrophy has been discussed recently. The purpose of this study is to evaluate the relationship between waist circumferences and prostatic hyperplasia in Taiwan. METHODS: There were 539 men enrolled in the study who had health examinations at the Healthcare Center of Chang Gung Memorial Hospital; 53 were excluded because of history of conditions affecting prostatic volume. Their anthropometry was measured and serum prostate-specific antigen (PSA) levels as well as lipid profiles were analyzed. Prostate volume was measured by transrectal ultrasonography performed by experienced urologists. RESULTS: The mean prostate volume was 26.43 mL, whereas mean body mass index (BMI) was 25.27 kg/m(2) and mean waist circumference (WC) was 90.81 cm. By age-adjusted logistic regression, PSA > 4 ng/mL, WC ≥ 90 cm, and BMI > 24 kg/m(2) are associated with increased risk of developing prostatic hyperplasia; only WC ≥ 90 cm can be validated by multiple logistic regression. Further analysis of obesity patterns showed that abdominal overweight/obesity places patients at increased risk independently rather than high WC or high BMI alone. CONCLUSIONS: Study results showed that waist circumference ≥ 90 cm is an independent risk factor of prostatic hyperplasia in Taiwan. Men with abdominal overweight/obesity (WC ≥ 90 cm and BMI > 24 kg/m(2)) have a twofold risk of developing prostatic hyperplasia.

Adjuvant androgen deprivation therapy loses its therapeutic benefit after premature termination: an experience of combined modality treatment on prostate cancer.

BACKGROUND: To investigate the effect of the premature termination of recommended androgen deprivation therapy (ADT) as an adjunct to radiotherapy. METHODS: Between December 2001 and March 2004, 92 patients with non-metastatic prostate cancer underwent primary, curative radiotherapy via an intensity-modulated technique. Four patients (5%) were treated with a dosage of 70.2 Gy, while 74 (80%) and 14 patients (15%) were treated to 72 and 75.6 Gy. Thirty patients (33%) received pelvic irradiation to 45 Gy as a part of their treatment. Seventy-nine patients (86%) also received variable ADT, but only 35 patients (38%) followed a strict protocol when on ADT. Biochemical failure was defined as nadir plus 2 ng/mL or if there was any clinical evidence of tumor recurrence. RESULTS: The median follow-up time was 37.5 months (20.4-57.8 months). The 3-year overall survival rate was 91.8%. The estimated 3 year recurrence-free survival rates were 100%, 88.9%, and 69.7% for the low, intermediate, and high risk groups, respectively. High risk group patients receiving ADT of an inappropriate length was the only significant risk factor correlated to disease recurrence. The 3-year recurrence-free survival rate was extremely poor (28.6%) in high risk group patients who received adjuvant ADT for less than 2 years. This was significantly worse than patients with the same risk who received long-term ADT (88.1%) or no adjuvant ADT (76.4%, p < 0.001). CONCLUSIONS: Long-term adjuvant ADT after radiotherapy on high risk prostate cancer has no benefit if the duration is less than 2 years. Premature termination should be avoided.

Preliminary treatment results of intensity-modulated radiotherapy for prostate cancer.

BACKGROUND: To review the initial treatment results of intensity-modulated radiotherapy (IMRT) for prostate cancer. METHODS: Ninety-two patients treated with IMRT before July 2003 were included in this study. The median follow-up was 32 months. The indications for IMRT included primary, adjuvant, and salvage treatment. Combined treatment with androgen suppression therapy was variable. The primary study endpoints were chronic adverse events which were subjectively reported. Only patients with an adenocarcinoma and who had been treated by primary radiotherapy were included in the analysis of disease relapse. RESULTS: At the time of analysis, 89 patients were still alive, and only 2 patients had died of prostate cancer. In the survival analysis, the 30-month failure-free survival rates were 100%, 89.2%, and 67.3% for the low-, intermediate-, and high-risk groups of patients, respectively. Pretreatment PSA level, Gleason score, risk classification, and adjuvant hormone therapy were significantly associated with relapse according to the univariate analysis, while only risk classification remained significant in the multivariate analysis. During follow-up, 5 (6%) patients developed grade 2 gastrointestinal (GI) adverse events (AE). Sixteen (18%) and 7 (8%) patients developed grade 2 and 3 urinary AE, respectively. Development of severe urinary adverse events was closely related to previous surgical treatment. No factor was identified as being correlated with the GI adverse events. The preservation rate of sexual function was 25.7%. CONCLUSIONS: Seventy-two Grays of irradiation, administered by IMRT, is a safe method as the primary treatment for prostate cancer. However, severe urinary toxicity was related to previous surgical treatment. There is a need for longer follow-up periods to verity the benetit of this dosage level.