Cardiovascular, bone, and metabolic health in men with castrate-resistant prostate cancer treated with androgen deprivation: a matched cohort study.

BACKGROUND: Descriptive data on late effects associated with castrate-resistant prostate cancer (CRPC) are sparse. We aimed to define the timing and incidence of cardiovascular disease (CVD), fractures, and diabetes in a patient population with CRPC. METHODS: In the population-based STHLM0 cohort 1464 men with CRPC were identified and matched with three men free from prostate cancer (PC) in the Stockholm region of Sweden. Kaplan-Meier estimates of net survival were used to describe time to CVD, fracture, and diabetes. Cox regression was used to compare incidence rates (IRRs) for the respective late effects. Cumulative incidence analyses of late effects in the presence of the competing risk of death were performed to estimate absolute risks. RESULTS: The Kaplan Meier estimates demonstrated a higher net probability for CVD, fracture, and diabetes among men diagnosed with CRPC compared to the matched comparators. The IRRs were 1.94 (95% CI: 1.79-2.12) for CVD, 2.08 (95% CI: 1.70-2.53) for fracture, and 2.00 (95% CI: 1.31-3.05) for diabetes, respectively, comparing men diagnosed with CRPC to men free from PC. The cumulative incidence of CVD at 12 months of follow-up was higher in men diagnosed with CRPC compared to healthy controls regardless of age with a difference in cumulative incidence being 0.20 for men aged <65 and 0.11 for men aged >84. CONCLUSIONS: In this cohort, the incidence of CVD was significantly higher among men with CRPC compared to healthy controls. Despite having this end-stage disease this finding proves that clinicians must recognize this late effect in men diagnosed with CRPC to improve preventive actions. These men did not have a higher absolute risk of fractures and diabetes after accounting for deaths due to any cause compared to healthy controls.

Can acid sulfate soils from the southern Baltic zone be a source of potentially toxic elements (PTEs)?

The mobility of Cr, Cu, Ni, Pb, and Zn in acid sulfate (AS) soils in the reverse delta of the Swina River, NE Poland was studied using extraction of the target metals using the BCR protocol, which targets acid-extractable (F1), reducible (F2), oxidizable (F3) fractions, and aqua regia digestion for residual (F4) fraction. It was assumed that the content of mobile forms determined in air-dried samples during consequent steps of BCR extraction refers to two scenarios of possible release of selected metals from the studied soils: (1) attributed to seasonal soil moisture variation or (2) caused by artificial drainage. The studied AS soils had thin organic layers (muck, peat and mud) overlaying deltaic sands, and contained hypersulfidic material. The field pH was 6.2 ± 0.5 and significantly decreased to 4.3 ± 1.4 after the 8-weeks incubation period. This can be explained by low buffering properties (e.g. lack of carbonates). Total concentrations of metals (Cr 17.9-61.6, Cu 5.7-27.7, Ni 6.2-47.0, Pb 2.2-17.7, and Zn 13.6-130 mg∙kg-1) in the AS soils were diversified but none of the concentrations exceeded the Polish legal limits. Despite the relative low content of analyzed metals, the studied soils can be a potential source of metal contamination affecting the coastal environment in the southern Baltic Sea region that has been overlooked so far. This is confirmed by the high proportion (44-82%) of Cr, Cu, Ni, and Zn in the F1-F3 fractions which can potentially be released as assumed in two scenarios. The BCR protocol seems to be a useful tool for understanding the chemical behavior and fate of metals in AS soils. Challenges in the assessment of metal mobility in the oxidized and unoxidized zones of individual soil profiles occurred due to their complex morphology resulting from the heterogeneous depositional environment under the human impact.