Prostate cancer in Asia: design of a patient registry to inform real-world treatments, outcomes, and quality of life.

BACKGROUND: The incidence of prostate cancer (PC) in Asian countries is increasing for reasons that are not clear. Data describing how PC is diagnosed and treated are fragmented across Asia, with marked intercountry and intracountry differences in outcome and knowledge gaps in clinical diagnostic and treatment practices. To address these knowledge gaps, we have established a PC disease registry with the aim of providing a comprehensive picture of PC diagnosis, prognosis, treatment and outcome, population characteristics, and comorbidities in real-world clinical practice in Asia. METHODS: This is a multinational, multicenter, longitudinal, and observational registry of PC patients presenting to participating tertiary-care hospitals in eight Asian countries (www.clinicaltrials.gov NCT02546908. Registry Identifier: NOPRODPCR4001). Approximately 3500-4000 eligible patients with existing or newly diagnosed high-risk localized PC (cohort 1), nonmetastatic biochemically recurrent PC (cohort 2), or metastatic PC (cohort 3) will be consecutively enrolled and followed-up for 5 years. An enrollment cap of 600 patients each will be applied to cohorts 1 and 2. Disease status is collected at enrollment, and outcome variables captured at 3-monthly intervals include diagnostic/staging, treatments including reason for change, laboratory results, comorbidities, and concomitant medications. Treatments and survival outcomes will be captured real time until study end. Patient-reported quality-of-life will be measured every 6 months, and medical resource utilization summarized at study end. Data analysis will include exploratory analyses of potential associations between multiple risk factors and socioeconomic variables with disease progression and evaluation of various treatments for PC including novel therapies on clinical outcome and health-related quality-of-life outcomes. RESULTS: 3636 men with PC were enrolled until July 2018; 416 in cohort 1, 399 in cohort 2 and 2821 in cohort 3. DISCUSSION: A total of 3636 patients were enrolled until July 2018. The prospective disease registry will provide comprehensive and wide-ranging real-world information on how PC is diagnosed and treated in Asia. Such information can be used to inform policy development for best practice and direct clinical study design evaluating new treatments.

Reversed association between levels of prostate specific antigen and levels of blood cadmium and urinary cadmium.

Prostate cancer associated with cadmium exposure may indicate a link between prostate specific antigen (PSA) and levels of blood cadmium (BCd) and urinary cadmium (UCd). Thus, these associations were investigated. We recruited 295 men, 50 years of age and above from a health check-up program at a health center as subjects of the study. They completed a self-reported questionnaire and provided fasting samples of blood and urine for cadmium assay. The assay was performed using atomic absorption spectrophotometry. Blood samples were also collected for the assays of total cholesterol and high-density lipoprotein measures. The means of BCd and UCd increased with age and the means of all subjects were 1.19±1.04 µg L(-1) and 1.37±1.76 µg g(-1) creatinine, respectively. The PSA levels were positively associated with the lipid levels, but reversely associated with BCd and UCd levels. The multivariate logistic regression analysis showed that men with PSA≥4.0 ng m L(-1) had an odds ratio (OR) of 0.4 (95% CI=0.1-0.9) to have BCd>0.49 µg L(-1), and an OR of 0.4 (95% CI=0.2-1.0) to have UCd>0.45 µg g(-1) creatinine. In conclusion, the PSA levels are reversely associated with BCd and UCd levels.

Cadmium burden and the risk and phenotype of prostate cancer.

BACKGROUND: Studies on the association between prostate cancer and cadmium exposure have yielded conflicting results. This study explored cadmium burden on the risk and phenotype of prostate cancer in men with no evident environmental exposure. METHODS: Hospital-based 261 prostate cancer cases and 267 controls with benign diseases were recruited from four hospitals in Taiwan. Demographic, dietary and lifestyle data were collected by standardized questionnaires. Blood cadmium (BCd) and creatinine-adjusted urine cadmium (CAUCd) levels were measured for each participant. Statistical analyses measured the prostate cancer risk associated with BCd and CAUCd separately, controlling for age, smoking and institution. BCd and CAUCd levels within cases were compared in relation to the disease stage and the Gleason score. RESULTS: High family income, low beef intake, low dairy product consumption and positive family history were independently associated with the prostate carcinogenesis. There was no difference in BCd levels between cases and controls (median, 0.88 versus 0.87 microg/l, p = 0.45). Cases had lower CAUCd levels than controls (median, 0.94 versus 1.40 microg/g creatinine, p = 0.001). However, cases with higher BCd and CAUCd levels tended to be at more advanced stages and to have higher Gleason scores. The prostate cancer cases with Gleason scores of > or = 8 had an odds ratio of 2.89 (95% confidence interval 1.25-6.70), compared with patients with scores of 2-6. CONCLUSION: Higher CAUCd and BCd levels may be associated with advanced cancer phenotypes, but there was only a tenuous association between cadmium and prostate cancer.