Association between environmental quality and prostate cancer stage at diagnosis.

BACKGROUND: Prostate cancer (PC) etiology is up to 57% heritable, with the remainder attributed to environmental exposures. There are limited studies regarding national level environmental exposures and PC aggressiveness, which was the focus of this study METHODS: SEER was queried to identify PC cases between 2010 and 2014. The environmental quality index (EQI) is a county-level metric for 2000-2005 combining data from 18 sources and reports an overall ambient environmental quality index, as well as 5 environmental quality sub-domains (air, water, land, built, and sociodemographic) with higher values representing lower environmental quality. PC stage at diagnosis was determined and, multivariable logistic regression models which adjusted for age at diagnosis (years) and self-reported race (White, Black, Other, Unknown) were used to test associations between quintiles of EQI scores and advanced PC stage at diagnosis. RESULTS: The study cohort included 252,164 PC cases, of which 92% were localized and 8% metastatic at diagnosis. In the adjusted regression models, overall environmental quality EQI (OR 1.20, CI 1.15-1.26), water EQI (OR: 1.34, CI: 1.27-1.40), land EQI (OR: 1.35, CI: 1.29-1.42) and sociodemographic EQI (OR: 1.29, CI: 1.23-1.35) were associated with metastatic PC at diagnosis. For these domains there was a dose response increase in the OR from the lowest to the highest quintiles of EQI. Black race was found to be an independent predictor of metastatic PC at diagnosis (OR: 1.36, CI: 1.30-1.42) and in stratified analysis by race; overall EQI was more strongly associated with metastatic PC in Black men (OR: 1.53, CI: 1.35-1.72) compared to White men (OR: 1.18, CI: 1.12-1.24). CONCLUSION(S): Lower environmental quality was associated with advanced stage PC at diagnosis. The water, land and sociodemographic domains showed the strongest associations. More work should be done to elucidate specific modifiable environmental factors associated with aggressive PC.

Single Port and Multiport Approaches for Robotic Vaginoplasty With the Davydov Technique.

OBJECTIVE: To demonstrate the feasibility, surgical technique, and initial outcomes of robotic vaginoplasty with peritoneal flap (Davydov) technique for vaginal reconstruction. METHODS: Following appropriate preoperative patient counseling, 11 consecutive patients underwent robotic vaginoplasty with the da Vinci (Intuitive Surgical, Sunnyvale CA) multiport Xi and single port robotic platforms. Perioperative and postoperative outcomes of interest were retrospectively collected. RESULTS: Between March 2019 and October 2019, a total of 11 patients have undergone robotic vaginoplasty with peritoneal flap technique at our institution-9 using the da Vinci single port platform and 2 using the da Vinci Xi platform. Reasons for vaginoplasty included primary gender-affirming genital reconstruction, vaginal stenosis after gender confirmation surgery, and vaginal hypoplasia secondary to disorders of sexual development. Mean operative time was 267.2 ± 85.9 minutes. Initial postoperative mean vaginal depth was 13.9 ± 0.5 cm. Mean estimated blood loss was 131.8 ± 92.9 mL. Mean length of stay was 5.2 ± 0.6 days and time to return of bowel function was 1.7 ± 0.9 days. Thirty-day readmission rate was 18% (N = 2/11) with 1 patient (9%) requiring surgical revision of the neovagina. CONCLUSION: Robotic-assisted Davydov technique is a potentially applicable, efficacious, and safe method of vaginal reconstruction in cisgender and transgender individuals.

Estrogens and prostate cancer.

BACKGROUND: Hormonal influences such as androgens and estrogens are known contributors in the development and progression of prostate cancer (CaP). While much of the research to the hormonal nature of CaP has focused on androgens, estrogens also have critical roles in CaP development, physiology as well as a potential therapeutic intervention. METHODS: In this review, we provide a critical literature review of the current basic science and clinical evidence for the interaction between estrogens and CaP. RESULTS: Estrogenic influences in CaP include synthetic, endogenous, fungi and plant-derived compounds, and represent a family of sex hormones, which cross hydrophobic cell membranes and bind to membrane-associated receptors and estrogen receptors that localize to the nucleus triggering changes in gene expression in various organ systems. CONCLUSIONS: Estrogens represent a under-recognized contributor in CaP development and progression. Further research in this topic may provide opportunities for identification of environmental influencers as well as providing novel therapeutic targets in the treatment of CaP.