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Cadmium is a known carcinogen that has been implicated in prostate cancer, but how it affects prostate carcinogenesis in humans remains unclear. Evidence from basic science suggests that cadmium can bind to the androgen receptor causing endocrine disruption. The androgen receptor is required for normal prostate development and is the key driver of prostate cancer progression. In this study, we examined the association between cadmium content and androgen receptor protein expression in prostate cancer tissue of African American (N = 22) and European American (N = 30) men. Although neither overall tumor cadmium content (log transformed) nor androgen receptor protein expression level differed by race, we observed a race-cadmium interaction with regard to androgen receptor expression (P = 0.003) even after accounting for age at prostatectomy, smoking history, and Gleason score. African American men had a significant positive correlation between tumor tissue cadmium content and androgen receptor expression (Pearson correlation = 0.52, P = 0.013), while European Americans showed a non-significant negative correlation between the two (Pearson correlation = -0.19, P = 0.31). These results were unchanged after further accounting for tissue zinc content or dietary zinc or selenium intake. African American cases with high-cadmium content (>median) in tumor tissue had more than double the androgen receptor expression (0.021 vs. 0.008, P = 0.014) of African American men with low-cadmium level. No difference in androgen receptor expression was observed in European Americans by cadmium level (high 0.015 vs. low 0.011, P = 0.30). Larger studies are needed to confirm these results and if upheld, determine the biologic mechanism by which cadmium increases androgen receptor protein expression in a race-dependent manner. Our results suggest that cadmium may play a role in race disparities observed in prostate cancer., (Copyright © 2018 Elsevier GmbH. All rights reserved.)

Purpose: The potential effects of statins on clinical and histopathologic variables, prostate size, or PSA density (PSAD) and resulting influences on active surveillance eligibility have not been adequately explored. This study examines the effect of statins on prostate specimens following prostatectomy., Materials and Methods: Patients that received robotic-assisted laparoscopic prostatectomy (RALP) (n = 2,632) were dichotomized according to preoperative statin use. Logistic regression was used to evaluate associations between statin use and patient clinical and pathological characteristics., Results: Men using statins at the time of prostatectomy were older (61.6 ± 6.4 versus 58.8 ± 7.2 years, P < .001), and had poorer health status (P < .001). Biopsy Gleason grade, clinical stage and prostate size were similar among the two groups, although statin users had lower diagnostic PSA levels (5.5 ± 3.6 versus 6.3 ± 4.9 ng/mL, P < .001) and PSAD (.12 versus .13, P = .001)., Conclusion: Men taking statins at the time of prostatectomy had similar histopathologic characteristics to non-users, despite having significantly lower serum PSA, being older and having similar sized prostates. This supports prior studies suggesting a PSA reduction effect of statins may warrant consideration of statin usage in decisionalgorithms for active surveillance.

Objectives: Longitudinal studies report racial disparities in prostate cancer (PCa) including greater incidence, more aggressive tumor biology, and increased cancer-specific mortality in African American (AA) men. Regret concerning primary treatment selection is underevaluated in patients with PCa. We investigated the relationships between clinicopathologic variables across racial and socioeconomic lines following robotic-assisted laparoscopic prostatectomy., Materials and Methods: We assessed treatment decisional regret using a validated questionnaire in a total of 484 white and 72 AA patients with PCa who were followed up for a median of 16.6 months post-robotic-assisted laparoscopic prostatectomy. Socioeconomic status (SES) information was aggregated from 2010 US census zip code data. Perioperative clinicopathologic characteristics and functional outcomes were compared between groups. Univariate and multivariate regression analyses were used to evaluate the influence of race, aggregate SES, and other clinical and demographic characteristics on decisional regret., Results: The majority (87.7%) of the population was not regretful of their decision to undergo treatment. However, a greater proportion of AA vs. white patients were regretful (20.6% vs. 11.2%, respectively; P = 0.03). AA and white men were similar on all functional, clinical, and pathologic features with the exception of younger age among AA men (56 vs. 60 y, respectively; P<0.001). Although there were significant differences in SES by race (P<0.001), regret did not differ by SES (β =-1.53; P = 0.15). Race, postoperative sexual dysfunction, pad usage, and length of hospital stay, however, were significantly associated with decisional regret., Conclusions: AA men were more regretful than white men, after adjusting for clinicopathologic characteristics and postoperative functional outcomes., (© 2013 Published by Elsevier Inc.)

Objectives: Metabolic syndrome (MetS), the constellation of obesity and related risk factors for cardiovascular disease, is an expanding epidemiologic concern in the United States and the developed world. However, the relationship between MetS and prostate cancer remains to be definitively assessed. We evaluated the association between obesity and MetS with prostate cancer pathology and surgical and functional outcomes., Materials and Methods: A total of 2,639 patients underwent robotic-assisted laparoscopic prostatectomy (RALP) for localized prostate cancer between March 2003 and July 2012. Of them, 186 patients met the criteria for MetS as defined by the presence of obesity (body mass index [BMI] ≥ 30 kg/m(2)) in conjunction with 2 or more of the following: hypertension (HTN), dyslipidemia (D), and diabetes (DM). Additionally, reference cohorts of (1) 663 nonobese men without HTN, D, or DM; (2) 184 obese patients without HTN, D, or DM; and (3) 211 obese men with solitary risk factors were identified for comparison. Demographic, histopathologic, and perioperative clinical parameters were compared., Results: In comparison with patients without MetS, patients with MetS had larger prostates (Odds Ratio (OR) = 1.609, 95% Confidence Interval (CI) = 1.04-2.49, P = 0.03), increased blood loss (OR = 1.592, 95% CI = 1.15-2.21, P = 0.01), and surgical complexity (OR = 4.940, 95% CI = 2.29-10.69, P<0.001). There was no statistical difference observed between these groups in regard to complication rates, pathologic grade, stage, and postoperative continence or erectile function. With the exception of larger prostates found among men with MetS, men with obesity alone and obesity with 1 additional risk factor appeared similar to those with MetS., Conclusions: Patients with MetS had similar perioperative, histopathologic, and functional outcomes compared with reference cohorts undergoing RALP. RALP is safe, feasible, and efficacious in men with MetS., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objectives: Prostate-specific antigen (PSA) based end points are commonly used to report outcomes after treatment for prostate cancer. This study examines the influence of follow-up length on biochemical control (bNED) rates., Methods: We reviewed 437 patients with clinically localized prostate cancer treated with conformal radiotherapy without neoadjuvant androgen deprivation. Biochemical failure was defined as three consecutive PSA increases or an increase large enough to prompt androgen deprivation therapy. The failure date was projected back to the midpoint between the PSA nadir and the first PSA increase (or between the nadir and the initiation of androgen deprivation therapy). The analysis was performed by censoring patients with longer follow-up in a stepwise fashion, thus creating smaller subgroups with shorter follow-up intervals. Subgroup 1 (n = 191) and subgroup 2 (n = 273) were defined to include those patients monitored for up to 2 years and up to 3 years, respectively., Results: The median follow-up intervals for subgroup 1, subgroup 2, and the original study population were 1.1, 1.5, and 2.5 years. No significant differences were seen in pretreatment prognostic factors among the three groups. The 2-year bNED of subgroup 1, subgroup 2, and the original population was 86%, 77%, and 73%, respectively. Although subgroup 1 had a superior bNED compared with the original population (P = 0.04), no differences in clinical recurrence rates were seen among any of the three groups., Conclusions: Because of projecting the biochemical failure dates back according to commonly used bNED definitions, control rates are highly dependent on the length of follow-up.