Exposure to Agent Orange is a significant predictor of prostate-specific antigen (PSA)-based recurrence and a rapid PSA doubling time after radical prostatectomy

Sagar R. Shah, Stephen J. Freedland, William J. Aronson, Christopher J. Kane, Joseph C. Presti, Christopher Amling, Martha K. Terris

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Objective To investigate and report the clinicopathological characteristics and outcomes after radical prostatectomy (RP) in patients with prostate cancer and previous exposure to Agent Orange (AO), particularly in relationship to race. Patients and Methods In 1495 veterans who had undergone RP the clinicopathological characteristics, biochemical progression rates, and prostate-specific antigen (PSA) doubling time (DT) after recurrence between AO-exposed and unexposed men were compared using logistic and linear regression and Cox proportional hazards analyses, and stratified by race. Results The 206 (14%) men with AO exposure were more likely to be black (P = 0.001), younger (P <0.001), treated more recently (P <0.001), have a higher body mass index (P = 0.001), have clinical stage T1 disease (P <0.001), and have lower preoperative PSA levels (P = 0.001). After adjusting for several clinical characteristics, AO exposure was not significantly related to adverse pathological features but was significantly associated with biochemical progression risk (relative risk 1.55, 95% confidence interval 1.15-2.09, P = 0.004) and shorter PSADT (P <0.001) after recurrence (8.2 vs 18.6 months). When stratified by race, these associations were present and similar in both races, with no significant interaction between race and AO exposure for predicting biochemical recurrence or mean adjusted PSADT (P interaction >0.20). Conclusions Patients with AO exposure and treated with RP were more likely to be black, present with lower risk features, have an increased risk of biochemical progression, and shorter PSADT after recurrence. When stratified by race, the association between AO exposure and poor outcomes was present in both races. These findings suggest that among selected men who choose RP, AO exposure might be associated with more aggressive prostate cancer.

Original languageEnglish (US)
Pages (from-to)1168-1172
Number of pages5
JournalBJU International
Volume103
Issue number9
DOIs
StatePublished - May 2009
Externally publishedYes

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Prostate-Specific Antigen
Prostatectomy
Recurrence
Prostatic Neoplasms
Proxy
Veterans
Agent Orange
Linear Models
Logistic Models

Keywords

  • Agent Orange
  • Biochemical recurrence
  • Prostate cancer
  • Radical prostatectomy

ASJC Scopus subject areas

  • Urology

Cite this

Exposure to Agent Orange is a significant predictor of prostate-specific antigen (PSA)-based recurrence and a rapid PSA doubling time after radical prostatectomy. / Shah, Sagar R.; Freedland, Stephen J.; Aronson, William J.; Kane, Christopher J.; Presti, Joseph C.; Amling, Christopher; Terris, Martha K.

In: BJU International, Vol. 103, No. 9, 05.2009, p. 1168-1172.

Research output: Contribution to journalArticle

Shah, Sagar R. ; Freedland, Stephen J. ; Aronson, William J. ; Kane, Christopher J. ; Presti, Joseph C. ; Amling, Christopher ; Terris, Martha K. / Exposure to Agent Orange is a significant predictor of prostate-specific antigen (PSA)-based recurrence and a rapid PSA doubling time after radical prostatectomy. In: BJU International. 2009 ; Vol. 103, No. 9. pp. 1168-1172.
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abstract = "Objective To investigate and report the clinicopathological characteristics and outcomes after radical prostatectomy (RP) in patients with prostate cancer and previous exposure to Agent Orange (AO), particularly in relationship to race. Patients and Methods In 1495 veterans who had undergone RP the clinicopathological characteristics, biochemical progression rates, and prostate-specific antigen (PSA) doubling time (DT) after recurrence between AO-exposed and unexposed men were compared using logistic and linear regression and Cox proportional hazards analyses, and stratified by race. Results The 206 (14{\%}) men with AO exposure were more likely to be black (P = 0.001), younger (P <0.001), treated more recently (P <0.001), have a higher body mass index (P = 0.001), have clinical stage T1 disease (P <0.001), and have lower preoperative PSA levels (P = 0.001). After adjusting for several clinical characteristics, AO exposure was not significantly related to adverse pathological features but was significantly associated with biochemical progression risk (relative risk 1.55, 95{\%} confidence interval 1.15-2.09, P = 0.004) and shorter PSADT (P <0.001) after recurrence (8.2 vs 18.6 months). When stratified by race, these associations were present and similar in both races, with no significant interaction between race and AO exposure for predicting biochemical recurrence or mean adjusted PSADT (P interaction >0.20). Conclusions Patients with AO exposure and treated with RP were more likely to be black, present with lower risk features, have an increased risk of biochemical progression, and shorter PSADT after recurrence. When stratified by race, the association between AO exposure and poor outcomes was present in both races. These findings suggest that among selected men who choose RP, AO exposure might be associated with more aggressive prostate cancer.",
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T1 - Exposure to Agent Orange is a significant predictor of prostate-specific antigen (PSA)-based recurrence and a rapid PSA doubling time after radical prostatectomy

AU - Shah, Sagar R.

AU - Freedland, Stephen J.

AU - Aronson, William J.

AU - Kane, Christopher J.

AU - Presti, Joseph C.

AU - Amling, Christopher

AU - Terris, Martha K.

PY - 2009/5

Y1 - 2009/5

N2 - Objective To investigate and report the clinicopathological characteristics and outcomes after radical prostatectomy (RP) in patients with prostate cancer and previous exposure to Agent Orange (AO), particularly in relationship to race. Patients and Methods In 1495 veterans who had undergone RP the clinicopathological characteristics, biochemical progression rates, and prostate-specific antigen (PSA) doubling time (DT) after recurrence between AO-exposed and unexposed men were compared using logistic and linear regression and Cox proportional hazards analyses, and stratified by race. Results The 206 (14%) men with AO exposure were more likely to be black (P = 0.001), younger (P <0.001), treated more recently (P <0.001), have a higher body mass index (P = 0.001), have clinical stage T1 disease (P <0.001), and have lower preoperative PSA levels (P = 0.001). After adjusting for several clinical characteristics, AO exposure was not significantly related to adverse pathological features but was significantly associated with biochemical progression risk (relative risk 1.55, 95% confidence interval 1.15-2.09, P = 0.004) and shorter PSADT (P <0.001) after recurrence (8.2 vs 18.6 months). When stratified by race, these associations were present and similar in both races, with no significant interaction between race and AO exposure for predicting biochemical recurrence or mean adjusted PSADT (P interaction >0.20). Conclusions Patients with AO exposure and treated with RP were more likely to be black, present with lower risk features, have an increased risk of biochemical progression, and shorter PSADT after recurrence. When stratified by race, the association between AO exposure and poor outcomes was present in both races. These findings suggest that among selected men who choose RP, AO exposure might be associated with more aggressive prostate cancer.

AB - Objective To investigate and report the clinicopathological characteristics and outcomes after radical prostatectomy (RP) in patients with prostate cancer and previous exposure to Agent Orange (AO), particularly in relationship to race. Patients and Methods In 1495 veterans who had undergone RP the clinicopathological characteristics, biochemical progression rates, and prostate-specific antigen (PSA) doubling time (DT) after recurrence between AO-exposed and unexposed men were compared using logistic and linear regression and Cox proportional hazards analyses, and stratified by race. Results The 206 (14%) men with AO exposure were more likely to be black (P = 0.001), younger (P <0.001), treated more recently (P <0.001), have a higher body mass index (P = 0.001), have clinical stage T1 disease (P <0.001), and have lower preoperative PSA levels (P = 0.001). After adjusting for several clinical characteristics, AO exposure was not significantly related to adverse pathological features but was significantly associated with biochemical progression risk (relative risk 1.55, 95% confidence interval 1.15-2.09, P = 0.004) and shorter PSADT (P <0.001) after recurrence (8.2 vs 18.6 months). When stratified by race, these associations were present and similar in both races, with no significant interaction between race and AO exposure for predicting biochemical recurrence or mean adjusted PSADT (P interaction >0.20). Conclusions Patients with AO exposure and treated with RP were more likely to be black, present with lower risk features, have an increased risk of biochemical progression, and shorter PSADT after recurrence. When stratified by race, the association between AO exposure and poor outcomes was present in both races. These findings suggest that among selected men who choose RP, AO exposure might be associated with more aggressive prostate cancer.

KW - Agent Orange

KW - Biochemical recurrence

KW - Prostate cancer

KW - Radical prostatectomy

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