Abduelmenem Alashkham

Can Angiotensin-Converting Enzyme Inhibitors Reduce the Incidence, Severity, and Duration of Radiation Proctitis?

PURPOSEnTo determine whether participants taking angiotensin-converting enzyme inhibitors (ACEIs) and treated with radical radiation therapy with neoadjuvant/adjuvant hormone therapy have less incidence, severity, and duration of radiation proctitis.nnnMETHODS AND MATERIALSnA propensity score analysis of 817 patients who underwent radical radiation therapy with neoadjuvant or adjuvant hormone therapy as primary line management in a cohort study during 2009 to 2013 was conducted. Patients were stratified as follows: group 1, hypertensive patients taking ACEIs (as a study group); group 2, nonhypertensive patients not taking ACEIs; and group 3, hypertensive patients not taking ACEIs (both as control groups). The incidence, severity, and duration of proctitis were the main outcome. χ(2) tests, Mann-Whitney U tests, analysis of variance, risk ratio (RR), confidence interval (CI), Kaplan-Meier plots, and log-rank tests were used.nnnRESULTSnThe mean age of the participants was 68.91 years, with a follow-up time of 3.38 years. Based on disease and age-matched comparison, there was a statistically significant difference of proctitis grading between the 3 groups: χ(2) (8, n=308) = 72.52, P<.001. The Mann-Whitney U test indicated that grades of proctitis were significantly lower in hypertensive patients taking ACEIs than in nonhypertensive patients not taking ACEIs and hypertensive patients not taking ACEIs (P<.001). The risk ratio (RR) of proctitis in hypertensive patients taking ACEIs was significantly lower than in hypertensive patients not taking ACEIs (RR 0.40, 95% CI 0.30-0.53, P<.001) and in nonhypertensive patients not taking ACEIs (RR 0.58, 95% CI 0.44-0.77, P<.001). Time to event analysis revealed that hypertensive patients taking ACEIs were significantly different from the control groups (P<.0001). Furthermore, hypertensive patients taking ACEIs had significantly faster resolution of proctitis (P<.0001).nnnCONCLUSIONnPatients who were taking ACEIs were significantly less likely to have high-grade proctitis after radical radiation therapy with neoadjuvant or adjuvant hormone therapy (P<.001). The intake of ACEIs was significantly associated with a reduced risk of radiation-induced proctitis and also with acceleration of its resolution.

Early oncological and functional outcomes following radical treatment of high-risk prostate cancer in men older than 70 years: A prospective longitudinal study

BACKGROUNDnAssess early oncological and functional outcomes following radical treatment of men with high-risk prostate cancer and aged more than 70 years.nnnPATIENTS AND METHODSnA total of 335 men with high-risk prostate cancer (prostate-specific antigen ≥20ng/ml or biopsy Gleason score 8 to 10 or≥cT2c) received radical treatment between 2007 and 2014. Men were identified from comprehensive clinical databases hosted at a tertiary cancer center in the UK. The data included basic demographics, and follow-up on functional and oncological outcomes using validated patient-reported outcome questionnaires. Univariate and multivariate analyses were used.nnnRESULTSnIn all, 117 patients received radical radiotherapy (RT) alone, 167 patients received neoadjuvant hormone therapy and RT, and 54 patients underwent radical prostatectomy with extended lymph node dissection. Mean age was 72.8, standard deviation (SD) = 2.1, mean follow-up of 40.9 months, SD = 25.5 months. Patients who underwent laparoscopic prostatectomy = 24 (44.4%) had positive surgical margins, and mean lymph nodes dissected were 18.7, SD = 6.7. Further, 5 men experienced postoperative complications in the form of pseudoaneurism of internal iliac branch, leg ischemia, high CO2 retention, and 2 men experienced sepsis. Incidence of biochemical recurrence was significantly lower at 16.7% in the surgery group, compared with RT 51.3% and RT and hormone therapy 30.5%, and Kaplan-Meier analysis P<0.001 over 3 years of follow-upnnnCONCLUSIONnRadical surgery with extended lymph nodes dissection appears to have good short-term oncological and functional outcomes compared with RT with or without hormones in high-risk men older than 70 years of age. Based on these findings, treatment decisions and surgical therapy should be considered on individual basis in older men with high-risk disease.

The Incidence and Risk of Biochemical Recurrence Following Radical Radiotherapy for Prostate Cancer in Men on Angiotensin-Converting Enzyme Inhibitors (ACEIs) or Angiotensin Receptor Blockers (ARBs).

BACKGROUNDnAngiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are linked to prostate cancer, but their effect on biochemical recurrence (BR) remains unknown. Our aims were to investigate the incidence and risk of BR in men on ACEIs/ARBs after radical radiotherapy with adjuvant∖neoadjuvant hormone treatment.nnnMATERIAL AND METHODSnA propensity score analysis of 558 men was conducted. Men were stratified into 3 groups: hypertensive men on ACEIs/ARBs (as a study group), non-hypertensive men not on ACEIs/ARBs, and hypertensive men not on ACEIs/ARBs (both as a control group). The multivariate analysis of variance, chi-square, Kruskal-Wallis, analysis of variance, risk ratio, confidence interval, Kaplan-Meier plots, and log-rank tests were used.nnnRESULTSnThe mean age and follow-up were 68.51 and 3.33 years, respectively. There was a statistically significant difference in the prevalence of BR among the treatment groups (Pxa0< .001). The incidence of BR was significantly lower in hypertensive men taking ACEIs/ARBs than in non-hypertensive men not taking ACEIs/ARBs (Pxa0< .001) or in hypertensive men not taking ACEIs/ARBs (Pxa0< .009). The incidence of BR was significantly lower in hypertensive men not taking ACEIs/ARBs than in non-hypertensive men not taking ACEIs/ARBs (Pxa0< .013). The risk ratio (RR) of BR in the group of hypertensive men taking ACEIs/ARBs was significantly lower than in the group of non-hypertensive men not taking ACEIs/ARBs (RR, 0.74; 95% CI, 0.64-0.86; Pxa0< .001) and in the group of hypertensive men not taking ACEIs/ARBs (RR, 0.78; 95% CI, 0.67-0.91; Pxa0< .001). The time-to-event analysis revealed that the group of hypertensive men taking ACEIs/ARBs was significantly different compared with the control groups (Pxa0< .031).nnnCONCLUSIONnMen who were taking ACEIs/ARBs had significantly lower incidence of BR after radical radiotherapy with hormone treatment. The intake of ACEIs/ARBs was associated with reduced risk of BR.

679 The incidence and risk of biochemical recurrence following radical radiotherapy for prostate cancer in men on angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARB)

ACEIs/ARB are linked to prostate cancer, but their effect on biochemical recurrence (BR) remains unknown. Our aims were to investigate the incidence and risk of BR in men on ACEIs/ARB after radical radiotherapy (RR) with adjuvantneoadjuvant hormone treatment (HT).A propensity score analysis of n=558 men was conducted. Men were stratified into: hypertensive on ACEIs/ARB (as a study group), non-hypertensive not on ACEIs/ARB and hypertensive not on ACEIs/ARB (both as a control group). Chi-square, Kruskal-Wallis, ANOVA, risk ratio, confidence interval, Kaplan-Meier plots and Log-Rank tests were used. The mean age and follow-up were 68.51 and 3.33 years respectively. There was a statistically significant difference in the prevalence of BR among the treatment groups (p<0.001). The incidence of BR was significantly lower in hypertensive on ACEIs/ARB than non-hypertensive not on ACEIs/ARB (p<0.001) or hypertensive not on ACEIs/ ARB (p<0.009). The incidence of BR was significantly lower in hypertensive not ACEIs/ARB than non-hypertensive not ACEIs/ARB (p<0.013). The risk ratio of BR in hypertensive on ACEIs/ARB group was significantly lower than non-hypertensive not on ACEIs/ARB group (RR 0.74, 95% CI, 0.64 0.86, P<0.001) and hypertensive not on ACEIs/ARB group (RR 0.78, 95% CL, 0.67 0.91, P<0.001). Time to event analysis revealed that hypertensive on ACEIs/ARB group was significantly different comparing to the control groups (p<0.031).Men were on ACEIs/ARB had significantly lower incidence of BR after RR with HT. The intake of ACEIs/ARB was associated with reduced risk of biochemical recurrence. Introduction The renin angiotensin system, which includes ACEIs and ARB, is a network of peptides and enzymes that regulates blood pressure [1]. Many studies [2-7] have reported that ACEIs/ARB have anti-tumour effects of different tissues including breast, skin, brain, gastrointestinal tract, and more recently, prostate tissues. A series of studies [8-10] suggested that the intake of ACEIs/ARB is not associated with the increase in prostate cancer mortality. One study [8] observed a decrease in the mortality rate in men who were on ACEIs/ARB, but it was not significant. Chiang et al. [11] reported that the risk of prostate cancer had significantly decreased in men who acquired ACEIs in their series (P<0.001). There is a dearth of research to date, that has investigated the mechanism of ACEIs/ARB in prostate cancer. There is emergent evidence to suggest that the risk of BR postradical prostatectomy is significantly lower in men who were administering ACEIs than in those who did not (P=0.034) [12]. The BR of prostate cancer in men who were on ACEIs/ARB and treated by radiotherapy and adjuvant/neoadjuvant radiotherapy is still unknown. This innovative study aimed to evaluate whether the concurrent use of ACEIs/ARB decreases the incidence and risk of BRin men affected by prostate cancer and treated by RR and adjuvantneoadjuvant hormonal therapy. Materials and methods The study obtained Caldecott institutional approval (Caldicott/ CSAppGN021211). Men with localised or locally advanced prostate cancer opting for RR with adjuvantneoadjuvant hormonal treatment were identified from electronic databases through a validated cross linkage methodology, as described by our group previously [13]. The record linkage technique brings together two or more records relating to the same individual, identified by a common identifier (Community Health Index [CHI] number in this series). NHS Tayside serves a predominantly Caucasian rural and urban population of more than 405,721 according to mid-year 2011 population estimates published by the General Register Office for Scotland. The population is served by 75 general practices and single tertiary urological cancers services. Correspondence to: Abduelmenem Alashkham, Urology Research Group, Division of Cancer Research, University of Dundee, Mailbox 5, Level 6, Corridor C, Ninewells Hospital, Dundee, DD1 9SY, UK, Tel: 00447853857313; E-mail: alashkham@yahoo.com