Sagar Shah

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

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.

Editorial comment on: Agent Orange exposure, Vietnam War veterans, and the risk of prostate cancer.

I n this issue of Cancer, Chamie and colleagues have presented a timely article characterizing the relative risk of prostate cancer in Vietnam War veterans exposed to Agent Orange compared with their unexposed counterparts. In 1998, the National Academy of Science concluded that ‘‘limited/suggestive evidence’’ existed of an association between Agent Orange and prostate cancer. The majority of data linking Agent Orange exposure to an increased risk of prostate cancer has come from farmers and forestry workers exposed to herbicides and dioxins. Initial studies evaluating the relation between Agent Orange exposure and prostate cancer in Vietnam veterans yielded conflicting results and were limited by small sample sizes and the lack of quantification of Agent Orange exposure, as mentioned by the authors. Continued publication of updated results is necessary as veterans exposed to Agent Orange reach an age at which they are more likely to be screened and diagnosed with prostate cancer. Prior studies performed when these veterans were younger men may have been less likely to detect a link between Agent Orange exposure and increased risk of prostate cancer because of a lack of an appropriate cohort. More recent studies by Akthar et al and Pavuk et al did not find a difference in the risk of prostate cancer between comparison veterans (those in Southeast Asia but not Vietnam) and those serving in Vietnam during the same time period as a whole, but when the results were reviewed more closely, these investigators found a higher risk of prostate cancer in Operation Ranch Hand veterans serving during the time periods with heaviest spraying and longest duration of spraying and those veterans with the highest levels of quantified exposure based on serum dioxin levels compared with controls and the comparison group. The current article by Chamie et al suggests an even more ubiquitous link in their analysis of a more contemporary series. On the basis of the current Veterans Health Administration Handbook, veterans who served in the Republic of Vietnam See referenced original article on pages 2464–70, this issue.

Comparison of urodynamic findings in women with anatomical versus functional bladder outlet obstruction.

Objectives To characterize the symptoms and urodynamic findings of anatomical bladder outlet obstruction (AO) and functional bladder outlet obstruction (FO) in women and to determine if future endeavors at defining bladder outlet obstruction in women can group these entities together. Methods Retrospective review of all videourodynamic studies was performed on women from March 2003 to July 2009. Women with diagnosis of obstruction were categorized based on the cause of obstruction into 2 groups: AO and FO. Demographic data, symptoms, and urodynamic findings were compared between the 2 groups. Results One hundred fifty-seven women were identified of which 86 (54.8%) were classified as having AO and 71 (45.2%) were classified as having FO. There were no differences in symptoms between the 2 groups. There was no difference (P=0.5789) in the mean detrusor pressure at maximum flow rate Qmax between AO (38.9 cm H20) and FO (41.0 cm H20). There was a difference in the Qmax between AO and FO (10.6 [0–41.7] and 7.4 [0–35.7] mL/s, respectively; P=0.0044), but there was considerable overlap between the values in these 2 groups. Conclusions Anatomical bladder outlet obstruction and FO have similar urodynamic voiding pressure findings, but Qmax was statistically significantly lower in AO. However, there is a large overlap in the Qmax values between the 2 groups. Therefore, future studies that attempt to characterize bladder outlet obstruction in women need not exclude either group.