Prostate cancer patients who exhibited high levels of neuroticism had significantly more adverse events following surgery, including sexual dysfunction and urinary incontinence, a survey of almost 1,000 patients showed.
Self-reported responses to a validated questionnaire completed an average of 3 years after radical prostatectomy showed that 22% of the men had high levels of neuroticism, which was associated with a 20% lower average score on a quality-of-life questionnaire, as compared with men who had low neuroticism scores. The high-neuroticism group had significantly higher rates of erectile dysfunction, urinary incontinence, and bowel dysfunction, Karol Axcrona, MD, of the University of Akershus in Lørenskog, Norway, reported at the European Association of Urology congress in Barcelona.
The rate of neuroticism in the patients was similar to rates in general populations of men in Norway and Western European countries, as shown in previous surveys, said Axcrona. Treatment failure — defined as the need for salvage radiation therapy, initiation of hormonal therapy, or severe PSA elevation — occurred in 21% of the patients and did not have a significant association with neuroticism.
“Neuroticism is not an illness, but a basic personality trait,” Axcrona said in a statement. “What we found was that those patients who show a greater tendency towards neuroticism have worse outcomes 3 years after prostate cancer surgery. This is a real effect, and doctors need to take account of this, in the same way that we would take physical factors into account before and after cancer treatment. This means we may need better advance personality testing for identification and counseling, and perhaps a more specialized follow-up of these men who might be at risk of poorer outcomes.”
Normal Testicular DNA in Infertile Men
The quality of testicular DNA from infertile men often matched that of sperm samples obtained from fertile men, suggesting an alternative strategy for male infertility, British investigators reported.
The extent of DNA damage, as determined by Comet score, averaged 40% for ejaculated sperm from 63 infertile men versus 15% for ejaculate from 76 fertile men. In contrast, DNA damage in testicular samples from the infertile men averaged 18%, significantly less than the ejaculate samples (P<0.001) and similar to that of fertile men, Jonathan Ramsey, MD, of Imperial College London, and colleagues reported.
The study confirmed other evidence that sperm DNA can incur substantial damage in transit from the testicles to ejaculation and suggests that use of testicular DNA offers a potentially effective assisted reproduction strategy for many infertile men.
“It wasn’t a surprise to see greater DNA damage in ejaculates of infertile men,” Ramsey said in a statement. “What we didn’t expect was the consistency in these results when we looked at sperm taken directly from the testicles of infertile men. We found that it was of similar quality to that of ejaculated, fertile sperm.”
Added co-investigator Sheena Lewis, PhD, of Queens University Belfast in Northern Ireland, “What this means is that the DNA in sperm from the testicles of infertile men are better quality than sperm from their ejaculates. This opens the way to taking sperm directly from the testes of men who have highly fragmented ejaculated DNA and failed cycles of treatment and trying to achieve fertility with these testicular sperm.”
“We also noted in a subgroup that the amount of the more serious double-stranded DNA breaks was lower in the sperm taken from testicles, so using these sperm is more likely to lead to an improvement in male fertility.”
Testosterone Blocks Prostate Cancer Recurrence?
Men who received testosterone-replacement therapy (TRT) to help preserve sexual function after radical prostatectomy had a 3-year disease recurrence rate that was one third the rate of men who did not get TRT, according to a study of 834 men with newly diagnosed prostate cancer.
The data showed a 5% rate of biochemical (PSA) recurrence at 3 years among 152 men with low-risk disease who received TRT after robotic radical prostatectomy. In contrast, the 682 men who were not treated with TRT had a 3-year recurrence rate of 15%. After adjustment for differences in patient and disease characteristics, TRT was associated with a threefold lower risk of prostate cancer recurrence, reported Thomas Ahlering, MD, of the University of California, Irvine.
The results seem to call into question the decades of evidence pointing to testosterone as the driving force in prostate cancer, leading to androgen-deprivation therapy as an integral component of treatment for the disease. However, beginning about 20 years ago, data emerged to show that castrate levels of testosterone achieved with ADT predisposed patients to metabolic disturbances — hyperglycemia, diabetes, dyslipidemia, abdominal fat accumulation — which often led to death from cardiovascular causes, not prostate cancer. As a result, some urologic oncology specialists began to advocate for TRT in selected patients with low-risk prostate cancer.
“This is not what we set out to prove, so it was a big surprise,” Ahlering said in a statement. “Not only did testosterone replacement not increase recurrence, but it actually lowered recurrence rates. While testosterone is not curing cancer per se, it is slowing the growth of the cancer, giving an average of an extra 1.5 years before traces of cancer can be found. We already know that testosterone can help with physiological markers — such as muscle mass, better cholesterol and triglyceride levels, and increased sexual activity — so this seems to be a win-win.”
“We’re not suggesting that treatment methods be changed just yet, but this puts us at the stage where we need to question the taboo against testosterone use in prostate cancer therapy, especially for low-risk patients after radical prostatectomy. We need the oncology/urology community to begin to review testosterone use.”
Early Menopause, Smoking Linked to Bladder Cancer
Menopause before age 45 significantly increased the risk of bladder cancer, particularly among women who smoked, a new analysis of 220,000 participants in the Nurses Health Study showed.
Early menopause alone was associated with a 45% higher risk of bladder cancer as compared with women who had menopause later in life. The difference increased to 53% for women who had early menopause and smoked, reported Mohammad Abufaraj, MD, of the University of Vienna.
Bladder cancer affects men more often than women, but more women have advanced cancer at diagnosis and are less likely to survive, Abufaraj noted. About 5% of women begin menopause before age 45, and smoking is a recognized risk factor for bladder cancer.
“Smoking remains the most important risk factor for bladder cancer,” Abufaraj said in a statement. “Our data also revealed that it is unlikely that female factors — such as age when periods begin, number of pregnancies, oral contraceptive use, or use of hormone replacement therapy — are associated with bladder cancer risk. Smoking is associated with earlier age at menopause, thereby further increasing the risk of developing bladder cancer.”