Antidiabetic drugs and prostate cancer prognosis in a Finnish population-based cohort

BACKGROUND: Hyperinsulemia and glycemic control may play a role as prostate cancer prognostic factors, while use of certain antidiabetic drugs, i.e metformin, could improve the prognosis. We examined the link between anti-diabetic medication use and prostate cancer survival taking into account simultaneous use of multiple drugs. METHODS: The study cohort composed of 6,537 men in The Finnish Randomized Study of Screening for Prostate Cancer with prostate cancer diagnosed 1996-2009. Use of Medication was attained from the nationwide prescription database of the Social Insurance Institution of Finland. Median follow-up was 9.2 years post-diagnosis. 1,603 (24,5%) men had used antidiabetic medication. 771 men died of prostate cancer during the follow-up. We used multivariable-adjusted Cox regression to evaluate the risk of prostate cancer death and onset of androgen deprivation therapy (ADT) with adjustment for prostate cancer clinical characteristics, co-morbidities and use of other drugs. Separate analyses were further adjusted for blood glucose. RESULTS: Risk of prostate cancer death was higher among antidiabetic drug users overall (HR1.42, 95%CI 1.18-1.70) compared to non-users, separately among insulin and metformin users. Adjustment for blood glucose level abolished the risk increase. Risk of ADT initiation was increased among the medication users; HR1.26 (95%CI 1.05-1.49). CONCLUSIONS: Men with prostate cancer using antidiabetic medication are generally at increased risk of dying from prostate cancer compared to non-users. The risk association is driven by underlying diabetes, as adjustment for blood glucose level ameliorates the risk increase. IMPACT: Type2 diabetes should be considered as a risk factor when considering prostate cancer prognosis.acceptedVersionPeer reviewe

Outcomes of Screening for Prostate Cancer Among Men Who Use Statins

Importance: Prostate-specific antigen (PSA) screening for prostate cancer has resulted in a slight reduction in prostate cancer mortality but also a concomitant overdiagnosis of low-risk tumors. Prostate-specific antigen levels are affected by use of cholesterol-lowering statin drugs, but the association of statin use with PSA screening performance is unknown. Objective: To investigate whether statin use was associated with outcomes of a randomized PSA-based prostate cancer screening intervention. Design, setting, and participants: This post hoc subgroup analysis of a cohort from a population-based randomized clinical trial used data from the population-based Finnish Randomized Study of Prostate Cancer Screening, which randomized men to PSA screening or routine care from March 1, 1996, to December 31, 1999, with follow-up continuing until December 31, 2015. The population included all men aged 55 to 67 years at baseline and residing in the Tampere or Helsinki districts of Finland. Information on statin purchases from 1996 to 2009 was obtained from a national prescription registry. Eligible men were identified from the population registry of Finland. Prevalent prostate cancer cases at baseline were excluded. Data were analyzed from January 1, 2019 to March 31, 2021. Interventions: Three invitations for PSA screening at 4-year intervals from 1996 to 2007 vs routine care. Main outcomes and measures: Risk for prostate cancer overall, high-risk disease, and prostate cancer mortality in the screening group vs the control group as an intention-to-treat analysis. The analysis was stratified by statin use. Results: The study comprised 78 606 men (median age, 59 years [range, 55-67 years]) with statin purchase data available. Although PSA screening was associated with increased prostate cancer incidence among statin nonusers (screening vs control, 11.2 vs 8.6 per 1000 person-years); rate ratio [RR], 1.31; 95% CI, 1.24-1.38), no similar increase in incidence was observed among statin users (6.9 vs 5.9 per 1000 person-years; RR, 1.02; 95% CI, 0.95-1.10; P < .001 for interaction). Incidence of low-risk (Gleason score 6) and localized tumors was lower among statin users, whereas detection of tumors with a Gleason score of 8 to 10 was similar. Screening was associated with a lower incidence of metastatic tumors regardless of statin use. Conclusion and relevance: In this post hoc subgroup analysis of a cohort from a population-based randomized clinical trial, PSA screening among statin users was associated with a decreased incidence of advanced prostate cancer that was similar among statin nonusers, but with less increase in detection of low-grade localized tumors in statin users than in nonusers. These findings suggest that statin use does not materially compromise benefits of PSA-based screening.acceptedVersionPeer reviewe

Use of near infrared spectroscopy and implantable Doppler for postoperative monitoring of free tissue transfer for breast reconstruction: a systematic review and meta-analysis

Background: Failure to accurately assess the perfusion of free tissue transfer (FTT) in the early postoperative period may contribute to failure, which is a source of major patient morbidity and healthcare costs. Goal: This systematic review and meta-analysis aims to evaluate and appraise current evidence for the use of nearinfrared spectroscopy (NIRS) and/or implantable Doppler (ID) devices compared with conventional clinical assessment (CCA) for postoperative monitoring of FTT in reconstructive breast surgery. Methods: A systematic literature search was performed in accordance with the PRISMA guidelines. Studies in human subjects published within the last decade relevant to the review question were identified. Meta-analysis using random effects models of FTT failure rate and STARD scoring were then performed on the retrieved publications. Results: 19 studies met the inclusions criteria. For NIRS and ID, the mean sensitivity for the detection of FTT failure is 99.36% and 100% respectively, with average specificity of 99.36% and 97.63% respectively. From studies with sufficient reported data, meta-analysis results demonstrated that both NIRS (OR = 0.09 [0.02, 0.36], P < 0.001) and ID (OR = 0.39 [0.27, 0.95], P = 0.04) were associated with significant reduction of FTT failure rates compared to CCA. Conclusion: The use of ID and NIRS provide equivalent outcomes in detecting FTT failure and were superior to CCA. The ability to acquire continuous objective physiological data regarding tissue perfusion is a perceived advantage of these techniques. Reduced clinical staff workload and minimised hospital costs are also perceived as positive consequences of their use