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

Authors

  • Sagar R. Shah,

    1. Sections of Urology, Augusta Veterans Affairs Medical Center, and
    2. Medical College of Georgia, Augusta, Georgia,
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  • Stephen J. Freedland,

    1. Department of Surgery, Durham Veterans Affairs Medical Center,
    2. Division of Urologic Surgery, Departments of Surgery and Pathology and Duke Prostate Center, Duke University School of Medicine, Durham, North Carolina,
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  • William J. Aronson,

    1. Urology Section, Department of Surgery, Veterans Affairs Greater Los Angeles Healthcare System,
    2. Department of Urology, University of California, Los Angeles, School of Medicine, Los Angeles,
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  • Christopher J. Kane,

    1. Division of Urology, Department of Surgery, University of California San Diego, San Diego,
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  • Joseph C. Presti Jr,

    1. Department of Urology, Stanford University School of Medicine, and
    2. Urology Section, Department of Surgery, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, and
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  • Christopher L. Amling,

    1. Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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  • Martha K. Terris

    1. Sections of Urology, Augusta Veterans Affairs Medical Center, and
    2. Medical College of Georgia, Augusta, Georgia,
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Martha K. Terris, Medical College of Georgia, 1120 Fifteenth Street, BA 8414, Augusta, GA 30912–4050, USA.
e-mail: mterris@mcg.edu

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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