Parkinson's disease and risk of prostate cancer: A Danish population-based case-control study, 1995-2010.

INTRODUCTION: Prostate cancer growth and progression may be linked to neurogenesis and to medical anti- Parkinson treatment, but results are inconclusive. Therefore, we examined the association between Parkinson's disease and risk of prostate cancer in a population based case-control study. METHODS: We identified 45,429 patients diagnosed with incident prostate cancer during 1997-2010 from the National Cancer Registry. Five age-matched population controls (n=227,145) were selected for each case. Odds ratios (ORs) adjusted for age and comorbidity for prostate cancer associated with Parkinson's disease were computed using conditional logistic regression. Analyses were stratified by duration of Parkinson's disease and stage of prostate cancer (localized and advanced). RESULTS: In total, 245 patients (0,5%) and 1656 controls (0,7%) had Parkinson's disease. Overall, patients with Parkinson's disease had a 27% lower risk of prostate cancer compared with patients without Parkinson's disease (adjusted OR (ORa) 0.73; 95% confidence interval (CI), 0.63-0.83). Risk of prostate cancer decreased with increasing duration of Parkinson's disease. The odds ratios were slightly lower for advanced prostate cancer (ORa, 0.68; 95% CI, 0.52-0.88) than for localized prostate cancer (ORa 0.76; 95% CI, 0.61-0.93). CONCLUSION: Parkinson's disease was associated with a risk reduction overall (27%), which decreased with increasing duration of Parkinson's disease.

Patient comorbidity is associated with conservative treatment of localized prostate cancer.

OBJECTIVE: The aim of this study was to investigate how prostate cancer treatment varies by level of comorbidity among men with localized prostate cancer. MATERIALS AND METHODS: A nationwide cohort study was conducted of all patients younger than 75 years of age with incident localized prostate cancer registered in the Danish Cancer Registry from 1 October 2003 to 31 December 2010. Number and percentages were tabulated, and the prevalence ratios were calculated of patients treated with radical prostatectomy or radiotherapy during the first year after prostate cancer diagnosis according to comorbidity level at the time of prostate cancer diagnosis. RESULTS: The study included 9643 patients, of whom 79% (7576) had no comorbidity, 10% (979) had a Charlson comorbidity index score of 1, 8% (779) had a Charlson score of 2, and 3% (309) had a Charlson score of 3 or more. The cumulative 1 year incidences of prostatectomies were 41%, 23% and 13% among those with Charlson scores of 0, 1-2 and ≥ 3, respectively. This corresponded to 1 year prevalence ratios of 0.60 [95% confidence interval (CI) 0.54-0.67] and 0.33 (95% CI 0.25-0.44) for patients with Charlson scores of 1-2 and ≥ 3, respectively, compared with patients with Charlson 0. The cumulative 1 year incidence of radiotherapy did not differ much by Charlson score. The 1 year prevalence ratios of radiotherapy were 1.27 (95% CI, 1.12-1.45) and 1.10 (95% CI 0.94-1.28) for patients with Charlson scores of 1 and ≥ 2, respectively, compared with patients with Charlson 0. CONCLUSION: The results show that patients with comorbidity were treated less aggressively for their localized prostate cancer than patients without comorbidity.

Statin use and risk of prostate cancer: a Danish population-based case-control study, 1997-2010.

PURPOSE: Conflicting evidence has suggested that statins possess chemopreventive properties against prostate cancer (PCa). Therefore, we examined the association between statin use and risk of PCa in a Denmark-based case-control study. MATERIALS AND METHODS: We identified 42,480 patients diagnosed with incident PCa during 1997-2010 from a national cancer registry. Five age-matched population controls (n=212,400) were selected for each case using risk-set sampling. Statin use from 1996 to the index date was obtained from the National Prescription Registry. Odds ratios (ORs) adjusted for age, comorbidity, non-steroidal anti-inflammatory drug use, and educational level for PCa associated with statin use, were computed using conditional logistic regression. Analyses were stratified by duration of statin use (0-1, 2-4, 5-9, or ≥10 years), stage of PCa (localized or advanced), and type of statin used (lipophilic or hydrophilic). RESULTS: In total, 7915 patients (19%) and 39,384 controls (19%) redeemed statin prescriptions prior to the index date. Overall, statin users had a 6% lower risk of PCa compared with non-users [adjusted OR (ORa), 0.94; 95% confidence interval (CI), 0.91-0.97]. Risk estimates did not differ substantially by duration or type of statin used. Slightly larger statin use-associated risk reductions were observed for advanced PCa (ORa, 0.90; 95% CI, 0.85-0.96) and with statin use ≥10 years (ORa, 0.78; 95% CI, 0.65-0.95). CONCLUSION: Statin use was associated with a risk reduction overall (6%) and, specifically with advanced PCa (10%). Differences in diagnostic measures and residual confounding by socioeconomic parameters may have influenced our results.

Androgen-deprivation therapy in treatment of prostate cancer and risk of myocardial infarction and stroke: a nationwide Danish population-based cohort study.

BACKGROUND: Androgen-deprivation therapy (ADT) has been suggested to increase the risk for cardiovascular diseases, including myocardial infarction (MI) and stroke, but data are inconsistent. OBJECTIVES: To investigate the association between ADT and risk for MI and stroke in Danish men with prostate cancer. DESIGN, SETTING, AND PARTICIPANTS: A national cohort study of all patients with incident prostate cancer registered in the Danish Cancer Registry from January 1, 2002, through 2010 was conducted. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We used Cox regression analysis to estimate hazard ratios (HR) of MI and stroke for ADT users versus nonusers, adjusting for age, prostate cancer stage, comorbidity, and calendar period. Additionally, we stratified the analysis on preexisting MI/stroke status. RESULTS AND LIMITATIONS: Of 31,571 prostate cancer patients, 9204 (29%) received medical endocrine therapy and 2060 (7%) were orchidectomized. Patients treated with medical endocrine therapy had an increased risk for MI and stroke with adjusted HRs of 1.31 (95% confidence interval [CI], 1.16-1.49) and 1.19 (95% CI, 1.06-1.35), respectively, compared with nonusers of ADT. We found no increased risk for MI (HR: 0.90; 95% CI, 0.83-1.29) or stroke (HR: 1.11; 95% CI, 0.90-1.36) after orchiectomy. One limitation of the study is that information on prognostic lifestyle factors was not included and might have further informed our estimates. CONCLUSIONS: In this nationwide cohort study of >30 000 prostate cancer patients, we found that endocrine hormonal therapy was associated with increased risk for MI and stroke. In contrast, we did not find this association after orchiectomy.

The influence of cardiovascular morbidity on the prognosis in prostate cancer. Experience from a 12-year nationwide Danish population-based cohort study.

BACKGROUND: To determine the impact of preexisting ischemic heart disease (IHD) and stroke on overall survival in prostate cancer patients. METHODS: We conducted a cohort study of patients with incident prostate cancer registered in the Danish Cancer Registry from 1997 through 2008. We identified patients diagnosed with IHD or stroke prior to the date of prostate cancer diagnosis in the Danish National Patient Registry. We constructed Kaplan-Meier curves to analyze time to death and Cox regression was used to estimate hazard ratios (HRs) to compare mortality rates by preexisting IHD or stroke status, adjusting for age, stage, comorbidity, and calendar period. RESULTS: Of 30,721 prostate cancer patients, 4,276 (14%) had preexisting IHD and 1,331 (4%) preexisting stroke. Crude 1- and 5-year survival rates were 85% and 44% in men without preexisting IHD or stroke, 81% and 36% in men with preexisting IHD, and 78% and 27% in men with preexisting stroke. Adjusted HRs were 1.05 (95% CI 1.00-1.10) for patients with IHD and 1.20 (95% CI 1.12-1.30) for patients with stroke compared with patients without preexisting IHD or stroke. CONCLUSIONS: Preexisting IHD had minimal impact on mortality in prostate cancer patients, whereas overall mortality was 20% higher in prostate cancer patients with preexisting stroke compared to those without IHD or stroke. These results highlight the importance of differentiating between various comorbidities.