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HYPOGONADAL MEN HAVE A SIGNIFICANT RISE IN SERUM TESTOSTERONE LEVELS FOLLOWING PROSTATECTOMY
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THE JOURNAL OF UROLOGY®
Bioavailable-T, Total-F and Bioavailable-F) and Saliva hormones (Saliva-T and Saliva-F) were measured directly by liquid chromatography / tandem mass spectrography. The International Index of Erectile Function (IIEF) was used as questionnaire to evaluate sexual dysfunction. RESULTS: Free-T and Bioavailable-T showed a significant inverse correlation with age (p<0.01). In the group not taking antidepressants, the levels of Bioavailable-F and Saliva-F showed a significant inverse correlation with score of IIEF domains (Erectile Function, Sexual Desire, Intercourse Satisfaction and IIEF5), and Total score of IIEF (p<0.05). However, Bioavailable-T and Saliva-T showed no association with IIEF score. In the group taking antidepressants, these hormone levels showed no correlation with IIEF. CONCLUSIONS: Using IIEF to evaluate sexual function, there was no significant relation with a reduction in T, but a significant correlation with Bioavailable-F and Saliva-F. Source of Funding: None
1027 HYPOGONADAL MEN HAVE A SIGNIFICANT RISE IN SERUM TESTOSTERONE LEVELS FOLLOWING PROSTATECTOMY John S Colen*, Jon A Rumohr, Osama Mohamed, Larry I Lipshultz, Mohit Khera, Houston, TX INTRODUCTION AND OBJECTIVES: There is limited data to suggest that serum testosterone values significantly rise after a radical prostatectomy and that the prostate may have an inhibitory effect on testosterone production (Miller, 2008). The objective of this study was to determine whether testosterone levels significantly increased in hypogonadal and eugonadal men following radical prostatectomy. METHODS: All patients scheduled to undergo a radical prostatectomy had testosterone levels drawn approximately 2 weeks prior to surgery as well as 3 month following surgery. The patient population was divided into two groups: eugonadal or hypogonadal. Hypogonadism was defined as a testosterone value less than 325 ng/dl. Testosterone values were determined using commercial immunoassay kits. Data was analyzed using paired samples t-test. RESULTS: There were 21 hypogonadal men enrolled into the study with an average age of 59.1 years. The average Gleason score in this group was 6.6. There was a significant difference in pre- and postprostatectomy testosterone values in this group of hypogonadal men (255 ng/dl vs 325 ng/dl, respectively, (p=0.03)). There were 34 eugonadal men enrolled into the study with an average age of 59.9 years and an average Gleason score of 6.9. There was no significant difference in the average pre- and post-prostatectomy serum testosterone values in these eugonadal men (443 ng/dl vs 420 ng/dl, respectively, (p > 0.05)). CONCLUSIONS: Hypogonadal men have a significant increase in serum testosterone values following radical prostatectomy. This rise in serum testosterone following radical prostatectomy was not appreciated in eugonadal men. Source of Funding: None
1028 PREDICTORS OF THE ANDROGEN DEFICIENCY IN MEN (ADAM) SYNDROME IN A PROSTATE CANCER SCREENING POPULATION Nelson N Stone*, New York, NY; Kathryn F Sullivan, Aurora, CO; Wendy Poage, Centennial, CO; E David Crawford, Aurora, CO INTRODUCTION AND OBJECTIVES: The ADAM10 is a 10-point questionnaire designed to be utilized in clinical practice to screen for low testosterone. We sought to determine its utility during prostate cancer awareness week (PCAW). METHODS: 10530 men attended PCAW 2007 and completed the ADAM questionnaire. A positive (+) ADAM was defined as a score of > 3 or a yes response to Q1 (decreased sex drive) or Q7 (erections less strong). Of the 10530, 4440 had serum testosterone determined and analyzed in a central lab. Associations between ADAM > 3, positive Q1 or Q7 and T
Vol. 181, No. 4, Supplement, Monday, April 27, 2009
cut-points were tested by chi-square analysis (Pearson). The sensitivity/ specificity for the most predictive T level was analyzed using ROC curves for ADAM8, Q1 and Q7. One way analysis (ANOVA) was used to test means for T levels against ADAM8, Q1, Q7 and age group. RESULTS: The median patient age was 61 (range 20-93) and the median T was 353 ng/dl (range 10-1650). 32.1%, 37.8%, and 52.3% had positive response to ADAM8, Q1, and Q7, respectively. Mean T levels for +ADAM8 were 357 vs. 375 (p<0.001), +Q1 358 vs. 377 (p<0.001) and for +Q7 363 vs. 378 (p=0.001). The cut point for T (low T) with the greatest area under the curve was <300 ng/dl (ROC: 0.545, 95% CI 0.525-0.564, p<0.001). Of the 4440, 1445 (32.5%) had a T < 300 ng/dl. 38.9% of men with low T had a +ADAM8 vs. 29.7% for those with normal T (p<0.001). 39.4% had +Q1 with low T vs. 28.9% with normal T (p<0.001) and 32.5% had +Q7 with low T compared to 28.7% with normal T (p<0.001). Age by decade also influenced men’s response to the questionnaire. Mean ADAM8 increased from 1.4 for < 40 years to 3.2 > 80 years old (p<0.001). The % of men with +Q1 and +Q7 similarly increased from 22.3% to 65.2% (p<0.001) and from 26% to 80.2% (p<0.001), respectively. However, regression analysis revealed that age was significant only in the 60-70 age group. CONCLUSIONS: Data from the PCAW 2007 population supports the use of the ADAM questionnaire to screen for a low T. A T level of <300 appears to be the most predictive value for androgen deficiency. Source of Funding: Prostate Cancer Education Council
1029 THE PREVALENCE OF HAEMOSTATIC AND FIBRINOLYTIC FACTORS IN MEN WITH ERECTILE DYSFUNCTION. A CONTROLLED TRIAL. Omer Baldo*, Lucinda K.M. Summers, Ian Eardley, Leeds, United Kingdom INTRODUCTION AND OBJECTIVES: There is some evidence that erectile dysfunction (ED) is an early predictor of cardiovascular diseases. Recent studies highlight the relationship between ED and metabolic syndrome. However, there is a paucity of controlled data to support this hypothesis. We assessed the prevalence of metabolic syndrome looking in particular into haemostatic and fibrinolytic markers in a group of men with ED versus a control group of men with normal potency. METHODS: 110 consecutive men with erectile dysfunction (ED group) and an age-matched control group of 118 men with normal potency (potent group) were recruited. Early morning fasting blood samples were obtained. The revised National Cholesterol Education Programme (NCEP) and International Diabetic Federation (IDF) criteria were used to identify metabolic syndrome. ED was assessed with International Index of Erectile Function (IIEF). The following markers were measured using a standard laboratory methods; fibrinogen, D-Dimer, PAI-1, hs-CRP and insulin. RESULTS: The mean age for the ED group was 58.4yrs and 57.8yrs for the potent group. NCEP definition reveled metabolic syndrome in 19% of men in the ED group and 11% in the potent group. The IDF identified a higher rate of metabolic syndrome of 49% and 33% in the ED group and the potent group respectively. The plasma circulating level of D-Dimer was significantly raised in the ED group (mean 103ng/ml) in comparison with the potent group (76ng/ml)( p< 0.005). Insulin was marginally but not significantly raised in the ED group. There was no difference between groups in fibrinogen, hs-CRP and PAI-1 CONCLUSIONS: It has been suggested that men with erectile dysfunction are at increased cardiovascular risk. However, our study did not reveal strong evidence of increased prevalence of metabolic syndrome the ED group in comparison to the potent controls. Source of Funding: Eli Lilly and Company Limited
THE JOURNAL OF UROLOGY®
Bioavailable-T, Total-F and Bioavailable-F) and Saliva hormones (Saliva-T and Saliva-F) were measured directly by liquid chromatography / tandem mass spectrography. The International Index of Erectile Function (IIEF) was used as questionnaire to evaluate sexual dysfunction. RESULTS: Free-T and Bioavailable-T showed a significant inverse correlation with age (p<0.01). In the group not taking antidepressants, the levels of Bioavailable-F and Saliva-F showed a significant inverse correlation with score of IIEF domains (Erectile Function, Sexual Desire, Intercourse Satisfaction and IIEF5), and Total score of IIEF (p<0.05). However, Bioavailable-T and Saliva-T showed no association with IIEF score. In the group taking antidepressants, these hormone levels showed no correlation with IIEF. CONCLUSIONS: Using IIEF to evaluate sexual function, there was no significant relation with a reduction in T, but a significant correlation with Bioavailable-F and Saliva-F. Source of Funding: None
1027 HYPOGONADAL MEN HAVE A SIGNIFICANT RISE IN SERUM TESTOSTERONE LEVELS FOLLOWING PROSTATECTOMY John S Colen*, Jon A Rumohr, Osama Mohamed, Larry I Lipshultz, Mohit Khera, Houston, TX INTRODUCTION AND OBJECTIVES: There is limited data to suggest that serum testosterone values significantly rise after a radical prostatectomy and that the prostate may have an inhibitory effect on testosterone production (Miller, 2008). The objective of this study was to determine whether testosterone levels significantly increased in hypogonadal and eugonadal men following radical prostatectomy. METHODS: All patients scheduled to undergo a radical prostatectomy had testosterone levels drawn approximately 2 weeks prior to surgery as well as 3 month following surgery. The patient population was divided into two groups: eugonadal or hypogonadal. Hypogonadism was defined as a testosterone value less than 325 ng/dl. Testosterone values were determined using commercial immunoassay kits. Data was analyzed using paired samples t-test. RESULTS: There were 21 hypogonadal men enrolled into the study with an average age of 59.1 years. The average Gleason score in this group was 6.6. There was a significant difference in pre- and postprostatectomy testosterone values in this group of hypogonadal men (255 ng/dl vs 325 ng/dl, respectively, (p=0.03)). There were 34 eugonadal men enrolled into the study with an average age of 59.9 years and an average Gleason score of 6.9. There was no significant difference in the average pre- and post-prostatectomy serum testosterone values in these eugonadal men (443 ng/dl vs 420 ng/dl, respectively, (p > 0.05)). CONCLUSIONS: Hypogonadal men have a significant increase in serum testosterone values following radical prostatectomy. This rise in serum testosterone following radical prostatectomy was not appreciated in eugonadal men. Source of Funding: None
1028 PREDICTORS OF THE ANDROGEN DEFICIENCY IN MEN (ADAM) SYNDROME IN A PROSTATE CANCER SCREENING POPULATION Nelson N Stone*, New York, NY; Kathryn F Sullivan, Aurora, CO; Wendy Poage, Centennial, CO; E David Crawford, Aurora, CO INTRODUCTION AND OBJECTIVES: The ADAM10 is a 10-point questionnaire designed to be utilized in clinical practice to screen for low testosterone. We sought to determine its utility during prostate cancer awareness week (PCAW). METHODS: 10530 men attended PCAW 2007 and completed the ADAM questionnaire. A positive (+) ADAM was defined as a score of > 3 or a yes response to Q1 (decreased sex drive) or Q7 (erections less strong). Of the 10530, 4440 had serum testosterone determined and analyzed in a central lab. Associations between ADAM > 3, positive Q1 or Q7 and T
Vol. 181, No. 4, Supplement, Monday, April 27, 2009
cut-points were tested by chi-square analysis (Pearson). The sensitivity/ specificity for the most predictive T level was analyzed using ROC curves for ADAM8, Q1 and Q7. One way analysis (ANOVA) was used to test means for T levels against ADAM8, Q1, Q7 and age group. RESULTS: The median patient age was 61 (range 20-93) and the median T was 353 ng/dl (range 10-1650). 32.1%, 37.8%, and 52.3% had positive response to ADAM8, Q1, and Q7, respectively. Mean T levels for +ADAM8 were 357 vs. 375 (p<0.001), +Q1 358 vs. 377 (p<0.001) and for +Q7 363 vs. 378 (p=0.001). The cut point for T (low T) with the greatest area under the curve was <300 ng/dl (ROC: 0.545, 95% CI 0.525-0.564, p<0.001). Of the 4440, 1445 (32.5%) had a T < 300 ng/dl. 38.9% of men with low T had a +ADAM8 vs. 29.7% for those with normal T (p<0.001). 39.4% had +Q1 with low T vs. 28.9% with normal T (p<0.001) and 32.5% had +Q7 with low T compared to 28.7% with normal T (p<0.001). Age by decade also influenced men’s response to the questionnaire. Mean ADAM8 increased from 1.4 for < 40 years to 3.2 > 80 years old (p<0.001). The % of men with +Q1 and +Q7 similarly increased from 22.3% to 65.2% (p<0.001) and from 26% to 80.2% (p<0.001), respectively. However, regression analysis revealed that age was significant only in the 60-70 age group. CONCLUSIONS: Data from the PCAW 2007 population supports the use of the ADAM questionnaire to screen for a low T. A T level of <300 appears to be the most predictive value for androgen deficiency. Source of Funding: Prostate Cancer Education Council
1029 THE PREVALENCE OF HAEMOSTATIC AND FIBRINOLYTIC FACTORS IN MEN WITH ERECTILE DYSFUNCTION. A CONTROLLED TRIAL. Omer Baldo*, Lucinda K.M. Summers, Ian Eardley, Leeds, United Kingdom INTRODUCTION AND OBJECTIVES: There is some evidence that erectile dysfunction (ED) is an early predictor of cardiovascular diseases. Recent studies highlight the relationship between ED and metabolic syndrome. However, there is a paucity of controlled data to support this hypothesis. We assessed the prevalence of metabolic syndrome looking in particular into haemostatic and fibrinolytic markers in a group of men with ED versus a control group of men with normal potency. METHODS: 110 consecutive men with erectile dysfunction (ED group) and an age-matched control group of 118 men with normal potency (potent group) were recruited. Early morning fasting blood samples were obtained. The revised National Cholesterol Education Programme (NCEP) and International Diabetic Federation (IDF) criteria were used to identify metabolic syndrome. ED was assessed with International Index of Erectile Function (IIEF). The following markers were measured using a standard laboratory methods; fibrinogen, D-Dimer, PAI-1, hs-CRP and insulin. RESULTS: The mean age for the ED group was 58.4yrs and 57.8yrs for the potent group. NCEP definition reveled metabolic syndrome in 19% of men in the ED group and 11% in the potent group. The IDF identified a higher rate of metabolic syndrome of 49% and 33% in the ED group and the potent group respectively. The plasma circulating level of D-Dimer was significantly raised in the ED group (mean 103ng/ml) in comparison with the potent group (76ng/ml)( p< 0.005). Insulin was marginally but not significantly raised in the ED group. There was no difference between groups in fibrinogen, hs-CRP and PAI-1 CONCLUSIONS: It has been suggested that men with erectile dysfunction are at increased cardiovascular risk. However, our study did not reveal strong evidence of increased prevalence of metabolic syndrome the ED group in comparison to the potent controls. Source of Funding: Eli Lilly and Company Limited