Healthcare utilization and costs in patients with benign prostatic hyperplasia： a population-based study

This study aimed to investigate differences in healthcare service utilization between patients with and those without benign prostatic hyperplasia （BPH） using Taiwan＇s National Health Insurance population-based database. A total of 7413 patients with BPH and 7413 age-matched patients without BPH were included. The outcome variable was 1-year utilization of healthcare services Jncluding the number of outpatient visits, inpatient days, and the costs of outpatient and inpatient treatments. In addition, we separated healthcare services into urology services and nonurology services for analysis. We found that as to the utilization of outpatient urological services, patients with BPH had more outpatient services （7.84 vs 0.52, P 〈 0.001）, higher outpatient costs （US$372 vs US$34, P 〈 0.001）, a longer length of inpatient stay （0.55 vs 0.11, P 〈 0.001）, higher in-patients costs （US$149 vs US$32, P 〈 0.001）, and higher total costs （US$521 vs US$67, P 〈 0.001） than the comparison group. As for nonurological services, patients with BPH also had more outpatient services （49.11 vs 24.79, P〈 0.001）, higher outpatient costs （US$1794 vs US$1014, P〈 0.001）, a longer length of in-patient stay （3.72 vs 2.04, P〈 0.001）, higher inpatient costs （US$874 vs US$486, P〈 0.001）, and higher total costs （US$2668 vs US$1500, P 〈 0.001） compared to comparison patients. We also found that the average total cost was about 2-fold greater for patients with BPH than comparison patients. We concluded that patients with BPH had higher healthcare utilization than comparison patients without BPH.

Impact of androgen-deprivation therapy on the outcome of dose-escalation prostate cancer radiotherapy without elective pelvic irradiation

The benefit of androgen-deprivation therapy （ADT） in combination with dose-escalated radiotherapy （DERT） for localized prostate cancer has not been determined in randomized studies. In this study, the benefit of ADT was assessed in patients uniformly treated with dose-escalated intensity-modulated radiation therapy （IMRT） to the prostate and seminal vesicles but not pelvis. In all, 419 patients with localized prostate adenocarcinoma underwent definitive IMRT （cumulative dose 78 Gy）, with 32.6%, 33.1%, 32.1%, and 2.1% having T1 through T4 disease, respectively, and 51.2% having high-risk disease. ADT was given to 76.1% of patients. With a median follow-up of 60 months, 5-year biochemical failure-free, disease-free, and overall survival rates were 87%, 86%, and 87%, respectively. T stage was an independent predictor of all three rates. Five-year pelvic nodal recurrence rate was 2.9%. ADT improved biochemical failure-free and disease-free survival but not overall survival. ADT showed benefit in high-risk disease but not intermediate-risk disease. Late gastrointestinal and genitourinary toxicities ≥ grade 2 occurred in 11.0% and 6.7%, respectively. In conclusion, DERT with 78 Gy yields good disease control and low rate of pelvic nodal recurrence. ADT improves disease-free survival in patients with high-risk but not intermediate-risk disease.

No increased risk of dementia in patients receiving androgen deprivation therapy for prostate cancer： a 5-year follow-up study

Prior studies suggested that the use of androgen deprivation therapy （ADT） in patients with prostate cancer （PC） might cause the impairment of cognitive function which is one of the common symptoms of dementia; however, the association between ADT and cognitive impairment still remains controversial. This retrospective cohort study aimed to investigate the relationship between ADT and subsequent risk of dementia using a population-based dataset, Data for this study were taken from the Taiwan （China） Longitudinal Health Insurance Database 2005. We included 755 PC patients who received ADT in the study cohort and 559 PC patients who did not receive ADT in the comparison cohort. Each patient was individually tracked for a 5-year period to define those who subsequently received a diagnosis of dementia. Results show that the incidence rates of dementia per 100 person-years were 2.35 （95% confidence interval [95% CI]： 1.82-2.98） and 1.85 （95% Ch 1.35-2.48） for PC patients who received ADT and those who did not receive ADT, respectively. The adjusted hazard ratio （HR） for dementia for PC patients who received ADT was 1.21 （95% Ch 0.82-1.78, P = 0,333） compared to those who did not receive ADT. In addition, the adjusted HRs for dementia for PC patients receiving ADT with gonadotropin-releasing hormone （GnRH） agonists and without GnRH agonists were 1.39 （95% Ch 0.80-2.40, P = 0.240） and 1.13 （95% CI： 0.75-1.71, P = 0.564）, respectively, compared to PC patients not receiving ADT. We concluded that there was no difference in the risk of subsequent dementia between PC patients who did and those who did not receive ADT.