title: Agent Orange and long-term outcomes after radical prostatectomy.
abstract: OBJECTIVE
  To investigate the association between Agent Orange (AO) exposure and long-term prostate cancer (PC) outcomes.
  
  
  METHODS
  Data from 1,882 men undergoing radical prostatectomy for PC between 1988 and 2011 at Veterans Affairs Health Care Facilities were analyzed from the Shared Equal Access Regional Cancer Hospital database. Men were stratified by AO exposure (binary). Associations between AO exposure and biopsy and pathologic Gleason sum (GS) and pathologic stage were determined by logistic regression models adjusted for preoperative characteristics. Hazard ratios for biochemical recurrence (BCR), secondary treatment, metastases, and PC-specific mortality were determined by Cox models adjusted for preoperative characteristics.
  
  
  RESULTS
  There were 333 (17.7%) men with AO exposure. AO-exposed men were younger (median 59 vs. 62 y), had lower preoperative prostate-specific antigen levels (5.8 vs. 6.7 ng/ml), lower clinical category (25% vs. 38% palpable), and higher body mass index (28.2 vs. 27.6 kg/m(2)), all P<0.01. Biopsy GS, pathologic GS, positive surgical margins, lymph node positivity, and extracapsular extension did not differ with AO exposure. At a median follow-up of 85 months, 702 (37.4%) patients had BCR, 603 (32.2%) patients received secondary treatment, 78 (4.1%) had metastases, and 39 (2.1%) died of PC. On multivariable analysis, AO exposure was not associated with BCR, secondary treatment, metastases, or PC mortality.
  
  
  CONCLUSIONS
  AO exposure was not associated with worse preoperative characteristics such as elevated prostate-specific antigen levels or biopsy GS nor with BCR, secondary treatment, metastases, or PC death. Thus, as data on AO-exposed men mature, possible differences in PC outcomes observed previously are no longer apparent.
authors.affiliation: Department of Urology, University of Illinois at Chicago, Chicago, IL.
authors.forename: Aaron E
authors.initials: AE
authors.lastname: Ovadia
authors.affiliation: Section of Urology, VAMC Augusta, Augusta, GA; Section of Urology, Medical College of Georgia, Augusta, GA.
authors.forename: Martha K
authors.initials: MK
authors.lastname: Terris
authors.affiliation: Department of Surgery, VA Greater Los Angeles Healthcare System, Los Angeles, CA; Department of Urology, UCLA School of Medicine, Los Angeles, CA.
authors.forename: William J
authors.initials: WJ
authors.lastname: Aronson
authors.affiliation: Department of Urology, UCSD, San Diego, CA; VAMC San Diego, San Diego, CA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Kane
authors.affiliation: Department of Urology, Oregon Health Sciences University, Portland, OR.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Amling
authors.affiliation: Department of Urology, UCSF Comprehensive Cancer Center, San Francisco, CA; Department of Surgery, VAMC, San Francisco, CA.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Cooperberg
authors.affiliation: Section of Urology, VAMC Durham, Durham, NC; Department of Surgery, Duke University School of Medicine, Chicago, IL.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Freedland
authors.affiliation: Department of Urology, University of Illinois at Chicago, Chicago, IL. Electronic address: mabern1@uic.edu.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Abern
mesh_terms: D015085:2,4,5-Trichlorophenoxyacetic Acid / Q000009:adverse effects*; D015084:2,4-Dichlorophenoxyacetic Acid / Q000009:adverse effects*; D000368:Aged; D000075182:Agent Orange; D003678:Defoliants, Chemical / Q000009:adverse effects*; D004781:Environmental Exposure / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D000072317:Polychlorinated Dibenzodioxins / Q000009:adverse effects*; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000139:chemically induced* / Q000601:surgery*; D012189:Retrospective Studies; D014481:United States; D014728:Veterans
chemical_list: D003678:Defoliants, Chemical; D000072317:Polychlorinated Dibenzodioxins; D015084:2,4-Dichlorophenoxyacetic Acid; D000075182:Agent Orange; D015085:2,4,5-Trichlorophenoxyacetic Acid; D017430:Prostate-Specific Antigen
keywords: Agent Orange; Prostate cancer; Prostatectomy