Implications of Prostate Cancer Treatment in Men With Inflammatory Bowel Disease.
To investigate the influences of inflammatory bowel disease (IBD), a rare but morbid disease with increasing incidence, on prostate cancer management decisions. We examined whether prostate cancer treatment differed for men with IBD, and whether treatment choice was associated with risk of IBD flare.



Using Veterans Health Administration cancer registry and administrative data, we identified 52,311 men diagnosed with prostate cancer from 2005 to 2008. We used International Classification of Diseases-9 codes and pharmacy and utilization data to identify IBD diagnoses, IBD-directed therapy, and flares (glucocorticoid escalation, hospitalization, and surgical intervention). We compared characteristics across men with and without IBD, and used multivariable regression to examine IBD flares after treatment according to treatment type.



Two hundred and forty men (0.5%) had IBD prior to prostate cancer diagnosis. Compared to non-IBD patients, IBD patients were more likely Caucasian (P < .001) with lower-risk cancer (P = .02). Surgery was more common in IBD patients (41% vs 28%, P < .001). In the year following prostate cancer treatment, 18% of IBD patients experienced flares. After adjustment, the only predictor of flare in the year after treatment was flare in the year prior to treatment (adjusted odds ratio, 12.5; 95% confidence interval, 5.4-29.2).



IBD patients were more likely to have lower-risk disease and be treated with surgery. Choice of prostate cancer treatment did not predict flares in the subsequent year. Better understanding of the intersection of IBD and prostate cancer can help inform treatment decisions for the increasing number of men managing both diseases.
Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI.
Peter S
PS
Kirk
Department of Gastroenterology, Division of Internal Medicine, University of Michigan Health System, Ann Arbor, MI.
Shail
S
Govani
Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI.
Tudor
T
Borza
Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI.
Brent K
BK
Hollenbeck
VA Health Services Research and Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI.
Jennifer
J
Davis
Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI.
Dean
D
Shumway
Department of Gastroenterology, Division of Internal Medicine, University of Michigan Health System, Ann Arbor, MI; VA Health Services Research and Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI.
Akbar K
AK
Waljee
Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI; VA Health Services Research and Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI. Electronic address: tskolar@med.umich.edu.
Ted A
TA
Skolarus
D000368:Aged; D015331:Cohort Studies; D005938:Glucocorticoids / Q000378:metabolism; D006760:Hospitalization; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D018579:Patient Selection; D011467:Prostate / Q000473:pathology; D011471:Prostatic Neoplasms / Q000150:complications* / Q000628:therapy*; D012042:Registries; D012307:Risk Factors; D014481:United States; D014493:United States Department of Veterans Affairs
D005938:Glucocorticoids