(272) EXPLORING THE IMPACT OF VARICOCELE ON PROSTATE CANCER PATIENTS: A PROPENSITY-SCORE MATCHED ANALYSIS USING GLOBAL REAL-WORLD DATA

Abstract Introduction Varicocele is the most common cause of male infertility. Emerging evidence has raised questions about a potential association between infertility and aggressive prostate cancer (PCa). Objective Our aim was to investigate whether having a varicocele affects PCa. Methods We queried the TriNetX database with access to electronic medical records from 108 partner healthcare organizations worldwide, covering over 129 million patients. We focused on adult males with prostate cancer between 2003 and 2023. Scrotal varices (ICD-10-CM: I86.1) were used to identify varicocele, while prostate cancer patients were identified by ICD-10-CM: C61 codes. We compared the baseline characteristics of PCa patients with and without varicocele, including erectile dysfunction (ED) (ICD-10-CM: N52) and “rising PSA level following PCa treatment” (coded as R97.21). We adjusted for age, BMI, diabetes mellitus, hypertensive diseases, total and free serum/plasma PSA levels, and Gleason score through logistic regression with a 1:1 propensity score matching (PSM). Calculated risk ratios (RR) and Kaplan Meier survival (KM) were calculated after PSM. Results Following PSM, 3,809 PCa patients were divided into two groups, with an average age of 66.9 +/- 10.6 years. Of the varicocele group, 50.97% were coded for “elevated PSA levels”, compared to 33.87% in the non-varicocele group, (p = < 0.001). Additionally, 33.89% of the varicocele group experienced ED, compared to 11.84% in the non-varicocele group, (p = < 0.001). Rising PSA level following PCa treatment was observed in 1.60% of the varicocele group, significantly higher than the non-varicocele group at 0.53%, (p = <0.001). Varicocele patients also exhibited a significantly higher rate of PCa screening, biopsy, and ultrasound-guided needle placement. On KM 5-year survival analysis for ED, patients without varicocele had 78.04% survival probability compared to 70.96% for patients with varicocele, (p = < 0.001). Conclusions Our study suggests a potential hypothetical association between varicocele and adverse outcomes in prostate cancer patients, including elevated PSA, ED, and rising PSA after PCa treatment. Further research is warranted to understand the clinical implications of this association and determine the usefulness of varicocelectomy on PCa outcomes. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Clarus Therapeutics, Antares Pharma, Acerus.