Standard of care treatment based on national guidelines for men with clinically localized high risk prostate cancer includes radical prostatectomy (RP) or external beam radiation therapy (EBRT) with androgen deprivation therapy (ADT). However, despite guideline recommendations, many patients undergo ADT alone or EBRT without ADT. We evaluated current trends in treatment of high risk prostate cancer and risk factors associated with non-standard of care treatment.METHODS: Men with high risk localized prostate cancer were retrospectively identified (cT3, PSA >20, Gleason 8-10, cN0M0) using the National Cancer Database (NCDB) between 2005-2015. Trends in treatment modalities were analyzed over this period. Multivariable logistic regression was performed to evaluate impact of clinical, racial, and socioeconomic factors on treatment method. Kaplan-Meier (KM) analysis was performed for overall survival (OS).RESULTS: A total of 149,343 patients with localized high risk prostate cancer were identified. 30,686 patients received non-standard of care treatment, categorized as EBRT without ADT or ADT alone. The percentage of men receiving non-standard of care treatment significantly decreased from 22.9% in 2005 to 18.7% in 2015 (P<0.001). The percent of men receiving ADT alone significantly decreased over this interval (13.2% in 2005, 11.5% in 2015, P<0.001), as did the percent of men receiving EBRT without ADT

We hypothesized exercise vasodilation in skeletal muscle differs between sexes due to nitric oxide synthase (NOS) and cyclooxygenase (COX) signalling. 39 healthy adults (19 females, F, 20 males, M, 26 ± 1 yrs) completed two 10‐min bouts of dynamic forearm exercise at 15% effort, separated by 20 min rest. After 5 min of control exercise, NOS or COX was inhibited during the final 5 min of exercise by intra‐arterial infusion of L‐NMMA or ketorolac, respectively. During min 5‐10 of the second exercise bout the remaining drug was infused to achieve double blockade (DB). Forearm blood flow (FBF; echo and Doppler ultrasound), arterial pressure (brachial catheter), and forearm lean mass (DEXA) were measured to calculate relative forearm vascular conductance (FVC) = FBF/100mmHg/100g lean mass. Results are mean ± SE. Females exhibited greater vasodilation than Males in control exercise (Δ FVC, 19±1 vs. 14±1, P < 0.01). L‐NMMA reduced FVC similarly (F: Δ ‐2.3 ± 1.3 vs. M: Δ – 3.7 ± 0.8, p = 0.85). In contrast, ketorolac increased FVC similarly in Females and Males (F: Δ 2.1 ± 1.3 vs. M: Δ 2.2± 1.9, p = 0.83). Despite Females exhibiting a greater exercise FVC, DB caused similar Δ FVC between the sexes (0.89). Females have a greater exercise vasodilatory response. NOS, COX, and DB responses are similar, thus, exercise vasodilation differences between sexes are due to a NOS‐COX independent mechanism(s). Grant Funding Source: Supported by NIH 144PRJ52FK