Is prostate cancer a Lynch syndrome cancer？

The question of whether men with an inherited genetic condition called Lynch syndrome have an increased risk of developing prostate cancer has been controversial. It is important to answer this question, for understanding the role of DNA mismatch repair in carcinogenesis of prostate as well as for clinical implications for screening.     

Does screen-detected breast cancer have better survival than symptomatic breast cancer?

OBJECTIVES: Evidence obtained from several randomized control trials suggest that mortality from breast cancer could be reduced by mammographic screening. However, a recent meta-analysis questioned the general acceptance that screening for breast cancer is beneficial. The purpose of the study was to analyze prospectively collected data from our unit and produce overall and comparative 5-year survival rates for screen-detected and symptomatic breast cancer. METHODS: Prospectively collected data on all patients diagnosed with invasive breast cancer between January 1993 and December 1994 (24 months), and monitored until the end of 1999, were collated and analyzed. Five-year survival was estimated and broken down by age at diagnosis, tumour size, grade and nodal status. The overall 5-year survival for women with screen-detected cancers was compared with that for women with symptomatically presenting cancers. RESULTS: Between January 1993 and December 1994, 308 patients with invasive breast cancer were referred to the unit (162 via the breast screening programme and 146 presenting symptomatically). The overall 5-year survival was 85.5% (confidence interval [CI], 80.8-89.1). Small tumour size, low grade and negative nodal status were associated with higher survival rates. Five-year survival of the screen-detected cancer patients (91.7%; CI, 85.8-95.2) was higher than that of patients presenting symptomatically (78.6%; CI, 70.6-84.6; p < 0.001). CONCLUSIONS: These findings suggest that patients with screen-detected breast cancer may have better survival compared to those with symptomatically detected breast cancer. The results support the argument in favour of a beneficial impact of breast screening programmes on patients' survival.     

Are risk factors for breast cancer similar in women with inflammatory breast cancer and in those with non-inflammatory breast cancer?

PURPOSE: The aim of the study was to compare reproductive factors in patients with inflammatory breast cancer (IBC), and with non-inflammatory breast cancer (non-IBC). The study was performed in two centers: one French including 49 IBC patients and 140 non-IBC and another Tunisian including 97 IBC and 139 non-IBC. Unconditional logistic regression was used for the analyses. PATIENTS AND METHODS: The French IBC patients had a lower educational level, a higher body mass index and a longer cumulative duration of breast-feeding, and they included a greater proportion of non-European women, than the non-IBC patients. In the multivariate analysis, only breast-feeding duration remained associated with the IBC status (P=10(-3)). These results could not be verified in the Tunisian series, because the duration of breast-feeding was unavailable in this center. RESULTS: This study suggests that the etiology of IBC might be different of that of non-IBC.     

Are predictive models for cancer volume clinically useful in localized prostate cancer?

Objectives: To evaluate the correlation between preoperatively predicted and pathologically measured prostate cancer volumes and to investigate the clinical use of preoperatively predicted cancer volume in predicting pathological stage. Methods: Correlations between pathological findings and various preoperative parameters, including the cancer volumes as predicted by using two methods (Vca and estimated PCvol), were analyzed in 196 patients who underwent radical prostatectomy for clinically localized prostate cancer. Results: Pathologically measured prostate cancer volume was significantly correlated with the Vca and estimated PCvol, but the correlation coefficients were respectively only 0.46 and 0.35. Prostate‐specific antigen (PSA), PSA density (PSAD), primary Gleason score, Vca, Vca fraction (Vcafx), and estimated PCvol were significantly higher in 82 patients with extraprostatic cancer than in 114 patients with organ‐confined cancer. Magnetic resonance imaging (MRI) findings were significantly correlated with pathological stage. Multivariate logistic regression analysis indicated that the Vcafx and MRI findings were significant predictors of extraprostatic cancer, but receiver operating characteristic analysis revealed that the combination of Vcafx and MRI findings had no advantage over the combination of Gleason score, PSAD, and MRI findings. Conclusions: Vca and estimated PCvol are significantly correlated with the pathologically measured cancer volume but their ability to accurately predict cancer volume is limited. Vcafx and MRI findings were statistically significant predictors of extraprostatic cancer but their combination was not superior to the combination of Gleason score, PSAD, and MRI findings.     

Interval breast cancer: is it a different type of breast cancer?

We have compared tumour type, tumour size, tumour grade and axillary lymph node status in three groups of women, 230 interval breast cancers (IC) in the West Sussex Breast Screening programme and 625 screen detected (SD) cancers and 916 symptomatic (S) cancers treated at Worthing Hospital between July 1989 to April 1996. Our true interval cancer detection rates were 5.28, 11.28 and 15.3 per 10,000 screened women for the 1st, 2nd and 3rd year after screening. The proportionate incidences of true interval cancer were 29%, 61% and 82% for the 1st, 2nd and 3rd year, similar to others' programmes in UK. In our programme a large proportion (42%) of IC and more than half of the true IC presented in the 3rd year after screening. Out of 230 interval cancers, 40% (90) were unclassifiable, the remaining 60% (140) were classified as: True interval cancers (T) 54% (76), False Negative Subtle (FNS) 12% (16), Occult (O) 12% (17), and 22% (31) as False Negative (FN). Analysis of interval cancers according to their classification did not demonstrate any significant difference with respect to tumour size (chi2 5.59, df 4, P=0.22), tumour grade (chi2 5.29, df 4, P=0.25) and axillary node status (chi2 3.16, df 4, P=0.53) thus establishing interval cancers as a single group. Invasive ductal carcinoma of no specific type was the main tumour type in all three groups. Analysis of variance (ANOVA) showed significant differences in size between the groups (df 2, F=71.36, p<0.0001). Symptomatic cancers were 1.19 times the size of IC while SD were 0.83 times the size of IC. The difference in groups in terms of tumour grade was significant (Kruskal-Wallis test chi2 33.31, df 2, P<0.0001). The incidence of grade 2 tumours was similar in the three groups while a third of the IC and S were grade 3 tumours. Comparison of axillary node status showed a significant difference between the three groups (chi2 26.59, df 2, P<0.0001). When means and 75th percentiles were compared IC had the greatest number of positive nodes while SD had the smallest number of positive nodes. Interval cancers are the middle spectrum between symptomatic and screen detected breast cancers and represent small cancers (<10 mm) not detected at the time of screening and de novo cancers developing in the screening interval. The need for improving the sensitivity of current screening methods and identifying newer methods of breast cancer detection is highlighted by our study.     

Can we prevent prostate cancer? Rationale and current status of prostate cancer chemoprevention

Prostate cancer has been one of the most frequent cancers among men in Western countries for the past decade. Investigation of prostate cancer prevention is very attractive, because prostate cancer has a high incidence, long-term natural history, regional difference in incidence, and is effected by sex steroids. Chemoprevention is defined as the use of specific agents to suppress or reverse carcinogenesis and to prevent the development of cancer. The development of chemoprevention strategies against prostate cancer would be of medical and economic importance. Basic and clinical research of chemoprevention of prostate cancer are under active investigation. This article aims to summarize and review the basic evidence and clinical trials on prostate cancer chemoprevention. Recent research has demonstrated that many agents, such as agents altering sex steroid signaling, drugs inducing antiproliferation/differentiation, retinoids, anti-inflammatory drugs, and antioxidants, could be potential preventatives for prostate cancer. Large-scale clinical trials have suggested that 5alpha-reductase inhibitor finasteride, selenium, and vitamin E can function as a chemopreventive agent. Although no definitely effective strategies of prostate cancer prevention have been identified yet, increasing evidence will provide effective and safe strategies that bring clinical benefits.     

Can anesthetic techniques or drugs affect cancer recurrence in patients undergoing cancer surgery?

Despite the development of effective chemotherapy and radiotherapy, surgery remains the mainstay treatment of many cancers, requiring anesthesia. Almost all cancer deaths after primary surgery are attributable to recurrence or metastases. Recently it has been hypothesized that the perioperative anesthetic management of cancer patients could potentially affect the risk of recurrence and metastases, which implies a key role for anesthesiologists in choosing anesthetic agents and techniques that optimize the balance between the metastatic potential of the tumor versus its elimination by antimetastatic immune defenses. This review summarizes available experimental information on the potential effects of common anesthetic agents and techniques on cancer metastases and the conflicting retrospective clinical data on regional anesthesia in various types of cancer. A number of prospective, randomized, multicenter, clinical trials are in progress, and their results are eagerly awaited.     

Bilateral testicular cancer: a preventable problem? Experience from a large cancer centre

OBJECTIVE: To report a retrospective review of patients with a testicular germ cell tumour treated in a large cancer centre who developed a second tumour, as 1.8-5% of such patients will subsequently develop a new primary tumour in the contralateral testis. PATIENTS AND METHODS: From a database of 570 men treated for testicular cancer in the West of Scotland between 1989 and 1998, all those who developed bilateral testicular tumours were identified. RESULTS: Nineteen men (3.3%) developed a second primary testicular malignancy; the mean age at diagnosis of the first tumour was 29.5 years, with the mean (range) interval to diagnosis of the second tumour of 76 (11-181) months (except for one man with synchronous tumours). The first tumour was teratoma in 11 and seminoma in seven; one patient had synchronous bilateral teratoma. The second primary was teratoma in 10 and seminoma in eight. Known risk factors for carcinoma in situ were present in nine patients, i.e. a small atrophic contralateral testis in five, a family history of testicular cancer in two, a history of infertility in two and unilateral undescended testis in one. Two patients had had contralateral testicular biopsies at the first diagnosis; both were negative for intratubular germ cell neoplasia (IGCN). Eight patients had chemotherapy to treat the first tumour and 14 for the second. All underwent bilateral orchidectomy. Overall, 18 of 19 men are alive and disease-free, with a median follow-up of 51 months. Pathology for 12 of the second testicular tumours was available for review; there was no IGCN in any of the slides from three patients, it was only present focally around the tumour in seven, and was diffuse in two patients. CONCLUSIONS: Chemotherapy for the first testicular tumour does not eliminate the risk of developing a contralateral tumour. Despite careful follow-up, in most patients the second primary tumour was not diagnosed early enough to avoid chemotherapy. The focal nature of IGCN in the second testis in most patients questions the value of biopsy of the contralateral testis. Improved methods of detecting patients at risk of second testicular tumours are needed.     

Resveratrol--a prostate cancer chemopreventive agent?

The incidence of prostate cancer in Western countries continues to rise. Whilst opinion remains divided on the best treatment for localized disease, intervention for metastatic, hormone-independent cancer remains extremely limited. The concept of chemoprevention is gaining popularity as an effective means of reducing the burden of prostate cancer on the population, and many compounds with putative chemopreventive activity are currently under investigation. Resveratrol is a plant-derived polyphenolic compound which has a wide spectrum of biological activity. It has anti-oxidant and anti-inflammatory properties, and may induce apoptosis as well as modulate the function of the androgen receptor in prostate cancer cell lines. Further studies to evaluate the use of this compound as a chemopreventive agent in prostate cancer are warranted.     

Can prostate cancer be prevented?

The goal of primary chemoprevention is to decrease the incidence of a given cancer, simultaneously reducing both treatment-related adverse events and mortality. Prostate cancer is an attractive and appropriate target for primary prevention because of its incidence, prevalence, and disease-related mortality; its long latency and molecular pathogenesis; and epidemiologic data indicating that modifiable environmental factors may decrease risk. The Prostate Cancer Prevention Trial (PCPT) demonstrated that finasteride can prevent prostate cancer, albeit with an apparently increased risk of high-grade disease. A substantial amount of epidemiologic, molecular, and clinical evidence suggests that both selenium and vitamin E might also prevent prostate cancer, and this combination is being tested in the Selenium and Vitamin E Cancer Prevention Trial (SELECT). Ultimately, the adoption of a preventive strategy hinges on its potential benefits weighed against the potential risks of the specific agents used.