DP方案治疗>75岁转移性去势抵抗性前列腺癌患者的疗效及安全性研究

目的探讨多西他赛+泼尼松(DP)方案治疗>75岁转移性去势抵抗性前列腺癌(mCRPC)患者的疗效及安全性。方法回顾性分析2013年2月至2019年12月北京医院收治的118例年龄≥60岁mCRPC患者的临床资料。患者中位年龄72(65,77)岁;美国东部肿瘤协作组(ECOG)评分均≤2分,G8量表评分(14.1±1.5)分,简易智力状态评估量表(Mini-Cog)评分中位值3(1,3)分;118例均出现骨转移。依据年龄将患者分为60~75岁组和>75岁组。其中60~75岁组65例,年龄67(63,71)岁;Gleason评分≤7分24例,>7分41例;61例行内分泌治疗,4例行睾丸切除术;ECOG评分0分37例,1分25例,2分3例;前列腺特异性抗原(PSA)90(35.5,258)ng/ml;G8量表评分(14.3±2.1)分;Mini-Cog评分3(2,3)分。>75岁组53例,年龄78(76, 83)岁,Gleason评分≤7分30例,>7分23例;43例行内分泌治疗,10例行睾丸切除术;ECOG评分0分5例,1分38例,2分10例;PSA 115(60,296)ng/ml;G8量表评分(13.6±1.1)分;Mini-Cog评分3(1,3)分。两组年龄、Gleason评分、去势方式、ECOG评分差异均有统计学意义(P<0.05),PSA水平、G8量表评分、Mini-Cog评分差异均无统计学意义(P>0.05)。两组患者均予DP方案化疗:多西他赛每周期予65~75mg/m²,第1天;多西他赛用药前12、3、1h予地塞米松7.5mg预处理;泼尼松5mg每天1次,第2~21天。每21天为1个周期。比较两组患者应用DP方案化疗的疗效及安全性。结果 118例均获得随访,中位随访时间21.5(6,62)个月。60~75岁组与>75岁组化疗周期数量[(6.1±1.3)个与(6.8±1.7)个]、化疗剂量[(70.3±4.3) mg/m²与(66.3±5.2) mg/m²]、PSA反应率[72.3%(47/65)与66.0%(35/53)]、骨痛缓解率[45.0%(9/20)与54.5%(6/11)]的差异均无统计学意义(P>0.05)。60~75岁组与>75岁组中位无进展生存时间[6.1(1.4,11.2)个月与5.9(2.0,12.0)个月]差异无统计学意义(P>0.05)。两组均无死亡病例,60~75岁组与>75岁组应用DP方案作为一线治疗后中位总生存时间(OS)[26.5(16.1,31.3)个月与24.8(17.5,28.4)个月]差异无统计学意义(P=0.223),两组应用DP方案作为二线或三线治疗后中位OS[17.3(13.2,20.5)个月和15.4(12.3,20.0)个月]差异也无统计学意义(P=0.331)。60~75岁组和>75岁组3级不良反应分别为3例(4.6%)和5例(9.4%),3级白细胞减少分别为1例次(1.5%)和2例次(3.8%),3级中性粒细胞减少性发热各1例次,两组上述并发症发生率的差异均无统计学意义(P>0.05)。结论通过G8量表评分、Mini-Cog评分进行筛选,DP方案化疗对>75岁的mCRPC患者有良好的PSA反应率、骨痛缓解率及OS,且未增加不良反应发生率;年龄不应成为前列腺癌应用DP方案化疗的绝对禁忌。     

Clinical characteristics of prostate cancer in elderly Japanese patients 80 years of age or older

OBJECTIVE: Prostate adenocarcinoma is predominantly a disease of elderly men. This study retrospectively examined prostate adenocarcinoma in Japanese patients 80 years of age or older to determine the natural history and prognosis of this malignancy in the elderly population. METHODS: The medical records of 593 patients were reviewed, with respect to age, histologic grade, clinical and pathological stage, treatment modality and clinical outcome. A variety of possible clinical factors were compared between patient groups > or = 80 and < 80 years old. RESULTS: No significant difference in clinical stage, tumor grade, and performance status (PS) was found between two age groups of patients with prostate cancer. A significant stage migration between pre-PSA era and PSA era was found only in the group < 80 years old. In the series of stage D2 cancer patients, while there was no significant difference in cause-specific and progression-free survival rates between the two groups, the younger group < 80 years old had a better marker response at 3 months from the start of endocrine therapy compared with the older group (P = 0.0048, chi2 analysis). CONCLUSION: These data suggest that patients > or = 80 years with prostate cancer present with similar histologic grade and disease stage as younger patients, although the younger group with stage D2 had a better marker response to endocrine therapy.     

Der ältere Prostatakrebspatient

Introduction

Some data exist on information and decision-making preferences of elderly prostate cancer patients but little is known about whether communication needs are being met in urological practice. Therefore, it was the aim of this study to examine the information and shared decision-making experiences of prostate cancer patients over 75 years old.

Materials and methods

The HAROW (hormonal therapy, active surveillance, radiation, operation and watchful waiting) study is a prospective, observational study designed to collect clinical data and patient reported outcome of different treatment options for patients newly diagnosed with localized prostate cancer under real conditions. At 6-month intervals general clinical data, PROs (e.g. quality of life, quality of physician-patient interaction) and individual costs are documented. Data from 2,482 patients at 4 time points from T0 (initial diagnosis) to T3 (24 months follow-up) were analyzed.

Results

T-tests and χ²-tests revealed no significant differences in terms of shared decision-making and information to different treatment options between patients aged over 75 years old and the rest of the sample. Regarding information on self-help groups, rehabilitation options and a second medical opinion, there were significant differences between prostate cancer patient age groups: patients aged over 75 years old received less information on these aspects at all points in time.

Conclusion

Patients at all ages feel activated by urologists and are informed about different treatment options. However, there is room for improvement in terms of informing especially elderly prostate cancer patients about rehabilitation, second medical opinions and self-help groups. Special information tools and decision aids for prostate cancer patients aged over 75years old should be developed and implemented to meet the specific information needs.     

鲁西冀南地区低剂量螺旋CT在肺癌筛查中的应用

目的探讨鲁西冀南地区低剂量螺旋CT(LDCT)在不同性别和年龄人群中肺癌检出率的差异,为制定更适宜的筛查方案提供依据。 方法回顾性分析2015年在聊城市第二人民医院进行LDCT肺癌筛查的2 056例受检者的资料。根据性别、国内肺癌高危人群年龄段,以及实际检出高危人群年龄段三种方法进行分组,比较各组间肺癌检出率的差异。 结果2 056例受检者中,确诊肺癌22例,其中腺癌20例,鳞癌2例。45～75岁共检出肺癌21例,占总检出人数的95.5%(21/22)。男性组肺癌检出率为0.8%(10/1 217),女性组为1.4%(12/839),两组比较差异无统计学意义(χ²＝1.738,P＝0.187)。根据国内肺癌高危人群定义中的年龄段分组,高危组(50～75岁)肺癌检出率为1.3%(15/1 158),低危组(<50岁或>75岁)为0.8%(7/898),两组比较差异无统计学意义(χ²＝1.271,P＝0.26)。根据实际检出高危人群的年龄段分组,新高危组(45～75岁)肺癌检出率为1.4%(21/1 502),新低危组(<45岁或>75岁)为0.2%(1/554),新高危组检出率显著高于新低危组(χ²＝5.668,P＝0.017)。 结论鲁西冀南地区人群在LDCT肺癌筛查中,不仅要关注男性,也要关注女性;且将肺癌筛查高危人群年龄调整为45～75岁更为合适。     

Efficacy and toxicity outcomes of elderly castrate-resistant prostate cancer patients treated with docetaxel—A pooled analysis of 3 randomized studies

BackgroundThe current study aims to assess the differences in efficacy and toxicity outcomes according to age among metastatic castrate-resistant prostate cancer patients within a pooled cohort of 3 trials.MethodsThis study is a pooled analysis of the control arms of 3 prospective studies (NCT00273338; NCT00988208; NCT00519285) which assessed docetaxel/prednisone among patients with metastatic castrate-resistant prostate cancer. Incidence of toxicities between the 2 age groups (<75 years vs. ≥75 years) was assessed through chi-squared testing. Through Kaplan-Meier survival estimates, overall survival was compared between the 2 age groups (<75 years vs. ≥75 years). Multivariate Cox regression analysis was then conducted to evaluate factors potentially affecting overall survival.ResultsA total of 1,212 patients were <75 years old and 388 patients were ≥75 years old were included in the pooled analysis. Comparing both patient subgroups together, older patients were more likely to have any high-grade adverse event (P < 0.001), any fatal adverse events (P = 0.007), any-grade anemia (P < 0.001), and any-grade neutropenia (P < 0.001). Using Kaplan-Meier survival estimates, there was no difference in overall survival between both age groups (P = 0.084). Multivariable Cox regression analysis was additionally conducted to further assess the impact of age on overall survival. There was no difference in overall survival according to age (hazard ratio for age < 75 years vs. age ≥ 75 years: 0.883; 0.738–1.057; P = 0.176).ConclusionOlder patients (≥75 years) have apparently similar survival outcomes compared to younger patients (<75 years). On the other hand, older patients have a higher risk of high-grade toxicities and fatal toxicities compared to younger patients.     

A large prostate at radical retropubic prostatectomy does not adversely affect cancer control,continence or potency rates

OBJECTIVES: To determine the effect of a large prostate at radical retropubic prostatectomy (RRP) on the pathological outcome, biochemical recurrence rates, potency and continence. PATIENTS AND METHODS: From a database of 440 patients treated with RRP, retrospective information was obtained on prostate weights, patient and tumour characteristics, and follow-up. Potency and continence after RRP was obtained using a self-reported validated questionnaire. Patients with prostates of > 75 or < or = 75 g were compared. RESULTS: The median (range) prostate size was 87 (76-182) and 42 (4.1-75) g in the two groups. The response rate to the questionnaire was 78% (344 men). Patients with prostates of > 75 g were older, with a median (range) age of 65 (51-74) years, than the other group, at 61 (40-76) years (P = 0.01), and had higher initial prostate-specific antigen (PSA) levels, at 9.6 (3.4-37.8) and 7.6 (0.1-30.0) ng/mL, respectively (P = 0.001). Tumours within larger prostates were of a lower stage (P = 0.035), lower Gleason grade (median 6 and 7, P = 0.015), of smaller volume (median 1.0, 0.1-12.4; and 1.5, 0.1-21.1 mL; P = 0.04) and more often 'clinically insignificant' (23% and 6%, P = 0.001). There was no difference in the number or distribution of positive surgical margins. For a limited median follow-up of 20-25 months, patients with prostates of > 75 g were less likely to have biochemical recurrence (5% vs 24%, P < 0.001). Potency and continence rates were similar between the groups. CONCLUSIONS: Prostate size at RRP does not affect the risk of impotence or incontinence afterward. A prostate of > 75 g is associated with a lower likelihood of PSA-relapse, potentially as a result of lead-time bias. While an enlarged prostate may contraindicate other potentially curative cancer treatments, the outcomes of RRP appear to be unaffected.     

Prevalence of prostate specific antigen testing for prostate cancer in elderly men

PURPOSE: We investigated the prevalence and outcome of PSA testing for prostate cancer screening or diagnosis in elderly men 75 years or older at our academic medical center. MATERIALS AND METHODS: A cross-sectional study design was used to identify all men 75 years or older who underwent a PSA test through the family medicine or internal medicine service at our institution between January 1, 1998 and June 30, 2004. All patients with a suspected (PSA less than 0.1 ng/ml) or confirmed prior diagnosis of prostate cancer were excluded. The prevalence of PSA testing was then compared to that in younger age groups (45 to 54, 55 to 64 and 65 to 74 years). We then examined the frequency and nature of further evaluation and treatment performed in men following the PSA test. RESULTS: The 8,787 male patients who were 75 years or older generated a total of 82,672 visits in the 5.5-year period. Of these patients 505 (5.7%) underwent at least 1 PSA test. The prevalence of PSA testing in the younger age groups was 10.3% (1,769 of 17,175) in patients 45 to 54 years old, 14.9% (2,052 of 13,772) in those 55 to 64 years old and 11.8% (1,258 of 10,661) in those 65 to 74 years old (chi-square test p <0.001). Of these patients 98 of 343 (28.6%) with PSA between 0.1 and 4 ng/ml were referred to a urologist at our institution and 3 underwent biopsy. None had a prostate cancer diagnosis. Of the 162 patients with PSA more than 4 ng/ml 84 (51.9%) were referred to a urologist. Only 10 of the 84 patients (11.9%) who were referred to a urologist underwent prostate biopsy. Six of the 10 men (60%) were diagnosed with prostate cancer, including 1 with a Gleason 6 tumor, 1 with a Gleason 7 tumor and 4 who were found to have tumors with a Gleason score of 8 or greater. All patients received androgen deprivation therapy, except 1 who received local external beam radiation therapy. An additional patient was diagnosed by biopsy of a vertebral lesion and he received hormone therapy. At a median followup of 51 months (range 28 to 72) 4 of 7 men (57%) were alive with disease. CONCLUSIONS: PSA testing for prostate cancer screening and diagnosis appear to decrease with advancing age. A small but significant proportion of men who are 75 years or older continue to undergo PSA testing. Abnormal PSA results do not always result in further evaluation and therapy for prostate cancer in elderly men. The establishment of firm guideline recommendations regarding PSA testing and further evaluation for prostate cancer in elderly men, perhaps based on individualized geriatric assessment, may be helpful.     

Global update on defining and treating high-risk localized prostate cancer with leuprorelin: a Japanese perspective--the effect of primary androgen deprivation therapy on stage C prostate cancer

Stage C prostate cancer, where the tumour has extended beyond the capsule of the prostate, is typically a high-risk disease. According to the National Cancer Institute Physician Data Query the treatments of choice for stage C disease comprise external beam radiation therapy (with or without the addition of adjuvant hormone therapy), androgen deprivation by either surgery or hormone therapy, radical prostatectomy, or careful observation. From 2001, the Japanese Urological Association initiated computer-based registration of all patients with prostate cancer in Japan. Data show that overall, 57% of all patients and 46% of those with T1c to T3 disease had primary androgen deprivation therapy (PADT). Similarly, the Japanese Prostate Cancer Group undertook a large-scale epidemiological surveillance study in Japan and found that the most commonly used hormone therapy is PADT, regardless of disease stage. To date, two randomized, controlled trials of the effect of PADT on stage C prostate cancer in elderly (> or =75 years old) patients have been undertaken in Japan. The results showed that patients with locally advanced prostate cancer treated with PADT are likely to have a life-expectancy similar to that of the normal population. In one study, combined androgen blockade (CAB) with leuprorelin plus chlormadinone appeared to prolong time to disease progression when compared with leuprorelin monotherapy, but there was no difference in survival between these treatment groups. In a second study CAB with an luteinizing hormone-releasing hormone (LHRH) agonist plus bicalutamide was found to prolong time to progression when compared with LHRH agonist monotherapy, but survival results for these regimens are still awaited.     

Hereditary prostate cancer: clinical characteristics and survival

PURPOSE: Hereditary prostate cancer accounts for 5% to 10% of all prostate cancer cases. We assessed clinical characteristics and survival in patients with hereditary prostate cancer MATERIALS AND METHODS: The study comprised 201 patients from 62 Swedish hereditary prostate cancer families and 402 controls with prostate cancer who were matched for age and calendar year at diagnosis, and the hospital where the diagnosis was made. Clinical data were obtained from the National Cancer Registry, Causes of Death Registry and medical records. RESULTS: Median age at the diagnosis of hereditary prostate cancer was 68 years, which was 6 years less than in patients with prostate cancer in the general population in Sweden. Distributions of tumor grade, symptoms at diagnosis and initial therapy were similar in hereditary prostate cancer cases and controls. More controls were classified with localized disease but it may have been due to methodological problems. Overall and cancer specific survival was similar in patients with hereditary prostate cancer and controls as well as in subgroup analyses including those with early onset and those diagnosed before 1990. Prostate cancer was the cause of death in 75% of patients with hereditary prostate cancer, in contrast to 55% with prostate cancer in the Swedish population. This difference was completely explained by the earlier age at the diagnosis of hereditary prostate cancer. CONCLUSIONS: Hereditary prostate cancer has an earlier onset than sporadic prostate cancer but this study did not indicate any other important difference in clinical characteristics or survival in patients with hereditary prostate cancer and those with sporadic prostate cancer. However, it cannot be excluded that individual hereditary prostate cancer genes may have specific biological characteristics.     

Prostate Cancer in Nigerians: Facts and Nonfacts

Purpose

We established the actual incidence of prostate cancer in Nigeria, the largest concentration of indigenous black patient in the world, to ascertain whether the global ranking for Nigeria as a low risk for prostate cancer is accurate.

Materials and Methods

We prospectively studied Nigerian men 45 years old or older with prostatic symptoms. Patients histologically positive for prostate cancer were analyzed for clinical features, tumor characteristics and survival. The hospital incidence, national prostate cancer risk, pool and death rate were calculated from the hospital admissions data and national population statistics.

Results

Mean age of patients with prostate cancer plus or minus standard deviation was 68.3 +/− 9.4 years. The hospital incidence was 127/100,000 cases. The national prostate cancer risk was 2% of patients, the pool was 110,000 and the death rate was 20,000 annually. The predominant clinical findings were those of advanced disease. Approximately 64% of the patients died within 2 years.

Conclusions

Prostate cancer incidence and the magnitude of the risk in our population may have been grossly underestimated. The clinical prostate cancer rate in Nigerians may be as great as that noted in black men in the United States, which may suggest a common genetic predisposition.     

70岁以上进展期贲门癌患者103例临床分析

目的探讨70岁以上进展期贲门癌患者的临床特点与外科治疗。方法对1991～2003年收治的103例70岁以上及小于70岁的进展期贲门癌患者的临床资料进行分析比较。结果两组患者在肿瘤病理分型、分期、手术方式方面比较,差异无统计学意义(P>0.05);临床症状和术前并存疾病比较,差异有统计学意义(P<0.01)。大于70岁组以进食梗阻感为主要症状(64%),术前并存心血管系统和肺部疾病者分别占63%、34%,有贫血和低蛋白血症者占68%。两组经腹全胃切除术分别占78%和73%(P>0.05)。术后发生肺部感染者两组差异无统计学意义(P>0.05)。两组手术死亡率分别为3%、2%(P>0.05)。结论对70岁以上进展期贲门癌患者,采用经腹全胃切除是安全的术式;术前应对患者重要脏器功能进行全面检测,术后尤应重视并发症的预防。     

Comparison of surgical outcomes of gastric cancer in elderly and middle-aged patients

BACKGROUND: We compared clinicopathological features and results of surgery for gastric carcinoma in elderly and middle-aged patients to develop appropriate treatment for elderly patients with gastric carcinoma. METHODS: Surgical results were assessed for 135 elderly patients (over 75 years old) and 665 middle-aged patients (between 45 and 65 years old) with gastric cancer. RESULTS: Distinct characteristics of elderly patients were male predominance; macroscopically well, or ill-defined, histologically differentiated tumors; and advanced stage disease. There was a significant difference in overall survival between the groups for early stage carcinomas but no difference in cause-specific survival. Postoperative morbidities did not differ between the curatively resected patients in the 2 groups. Moreover, deaths from other cancers or comorbid disease were frequent among the elderly. CONCLUSION: Meticulous treatment and follow-up not only for gastric carcinoma but also for other diseases would improve survival in elderly patients, particularly those with early-stage tumors.     

青年人与老年人胃癌的临床对比分析

目的探讨青年人胃癌区别于老年性胃癌的临床特点,并提出相应的治疗对策。方法对79例45岁以下(青年组)和120例65岁以上(老年组)胃癌患者的临床资料进行对比分析。结果两组患者性别构成差异无统计学意义(P=0.226)。与老年组比较,青年组患者早期无特异症状、病程较短(165dvs400d,P=0.029)、并以胃下部癌多见(49.4%vs41.7%,P=0.038);病理分期两组构成比比较,差异有统计学意义(P=0.027);总的中位生存时间,青年、老年组分别为1006d和530d(P=0.108);根治术后,青年、老年组的中位生存时间分别为1197d和919d,差异无统计学意义(P=0.242)。结论青年人胃癌具有症状无特异性、恶性度高、发展迅速等特性,但通过恰当的治疗,效果与老年患者无异。     

Survival prospects after screen-detection of prostate cancer

OBJECTIVE: To ascertain more realistic survival values for screen-detected prostate cancer than those in current use which are derived from conventionally presenting, usually symptomatic, populations. MATERIALS AND METHODS: Survival data for conventionally detected cases were derived from the Surveillance, Epidemiology and End Results database for men diagnosed in the years 1983-1988. The incidence of screen-detected prostate cancer by age and grade was taken from published data. RESULTS: For a cohort of men, initially 55 years old, screen-detected cases were estimated to outnumber by 2-3-fold, depending on age, those detected by conventional means. By assuming various survival characteristics for the screen-detected cases the mean lead time was estimated to be 9 years. Because screen-detected cases usually have clinically localized disease they are commonly advised on survival times derived from conventionally detected cases. Applying these survival times over-predicts the number of deaths by factors of at least 3.4, 1.9 and 1.5 at 65, 75 and 85 years old, respectively. CONCLUSIONS: Screening detects prostate cancer a mean of 9 years before clinical presentation. The prognosis of screen-detected prostate cancer is considerably better than that of conventionally presenting localized disease. The advice given to patients with early prostate cancer should take account of this.     

Prostate-specific antigen velocity based risk-adapted discontinuation of prostate cancer screening in elderly men

Study Type – Prognostic (cohort)
Level of Evidence 2b What’s known on the subject? and What does the study add? Currently, the U.S. Preventive Services Task Force (USPSTF) recommends against PSA screening for prostate cancer in men aged ≥75 years as it concluded that “the harm of screening for prostate cancer in men age ≥75 years may outweigh the potential benefits”. Our findings suggest that elderly men with a PSA velocity of ≥0.45 ng/ml/year have higher risk of death from prostate cancer. Continuing PSA testing may be beneficial for these men.

OBJECTIVE

? To evaluate weather prostate‐specific antigen (PSA) velocity could be used to stratify patients at risk of death from prostate cancer (PCa) and be useful in aiding decision making regarding PSA screening in elderly men, as previous studies have shown that PSA velocity can predict PCa risk.

PATIENTS AND METHODS

? The cohort included 3,525 patients aged ≥ 75 years with two or more PSA tests before a diagnosis of PCa. Cox proportional hazard model was used to evaluate which variables at time of last PSA measurement were associated with death from PCa. ? The rates of death from PCa after diagnosis in different PSA velocity groups were calculated. Kaplan‐Meier and log rank test were used to assess the significant difference in death from PCa after diagnosis, stratified by PSA velocity cutoff.

RESULTS

? On multivariate analysis, men with a PSA velocity of PSA velocity ≥0.45 ng/mL/year had a 4.8‐fold higher risk of death from PCa as compared to men with a PSA velocity of <0.45 ng/mL/year (p value = 0.013). After a median 6.5 (up to 16.9) years of follow‐up from diagnosis, 1.4% of the men with a PSA velocity <0.45 ng/mL/year had died of PCa as compared to 8.7% of those with a PSA velocity ≥0.45 ng/mL/year. ? The cumulative rate of death from PCa after diagnosis, stratified by a PSA velocity of 0.45 ng/mL/year, was statistically different (log rank test, P < 0.001).

CONCLUSION

? Men age ≥ 75 years old with a PSA velocity of <0.45 ng/mL/year are unlikely to die of PCa. It may be safe to discontinue PSA screening in these men.     

基于bpMRI的前列腺活检对PSA≤20 ng/ml前列腺癌诊断价值的研究

目的:探讨基于双参数磁共振(bpMRI)的前列腺活检对PSA≤20ng/ml前列腺癌的诊断价值。方法:回顾性分析2017年11至2019年10月南京医科大学第一附属医院行前列腺活检的394例患者的临床资料。其中177例行经直肠超声(TRUS)引导改良系统活检,为TRUS组;217例活检前行bpMRI检查,为MRI组,其...     

Diabetes mellitus and the risk of prostate cancer in Italy

OBJECTIVE: We investigated the relation between diabetes and the risk of prostate cancer, as epidemiological results are controversial. METHODS: A hospital-based case-control study was conducted in Italy between 1991 and 2002. Cases were 1294 men, aged <75 years, with incident histologically confirmed prostate cancer, and controls were 1451 men, aged <75 years, admitted to hospital for acute non-neoplastic diseases. Odds ratios (OR) and the corresponding 95% confidence intervals (CI) were estimated using unconditional multiple logistic regression models. RESULTS: No material association between diabetes and prostate cancer was observed, with a multivariate OR of 1.02 (95%CI 0.75-1.40). Prostate cancer was not related to time since diagnosis of diabetes (OR 0.82 and 0.97 for <5 and >/=15 years since diagnosis respectively). The OR were respectively 1.63 (95%CI 0.70-3.81) and 0.96 (95%CI 0.68-1.34) in men diagnosed with diabetes at age <45 or >/=45 years. The risk estimates were similar across strata of age at interview, body mass index and, among cases, of Gleason score. CONCLUSIONS: This study shows no material association between diabetes and prostate cancer risk.     

An audit of the investigation and treatment of localised prostatic cancer in the south west region.

Prostate cancer constitutes a major health care dilemma in terms of treatment options available and increasing patient load on both a regional and national level. An audit was undertaken of all patients in the South West Region with localised prostate cancer newly diagnosed in 1993 to assess regional management of this disease. In 1993, 1407 patients were newly diagnosed as having prostatic cancer. Patients > 75 years old and those with a prostate-specific antigen (PSA) > 40 ng/ml were excluded, leaving 262 patients whose case notes were examined. The interval between referral and clinic (mean 67 days) was altered by the presence of a GP performed PSA, being shorter if the PSA was > 10 ng/ml (average 54 days) than if the PSA was < 10 ng/ml (average 104 days). Overall, 34% of patients underwent radical treatment (10% radical prostatectomy and 24% radiotherapy). In all, 27% received hormone manipulation or orchidectomy, and the remainder 'watchful waiting'. The majority (78%) of patients < 60 years old received radical treatment, as did 35% of those 60-70 years and 15% of 70-75 year olds. Over 90% of tumours were category T1 and were well or moderately differentiated. All patients had a histological diagnosis and 84% had their tumour staged before treatment. This study highlighted the need for improvements in patient assessment, improved note keeping and a regional cancer register to allow ongoing assessment of patient management. This audit of management of localised prostate cancer serves as a baseline from which to initiate and monitor improvements in the service regionally and will also allow assessment of the impact of such changes.     

346例前列腺癌的Gleason评分分布特征及其与临床分期的关系

目的:探讨前列腺癌患者G leason评分分布特征及其与临床分期的关系。方法:收集我院1992年1月~2005年6月346例前列腺癌病例资料,建立临床资料数据库,对病理切片进行G leason评分。将病例按不同年份分成3组:1992~1999年、2000~2002年和2003年~2005年6月。采用χ2检验分析G leason评分分布及各组间差异,采用Spearm an等级相关分析,分析前列腺癌G leason评分与临床分期的关系。结果:3组间G leason评分分布差异有显著性(χ2=17.703,P<0.01),G leason评分平均值稍有降低,G leason评分5~7分前列腺癌比例增加(χ2=10.736,P<0.01),临床意义较大的G leason评分7、8、9、10分作为一组,其比例无显著变化(χ2=4.038,P>0.05)。346例前列腺癌中,G leason评分2~6分预测局限性前列腺癌与G leason评分7分和8~10分差异有显著性(χ2=8.786,P<0.01,χ2=22.956,P<0.01),G leason评分7分和8~10分预测局限性前列腺癌差异无显著性(χ2=0.787,P>0.05)。G leason评分与临床分期相关(r=0.452,P<0.01)。结论:G leason评分7分与G leason评分8~10分在预测肿瘤进展方面具有相似效应。G leason评分与临床分期有关,提示其可能是判断前列腺癌预后的一个有意义的指标。