Clinical utility of the percentage of positive prostate biopsies in defining biochemical outcome after radical prostatectomy for patients with clinically localized prostate cancer.

PURPOSE: To determine the clinical utility of the percentage of positive prostate biopsies in predicting prostate-specific antigen (PSA) outcome after radical prostatectomy (RP) for men with PSA-detected or clinically palpable prostate cancer. METHODS: A Cox regression multivariable analysis was used to determine whether the percentage of positive prostate biopsies provided clinically relevant information about PSA outcome after RP in 960 men while accounting for the previously established risk groups that are defined according to pretreatment PSA level, biopsy Gleason score, and the 1992 American Joint Committee on Cancer (AJCC) clinical T stage. The findings were then tested using an independent surgical database that included data for 823 men. RESULTS: Controlling for the known prognostic factors, the percentage of positive prostate biopsies added clinically significant information (P <.0001) regarding time to PSA failure after RP. Specifically, 80% of the patients in the intermediate-risk group (1992 AJCC T2b, or biopsy Gleason 7 or PSA > 10 ng/mL and 相似文献   

Metastatic Prostate Cancer

The treatment of metastatic prostate cancer is based upon the principle that prostate cancer growth is stimulated by androgens. Androgen ablation therapy is an effective treatment for metastatic prostate cancer. The timing of initiation of androgen ablation and the role of combined androgen blockade have been investigated. The utilization of intermittent androgen suppression offers the potential for improved quality of life. Intermittent therapy for metastatic disease is being compared with continuous therapy in an ongoing cooperative group trial. Recent studies have defined the evolving role of cytotoxic chemotherapy in hormone-refractory disease.     

Joint effects of inflammation and androgen metabolism on prostate cancer severity

Multiple pathways of prostate carcinogenesis have been proposed, including those involving androgen metabolism and inflammation. These pathways are not independent, and may act together in prostate cancer etiology: androgens promote both inflammatory processes and serve as mitogens in prostate tumor growth. To explore the possible joint effects of these pathways in prostate cancer severity, we studied 1,090 Caucasian prostate cancer cases to evaluate whether tumor severity is influenced by a history of benign prostatic hyperplasia (BPH) interacting with genotypes involved in inflammation or androgen metabolism including MSR1, RNASEL, AR, CYP3A4, CYP3A43, CYP3A5 and SRD5A2. We observed a statistically significant interaction between a number of genotypes and BPH. After considering the potential for false positive associations, the only remaining significant associations involved CYP3A43 P340A genotypes and history of BPH on both Gleason grade (interaction p-value = 0.026) and tumor stage (interaction p-value = 0.017). These results suggest that androgen metabolism may act in concert with inflammatory phenotypes such as BPH in determining prostate cancer severity.     

Variation in quality of care among older men with localized prostate cancer

BACKGROUND:

The objective of this study was to assess the racial and ethnic disparities in outcomes and their association with process‐of‐care measures for elderly Medicare recipients with localized prostate cancer.

METHODS:

The Surveillance, Epidemiology, and End Results‐Medicare databases for the period from 1995 to 2003 were used to identify African‐American men, non‐Hispanic white men, and Hispanic men with localized prostate cancer, and data were obtained for the 1‐year period before the diagnosis of prostate cancer and up to 8 years postdiagnosis. The short‐term outcomes of interest were complications, emergency room visits, readmissions, and mortality; the long‐term outcomes of interest were prostate cancer‐specific mortality and all‐cause mortality; and process‐of‐care measures of interest were treatment and time to treatment. Cox proportional hazards regression, logistic regression, and Poisson regression were used to study the racial and ethnic disparities in outcomes and their association with process‐of‐care measures.

RESULTS:

Compared with non‐Hispanic white patients, African‐American patients (Hazard ration [HR], 1.43; 95% confidence interval [CE], 1.19‐1.86) and Hispanic patients (HR=1.39; 95% CI, 1.03‐1.84) had greater hazard of long term prostate specific mortality. African‐American patients also had greater odds of emergency room visits (odds ratio, 1.4; 95% CI, 1.2‐1.7) and greater all‐cause mortality (HR, 1.39; 95% CI, 1.3‐1.5) compared with white patients. The time to treatment was longer for African‐American patients and was indicative of a greater hazard of all‐cause, long‐term mortality. Hispanic patients who underwent surgery or received radiation had a greater hazard of long‐term prostate‐specific mortality compared with white patients who received hormone therapy.

CONCLUSIONS:

Racial and ethnic disparities in outcomes were associated with process‐of‐care measures (the type and time to treatment). The current results indicated that there is an opportunity to reduce these disparities by addressing these process‐of‐care measures. Cancer 2011. © 2010 American Cancer Society.     

Racial differences in well-being and cancer concerns in prostate cancer patients

Background  

We analyzed the racial differences in physical well-being, social/family well-being, functional well-being, emotional well-being, and prostate cancer specific worry among men with clinically localized prostate cancer.     

Interleukins,laminin and epstein - barr virus latent membrane protein 1 (EBV LMP1) Promote metastatic phenotype in nasopharyngeal carcinoma

Background  

Nasopharyngeal carcinoma (NPC) is a type of neoplasm that is highly prevalent in East Asia and Africa with Epstein-Barr virus (EBV), genetic, and dietary factors implicated as possible aetiologic factors. Previous studies suggested the association of certain cytokines with the invasion and metastatic properties of NPC. The present study examined the roles of EBV latent membrane protein-1 (LMP1), interleukin-6 (IL-6), interleukin-10 (IL-10), transforming growth factor-beta 1 (TGF-β1) and laminin in the regulation of matrix-metalloproteinases (MMPs) and vascular endothelial growth factor (VEGF) in NPC. The effects of these factors on bmi-1, an oncogene, and ngx6, a tumour suppressor gene, were also investigated.     

Limited Margins Using Modern Radiotherapy Techniques Does Not Increase Marginal Failure Rate of Glioblastoma

PURPOSE: We investigate the patterns of failure in the treatment of glioblastoma(GBM) based on clinical target volume(CTV) margin size,dose delivered to the site of initial failure,and the use of temozolomide and intensity-modulated radiotherapy(IMRT).METHODS: Between August 2000 and May 2010,161 patients with GBM were treated with radiotherapy with or without concurrent temozolomide.Patients were treated with CTV expansions that ranged from 5 to 20 mm using a shrinking field technique.Patterns of failure and time to progression and overall survival were compared based on CTV margin,use of temozolomide,and use of IMRT.Kaplan Meier analysis was used to estimate survival times,and χ test was used for comparison of cohorts.RESULTS: For patients treated with 5-,10-,and 15-to 20-mm CTV,79%,77%,and 86% experienced failures in the 60 Gy volume,respectively.Forty-eight percent,55%,and 66% of patients with 5-,10-,and 15-to 20-mm CTV experienced failures in the 46 Gy volume,respectively.There was no statistical difference between patients treated with 5-,10-,15-to 20-mm margins with regard to 60 Gy failure(P=0.76),46 Gy failure(P=0.51),or marginal failure(P=0.73).Eighty percent of patients receiving temozolomide experienced failures in the 60 Gy volume.There was no increased likelihood of marginal failures in patients receiving IMRT(P =0.97).CONCLUSIONS: Modern treatment techniques including use of concurrent temozolmide,limited CTV margin size,and IMRT have not greatly changed the patterns of failure of GBM.     

临床医护

细菌的耐药笥民为一个全球性问题,并从医院扩展到了家庭及社区。同时,抗生素的滥用对微生物的生态环境造成了极大的破坏。我们可以通过改变抗生素的使用频度和改变耐药性基因来逆转药性问题,同时需要有一个全球性的监测系统来追踪耐药菌的、去向及新菌种的出现。     

Antihypertensive efficacy of metoprolol XL/Low dose chlorthalidone (6.25 mg) combination: a randomized,comparative study in Indian patients with mild-to-moderate essential hypertension

Objective

High blood pressure is one of the most important risk factors, directly responsible for increasing the cardiovascular morbidity and mortality. The primary objective was to evaluate the efficacy of metoprolol XL/chlorthalidone against metoprolol XL/hydrochlorothiazide with respect to mean fall in systolic and diastolic blood pressure. The secondary objective was to compare the response rates and to evaluate the tolerability of study medications in patients with mild-tomoderate essential hypertension.

Methods

Total 130 eligible patients (65: metoprolol XL 25 mg/chlorthalidone 6.25 mg; 65: metoprolol XL 25 mg/HCTZ 12.5 mg) were enrolled in this randomized, comparative, multicentric, 12-weeks study. Sixty-two patients from each group completed the study. After 4-weeks of treatment, non-responders from chlorthalidone 6.25 mg combination group were shifted to metoprolol XL 50 mg/chlorthalidone 12.5 mg and non-responders from HCTZ 12.5 mg combination group were escalated to metoprolol XL 50 mg/HCTZ 12.5 mg.

Results

The study treatment groups were comparable with respect to demography and baseline disease characteristics. Both the starting therapies were comparable with respect to mean fall in SBP (p = 0.788) and DBP (p = 0.939), and response rates (p = 1.0) after 4-weeks of therapy. Also both the step-up therapies showed similar mean fall in SBP (p = 0.277) and DBP (p = 0.507) at the end of 12-weeks. However, significantly more number of patients from chlorthalidone 12.5 mg/metoprolol XL 50 mg group responded to therapy as compared to that from HCTZ 12.5 mg/metoprolol XL 50 mg group (p = 0.045). All the reported adverse events were of mild-to-moderate intensity. There were no clinically significant trends in electrolytes (Na⁺, K⁺, Cl^-)and fasting blood sugar, evident across the treatment groups.

Conclusion

Chlorthalidone in combination with metoprolol XL is as effective and well tolerated as widely used combination of metoprolol XL/HCTZ, thus providing an alternative therapeutic option.