Search

OBJECTIVE To investigate the effect of smoking on the outcome in a cohort of men treated for localized prostate cancer at one institution with a uniform protocol of radical external beam radiotherapy (EBRT). PATIENTS AND METHODS The study was a retrospective review of 434 patients with cT1-T4 N0m0 prostate cancer treated with curative intent with EBRT (66 Gy in 33 fractions) between 1990 and 1999. Univariate and multivariate Cox regression analyses were used to estimate the risk associated with smoking on biochemical failure (American Society for Therapeutic Radiology and Oncology definition), local failure, distant failure, overall and disease-specific survival. RESULTS The median follow-up was 70.3 months. A smoking history was obtained in 96% of cases; 16.8% were current smokers, 54.4% previous smokers and 28.8% non-smokers. Current smokers presented at a younger median age, by 3.6 years ( P = 0.06). There were no differences in clinical T stage, Gleason score or prostate-specific antigen level amongst the three patient groups. Smoking conferred a higher risk of developing metastatic disease in both current smokers (hazard ratio 5.24; 95% confidence interval 1.75–15.72) and previous smokers (2.90, 1.09–7.67). There were also increases in risk, although not quite significant, for biochemical failure (1.49, 0.88–2.40) and overall survival (1.72, 0.94–3.15). CONCLUSIONS After curative treatment with EBRT, a history of smoking was associated with a greater risk of developing metastatic disease. Smoking status was not associated with worse disease on presentation. [ABSTRACT FROM AUTHOR]

OBJECTIVE To review patients with genitourinary (GU) small cell carcinoma (SCC) treated at a regional cancer centre, as due to its rarity and aggressive nature, GU SCC remains a therapeutic challenge. PATIENTS AND METHODS The charts of patients managed at a regional cancer centre between 1991 and 2002 for any GU diagnosis were manually reviewed to identify GU SCC. Demographic, staging, treatment and outcome data were extracted. The Veterans Administration small cell lung cancer staging classification of ‘limited’ or ‘extensive’ disease was adapted for SCC of the prostate and bladder (with ‘limited’ defined as disease localized to the true and false pelvis, and ‘extensive’ as disease beyond the pelvis). RESULTS In all, 555, 858 and 5066 new cases of primary renal, bladder and prostate cancer, respectively, were identified. Of these patients, 22 had GU SCC (12 bladder and 10 prostate; there were no cases of SCC of the kidney). Eight of 12 patients with bladder SCC had limited disease; five of 12 are alive (all with limited disease at diagnosis), and the median survival was 19.8 months. Surviving patients received similar therapy, with transurethral resection of the bladder tumour, platinum-based chemotherapy, etoposide (4–6 cycles), and radical radiotherapy (56–60 Gy). Two of 10 patients with SCC of the prostate had limited-stage disease, but all 10 died, the median survival being 9.5 months. Survival by stage for both types combined was 59 months for limited disease and 8 months for extensive disease. CONCLUSIONS These results indicate that GU SCC is an aggressive cancer; limited-stage SCC of the bladder or prostate, when treated with platinum/etoposide chemotherapy and radical radiotherapy, has a more favourable outcome than that of extensive GU SCC. [ABSTRACT FROM AUTHOR]

To assess the feasibility and tolerability of intermittent androgen suppression therapy (IAS) in prostate cancer. Patients with recurrent or metastic prostate cancer received cyclical periods of treatment with leuprolide acetate and nilutamide for 8 months, and rest periods. Cycles were repeated at progression until the treatment failed to achieve normal prostate-specific antigen (PSA) levels. Patients were followed with PSA level, testosterone level, haemoglobin level, weight and bone mineral density evaluations. The median time to treatment failure, recovery from anaemia, or normalization of testosterone level was estimated by the Kaplan-Meier method. In all, 95 patients received 245 cycles; the median duration of rest periods was 8 months and median time to treatment failure 47 months. Testosterone recovery during rest periods was documented in 117 (61%) of cycles. Anaemia was mild and reported in 33%, 44% and 67% of cycles 1, 2 and 3, respectively. Sexual function recovered during the rest periods in 47% of cycles. There was no significant overall change in body mass index at the end of the treatment period. Osteoporosis was documented in at least one site evaluated in 41 patients (37%). IAS has the potential to reduce side-effects, including recovery of haemoglobin level, return of sexual function and absence of weight gain at the end of the study period. [ABSTRACT FROM AUTHOR]