Search

OBJECTIVES: To characterize bone scan use, and potential overuse, after radical prostatectomy using a large, national integrated delivery system. Overuse of imaging is well documented in the setting of newly diagnosed prostate cancer, but whether overuse persists following radical prostatectomy remains unknown. MATERIALS AND METHODS: We identified 12,269 prostate cancer patients treated with radical prostatectomy between 2005-2008 using the Veterans Administration Central Cancer Registry. We used administrative and laboratory data to examine rates of bone scan use, including preceding PSA levels, and receipt of adjuvant or salvage therapy. We then performed multivariable logistic regression to identify factors associated with post-prostatectomy bone scan use. RESULTS: At a median follow up of 6.8 years, one in five men (22%) underwent a postoperative bone scan at a median PSA of 0.2 ng/mL. Half of bone scans (48%) were obtained in men who did not receive further treatment with androgen deprivation (ADT) or radiation therapy. After adjustment, post-prostatectomy bone scan was associated with a prior bone scan (adjusted Odds Ratio (aOR) 1.55, 95% Confidence Interval (CI) 1.32 – 1.84), positive surgical margin (aOR 1.68, 95% CI 1.40 – 2.01), preoperative PSA (aOR 1.02, 95% CI 1.01 – 1.03) as well as Hispanic ethnicity, black race, and increasing D’Amico risk category, but not with age or comorbidity. CONCLUSION: We found a substantial rate of bone scan utilization after radical prostatectomy. The majority was performed for PSA

Objectives To assess bone density testing (BDT) use among prostate cancer survivors receiving ADT, and downstream implications for osteoporosis and fracture diagnoses as well as pharmacologic osteoporosis treatment in a national integrated delivery system. Methods We identified 17,017 men with prostate cancer who received any ADT between 2005 and 2014 using Veterans Health Administration cancer registry and administrative data. We identified claims for BDT within a 3-year period of ADT initiation. We then used multivariable regression to examine the association between BDT use and incident osteoporosis, fracture, and use of pharmacologic treatment. Results We found a minority of patients received BDT (n=2,502, 15%), however the rate of testing increased to over 20% by the end of the study period. Men receiving BDT were older at diagnosis and had higher-risk prostate cancer (both p

OBJECTIVE To define the prognostic relevance of capsular involvement (invasion with no penetration) and collecting-system invasion in patients with stage I (pT1N0M0) and stage II (pT2N0M0) renal cell carcinoma (RCC), by evaluating the outcome of patients treated with nephrectomy. PATIENTS AND METHODS In all, 519 patients from a kidney cancer database treated with nephrectomy for stage I and II RCC between 1985 and 2005 were assessed retrospectively. The primary endpoint was recurrence-free survival time. The prognostic relevance of capsular involvement and collecting-system invasion were examined using univariate and multivariate survival analysis. RESULTS Capsular involvement and collecting-system invasion were evident in 112 (21.6%) and 39 (7.5%) patients, respectively. Capsular involvement was associated with higher Fuhrman grades and larger tumours. The incidence of collecting-system invasion was higher in patients with microvascular invasion. The median follow-up was 49 months. In univariate analysis, patients with capsular involvement and collecting-system invasion had a worse prognosis than patients without (P = 0.007 and

The use of carbonic anhydrase IX as a promising molecular marker in RCC is described by authors from Los Angeles, who discuss the promise that molecular markers hold to improve diagnosis, staging, treatment, surveillance and survival of patients with RCC. There is a whole range of new treatments being introduced in the management of metastatic renal cancer. The use of VEGF-targeted therapy has particular importance, especially as it has a strong genetically linked rationale for its potential success in this area. Authors from the USA show that substantial clinical activity has been reported in initial clinical trials. In prostate cancer, drugs targeting microtubules, such as taxanes, have already been introduced clinically, and their success has received widespread attention. A new group of drugs, the epothilones, have similar but not identical binding properties to microtubules, and authors from the USA describe how they have shown activity in hormone-refractory prostate cancer, and are moving to phase III testing.