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The 8th Engineer Battalion deployed to Baghdad for Operation Iraqi Freedom from March 2004 to March 2005. Although the unit performed a wide range of combat engineer and security tasks, [...]

Background:: The optimal treatment for oligorecurrent prostate cancer (PCa) is a matter of debate. We aimed to assess oncologic outcomes of patients treated with metastasis-directed therapy (MDT) vs. androgen deprivation therapy (ADT) for oligorecurrent PCa. Methods:: We analyzed data from patients with oligorecurrent PCa treated with ADT (n= 121), salvage lymph node dissection (sLND) (n= 191) or external beam RT (EBRT) (n= 178). Radiological recurrence (RAR) was defined as a positive positron emission tomography imaging after MDT or ADT. Second-line systemic therapies (SST) were defined as any systemic therapy administered for progression. Oncologic outcomes were evaluated separately for patients with node-only or bone metastases. Kaplan–Meier method was used to assess time to RAR, SST, and cancer-specific mortality (CSM). Predictors of RAR, SST, and castration-resistant PCa (CRPCa) were assessed with Cox regression analyses. Results:: Overall, 74 (22.6%), 63 (19.2%), and 191 (58.2%) patients were treated with ADT, EBRT, and sLND for lymph node-only recurrence. Both sLND (HR 0.56, 95% CI 0.33–0.94) and EBRT (HR 0.46, 95% CI 0.25–0.85) were associated with better RAR than ADT. Similarly, sLND (HR 0.25, 95% CI 0.13–0.50) and EBRT (HR 0.41, 95% CI 0.19–0.87) were associated with longer SST, as compared with ADT. Similar results were found for CRPCa status. Oncologic outcomes were similar between sLND and EBRT. MDT was not associated with survival benefit in patients with bone metastases as compared with ADT. Conclusions:: sLND and EBRT were associated with better RAR, SST, and CRPCa-free survival as compared with ADT in patients with oligometastatic PCa nodal recurrence. No difference in survival outcomes was observed between sLND and EBRT. MDT was not associated with survival benefit in patients with bone metastases, as compared with ADT.

IMPORTANCE: In 2016, the American Joint Committee on Cancer (AJCC) established criteria to evaluate prediction models for staging. No localized prostate cancer models were endorsed by the Precision Medicine Core committee, and 8th edition staging was based on expert consensus. OBJECTIVE: To develop and validate a pretreatment clinical prognostic stage group system for nonmetastatic prostate cancer. DESIGN, SETTING, AND PARTICIPANTS: This multinational cohort study included 7 centers from the United States, Canada, and Europe, the Shared Equal Access Regional Cancer Hospital (SEARCH) Veterans Affairs Medical Centers collaborative (5 centers), and the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry (43 centers) (the STAR-CAP cohort). Patients with cT1-4N0-1M0 prostate adenocarcinoma treated from January 1, 1992, to December 31, 2013 (follow-up completed December 31, 2017). The STAR-CAP cohort was randomly divided into training and validation data sets; statisticians were blinded to the validation data until the model was locked. A Surveillance, Epidemiology, and End Results (SEER) cohort was used as a second validation set. Analysis was performed from January 1, 2018, to November 30, 2019. EXPOSURES: Curative intent radical prostatectomy (RP) or radiotherapy with or without androgen deprivation therapy. MAIN OUTCOMES AND MEASURES: Prostate cancer–specific mortality (PCSM). Based on a competing-risk regression model, a points-based Score staging system was developed. Model discrimination (C index), calibration, and overall performance were assessed in the validation cohorts. RESULTS: Of 19 684 patients included in the analysis (median age, 64.0 [interquartile range (IQR), 59.0-70.0] years), 12 421 were treated with RP and 7263 with radiotherapy. Median follow-up was 71.8 (IQR, 34.3-124.3) months; 4078 (20.7%) were followed up for at least 10 years. Age, T category, N category, Gleason grade, pretreatment serum prostate-specific antigen level, and the percentage of positive core biopsy results among biopsies performed were included as variables. In the validation set, predicted 10-year PCSM for the 9 Score groups ranged from 0.3% to 40.0%. The 10-year C index (0.796; 95% CI, 0.760-0.828) exceeded that of the AJCC 8th edition (0.757; 95% CI, 0.719-0.792), which was improved across age, race, and treatment modality and within the SEER validation cohort. The Score system performed similarly to individualized random survival forest and interaction models and outperformed National Comprehensive Cancer Network (NCCN) and Cancer of the Prostate Risk Assessment (CAPRA) risk grouping 3- and 4-tier classification systems (10-year C index for NCCN 3-tier, 0.729; for NCCN 4-tier, 0.746; for Score, 0.794) as well as CAPRA (10-year C index for CAPRA, 0.760; for Score, 0.782). CONCLUSIONS AND RELEVANCE: Using a large, diverse international cohort treated with standard curative treatment options, a proposed AJCC-compliant clinical prognostic stage group system for prostate cancer has been developed. This system may allow consistency of reporting and interpretation of results and clinical trial design.

On May 22, 2012, the US Preventive Services Task Force (USPSTF) issued a statement regarding the use of the serum prostate-specific antigen (PSA) test to facilitate prostate cancer detection. The [...]

Brachytherapy (BT), using low-dose-rate (LDR) permanent seed implantation or high-dose-rate (HDR) temporary source implantation, is an acceptable treatment option for select patients with prostate cancer of any risk group. The benefits of HDR-BT over LDR-BT include the ability to use the same source for other cancers, lower operator dependence, and — typically — fewer acute irritative symptoms. By contrast, the benefits of LDR-BT include more favourable scheduling logistics, lower initial capital equipment costs, no need for a shielded room, completion in a single implant, and more robust data from clinical trials. Prospective reports comparing HDR-BT and LDR-BT to each other or to other treatment options (such as external beam radiotherapy (EBRT) or surgery) suggest similar outcomes. The 5-year freedom from biochemical failure rates for patients with low-risk, intermediate-risk, and high-risk disease are >85%, 69–97%, and 63–80%, respectively. Brachytherapy with EBRT (versus brachytherapy alone) is an appropriate approach in select patients with intermediate-risk and high-risk disease. The 10-year rates of overall survival, distant metastasis, and cancer-specific mortality are >85%, <10%, and <5%, respectively. Grade 3–4 toxicities associated with HDR-BT and LDR-BT are rare, at <4% in most series, and quality of life is improved in patients who receive brachytherapy compared with those who undergo surgery.

Brachytherapy is performed by directly inserting radioactive sources into the prostate gland and is an important treatment option for appropriately selected men with prostate adenocarcinoma. Brachytherapy provides highly conformal radiotherapy and delivers tumoricidal doses that exceed those administered with external beam radiation therapy. There is a significant body of literature supporting the excellent long-term oncologic and safety outcomes achieved when brachytherapy is used for men in all risk categories of nonmetastatic prostate cancer. This article highlights some important considerations and published outcomes that relate to brachytherapy and its role in the treatment of prostate cancer.

To report outcomes of multimodality therapy incorporating surgical resection and intraoperative electron radiotherapy (IOERT) for patients with locoregionally (LR) recurrent or advanced primary urothelial carcinoma.

IMPORTANCE: Radiotherapy combined with androgen deprivation therapy (ADT) is a standard of care for high-risk prostate cancer. However, the interplay between radiotherapy dose and the required minimum duration of ADT is uncertain. OBJECTIVE: To determine the specific ADT duration threshold that provides a distant metastasis-free survival (DMFS) benefit in patients with high-risk prostate cancer receiving external beam radiotherapy (EBRT) or EBRT with a brachytherapy boost (EBRT+BT). DESIGN, SETTINGS, AND PARTICIPANTS: This was a cohort study of 3 cohorts assembled from a multicenter retrospective study (2000-2013); a post hoc analysis of the Randomized Androgen Deprivation and Radiotherapy 03/04 (RADAR; 2003-2007) randomized clinical trial (RCT); and a cross-trial comparison of the RADAR vs the Deprivación Androgénica y Radio Terapía (Androgen Deprivation and Radiation Therapy; DART) 01/05 RCT (2005-2010). In all, the study analyzed 1827 patients treated with EBRT and 1108 patients treated with EBRT+BT from the retrospective cohort; 181 treated with EBRT and 203 with EBRT+BT from RADAR; and 91 patients treated with EBRT from DART. The study was conducted from October 15, 2020, to July 1, 2021, and the data analyses, from January 5 to June 15, 2021. EXPOSURES: High-dose EBRT or EBRT+BT for an ADT duration determined by patient-physician choice (retrospective) or by randomization (RCTs). MAIN OUTCOMES AND MEASURES: The primary outcome was DMFS; secondary outcome was overall survival (OS). Natural cubic spline analysis identified minimum thresholds (months). RESULTS: This cohort study of 3 studies totaling 3410 men (mean age [SD], 68 [62-74] years; race and ethnicity not collected) with high-risk prostate cancer found a significant interaction between the treatment type (EBRT vs EBRT+BT) and ADT duration (binned to &lt;6, 6 to &lt;18, and ≥18 months). Natural cubic spline analysis identified minimum duration thresholds of 26.3 months (95% CI, 25.4-36.0 months) for EBRT and 12 months (95% CI, 4.9-36.0 months) for EBRT+BT for optimal effect on DMFS. In RADAR, the prolongation of ADT for patients receiving only EBRT was not associated with significant improvements in DMFS (hazard ratio [HR], 1.01; 95% CI, 0.65-1.57); however, for patients receiving EBRT+BT, a longer duration was associated with improved DMFS (DMFS HR, 0.56; 95% CI, 0.36-0.87; P = .01). For patients receiving EBRT alone (DART), 28 months of ADT was associated with improved DMFS compared with 18 months (RADAR HR, 0.37; 95% CI, 0.17-0.80; P = .01). CONCLUSIONS AND RELEVANCE: These cohort study findings suggest that the optimal minimum ADT duration for treatment with high-dose EBRT alone is more than 18 months; and for EBRT+BT, it is 18 months or possibly less. Additional studies are needed to determine more precise minimum durations.

To determine whether higher intensity of prostate-specific antigen (PSA) surveillance was associated with earlier detection of biochemical recurrence (BCR) or survival.

The use of adjuvant radiation therapy following prostatectomy is commonplace. The purpose of this review is to summarize completed and ongoing clinical trials and to review recent relevant studies and debates related to this subject.

IMPORTANCE: The optimal management strategy for high-risk prostate cancer and additional adverse clinicopathologic features remains unknown. OBJECTIVE: To compare clinical outcomes among patients with high-risk prostate cancer after definitive treatment. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included patients with high-risk prostate cancer (as defined by the National Comprehensive Cancer Network [NCCN]) and at least 1 adverse clinicopathologic feature (defined as any primary Gleason pattern 5 on biopsy, clinical T3b-4 disease, =50% cores with biopsy results positive for prostate cancer, or NCCN =2 high-risk features) treated between 2000 and 2014 at 16 tertiary centers. Data were analyzed in November 2020. EXPOSURES: Radical prostatectomy (RP), external beam radiotherapy (EBRT) with androgen deprivation therapy (ADT), or EBRT plus brachytherapy boost (BT) with ADT. Guideline-concordant multimodal treatment was defined as RP with appropriate use of multimodal therapy (optimal RP), EBRT with at least 2 years of ADT (optimal EBRT), or EBRT with BT with at least 1 year ADT (optimal EBRT with BT). MAIN OUTCOMES AND MEASURES: The primary outcome was prostate cancer–specific mortality; distant metastasis was a secondary outcome. Differences were evaluated using inverse probability of treatment weight–adjusted Fine-Gray competing risk regression models. RESULTS: A total of 6004 men (median [interquartile range] age, 66.4 [60.9-71.8] years) with high-risk prostate cancer were analyzed, including 3175 patients (52.9%) who underwent RP, 1830 patients (30.5%) who underwent EBRT alone, and 999 patients (16.6%) who underwent EBRT with BT. Compared with RP, treatment with EBRT with BT (subdistribution hazard ratio [sHR] 0.78, [95% CI, 0.63-0.97]; P?=?.03) or with EBRT alone (sHR, 0.70 [95% CI, 0.53-0.92]; P?=?.01) was associated with significantly improved prostate cancer–specific mortality; there was no difference in prostate cancer–specific mortality between EBRT with BT and EBRT alone (sHR, 0.89 [95% CI, 0.67-1.18]; P?=?.43). No significant differences in prostate cancer–specific mortality were found across treatment cohorts among 2940 patients who received guideline-concordant multimodality treatment (eg, optimal EBRT alone vs optimal RP: sHR, 0.76 [95% CI, 0.52-1.09]; P?=?.14). However, treatment with EBRT alone or EBRT with BT was consistently associated with lower rates of distant metastasis compared with treatment with RP (eg, EBRT vs RP: sHR, 0.50 [95% CI, 0.44-0.58]; P?&lt;?.001). CONCLUSIONS AND RELEVANCE: These findings suggest that among patients with high-risk prostate cancer and additional unfavorable clinicopathologic features receiving guideline-concordant multimodal therapy, prostate cancer–specific mortality outcomes were equivalent among those treated with RP, EBRT, and EBRT with BT, although distant metastasis outcomes were more favorable among patients treated with EBRT and EBRT with BT. Optimal multimodality treatment is critical for improving outcomes in patients with high-risk prostate cancer.

Polychlorinated dibenzo-p-dioxins and furans (PCDD/Fs) have been monitored in air and deposition at four UK urban sites (London, Cardiff, Manchester and Stevenage) since the beginning of 1991; data from the first 2 years are presented here. Median Σ2,3,7,8-substituted PCDD/F concentrations in air were 3.2, 4.0, 3.5 and 2.6 pg/m3respectively for London, Cardiff, Manchester and Stevenage. Median Σ2,3,7,8-substituted PCDD/F deposition fluxes were 1.5 ng/m2/day in London, 1.4 ng/m2/day in Cardiff and Manchester and 0.79 ng/m2/day in Stevenage. Seasonal variations in the PCDD/F concentrations were observed at all sites for both air and deposition, with concentrations/fluxes generally elevated during the winter.

The article reports on host of vessel M/V Chimacum to the ferry fleet of Naval Supply Systems Command (NAVSUP) Fleet Logistic Center (FLC) for functional exercise at Manchester Fuel Depot (MFD) on June 19, 2018. Topics discussed include views of Scott McCarthy, NAVSUP FLC Puget Sound Regional Fuels Director lieutenant commander, on the same, prediction on damage of road and bridges from earthquake strike in Pacific Northwest region and consideration of environmental compliance.

The article discusses the participation of NAVSUP Fleet Logistics Center(FLC) at Puget Sound in the Quartermaster Liquid Logistics Exercise (QLLEX) organized by the U.S. Army Reserve at the Manchester Fuel Depot (MFD). It further highlights the procedure of transporting aviation fuel the Navel Air Station, its mission to provide realistic training to soldiers and MFD's role in providing fuel support to the United States.

The article talks about Joint fuel spill response exercise attended by the teams of U.S. Naval Supply Systems Command Fleet Logistics Center (NAVSUP FLC) Puget Sound Fuel Department in Blake Island, Washington. It is mentions the training of team to handle real life situation, advance containing and cleaning up the fuel, and protect critical areas. The article adds that Washington Department of Ecology Spill Prevention and Preparedness & Response Program overlooked the exercise.

The article talks about Puget Sound-based U.S. Naval Supply Systems Command's (NAVSUP) support for USS Nimitz (CVN 68) deployment. It is mentioned that Nimitz to make daily deliveries of logistics, materials and delivered 200 pallets of stock materials and 1,102 pallets of food. The article adds about training of the designated Sailors, official mail program, and reutilization and delivery of hazardous materials (HAZMAT).

The article discusses the 2017 Northwest Junior Officer Training Symposium (JOTS) hosted by Naval Supply Systems Command (NAVSUP) Fleet Logistics Center (FLC) Puget Sound that was held at the Naval Base Kitsap, Bangor, Washington in March 2017. The symposium attended by Navy Supply Corps officers focused on mentoring and professional development as well as peer networking. Commander Subramarine Group NINE Rear Adm. John Tammen was the guest speaker at the annual event.

The article offers information about the Junior Officers Training Symposium (JOTS) by the U.S. Naval Supply Systems Command at Naval Undersea Warfare Center in Keyport, Washington on September 18 and 19, 2016 and features topics like career development.

The article offers information on the U.S. Naval Supply Systems Command (NAVSUP) Fleet Logistics Center (FLC) Puget Sound's General Mess Seminar to be held at the Naval Undersea Warfare Center in Keyport, Washington as of July 2015.

The article discusses the decommissioning of the nuclear powered USS Dallas submarine at Naval Base Kitsap in Bremerton by NAVSUP Fleet Logistics Center Puget Sound.

The article focuses on participation of the U.S. Naval Supply Systems Command (NAVSUP) Fleet Logistics Center (FLC) Puget Sound as part of the U.S. Navy ships at the Seattle Seafair Fleet Week of 2017. It mentions that a logistics support representative (LSR) was assigned as a liaison to the ships for the duration of the port visit.

The article reports that personnel from Naval Supply Systems Command (NAVSUP) Fleet Logistics Center (FLC) Puget Sound provided logistics support for U.S. Navy ships making port calls in Portland, Oregon, June 8-12, 2017, during the annual Portland Rose Festival Fleet Week. It discusses the efforts of logistics support specialists (LSRs) and postal operations personnel to ensure a smooth port visit for the Navy's littoral combat ship USS Jackson and guided-missile cruiser USS Bunker Hill.

The article discusses United States. Naval Supply Systems Command's efforts to help ensure postal security for Military Sealift Command (MSC). It tells us about efforts of John Wakefield and his visits to conduct training under a voluntary program the NAVSUP FLC Puget Sound postal department initiated to make sure civilian mariners in the area are up-to speed regarding the security of their mail system, and that they know how to identify and deal with suspicious packages and smooth operations.

The article focuses on U.S. Navy Reserve members to Pacific Northwest being invited by Naval Supply Systems Command (NAVSUP) Fleet Logistics Center (FLC) Puget Sound. Topics discussed include views of naval officer Robert Allen regarding participation of Reserve group in weekend drills, training opportunities for Reservists being offered by NAVSUP FLC Puget Sound and participation of reservists serving in NAVSUP FLC Puget Sound in running a warehouse and handling hazardous materials (HAZMAT).

This article reports that on February 24-25, 2016, the Naval Supply Systems Command Fleet Logistics Center (NAVSUP FLC) Puget Sound Fuel Department opened the gates of Manchester Fuel Depot in Washington to volunteers from a local high school to conduct a salmon release project at Beaver Creek. Discussed also is the involvement in the project of the South Kitsap Discovery Alternative High School, the Port Orchard Rotary Club, and the Washington State Department of Fish and Wildlife.

This article reports that on March 15, 2016, the Naval Supply Systems Command Fleet Logistics Center (NAVSUP FLC) Puget Sound hosted a Women's History Month presentation at the Naval Undersea Museum in Keyport, Washington. Mentioned also is the appearance in the event of Michele Burk, chief logistician for the Naval Undersea Warfare Command (NUWC), Lt. Cmdr. Britta Christianson, head of the NAVSUP FLC Puget Sound Operations Department, and Senior Chief Logistics Specialist Stephanie Lerette.

The article reports that the Naval Supply Systems Command (NAVSUP) Fleet Logistics Center (FLC) Puget Sound has provided alternative fuel to the combat support ship USNS Rainier in support of the U.S. Navy's Great Green Fleet (GGF) initiative. Topics mentioned include the GGF's advantages to the Navy including operational flexibility, and a background on the mission and scope of operation of the Defense Department's Manchester Fuel Depot located in Washington state.

The article reports on the gathering of the U.S. Naval Supply Systems Command (NAVSUP) Fleet Logistics Center (FLC) Puget Sound Supply Corps officers at the Brooks Sports, Inc. Distribution Center to view the company's warehouse operations on November 7, 2015. It mentions that Brooks Sports executives kicked off the day with a brief overview of the company and its operations. It also presents the views of Gina M. Slaby, NAVSUP FLC Puget Sound logistics support officer, on the same.

The article reports on the physical and administrative control of the Hazardous Material Minimization Center (HAZMINCEN) by the U.S. Naval Supply Systems Command (NAVSUP) Fleet Logistics Center Puget Sound at Naval Air Station (NAS) Whidbey Island, October 1, 2015. It mentions that NAVSUP command's hazardous materials (HAZMAT) guidance and policies. It also presents the views of John S. Gonzalez, deputy head of NAVSUP FLC Puget Sound Installation Support Department, regarding the same.

The article reports on the partnership between the U.S. Naval Supply Systems Command (NAVSUP) Fleet Logistics Center (FLC) Puget Sound with Naval Facilities Engineering Command (NAVFAC) Northwest Shop Stores facility. It mentions that the facility will provide logistics support to the NAVFAC Northwest Production Shop. It also presents the views of Mark Geronime, NAVFAC Northwest commanding officer, regarding the same.

The article reports on the visit of Rear Admiral James McNeal, the Commander of Naval Supply Systems Command (NAVSUP) Global Logistics Support (GLS), to the regional facilities run by NAVSUP Fleet Logistics Center Puget Sound on July 29, 2015 which include the Naval Base Kitsap in Washington state.