Search

Background: The Veterans Affairs Cooperative Studies Program study #553 was designed to evaluate the efficacy of adjuvant chemotherapy added to the standard of care (SOC) for patients who are at high risk for relapse after prostatectomy., Objective: To test whether addition of chemotherapy to surgery for high-risk prostate cancer improves progression-free survival (PFS)., Design, Setting, and Participants: Eligible patients after prostatectomy were randomized to the SOC group with observation or to the chemotherapy group with docetaxel and prednisone administered every 3 wk for six cycles. Randomization was stratified for prostate-specific antigen, Gleason, tumor stage, and surgical margin status., Outcome Measurements and Statistical Analysis: The primary endpoint was PFS. Secondary endpoints included overall, prostate cancer-specific, and metastasis-free survival, and time to androgen deprivation therapy., Results and Limitations: A total of 298 of the planned 636 patients were randomized. The median follow-up was 59.1 mo (0.2-103.7 mo). For the primary endpoint, the two groups did not statistically differ in PFS (median 55.5 mo in the chemotherapy group and 42.2 mo in the SOC group; test adjusted for site via gamma frailty p=0.21; adjusted hazard ratio [HR] 0.80; 95% confidence interval [CI] 0.58-1.11; p=0.18). Prespecified subgroup analyses showed benefit in PFS for patients with tumor stage ≥T3b (HR 0.54, 95% CI 0.32-0.92; p=0.022) and patients with Gleason score ≤7 (HR 0.65, 95% CI 0.43-0.99; p=0.046). Secondary endpoint analyses are hampered by low event rates. The most common adverse events (≥grade 3 related or possibly related to chemotherapy) included neutropenia (43%), hyperglycemia (20%), and fatigue (5%), with febrile neutropenia in 2%., Conclusions: Adjuvant chemotherapy in high-risk prostate cancer using docetaxel and prednisone did not lead to statistically significant improvement in PFS for the intention-to-treat population as a whole. The analysis was challenged by lower power due to accrual limitation. Subgroup analyses suggest potential benefit for patients with Gleason grade ≤7 and stage≥pT3b (ClinicalTrials.gov number NCT00132301)., Patient Summary: In this randomized trial, we tested whether addition of chemotherapy to surgery for high-risk prostate cancer decreased the risk of prostate-specific antigen rise after surgery. We found no benefit from docetaxel given after radical prostatectomy, although some subgroups of patients may benefit., (Copyright © 2020 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Electrospinning of natural polymer nanofibers useful for biomedical applications often requires the use of cytotoxic organic solvents. In this study, gelatin nanofibers are electrospun from phosphate buffer saline/ethanol binary mixtures as a benign solvent at ambient temperature. The influences of ionic strength, ethanol concentration, and gelatin concentration on the electrospinnability of gelatin solutions and the fiber microarchitectures are analyzed. The electrospun scaffolds retain their morphologies during vapor-phase crosslinking with glutaraldehyde in ethanol and the subsequent removal of salts contained in the nanofibers via water rinsing. When fully hydrated, the mechanically preconditioned scaffolds display a Young's modulus of 25.5 ± 5.3 kPa, tensile strength of 55.5 ± 13.9 kPa, deformability of 160 ± 15%, and resilience of 89.9 ± 1.8%. When cultured on the gelatin scaffolds, 3T3 fibroblasts displayed spindle-like morphology, similar to the cell's normal morphology in a 3D extracellular matrix., (Copyright © 2012 Wiley Periodicals, Inc.)