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Trends in the Incidence of Fatal Prostate Cancer in the United States by Race

Abstract Background

Prostate-specific antigen (PSA) testing has dramatically changed the composition of prostate cancer (PCa), making it difficult to interpret incidence trends. New methods are needed to examine temporal trends in the incidence of clinically significant PCa and whether trends vary by race.

Objective

To conduct an in-depth analysis of incidence trends in clinically significant PCa, defined as cases in which PCa was the underlying cause of death within 10 yr of diagnosis.

Design, setting, and participants

We extracted incident PCa cases during the period 1975–2002 and associated causes of death and survival through 2012 from nine cancer registries in the population-based Surveillance Epidemiology and End Results program database.

Outcome measurements and statistical analysis

We applied joinpoint regression analysis to identify when significant changes in trends occurred and age–period–cohort models to examine longitudinal and cross-sectional trends in the incidence of fatal PCa.

Results and limitations

Among 51 680 fatal PCa cases, incidence increased 1% per year prior to 1992, declined 15% per year from 1992 to 1995, and further declined by 5% per year through 2002. Age-specific incidence rates of fatal disease decreased >2% per year among men aged ≥60 yr, yet rates remained relatively stable among men aged ≤55 yr. Fatal disease rates were >2-fold higher in black men compared with white men, a racial disparity that increased to 4.2-fold among younger men.

Conclusions

The incidence of fatal PCa substantially declined after widespread PSA screening and treatment advances. Nevertheless, rates of fatal disease among younger men have remained relatively stable, suggesting the need for additional attention to early onset PCa, especially among black men. The persistent black-to-white racial disparity observed in fatal PCa underscores the need for greater understanding of the causes of this difference so that strategies can be implemented to eliminate racial disparities.

Patient summary

We assessed how the incidence of ultimately fatal prostate cancer (PCa) changed over time. We found that the incidence of fatal PCa declined by >50% since the introduction of prostate-specific antigen testing and advances in treatment options; however, incidence rates among younger men remained relatively stable, and younger black men exhibited a 4.2-fold higher risk for fatal disease compared with white men.

Take Home Message

The incidence of clinically significant prostate cancer (PCa) declined substantially after widespread prostate-specific antigen testing and treatment advances. Nevertheless, among younger men, the stable rates and the large black-to-white racial disparity underscore the need for additional attention to early onset PCa.

Keywords: Cancer trends, Cause-specific mortality, Disease progression, Prostate cancer, Prostate-specific antigen.

Footnotes

a Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA

b Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA

Corresponding author. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Room 7E-106, MSC 9774, Bethesda MD 20892, USA. Tel. +1 240 276 7298; Fax: +1 240 276 7838.

Article information

PII: S0302-2838(16)30175-0
DOI: 10.1016/j.eururo.2016.05.011
© 2016 Published by Elsevier B.V.

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Markers that cause toxic radiotherapy side-effects in prostate cancer identified

MedicalNewsToday - Wed, 07/27/2016 - 02:00
A new study involving researchers from The University of Manchester looked at the genetic information of more than 1,500 prostate cancer patients and identified two variants linked to increased...
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Editorial Comment

Recent molecular characterization of prostate cancer has revealed striking genomic heterogeneity and defined distinct molecular subclasses that may provide insight into the variable clinical course of the disease.1,2 Understanding the natural history and prognostic value of these molecular subtypes in at risk cohorts like the ones interrogated here is a necessary first step, exposing underlying disease biology. Furthermore, in an era in which the question, “Does this cancer need to be treated?” is among the most important in our field, understanding the intrinsic aggressiveness of certain disease subtypes can inform clinical decision making.
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Use of the UPOINT Classification in Turkish Chronic Prostatitis/Chronic Pelvic Pain Syndrome Patients

Urology (Gold Journal) In Press - Wed, 07/27/2016 - 00:00
To determine the positive subdomain numbers and distribution of the UPOINT classification in chronic prostatitis and to compare the erectile dysfunction (ED) pattern.
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Design and Methodological Considerations of the National Spina Bifida Patient Registry Urologic and Renal Protocol for the Newborn and Young Child

Care of children with spina bifida (SB) has significantly advanced over the last half-century, resulting in gains in longevity and quality of life for affected children and caregivers. Bladder dysfunction is the norm in SB patients and may result in infection, renal scarring, and chronic kidney disease. However, the optimal urologic management for SB-related bladder dysfunction is unknown.
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Use of EPIC for Clinical Practice (EPIC-CP) to Assess Patient-Reported Prostate Cancer Quality-of-Life Following Robot-Assisted Radical Prostatectomy

The Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) is a short questionnaire that comprehensively measures patient-reported health-related quality of life (HRQOL) at the point of care. We evaluated the feasibility of using EPIC-CP in the routine clinical care of prostate cancer patients without research infrastructure, and compared longitudinal patient-reported and practitioner-reported prostate cancer outcomes.
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Optical Coherence Tomography as a Tool for in Vivo Staging and Grading of Upper Urinary Tract Urothelial Carcinoma: A Study for Diagnostic Accuracy

Biopsies and cytology are cornerstones in the diagnosis of upper urinary tract urothelial carcinoma (UTUC). However, a high rate of non-diagnostic biopsies, tumor upgrading and -staging after nephroureterectomy is observed. In this prospective in vivo study we aimed to evaluate the diagnostic accuracy of OCT for grading and staging of UTUC
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Outcomes following complete surgical metastasectomy for patients with metastatic renal cell carcinoma: a systematic review and meta-analysis

The benefit of complete surgical metastasectomy (CM) for patients with metastatic renal cell carcinoma (mRCC) remains controversial due to limited outcome data. Here, we performed a systematic review and meta-analysis to determine whether CM confers a survival benefit compared to incomplete or no metastasectomy (no-CM) for patients with mRCC.
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Correlation of ASA Grade and the Charlson Comorbidity Index with Complications in Patients after Transurethral Resection of Prostate

Urology (Gold Journal) In Press - Wed, 07/27/2016 - 00:00
To re-assess the Charlson Comorbidity Index (CCI) and the American Society of Anesthesiologists Physical Status Classification System (ASA grade) as predictive factors of complications after transurethral resection of prostate.
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The Decline of the Open Ureteral Reimplant in the United States: National Data From 2003-2013

Urology (Gold Journal) In Press - Wed, 07/27/2016 - 00:00
To examine trends in the number of cases of primary vesicoureteral reflux managed by ureteral reimplantation nationally over the last decade. Substantial changes have occurred in management of vesicoureteral reflux (VUR) over time, but trends in use of ureteral reimplantation have yet to be investigated on a national scale with annualized data.
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Complete AZFb Deletion of Y Chromosome in an Infertile Male with Severe Oligoasthenozoospermia: Case Report and Literature Review

Urology (Gold Journal) In Press - Wed, 07/27/2016 - 00:00
To report on a male patient with complete deletion of azoospermia factor b (AZFb) who presented with severe oligoasthenozoospermia, but who successfully fathered a child via intracytoplasmic sperm injection (ICSI).
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Robot-assisted Surgery for Benign Ureteral Strictures: Experience and Outcomes from Four Tertiary Care Institutions

Abstract Background

Minimally invasive treatment of benign ureteral strictures is still challenging because of its technical complexity. In this context, robot-assisted surgery may overcome the limits of the laparoscopic approach.

Objective

To evaluate outcomes for robotic ureteral repair in a multi-institutional cohort of patients treated for ureteropelvic junction obstruction and ureteral stricture (US) at four tertiary referral centres.

Design, setting, and participants

This retrospective study reports data for 183 patients treated with standard robot-assisted pyeloplasty (PYP) and robotic uretero-ureterostomy (UUY) at four high-volume centres from January 2006 to September 2014.

Surgical procedure

Robotic PYP and robot-assisted UUY were performed according to previously reported surgical techniques.

Outcome measurements and statistical analysis

Preoperative, intraoperative, and postoperative variables and outcomes were assessed. A descriptive statistical analysis was performed.

Results and limitations

No robot-assisted UUY cases required surgical conversion, while 2.8% of PYP cases were not completed robotically. The median operative time was 120 and 150 min for robot-assisted PYP and robot-assisted UUY, respectively. No intraoperative complications were reported. The overall complication rate for all procedures was 11% (n = 20) and complications were mostly of low grade. The high-grade complication rate was 2.2% (n = 4). At median follow-up of 24 mo, the overall success rate was >90% for both procedures. The study limitations include its retrospective nature and the heterogeneity of the study population.

Conclusions

Robotic surgery for benign US is safe and effective, with limited risk of high-grade complications and good intermediate-term results.

Patient summary

In this study we review the use of robotic surgery at four different tertiary care centres in the treatment of patients affected by benign ureteral strictures. Our results demonstrate that robotic surgery is a safe alternative to the standard open approach in the treatment of ureteral strictures.

Take Home Message

The results of the current study confirm the feasibility, safety, and efficacy of robotic surgery as a minimally invasive alternative to open surgery for the treatment of benign ureteral strictures.

Keywords: Ureter, Ureteral strictures, Robot-assisted surgery, Surgical technique, Outcomes, Ureteral surgery, Reimplantation.

Footnotes

a Department of Urology, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy

b Department of Urology, Humanitas Mater Domini, Castellanza, Varese, Italy

c San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy

d Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy

e Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium

f OLV Vattikuti Robotic Surgery Institute, Melle, Belgium

Corresponding author. Department of Urology, Humanitas Clinical and Research Center, Via Alessandro Manzoni 56, 20089 Rozzano, Milan, Italy. Tel. +39 347 5381313; Fax: +39 028 2245721.

Article information

PII: S0302-2838(16)30427-4
DOI: 10.1016/j.eururo.2016.07.022
© 2016 Published by Elsevier B.V.

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Expression of AR-V7 in Circulating Tumour Cells Does Not Preclude Response to Next Generation Androgen Deprivation Therapy in Patients with Castration Resistant Prostate Cancer

Abstract

The androgen receptor splice variant AR-V7 has recently been discussed as a predictive biomarker for nonresponse to next-generation androgen deprivation therapy (ADT) in patients with castration-resistant prostate cancer. However, we recently identified one patient showing a response from abiraterone despite expression of AR-V7 in his circulating tumour cells (CTC).

Therefore, we precisely assessed the response in a cohort of 21 AR-V7 positive castration-resistant prostate cancer patients who had received therapy with abiraterone or enzalutamide. We detected a subgroup of six AR-V7 positive patients showing benefit from either abiraterone or enzalutamide. Their progression free survival was 26 d (censored) to 188 d. Four patients displayed a prostate-specific antigen decrease of >50%. When analysing prior therapies, we noticed that only one of the six patients had received next-generation ADT prior to CTC collection.

As a result, we conclude that AR-V7 status in CTC cannot entirely predict nonresponse to next generation ADT and AR-V7-positive patients should not be systematically denied abiraterone or enzalutamide treatment, especially as effective alternative treatment options are still limited.

Patient summary

A subgroup of patients can benefit from abiraterone and/or enzalutamide despite detection of AR-V7 splice variants in their circulating tumour cells.

Take Home Message

Androgen receptor splice variant-7 expression in circulating tumour cells from patients with castration-resistant prostate cancer cannot entirely predict nonresponse to next-generation androgen deprivation therapy. Therefore, androgen receptor splice variant-7-positive patients should not be denied abiraterone or enzalutamide treatment systematically, especially as effective alternative treatment options are still limited.

Keywords: Abiraterone, Enzalutamide, Androgen receptor splice variant, AR-V7, Castration resistant prostate cancer.

Footnotes

a Clinic of Urology, University Hospital Muenster, Muenster, Germany

b Clinic of Urology, University Hospital Ulm, Ulm, Germany

c Gerhard-Domagk-Institute of Pathology, University Hospital Muenster, Muenster, Germany

Corresponding author. Department of Urology, Muenster University Medical Centre, Albert-Schweitzer-Campus 1, Building A 1, Muenster D-48149, Germany. Tel. +49 (0) 2 51/83-44609; Fax: +49 (0) 2 51/83-44619.

Article information

PII: S0302-2838(16)30426-2
DOI: 10.1016/j.eururo.2016.07.021
© 2016 European Association of Urology, Published by Elsevier B.V.

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Reply to Lu Yang, Shi Qiu and Qiang Wei's Letter to the Editor re: Christopher E. Bayne, Stephen B. Williams, Matthew R. Cooperberg, et al. Treatment of the Primary Tumor in Metastatic Prostate Cancer: Current Concepts and Future Perspectives. Eur Urol...

Refers to article:

Re: Christopher E. Bayne, Stephen B. Williams, Matthew R. Cooperberg, et al. Treatment of the Primary Tumor in Metastatic Prostate Cancer: Current Concepts and Future Perspectives. Eur Urol 2016;69:775–87

Lu Yang, Shi Qiu and Qiang Wei

Accepted 12 July 2016

Refers to article:

Treatment of the Primary Tumor in Metastatic Prostate Cancer: Current Concepts and Future Perspectives

Christopher E. Bayne, Stephen B. Williams, Matthew R. Cooperberg, Martin E. Gleave, Markus Graefen, Francesco Montorsi, Giacomo Novara, Marc C. Smaldone, Prasanna Sooriakumaran, Peter N. Wiklund and Brian F. Chapin

Accepted 22 April 2015

May 2016 (Vol. 69, Issue 5, pages 775 - 787)

Footnotes

a Department of Urology, The George Washington University, Washington, DC, USA

b Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX, USA

c Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

Corresponding author. The University of Texas, M.D. Anderson Cancer Center, Department of Urology, 1515 Holcombe Blvd, Unit 1373, Houston, TX 77030, USA.

Article information

PII: S0302-2838(16)30421-3
DOI: 10.1016/j.eururo.2016.07.016
© 2016 European Association of Urology, Published by Elsevier B.V.

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Quantifying Non-Index Hospital Readmissions and Care Fragmentation Following Major Urologic Oncology Surgeries in a Nationally Representative Sample

To quantify the underestimation of readmission rates that can occur with institutional databases and the incidence of care fragmentation among patients undergoing urologic oncology procedures in a nationally representative database.
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Immunotherapy in the Treatment of Urothelial Carcinoma

To review the biological mechanisms of action, clinical safety, and efficacy of immunotherapies for urothelial carcinoma (UC). To describe current areas of investigation in immunotherapy, and to highlight ongoing trials and promising investigational agents.
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Remarkable Points for Urodynamic Studies in Neurogenic Bladder Management

Urology (Gold Journal) In Press - Sat, 07/23/2016 - 00:00
I have taken a great interest in the recently published article entitled “The Clinical and Urodynamic Results of Percutaneous Posterior Tibial Nerve Stimulation on Neurogenic Detrusor Overactivity in Patients With Parkinson's Diseas” by Kabay et al (1). However, i have a few remarks with respect to the methodology of the study.
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MiR-34C Disrupts the Stemness of Purified CD133 Prostatic Cancer Stem Cells

Urology (Gold Journal) In Press - Sat, 07/23/2016 - 00:00
To find the potential miRNA that could determine the fate of PCa stem cells.
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Remarkable Points for Urodynamic Studies in Neurogenic Bladder Management

Urology (Gold Journal) In Press - Sat, 07/23/2016 - 00:00
I have taken a great interest in the recently published article entitled “The Clinical and Urodynamic Results of Percutaneous Posterior Tibial Nerve Stimulation on Neurogenic Detrusor Overactivity in Patients With Parkinson's Diseas” by Kabay et al (1). However, i have a few remarks with respect to the methodology of the study.
Categories: Urology News Feeds

MiR-34C Disrupts the Stemness of Purified CD133 Prostatic Cancer Stem Cells

Urology (Gold Journal) In Press - Sat, 07/23/2016 - 00:00
To find the potential miRNA that could determine the fate of PCa stem cells.
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