bluuebunny/crossref_metadata_2025_split huggingface dataset:
Performance characteristics of PSA in patients undergoing radical prostatectomy.
Authors: Liu Jen-Jane , Brooks James D , Ferrari Michelle , Nolley Rosie , Presti Joseph C. 
Published: February 2017

199 Background: The Prostate Cancer Prevention Trial demonstrated that the performance characteristics of PSA are improved for diagnosis of high grade disease. We assessed the performance of PSA for determining total and high grade cancer volume in a radical prostatectomy series. Methods: We identified 1307 patients from the Stanford Radical Prostatectomy Database with clinical stage T1c (n=658) and T2 (n=549) disease who had surgery between 1988 and 2002 and detailed morphometric mapping by a single pathologist. Patients with T1c and T2 disease were analyzed separately as the indication for biopsy was different in these two populations (elevated PSA versus abnormal DRE). We generated receiver operating characteristic (ROC) curves for PSA based on total tumor volume and volume of Gleason 4 or 5 disease and compared the areas under the curve (AUC) for different cut points of total and high grade cancer volume. Results: For patients with clinical stage T1c disease, as total and high grade cancer volumes increased, so did the AUC for PSA performance. There was a significant difference in AUC for PSA for total cancer volumes greater than 0.5 cc (AUC=0.62) compared to greater than 2 cc (AUC=0.72, p=0.02), and also between volumes greater than 2 cc (AUC=0.72) and 5 cc (AUC=0.79, p=0.0003, Fig.1). The AUC for PSA performance for volume of high grade disease increased from 0.66, to 0.68, to 0.76 for Gleason 4 or 5 volumes of 0, 0.5, and 3 cc, respectively (Fig. 2). For patients with clinical stage T2 disease, the AUCs for total or high grade cancer volume were not different across cut points, but were overall higher compared to the T1c group. Conclusions: In T1c patients, PSA performance improved in a stepwise fashion with higher total and high grade cancer volumes as evidenced by improved receiver operating characteristics. In T2 patients, no similar trend was observed, although overall PSA performance was improved compared to T1c patients. Prior studies show that PSA performs better for the detection of high grade disease; here, we show that PSA performs better in predicting volume of high grade disease in radical prostatectomy specimens.
Phase II trial of bevacizumab and lenalidomide with docetaxel and prednisone in patients with metastatic castration-resistant prostate cancer (mCRPC).
Authors: Adesunloye Bamidele , Huang Xuan , Ning Yangmin M. , Madan Ravi A. , Gulley James L. , Beatson Melony , Kluetz Paul Gustav , Adelberg David , Arlen Philip M. , Parnes Howard L. , Mulquin Marcia , Steinberg Seth M. , Wright John Joseph , Trepel Jane B. , Dawson Nancy Ann , Chen Clara , Apolo Andrea Borghese , Figg William Douglas , Dahut William L. 
Published: February 2017

207 Background: Angiogenesis may be vital to mCRPC. Previously, we had shown the potent anti−tumor activity of dual antiangiogenic therapy by combining thalidomide (T) and bevacizumab (B) with docetaxel (D) and prednisone (P) in mCRPC (Ning JCO 2010). We hypothesized that combining lenalidomide (L), an analogue of T, with B, D, and P would have a more favorable efficacy/toxicity profile. Methods: All patients (pts) had chemotherapy−naïve mCRPC. 3 pts received R 15 mg daily, 3 pts had 20 mg daily, and the rest had 25 mg daily for 14 days of every 21−day cycle (C). All pts received D 75 mg/m2 and B 15 mg/kg on day 1 with P 10 mg and enoxaparin daily throughout each C. Pegfilgrastim was given on day 2. PSA was assayed each C with imaging after C2 and then after every 3C. Results: 47 of the planned 51 pts have been enrolled. Median age was 66 (51−82), Gleason score 8 (5−10), on−study PSA 91.6 ng/ml (0.15−3520), pre−study PSA doubling time 1.43 months (0.52−6.73), number of Cs 14 (1−31), and PFS was 19.3 months as of this analysis. Among 45 pts who have completed ≥2 cycles, 39 (86.7%) and 30 (66.7%) had PSA declines of ≥50% and ≥75%, respectively. Of 29 pts with measurable disease there were 2 CR, 21 PR, and 6 SD (79.3% overall RR). 10/47 pts were taken off study for radiographic disease progression and 5/47 for other reasons. Grade ≥3 toxicities included neutropenia (24/47), anemia (9/47), thrombocytopenia (5/47), weight loss (1/47), hypertension (3/47), and febrile neutropenia (4/47). Other toxicities included perianal fistula (3/47), rectal fissure (1/47), myocardial infarction (1/47), and osteonecrosis of the jaw (ONJ) (16/47, 34.0%). At the time of diagnosis of ONJ, 9/16 pts were on bisphosphonates and 3/16 had used bisphosphonates previously. Although the incidence of ONJ was higher than the 18.3% reported by Ning, a recent study of carboplatin plus weekly docetaxel reported an incidence of 29.3%. Conclusions: Dual antiangiogenic therapy with, B and L, plus D and P was associated with high PSA (86.7%) and tumor (79.3%) responses with manageable toxicities. Further studies are underway to explore the high incidence of ONJ.
Impact of U.S. Preventive Services Task Force recommendation on screening for prostate cancer in men age 75 or older.
Authors: Drazer Michael W. , Prasad Sandip M. , Huo Dezheng , Schonberg Mara A , Eggener Scott E. 
Published: February 2017

216 Background: In 2008, the U.S. Preventive Services Task Force (USPSTF) recommended against screening for prostate cancer in men age 75 years or older. We sought to determine the impact of this statement on utilization of prostate-specific antigen (PSA) testing in this patient group. Methods: Using the 2005 and 2010 National Health Interview Survey, a cross-sectional household interview survey providing a representative sample of the U.S. population, we analyzed the use of PSA testing in men age 40 years or older prior to and following the release of the USPSTF statement on prostate cancer screening. Results: In 2010, there were an estimated 2.0 million PSA tests ordered in men 75 years of age and older. In this group, PSA testing rates did not decline between 2005 and 2010 (40.4% vs. 40.6%). In 2010, PSA testing was more common in men aged 75 years and older than in men aged 40 to 49 (9.2%) and 50 to 59 (26.2%) (p < 0.01 between groups). In both 2005 and 2010, PSA testing rates were lowest in men aged 40-49 and highest in men aged 60-74. Conclusions: Despite the USPSTF recommendation against prostate cancer screening in men age 75 or older, there was no decrease in PSA testing rates in these men. A significant proportion of elderly men continue to receive PSA screening despite a very low likelihood of benefit. [Table: see text]
The influence of metabolic syndrome on prostate cancer risk detection and its aggressiveness.
Authors: Morales Rafael , Suarez Cristina , Ropero Jordi , Nunez Isaac , Planas Jacques , Placer Jose , Valverde Claudia María , Maldonado Xavier , Morote Juan , Carles Joan 
Published: February 2017

226 Background: Metabolic syndrome (MS) is a frequent pathological condition that increase cardiovascular risk and mortality. MS is frequently diagnosed in adult men who are at risk of prostate cancer (PC). Some studies have postulated a relationship between MS and overall oncogenesis, however no information exist in relation to PC. The objective of this study was to analyze the impact of MS on PC detection risk and PC aggressiveness. Methods: A group of 2408 men were consecutively subjected to prostate biopsy for cause, PSA >4 ng/mL (64.4%), abnormal DRE (9%) or both (26.6%). Median PSA was 7.0 ng/mL (0.7-1279) and median age 68 years (46–86). MS was evaluated according to the ATPIII criteria (three or more conditions: waist circumference >102 cm, triglyceride level >150 mg/dL, high density lipoprotein level <40 mg/dL, fasting glucosa level >110 ng/dL and blood pressure >130/85 mmHg. Men on lipid-lowering medications, hypoglicemiants and antihypertensives were classified as positive for the respective criterion. We took at least 10 cores in PB, plus 1 to 8 additional cores depending on age and prostate volume according to a modified Vienna’s nomogram. Overall PC detection rate was 35.2% and high grade (HG) rate (Gleason score >7) 28.3%. Binary logistic regression and contingence analysis were performed and odds ratios (OR) calculated to analyze the strength of relationships. Results: The overall prevalence of MS was 61.5% (1480/2408). Multivariate analysis showed that MS was not an independent predictor of PC however MS was an independent predictor of HGPC. The rate of PC was 34.3% in men with MS (508 of 1480) and 36.6% in men without MS (340/928), p=0.255. OR: 0.904 (95%CI 0.762-1.073). The rate of HGPC was 33.1% among the PCs detected in men with MS and 21.2% among the PCs detected in men without MS, p <0.001, OR 1.839 (95%IC 1.337-2.531). Conclusions: MS does not seem to increase the risk of prostate cancer detection in men subjected to PB for cause. However, we have detected an increase of the aggressiveness among PCs detected in men with MS.
Association of single-nucleotide polymorphisms in BCL2L1 and TACC3 with response to bacillus Calmette-Guérin intravesical therapy in non-muscle-invasive bladder cancer.
Authors: Alanee Shaheen , Gallagher David James , Vijai Joseph , Hamilton Robert James , Ostrovnaya Irina , Garcia-Grossman Ilana Rebecca , Riches Jamie C. , Regazzi Ashley Marie , Przybylo Jennifer A. , Gaudet Mia , Milowsky Matthew I. , Herr Harry W. , Offit Kenneth , Bajorin Dean F. 
Published: February 2017

260 Background: Bacillus Calmette-Guérin intravesical therapy (BCG) has an important role in the management of high risk non-muscle-invasive bladder cancer (NMIBC). This study examines the association between germline single nucleotide polymorphisms (SNPs) and response to BCG therapy. Methods: Saliva or blood was collected from pts with NMIBC treated at a single center and diagnosed between 1984 and 2010. SNPs were selected based on reported associations with bladder cancer and BCG response, and genotyped using the Sequenom MassARRAY iPLEX system. No response to BCG was defined as the presence at 6 months of pathologically documented tumor in the bladder. Univariate logistic regression was used to test the association between the outcome of interest (no response to BCG at 6 months) and clinical variables (stage, grade and multifocality), or individual SNPs. Results: The cohort consisted of 158 pts with a median age of 65 years who received intravesical BCG for NMIBC (35.2% stage T1, 32.7% stage Ta and 31.4% stage Tis) with 93% having high-grade disease. At 6 months follow up, 22 (13.9%) patients showed no response to BCG. We successfully genotyped 80 of the 88 selected SNPs. Of these, 2 SNPs were associated with lack of response to BCG; rs798766 is an intronic SNP in TACC3 (OR for no response is 2.4 for each T allele relative to CC genotype, P=0.01), and rs1994251 an intronic SNP in BCL2L1 (OR for no response is 3.2 for each C allele relative to AA, p= 0.0008). Both SNPs remained significantly associated with lack of response after adjusting for predictive clinical variables. Conclusions: Single nucleotide polymorphisms of BCL2L1 and TACC3 may be predictive of BCG refractory bladder cancer. Future validation studies on independent datasets are needed to determine the clinical utility of these findings.
The influence of variant histology on survival outcomes of radical cystectomy for bladder cancer.
Authors: Fairey Adrian Stuart , Skinner Eila C. , Schuckman Anne , Leiskovsky Gary , Cai Jie , Miranda Gus , Daneshmand Siamak 
Published: February 2017

278 Background: The role of variant histology bladder cancer as an independent prognostic factor for survival after radical cystectomy is poorly defined. Our aim was to examine the impact of variant histology on survival. Methods: A retrospective analysis of prospectively collected data from the University of Southern California Bladder Cancer Database was performed. Between 1971 and 2008, 2098 patients underwent radical cystectomy and extended pelvic lymph node dissection for primary bladder cancer. All surgical specimens underwent centralized pathologic review by dedicated genitourinary pathologists. Histologic type was categorized according to the WHO/ISUP 1998 classification as urothelial carcinoma (UC; n=1595), UC + variant (n=380), or non-urothelial carcinoma (Non-UC; n=123). The outcomes were overall survival (OS) and recurrence-free survival (RFS). The Kaplan-Meier method and Cox proportional regression models were used to analyze survival data. Results: The median follow-up duration was 12.8 years (range, 0 to 36.6 years). The predicted 5-year OS (61%, 53%, and 47%, Log rank p=0.005) and RFS (68%, 59%, and 58%, Log rank p=0.001) rates differed between patients with UC, UC + variant, and Non-UC histology. Multivariable analysis showed that Non-UC (but not UC + variant) histology was independently associated with OS (Non-UC versus UC: HR 1.26, 95% CI 1.01 to 1.57, p=0.040; UC + variant versus UC: HR 0.97, 95% CI 0.85 to 1.12, p=0.697) but not RFS (Non-UC versus UC: HR 1.14, 95% CI 0.83 to 1.56, p=0.411; UC + variant versus UC: HR 1.06, 95% CI 0.88 to 1.28, p=0.551). Conclusions: Non-UC histology was independently associated with poorer OS after radical cystectomy for bladder cancer. Clinical trials are needed to determine whether this high risk group will benefit from multimodal therapy.
Multi-institutional review of sequential intravesical gemcitabine and mitomycin C chemotherapy for non-muscle-invasive bladder cancer.
Authors: Lightfoot Andrew J. , Breyer Benjamin N. , Rosevear Henry M. , Konety Badrinath , O'Donnell Michael A. 
Published: February 2017

294 Background: Combination chemotherapy is the standard of care for neoadjuvant, adjuvant, and metastatic bladder cancer due to increased efficacy when compared to monotherapy. We report our experience with sequential intravesical combination chemotherapy using gemcitabine and mitomycin C (MMC) for non-muscle invasive bladder cancer (NMIBC). Methods: We performed a multi-institutional retrospective review of 47 consecutive patients who received 6 weekly treatments with sequential gemcitabine (1g) and mitomycin C (40mg) chemotherapy for NMIBC. Thirty patients received treatment at University of Iowa, 14 at UCSF and 3 at University of Minnesota. Results: A total 47 patients (median age 70, range 32-85; 36 males, 11 females) previously failing a median of 2 intravesical treatments were reviewed. The complete response (CR), 1-year recurrence-free survival (1-RFS) and 2-year recurrence-free survival (2-RFS) for all patients was 68%, 48% and 38%, respectively. In all, 14 of 47 patients (30%) remain free of recurrence with a median time to followup of 26 months (range 6-80 months). The median time to recurrence for all patients who recurred was 4 months (range 1-33 months). Ten patients required cystectomy. Conclusions: Sequential intravesical combination chemotherapy using gemcitabine and MMC appears to be a useful treatment for patients with a history of NMIC which has failed BCG or other intravesical therapy, in addition to patients with intermediate and high-risk disease.
Survival trends among patients with metastatic bladder cancer in the United States.
Authors: Shah Binay Kumar , Mandal Rakesh 
Published: February 2017

306 Background: The chemotherapy regimens for metastatic bladder cancer (MBC) have evolved over the last two decades. Due to favorable toxicity profile, a combination of cisplatin and gemcitabine is widely used for the treatment of MBC since 2000. It is unclear if the survival trend in MBC has changed over last two decades. This study was conducted to evaluate the relative survival rates for patients with MBC in the United States during 1991-1999 and 2000-2008. Methods: We used the Surveillance, Epidemiology, and End Results (SEER*Stat) program to analyze 6-month and 12-month relative survival rates of AJCC stage-IV bladder cancer patients included in the SEER database. We used Z-test in the SEER*Stat program to compare relative survival rates among cohorts of patients categorized by race, gender, and age groups (<60 and ≥60 years). Results: The dataset comprised 9,819 and 986 patients with AJCC stage-IV bladder cancer among Caucasians and African Americans (AA), respectively. Among Caucasian men (<60 years), 6-month survival rates were 85.4±1.7% (n=442) and 77.9±1.3% (n=1,117) for 1991-1999 and 2000-2008, respectively. Similarly, 12-month survival rates in this group were 68.6±2.2% (n=442) and 60.4±1.5% (n=1,117) for 1991-1999 and 2000-2008, respectively. Thus, both 6-month and 12-month survival rates in 2000-2008 were lower among young Caucasians; and the differences were statistically significant when compared to 1991-1999 (6-month: Z-value = -3.205, p=0.001; 12-month: Z-value= -2.984, p=0.003). The survival rates among AA were not statistically significant. Conclusions: In young Caucasian patients (<60 years) with MBC, 6- month and 12-month relative survival rates were lower for the period 2000-2008 compared to 1991-1999. Further studies may be required to evaluate factors responsible for decreased survival rates among this population.
Empiric antibiotics for an elevated PSA: A randomized, prospective multi-institutional trial.
Authors: Large Michael Christopher , Gerber Glenn Scott , Pettus Joseph Atkins , Smith John , Yossepowitch Ofer , Smith Norm D. , Kundu Shilajit , Raman Jay D. , Eggener Scott E. 
Published: February 2017

32 Background: The impact of an empiric course of antibiotics for a newly elevated PSA in an asymptomatic male is poorly understood. Methods: Men of any age with a PSA > 2.5 ng/ml and normal digital rectal examination undergoing their first prostate biopsy were recruited from six medical centers. Patients with previous biopsy, prostate cancer, urinary tract infection (UTI) or prostatitis within the prior year, antibiotic use within one month, 5−alpha reductase inhibitor use, allergy to fluoroquinolones or clinical suspicion of UTI were excluded. Men were randomized to two weeks of ciprofloxacin 500 mg twice daily or no antibiotic. A PSA was obtained 21−45 days following randomization and immediately prior to prostate biopsy. All patients received institution−specific prophylactic peri−procedural antibiotics. Primary endpoint was change in PSA between baseline and on the day of biopsy. The trial was closed early following an interim analysis and decision rule for futility and early stopping. Results: Complete data was available on 77 men with a mean age of 60.6 (IQR: 53.8 – 66.7). In the control group (no antibiotic; n=39), mean baseline and pre−biopsy PSA were 6.5 and 6.9 ng/ml, respectively (p=0.8). In men receiving antibiotic (n=38), mean baseline and pre−biopsy (post−antibiotic) PSA were 7.6 and 8.5 ng/ml, respectively (p=0.7). Prostate cancer was detected in 36 (47%) men. Detection rates did not significantly differ between individuals with an increasing PSA or decreasing PSA between the two measurements. Conclusions: Empiric use of antibiotics for an elevated PSA in an asymptomatic patient is not of clinical benefit.
Impact of renal impairment and granulocyte colony stimulating factor (GCSF) on bleomycin-induced pneumonitis (bleo lung), febrile neutropenia (FN), and survival in patients (pts) with germ cell tumor (GCT) treated with chemotherapy (chemo).
Authors: Tran Ben , Moore Malcolm J. , Amir Eitan , Jewett Michael A , Anson-Cartwright Lynn , Sturgeon Jeremy F. G. , Chung Peter W. M. , Warde Padraig Richard , Bedard Philippe 
Published: February 2017

328 Background: Use of GCSF and the development of renal impairment in GCT pts receiving chemo are common, but their effect on toxicity and survival is unclear. This study examines the impact of GCSF and renal impairment on bleo lung, FN and survival, in GCT pts receiving 1st line chemo. Methods: Clinical data from our institutional GCT database was complemented by review of radiology, pharmacy and medical records. All GCT pts receiving 1st line chemo between 1-Jan-00 and 31-Dec-10 were included. Pts receiving at least one GCSF dose were identified. Renal impairment during chemo was defined as any serum creatinine above the institutional upper limit of normal. Bleo lung was graded (G1-5) using CTCAE criteria. FN was defined as temperature ≥38C and neutrophil count <1.0. Results: The cohort consisted of 260 GCT pts, median age 31.5 years, 171 (66%) had IGCCCG good risk disease, 42 (16%) intermediate, and 41 (16%) poor, while 6 (2%) received adjuvant chemo. 159 (61%) received GCSF and 49 (19%) developed renal impairment. 212 (82%) received BEP of which 73 (34%) developed bleo lung (56 pts G1 asymptomatic, 13 pts G2, 4 pts ≥G3). Renal impairment was associated with bleo lung in univariate (OR 2.87, p=0.008) and multivariate (OR 2.69, p=0.01) analyses. GCSF was associated with increasing severity of bleo lung (OR 1.86, p=0.045) but this was not significant in a multivariate analysis (OR 1.72, p=0.08). FN occurred in 33 (13%) of 260 pts. Renal impairment (OR 3.91, p=0.001) was associated with FN. Primary GCSF prophylaxis reduced FN (OR 0.26, p=0.001), however, 8 (7%) of 112 patients developed FN in spite of GCSF prophylaxis. Survival analyses demonstrated GCSF and renal impairment did not impact progression free or overall survival (OS), however, bleo lung was associated with poorer OS in a multivariable Cox proportional hazards analysis (HR 2.85, p=0.029). Conclusions: Our findings demonstrate both renal impairment and GCSF are risk factors for bleo lung, while renal impairment itself is also a risk factor for FN. Additionally, we identify bleo lung as a significant poor prognostic factor for OS.
Seminoma and sarcoid: A confusing collision.
Authors: Brady Claire , Bambury Richard Martin , Teo MinYuen , El-Gammal Alamani , McCarthy Julie , O'Driscoll Martin , Kennedy Marcus , O'Connor Terry , O'Reilly Seamus , Power Derek Gerard 
Published: February 2017

339 Background: In patients with active or prior malignancy, the presence of mediastinal lymphadenopathy is often assumed to indicate metastases. However, sarcoidosis can imitate malignancy on CT and PET imaging. The incidence of sarcoidosis or “sarcoid-like reaction” in cancer patients (especially testicular germ cell tumor patients) appears to be higher than in the general population. Methods: We report a series of 4 testicular cancer patients with mediastinal adenopathy mimicking metastatic disease. Subsequent investigations and follow-up revealed sarcoid-like reaction without active malignancy. Results: A 25 year old man presented with a neck swelling and was found to have left cervical adenopathy, mediastinal adenopathy and a right testicular mass. Biopsy of the cervical nodes revealed a mixed seminoma and non-seminomatous germ cell tumour. After 4 cycles of chemotherapy PET/CT revealed persistent hypermetabolic mediastinal adenopathy. Transbronchial needle aspirate (TBNA) revealed non-caseating granulomas (NCGs). After right orchiectomy and retroperitoneal lymph node dissection he remains in complete remission. A 26 year old man presented with scrotal swelling and investigations revealed bilateral testicular seminoma. CT revealed mediastinal adenopathy. TBNA revealed NCGs and he remains disease free after orchiectomy. A 42 year old man presented with right sided scrotal swelling. CT revealed mediastinal adenopathy. TBNA revealed NCGs. He was treated successfully with orchiectomy and chemotherapy for stage 1 seminoma. A 20 yr old man had mediastinal adenopathy on a surveillance CT 5 years after high dose chemotherapy and stem cell transplant for platinum-refractory seminoma. TBNA revealed NCGs and the adenopathy resolved with oral prednisone therapy. Conclusions: Sarcoid-like reaction in cancer patients may be due to an immunologic hypersensitivity to tumor-associated antigens. Although the precise pathogenesis is unknown, the clinical relevance of this phenomenon is clear. There is a need for histologic confirmation of suspected metastatic mediastinal adenopathy in patients with testicular cancer. We are collecting more cases in other malignancies and will present an update.