Decision models for distinguishing between clinically insignificant and significant tumors in prostate cancer biopsies: an application of Bayes' Theorem to reduce costs and improve outcomes.

Prostate cancer is the second leading cause of death from cancer, behind lung cancer, for men in the U. S, with nearly 30,000 deaths per year. A key problem is the difficulty in distinguishing, after biopsy, between significant cancers that should be treated immediately and clinically insignificant tumors that should be monitored by active surveillance.

The use of serum hCG as a marker of tumor progression and of the response of metastatic urothelial cancer to systemic chemotherapy.

This case confirms the observation that urothelial carcinomas can secrete beta-hCG, and that beta-hCG can potentially be used as a marker of a patient's clinical response to treatment. Prospective studies are clearly warranted by these observations.

Vascularity of primary and metastatic renal cell carcinoma specimens.

Purpose: Anti-angiogenic therapies are among the most commonly used drugs in renal cell carcinoma. Tumor vascularity, defined by microvessel area, may be associated with response to these drugs. Clinical studies suggest that metastatic sites are more responsive than primary tumors.

An Internet intervention for management of uncertainty during active surveillance for prostate cancer.

Purpose/objectives: To provide preliminary data on an Internet intervention that incorporates cognitive reframing and self-management strategies to help older men undergoing active surveillance (AS) self-manage disease-related issues and improve quality of life (QOL).

Design: Single-subject design.

Setting: Two participating urologic practices at major academic medical centers in the northeastern United States.

Radical prostatectomy vs. intensity-modulated radiation therapy in the management of localized prostate adenocarcinoma.

Background And Purpose: To determine whether radical prostatectomy (RP) or intensity-modulated radiation therapy (IMRT) to > or =72 Gy, plus hormonal therapy if indicated, results in improved biochemical disease-free survival (BDFS) in localized prostate adenocarcinoma.

Materials And Methods: Between 1997 and 2005, a consecutive sample of 556 patients who underwent RP (n=204) or IMRT (n=352) at two referral centers was analyzed. The patients were stratified into prognostic groups based on clinical stage, Gleason score, and pretreatment prostate-specific antigen (PSA).

Whole pelvic radiotherapy versus prostate only radiotherapy in the management of locally advanced or aggressive prostate adenocarcinoma.

Purpose: To determine whether whole pelvic radiotherapy (WPRT) or prostate-only radiotherapy (PORT) yields improved biochemical disease-free survival (BDFS) in patients with advanced or aggressive prostate adenocarcinoma.

Methods And Materials: Between 2000 and 2007, a consecutive sample of 277 patients with prostate adenocarcinoma and at least a 15% likelihood of lymph node involvement who had undergone WPRT (n = 68) or PORT (n = 209) at two referral centers was analyzed. The median radiation dose in both arms was 75.

Surgery versus implant for early prostate cancer: results from a single institution, 1992-2005.

Purpose: The aim of this study was to compare the biochemical disease-free survival rates for radical prostatectomy versus transperineal ultrasound-guided prostate implant for patients with early prostate cancer treated at a single institution from 1992 through 2005.

Materials And Methods: The charts of 741 patients with early prostate cancer (350 implant and 391 surgery) treated from 1992 through 2005 were retrospectively reviewed. Surgery patients were treated by members of the academic Urology Section at Yale University School of Medicine.

The effect of age on prostate implantation results.

Purpose: The current study was undertaken to determine the effect of young age (60 years or younger) on the 5-year biochemical disease-free survival rate following ultrasound-guided transperineal prostate implantation.

Patients And Methods: The radiation therapy charts of 330 patients who underwent ultrasound-guided transperineal prostate implantation who were treated from 1992 through 2004 were retrospectively reviewed. Follow-up ranged from 12 to 120 months, with a mean of 48 months.

Iodine 125 versus palladium 103 implants for prostate cancer: clinical outcomes and complications.

Purpose: The purpose of this study was to evaluate the clinical outcomes and compare complication rates for patients with prostate cancer treated with iodine 125 ((125)I) and palladium 103 ((103)Pd) prostate brachytherapy at a single institution.

Patients And Methods: Between 1992 and 2002, 272 patients with prostate cancer were treated with ultrasound-guided transperineal implantation incorporating (125)I (107 patients) or (103)Pd (165 patients). Three months of hormonal therapy was incorporated into the treatment program in 33% of the patients in both groups.

Effect of intravesical treatment of transitional cell carcinoma with bacillus Calmette-Guerin and mitomycin C on urinary survivin levels and outcome.

Purpose: Urine survivin is a predictive/prognostic molecular marker that detects transitional cell carcinoma (TCC) with high specificity and sensitivity. The presence of urine survivin in patients with TCC who receive intravesical instillation of bacillus Calmette-Guerin or mitomycin C may predict recurrence.

Materials And Methods: Urine from 25 subjects receiving 27 intravesical treatments of bacillus Calmette-Guerin or mitomycin C for TCC were collected prior to, during and after treatment.

Surgery, brachytherapy, and external-beam radiotherapy for early prostate cancer.

Patients diagnosed with early prostate cancer after 2000 can expect better outcomes from treatment than patients who were diagnosed in the 1980s and early 1990s. These improved outcomes are the result of stage migration, new technologies such as three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated external-beam radiotherapy (IMRT), better implant techniques, and optimum use of hormone therapy. We review the outcomes for radical prostatectomy, permanent seed implant, 3DCRT, and IMRT.