Predictive and prognostic models in radical prostatectomy candidates: a critical analysis of the literature.

Context: Numerous predictive and prognostic tools have recently been developed for risk stratification of prostate cancer (PCa) patients who are candidates for or have been treated with radical prostatectomy (RP).

Objective: To critically review the currently available predictive and prognostic tools for RP patients and to describe the criteria that should be applied in selecting the most accurate and appropriate tool for a given clinical scenario.

Evidence Acquisition: A review of the literature was performed using the Medline, Scopus, and Web of Science databases.

Gene based prediction of clinically localized prostate cancer progression after radical prostatectomy.

Purpose: Accurate estimates of recurrence risk are needed for optimal treatment of patients with clinically localized prostate cancer. We combined an established nomogram and what to our knowledge are novel molecular predictors into a new prognostic model of prostate specific antigen recurrence.

Materials And Methods: We analyzed gene expression profiles from formalin fixed, paraffin embedded, localized prostate cancer tissues to identify genes associated with prostate specific antigen recurrence.

Measurement of 60Co high gamma dose using gamma activation of 115 In and 111 Cd foils.

Cobalt-60 gamma irradiation facilities are used in many industrial and medical applications. Gamma activation technique of (115)In and (111)Cd foils was used in this work to assess the performance of ethanol-chlorobenzene gamma dosimeter at high dose range of (60)Co irradiation facility. Dose mapping was also performed using (115)In foils.

Comparative 5-year outcomes of brachytherapy and surgery for prostate cancer.

Purpose: To compare the predicted outcome by radical retropubic prostatectomy (RRP) of patients actually treated with prostate brachytherapy (PB) for low- and intermediate-risk prostate cancer, using a surgical nomogram.

Methods And Materials: Data of consecutive patients treated with PB from the start of our program in 1998 to February 1, 2005 were extracted from a prospectively maintained database that records patient, tumor, and outcomes information. Prognostic features of each patient and brachytherapist experience were entered into a nomogram of surgical outcomes that incorporates surgeon experience.

Evaluation of neoadjuvant therapy and histopathologic response in primary, high-grade retroperitoneal sarcomas using the sarcoma nomogram.

Background: Patients with primary high-grade retroperitoneal soft tissue sarcomas have a 5-year disease-specific survival (DSS) of <40%. The impact of neoadjuvant therapy on histopathologic response and DSS are unknown.

Methods: From 1987 to 2007, 55 patients with primary high-grade retroperitoneal sarcoma received neoadjuvant therapy.

Allergen-specific IgE as a biomarker of exposure plus sensitization in inner-city adolescents with asthma.

Background: Relationships among allergen-specific IgE levels, allergen exposure and asthma severity are poorly understood since sensitization has previously been evaluated as a dichotomous, rather than continuous characteristic.

Methods: Five hundred and forty-six inner-city adolescents enrolled in the Asthma Control Evaluation study underwent exhaled nitric oxide (FE(NO)) measurement, lung function testing, and completion of a questionnaire. Allergen-specific IgE levels and blood eosinophils were quantified.

Surgery confounds biology: the predictive value of stage-, grade- and prostate-specific antigen for recurrence after radical prostatectomy as a function of surgeon experience.

Statistical models predicting cancer recurrence after surgery are based on biologic variables. We have shown previously that prostate cancer recurrence is related to both tumor biology and to surgical technique. Here, we evaluate the association between several biological predictors and biochemical recurrence across varying surgical experience.

Recent advances in evaluating the prognostic value of a marker.

Predominately, the intended purpose of a new marker is to augment currently available knowledge about a disease process. That is, by combining the marker with existing knowledge, the researcher hopes to obtain a more accurate estimate of a patient's risk for a certain outcome. This estimate is a measure of absolute risk; for example, if the outcome is binary (such as whether or not metastatic disease is present within 5 years after tumor resection surgery), the absolute risk for a given patient would be the estimated probability of the outcome.

Evaluation of peri-operative chemotherapy using a prognostic nomogram for survival after resection of colorectal liver metastases.

Introduction: Nomograms are statistical tools designed to predict outcomes. This study evaluates the effects of peri-operative chemotherapy on the accuracy of a prognostic nomogram for disease-specific survival (DSS) after resection of colorectal liver metastases (CRLM) established at Memorial-Sloan Kettering Cancer Center (MSKCC).

Methods: An external cohort of 203 patients who underwent resection of CRLM between 1996 and 2006 was used to assess the nomogram.

Development and validation of a nomogram for predicting a positive repeat prostate biopsy in patients with a previous negative biopsy session in the era of extended prostate sampling.

Objective: To create a nomogram for predicting the probability of a positive biopsy in men with one or more previous negative biopsies, as the false-negative rate of prostate biopsy in contemporary series remains substantial, and there is a need to identify those with a negative result but with a high risk of having unrecognized prostate cancer.

Patients And Methods: The study included 408 patients from Cleveland Clinic who had one or more repeat biopsies after an initial negative biopsy from 1999 to 2008. Another 470 men with the same criteria were used to validate the nomogram.

Nomogram to predict seminal vesicle invasion using the status of cancer at the base of the prostate on systematic biopsy.

Objective: The aim of this study was to predict seminal vesicle invasion (SVI) by developing a new nomogram based on clinical features including the status of cancer at the base of the prostate on systematic biopsy.

Methods: We studied the 466 patients with T1-3N0M0 prostate cancer who were treated with radical prostatectomy at three institutions. Preoperative clinical variables were correlated with the presence or absence of SVI with an area under the curve (AUC) of receiver-operator characteristics analysis.

Phenotypically directed multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome: a prospective study using UPOINT.

Objectives: Large, controlled trials in chronic pelvic pain syndrome (CPPS) have failed due to patient heterogeneity. To phenotype CPPS patients, we developed the UPOINT system with 6 domains (Urinary, Psychosocial, Organ-Specific, Infection, Neurologic/Systemic and Tenderness). In this study, we treated patients with multimodal therapy based on the UPOINT phenotype and measured response after at least 6 months.

The 'CaP Calculator': an online decision support tool for clinically localized prostate cancer.

Objective: To design a decision-support tool to facilitate evidence-based treatment decisions in clinically localized prostate cancer, as individualized risk assessment and shared decision-making can decrease distress and decisional regret in patients with prostate cancer, but current individual models vary or only predict one outcome of interest.

Methods: We searched Medline for previous reports and identified peer-reviewed articles providing pretreatment predictive models that estimated pathological stage and treatment outcomes in men with biopsy-confirmed, clinical T1-3 prostate cancer. Each model was entered into a spreadsheet to provide calculated estimates of extracapsular extension (ECE), seminal vesicle invasion (SVI), and lymph node involvement (LNI).

Management of prostate cancer in older men: recommendations of a working group of the International Society of Geriatric Oncology.

Prostate cancer is the most prevalent cancer in men and predominantly affects older men (aged >or=70 years). The median age at diagnosis is 68 years; overall, two-thirds of prostate cancer-related deaths occur in men aged >or=75 years. With the exponential ageing of the population and the increasing life-expectancy in developed countries, the burden of prostate cancer is expected to increase dramatically in the future.

Asthma control, adiposity, and adipokines among inner-city adolescents.

Background: There is an association between adiposity and asthma prevalence, but the relationship to asthma control is unclear.

Objectives: We sought to understand the relationships among adiposity, sex, and asthma control in inner-city adolescents with asthma.

Methods: We prospectively followed 368 adolescents with moderate-to-severe asthma (ages 12-20 years) living in 10 urban areas for 1 year.

The risk of overall mortality in patients with type 2 diabetes receiving glipizide, glyburide, or glimepiride monotherapy: a retrospective analysis.

Objective: Sulfonylureas have historically been analyzed as a medication class, which may be inappropriate given the differences in properties inherent to the individual sulfonylureas (hypoglycemic risk, sulfonylurea receptor selectivity, and effects on myocardial ischemic preconditioning). The purpose of this study was to assess the relationship of individual sulfonylureas and the risk of overall mortality in a large cohort of patients with type 2 diabetes.

Research Design And Methods: A retrospective cohort study was conducted using an academic health center enterprise-wide electronic health record (EHR) system to identify 11,141 patients with type 2 diabetes (4,279 initiators of monotherapy with glyburide, 4,325 initiators of monotherapy with glipizide, and 2,537 initiators of monotherapy with glimepiride), >or=18 years of age with and without a history of coronary artery disease (CAD) and not on insulin or a noninsulin injectable at baseline.

Cost effectiveness of 5-alpha reductase inhibitors for the prevention of prostate cancer in multiple patient populations.

Background: Although 5-alpha reductase inhibitors (5ARIs) have demonstrated that they reduce the risk of prostate cancer (PCa), they have not demonstrated cost effectiveness in the patient populations in which they have been examined.

Objective: A decision-analytic model was created to explore economic benefits from a third-party payer perspective of the use of 5ARIs in preventing PCa in men with different risk factors for developing the disease.

Methods: A Markov model was developed to simulate a cohort of men annually through health states (e.

Prenatal maternal stress and cord blood innate and adaptive cytokine responses in an inner-city cohort.

Rationale: Stress-elicited disruption of immunity begins in utero.

Objectives: Associations among prenatal maternal stress and cord blood mononuclear cell (CBMC) cytokine responses were prospectively examined in the Urban Environment and Childhood Asthma Study (n = 557 families).

Methods: Prenatal maternal stress included financial hardship, difficult life circumstances, community violence, and neighborhood/block and housing conditions.

Tailored cancer outcome prediction and informed consent.

Clinically relevant disparities in the outcomes of cancer treatment between institutions are well established. Some authors have argued that physicians have an ethical obligation to disclose these disparities as part of the informed consent process.(1) We believe that preservation of patient autonomy requires disclosure of treatment institution-specific outcomes and that statistical prediction models tailored to individual patients are the best way to frame this discussion.

What is a real nomogram?

The current resurgence in the use of nomograms as diagnostic and prognostic tools has legitimate roots in their effectiveness in facilitating communication between the doctor and patient. By returning to a more classical approach to nomography, graphical insights can further enlighten the patient beyond what can be achieved with current methods, while at the same time simplifying the process. We propose a going-forward extension that addresses the issue of further use of computing technology to continue to enhance understanding.

The learning curve for surgical margins after open radical prostatectomy: implications for margin status as an oncological end point.

Purpose: Surgical margin status is commonly used as an end point for surgical learning. We examined the surgical margin learning curve and investigated whether surgical margins are a good marker for oncological outcome.

Materials And Methods: The study cohort included 7,765 patients with prostate cancer treated with radical prostatectomy by 1 of 72 surgeons at a total of 4 major American academic medical centers.

Differential effects of outdoor versus indoor fungal spores on asthma morbidity in inner-city children.

Background: Although sensitization to fungal allergens is prevalent in inner-city children with asthma, the relationship between fungal exposure and morbidity is poorly understood.

Objective: We examined relationships between fungal sensitization, exposure, and asthma morbidity in inner-city children.

Methods: Participants were 5 to 11 years old and enrolled in the Inner-City Asthma Study.