Elevated alkaline phosphatase velocity strongly predicts overall survival and the risk of bone metastases in castrate-resistant prostate cancer.

Objectives: In patients with a rising prostate-specific antigen (PSA) level during treatment with androgen deprivation therapy, identification of men who progress to bone metastasis and death remains problematic. Accurate risk stratification models are needed to better predict risk for bone metastasis and death among patients with castration-resistant prostate cancer (CRPC). This study evaluates whether alkaline phosphatase (AP) kinetics predicts bone metastasis and death in patients with CRPC.

Health-related quality of life for men with prostate cancer--an evaluation of outcomes 12-24 months after treatment.

Objective: To determine the health-related quality of life (HRQoL) impact of prostate cancer interventions at 2 years post-treatment, and between the 12- and 24-month interval, to better characterize this measure.

Materials And Methods: Patients treated at the Center for Prostate Disease Research between June 2003 and February 2010 were offered enrollment into a HRQoL study that entailed a baseline evaluation before prostate biopsy and at 3, 6, 9, 12, 18, 24, and 30 months thereafter. The instruments used were the Expanded Prostate Cancer Index Composite (EPIC), EPIC Demographic, and Medical Outcomes Study Short-Form 36 (SF-36).

The burden of prostate cancer in Asian nations.

Introduction: In this review, the International Agency for Research on Cancer's cancer epidemiology databases were used to examine prostate cancer (PCa) age-standardized incidence rates (ASIR) in selected Asian nations, including Cancer Incidence in Five Continents (CI5) and GLOBOCAN databases, in an effort to determine whether ASIRs are rising in regions of the world with historically low risk of PCa development.

Materials And Methods: Asian nations with adequate data quality were considered for this review. PCa ASIR estimates from CI5 and GLOBOCAN 2008 public use databases were examined in the four eligible countries: China, Japan, Korea and Singapore.

Clinical potential of the ERG oncoprotein in prostate cancer.

Oncogenic activation of ERG resulting from gene fusion is present in over half of all patients with prostate cancer in Western countries. Although the underlying genetic mechanisms have been extensively studied, evaluation of the ERG oncoprotein--the translational product of ERG gene fusions--has just begun. The robust correlation between ERG oncoprotein detection and gene fusion status enables rapid characterization of this protein in large patient cohorts.

Racial/Ethnic patterns in prostate cancer outcomes in an active surveillance cohort.

Introduction. Concern regarding overtreatment of prostate cancer (CaP) is leading to increased attention on active surveillance (AS). This study examined CaP survivors on AS and compared secondary treatment patterns and overall survival by race/ethnicity.

Low risk prostate cancer in men ≥ 70 years old: to treat or not to treat.

Objectives: Prostate cancer (CaP) in the aging male will become an increasingly important and controversial health care issue. We evaluated the outcomes between a variety of treatments for low-risk CaP in patients 70 years of age and older.

Methods And Materials: A total of 3,650 men diagnosed with CaP between 1989 and 2009 were identified in the Center for Prostate Disease Research database to be 70 years of age or older at time of diagnosis.

Prostate cancer in men less than the age of 50: a comparison of race and outcomes.

Objective: To compare clinicopathologic features and survival outcomes for men 50 years of age in relation to other age groups stratified by race to further define prostate cancer (CaP) in young men. Controversy exists regarding the appropriate age to undergo CaP screening, outcomes for early intervention, and whether there is unique age-associated tumor biology. We compared clinicopathologic features and survival outcomes for men <50 years of age in relation to other age groups stratified by race to further define CaP in young men.

Fusion imaging: a novel staging modality in testis cancer.

Objective: Computed tomography and chest radiographs provide the standard imaging for staging, treatment, and surveillance of testicular germ cell neoplasms. Positron emission tomography has recently been utilized for staging, but is somewhat limited in its ability to provide anatomic localization. Fusion imaging combines the metabolic information provided by positron emission tomography with the anatomic precision of computed tomography.

Long-term overall survival and metastasis-free survival for men with prostate-specific antigen-recurrent prostate cancer after prostatectomy: analysis of the Center for Prostate Disease Research National Database.

Objective: • To describe metastasis-free survival (MFS) and overall survival (OS) among men with prostate-specific antigen (PSA)-recurrent prostate cancer after radical prostatectomy who did not receive additional therapy until metastasis, using a multicentre database capturing a wide ethnic mix.

Patients And Methods: • A retrospective analysis of the Center for Prostate Disease Research National Database (comprised of five US military hospitals and one civilian centre) was performed for patients with PSA relapse (≥ 0.2 ng/mL) after radical prostatectomy who had no additional therapy until the time of radiographic metastatic disease.

Prostate cancer in men 70 years old or older, indolent or aggressive: clinicopathological analysis and outcomes.

Purpose: Currently there is a lack of consensus on screening recommendations for prostate cancer with minimal guidance on the cessation of screening in older men. We defined the clinicopathological features and outcomes for men 70 years old or older who were diagnosed with prostate cancer.

Materials And Methods: The Center for Prostate Disease Research database was queried for all men diagnosed with prostate cancer from 1989 to 2009.

Prostate cancer in Asian Americans: incidence, management and outcomes in an equal access healthcare system.

Unlabelled: Study Type--Therapy (outcomes research) Level of Evidence 2c. What's known on the subject? and What does the study add? While epidemiological studies have shown a significantly lower incidence of adenocarcinoma of the prostate in Asia than the United States, several studies have demonstrated that Asian Americans present with more advanced stages, higher tumour grades, and worse mortality-incidence ratios than Caucasian Americans. This study, conducted in an equal access military healthcare system, reveals improved pathological and survival outcomes in Asian Americans compared to other races.

Assessment of circulating tumor cells (CTCs) in prostate cancer patients with low-volume tumors.

The objective of this study was to assess the incidence of circulating tumor cells (CTCs) in prostate cancer patients with low-volume tumors (less than 0.5 cc) after radical prostatectomy (RP). Blood samples were collected from 64 RP patients to assess the incidence of CTCs following RP.

Venous thromboembolism in urologic surgery: prophylaxis, diagnosis, and treatment.

Venous thromboembolism (VTE) represents one of the most common and potentially devastating complications of urologic surgery. With VTE's rapid onset of symptoms, association with a precipitous clinical course, and high mortality rate, all urologists should be well versed in appropriate prophylaxis, prompt diagnosis, and expeditious treatment. A MEDLINE(R) search was performed for articles that examined the incidence, diagnosis, and treatment of VTE in urologic surgery.

Comprehensive quality-of-life outcomes in the setting of a multidisciplinary, equal access prostate cancer clinic.

Objectives: To identify racial and demographic factors that influence treatment choice and its resulting impact on health-related quality of life (HRQoL) for prostate cancer patients.

Methods: Patients presenting to an equal access, military, multidisciplinary prostate cancer clinic composed the study group. The Expanded Prostate Cancer Index Composite (EPIC), EPIC Demographic, and Medical Outcomes Study Short Form 36 were the instruments used.

Evaluation of the ETS-related gene mRNA in urine for the detection of prostate cancer.

Purpose: Prevalent gene fusions in prostate cancer involve androgen-regulated promoters (primarily TMPRSS2) and ETS transcription factors (predominantly ETS-regulated gene (ERG)], which result in tumor selective overexpression of ERG in two thirds of patients. Because diverse genomic fusion events lead to ERG overexpression in prostate cancer, we reasoned that it may be more practical to capture such alterations using an assay targeting ERG sequences retained in such gene fusions. This study evaluates the potential of an assay quantitating ERG mRNA in post-digital rectal exam (DRE) urine for improving prostate cancer detection.

Clinicopathological behavior of single focus prostate adenocarcinoma.

Purpose: With the increasing use of focal therapy for prostate adenocarcinoma a pathological basis for its appropriate application must be established. We determined the clinicopathological characteristics and natural history of single focus prostate cancer since this entity seems to be the ideal target for focal therapy.

Materials And Methods: We queried the Center for Prostate Disease Research database for all patients who underwent radical prostatectomy at Walter Reed Army Medical Center from 1993 through 2008.

The Center for Prostate Disease Research (CPDR): a multidisciplinary approach to translational research.

This article describes the history, structure, and contributions of the Center for Prostate Disease Research. It divides the organization into the clinical program at Walter Reed Army Medical Center, the basic science program in Rockville, MD, and the multi-center national database. The emphasis of this article is not the achievements of the individual programs but their synergy, establishing a comprehensive multidisciplinary prostate center.

Advances made in the treatment of testicular cancer in the U.S. Military: 1946 to the present.

Testicular cancer is presently one of the most curable solid tumors, and thanks to diagnostic, surgical, and medical advances over the last several decades, the treatment of this tumor serves as a paradigm for multimodal treatment of solid malignancies. Due to testicular cancer's predilection for younger patients, many of the seminal improvements and discoveries were made possible as a result of initial investigatory groundwork laid by military physicians treating servicemen. This article reviews historical contributions of the United States Military Medical Departments in the arena of testicular cancer treatment in the post-World War II era.

PCA3 score before radical prostatectomy predicts extracapsular extension and tumor volume.

Purpose: PCA3 is a prostate specific, nonprotein coding RNA that is over expressed in prostate cancer. Recent studies showed the diagnostic potential of a urine based PCA3 for predicting biopsy outcome. We assessed the relationship between urine PCA3 and pathological features in whole mount radical prostatectomy specimens.

The design and implementation of a multidisciplinary prostate cancer clinic.

The authors describe how a "traditional" clinical center and research organization was transformed into a multidisciplinary clinic for patients with prostate cancer. How and why the clinic was designed and implemented, as well as benefits to patients, staff, and research initiatives, are detailed.

Contemporary intravesical treatment options for urothelial carcinoma of the bladder.

To provide a comprehensive review of intravesical treatment options for non-muscle-invasive bladder cancer, we performed a search of the PubMed database for articles between 1980 and 2006 that reported on intravesical agents for treating this disease. Data were compiled and analyzed, emphasizing findings from large multicenter trials, studies providing reproducible results, data that could be confirmed by cross-referencing the literature, and phase I or II studies for pertinent novel agents. A critical analysis of evidence shows that: 1) treatment with Bacillus Calmette-Guérin (BCG), including a maintenance schedule (with or without interferon-alpha), is the most effective therapy for limiting recurrence, is the only therapy that reduces the incidence of progression, and overall is superior to chemotherapy; 2) mitomycin C, gemcitabine, anthracyclines, and thiotepa provide similar benefits for preventing recurrence in patients with minimal effect on progression; and 3) using chemotherapeutic agents immediately after transurethral resection (when use of BCG is contraindicated because of the risk for systemic absorption) reduces the recurrence rate by up to 50% and seems to be the ideal method of chemotherapy.

Perioperative complications of radical retropubic prostatectomy.

The opinions and assertions contained herein are the private views of the authors and are not to be construed as reflective of the views of the US Army or the Department of Defense. Radical retropubic prostatectomy has long been considered one of the most difficult procedures in the urologist's armamentarium. Therefore, we performed a thorough review of recent literature regarding intraoperative and postoperative complications.