News
July 18, 2008
Computerized Tomography Findings In Pediatric Renal Trauma - Indications For Early Intervention?
UroToday.com - The study out of Children's Hospital of Pittsburgh evaluated CT scans for blunt renal
trauma to see if they correlated with the need for operative intervention when urinary extravasation was present.
A total of 17 patients with grade IV blunt renal trauma and urinary extravasation were identified between 2000
and 2007. Each CT scan was reviewed to determine location, size and number of sites of extravasation, as well
as the presence of contrast material in the ipsilateral ureter. These were then compared to the findings at
the time of surgery - whether surgey included stent placement, percutaneous urinoma drainage, angiographic
embolization and nephrectomy.
Read entire article here.
July 15, 2008
Increased Risk Of Kidney Stone Disease Due To Global Warming, Predicts UT Southwestern Researchers
Global warming is likely to increase the proportion of the population affected by kidney stones by expanding the higher-risk
region known as the "kidney-stone belt" into neighboring states, researchers at UT Southwestern Medical Center and UT Dallas have found.
Dehydration is one of the risk factors linked to kidney-stone disease, and the paper suggests global warming will exacerbate this
effect. The researchers predict that by 2050, higher temperatures will cause an additional 1.6 million to 2.2 million kidney-stone
cases, representing up to a 30 percent growth in some areas.
Read entire article here.
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Information
Prostate cancer is the second leading cause of death
among men. In 2002 it is estimated that 30,200 men will die from prostate
cancer and 189,000 men will be diagnosed (American Cancer Society Facts
& Figures 2002). The incidence of prostate cancer increases with age with
75% of all prostate cancers being diagnosed in men over the age of 65.
Prostate Cancer Management
The critical focus for the treatment of prostate cancer is to treat those cancers
where it is necessary, and not to treat those that do not need it.
Decisions
about the best management of prostate cancer can be complex and depend upon the:
- Pathology of the cancer (unlike other cancers, prostate cancer often progresses very slowly)
- Stage of the disease (non-metastatic (localized or locally advanced), metastatic or hormone refractory)
- Age and general health of the patients at diagnosis
- The impact that treatment can have on quality of life, including sexual activity.
- Patient's preference for treatment
- PSA at diagnosis
Please visit the National Prostate Cancer Coalition for more information.
August is National Immunization Awareness Month
Vaccine-preventable disease levels are at or near record lows. However, we cannot take high immunization coverage
levels for granted. To continue to protect America's children and adults, we must obtain maximum immunization coverage
in all populations, establish effective partnerships, conduct reliable scientific research, implement immunization
systems, and ensure vaccine safety.
Read more ....
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Defining the Risk of Recurrence in Prostate Cancer
The Urology Clinic is committed to the fight against prostate cancer. As part
of that commitment, we are continually providing educational materials that facilitate
discussions between you and your patients about treatment. The following information
examines the rates of disease recurrence associated with current treatment standards
for prostate cancer. We believe this information may be helpful to you when discussing
treatment options with our patients. If our patients understand the risk of disease
recurrence following definitive therapy, they may be better prepared to meet the
challenges ahead.
Prostate Cancer Recurrence Rates
Prostate cancer is now detected at earlier stages due to heightened awareness
and improved screening techniques. Despite definitive therapy, cancer cells may
remain and can go undetected for years until they develop into metastatic disease.
The risk of recurrence is high, suggesting there is a need to improve treatment
approaches. Therefore, it is important to predict pathological stage and risk of
disease recurrence early, so that appropriate treatment and/or monitoring can be
initiated.
- Approximately one decade ago, the 10-year clinical recurrence rates in a
majority of T1-T2 (N0, M0) patients following radical prostatectomy (RP) and
radiotherapy (RT) were reported to be 28% and 33%, respectively.1,2
- More recently, the 5-year clinical recurrence rates following RP and RT were
reported to be up to 7% and 24%, respectively.3
- The 10-year clinical recurrence rates following RP and RT were reported to
be up to 31% and 44%, respectively.3
Evaluating the Utility of Prognosticators in Prostate Cancer
There are several prognostic tools available to assist you in predicting pathological
stage and/or risk of recurrence following definitive therapy. Below is information
about several of the published tools in a chart format to help you evaluate their
utility.
| Definitive Therapy |
Prognostic Tool/Nomogram |
Design |
Limitations |
| Radical prostatectomy |
Partin
Predictor variables:preoperative PSA, TNM clinical
stage, biopsy Gleason score
Predicted outcome:pathological stage4
|
Patient number:5079 (T1c-T2c,60%T1c) 4
Recently updated to include more patients4
No neoadjuvant hormonal therapy 4
|
Single-institution study 4
Limited African-American population (6%) 4
|
| Radical prostatectomy |
Kattan
Predictor variables:preoperative PSA, specimen Gleason
score,capsular invasion,surgical margin status,seminal vesicle invasion,lymph
node status 5
Predicted outcome:7-year disease recurrence 5
|
Patient number:996 (T1a-T3c, NX,M0,majority of patients
T2) 5 |
Single-institution study 5
All Caucasian population 5
|
| Radical prostatectomy |
Center for Prostate Disease Research (CPDR)
Predictor variables:age, race, prostatic acid phosphatase,
nuclear grade, preoperative PSA, pathological stage, postoperative Gleason
score 6
Predicted outcome:relative risk of recurrence
6
|
Patient number:378 (only 162 pathologically confined
to the prostate) 6
31.8%African-American patients 6
|
Single-institution study 6
No clinical staging 6
|
| External beam radiation therapy (3D conformal) |
Kattan
Predictor variables:clinical stage, biopsy Gleason
score,pretreatment PSA,radiation dose,administration of neoadjuvant
hormonal therapy 7
Predicted outcome:5-year biochemical risk of recurrence
7
|
Patient number:1042 (T1c –T3c, NX,M0,majority of patients
T2) 7
62.9% did not receive neoadjuvant hormonal therapy
7
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Single-institution study 7
Limited African-American population 7
|
| Brachytherapy |
Kattan
Predictor variables:pretreatment PSA, clinical stage,biopsy
Gleason score, adjuvant external beam radiotherapy 8
Predicted outcome:5-year biochemical risk of recurrence
without neoadjuvant hormonal therapy 8
|
Patient number:920 (T1c –T2b, majority of patients
T1c) 8
18% received external beam adjuvant radiation therapy
8
|
Single-institution study 8 |
References:
- Paulson DF, Moul JW, Walther PJ. Radical prostatectomy for
clinical Stage T1-2N0M0 prostatic adenocarcinoma:long-term results. J Urol.
1990;144:1180-1184.
- Hanks GE, Asbell S, Krall JM, et al. Outcome for lymph node
dissection negative T-1b,T-2 (A-2,B) prostate cancer treated with external beam
radiation therapy in RTOG 77-06. Int J Radiat Oncol Biol Phys. 1991;21:1099-1103.
- Walsh PC, Retik AB, Vaughan ED, eds. Campbell 's Urology.
7th ed. Philadelphia, Pa: WB Saunders Company; 1998.
- Partin AW, Mangold LA, Lamm DM, et al. Contemporary update
of prostate cancer staging nomograms (Partin tables) for the new millennium.
Urology. 2001;58:843-848.
- Kattan MW, Wheeler TM, Scardino PT. Postoperative nomogram
for disease recurrence after radical prostatectomy for prostate cancer.
J Clin Oncol.1999;17:1499-1507.
- Bauer JJ, Connelly RR, Seterhenn IA, et al. Biostatistical
modeling using traditional preoperative and pathological prognostic variables
in the selection of men at high risk for disease recurrence after radical prostatectomy
for prostate cancer. J Urol. 1998;159:929-933.
- Kattan MW, Zelefsky MJ, Kupelian PA, et al. Pretreatment nomogram
for predicting the outcome of three-dimensional conformal radiotherapy in prostate
cancer. J Clin Oncol. 2000;18:3352-3359.
- Kattan MW, Potters L, Blasko JC, et al. Pretreatment nomogram
for predicting freedom from recurrence after permanent prostate brachytherapy
in prostate cancer. Urology. 2001;58:393-399.
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