Abstract:The use of biomarkers for prostate cancer (PCa) screening, detection, and prognostication have revolutionized the diagnosis and management of the disease. Current clinical practice has been driven largely by the utilization of prostate-specific antigen (PSA). The lack of specificity of PSA for PCa has led to both unnecessary biopsies and overdiagnosis of indolent cancers. The recent controversial recommendation by the United States Preventive Services Task Force against PCa screening has highlighted the need for novel clinically useful biomarkers. We review the literature on PCa biomarkers in serum, urine, and tissue. While these markers show promise, none seems poised to replace PSA, but rather may augment it. Further validation and consideration of how these novel markers improve clinical outcome is necessary. The discovery of new genetic markers shows promise in stratifying men with aggressive PCa.

BACKGROUND Prostate cancer treatment after failure of primary therapy by either radical prostatectomy or radiation therapy can vary greatly. This study sought to determine trends and predictors of salvage treatment after failure of primary treatment in a community cohort over the past 10 years. METHODS From the community‐based Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) database, 6275 patients were identified who initiated a form of primary treatment for prostate cancer; 839 of these were identified as failing treatment by biochemical recurrence or initiation of secondary treatment between 2000 and 2010. Salvage therapy was categorized as either systemic, local, or none. Patient characteristics were tested for association with salvage therapy using analysis of variance, Pearson chi‐square tests, and multinomial logistic regression analysis. RESULTS Of the 839 patients identified as failing therapy, 390 (47%), 146 (17%), and 303 (36%) received systemic, local, or no salvage therapy, respectively. Type of primary treatment received was associated with type of salvage therapy (P < .01). There has been an increasing trend in the use of local salvage therapy over the past 10 years (P = .04). Primary treatment type and biopsy Gleason score were significantly associated with type of salvage therapy. CONCLUSIONS The use of local salvage therapy has increased over the past decade, whereas the use of systemic salvage therapy has declined. Primary treatment is an important factor in determining which type of salvage therapy a patient will receive. Cancer 2014;120:507–512. © 2013 American Cancer Society.

The surgical management of both early and advanced stage germ cell tumors of the testis remains a complex process of surgical decision making to maximize oncologic control while minimizing morbidity. Over the past 5 decades, the evolution of the surgical template for retroperitoneal lymphadenectomy (RPLND) has resulted in important modifications to achieve these goals. In this review, we will characterize the historical motivating factors that led to the modified template, outline patient and clinical factors in selecting these approaches in both early and advanced stage disease, and briefly discuss future horizons for their implementation.

The purpose of this review is to identify clinical risk factors for prostate cancer and to assess the utility and limitations of our current tools for prostate cancer screening. Prostate-specific antigen is the single most important factor for identifying men at increased risk of prostate cancer but is best assessed in the context of other clinical factors; increasing age, race, and family history are well-established risk factors for the diagnosis of prostate cancer. In addition to clinical risk calculators, novel tools such as multiparametric imaging, serum or urinary biomarkers, and genetic profiling show promise in improving prostate cancer diagnosis and characterization. Optimal use of existing and future tools will help alleviate the problems of overdiagnosis and overtreatment of low-risk prostate cancer without reversing the substantial mortality declines that have been achieved in the screening era.

BackgroundAmong cancer patients, prior antidepressant use has been associated with impaired survival. This could be due to differences in stage at diagnosis, in receipt of treatment, or in treatment complications. The purpose of this study was, therefore, to examine if preadmission antidepressant use in patients with bladder cancer is associated with tumor stage at diagnosis, rate of cystectomy, and surgical outcomes, including survival.MethodsWe performed a registry-based cohort study including all patients with incident invasive bladder cancer in Denmark 2005–2015. Exposure was defined as redemption of two or more antidepressant prescriptions one year before cancer diagnosis. We compared tumor stage using logistic regression, postsurgical inpatient length of stay using linear regression, and other outcomes using Cox regression. All results were adjusted for age, sex, comorbidity, and marital status.ResultsAmong 10,427 bladder cancer patients, 10% were antidepressant users. At diagnosis, 51% of users and 52% of non-users had muscle-invasive disease. However, upon adjustment for age, sex, comorbidity, and marital status, users had lower odds of muscle-invasive disease (adjusted odds ratio 0.86 (95% confidence interval (CI) 0.74–0.99)). Among patients with muscle-invasive disease, fewer users than non-users had surgery within three months (15% vs. 24%, adjusted hazard ratio (aHR) 0.75 (95% CI 0.59–0.95)). Of 2532 patients undergoing surgery, 6% were antidepressant users. Postsurgical inpatient length of stay did not differ between users and non-users. The 30-day cumulative incidence of readmission was higher for users (41% vs. 33%, aHR 1.33 (95% CI 1.05–1.67)), while the 90-day incidence of postoperative procedures was 44% for users and 38% for non-users (aHR 1.18 (95% CI 0.93–1.51)). One-year mortality was comparable in users (15%) and non-users (14%).ConclusionsAntidepressant use in bladder cancer patients was associated with less advanced stage at diagnosis and lower rate of cystectomy. After cystectomy, users had higher rate of readmission and postoperative procedures than non-users, but we found no difference in length of stay or one-year mortality. The results point to the importance of differentiated clinical care according to individual patient characteristics.Electronic supplementary materialThe online version of this article (10.1186/s12885-018-4939-8) contains supplementary material, which is available to authorized users.

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The authors suggest that the size of their sample of consecutive patients is sufficient to overcome this referral bias. It is not clear why this is so. They give little information about the SEER distant cohort and explain the limitations of the different staging systems, but why did they not report the IU cohort staging the same way as SEER? The one point of comparison they report is the ethnicity; 97% IU sample of 704 were white, 87% SEER sample of 1283 were white. The difference is 10% (95% CI 7.8-12.3) and in the USA racial differences seem to be a surrogate for socioeconomic differences which are associated with differences in outcome.The IU team are to be congratulated for their many achievements in germ cell tumour management but in constructing health delivery models to enhance value and improve clinical outcomes a centralisation of services in a way that makes them inaccessible to many patients is to be avoided. It would be inappropriate to use this analysis to make a case for such changes.

Considering the disease status at SCT and response to prior chemotherapy (CT) we divided the pt in the following groups: 1) 64 pt in 1 st complete remission (CR) after 1 CT line, all with IPI!2; 2) 15 pt in 1 st CR after !2 CT lines; 3) 15 pt in 2 nd CR; 4) 19 pt with more advanced diseased. Rituximab (R) was used with CT in 78 pt before SCT. The 1 st line CT most frequently used was: R-CHOP: 71 pt (63%); CHOP: 28 pt (25%). Conditioning regimen was: 93 pt BEAM and 20 pt FEAM. Hematopoietic stem cells were collected from: peripheral blood (PB) in 100, bone marrow (BM) in 2, and PB+BM in 11 pt. The cause of death was: relapse/progression-17 pt; nonrelapsed mortality e 8 pt and secondary neoplasia 1pt. The median follow up of alive pt was 34 months (1-221). Overall survival (OS) at 1, 3 and 5 years was 85%(AE3); 75%(AE4); 73%(AE5). DFS at 1, 3 and 5 years was 84%(AE4); 80%(AE4); 75%(AE5) respectively. There were significant differences in OS between the 4 groups considered e table 2 (p<0.01). In univariate analysis OS was significantly better if: early stage at diagnosis, less than 2 CT lines before SCT, disease status before SCT in CR, first line CT with R-CHOP, PB stem cells. Conclusion: About 70 % of high-risk pt were free of disease after conventional CT followed by SCT. The outcome is influenced by disease status at SCT. Despite our results don't allow direct comparison of the impact of immunoCT with R, our pt in the R group had a better outcome. Most studies with SCT consolidation in these pt were performed in the pre-R era. There is as need to redefine the role of this treatment strategy nowadays. Further knowledge of prognosis factors is necessary, especially in young pt with high-risk disease at 1 st CR, to determine whether the SCT still improves outcome.