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Editor’s Choice : Prostate Cancer Treatment on the Basis of an Individual Risk Profile; Can we Reduce Overtreatment?
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Abstract: Prostate cancer (PCa) is the most prevalent cancer in male population with an incidence rate of 93 per 100.000 men in Europe and is the sixth leading cause of cancer related deaths in men. In the last two decades the incidence of PCa has increased, which is related to widespread prostate-specific antigen (PSA) based screening and increased life expectancy. Mortality rates of prostate cancer have been reduced due to improvement in treatment and/or the widespread screening activities. Major down sides of screening are the potential risks of overdiagnosis and subsequent overtreatment. Approximately 50% of PCa cases detected through screening are potentially overdiagnosed and hence do not require active treatment. However, in clinical practice men with a potentially non-life-threatening cancer (indolent cancer) are often treated actively resulting in unnecessary suffering from serious side effects coinciding with active treatment. The way out of this dilemma is two-fold. First, the actual diagnosis could be delayed or even avoided and second, radical treatment could be delayed or avoided for patients with low-risk PCa. To better predict the presence of a (potentially indolent) prostate cancer nomograms have been developed. These multivariate prediction tools can be of aid in avoiding unnecessary biopsies reducing overdiagnosis, or identifying potentially indolent prostate cancer after diagnosis and hence adapt the treatment strategy. In this expert opinion we discuss the available tools and their performance in reducing the unwanted side effects of prostate cancer screening. In addition, we provide an overview of strategies concerning optimisation and individualisation of treatment, to reduce overtreatment of prostate cancer. Keywords: Prostate cancer, indolent disease, PSA, screening, mortality reduction, overdiagnosis, overtreatment, comorbidity, prediction tool, nomogram, risk calculator.Download Full Article |
Editor’s Choice : Nanoradiopharmaceuticals: Development oF Labeling Process for Polymeric Nanoparticles
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Abstract: Nanomedicine, probably, is the future of modern medicine. Hence, there is a global effort being made in the development of nanopharmaceuticals. Among all the nano-pharmaceuticals developed so far, radiopharmaceuticals are the fewest in number of published studies. The development of nanoradiopharmaceuticals is complex but not impossible. In this work we discuss the possibility and the results of developing 4 nanoradiopharmaceuticals based on 3 different types of nanoparticles as alternative drug delivery systems. Also we present the preliminary results in animals. Keywords: Radiopharmaceuticals, nanomedicine, nanobiotechnology, drug delivery system.Download Full Article |
Editor’s Choice : Cancer Screening Among U.S. Medicaid Enrollees with Chronic Comorbidities or Residing in Long-Term Care Facilities
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Abstract: Background: Ensuring appropriate cancer screenings among low-income persons with chronic conditions and persons residing in long-term care (LTC) facilities presents special challenges. This study examines the impact of having chronic diseases and of LTC residency status on cancer screening among adults enrolled in Medicaid, a joint state-federal government program providing health insurance for certain low-income individuals in the U.S. Methods: We used 2000-2003 Medicaid data for Medicaid-only beneficiaries and merged 2003 Medicare-Medicaid data for dually-eligible beneficiaries from four states to estimate the likelihood of cancer screening tests during a 12-month period. Multivariate regression models assessed the association of chronic conditions and LTC residency status with each type of cancer screening. Results: LTC residency was associated with significant reductions in screening tests for both Medicaid-only and Medicare-Medicaid enrollees; particularly large reductions were observed for receipt of mammograms. Enrollees with multiple chronic comorbidities were more likely to receive colorectal and prostate cancer screenings and less likely to receive Papanicolaou (Pap) tests than were those without chronic conditions. Conclusions: LTC residents have substantial risks of not receiving cancer screening tests. Not performing appropriate screenings may increase the risk of delayed/missed diagnoses and could increase disparities; however, it is also important to consider recommendations to appropriately discontinue screening and decrease the risk of overdiagnosis. Although anecdotal reports suggest that patients with serious comorbidities may not receive regular cancer screening, we found that having chronic conditions increases the likelihood of certain screening tests. More work is needed to better understand these issues and to facilitate referrals for appropriate cancer screenings. Keywords: Neoplasms, Medicaid, Mass Screening, Healthcare Disparities, Nursing Homes.Download Full Article |
Editor’s Choice : Clinical and Biochemical Outcomes of High-Risk Prostate Cancer Patients treated with Third Generation Prostate Cryosurgery
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Abstract: Objectives: To report on outcomes after modern-day primary prostate cryosurgery (CS) in D’Amico high-risk (PSA >20 ng/ml, Gleason score ≥8, or tumor stage T2c or T3) localised prostate cancer (PCa) patients treated at a large academic center. Materials and Methods: 730 consecutive cases of total gland prostate CS were reviewed, and 80 men with high-risk disease identified. Clinical data was analyzed, with primary and secondary endpoints being overall survival, cancer-specific survival, biochemical recurrence (BCR), and clinical progression. Results: Median age was 75.8 (55.4-88.1) years, median presenting PSA 20.0 (2.6-236.5) ng/ml, and median Gleason score 8 (6-10). Median follow-up was 49.6 (8.9-159.3) months. There were three PCa related deaths (4%); 34 (43%) and 39 (49%) men had BCR as defined by the Phoenix- and Stuttgart-criteria, respectively; 24 of the 39 (64%) men were re-biopsied. 13 of 80 (16%) had biopsy proven recurrent PCa. Nine (11%) subsequently underwent salvage CS. Six of the 39 (15%) men with BCR had metastatic disease on bone scan; 19 of 34 (49%) men with BCR received anti-androgen therapy, 18 (95%) of whom had also received neoadjuvant hormonal therapy. Conclusions: Prostate CS is a controversial treatment for high-risk patients, and our early experience revealed low cancer-specific mortality and morbidity, with encouraging biochemical and local control rates for these high-risk patients. In our series the incidence of metastases was less than that reported by Bolla et al. post-EBRT and hormones, and we therefore believe that prostate CS be strongly considered for these high-risk patients, and mandate that further study of CS for high-risk disease is warranted. Keywords: Prostate cancer, high-risk, cryosurgery, biochemical recurrence, overall survival, cancer-specific survival.Download Full Article |
