Problem-solving skills training in adult cancer survivors: Bright IDEAS-AC pilot study

PURPOSE

Cancer patients experience significant distress and burden of decision-making throughout treatment and beyond. These stressors can interfere with their ability to make reasoned and timely decisions about their care and lead to low physical and social functioning and poor survival. This pilot study examined the impact of offering Problem-Solving Skills Training (PSST) to adult cancer survivors to help them and their caregivers cope more successfully with post-treatment decision-making burden and distress.

PATIENTS AND METHODS

Fifty patients who completed their definitive treatment for colorectal, breast or prostate cancer within the last 6 months and reported distress (level > 2 on the National Comprehensive Cancer Network distress thermometer) were randomly assigned to either care as usual (CAU) or 8 weekly PSST sessions. Patients were invited to include a supportive other (n = 17). Patient and caregiver assessments at baseline (T1), end of intervention or 3 months (T2), and at 6 months (T3) focused on problem-solving skills, anxiety/depression, quality of life and healthcare utilization. We compared outcomes by study arm and interviewed participants about PSST burden and skill maintenance.

RESULTS

Trial participation rate was 60%; 76% of the participants successfully completed PSST training. PSST patients reported reduction in anxiety/depression, improvement in QoL (p < 0.05) and lower use of hospital and emergency department services compared to CAU patients (p = 0.04).

CONCLUSIONS

The evidence from this pilot study indicates that a remotely delivered PSST is a feasible and potentially effective strategy to improve mood and self-management in cancer survivors in community oncology settings.

Problem-solving skills training in adult cancer survivors: Bright IDEAS-AC

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Background: Cancer patients experience significant distress throughout treatment and especially during transition back to normal life with greater burden on socially disadvantaged patients and those with medical comorbidities. Patient stressors can interfere with their ability to make reasoned and timely decisions about survivorship care and lead to poor quality of life and low physical and social functioning. This pilot effectiveness-implementation study examined the impact and feasibility of offering the Bright IDEAS system of Problem-Solving Skills Training (PSST) to adult cancer survivors to help them and their caregivers cope more successfully with decision making and distress. Methods: Patients with breast (21), prostate (9) or colorectal (20) cancer who completed their definitive cancer treatment within the last 6 months and had their cancer survivorship visit were recruited from two regional cancer centers and affiliated community oncology clinics. Patients with an NCCN distress level > 2 were randomly assigned to either care as usual (CAU) or 8 weekly PSST sessions provided by a trained therapist in person or remotely. Patients were invited but not required to include a supportive other (n = 17). Patient and caregiver assessments at baseline (T1), end of intervention/3 months (T2), and 3 months post intervention/6 months (T3) focused on problem-solving skills (SPSI-25), distress (HADS) and quality of life (FACT). We also collected healthcare utilization data. We compared outcome changes T1-T2 and T1-T3, by study arm, using t-tests. Multivariate regression analysis identified subgroups of patients with positive and negative responses to skills training. Results: Average age of the participants was 63 years (45 to 87) with racial and ethnic distributions representative of the local population (88% white). Two thirds were women (n = 32), one third of the patients were recruited and received therapy fully remotely due to COVID-19-related protocol changes. Patients who received PSST reported a reduction in dysfunctional problem-solving style and improvement in constructive style while problem-solving skills of CAU patients trended in the opposite direction. Patients in the PSST arm also reported significant reduction in anxiety and depression and improvement in cancer-specific quality of life (p < 0.05) that was sustained at 6 months. Patients in the PSST arm reported lower use of hospital and ED services compared to CAU patients (p = 0.07). Better improvement in outcomes was driven by lower problem-solving skills at baseline. Conclusions: Despite the logistical complexity of running a clinical trial during quarantine, patients and caregivers in the PSST arm demonstrated meaningful improvement in distress and quality of life. The evidence from this pilot study will help guide development of a future multi-site randomized clinical trial of the effect of PSST on cancer survivorship care and outcomes. Clinical trial information: NCT03567850.

Feasibility of fully remote administration of problem-solving skills training (PSST) to adult cancer survivors in community settings

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Background: Cancer survivors experience significant stress throughout cancer treatment and especially during transition back to normal life. These stressors are particularly severe for rural or socially disadvantaged patients with limited access to care. Improving their problem-solving skills is known to help patients make reasoned and timely decisions about survivorship care that reduce stress and enhance quality of life, physical and social functioning, and overall cancer prognosis. This pilot implementation study examined barriers to and facilitators of providing Problem-Solving Skills Training (PSST) to adult cancer survivors and their caregivers in community settings. Methods: Patients (n = 50) who completed their definitive cancer treatment and cancer survivorship visit within the previous 6 months were recruited from two regional cancer centers and affiliated community cancer clinics. Patients with NCCN distress level >2 were randomly assigned to either care as usual (CAU) or 8 weekly PSST sessions using the Bright IDEAS system of teaching problem solving. Training was offered by a trained therapist in person at the patient’s preferred location or remotely. Patients were invited but not required to include a supportive other (SO). Patient outcomes were assessed at baseline (T1), the end of the intervention/3 months (T2), and 3 months post intervention/6 months (T3). We examined patient and caregiver preferences for mode of communication and therapy, barriers to PSST participation, and adherence rates. An independent consultant interviewed patients and caregivers about factors that promote or inhibit intervention sustainability and its wider adaptation and usefulness. Results: Average age of the participants was 63 years (45-87) with gender, racial and ethnic distributions representative of the local population (64% women, 88% white). Women were 80% less likely to include a SO than men. Among the third of the patients recruited fully remotely, 50% preferred receiving consent materials via regular mail and 18% preferred electronic communication. Among the two patients lost to follow-up before PSST completion and one patient who withdrew despite reporting significant distress, none had a SO in the study. Seventy-six percent of the PSST patients completed the training (defined as > 6 sessions). After study completion, all patients and caregivers reported high satisfaction with Bright IDEAS and high probability of continuing to use the skills learned. Conclusions: Despite significant distress and numerous reported social challenges, patients and caregivers in the PSST arm demonstrated high adherence, skill retention and overall satisfaction. Future research should be tailored to accommodate the preferred type of communication and recruitment approaches of the targeted population and emphasize the positive role of informal caregivers. Clinical trial information: NCT03567850.

Application of IRIS Three-Dimensional Anatomical Models As Preoperative Surgical Planning Tools in the Management of Localized Renal Masses

Introduction: The use of volume-rendered images is gaining popularity in the surgical planning for complex procedures. IRIS™ is an interactive software that delivers three-dimensional (3D) virtual anatomical models. We aimed to evaluate the preoperative clinical utility of IRIS for patients with ≤T2 localized renal tumors who underwent either partial nephrectomy (PN) or radical nephrectomy (RN). Patients and Methods: Six urologists (four faculty and two trainees) reviewed CT scans of 40 cases over 2 study phases, using conventional two-dimensional (2D) CT alone (Phase-I), followed by the CT + IRIS 3D model (Phase-II). After each review, surgeons reported their decision on performing a PN or an RN and rated (Likert scale) their confidence in completing the procedure as well as how the imaging modality influenced specific procedural decisions. Modifications to the choice of procedure and confidence in decisions between both phases were compared for the same surgeon. Concordance between surgeons was also evaluated. Results: A total of 462 reviews were included in the analysis (231 in each phase). In 64% (95% CI: 58-70%) of reviews, surgeons reported that IRIS achieved a better spatial orientation, understanding of the anatomy, and offered additional information compared with 2D CT alone. IRIS impacted the planned procedure in 20% of the reviews (3.5% changed decision from PN to RN and 16.5% changed from RN to PN). In the remaining 80% of reviews, surgeons' confidence increased from 78% (95% CI: 72-84%) with 2D CT, to 87% (95% CI: 82-92%) with IRIS (p = 0.02); this confidence change was more pronounced in cases with a high RENAL score (p = 0.009). In 99% of the reviews, surgeons rated that the IRIS accurately represented the anatomical details of all kidney components. Conclusion: Application of IRIS 3D models could influence the surgical decision-making process and improve surgeons' confidence, especially for robot-assisted management of complex renal tumors.

Clinical Proof-of-concept of a Novel Platform Utilizing Biopsy-derived Live Single Cells, Phenotypic Biomarkers, and Machine Learning Toward a Precision Risk Stratification Test for Prostate Cancer Grade Groups 1 and 2 (Gleason 3 + 3 and 3 + 4)

OBJECTIVE

To examine the ability of a novel live primary-cell phenotypic (LPCP) test to predict postsurgical adverse pathology (P-SAP) features and risk stratify patients based on SAP features in a blinded study utilizing radical prostatectomy (RP) surgical specimens.

METHODS

Two hundred fifty-one men undergoing RP were enrolled in a prospective, multicenter (10), and proof-of-concept study in the United States. Fresh prostate samples were taken from known areas of cancer in the operating room immediately after RP. Samples were shipped and tested at a central laboratory. Utilizing the LPCP test, a suite of phenotypic biomarkers was analyzed and quantified using objective machine vision software. Biomarkers were objectively ranked via machine learning-derived statistical algorithms (MLDSA) to predict postsurgical adverse pathological features. Sensitivity and specificity were determined by comparing blinded predictions and unblinded RP surgical pathology reports, training MLDSAs on 70% of biopsy cells and testing MLDSAs on the remaining 30% of biopsy cells across the tested patient population.

RESULTS

The LPCP test predicted adverse pathologies post-RP with area under the curve (AUC) via receiver operating characteristics analysis of greater than 0.80 and distinguished between Prostate Cancer Grade Groups 1, 2, and 3/Gleason Scores 3 + 3, 3 + 4, and 4 + 3. Further, LPCP derived-biomarker scores predicted Gleason pattern, stage, and adverse pathology with high precision-AUCs>0.80.

CONCLUSION

Using MLDSA-derived phenotypic biomarker scores, the LPCP test successfully risk stratified Prostate Cancer Grade Groups 1, 2, and 3 (Gleason 3 + 3 and 7) into distinct subgroups predicted to have surgical adverse pathologies or not with high performance (>0.85 AUC).

Quality Improvement in Cystectomy Care with Enhanced Recovery (QUICCER) study

OBJECTIVES

To determine if patients managed with a cystectomy enhanced recovery pathway (CERP) have improved quality of care after radical cystectomy (RC), as defined by a decrease in length of hospital stay (LOS) without an increase in complications or readmissions compared with those not managed with CERP.

SUBJECTS AND METHODS

The Quality Improvement in Cystectomy Care with Enhanced Recovery (QUICCER) study was a non-randomized quasi-experimental study. Data were collected between June 2011 and April 2015. The CERP was implemented in July 2013. The primary endpoint was LOS. Secondary endpoints were quality scores, complications and readmissions. Multivariable regression was performed. Propensity score matching was carried out to further simulate randomized clinical trial conditions. A CERP quality composite score was created and evaluated with regard to adherence to CERP elements.

RESULTS

The study included 79 patients managed with CERP and 121 who were not managed with CERP. After matching, there were 75 patients in the non-CERP group. The LOS was significantly different between the groups: the median LOS was 5 and 8 days for the CERP and non-CERP group, respectively (P < 0.001). Multivariable linear regression showed that any complication was the most significant predictor of total LOS at 90 days after RC. The higher the quality composite score the shorter the LOS (P < 0.001). There was no association between CERP and a greater number of complications or readmissions.

CONCLUSIONS

Audited quality measures in the CERP are associated with a reduction in LOS with no increase in readmissions or complications. The CERP is important for the future improvement of peri-operative care for RC and provides an opportunity to improve the quality of care provided.

A live cell microfluidics device utilizing phenotypic biomarkers for prostate cancer

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Background: A novel tissue based biomarker panel is introduced to objectively assess disease aggressiveness and invasive potential of Prostate Cancer (CaP). The biomarker diagnostic platform incorporates both molecular and phenotypic data that may allow an improved understanding of local growth and metastatic potential. The tissue based diagnostic incorporates matrix biology, phenotypic biomarkers, microfluidics, and machine vision. This technology presents the opportunity to culture samples, and both determine and automate biomarker measurements from machine vision algorithm analysis. Data are presented towards clinical validation, the ability to risk stratify, and prediction of local aggressiveness and metastasis. Methods: Conditions were optimized for reliably culturing primary cancer cells in vitro by simulating in vivo conditions on an extracellular matrix formulation. A mcirofluidics device was used to culture live tumor samples ex vivo enabling automated imaging of the label free and label-based biomarkers. Results: The validation study was IRB approved and performed in 200 consecutive CaP radical prostatectomy derived specimens collected between 03/2014 and 09/2015. Data was analyzed with receiver operating characteristics (ROC) generated Area-under-the-Curve (AUC) and specifically included capsular penetration, seminal vesicle invasion, as well as margin-positive disease. AUC Graphs are presented. The study further demonstrated that a normal set of phenotypic biomarkers can produce secondary metrics termed oncogenic potential (OP) and metastatic potential (MP). Concordance analysis supports that OP and MP are integral for distinguishing between benign histology and malignancy, predicting both stage and adverse pathology such as extra-prostatic extension (EPE) and lympho-vascular invasion (LVI). The study results demonstrate AUCs greater than 0.90 in predicting EPE and LVI. Conclusions: Results support the clinical validation of a novel live- cell phenotypic in vitro tumor diagnostic test. This test has the potential to predict adverse pathologies for CaP and may have extended clinical applications to optimize staging and risk stratification.

Abstract 4347: A novel live cell diagnostic platform measuring phenotypic biomarkers using objective algorithmic analysis enables further risk stratification for intermediate-risk prostate cancer patients

Due to the inconsistencies of existing molecular, genomic, and pathophysiologic markers for patient risk stratification, effective prostate cancer diagnostics and treatment remains a challenge in clinical practice. Therefore, the development of a diagnostic platform that differentiates cancer patients who have clinically significant disease from those who have a low risk of progression is an important area of interest. In this study, we tested a diagnostic platform that combines a scalable microfluidic device, an automated live cell assay, and objective machine vision algorithms to measure phenotypic biomarkers [defined here as functional biophysical and molecular biomarkers], which evaluate both local growth and metastatic potential of prostate cancer.

An analytical validation study was performed on fresh prostate cancer samples (n = 100) obtained at the time of radical prostatectomy (RP). The diagnostic platform enables: 1) growth of patient cells ex vivo on extra cellular matrix formulations supporting adhesion/survival for 72 hours 2) high-throughput imaging of multiple phenotypic biomarkers such as morphology, cytoskeleton dynamics, and protein subcellular localization & modification states and 3) objective quantification of biomarkers via machine vision analysis. Patient samples were imaged over a three hour period capturing live-cell biophysical biomarkers. After three hours cells were fixed and stained for molecular biomarkers. Machine vision technology was then utilized to analyze phenotypic biomarkers to yield specific metrics that quantified local tumor growth (Oncogenic Potential-OPs) and invasive potential of the tumor to other tissues (Metastatic Potential- MPs) that correlated with RP specimen pathologic findings.

Analysis of quantified phenotypic biomarkers distinguished normal cells from cancer cells. The OP and MP metrics demonstrated statistical significance in distinguishing Gleason 6 (low-risk) from Gleason 7 (intermediate-risk) prostate cancer with 80% sensitivity and 80% specificity and concordance with relevant RP pathology findings.

Specifically, OP and MP derived from defined phenotypic biomarker metrics, demonstrated the ability to differentiate Gleason 6 and 7 scores and correlated with, 1) seminal vesicle invasion, 2) positive RP surgical margins, 3) vascular invasion, and 4) lymph node involvement. This novel functional-live-cell diagnostic platform allows for the measurement of a biomarker panel that further stratifies patients to improve prostate cancer treatment, clinical decision-making, further risk stratification of intermediate prostate cancer populations, and potentially predict actionable pathological findings leading to improved treatment outcomes for prostate cancer patients.

Citation Format: Michael S. Manak, Wendell R. Su, Andrew Min, Brad J. Hogan, Matthew J. Whitfield, Jonathan S. Varsanik, Delaney Berger, Mani Foroohar, Kimberly M. Rieger-Christ, Travis B. Sullivan, Naveen Kella, Ray Hernandez, Vladimir Mouraviev, Kevin B. Knopf, Hani H. Rashid, David M. Albala, Grannum R. Sant, Ashok C. Chander. A novel live cell diagnostic platform measuring phenotypic biomarkers using objective algorithmic analysis enables further risk stratification for intermediate-risk prostate cancer patients. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 4347. doi:10.1158/1538-7445.AM2015-4347

Novel live tumor cell diagnostic test utilizing biophysical and molecular biomarkers to assess local, advanced, and metastatic prostate cancer

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Background: Over-treatment of prostate cancer affects 144,000 patients annually in the U.S. due to the inaccuracy of current diagnostics for risk stratification. Functional molecular and biophysical biomarkers combined with clinically actionable diagnostic platforms are used for evaluating the local invasiveness and metastatic potential of cells derived from biopsy. Such a diagnostic test may improve patient outcomes in low-to high-risk prostate cancers according to D’Amico’s definition. This study describes the development of a novel phenotypic diagnostic using a set of biomarkers measured with a proprietary live cell assay coupled with innovative machine vision algorithms for patient tumor samples using a unique microfluidic platform. Methods: We assessed 60 prostate cancer samples collected post radical prostatectomy (RP). We report the assay details for culturing live tumor cells ex vivo, enabling automated imaging of phenotypic biomarkers. The test is designed to sustain survival of prostate tumor cells from fresh biopsy/surgical samples for up to three days prior to analysis of phenotypic characteristics. Results: We show that this test distinguishes live normal and tumor cells via molecular and biophysical biomarkers. The primary biomarkers are calculated using objective machine vision algorithms and are used to derive secondary metrics termed “Metastatic Potential (MP) and Oncogenic Potential (OP)”. In comparing clinical measures with results of this test, concordance analysis show that OP and MP are statistically significant in distinguishing between Gleason 6 and Gleason 7 with 85% sensitivity and 80% specificity. Conclusions: This phenotypic diagnostic generates scoring metrics of MP and OP that correlate with 1) aggressive vs. indolent Gleason 6, 2) seminal vesicle invasion, 3) occurrence of margins after RP, 4) lymph node invasion and 5) systemic metastatic process. These results will further help stratify patient tumors to improve clinical decision-making in low to intermediate- and high-risk prostate cancer populations, and potentially avoid unnecessary surgery or radiation, ultimately leading to improved patient quality of life.

Prostate cancer disease-free survival after radical retropubic prostatectomy in patients older than 70 years compared to younger cohorts

OBJECTIVES

To evaluate the feasibility of radical retropubic prostatectomy (RRP) as an option for treating men older than 70 years with organ confined prostate cancer and to compare biochemical progression-free survival with younger cohorts.

MATERIALS AND METHODS

A total of 689 consecutive patients who were treated with RRP from 1994 to 2002 for clinically localized prostate cancer were categorized into 3 different age groups: younger than 50 years (n = 49), 50-70 years (n = 601), and older than 70 years (n = 39). Patients older than 70 years were healthy individuals for their age. Preoperative and postoperative cancer-specific characteristics were compared among these 3 groups.

RESULTS

There was no statistical significant difference among the 3 age strata in terms of clinical parameters (prostate-specific antigen, Gleason score, clinical stage, percent and number of positive biopsy cores) and pathologic findings (surgical margin, lymph node status, extracapsular extension, lymphovascular invasion, and pathologic Gleason score). The rate of seminal vesicle invasion and prostate volume increased with advancing age (P = 0.034 and P < 0.001). In multivariate logistic regression analysis, age was not associated with seminal vesicle invasion. The 5-year prostate-specific antigen progression-free estimates for patients younger than 50, 50-70, and older than 70 years were 82% (95% confidence interval [CI] 69% to 96%), 82% (95% CI 78% to 86%), and 65% (95% CI 43% to 86%), respectively (P = 0.349). The overall and cause-specific mortalities were not different.

CONCLUSIONS

RRP could be considered a standard treatment option in men older than 70 years with localized prostate cancer. Further studies are necessary to assess the survival benefit and health-related quality of life after radical prostatectomy versus watchful waiting in patients older than 70 years.

The Virtual Reality Transurethral Prostatic Resection Trainer: Evaluation of Discriminate Validity

PURPOSE

To understand how urologists acquire resection skills we analyzed factors correlating with favorable resection metrics in groups defined as experts, residents and novices. We then evaluated discriminate validity by determining factors correlating with proficiency among individuals in the expert, resident and novice groups.

MATERIALS AND METHODS

A total of 136 subjects completed the protocol, including 72 urologists, 45 residents and 19 novices. After a pre-task questionnaire and training video subjects performed a standardized 5-minute resection task. Primary metrics were gm resected, blood loss, irrigant volume used, foot pedal use and differential time spent with orientation, cutting or coagulation.

RESULTS

Among experts larger resection correlated with more time spent cutting (p <0.001). In contrast, increased coagulation time correlated with gm resected in the novice group (p = 0.001). The number of transurethral prostate resections that residents reported having done in the real operating room correlated with gm resected (p = 0.043), use of more irrigating fluid (p = 0.024) and less time spent coagulating (p = 0.027) on the simulator. In residents and experts exclusively primary resection efficiency metrics, fluid use and blood loss correlated with cuts at tissue and correlated inversely with coagulation and orientation time (p <0.05).

CONCLUSIONS

Different factors determine transurethral prostate resection performance metrics among experts, residents and novices. These correlations reinforce discriminate validity and provide insight into specific factors that likely determine success at different training levels. Such data could be used to isolate and train skill subsets in the curriculum and they may elucidate the safest and most efficient approach to train resection skills.

Bladder cancer: toward state of the art multidisciplinary molecular medicine

Recent advances in bladder cancer research, and clinical diagnosis and therapy are explored. Major advances in biologic understanding are applied toward better early diagnosis and staging. Using molecular medicine to help informed clinical trial design and implementation will lead to more effective therapeutic intervention in transitional cell carcinoma. Interdisciplinary care and multimodal approach will allow better outcomes, stage for stage and grade for grade. The challenge is for clinician-scientists to integrate basic and translational advances efficiently and rapidly into the clinic, recognizing the value of a multifaceted paradigm.

Robotic surgical education: A systematic approach to training urology residents to perform robotic-assisted laparoscopic radical prostatectomy

OBJECTIVES

Robotic-assisted surgery using the da Vinci Surgical System is gaining popularity among urologists. However, training residents to use this system presents new challenges for surgical educators. We describe a method for training residents to perform robotic-assisted radical prostatectomy.

METHODS

Residents first received da Vinci certification training followed by table-side assistance with a second attending urologist present to provide real-time instruction. After demonstrating proficiency with assistance, residents performed segments of robotic prostatectomies as the console surgeon. The procedure was divided into five steps: (a) bladder take-down, (b) endopelvic fascia and dorsal venous complex, (c) bladder neck and posterior dissection, (d) neurovascular bundles, and (e) urethral anastomosis. Performance was rated using an analog scale (0, very poor to 5, outstanding). The resident was allowed to proceed to the next step once proficiency (score greater than 3 of 5) had been demonstrated on three separate occasions. In addition, each procedure was digitally recorded and reviewed with the attending physician after the operation.

RESULTS

Two chief residents underwent this training regimen. All 83 cases with surgical console involvement during a 7-month period were reviewed. The combined residents' mean operative time in minutes and overall performance (score 0 of 5 to 5 of 5) for each step were recorded. Using logistic regression analysis, a statistically significant trend was seen, with faster operative times and greater analog scores over time for both residents (P <0.005).

CONCLUSIONS

A systematic approach can be used to safely and effectively train urology residents to perform robotic radical prostatectomy using the da Vinci robotic system.

Testicular microlithiasis: a review and its association with testicular cancer

Testicular microlithiasis (TM) is an entity of unknown etiology that results in the formation of intratubular calcifications. It is of concern to the urologist because of its possible association with intratubular germ cell neoplasia and testicular germ cell cancer. Although commonly present in patients with germ cell tumors, there appears to be no definitive association with TM and cancer. Therefore, follow-up at this time should be dictated based on risk factors for developing testis cancer more than on the presence of TM.

Interstitial cystitis antiproliferative factor (APF) as a cell-cycle modulator

Background

Interstitial cystitis (IC) is a chronic bladder disorder of unknown etiology. Antiproliferative factor (APF), a peptide found in the urine of IC patients, has previously been shown to decrease incorporation of thymidine by normal bladder epithelial cells. This study was performed to determine the effect of APF on the cell cycle of bladder epithelial cells so as to better understand its antiproliferative activity.

Methods

Explant cultures from normal bladder biopsy specimens were exposed to APF or mock control. DNA cytometry was performed using an automated image analysis system. Cell cycle phase fractions were calculated from the DNA frequency distributions and compared by two-way analysis of variance (ANOVA).

Results

APF exposure produced statistically significant increases in the proportion of tetraploid and hypertetraploid cells compared to mock control preparations, suggesting a G2 and/or M phase cell cycle block and the production of polyploidy.

Conclusions

APF has a specific effect on cell cycle distributions. The presence of a peptide with this activity may contribute to the pathogenesis of interstitial cystitis through disruption of normal urothelial proliferation and repair processes.

The role of mannitol in alleviating renal injury during extracorporeal shock wave lithotripsy

PURPOSE

We determined the role of mannitol in preventing or alleviating renal injury during extracorporeal shock wave lithotripsy (ESWL, Dornier Medical Systems, Inc., Marietta, Georgia).

MATERIALS AND METHODS

Patients undergoing ESWL were randomized to receive mannitol or control. Change in the levels of urinary enzymes, beta 2-microglobulin and microalbumin were compared in the groups before and after the procedure.

RESULTS

Mannitol treated patients had a statistically significant decrease in beta 2-microglobulin excretion after ESWL compared with the control group.

CONCLUSIONS

Mannitol may serve a protective function by decreasing the amount of renal injury caused by ESWL for renal calculous disease.

A prospective analysis of time to normalization of serum testosterone after withdrawal of androgen deprivation therapy

PURPOSE

Patients with prostate cancer are treated with neoadjuvant, adjuvant and intermittent androgen deprivation therapy. Prostate specific antigen (PSA) is altered during androgen deprivation therapy, and as a result the prognostic significance and accuracy of PSA values measured before serum testosterone has normalized are questionable because the patient is still effectively on androgen deprivation therapy. We determine the time it takes for serum testosterone to return to normal after withdrawal of androgen deprivation therapy.

MATERIALS AND METHODS

Serial serum testosterone was prospectively measured at 3-month intervals in 68 men after withdrawal of androgen deprivation therapy. The number of months to return to normal serum testosterone 270 ng./dl. or greater, was calculated for each patient. Patients were stratified according to duration of androgen deprivation, age and type of luteinizing hormone releasing hormone agonist used.

RESULTS

Median patient age was 71 years (range 46 to 88). Median time to normalization of testosterone was 7 months (range 1 to 58). At 3, 6 and 12 months 28%, 48% and 74% of men had normal serum testosterone, respectively. Serum testosterone took significantly longer to return to normal in patients on androgen deprivation therapy for 24 months or greater compared to those on therapy for less than 24 months (log-rank p = 0.0034). There was no statistical significance based on age or type of luteinizing hormone releasing hormone agonist used.

CONCLUSIONS

Androgen deprivation has an effect on serum testosterone that extends beyond the cessation of treatment. Serum testosterone should be measured in all men until normalization. These results should be applied to the interpretation of PSA levels after withdrawal of androgen deprivation therapy. In addition, these data have implications regarding dose scheduling and definition of biochemical (PSA) failure after primary therapy.