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Tosoian JJ, Alam R, Gergis C, Narang A, Radwan N, Robertson S, McNutt T, Ross AE, Song DY, DeWeese TL, Tran PT, Walsh PC. Unscreened older men diagnosed with prostate cancer are at increased risk of aggressive disease. Prostate Cancer Prostatic Dis 2017; 20:193-196. [PMID: 28045113 DOI: 10.1038/pcan.2016.64] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/17/2016] [Accepted: 11/10/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND To evaluate the relationship between PSA testing history and high-risk disease among older men diagnosed with prostate cancer. METHODS Records from 1993 to 2014 were reviewed for men who underwent radiotherapy for prostate cancer at age 75 years or older. Patients were classified into one of four groups based on PSA-testing history: (1) no PSA testing; (2) incomplete/ineffective PSA testing; (3) PSA testing; or (4) cannot be determined. Outcomes of interest were National Comprehensive Cancer Network (NCCN) risk group (that is, low, intermediate or high risk) and biopsy grade at diagnosis. Multivariable logistic regression was used to determine the association between PSA testing history and high-risk cancer. RESULTS PSA-testing history was available in 274 (94.5%) of 290 subjects meeting study criteria. In total, 148 men (54.0%) underwent PSA testing with follow-up biopsy, 72 (26.3%) underwent PSA testing without appropriate follow-up, and 54 men (19.7%) did not undergo PSA testing. Patients who underwent PSA testing were significantly less likely to be diagnosed with NCCN high-risk cancer (23.0% vs 51.6%, P<0.001). On multivariable analysis, men with no/incomplete PSA testing had more than three-fold increased odds of high-risk disease at diagnosis (odds ratio 3.39, 95% confidence interval 1.96-5.87, P<0.001) as compared to the tested population. CONCLUSIONS Older men who underwent no PSA testing or incomplete testing were significantly more likely to be diagnosed with high-risk prostate cancer than those who were previously screened. It is reasonable to consider screening in healthy older men likely to benefit from early detection and treatment.
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Affiliation(s)
- J J Tosoian
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - R Alam
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - C Gergis
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A Narang
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - N Radwan
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - S Robertson
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - T McNutt
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A E Ross
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - D Y Song
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - T L DeWeese
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - P T Tran
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - P C Walsh
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Tosoian JJ, Cameron JL, Allaf ME, Hruban RH, Nahime CB, Pawlik TM, Pierorazio PM, Reddy S, Wolfgang CL. Resection of isolated renal cell carcinoma metastases of the pancreas: outcomes from the Johns Hopkins Hospital. J Gastrointest Surg 2014; 18:542-8. [PMID: 24163138 PMCID: PMC4859208 DOI: 10.1007/s11605-013-2278-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 06/24/2013] [Indexed: 02/07/2023]
Abstract
PURPOSE This study aims to assess outcomes and characteristics associated with resection of metastatic renal cell carcinoma (mRCC) to the pancreas. MATERIALS AND METHODS From April 1989 to July 2012, a total of 42 patients underwent resection of pancreatic mRCC at our institution. We retrospectively reviewed records from a prospectively managed database and analyzed patient demographics, comorbidities, perioperative outcomes, and overall survival. Cox proportional hazards models were used to evaluate the association between patient-specific factors and overall survival. RESULTS The mean time from resection of the primary tumor to reoperation for pancreatic mRCC was 11.2 years (range, 0-28.0 years). In total, 17 patients underwent pancreaticoduodenectomy, 16 underwent distal pancreatectomy, and 9 underwent total pancreatectomy. Perioperative complications occurred in 18 (42.9%) patients; there were two (4.8%) perioperative mortalities. After pancreatic resection, the median follow-up was 7.0 years (0.1-23.2 years), and median survival was 5.5 years (range, 0.4-21.9). The overall 5-year survival was 51.8%. On univariate analysis, vascular invasion (hazard ratio, 5.15; p = 0.005) was significantly associated with increased risk of death. CONCLUSIONS Pancreatic resection of mRCC can be safely achieved in the majority of cases and is associated with long-term survival. Specific pathological factors may predict which patients will benefit most from resection.
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Affiliation(s)
- J. J. Tosoian
- The Department of Surgery, Johns Hopkins Medical Institutions Sol Goldman Pancreatic Research Center, 604 Blalock Building, 600 N. Wolfe Street, Baltimore, MD 21287, USA. The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Park Building 223, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - J. L. Cameron
- The Department of Surgery, Johns Hopkins Medical Institutions Sol Goldman Pancreatic Research Center, 604 Blalock Building, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - M. E. Allaf
- The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Park Building 223, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - R. H. Hruban
- The Department of Pathology, Johns Hopkins Medical Institutions Sol Goldman Pancreatic Research Center, Baltimore, MD, USA. Department of Oncology, Johns Hopkins Medical Institutions, Sol Goldman Pancreatic Research Center, Baltimore, MD, USA
| | - C. B. Nahime
- The Department of Surgery, Johns Hopkins Medical Institutions Sol Goldman Pancreatic Research Center, 604 Blalock Building, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - T. M. Pawlik
- The Department of Surgery, Johns Hopkins Medical Institutions Sol Goldman Pancreatic Research Center, 604 Blalock Building, 600 N. Wolfe Street, Baltimore, MD 21287, USA. Department of Oncology, Johns Hopkins Medical Institutions, Sol Goldman Pancreatic Research Center, Baltimore, MD, USA
| | - P. M. Pierorazio
- The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Park Building 223, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - S Reddy
- The Department of Surgery, The University of Alabama at Birmingham, The Kirklin Clinic, 2000 6th Avenue South, Birmingham, AL 35233, USA
| | - C. L. Wolfgang
- The Department of Surgery, Johns Hopkins Medical Institutions Sol Goldman Pancreatic Research Center, 604 Blalock Building, 600 N. Wolfe Street, Baltimore, MD 21287, USA. The Department of Pathology, Johns Hopkins Medical Institutions Sol Goldman Pancreatic Research Center, Baltimore, MD, USA. Department of Oncology, Johns Hopkins Medical Institutions, Sol Goldman Pancreatic Research Center, Baltimore, MD, USA
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