Chen MH Research Articles

The prevalence and clinical characteristics of restless legs syndrome in patients with iron deficiency anemia in Korea.

While the prevalence and clinical characteristics of restless legs syndrome (RLS) are known to vary according to ethnicity, a detailed evaluation of this condition among patients with iron deficiency anemia (IDA) has not yet been reported in an Asian population. We investigated the prevalence and clinical characteristics of RLS in patients with IDA in Korea compared with age- and sex-matched patients diagnosed with idiopathic RLS. This prospective single-center study was performed at a regional university hospital. Consecutive patients with IDA were enrolled over a 4-year period. Clinical interviews and laboratory tests were conducted at the first visit. RLS diagnosis was confirmed through face-to-face interviews. We randomly selected patients with idiopathic RLS without comorbid medical disorders from our sleep center dataset as control patients. The clinical characteristics of both groups were compared. We enrolled 124 patients with IDA. Fifty (40.3%) patients were diagnosed with RLS, with 82% exhibiting severe to very severe symptoms. Patients with IDA and RLS were older and reported more sleep deterioration than patients with IDA without RLS. Patients with IDA and RLS also had a more depressed mood and higher periodic limb movement index scores than patients with idiopathic RLS. The prevalence of RLS among patients with IDA in Korea was high, with the majority having severe to very severe symptoms. Patients with IDA and RLS had poorer sleep quality and more emotional problems than patients with IDA without RLS. Therefore, patients with IDA should be screened for RLS to prevent adverse effects on the quality of sleep and life.

Editorial Comment

Monitoring prostate-specific antigen (PSA) is the mainstay of evaluating definitive therapy in that a rising PSA is predictive of developing distant metastases and prostate cancer-specific mortality (PCSM). Recent studies have identified post treatment PSA based surrogates for PCSM which is important given that it takes 10-20years to die after unsuccessful definitive therapy. 1 Royce TJ Chen MH Wu J et al. Surrogate end point for all-cause mortality in men with localized unfavorable -risk prostate cancer treated with radiation therapy vs radiation therapy plus androgen deprivation therapy: a secondary analysis of a randomized clinical trial. JAMA Oncol. 2017; 3: 652-658 Crossref PubMed Scopus (34) Google Scholar , 2 Romesser PB Pei X Shi W et al. Prostate-Specific Antigen (PSA) bounce after dose-escalated external beam radiation therapy is an independent predictor of PSA recurrence, metastasis, and survival in prostate adenocarcinoma patients. Int J Radiat Oncol Biol Phys. 2018; 100: 59-67 Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar In this article, investigators describe an analysis of 204 men with unfavorable prostate cancer enrolled in a randomized clinical trial comparing 70.2 Gy external beam radiotherapy with or without 6 months of androgen deprivation (ADT). With a median follow-up more than 18years, men with a PSA nadir >0.2ng/mL and a time to nadir (TTN) <12 months had a statistically significant increased PCSM rate. The authors conclude that these observations infer a high likelihood of castrate resistant prostate cancer (CRPC) and propose that men with a measurable PSA nadir and a short TTN be considered for randomized trials evaluating the impact on survival of salvage ADT with or without novel agents shown to prolonged survival in men with CRPC.

Post-traumatic stress disorder was associated with a threefold increased risk for stroke in a Taiwanese National Health Insurance Database

ABSTRACT FROM: Chen MH, Pan TL, Li CT, et al . Risk of stroke among patients with post-traumatic stress disorder: nationwide longitudinal study. Br J Psychiatry 2015;206:302–7. People with post-traumatic...

PWE-288 Is computed tomographic colonography more useful than colonoscopy in 2 week wait patients?

<h3>Introduction</h3> CT colonography (CTC) is now widely available as the radiological imaging test for the colon, replacing barium enema. It is recommended that regular audit processes should be in place to audit the quality of CTC service provision against internationally agreed standards. This is especially important when considering the national bowel cancer screening programme with reference to FOB positive patients unfit for a colonoscopy and/or with incomplete colonoscopic examinations. The other advantage of CTC is the ability to detect extra colonic lesions at the same time as evaluating the colon. We aimed to audit our CTC practice with reference to endoscopic findings and to determine the value of any extra colonic lesions found on CTC, especially in our 2 week wait and bowel cancer screening patients. <h3>Method</h3> All patients who had a CTC performed over a period of 13 months were evaluated against the electronic record of endoscopic procedures. Of 264 patients who had a CTC, 78 also had a contemporaneous flexible sigmoidoscopy or colonoscopy performed. <h3>Results</h3> The main indications for an investigation of the colon were altered bowel habit (45%), anaemia (11%), abdominal pain (6.8%) and cancer/ polyp follow up (7.9%). The most common indication for CTC in the 264 patients reviewed was exclusion of synchronous colonic tumours in patients who had an incomplete colonoscopy (112 patients); 140 patients had been deemed unfit to have a colonoscopy and 12 patients declined one. 11 BCSP underwent CTC, 5 due to an incomplete scope and 6 were deemed unfit for colonoscopy. 68% of the CTC and endoscopic findings were in agreement. 19/78 endoscopic abnormalities were not picked up on CTC (24%). No cancers were missed on CTC. The most common positive findings were diverticular disease (24%) and polyps (14%). We found that 37.5% of patients had extra colonic abnormalities. There were no recorded complications. <h3>Conclusion</h3> It is essential to audit the quality of CTC service provision against standards set by the International CT Colonography Standards Collaboration and the NHS Bowel Cancer Screening Programme. In our institution, the correlation of CTC and endoscopic findings was reassuring. In addition, a large number of extra colonic abnormalities were detected using CTC, some of which were significant – this is especially important in the 2 week wait patients. Colonoscopy, however, still remains the gold standard investigation for the detection of colon related pathology. <h3>Disclosure of interest</h3> None Declared. <h3>References</h3> Johnson CD, Chen MH, Toledano AY <i>et al</i>. Accuracy of CT colonography for detection of large adenomas and cancer. NEJM. 2008;359:1207–17 Burling D. Effect of Directed training on reader performance for CT colonography: multicenter study. Radiology. 2007;242:152–61 NICE guidelines CT Colonography. http://guidance.nice.org.uk/IPG129;2009

Highlights from recent advances in nanomedicine.

Highlights from recent advances in nanomedicine.

Commentary on “Initial management of prostate-specific antigen-detected, low-risk prostate cancer and the risk of death from prostate cancer.” Aizer AA, Chen MH, Hattangadi J, D'Amico AV. Harvard Radiation Oncology program, Boston, MA.: BJU Int 2013. doi: 10.1111/j.1464-410X.2012.11789.x. [Epub ahead of print

WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: The recently published Prostate Cancer Intervention versus Observation Trial (PIVOT) did not identify differences in prostate cancer-specific mortality or all-cause mortality among patients with low-risk disease managed conservatively vs those managed definitively; however, recently published data suggest that older men may harbour more aggressive disease than is identified at biopsy owing to sampling error and undergrading. Whether older men with apparent low-risk disease are placed at risk of prostate cancer-specific mortality when managed conservatively remains unknown. The study used population-level data to show that non-curative approaches for older men with low-risk prostate cancer do result in an increased risk of prostate cancer-specific mortality. Differences between our study and the PIVOT trial include the fact that we included a larger sample size, analysed the data using an 'as-treated' approach, and included a healthier cohort of men as evinced by lower 4-year all-cause mortality estimates in our study than in the PIVOT. Our results suggest that older men with apparent low-risk prostate cancer are at risk of undergrading, which probably explains the differences in prostate cancer-specific mortality observed between men managed conservatively vs those managed definitively. Our study suggests that alternative approaches to excluding occult, high grade prostate cancer are needed in such men. ObjectiveTo evaluate whether older age in men with low-risk prostate cancer increases the risk of prostate cancer-specific mortality (PCSM) when non-curative approaches are selected as initial management. Patients and methodsThe study cohort consisted of 27 969 men, with a median age of 67 years, with prostate-specific antigen (PSA)-detected, low-risk prostate cancer (clinical category T1c, Gleason score≤6, and PSA≤10) identified by the Surveillance, Epidemiology and End Results programme between 2004 and 2007. Fine and Gray's competing risk regression analysis was used to evaluate whether management with non-curative vs curative therapy was associated with an increased risk of PCSM after adjusting for PSA level, age at diagnosis and year of diagnosis. ResultsAfter a median follow-up of 2.75 years, 1121 men died, 60 (5.4%) from prostate cancer. Both older age (adjusted hazard ratio [AHR] 1.05; 95% confidence interval (CI) 1.02-1.08; P<0.001) and non-curative treatment (AHR 3.34; 95% CI 1.97-5.67; P<0.001) were significantly associated with an increased risk of PCSM. Men>the median age experienced increased estimates of PCSM when treated with non-curative as opposed to curative intent (P<0.001); this finding was not seen in men≤the median age (P = 0.17). ConclusionPending prospective validation, our study suggests that non-curative approaches for older men with 'low-risk' prostate cancer result in an increased risk of PCSM, suggesting the need for alternative approaches to exclude occult, high grade prostate cancer in these men.

Tardive Dyskinesia Induced by a Switch From Haloperidol Depot to Paliperidone Palmitate

Tardive Dyskinesia Induced by a Switch From Haloperidol Depot to Paliperidone Palmitate

Abstracts of the 17th International Symposium on Bioluminescence and Chemiluminescence ‐ (ISBC 2012)

WARNING : The light-emitting molecular structures responsible for the chemiluminescence and fluorescence phenomena are not necessarily the same!

Feasibility of Adenovirus-Mediated hNIS Gene Transfer and 131I Radioiodine Therapy as a Definitive Treatment for Localized Prostate Cancer

We have developed a replication-competent adenovirus (Ad5-yCD/mutTK(SR39)rep-hNIS) armed with two suicide genes and the human sodium iodide symporter (hNIS) gene. In this context, hNIS can be used as a reporter gene in conjunction with nuclear imaging and as a potentially therapeutic gene when combined with (131)I radioiodine therapy. Here, we quantified the volume and magnitude of hNIS gene expression in the human prostate following injection of a high Ad5-yCD/mutTK(SR39)rep-hNIS dose using a standardized injection algorithm, and estimated the radiation dose that would be delivered to the prostate had men been administered (131)I with curative intent. Six men with clinically localized prostate cancer received an intraprostatic injection of Ad5-yCD/mutTK(SR39)rep-hNIS under transrectal ultrasound guidance. All men received 2 × 0.5 ml deposits (5 × 10(11) vp/deposit) in each of the four base and midgland sextants and 2 × 0.25 ml deposits (2.5 × 10(11) vp/deposit) in each of the two apex sextants for a total of 12 deposits (5 × 10(12) vp) in 5 ml. On multiple days after the adenovirus injection, men were administered sodium pertechnetate (Na(99m)TcO(4)) and hNIS gene expression in the prostate was quantified by single photon emission computed tomography (SPECT). hNIS gene expression was detected in the prostate of six of six (100%) men. On average, 45% (range 18-83%) of the prostate volume was covered with gene expression. Had men been administered 200 mCi (131)I, we estimate that the mean absorbed dose to the prostate would be 7.2 ± 4.8 Gy (range 2.1-13.3 Gy), well below that needed to sterilize the prostate. We discuss the obstacles that must be overcome before adenovirus-mediated hNIS gene transfer and (131)I radioiodine therapy can be used as a definitive treatment for localized prostate cancer.

Commentary on “Impact of postoperative prostate-specific antigen disease recurrence and the use of salvage therapy on the risk of death”. Choueiri TK, Chen MH, D'Amico AV, Sun L, Nguyen PL, Hayes JH, Robertson CN, Walther PJ, Polascik TJ, Albala DM, Moul JW, Department of Medical Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA: Cancer 2010;116:1887–92

Commentary on “Impact of postoperative prostate-specific antigen disease recurrence and the use of salvage therapy on the risk of death”. Choueiri TK, Chen MH, D'Amico AV, Sun L, Nguyen PL, Hayes JH, Robertson CN, Walther PJ, Polascik TJ, Albala DM, Moul JW, Department of Medical Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA: Cancer 2010;116:1887–92

Science to Practice: Will Randomized Prospective Clinical Trials Be Necessary for RF Ablation of Large Liver Tumors with Liposomal Doxorubicin?

HomeRadiologyVol. 255, No. 1 Next SCIENCE TO PRACTICEScience to Practice: Will Randomized Prospective Clinical Trials Be Necessary for RF Ablation of Large Liver Tumors with Liposomal Doxorubicin?Evan C. UngerEvan C. UngerEvan C. UngerPublished Online:Mar 10 2010https://doi.org/10.1148/radiol.092424MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractThe study by Solazzo et al, defining the mechanisms of cell stress and repair, provides a scientific backstop to help support the clinical use of liposomal doxorubicin at radiofrequency ablation.References1 Solazzo S, Ahmed M, Schor-Bardach Ret al.. Liposomal doxorubicin increases radiofrequency ablation–induced tumor destruction by increasing cellular oxidative and nitrative stress and accelerating apoptotic pathways. Radiology 2010;255(1):62–74. Link, Google Scholar2 Curley SA. Radiofrequency ablation of malignant liver tumors. Oncologist 2001;6(1):14–23. Crossref, Medline, Google Scholar3 Chen MH, Yang W, Yan Ket al.. Large liver tumors: protocol for radiofrequency ablation and its clinical application in 110 patients—mathematic model, overlapping mode, and electrode placement process. Radiology 2004;232(1):260–271. Link, Google Scholar4 Goldberg SN, Girnan GD, Lukyanov ANet al.. Percutaneous tumor ablation: increased necrosis with combined radiofrequency ablation and intravenous liposomal doxorubicin in a rat breast tumor model. Radiology 2002;222(3):797–804. Link, Google Scholar5 Goldberg SN, Kamel IR, Kruskal JBet al.. Radiofrequency ablation of hepatic tumors: increased tumor destruction with adjuvant liposomal doxorubicin therapy. AJR Am J Roentgenol 2002;179(1):93–101. Crossref, Medline, Google Scholar6 Doxil. Centocor Ortho Biotech Products. http://www.doxil.com/assets/DOXIL_PI_Booklet.pdf. Accessed September 2009. Google Scholar7 Rivera E. Liposomal anthracyclines in metastatic breast cancer: clinical update. Oncologist 2003;8(suppl 2):3–9. Crossref, Medline, Google ScholarArticle HistoryPublished online: Mar 10 2010Published in print: Apr 2010 FiguresReferencesRelatedDetailsRecommended Articles Therapeutic Effects of CT-guided Radiofrequency Ablation with Concurrent Platinum-Doublet Chemotherapy in a Rabbit VX2 Lung Tumor ModelRadiology2016Volume: 283Issue: 2pp. 391-398Targeting STAT3 to Suppress Systemic Pro-Oncogenic Effects from Hepatic Radiofrequency AblationRadiology2017Volume: 286Issue: 2pp. 524-536Hepatic Thermal Ablation: Effect of Device and Heating Parameters on Local Tissue Reactions and Distant Tumor GrowthRadiology2016Volume: 281Issue: 3pp. 782-792Radiofrequency Ablation Followed by Surgical Excision versus Lumpectomy for Early Stage Breast Cancer: A Randomized Phase II Clinical TrialRadiology2018Volume: 289Issue: 2pp. 317-324Science to Practice: Molecular-targeted Drug Delivery in Combination with Radiofrequency Ablation of Liver Cancer: A Magic Bullet?Radiology2017Volume: 285Issue: 2pp. 333-335See More RSNA Education Exhibits Novel Image-Guided Micro-Invasive Percutaneous Treatments of Breast Lesions: Where Do We Stand?Digital Posters2019The Fast and the Furious: Rapid Progression of HCC After Locoregional Therapy — A Tri-Institutional Collaboration on Imaging PatternsDigital Posters2018Imaging Follow-Up After Radiofrequency Ablation (RFA) in Patients with Early Stage Non-Small Cell Lung Cancer (NSCLC): An Experience-Based Pictorial ReviewDigital Posters2018 RSNA Case Collection Solitary breast plasmacytomaRSNA Case Collection2021AIDS-associated Kaposi sarcomaRSNA Case Collection2020Medication Related Osteonecrosis of the Jaw RSNA Case Collection2021 Vol. 255, No. 1 Metrics Altmetric Score PDF download

Continuous androgen-deprivation therapy increased risk for diabetes and fragility fractures in older men with prostate cancer

ACP Journal Club15 December 2009Continuous androgen-deprivation therapy increased risk for diabetes and fragility fractures in older men with prostate cancerJulio Hajdenberg, MD, FACPJulio Hajdenberg, MD, FACPMD Anderson Cancer Center Orlando, Orlando, Florida, USA (J.H.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-151-12-200912150-02014 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Source CitationAlibhai SM, Duong-Hua M, Sutradhar R, et al. Impact of androgen deprivation therapy on cardiovascular disease and diabetes. J Clin Oncol. 2009;27:3452−8. https://pubmed.ncbi.nlm.nih.gov/19506162Clinical Impact RatingsGIM/FP/GP: Endocrinology: Oncology: References1 Saigal CS, Gore JL, Krupski TL, et al. Androgen deprivation therapy increases cardiovascular morbidity in men with prostate cancer. Cancer. 2007;110:1493-1500. [PMID: 17657815] Google Scholar2 Efstathiou JA, Bae K, Shipley WU, et al. Cardiovascular mortality and duration of androgen deprivation for locally advanced prostate cancer: analysis of RTOG 92-02. Eur Urol. 2008;54:816-23. [PMID: 18243498] Google Scholar3 Nanda A, Chen MH, Braccioforte MH, Moran BJ, D’Amico AV. Hormonal therapy use for prostate cancer and mortality in men with coronary artery disease-induced congestive heart failure or myocardial infarction. JAMA. 2009;302:866−73. [PMID: 19706860] Google Scholar4 National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. Prostate cancer. Version 1; 2009. www.nccn.org/professionals/physician_gls/f_guidelines.asp (accessed 26 Oct 2009). Google Scholar Author, Article, and Disclosure InformationAffiliations: MD Anderson Cancer Center Orlando, Orlando, Florida, USA (J.H.)This article was published at Annals.org on 1 December 2009. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byAndrogen deprivation therapy is associated with diabetes: Evidence from meta‐analysis 15 December 2009Volume 151, Issue 12Page: JC6-14KeywordsCardiovascular therapyDatabasesDiabetes mellitusHeart failureMortalityMyocardial infarctionProstate cancerSudden cardiac deathSurgeryToxicity ePublished: 15 December 2009 Issue Published: 15 December 2009 Copyright & PermissionsCopyright © 2009 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Comparative Effectiveness Research: What It Means for Radiology

The coming years will be an ideal time for investigators in radiology to develop a comparative effectiveness research (CER) initiative and to establish a lasting precedent for CER in our field.

CT colonography had 90% sensitivity and 86% specificity for diagnosing large adenomas and cancer in asymptomatic adults

Source Citation Johnson CD, Chen MH, Toledano AY, et al. Accuracy of CT colonography for detection of large adenomas and cancers. N Engl J Med. 2008;359:1207-17. 18799557

Point:Counterpoint: Respiratory sinus arrhythmia is due to a central mechanism vs. respiratory sinus arrhythmia is due to the baroreflex mechanism

Blood pressure and heart periods fluctuate at respiratory frequencies in healthy humans. Some researchers ([8][1], [23][2]) explain this as a cause-and-effect relation: blood pressure changes trigger baroreflex-mediated R-R interval changes. Here I make the case that respiratory sinus arrhythmia is

Larger Dose of Intradermal Influenza Vaccination May Be More Immunogenic in Transplant Recipients

To the Editor: I read with interest the article by Manuel et al. (1Manuel O Humar A Chen MH et al.Immunogenicity and safety of an intradermal boosting strategy for vaccination against influenza in lung transplant recipients.Am J Transplant. 2007; 11: 2567-2572Abstract Full Text Full Text PDF Scopus (57) Google Scholar). I wonder if a larger dose of the vaccine administered intradermally may have been more immunogenic, through stimulation of more dendritic cells. The study by Belshe et al. (2Belshe RB Newman FK Cannon J et al.Serum antibody responses after intradermal vaccination against influenza.N Engl J Med. 2004; 35: 2286-2294Crossref Scopus (292) Google Scholar) used a dose of 6 μg of hemagglutinin for each influenza antigen; double the dose used in the study by Manuel et al. A recent study also showed that a higher dose of influenza vaccine was more immunogenic in elderly persons (3Keitel WA Atmar RL Cate TR et al.Safety of high doses of influenza vaccine and effect on antibody responses in elderly persons.Arch Intern Med. 2006; 166: 1121-1127Crossref PubMed Scopus (159) Google Scholar). In another study (4Nashida Y Kumamoto T Azuma E et al.Development of a dendritic cell vaccine against measles for patients following hematopoietic cell transplantation.Transplantation. 2006; 82: 1104-1107Crossref PubMed Scopus (2) Google Scholar), a dendritic cell-based measles virus vaccine induced specific immunity in hematopoietic stem cell transplant recipients. It is encouraging to know that the intradermal influenza vaccine was better tolerated in lung transplant recipients compared to healthy people (2Belshe RB Newman FK Cannon J et al.Serum antibody responses after intradermal vaccination against influenza.N Engl J Med. 2004; 35: 2286-2294Crossref Scopus (292) Google Scholar,5Kenney RT Frech SA Muenz LR Villar CP Glenn GM Dose sparing with intradermal injection of influenza vaccine.N Engl J Med. 2004; 351: 2295-2301Crossref PubMed Scopus (363) Google Scholar). In the study by Kenney et al., 96% of healthy people developed a local reaction to the intradermal influenza vaccine, while only 13% of lung transplant recipients in study by Manuel et al. had a local reaction after an intradermal vaccination. Interestingly, local reactions were more common after intramuscular injection than intradermal injection in lung transplant recipients, but the reverse was true in healthy people.

Editorial Comment on: Current Applications for Prostate-Specific Antigen Doubling Time

[38] Valicenti RK, Desilvio M, Hanks GE, et al. Posttreatment prostatic-specific antigen doubling time as a surrogate endpoint for prostate cancer-specific survival: An analysis of Radiation Therapy Oncology Group Protocol 92-02. Int J Radiat Oncol Biol Phys 2006;66:1064–71. [39] Stephenson AJ, Scardino PT, Kattan MW, et al. Predicting the outcome of salvage radiation therapy for recurrent prostate cancer after radical prostatectomy. J Clin Oncol 2007;25:2035–41. [40] Moul JW, Wu H, Sun L, et al. Early versus delayed hormonal therapy for prostate specific antigen only recurrence of prostate cancer after radical prostatectomy. J Urol 2004;171:1141–7. [41] Hanlon AL, Horwitz EM, Hanks GE, Pollack A. Short-term androgen deprivation and PSA doubling time: their association and relationship to disease progression after radiation therapy for prostate cancer. Int J Radiat Oncol Biol Phys 2004;58:43–52. [42] Sengupta S, Blute ML, Bagniewski SM, et al. Increasing prostate specific antigen following radical prostatectomy and adjuvant hormonal therapy: doubling time predicts survival. J Urol 2006;175:1684–90, discussion 1690. [43] Stewart AJ, Scher HI, Chen MH, et al. Prostate-specific antigen nadir and cancer-specific mortality following hormonal therapy for prostate-specific antigen failure. J Clin Oncol 2005;23:6556–60. [44] Rodrigues NA, Chen MH, Catalona WJ, Roehl KA, Richie JP, D’Amico AV. Predictors of mortality after androgen-depri-

Intermediate end point for prostate cancer-specific mortality following salvage hormonal therapy for prostate-specific antigen failure: D’Amico AV, Moul JW, Carroll PR, Cote K, Sun L, Lubeck D, Renshaw AA, Loffredo M, Chen MH, Department of Radiation Oncology, Brigham and Women’s Hospital and Dana-Farber Cancer Institute, Boston, MA. J Natl Cancer Inst 2004;96:509–15

Whether the prostate-specific antigen (PSA) response to salvage hormonal therapy can act as an intermediate end point for prostate cancer-specific mortality (PCSM) remains unclear. Therefore, we evaluated whether PSA response, defined as the absolute value of the ratio of the rate of PSA change after salvage hormonal therapy to the rate of PSA change before salvage therapy, is associated with the time to PCSM following salvage hormonal therapy. A single-institution and two pooled multi-institution databases containing baseline, treatment, and follow-up information on men who received salvage hormonal therapy for PSA failure following surgery or radiation therapy from January 1, 1988, to January 1, 2002, formed the study (n = 199) and validation cohorts (n = 1255), respectively. The ability of PSA response and its constituents (i.e., pre-salvage hormonal therapy PSA slope and post-salvage hormonal therapy PSA slope) to predict time to PCSM following salvage hormonal therapy was assessed using Cox regression analysis. For illustrative purposes, PSA response was analyzed as a dichotomous variable with a breakpoint for the ratio of PSA response of 1. All statistical tests were two-sided. PSA response was statistically significantly associated with time to PCSM following salvage hormonal therapy in both the study (P(Cox) = .0014) and validation (P(Cox) < .001) cohorts; however, its constituents were not (pre-salvage hormonal therapy PSA slope: P(Cox-study) = .97, P(Cox-validation) = .57; post-salvage hormonal therapy PSA slope: P(Cox-study) = .27, P(Cox-validation) = .31). Patients with a PSA response that was less than or equal to 1 had a statistically significantly shorter time to PCSM than patients with a PSA response of greater than 1 in both the study (hazard ratio [HR] = 3.6, 95% confidence interval [CI] = 1.3 to 10.3; P(Cox) = .01) and validation (HR = 12.8, 95% CI = 6.2 to 26.3; P(Cox) < .001) cohorts. The PSA response to salvage hormonal therapy can serve as an intermediate end point for PCSM in patients with a rising PSA level following surgery or radiation therapy.

Intermediate end point for prostate cancer-specific mortality following salvage hormonal therapy for prostate-specific antigen failure. D'Amico AV, Moul JW, Carroll PR, Cote K, Sun L, Lubeck D, Renshaw AA, Loffredo M, Chen MH, Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA.: J Natl Cancer Inst 2004;96:509–15

Whether the prostate-specific antigen (PSA) response to salvage hormonal therapy can act as an intermediate end point for prostate cancer-specific mortality (PCSM) remains unclear. Therefore, we evaluated whether PSA response, defined as the absolute value of the ratio of the rate of PSA change after salvage hormonal therapy to the rate of PSA change before salvage therapy, is associated with the time to PCSM following salvage hormonal therapy. A single-institution and two pooled multi-institution databases containing baseline, treatment, and follow-up information on men who received salvage hormonal therapy for PSA failure following surgery or radiation therapy from January 1, 1988, to January 1, 2002, formed the study ( n = 199) and validation cohorts ( n = 1255), respectively. The ability of PSA response and its constituents (i.e., pre-salvage hormonal therapy PSA slope and post-salvage hormonal therapy PSA slope) to predict time to PCSM following salvage hormonal therapy was assessed using Cox regression analysis. For illustrative purposes, PSA response was analyzed as a dichotomous variable with a breakpoint for the ratio of PSA response of 1. All statistical tests were two-sided. PSA response was statistically significantly associated with time to PCSM following salvage hormonal therapy in both the study ( P Cox = .0014) and validation ( P Cox < .001) cohorts; however, its constituents were not (pre-salvage hormonal therapy PSA slope: P Cox-study ) = .97, P Cox-validation = .57; post-salvage hormonal therapy PSA slope: P Cox-study = .27, P Cox-validation = .31). Patients with a PSA response that was less than or equal to 1 had a statistically significantly shorter time to PCSM than patients with a PSA response of greater than 1 in both the study (hazard ratio [HR] = 3.6, 95% confidence interval [CI] = 1.3 to 10.3; P Cox = .01) and validation (HR = 12.8, 95% CI = 6.2 to 26.3; P Cox < .001) cohorts. The PSA response to salvage hormonal therapy can serve as an intermediate end point for PCSM in patients with a rising PSA level following surgery or radiation therapy.

Intermediate end point for prostate cancer-specific mortality following salvage hormonal therapy for prostate-specific antigen failure. D'Amico AV, Moul JW, Carroll PR, Cote K, Sun L, Lubeck D, Renshaw AA, Loffredo M, Chen MH, Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA.J Natl Cancer Inst 2004;96:509–15

Whether the prostate-specific antigen (PSA) response to salvage hormonal therapy can act as an intermediate end point for prostate cancer-specific mortality (PCSM) remains unclear. Therefore, we evaluated whether PSA response, defined as the absolute value of the ratio of the rate of PSA change after salvage hormonal therapy to the rate of PSA change before salvage therapy, is associated with the time to PCSM following salvage hormonal therapy. A single-institution and two pooled multi-institution databases containing baseline, treatment, and follow-up information on men who received salvage hormonal therapy for PSA failure following surgery or radiation therapy from January 1, 1988, to January 1, 2002, formed the study ( n = 199) and validation cohorts ( n = 1255), respectively. The ability of PSA response and its constituents (i.e., pre-salvage hormonal therapy PSA slope and post-salvage hormonal therapy PSA slope) to predict time to PCSM following salvage hormonal therapy was assessed using Cox regression analysis. For illustrative purposes, PSA response was analyzed as a dichotomous variable with a breakpoint for the ratio of PSA response of 1. All statistical tests were two-sided. PSA response was statistically significantly associated with time to PCSM following salvage hormonal therapy in both the study ( P Cox = .0014) and validation ( P Cox < .001) cohorts; however, its constituents were not (pre-salvage hormonal therapy PSA slope: P Cox-study ) = .97, P Cox-validation = .57; post-salvage hormonal therapy PSA slope: P Cox-study = .27, P Cox-validation = .31). Patients with a PSA response that was less than or equal to 1 had a statistically significantly shorter time to PCSM than patients with a PSA response of greater than 1 in both the study (hazard ratio [HR] = 3.6, 95% confidence interval [CI] = 1.3 to 10.3; P Cox = .01) and validation (HR = 12.8, 95% CI = 6.2 to 26.3; P Cox < .001) cohorts. The PSA response to salvage hormonal therapy can serve as an intermediate end point for PCSM in patients with a rising PSA level following surgery or radiation therapy.