Risk Of Urological Cancers Research Articles

Autoimmune Disease and Subsequent Urological Cancer

We examined the subsequent risk and prognosis of urological cancer in individuals diagnosed with autoimmune disease. We systematically analyzed the risk and prognosis of prostate, kidney and bladder cancers in individuals diagnosed with any of 33 autoimmune diseases based on a national Swedish database for 1964 through 2008. The SIR and HR were calculated for subsequent urological cancers between 1964 and 2008 in individuals hospitalized for autoimmune disease. An increased SIR for urological cancer was recorded after 26 autoimmune diseases. An increased HR for cancer specific survival was noted after 4 autoimmune diseases and for overall survival after 18. The highest SIRs were seen for kidney cancer after polyarteritis nodosa (2.85) and polymyositis/dermatomyositis (2.68), and for bladder cancer after polymyositis/dermatomyositis (2.45). The highest risk of prostate cancer (1.70) was observed after polyarteritis nodosa. SIRs were lower during followup from 1990 to 2008 compared to the previous period. Individuals diagnosed with prostate and kidney cancers showed an improved cancer specific prognosis, in contrast to the poorer overall prognosis for all 3 urological cancers. The risk of urological cancer was increased after all autoimmune diseases. The most significant changes after individual autoimmune diseases were toward higher risk. Survival data were reassuring since autoimmune disease only marginally influences the prognosis of cancer specific mortality. However, overall survival was decreased for the 3 types of cancer.

Aspirin and urologic cancer risk: an update

Aspirin has been associated with a reduced risk of colorectal cancer. With specific reference to urological cancers, a protective role for aspirin has been suggested for prostate cancer, but data for cancers of the bladder and kidney have been limited and inconsistent. Epidemiological evidence suggests that prostate cancer risk is reduced by 10% in regular aspirin users, with similar risk reductions reported in both case-control and cohort studies, and for both slow-growing and aggressive cancers. However, risk estimates were significantly heterogeneous and there was no relationship between risk reduction and frequency, dose or duration of use. Thus, inference for causality and public health implications remain far from conclusive. Although a few case-control studies have reported a favorable effect of aspirin on bladder cancer, most investigations did not find any meaningful association. A modest nonsignificant increased risk was reported for kidney cancer. Such excess risk, however, might be due to exposure to phenacetin-containing analgesics, which have been reported to increase renal cell cancer risk.

55 AN INNOVATIVE WEB TOOL FOR OBJECTIFYING CRITICAL DECISION-MAKING IN PATIENTS WITH UROLOGIC CANCERS

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-based Medicine & Outcomes1 Apr 201155 AN INNOVATIVE WEB TOOL FOR OBJECTIFYING CRITICAL DECISION-MAKING IN PATIENTS WITH UROLOGIC CANCERS Alexander Kutikov, Joseph Bland, Daniel Canter, Boris Rozenfeld, Steven Sterious, David Y.T. Chen, and Robert G. Uzzo Alexander KutikovAlexander Kutikov Philadelphia, PA More articles by this author , Joseph BlandJoseph Bland Philadelphia, PA More articles by this author , Daniel CanterDaniel Canter Philadelphia, PA More articles by this author , Boris RozenfeldBoris Rozenfeld Philadelphia, PA More articles by this author , Steven SteriousSteven Sterious Philadelphia, PA More articles by this author , David Y.T. ChenDavid Y.T. Chen Philadelphia, PA More articles by this author , and Robert G. UzzoRobert G. Uzzo Philadelphia, PA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2657AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Despite the development of treatment guidelines, quantitative risk stratification and management of urologic malignancies remains overly subjective. Nomograms and statistical algorithms offer an objective basis for critical decision-making by both physicians and patients. These tools remain largely underutilized in routine clinical practice due to barriers of access and ease of use. We sought to create a novel internet tool where published urologic cancer risk stratification and predictive models can be easily accessed, interpreted, and applied by physicians and patients. METHODS A MEDLINE review was performed to identify published nomograms/models relevant to prostate, renal, urothelial, testicular and penile cancers. Nomograms were grouped by defining characteristics (pre-operative versus post operative predictive models, predictive models for metastatic disease, etc). Additional operationalized models included staging tools, NCCN surveillance models and ACS cancer statistics. Nomograms were selected based on predictive accuracy, applicability, and ability to objectify risk stratification. Only nomograms with an AUC of greater than 0.7 were operationalized. Redundant nomograms were excluded. RESULTS www.cancernomograms.com organizes and operationalizes over 40 interactive predictive models for urologic malignancies. Each model was developed as an independent software program and deployed as an interactive flash object embedded in an HTML page allowing point of care risk calculation (Fig. 1). The website decreased calculation of nomogram metrics by 15 subjects (8 scenarios per subject) from minutes to seconds, demonstrating improved efficacy and utilization of a computer-based platform for nomograms (p=0.0003). CONCLUSIONS www.cancernomograms.com is a novel web portal that allows point of care risk quantification using published statistical models. This web tool affords real-time objectification of critical-decision making in a busy clinical setting. Moreover, the portal offers users the opportunity to submit requests to have the latest predictive models operationalized. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e23-e24 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexander Kutikov Philadelphia, PA More articles by this author Joseph Bland Philadelphia, PA More articles by this author Daniel Canter Philadelphia, PA More articles by this author Boris Rozenfeld Philadelphia, PA More articles by this author Steven Sterious Philadelphia, PA More articles by this author David Y.T. Chen Philadelphia, PA More articles by this author Robert G. Uzzo Philadelphia, PA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Increased Risks of Upper Tract Urothelial Carcinoma in Male and Female Chinese Herbalists

It has been shown that herbs that contain aristolochic acid induce urological cancer. Chinese herbalists have easy access to such herbs. Our previous mortality study has shown a significantly increased risk of urological cancer in female but not male herbalists. To re-examine this risk in male herbalists, the incidence of urological cancer was analyzed. We enrolled all 6550 Chinese herbalists in Taiwan registered during 1985-2000, and we retrospectively followed the development of cancer until 2001 by analysis of data collected from the Taiwan Cancer Registry. Standardized incidence ratios (SIRs) were calculated for urological cancers in herbalists and compared with those for the general population in Taiwan. There were 30 newly diagnosed cases of urological cancer and most of them were transitional cell carcinoma (93.1%). The mean age at diagnosis for urothelial carcinoma was 51.6 years, and 51.9% were in the upper urinary tract. After adjustment for age and sex, the SIR for all urological cancers was 3.51 [(95% confidence interval (CI): 2.37-5.01]. When stratified by location, the SIRs for kidney and upper urinary tract cancers and bladder cancer were 4.24 (95% CI: 2.47-6.80) and 2.86 (95% CI: 1.52-4.89), respectively. When analyzed by sex, the SIRs for all urological cancers, kidney and upper urinary tract cancers, and bladder cancer were also significantly increased in male herbalists. The significant risk of urothelial carcinoma noted in male herbalists increases our suspicion that this is an occupational disease that renders regular health assessment of herbalists an urgent necessity.

Familial risk of urological cancers: data for clinical counseling.

Familial risks for cancer are important for clinical counseling and understanding cancer etiology. The nationwide Swedish Family-Cancer Database includes all Swedes born in 1932 and later (0 to 68-year-old offspring) with their parents, totaling over 10.2 million individuals. Urological cancer cases were retrieved from the Swedish Cancer Registry up to year 2000. Standardized incidence ratios (SIR) and 95% confidence limits (CI) were calculated for age-specific familial risk in offspring by an exact proband status. The familial risks for offspring cancer were increased at all urological sites from concordant cancer in the parent and in a sibling proband. The highest SIRs by parent were for testicular and prostate cancer (4.26 and 2.45). When a sibling was affected, even kidney cancer (4.74) showed a high SIR. For kidney cancers, and also for prostate and testicular cancers, the SIRs were higher among siblings than among offspring and parents, which may indicate the involvement of recessive effects. Family members of patients with prostate cancer or von Hippel Lindau disease can expect organized clinical counseling, but family members of patients with other urological cancers are probably not counseled. Guidelines for clinical counseling or action level should be developed for all urological cancers because of the established familial risks. Urological cancers also offer a challenge to molecular geneticists attempting to identify the susceptibility genes underlying the familial clustering.

Allelic frequency of p53 gene codon 72 polymorphism in urologic cancers.

Alterations in the p53 tumor suppressor gene appear to be important in the development of many human tumors. The wild‐type p53 gene has a polymorphism at codon 72 that presents the arginine (CGC) or proline (CCC) genotype, which recently has been reported to be associated with genetically determined susceptibility to smoking‐related lung cancers. To determine whether this p53 genotype influences individual risk of urologic cancer and/or its progression, we used polymerase chain reaction‐restriction fragment length polymorphism (PCR‐RFLP) analysis to assay the allelic frequencies of this polymorphism in 85 renal cell carcinoma patients, 151 urothelial cancer patients, 33 testicular cancer patients, 28 prostatic cancer patients and 56 patients without neoplastic disease. The allelic distributions of the three genotypes (Arg/Arg, Arg/Pro, Pro/Pro) in patients with renal cell carcinoma (29.4%, 55.3%, 15.3%), urothelial cancers (45.7%, 39.7%, 14.6%), testicular cancer (45.4%, 48.5%, 6.1%) or prostate cancer (42,9%, 50.0%, 7.1%) did not differ significantly from those in the normal controls. However, Pro/Pro genotype in renal cell carcinoma and urothelial cancer (smoking‐related cancers) was more frequent than that in prostate cancer and testicular cancer (smoking‐unrelated cancers) with borderline significance (P=0.0881). There was no particular correlation between frequency of the three genotypes and grade or stage of each type of tumor. The association of genetic predisposition to urologic cancers with p53 gene codon 72 polymorphism is not so clear as the previous study of Japanese lung cancer patients, but this polymorphism may play some role in urothelial cancers and renal cell carcinoma, in which smoking is an epidemiological risk factor.

Recurrent unexplained haematuria and risk of urological cancer. A follow-up study.

To evaluate the risk of urological cancer in patients with unexplained haematuria, 93 patients, who had undergone complete urological examination and who were classified as having unexplained haematuria, were followed. Mean age was 46 years, range 16-84 years. Seventy-seven patients had gross haematuria and 16 patients had microscopic haematuria. Mean follow-up time was 62 months (range 6-360 months). Urological neoplasms were found in 7 of 38 patients (18%; 95% confidence limits 8-34%) with recurrent haematuria after primary urological examination, and in 1 of 36 patients (3%; 95% confidence limits 0.07-14%) without additional haematuria after primary examination. Regular urological examination of patients with recurrent unexplained haematuria is justified. In patients without additional incidents of haematuria after primary urological examination the risk of urological cancer is not significantly increased.