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Main Category: Prostate / Prostate Cancer
Also Included In: Public Health
Article Date: 17 May 2012 – 1:00 PDT

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Black prostate cancer patients may not be getting the same quality of care as white patients, according to a first-of-its-kind study by researchers at Henry Ford Hospital who found racial disparities in the results of surgery to remove diseased prostates.

While it is possible that anatomical differences or tumor characteristics may explain why the results of radical prostatectomy are not as good for African Americans as for white patients undergoing the same procedure, the study concluded that “surgeons, administrators and policymakers need to implement measures to address these disparities.”

The new research findings, based on population samples from throughout the U.S., will be presented this week at the American Urological Association’s Annual Meeting in Atlanta.

Quoc-Dien Trinh, M.D., a Fellow at Henry Ford Hospital’s Vattikuti Urology Institute and lead author of the study, says that while no one before has reported racial disparities in the results of cancer surgery, earlier studies have found similar differences in other areas of medical treatment and care.

“Again, research raises a serious issue in the difference between Caucasian and African American patients, and we’re trying to understand why it is happening,” Dr. Trinh says.

“Is it a biological issue? African American patients might present with worse disease, therefore surgery and treatment are more difficult. For some cancers, like pancreatic, if you have worse disease, the surgery is harder. But that’s doubtful with prostate cancer. It shouldn’t be the case.”

Dr. Trinh also notes that it is possible that African American patients have an anatomical difference – the form of their pelvis – that makes their surgeries harder, and there are studies to support that. “It’s not controversial, just related to bone structure. And it might, big question mark, might make surgery harder,” he says.

“But if it’s not anatomy or a disease aggressiveness issue then why do Caucasians have a better outcome than African American patients? While this study does not go into those specific issues, it raises the question.”

Using the most recent available data from the Nationwide Inpatient Sample (NIS), Dr. Trinh and his fellow researchers identified 7,408 African American and 51,319 white prostate cancer patients who underwent radical prostatectomy (RP) between 2001 and 2007. In RP, the entire cancerous prostate and some surrounding tissue are surgically removed.

They then compared the surgery’s immediate and short-term outcome, according to race, in five areas: rates of blood transfusions, complications during and after surgery, prolonged hospital stay, and in-hospital death. They found that compared to their white counterparts, African American patients had:

• Significantly higher rates of blood transfusions, 9 percent compared to 6 percent
• More complications during surgery, 1.7 percent compared to 1.3 percent
• Higher rates of overall complications after surgery, 13 percent vs. 10.3 percent
• Longer hospital stays (more than the median 3 days), 28.7 percent vs. 20.9 percent
• No differences for in-hospital mortality rates

Trinh says because of limitations on available data, there is no way to know exactly why these disparities exist yet. “Is it physician and patient interaction, types of insurance, how these patients are perceived? It’s hard to know,” he says.

“I’d say that it’s a little bit of everything – worse disease, presentation, anatomy that makes surgery harder. But it’s also a question of quality of care for ethnic minorities, especially in the American health care system. And that needs to be raised.”

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Source: http://www.medicalnewstoday.com/releases/245478.php

Main Category: Prostate / Prostate Cancer
Also Included In: Public Health;  Medical Students / Training
Article Date: 17 May 2012 – 1:00 PDT

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Patients who undergo radical surgery for prostate cancer may expect better results, on average, if they’re treated in accredited teaching hospitals with residency programs, and better still if the hospitals also have medical fellowships, according to a new study by Henry Ford Hospital.

The study, which evaluated postoperative complications in 47,100 radical prostatectomy (RP) patients throughout the U.S., also found that those with fewer complications after the surgery were more likely to have private insurance.

“To our knowledge, this is the first study to suggest that better post-operative outcomes may be expected at fellowship training than residency training institutions,” says Quoc-Dien Trinh, M.D., a Fellow at Henry Ford Hospital’s Vattikuti Urology Institute and lead author of the study.

The findings will be presented this week at the American Urological Association’s Annual Meeting in Atlanta.

In residency, students who have earned their medical degree begin to practice in a specific type of medicine under the supervision of physicians licensed in that specialty. A fellowship provides training in a sub-specialty after the residency is finished.

Dr. Trinh says that while the researchers found better outcomes, on average, in teaching hospitals with one or both programs, they can’t say exactly why.

“If you actually have a fellowship program for a particular sub-specialty, in this case urologic oncology, you could expect that the level of sub-specialized care might be better than in a typical all-purpose teaching hospital,” Dr. Trinh says. “All this remains hypothetical, because the study of these mechanisms can’t be done in large population-based datasets.”

Of the study’s 47,100 RP cases – which were drawn from the Nationwide Inpatient Sample between 2003 and 2007 – 19,193 were performed at non-teaching institutions, 24,006 at residency teaching hospitals and 3,901 at fellowship teaching institutions.

The study’s findings were based on comparisons of the length of time each patient spent in the hospital beyond the median of three days, death while in the hospital, and complications during and after RP surgery.

While stressing that explanations for better results found in residency and teaching hospitals are only hypothetical, Dr. Trinh says they may be due to several processes of care that exist at academic institutions.

“These characteristics may include the peer-review process associated with every level of clinical decision-making. Or, the more detailed nature of the peer-review process may translate into better selection of surgical candidates,” he notes.

“Others may be the extent of patient history and physical examination, documentation of the work-up, ordering of diagnostic and laboratory tests, availability of advanced technology, and adherence to standardized clinical guidelines.”

Because prostate cancer is one of the most common cancers among men, and the standard treatment for a significant number of those patients is radical prostatectomy – in which the entire prostate gland and some of the surrounding tissue are surgically removed – “it is essential to evaluate and to optimize the outcomes of patients undergoing RP,” Dr. Trinh says, explaining why the Henry Ford researchers decided to do this study.

Experts predict, based on the current rates of prostate cancer, by 2045 there will be an estimated 425,000 new cases each year.

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Source: http://www.medicalnewstoday.com/releases/245470.php

In a small clinical trial, six months of treatment with the drug, Johnson Johnson’s Zytiga, added to standard therapy, eliminated or nearly eliminated tumors in about one-third of men whose disease had not yet spread beyond the prostate gland but was considered likely to do so.

The exact significance of this must still be determined through larger studies. But researchers said that with breast cancer and bladder cancer, patients whose tumors are eliminated before an operation, by what is called neoadjuvant chemotherapy, tend to live longer.

“This is the first time we’ve seen this degree of complete response in prostate cancer given neoadjuvant therapy,” Dr. Nicholas J. Vogelzang, who represents the American Society of Clinical Oncology, said during a telephone news conference on Wednesday.

The prostate study is one of more than 4,500 that will be presented at the oncology society’s annual meeting in Chicago in early June.

Abstracts for all but a small number of the most significant studies were released on Wednesday, setting off a scramble by Wall Street analysts and investors to sift through the data for information that could move stocks.

Another study released on Wednesday showed that the Pfizer lung cancer drug Xalkori could help some children with aggressive cancers.

Xalkori, also known as crizotinib, was approved in August to treat the roughly 5 percent of non-small-cell lung cancer cases in which tumor growth is driven by abnormalities in a gene called ALK.

The new study shows that the drug also works in some childhood cancers with the same abnormal gene, particularly anaplastic large-cell lymphoma, neuroblastoma and inflammatory myofibroblastic tumors. Seven of eight children with anaplastic large-cell lymphoma had no detectable tumors after treatment.

“It’s remarkable that this targeted oral medication provided such a substantial benefit in these children with highly aggressive cancers, most of whom had already undergone every available therapy,” Dr. Yael P. Mossé of the Children’s Hospital of Philadelphia, the lead investigator, said in a statement.

Abnormalities in the ALK gene are found in 80 to 95 percent of anaplastic large-cell lymphomas, half of inflammatory myofibroblastic tumors and 10 to 15 percent of aggressive neuroblastomas.

As for Zytiga, also known as abiraterone, it was approved in April 2011 for use by men whose cancer has spread beyond the prostate gland and who have already tried the chemotherapy drug docetaxel. Zytiga powerfully inhibits the production of testosterone, which fuels prostate tumor growth.

The trial reported Wednesday involved 58 men with localized high-risk disease. Unlike lower-risk localized prostate cancer, the high-risk cases are not often cured by surgery, said Dr. Mary-Ellen Taplin of the Dana-Farber Cancer Institute, the trial’s lead investigator.

The men took Zytiga for either 12 or 24 weeks. They were also given a steroid and the standard hormone therapy leuprolide acetate, also known by the brand name Lupron. Their prostate glands were then removed by surgery and examined.

Among the men who took Zytiga for 24 weeks, 10 percent had a pathological complete response, meaning no tumor was detected upon surgery, and another 24 percent had a near-complete response, meaning only a tiny amount of tumor was present. In the group that received 12 weeks of Zytiga, 4 percent had a complete response, and 11 percent had a near-complete response.

Lupron alone has not been shown to produce such a high rate of responses, said Dr. Taplin, who has received research funds, consulting fees and honorariums from Johnson Johnson.

She said it was too soon for doctors to start prescribing Zytiga, which costs about $5,000 a month, so early in the course of the disease.

“This is a 58-patient trial and with a very, very expensive drug,” Dr. Taplin said. “So I don’t think anyone is going to be encouraging this type of treatment without more data.”

Wall Street is focusing less on this study than on a larger one in which Zytiga was used for metastatic prostate cancer, but before chemotherapy rather than afterward. If this trial succeeds, Zytiga should become a competitor to the Dendreon drug Provenge.

Johnson Johnson has already said Zytiga succeeded, but it did not release the data. It will be held until the conference itself in June.

Source: http://feeds.nytimes.com/click.phdo?i=9a6cec89197749a0dfceb01cfadae512

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Public Health
Article Date: 16 May 2012 – 6:00 PDT

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Older, sicker, high-risk patients who undergo one of the most common treatments for prostate cancer get better results in larger, busier hospitals, according to new research by Henry Ford Hospital.

In such cases, the same research showed the experience level of the surgeon doing the procedure mattered somewhat less than the hospital setting.

The results, based on data gathered throughout the U.S., will be presented this week at the American Urological Association Annual Meeting in Atlanta.

It is both intuitive – “practice makes perfect” – and has been well known and accepted in the medical community, that both higher hospital volume (the number of occupied beds) and higher surgeon volume (the number of operations performed) lead to better surgical results.

But the new study is the first to test that conclusion in a head-to-head comparison of the two factors on radical prostatectomy (RP).

“There’s a clear and distinct relation between surgeon and hospital volume and outcome – the more you do the better the results,” says Quoc-Dien Trinh, M.D., a Fellow at Henry Ford Hospital’s Vattikuti Urology Institute and lead author of the study.

“I think the novelty of this research is that there are not a lot of studies that have compared hospital to surgeon volume. When does hospital volume matter more, and when does surgeon volume?”

RP, in which the entire prostate gland and some of the surrounding tissue are surgically removed, is the most widely used treatment for prostate cancer, the second most common cancer in American men older than 45. The surgery is highly complex and the results can have serious effects on quality of life, including incontinence and erectile dysfunction.

Drawing on data from the National Cancer Institute’s Surveillance, Epidemiology and End Results Program (SEER), the researchers identified 19,225 Medicare patients with prostate cancer who underwent RP from 1995 to 2005. Then, looking at the outcome for each patient within 30 days after surgery, they analyzed the effect of both hospital volume (HV) and surgeon volume (SV) in predicting complications, including blood transfusion, anastomotic stricture (scarring and narrowing of incision lines), long-term incontinence, and erectile dysfunction.

In each case, the results were adjusted for the patient’s age, race, the presence of other disease or disorders, and marital and socioeconomic status, as well the hospital’s surrounding population density, the surgical approach, and the seriousness of the cancer.

The study found:

• Both higher HV and higher SV led to lower rates of overall complications.
• HV and SV were each related to fewer respiratory and vascular complications.
• Higher SV led to less need for blood transfusion.
• Both HV and SV were associated with lower rates of anastomotic stricture, urinary incontinence, and erectile dysfunction.

Based on these findings and others, the researchers concluded “hospital volume matters more where it’s about general delivery of care – for example, preventing complications and mortality,” Dr. Trinh says. “That probably depends on the quality of the hospital’s intensive care unit, the nursing staff, and other factors such as those, rather than on a specific surgeon’s skill.

“But risk of recurrence probably depends on the skill of the surgeon to remove the cancer properly, not on how good the hospital is.”

Overall, Dr. Trinh adds, “the main finding is that hospital volume matters more than surgeon volume with regard to 30-day complication rates, especially for older, sicker patients, those at higher risk of complications.”

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Source: http://www.medicalnewstoday.com/releases/245472.php

Editor’s Choice
Main Category: Prostate / Prostate Cancer
Article Date: 16 May 2012 – 11:00 PDT

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Each year, in the United States, more than 650,000 men receive a negative prostate biopsy result, with around 25-35% of these results being false negative. However, a new prostate cancer test has been launched by MdxHealth. The test – ConfirmMDx™ for Prostate Cancer – will help physicians identify which men have a true-negative prostate biopsy from those who may have occult cancer.

Professor Dr. Wim van Crienkinge, Chief Scientific Office at MDxHealth, said:

“As many as one in four men could be misdiagnosed due to limitations with current prostate biopsy procedures, commonly described as ‘sampling error’. As a consequence, the standard of care for men with persistently high-risk factors, but no evidence of prostate cancer in a biopsy, is limited to continued surveillance and repeat biopsies, often on prostate-cancer-free men.
The ConfirmMDx for Prostate Cancer test detects epigenetic changes associated with the presence or absence of prostate cancer.”

Dr. Jan Groen, CEO of MDxHealth explained:

“The launch of ConfirmMDx for Prostate Cancer represents the culmination of extensive research and development efforts and demonstrates the commitment of the MDxHealth team to deliver on its new commercial strategy. MDxHealth is uniquely positioned with its portfolio of epigenetic assays to capitalize on the realization of true personalized medicine, improving patient care, while reducing healthcare costs.”

At present, prostate biopsies only sample less than 1% of a man’s prostate – collecting 10-12 needle biopsy cores on average. As a result men are often left at risk of occult cancer, leading to a high rate of subsequent biopsies.

The new test – which can detect an epigenetic field effect or “halo” linked with the cancerization process at the DNA level in cells adjacent to cancer foci – will help physicians distinguish men who have true-negative biopsy from men at risk for occult cancer.

This molecular “halo” surrounding a cancer lesion can be present even though its appearance is normal under the microscope. As a result the new test will help urologists distinguish which men are able to do without unnecessary repeat biopsies.

Written By Grace Rattue

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Source: http://www.medicalnewstoday.com/articles/245488.php