Genitourinary Cancer

Among African American men with abnormal prostate-specific antigen levels or abnormal findings on digital rectal examination of the prostate, biopsies are more likely to detect prostate cancer in those who have vitamin D deficiency than in those who don’t, according to a report published online May 1 in Clinical Cancer Research.

And in both American men of European descent and African American men who have vitamin D deficiency, initial biopsies are more likely to show tumors with high Gleason grade and more advanced clinical stage than are tumor biopsies in men who don’t have vitamin D deficiency, reported Dr. Adam B. Murphy of Northwestern University, Chicago, and his coauthors.

Their "novel" findings corroborate "a plethora of in vitro, animal, and clinical data suggesting potential mechanisms for the role of vitamin D in prostate differentiation and tumor progression," the investigators noted.

©Kaspri/Fotolia.com

If vitamin D is involved in prostate cancer initiation or progression, then vitamin D supplements may prove helpful for both primary and secondary prevention, especially in the highest-risk group of African American men, Dr. Murphy and his colleagues said.

The researchers investigated this issue because no prior studies have assessed the association between vitamin D status and prostate biopsy outcomes, even though several have suggested that vitamin D deficiency might explain the disparity between blacks and whites in prostate cancer incidence and survival. "African American men have lower serum vitamin D levels than their European American and Hispanic counterparts, in part due to lower skin synthesis from the ultraviolet-blocking effects of melanin in the skin," Dr. Murphy and his associates said.

They examined these outcomes in an ethnically diverse population of 667 men residing in Chicago, a city with low ultraviolet light exposure. There were 275 European Americans, 273 African Americans, and 119 men of other ethnicities.

The study participants, aged 40-79 years, were enrolled over a 4-year period from five urology clinics. They were undergoing an initial biopsy because of elevated prostate-specific antigen levels and/or abnormal findings on digital rectal exam. Vitamin D status was determined using serum samples collected on the day of biopsy.

Vitamin D deficiency (a 25-hydroxyvitamin D level less than 20 ng/mL) was quite common, affecting 41% of the entire study population. Severe vitamin D deficiency (a 25[OH]D level less than 12 ng/mL) was relatively common, affecting 16%.

Prostate cancer was detected in 383 biopsies.

Vitamin D deficiency was not associated with a biopsy finding of prostate cancer among European American men, but it was strongly associated with a biopsy finding of prostate cancer among African Americans (odds ratio, 2.43). This association remained robust when the data were controlled for patient age, prostate-specific antigen level, family history, and cigarette and alcohol use.

In addition, severe vitamin D deficiency was associated with a higher Gleason score and higher tumor stage in both races, and thus with a higher risk category by National Comprehensive Cancer Network criteria (Clin. Cancer Res. 2014;20:2289-99).

"Our work supports the hypothesis that 25-hydroxyvitamin D is a potential biomarker that plays a clinically significant role in prostate cancer, and it may be a useful modifiable risk factor in the disease. Additionally, differences in 25-hydroxyvitamin D levels may explain ethnic disparities in prostate cancer–specific incidence, morbidity, and mortality," Dr. Murphy and his associates wrote.

This study was supported in part by grants from the National Institutes of Health and the U.S. Department of Defense. Dr. Murphy reported no financial conflicts of interest; one of his coauthors reported ties to Beckman Coulter, DeCode Genetics, and Ohmx.

Among African American men with abnormal prostate-specific antigen levels or abnormal findings on digital rectal examination of the prostate, biopsies are more likely to detect prostate cancer in those who have vitamin D deficiency than in those who don’t, according to a report published online May 1 in Clinical Cancer Research.

And in both American men of European descent and African American men who have vitamin D deficiency, initial biopsies are more likely to show tumors with high Gleason grade and more advanced clinical stage than are tumor biopsies in men who don’t have vitamin D deficiency, reported Dr. Adam B. Murphy of Northwestern University, Chicago, and his coauthors.

Their "novel" findings corroborate "a plethora of in vitro, animal, and clinical data suggesting potential mechanisms for the role of vitamin D in prostate differentiation and tumor progression," the investigators noted.

©Kaspri/Fotolia.com

If vitamin D is involved in prostate cancer initiation or progression, then vitamin D supplements may prove helpful for both primary and secondary prevention, especially in the highest-risk group of African American men, Dr. Murphy and his colleagues said.

The researchers investigated this issue because no prior studies have assessed the association between vitamin D status and prostate biopsy outcomes, even though several have suggested that vitamin D deficiency might explain the disparity between blacks and whites in prostate cancer incidence and survival. "African American men have lower serum vitamin D levels than their European American and Hispanic counterparts, in part due to lower skin synthesis from the ultraviolet-blocking effects of melanin in the skin," Dr. Murphy and his associates said.

They examined these outcomes in an ethnically diverse population of 667 men residing in Chicago, a city with low ultraviolet light exposure. There were 275 European Americans, 273 African Americans, and 119 men of other ethnicities.

The study participants, aged 40-79 years, were enrolled over a 4-year period from five urology clinics. They were undergoing an initial biopsy because of elevated prostate-specific antigen levels and/or abnormal findings on digital rectal exam. Vitamin D status was determined using serum samples collected on the day of biopsy.

Vitamin D deficiency (a 25-hydroxyvitamin D level less than 20 ng/mL) was quite common, affecting 41% of the entire study population. Severe vitamin D deficiency (a 25[OH]D level less than 12 ng/mL) was relatively common, affecting 16%.

Prostate cancer was detected in 383 biopsies.

Vitamin D deficiency was not associated with a biopsy finding of prostate cancer among European American men, but it was strongly associated with a biopsy finding of prostate cancer among African Americans (odds ratio, 2.43). This association remained robust when the data were controlled for patient age, prostate-specific antigen level, family history, and cigarette and alcohol use.

In addition, severe vitamin D deficiency was associated with a higher Gleason score and higher tumor stage in both races, and thus with a higher risk category by National Comprehensive Cancer Network criteria (Clin. Cancer Res. 2014;20:2289-99).

"Our work supports the hypothesis that 25-hydroxyvitamin D is a potential biomarker that plays a clinically significant role in prostate cancer, and it may be a useful modifiable risk factor in the disease. Additionally, differences in 25-hydroxyvitamin D levels may explain ethnic disparities in prostate cancer–specific incidence, morbidity, and mortality," Dr. Murphy and his associates wrote.

This study was supported in part by grants from the National Institutes of Health and the U.S. Department of Defense. Dr. Murphy reported no financial conflicts of interest; one of his coauthors reported ties to Beckman Coulter, DeCode Genetics, and Ohmx.

Among African American men with abnormal prostate-specific antigen levels or abnormal findings on digital rectal examination of the prostate, biopsies are more likely to detect prostate cancer in those who have vitamin D deficiency than in those who don’t, according to a report published online May 1 in Clinical Cancer Research.

And in both American men of European descent and African American men who have vitamin D deficiency, initial biopsies are more likely to show tumors with high Gleason grade and more advanced clinical stage than are tumor biopsies in men who don’t have vitamin D deficiency, reported Dr. Adam B. Murphy of Northwestern University, Chicago, and his coauthors.

Their "novel" findings corroborate "a plethora of in vitro, animal, and clinical data suggesting potential mechanisms for the role of vitamin D in prostate differentiation and tumor progression," the investigators noted.

©Kaspri/Fotolia.com

If vitamin D is involved in prostate cancer initiation or progression, then vitamin D supplements may prove helpful for both primary and secondary prevention, especially in the highest-risk group of African American men, Dr. Murphy and his colleagues said.

The researchers investigated this issue because no prior studies have assessed the association between vitamin D status and prostate biopsy outcomes, even though several have suggested that vitamin D deficiency might explain the disparity between blacks and whites in prostate cancer incidence and survival. "African American men have lower serum vitamin D levels than their European American and Hispanic counterparts, in part due to lower skin synthesis from the ultraviolet-blocking effects of melanin in the skin," Dr. Murphy and his associates said.

They examined these outcomes in an ethnically diverse population of 667 men residing in Chicago, a city with low ultraviolet light exposure. There were 275 European Americans, 273 African Americans, and 119 men of other ethnicities.

The study participants, aged 40-79 years, were enrolled over a 4-year period from five urology clinics. They were undergoing an initial biopsy because of elevated prostate-specific antigen levels and/or abnormal findings on digital rectal exam. Vitamin D status was determined using serum samples collected on the day of biopsy.

Vitamin D deficiency (a 25-hydroxyvitamin D level less than 20 ng/mL) was quite common, affecting 41% of the entire study population. Severe vitamin D deficiency (a 25[OH]D level less than 12 ng/mL) was relatively common, affecting 16%.

Prostate cancer was detected in 383 biopsies.

Vitamin D deficiency was not associated with a biopsy finding of prostate cancer among European American men, but it was strongly associated with a biopsy finding of prostate cancer among African Americans (odds ratio, 2.43). This association remained robust when the data were controlled for patient age, prostate-specific antigen level, family history, and cigarette and alcohol use.

In addition, severe vitamin D deficiency was associated with a higher Gleason score and higher tumor stage in both races, and thus with a higher risk category by National Comprehensive Cancer Network criteria (Clin. Cancer Res. 2014;20:2289-99).

"Our work supports the hypothesis that 25-hydroxyvitamin D is a potential biomarker that plays a clinically significant role in prostate cancer, and it may be a useful modifiable risk factor in the disease. Additionally, differences in 25-hydroxyvitamin D levels may explain ethnic disparities in prostate cancer–specific incidence, morbidity, and mortality," Dr. Murphy and his associates wrote.

This study was supported in part by grants from the National Institutes of Health and the U.S. Department of Defense. Dr. Murphy reported no financial conflicts of interest; one of his coauthors reported ties to Beckman Coulter, DeCode Genetics, and Ohmx.

LAS VEGAS – Patients with chronic kidney disease appear to be at increased risk for cancer, a study showed.

A retrospective analysis of data on 31,896 participants in ALLHAT (the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) showed that during a mean 4.9 years of in-trial follow-up, 2,529 subjects were diagnosed with various cancers.

The 5-year rate of incident cancer was 7.24 cases per 100 person-years among subjects with a baseline normal estimated glomerular filtration rate (eGFR) greater than 90 mL/min per 1.73 m². The cancer rate rose with decreasing renal function: 8.38 cases per 100 person-years in patients with a baseline eGFR of 60-89.9, 9.18 per 100 person-years in those with an eGFR of 45-59.9, and 11.58 per 100 person-years in patients with an eGFR below 45 mL/min per 1.73 m², Dr. Dhruti P. Chen reported at a meeting sponsored by the National Kidney Foundation.

An additional 4 years of follow-up for mortality due to cancer was available through national databases after ALLHAT ended. During the mean total 8.9 years of follow-up, there were 2,338 cancer-related deaths. The 10-year rate of cancer mortality was 7.90 cases per 100 person-years in patients with an eGFR greater than 90; 7.71 in those with an eGFR of 60-89.9; 10.11 per 100 person-years with an eGFR of 45-59.9; and 13.19 per 100 person-years in patients with an eGFR below 45 mL/min per 1.73 m², added Dr. Chen of the department of medicine at Case Western Reserve University, Cleveland.

In a multivariate analysis adjusted for demographics, body mass index, diabetes, cardiovascular risk factors, blood glucose level, and the antihypertensive agent to which a patient was randomized, the association between chronic kidney disease and incident cancer was attenuated. Nonetheless, having a baseline eGFR below 45 mL/min per 1.73 m² was independently associated with an adjusted 28% increased risk of incident cancer during 4.9 years of follow-up, compared with those with an eGFR greater than 90, as well as with a 55% increased risk of cancer mortality during 8.9 years of follow-up.

Colon cancer was the only common type of malignancy whose incidence was significantly increased in patients with chronic kidney disease, although Dr. Chen said she didn’t attach much significance to this finding, given the limited number of cancers that accrued.

In an interview, she observed that a post hoc analysis such as this can’t establish causality or the mechanisms involved. She speculated that the most likely explanation for the findings is that patients with impaired kidney function have incomplete removal of various toxins, some of which are oncogenic.

ALLHAT was funded by the National Heart, Lung, and Blood Institute. Dr. Chen reported having no financial conflicts of interest.

bjancin@frontlinemedcom.com

LAS VEGAS – Patients with chronic kidney disease appear to be at increased risk for cancer, a study showed.

A retrospective analysis of data on 31,896 participants in ALLHAT (the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) showed that during a mean 4.9 years of in-trial follow-up, 2,529 subjects were diagnosed with various cancers.

The 5-year rate of incident cancer was 7.24 cases per 100 person-years among subjects with a baseline normal estimated glomerular filtration rate (eGFR) greater than 90 mL/min per 1.73 m². The cancer rate rose with decreasing renal function: 8.38 cases per 100 person-years in patients with a baseline eGFR of 60-89.9, 9.18 per 100 person-years in those with an eGFR of 45-59.9, and 11.58 per 100 person-years in patients with an eGFR below 45 mL/min per 1.73 m², Dr. Dhruti P. Chen reported at a meeting sponsored by the National Kidney Foundation.

An additional 4 years of follow-up for mortality due to cancer was available through national databases after ALLHAT ended. During the mean total 8.9 years of follow-up, there were 2,338 cancer-related deaths. The 10-year rate of cancer mortality was 7.90 cases per 100 person-years in patients with an eGFR greater than 90; 7.71 in those with an eGFR of 60-89.9; 10.11 per 100 person-years with an eGFR of 45-59.9; and 13.19 per 100 person-years in patients with an eGFR below 45 mL/min per 1.73 m², added Dr. Chen of the department of medicine at Case Western Reserve University, Cleveland.

In a multivariate analysis adjusted for demographics, body mass index, diabetes, cardiovascular risk factors, blood glucose level, and the antihypertensive agent to which a patient was randomized, the association between chronic kidney disease and incident cancer was attenuated. Nonetheless, having a baseline eGFR below 45 mL/min per 1.73 m² was independently associated with an adjusted 28% increased risk of incident cancer during 4.9 years of follow-up, compared with those with an eGFR greater than 90, as well as with a 55% increased risk of cancer mortality during 8.9 years of follow-up.

Colon cancer was the only common type of malignancy whose incidence was significantly increased in patients with chronic kidney disease, although Dr. Chen said she didn’t attach much significance to this finding, given the limited number of cancers that accrued.

In an interview, she observed that a post hoc analysis such as this can’t establish causality or the mechanisms involved. She speculated that the most likely explanation for the findings is that patients with impaired kidney function have incomplete removal of various toxins, some of which are oncogenic.

ALLHAT was funded by the National Heart, Lung, and Blood Institute. Dr. Chen reported having no financial conflicts of interest.

bjancin@frontlinemedcom.com

LAS VEGAS – Patients with chronic kidney disease appear to be at increased risk for cancer, a study showed.

A retrospective analysis of data on 31,896 participants in ALLHAT (the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) showed that during a mean 4.9 years of in-trial follow-up, 2,529 subjects were diagnosed with various cancers.

The 5-year rate of incident cancer was 7.24 cases per 100 person-years among subjects with a baseline normal estimated glomerular filtration rate (eGFR) greater than 90 mL/min per 1.73 m². The cancer rate rose with decreasing renal function: 8.38 cases per 100 person-years in patients with a baseline eGFR of 60-89.9, 9.18 per 100 person-years in those with an eGFR of 45-59.9, and 11.58 per 100 person-years in patients with an eGFR below 45 mL/min per 1.73 m², Dr. Dhruti P. Chen reported at a meeting sponsored by the National Kidney Foundation.

An additional 4 years of follow-up for mortality due to cancer was available through national databases after ALLHAT ended. During the mean total 8.9 years of follow-up, there were 2,338 cancer-related deaths. The 10-year rate of cancer mortality was 7.90 cases per 100 person-years in patients with an eGFR greater than 90; 7.71 in those with an eGFR of 60-89.9; 10.11 per 100 person-years with an eGFR of 45-59.9; and 13.19 per 100 person-years in patients with an eGFR below 45 mL/min per 1.73 m², added Dr. Chen of the department of medicine at Case Western Reserve University, Cleveland.

In a multivariate analysis adjusted for demographics, body mass index, diabetes, cardiovascular risk factors, blood glucose level, and the antihypertensive agent to which a patient was randomized, the association between chronic kidney disease and incident cancer was attenuated. Nonetheless, having a baseline eGFR below 45 mL/min per 1.73 m² was independently associated with an adjusted 28% increased risk of incident cancer during 4.9 years of follow-up, compared with those with an eGFR greater than 90, as well as with a 55% increased risk of cancer mortality during 8.9 years of follow-up.

Colon cancer was the only common type of malignancy whose incidence was significantly increased in patients with chronic kidney disease, although Dr. Chen said she didn’t attach much significance to this finding, given the limited number of cancers that accrued.

In an interview, she observed that a post hoc analysis such as this can’t establish causality or the mechanisms involved. She speculated that the most likely explanation for the findings is that patients with impaired kidney function have incomplete removal of various toxins, some of which are oncogenic.

ALLHAT was funded by the National Heart, Lung, and Blood Institute. Dr. Chen reported having no financial conflicts of interest.

bjancin@frontlinemedcom.com

Men whose benign prostate biopsy cores showed signs of chronic inflammation had more than twice the odds of high-grade prostate cancer, investigators reported online April 18 in Cancer Epidemiology, Biomarkers & Prevention.

The association existed even when prostate-specific antigen was low (less than 2 ng/mL at biopsy), suggesting that the results were not due to detection bias, said Dr. Bora Gurel of Johns Hopkins University, Baltimore, and his associates.

The nested case-control study included 191 patients with biopsy-proven prostate cancer and 209 cancer-free patients from the placebo arm of the Prostate Cancer Prevention Trial. To measure the presence and extent of inflammation, a pathologist who was blinded to case-control status examined stained tissue sections from benign areas of prostate biopsy cores. The presence of any inflammatory cells, both acute inflammatory cells and chronic inflammatory cells (cells with an appearance consistent with that of lymphocytes and macrophages) in the benign tissue for each biopsy core on each slide, were noted.

Signs of inflammation were found in at least one biopsy core in 78.2% of controls, 86.2% of cases overall, and 88.4% of high-grade cases. Most of the signs of inflammation in both controls and cases reflected chronic inflammation.

Men who had at least one biopsy core with inflammation had greater odds of a prostate cancer diagnosis (odds ratio, 1.78; 95% confidence interval, 1.04–3.06) than men who had zero cores with inflammation, and even greater odds of a high-grade diagnosis (OR, 2.24; 95% CI, 1.06-4.71), the researchers reported (Cancer Epidemiol. Biomarkers Prev. 2014 April 18 [doi: 10.1158/1055-9965.EPI-13-1126]).

But it was unclear if inflammation preceded cancer onset, because the biopsy cores were obtained to evaluate patients for prostate cancer, the investigators said.

The finding that inflammation, primarily chronic, in benign prostate tissue is associated with an increased odds of prostate cancer, and high-grade prostate cancer in particular, will inform the etiology of this disease, the investigators concluded.

"Identifying those men at highest risk of developing aggressive disease is the first step in being able to prevent lethal prostate cancer," they said. "Rather than targeting interventions to all healthy men, which may result in unintended harms, if causal, the findings from our work may allow preventive interventions to be targeted to those men who would benefit the most," they wrote.

The National Cancer Institute funded the study. The authors disclosed no relevant financial conflicts of interest.

Men whose benign prostate biopsy cores showed signs of chronic inflammation had more than twice the odds of high-grade prostate cancer, investigators reported online April 18 in Cancer Epidemiology, Biomarkers & Prevention.

The association existed even when prostate-specific antigen was low (less than 2 ng/mL at biopsy), suggesting that the results were not due to detection bias, said Dr. Bora Gurel of Johns Hopkins University, Baltimore, and his associates.

The nested case-control study included 191 patients with biopsy-proven prostate cancer and 209 cancer-free patients from the placebo arm of the Prostate Cancer Prevention Trial. To measure the presence and extent of inflammation, a pathologist who was blinded to case-control status examined stained tissue sections from benign areas of prostate biopsy cores. The presence of any inflammatory cells, both acute inflammatory cells and chronic inflammatory cells (cells with an appearance consistent with that of lymphocytes and macrophages) in the benign tissue for each biopsy core on each slide, were noted.

Signs of inflammation were found in at least one biopsy core in 78.2% of controls, 86.2% of cases overall, and 88.4% of high-grade cases. Most of the signs of inflammation in both controls and cases reflected chronic inflammation.

Men who had at least one biopsy core with inflammation had greater odds of a prostate cancer diagnosis (odds ratio, 1.78; 95% confidence interval, 1.04–3.06) than men who had zero cores with inflammation, and even greater odds of a high-grade diagnosis (OR, 2.24; 95% CI, 1.06-4.71), the researchers reported (Cancer Epidemiol. Biomarkers Prev. 2014 April 18 [doi: 10.1158/1055-9965.EPI-13-1126]).

But it was unclear if inflammation preceded cancer onset, because the biopsy cores were obtained to evaluate patients for prostate cancer, the investigators said.

The finding that inflammation, primarily chronic, in benign prostate tissue is associated with an increased odds of prostate cancer, and high-grade prostate cancer in particular, will inform the etiology of this disease, the investigators concluded.

"Identifying those men at highest risk of developing aggressive disease is the first step in being able to prevent lethal prostate cancer," they said. "Rather than targeting interventions to all healthy men, which may result in unintended harms, if causal, the findings from our work may allow preventive interventions to be targeted to those men who would benefit the most," they wrote.

The National Cancer Institute funded the study. The authors disclosed no relevant financial conflicts of interest.

Men whose benign prostate biopsy cores showed signs of chronic inflammation had more than twice the odds of high-grade prostate cancer, investigators reported online April 18 in Cancer Epidemiology, Biomarkers & Prevention.

The association existed even when prostate-specific antigen was low (less than 2 ng/mL at biopsy), suggesting that the results were not due to detection bias, said Dr. Bora Gurel of Johns Hopkins University, Baltimore, and his associates.

The nested case-control study included 191 patients with biopsy-proven prostate cancer and 209 cancer-free patients from the placebo arm of the Prostate Cancer Prevention Trial. To measure the presence and extent of inflammation, a pathologist who was blinded to case-control status examined stained tissue sections from benign areas of prostate biopsy cores. The presence of any inflammatory cells, both acute inflammatory cells and chronic inflammatory cells (cells with an appearance consistent with that of lymphocytes and macrophages) in the benign tissue for each biopsy core on each slide, were noted.

Signs of inflammation were found in at least one biopsy core in 78.2% of controls, 86.2% of cases overall, and 88.4% of high-grade cases. Most of the signs of inflammation in both controls and cases reflected chronic inflammation.

Men who had at least one biopsy core with inflammation had greater odds of a prostate cancer diagnosis (odds ratio, 1.78; 95% confidence interval, 1.04–3.06) than men who had zero cores with inflammation, and even greater odds of a high-grade diagnosis (OR, 2.24; 95% CI, 1.06-4.71), the researchers reported (Cancer Epidemiol. Biomarkers Prev. 2014 April 18 [doi: 10.1158/1055-9965.EPI-13-1126]).

But it was unclear if inflammation preceded cancer onset, because the biopsy cores were obtained to evaluate patients for prostate cancer, the investigators said.

The finding that inflammation, primarily chronic, in benign prostate tissue is associated with an increased odds of prostate cancer, and high-grade prostate cancer in particular, will inform the etiology of this disease, the investigators concluded.

"Identifying those men at highest risk of developing aggressive disease is the first step in being able to prevent lethal prostate cancer," they said. "Rather than targeting interventions to all healthy men, which may result in unintended harms, if causal, the findings from our work may allow preventive interventions to be targeted to those men who would benefit the most," they wrote.

The National Cancer Institute funded the study. The authors disclosed no relevant financial conflicts of interest.

Background With modern treatment, more than 95% of American men who are diagnosed with testicular cancer will be cured. Although there is growing evidence that these individuals may face heightened risk of cardiovascular disease after chemotherapy, there is a paucity of research to objectively classify health-promoting behaviors in this population and to identify the barriers to improving their health behaviors.

Objectives To identify health behavior patterns in a group of testicular cancer survivors (TCSs) and the barriers to more positive health behaviors and to examine the relationship between barriers, health behaviors, and quality of life (QOL).

Methods TCSs from the Pennsylvania State Cancer Registry who had been diagnosed during 1990-2005 completed a comprehensive survey about QOL, health behaviors, and barriers to optimal healthy behaviors. QOL, health behaviors, and the barriers were assessed for 189 respondents.

Results Smoking (25%), risky drinking (35%), elevated body-mass index (83%), poor diet (95% did not meet the guidelines for fruit and vegetable intake), and inadequate exercise (50%) were common. Barriers to achieving optimal health behaviors were categorized as either cancer-related or competing demands. Cancer-related barriers contributed to worse physical QOL, whereas competing demands related to worse mental-health–related QOL.

Limitations Our sample size was moderate and self-selected. In addition, we used self-reports rather than the more standardized observation or interview-based data collection.

Conclusion TCSs demonstrate behaviors that put them at increased risk for future cardiovascular disease and complications. Interventions aimed at reducing tobacco and risky alcohol use and improving dietary and physical activity levels are needed.

Funding/sponsorship NCI grant number 1R03CA124217; the Livestrong Foundation. Disclosures The authors have no disclosures.

Click on the PDF icon at the top of this introduction to read the full article.

Background With modern treatment, more than 95% of American men who are diagnosed with testicular cancer will be cured. Although there is growing evidence that these individuals may face heightened risk of cardiovascular disease after chemotherapy, there is a paucity of research to objectively classify health-promoting behaviors in this population and to identify the barriers to improving their health behaviors.

Objectives To identify health behavior patterns in a group of testicular cancer survivors (TCSs) and the barriers to more positive health behaviors and to examine the relationship between barriers, health behaviors, and quality of life (QOL).

Methods TCSs from the Pennsylvania State Cancer Registry who had been diagnosed during 1990-2005 completed a comprehensive survey about QOL, health behaviors, and barriers to optimal healthy behaviors. QOL, health behaviors, and the barriers were assessed for 189 respondents.

Results Smoking (25%), risky drinking (35%), elevated body-mass index (83%), poor diet (95% did not meet the guidelines for fruit and vegetable intake), and inadequate exercise (50%) were common. Barriers to achieving optimal health behaviors were categorized as either cancer-related or competing demands. Cancer-related barriers contributed to worse physical QOL, whereas competing demands related to worse mental-health–related QOL.

Limitations Our sample size was moderate and self-selected. In addition, we used self-reports rather than the more standardized observation or interview-based data collection.

Conclusion TCSs demonstrate behaviors that put them at increased risk for future cardiovascular disease and complications. Interventions aimed at reducing tobacco and risky alcohol use and improving dietary and physical activity levels are needed.

Funding/sponsorship NCI grant number 1R03CA124217; the Livestrong Foundation. Disclosures The authors have no disclosures.

Click on the PDF icon at the top of this introduction to read the full article.

Background With modern treatment, more than 95% of American men who are diagnosed with testicular cancer will be cured. Although there is growing evidence that these individuals may face heightened risk of cardiovascular disease after chemotherapy, there is a paucity of research to objectively classify health-promoting behaviors in this population and to identify the barriers to improving their health behaviors.

Objectives To identify health behavior patterns in a group of testicular cancer survivors (TCSs) and the barriers to more positive health behaviors and to examine the relationship between barriers, health behaviors, and quality of life (QOL).

Methods TCSs from the Pennsylvania State Cancer Registry who had been diagnosed during 1990-2005 completed a comprehensive survey about QOL, health behaviors, and barriers to optimal healthy behaviors. QOL, health behaviors, and the barriers were assessed for 189 respondents.

Results Smoking (25%), risky drinking (35%), elevated body-mass index (83%), poor diet (95% did not meet the guidelines for fruit and vegetable intake), and inadequate exercise (50%) were common. Barriers to achieving optimal health behaviors were categorized as either cancer-related or competing demands. Cancer-related barriers contributed to worse physical QOL, whereas competing demands related to worse mental-health–related QOL.

Limitations Our sample size was moderate and self-selected. In addition, we used self-reports rather than the more standardized observation or interview-based data collection.

Conclusion TCSs demonstrate behaviors that put them at increased risk for future cardiovascular disease and complications. Interventions aimed at reducing tobacco and risky alcohol use and improving dietary and physical activity levels are needed.

Funding/sponsorship NCI grant number 1R03CA124217; the Livestrong Foundation. Disclosures The authors have no disclosures.

Click on the PDF icon at the top of this introduction to read the full article.

A case of non–islet cell tumor hypoglycemia caused by recurrent renal cell carcinoma as a result of the production of high-molecular-weight insulinlike growth factor–2 was reported online in the Journal of Clinical Oncology.

Malignant fibrous histiocytoma is the most common origin of non–islet cell tumor hypoglycemia (NICTH), while NICTH caused by renal cell carcinoma is rare, Dr. Shingo Kimura of the Tohoku University, Sendai, Japan, and associates reported (J. Clin. Oncology 2014 April [doi:10.1200/JCO.2013.49.5374]).

The 60-year-old male patient had a history of radial nephrectomy for a left renal tumor 17 years earlier, but no recurrence had been observed as of the 10-year postoperative follow-up. Computed tomography found a relatively homogeneous, hypervascular 20-cm tumor in the left retroperitoneal space. It was widely adherent to the stomach, pancreas, and colon.

Once the tumor was removed, hypoglycemia disappeared immediately, and the patient has remained free from hypoglycemia and tumor recurrence for 1 year postoperatively.

Hypoglycemia can be induced by several different tumors, including islet cell and non–islet cell tumors, the researchers noted. The most common cause of NICTH is the overproduction of the proprotein insulinlike growth factor–2 (IGF-2) because of its high molecular weight. The structure and function of IGF-2 are similar to those of insulin, and the protein may interfere with the insulin receptor and lead to hypoglycemia.

In the patient, there were strongly positive indications of IGF-2 in both the primary renal tumor and the retroperitoneal tumor; however, hypoglycemia had not been observed in the primary renal tumor. While NICTH originating from renal cell carcinoma is rare, three cases have been reported. However, this is the first case of recurrent renal cell carcinoma that led to NICTH, the researchers said.

The authors reported no financial conflicts of interest.

A case of non–islet cell tumor hypoglycemia caused by recurrent renal cell carcinoma as a result of the production of high-molecular-weight insulinlike growth factor–2 was reported online in the Journal of Clinical Oncology.

Malignant fibrous histiocytoma is the most common origin of non–islet cell tumor hypoglycemia (NICTH), while NICTH caused by renal cell carcinoma is rare, Dr. Shingo Kimura of the Tohoku University, Sendai, Japan, and associates reported (J. Clin. Oncology 2014 April [doi:10.1200/JCO.2013.49.5374]).

The 60-year-old male patient had a history of radial nephrectomy for a left renal tumor 17 years earlier, but no recurrence had been observed as of the 10-year postoperative follow-up. Computed tomography found a relatively homogeneous, hypervascular 20-cm tumor in the left retroperitoneal space. It was widely adherent to the stomach, pancreas, and colon.

Once the tumor was removed, hypoglycemia disappeared immediately, and the patient has remained free from hypoglycemia and tumor recurrence for 1 year postoperatively.

Hypoglycemia can be induced by several different tumors, including islet cell and non–islet cell tumors, the researchers noted. The most common cause of NICTH is the overproduction of the proprotein insulinlike growth factor–2 (IGF-2) because of its high molecular weight. The structure and function of IGF-2 are similar to those of insulin, and the protein may interfere with the insulin receptor and lead to hypoglycemia.

In the patient, there were strongly positive indications of IGF-2 in both the primary renal tumor and the retroperitoneal tumor; however, hypoglycemia had not been observed in the primary renal tumor. While NICTH originating from renal cell carcinoma is rare, three cases have been reported. However, this is the first case of recurrent renal cell carcinoma that led to NICTH, the researchers said.

The authors reported no financial conflicts of interest.

A case of non–islet cell tumor hypoglycemia caused by recurrent renal cell carcinoma as a result of the production of high-molecular-weight insulinlike growth factor–2 was reported online in the Journal of Clinical Oncology.

Malignant fibrous histiocytoma is the most common origin of non–islet cell tumor hypoglycemia (NICTH), while NICTH caused by renal cell carcinoma is rare, Dr. Shingo Kimura of the Tohoku University, Sendai, Japan, and associates reported (J. Clin. Oncology 2014 April [doi:10.1200/JCO.2013.49.5374]).

The 60-year-old male patient had a history of radial nephrectomy for a left renal tumor 17 years earlier, but no recurrence had been observed as of the 10-year postoperative follow-up. Computed tomography found a relatively homogeneous, hypervascular 20-cm tumor in the left retroperitoneal space. It was widely adherent to the stomach, pancreas, and colon.

Once the tumor was removed, hypoglycemia disappeared immediately, and the patient has remained free from hypoglycemia and tumor recurrence for 1 year postoperatively.

Hypoglycemia can be induced by several different tumors, including islet cell and non–islet cell tumors, the researchers noted. The most common cause of NICTH is the overproduction of the proprotein insulinlike growth factor–2 (IGF-2) because of its high molecular weight. The structure and function of IGF-2 are similar to those of insulin, and the protein may interfere with the insulin receptor and lead to hypoglycemia.

In the patient, there were strongly positive indications of IGF-2 in both the primary renal tumor and the retroperitoneal tumor; however, hypoglycemia had not been observed in the primary renal tumor. While NICTH originating from renal cell carcinoma is rare, three cases have been reported. However, this is the first case of recurrent renal cell carcinoma that led to NICTH, the researchers said.

The authors reported no financial conflicts of interest.

Women who underwent radical cystectomy for bladder cancer had a small but significant increase in risk of disease recurrence and cancer-related mortality compared with male patients, even after adjustment for clinical and pathologic factors and competing risk of non–cancer-related death, researchers reported in the April issue of Urology.

Women were 1.16 times more likely to have their bladder cancer recur (P = .03) and 1.27 times more likely to die of cancer-related causes (P = .007), compared with men, reported Dr. Jamie C. Messer of the University of Louisville (Ky.) and his associates.

"Our findings support observations of others that women have a worse survival than men among patients with bladder cancer despite adjustment for stage," the investigators wrote (Urology 2014;83:863-8).

Prior studies have reported 5-year bladder cancer survival rates of 73.1% for women vs. 79.5% for men. To further explore the association, the investigators conducted an international, observational cohort analysis of retrospective data from 4,296 patients who underwent radical cystectomy for advanced bladder cancer. In all, 21% of patients were women. The investigators found that 33.9% of patients had disease recurrence at a median of 11 months after surgery, and that the recurrence rate was higher for women (36.8%) than men (33.1%). Cancer-specific death rates also were higher for women (33% vs. 27.2%).

"The factors that contribute to this increased risk remain to be determined," the investigators said. They noted that adjuvant chemotherapy was linked to "surprisingly lower" disease-specific survival on multivariable analysis, which could mean that residual confounding affected the model and influenced the association of gender with mortality.

The authors reported that they had no relevant financial interests.

Women who underwent radical cystectomy for bladder cancer had a small but significant increase in risk of disease recurrence and cancer-related mortality compared with male patients, even after adjustment for clinical and pathologic factors and competing risk of non–cancer-related death, researchers reported in the April issue of Urology.

Women were 1.16 times more likely to have their bladder cancer recur (P = .03) and 1.27 times more likely to die of cancer-related causes (P = .007), compared with men, reported Dr. Jamie C. Messer of the University of Louisville (Ky.) and his associates.

"Our findings support observations of others that women have a worse survival than men among patients with bladder cancer despite adjustment for stage," the investigators wrote (Urology 2014;83:863-8).

Prior studies have reported 5-year bladder cancer survival rates of 73.1% for women vs. 79.5% for men. To further explore the association, the investigators conducted an international, observational cohort analysis of retrospective data from 4,296 patients who underwent radical cystectomy for advanced bladder cancer. In all, 21% of patients were women. The investigators found that 33.9% of patients had disease recurrence at a median of 11 months after surgery, and that the recurrence rate was higher for women (36.8%) than men (33.1%). Cancer-specific death rates also were higher for women (33% vs. 27.2%).

"The factors that contribute to this increased risk remain to be determined," the investigators said. They noted that adjuvant chemotherapy was linked to "surprisingly lower" disease-specific survival on multivariable analysis, which could mean that residual confounding affected the model and influenced the association of gender with mortality.

The authors reported that they had no relevant financial interests.

Women who underwent radical cystectomy for bladder cancer had a small but significant increase in risk of disease recurrence and cancer-related mortality compared with male patients, even after adjustment for clinical and pathologic factors and competing risk of non–cancer-related death, researchers reported in the April issue of Urology.

Women were 1.16 times more likely to have their bladder cancer recur (P = .03) and 1.27 times more likely to die of cancer-related causes (P = .007), compared with men, reported Dr. Jamie C. Messer of the University of Louisville (Ky.) and his associates.

"Our findings support observations of others that women have a worse survival than men among patients with bladder cancer despite adjustment for stage," the investigators wrote (Urology 2014;83:863-8).

Prior studies have reported 5-year bladder cancer survival rates of 73.1% for women vs. 79.5% for men. To further explore the association, the investigators conducted an international, observational cohort analysis of retrospective data from 4,296 patients who underwent radical cystectomy for advanced bladder cancer. In all, 21% of patients were women. The investigators found that 33.9% of patients had disease recurrence at a median of 11 months after surgery, and that the recurrence rate was higher for women (36.8%) than men (33.1%). Cancer-specific death rates also were higher for women (33% vs. 27.2%).

"The factors that contribute to this increased risk remain to be determined," the investigators said. They noted that adjuvant chemotherapy was linked to "surprisingly lower" disease-specific survival on multivariable analysis, which could mean that residual confounding affected the model and influenced the association of gender with mortality.

The authors reported that they had no relevant financial interests.

Daily tadalafil failed to preserve erectile function among men undergoing radiotherapy for prostate cancer, according to investigators. The report was published online April 1 in JAMA.

In what they described as the first study to assess tadalafil for prevention of erectile dysfunction, researchers proposed that in contrast to episodic, on-demand use of the drug, the regular, daily use might maintain erectile function during and after radiotherapy. They tested this treatment against placebo in a randomized double-blind clinical trial (NCT00931528) involving 242 men with stage II prostate adenocarcinoma and intact erectile function. The men were enrolled at 76 community-based and tertiary medical centers in the United States and Canada.

They took 5 mg tadalafil or a matching placebo for 24 weeks, beginning at the start of either external radiotherapy (63%) or brachytherapy (37%), and were followed at intervals for 1-4 years. The primary outcome – retained erectile function 6 weeks after completion of the study agent – was reported by 79% of men who took tadalafil and 74% of those who took placebo. This was not a significant difference, said Dr. Thomas M. Pisansky of the Mayo Clinic, Rochester, Minn., and his associates.

Tadalafil also was no better than placebo at preserving erectile function at the 1-year follow-up (72% vs 71%, respectively). It was no more effective than was placebo for any subgroup of patients, regardless of patient age (younger vs. older than 65 years) or type of radiotherapy. The active drug also failed to outperform placebo on a wide variety of secondary outcomes, including orgasmic function, sexual desire, intercourse satisfaction, fatigue, sexual well-being, marital adjustment, or partners’ sexual satisfaction (JAMA 2014 April 1 [doi:10.1001/jama.2014.2626]).

This study was conducted by the Radiation Therapy Oncology Group, which is supported by the National Cancer Institute, and by Eli Lilly, maker of tadalafil. Dr. Pisansky reported no disclosures.

tor@frontlinemedcom.com

Daily tadalafil failed to preserve erectile function among men undergoing radiotherapy for prostate cancer, according to investigators. The report was published online April 1 in JAMA.

In what they described as the first study to assess tadalafil for prevention of erectile dysfunction, researchers proposed that in contrast to episodic, on-demand use of the drug, the regular, daily use might maintain erectile function during and after radiotherapy. They tested this treatment against placebo in a randomized double-blind clinical trial (NCT00931528) involving 242 men with stage II prostate adenocarcinoma and intact erectile function. The men were enrolled at 76 community-based and tertiary medical centers in the United States and Canada.

They took 5 mg tadalafil or a matching placebo for 24 weeks, beginning at the start of either external radiotherapy (63%) or brachytherapy (37%), and were followed at intervals for 1-4 years. The primary outcome – retained erectile function 6 weeks after completion of the study agent – was reported by 79% of men who took tadalafil and 74% of those who took placebo. This was not a significant difference, said Dr. Thomas M. Pisansky of the Mayo Clinic, Rochester, Minn., and his associates.

Tadalafil also was no better than placebo at preserving erectile function at the 1-year follow-up (72% vs 71%, respectively). It was no more effective than was placebo for any subgroup of patients, regardless of patient age (younger vs. older than 65 years) or type of radiotherapy. The active drug also failed to outperform placebo on a wide variety of secondary outcomes, including orgasmic function, sexual desire, intercourse satisfaction, fatigue, sexual well-being, marital adjustment, or partners’ sexual satisfaction (JAMA 2014 April 1 [doi:10.1001/jama.2014.2626]).

This study was conducted by the Radiation Therapy Oncology Group, which is supported by the National Cancer Institute, and by Eli Lilly, maker of tadalafil. Dr. Pisansky reported no disclosures.

tor@frontlinemedcom.com

Daily tadalafil failed to preserve erectile function among men undergoing radiotherapy for prostate cancer, according to investigators. The report was published online April 1 in JAMA.

In what they described as the first study to assess tadalafil for prevention of erectile dysfunction, researchers proposed that in contrast to episodic, on-demand use of the drug, the regular, daily use might maintain erectile function during and after radiotherapy. They tested this treatment against placebo in a randomized double-blind clinical trial (NCT00931528) involving 242 men with stage II prostate adenocarcinoma and intact erectile function. The men were enrolled at 76 community-based and tertiary medical centers in the United States and Canada.

They took 5 mg tadalafil or a matching placebo for 24 weeks, beginning at the start of either external radiotherapy (63%) or brachytherapy (37%), and were followed at intervals for 1-4 years. The primary outcome – retained erectile function 6 weeks after completion of the study agent – was reported by 79% of men who took tadalafil and 74% of those who took placebo. This was not a significant difference, said Dr. Thomas M. Pisansky of the Mayo Clinic, Rochester, Minn., and his associates.

Tadalafil also was no better than placebo at preserving erectile function at the 1-year follow-up (72% vs 71%, respectively). It was no more effective than was placebo for any subgroup of patients, regardless of patient age (younger vs. older than 65 years) or type of radiotherapy. The active drug also failed to outperform placebo on a wide variety of secondary outcomes, including orgasmic function, sexual desire, intercourse satisfaction, fatigue, sexual well-being, marital adjustment, or partners’ sexual satisfaction (JAMA 2014 April 1 [doi:10.1001/jama.2014.2626]).

This study was conducted by the Radiation Therapy Oncology Group, which is supported by the National Cancer Institute, and by Eli Lilly, maker of tadalafil. Dr. Pisansky reported no disclosures.

tor@frontlinemedcom.com

A DNA methylation marker panel from urine sediments was superior to gold standard tests for predicting recurrence of bladder cancer, investigators reported April 1 in Clinical Cancer Research.

Eighty percent of patients with positive scores on the three-marker panel developed recurrent, biopsy-proven urothelial carcinoma after complete resection of the visible primary tumor (95% confidence interval, 62%-98%), reported Dr. Sheng-Fang Su of University of Southern California Norris Comprehensive Cancer Center, Los Angeles, and his associates.

The panel’s positive predictive value far exceeded the values for cytology (35%; 95% CI, 14%-56%) and cytoscopy (15%; 95% CI, 0-31%), the investigators reported (Clin. Cancer Res. 2014 [doi:10.1158/1078-0432.CCR-13-2637]).

©Sebastian Kaulitzki/thinkstockphotos.com

The prospective study enrolled 90 patients who had undergone transurethral resection of noninvasive urothelial carcinomas (Tis, Ta, T1; grade low high). Median age of patients was 69 years (range, 41-96). Patients with high-grade Ta/T1 tumors had received intravesical Bacillus Calmette-Guerin vaccine or mitomycin C at their physicians’ discretion.

The investigators performed cytology and extracted DNA from 368 urine and bladder wash specimens collected from patients over a seven-year period. Patients also underwent cytoscopy. The investigators used logistic regression to assess the sensitivity and specificity of various combinations of DNA methylation markers.

The optimal panel included a tumor-specific hypermethylated marker (SOX1), an epigenetic marker (IRAK3), and a field defect-associated hypomethylated marker (L1-MET), the researchers said. The panel’s sensitivity was 80% (95% CI, 60%-96%) and specificity was 97% (95% CI, 91%-100%), they reported. The negative predictive value of the panel (74%) resembled that of cytoscopy (80%) and cytology (76%), they said.

Dr. Su and his associates noted that previous marker tests were more sensitive than cytology, including the FDA-approved NMP-22, ImmunoCyst, and UroVysion tests. But these are expensive, labor-intensive, less specific, and benign urinary conditions can compromise their reliability, they added.

A panel like the one used in the study could help clinicians determine the appropriate frequency of follow-up cytology after bladder cancer resection, the investigators said. But they noted that the validation sets were not ideal and that the urine markers should be further explored in a larger, independent cohort.

The National Cancer Institute funded the research. One of the researchers, Dr. Jones, reported having been a consultant and advisory board member of Astex, Lilly, and Zymo. The other authors reported no conflicts of interest.

A DNA methylation marker panel from urine sediments was superior to gold standard tests for predicting recurrence of bladder cancer, investigators reported April 1 in Clinical Cancer Research.

Eighty percent of patients with positive scores on the three-marker panel developed recurrent, biopsy-proven urothelial carcinoma after complete resection of the visible primary tumor (95% confidence interval, 62%-98%), reported Dr. Sheng-Fang Su of University of Southern California Norris Comprehensive Cancer Center, Los Angeles, and his associates.

The panel’s positive predictive value far exceeded the values for cytology (35%; 95% CI, 14%-56%) and cytoscopy (15%; 95% CI, 0-31%), the investigators reported (Clin. Cancer Res. 2014 [doi:10.1158/1078-0432.CCR-13-2637]).

©Sebastian Kaulitzki/thinkstockphotos.com

The prospective study enrolled 90 patients who had undergone transurethral resection of noninvasive urothelial carcinomas (Tis, Ta, T1; grade low high). Median age of patients was 69 years (range, 41-96). Patients with high-grade Ta/T1 tumors had received intravesical Bacillus Calmette-Guerin vaccine or mitomycin C at their physicians’ discretion.

The investigators performed cytology and extracted DNA from 368 urine and bladder wash specimens collected from patients over a seven-year period. Patients also underwent cytoscopy. The investigators used logistic regression to assess the sensitivity and specificity of various combinations of DNA methylation markers.

The optimal panel included a tumor-specific hypermethylated marker (SOX1), an epigenetic marker (IRAK3), and a field defect-associated hypomethylated marker (L1-MET), the researchers said. The panel’s sensitivity was 80% (95% CI, 60%-96%) and specificity was 97% (95% CI, 91%-100%), they reported. The negative predictive value of the panel (74%) resembled that of cytoscopy (80%) and cytology (76%), they said.

Dr. Su and his associates noted that previous marker tests were more sensitive than cytology, including the FDA-approved NMP-22, ImmunoCyst, and UroVysion tests. But these are expensive, labor-intensive, less specific, and benign urinary conditions can compromise their reliability, they added.

A panel like the one used in the study could help clinicians determine the appropriate frequency of follow-up cytology after bladder cancer resection, the investigators said. But they noted that the validation sets were not ideal and that the urine markers should be further explored in a larger, independent cohort.

The National Cancer Institute funded the research. One of the researchers, Dr. Jones, reported having been a consultant and advisory board member of Astex, Lilly, and Zymo. The other authors reported no conflicts of interest.

A DNA methylation marker panel from urine sediments was superior to gold standard tests for predicting recurrence of bladder cancer, investigators reported April 1 in Clinical Cancer Research.

Eighty percent of patients with positive scores on the three-marker panel developed recurrent, biopsy-proven urothelial carcinoma after complete resection of the visible primary tumor (95% confidence interval, 62%-98%), reported Dr. Sheng-Fang Su of University of Southern California Norris Comprehensive Cancer Center, Los Angeles, and his associates.

The panel’s positive predictive value far exceeded the values for cytology (35%; 95% CI, 14%-56%) and cytoscopy (15%; 95% CI, 0-31%), the investigators reported (Clin. Cancer Res. 2014 [doi:10.1158/1078-0432.CCR-13-2637]).

©Sebastian Kaulitzki/thinkstockphotos.com

The prospective study enrolled 90 patients who had undergone transurethral resection of noninvasive urothelial carcinomas (Tis, Ta, T1; grade low high). Median age of patients was 69 years (range, 41-96). Patients with high-grade Ta/T1 tumors had received intravesical Bacillus Calmette-Guerin vaccine or mitomycin C at their physicians’ discretion.

The investigators performed cytology and extracted DNA from 368 urine and bladder wash specimens collected from patients over a seven-year period. Patients also underwent cytoscopy. The investigators used logistic regression to assess the sensitivity and specificity of various combinations of DNA methylation markers.

The optimal panel included a tumor-specific hypermethylated marker (SOX1), an epigenetic marker (IRAK3), and a field defect-associated hypomethylated marker (L1-MET), the researchers said. The panel’s sensitivity was 80% (95% CI, 60%-96%) and specificity was 97% (95% CI, 91%-100%), they reported. The negative predictive value of the panel (74%) resembled that of cytoscopy (80%) and cytology (76%), they said.

Dr. Su and his associates noted that previous marker tests were more sensitive than cytology, including the FDA-approved NMP-22, ImmunoCyst, and UroVysion tests. But these are expensive, labor-intensive, less specific, and benign urinary conditions can compromise their reliability, they added.

A panel like the one used in the study could help clinicians determine the appropriate frequency of follow-up cytology after bladder cancer resection, the investigators said. But they noted that the validation sets were not ideal and that the urine markers should be further explored in a larger, independent cohort.

The National Cancer Institute funded the research. One of the researchers, Dr. Jones, reported having been a consultant and advisory board member of Astex, Lilly, and Zymo. The other authors reported no conflicts of interest.

Only 1.9% of tumor patients who did not have prophylactic antibiotics developed febrile urinary tract infections after flexible cystoscopy, according to research published in the April issue of European Urology.

Even when patients presented with asymptomatic bacteriuria, less than 5% developed UTIs after cystoscopy, said Dr. Harry W. Herr, a urologist at Memorial Sloan-Kettering Cancer Center in New York.

When UTIs occurred, they resolved within 24 hours of starting oral antibiotic therapy and did not involve bacterial sepsis, he reported (Eur. Urol. 2014;65:839-42).

"These data strengthen European guidelines on urologic infections, which state that antibiotic prophylaxis is not recommended before cystoscopy in standard cases," said Dr. Herr. "However, the data also justify avoiding antibiotics in bacteriuric patients."

The prospective registry study enrolled consecutive outpatients with bladder cancer. Patients submitted voided urine samples for culture prior to undergoing flexible cystoscopy, and received no antibiotics before or immediately after. Dr. Herr defined significant bacteriuria as a single-organism culture of greater than 10⁴ colony-forming units per milliliter, and febrile UTI as dysuria and temperature greater than 38° C, or receiving antibiotics from an outside physician for urinary tract symptoms.

Among the 2,010 patients, 489 (24%) had asymptomatic bacteriuria, while 1,521 (76%) had sterile urine, Dr. Herr reported. Thirty-nine patients (1.9%) developed febrile UTI within 30 days of cystoscopy, including 1.1% of noncolonized patients and 4.5% of colonized patients (P = .02).

Cystoscopy is common, and bladder cancer patients have variable risk factors for UTI, so "urologists may need to accept a 4.5% risk of symptomatic UTI to practice antibiotic stewardship by avoiding the overuse (misuse) of unnecessary antibiotics," wrote Dr. Herr.

He relied on patients to self-report UTI and related factors after their first week of follow-up, but he said that this limitation probably did not lead to underdetection of UTIs because most infections develop within several days of cystoscopy.

"It is the responsibility of all physicians to practice antibiotic stewardship and to avoid the unnecessary use of antibiotics where justified," Dr. Herr added. "The current robust data should persuade urologists to do their part."

The study received no funding support, and Dr. Herr reported that he had no conflicts of interest.

Only 1.9% of tumor patients who did not have prophylactic antibiotics developed febrile urinary tract infections after flexible cystoscopy, according to research published in the April issue of European Urology.

Even when patients presented with asymptomatic bacteriuria, less than 5% developed UTIs after cystoscopy, said Dr. Harry W. Herr, a urologist at Memorial Sloan-Kettering Cancer Center in New York.

When UTIs occurred, they resolved within 24 hours of starting oral antibiotic therapy and did not involve bacterial sepsis, he reported (Eur. Urol. 2014;65:839-42).

"These data strengthen European guidelines on urologic infections, which state that antibiotic prophylaxis is not recommended before cystoscopy in standard cases," said Dr. Herr. "However, the data also justify avoiding antibiotics in bacteriuric patients."

The prospective registry study enrolled consecutive outpatients with bladder cancer. Patients submitted voided urine samples for culture prior to undergoing flexible cystoscopy, and received no antibiotics before or immediately after. Dr. Herr defined significant bacteriuria as a single-organism culture of greater than 10⁴ colony-forming units per milliliter, and febrile UTI as dysuria and temperature greater than 38° C, or receiving antibiotics from an outside physician for urinary tract symptoms.

Among the 2,010 patients, 489 (24%) had asymptomatic bacteriuria, while 1,521 (76%) had sterile urine, Dr. Herr reported. Thirty-nine patients (1.9%) developed febrile UTI within 30 days of cystoscopy, including 1.1% of noncolonized patients and 4.5% of colonized patients (P = .02).

Cystoscopy is common, and bladder cancer patients have variable risk factors for UTI, so "urologists may need to accept a 4.5% risk of symptomatic UTI to practice antibiotic stewardship by avoiding the overuse (misuse) of unnecessary antibiotics," wrote Dr. Herr.

He relied on patients to self-report UTI and related factors after their first week of follow-up, but he said that this limitation probably did not lead to underdetection of UTIs because most infections develop within several days of cystoscopy.

"It is the responsibility of all physicians to practice antibiotic stewardship and to avoid the unnecessary use of antibiotics where justified," Dr. Herr added. "The current robust data should persuade urologists to do their part."

The study received no funding support, and Dr. Herr reported that he had no conflicts of interest.

Only 1.9% of tumor patients who did not have prophylactic antibiotics developed febrile urinary tract infections after flexible cystoscopy, according to research published in the April issue of European Urology.

Even when patients presented with asymptomatic bacteriuria, less than 5% developed UTIs after cystoscopy, said Dr. Harry W. Herr, a urologist at Memorial Sloan-Kettering Cancer Center in New York.

When UTIs occurred, they resolved within 24 hours of starting oral antibiotic therapy and did not involve bacterial sepsis, he reported (Eur. Urol. 2014;65:839-42).

"These data strengthen European guidelines on urologic infections, which state that antibiotic prophylaxis is not recommended before cystoscopy in standard cases," said Dr. Herr. "However, the data also justify avoiding antibiotics in bacteriuric patients."

The prospective registry study enrolled consecutive outpatients with bladder cancer. Patients submitted voided urine samples for culture prior to undergoing flexible cystoscopy, and received no antibiotics before or immediately after. Dr. Herr defined significant bacteriuria as a single-organism culture of greater than 10⁴ colony-forming units per milliliter, and febrile UTI as dysuria and temperature greater than 38° C, or receiving antibiotics from an outside physician for urinary tract symptoms.

Among the 2,010 patients, 489 (24%) had asymptomatic bacteriuria, while 1,521 (76%) had sterile urine, Dr. Herr reported. Thirty-nine patients (1.9%) developed febrile UTI within 30 days of cystoscopy, including 1.1% of noncolonized patients and 4.5% of colonized patients (P = .02).

Cystoscopy is common, and bladder cancer patients have variable risk factors for UTI, so "urologists may need to accept a 4.5% risk of symptomatic UTI to practice antibiotic stewardship by avoiding the overuse (misuse) of unnecessary antibiotics," wrote Dr. Herr.

He relied on patients to self-report UTI and related factors after their first week of follow-up, but he said that this limitation probably did not lead to underdetection of UTIs because most infections develop within several days of cystoscopy.

"It is the responsibility of all physicians to practice antibiotic stewardship and to avoid the unnecessary use of antibiotics where justified," Dr. Herr added. "The current robust data should persuade urologists to do their part."

The study received no funding support, and Dr. Herr reported that he had no conflicts of interest.

Routine screening for prostate cancer decreased in Ohio after the U.S. Preventive Services Task Force recommended against it, with a more immediate and pronounced decrease in the urban/academic setting and a less gradual change in suburban and rural settings, researchers reported online in the Journal of Urology.

The decreases in ordering the test were observed in all specialties, the investigators reported. "Interestingly, the greatest impact was seen among urologists," said Dr. Robert Abouassaly and his associates at University Hospitals Case Medical Center, Cleveland.

The incidence of diagnosed prostate cancer rose dramatically in the United States after the Food and Drug Administration approved routine PSA screening in men aged 50 years and older. With that increase came debate about possible overdiagnosis and overtreatment of "clinically insignificant" prostate cancer, the investigators said (J. Urol. 2013 [doi:10.1016/j.juro.2013.12.010]).

Screening trial results published in 2009 led the USPSTF to recommend against routine PSA testing in May 2012, saying the potential risks outweighed the benefits. To assess the impact of the task force recommendations, Dr. Abouassaly and his colleagues performed a regression analysis of all PSA screening tests (n = 43,498) at University Hospitals Case Medical Center and affiliated hospitals in Northeastern Ohio from January 2008 to December 2012.

They found that testing of men aged 50 and older increased significantly across all fields of practice until the first screening trial results were published in March 2009 (P less than .001). After that, screening decreased significantly until May 2012 (P less than .001), when the USPSTF recommendations were published. Screening continued to decrease after that, but the decrease was nonsignificant.

Specialists in internal medicine ordered the most tests (64.9%), followed by family medicine (23.7%), urology (6.1%), and hematology/oncology (1.3%), the investigators said.

Ordering of the screening test declined most at an urban teaching hospital and among urologists, for whom "prostate cancer is a focal point of daily practice," the researchers added.

"Overall we believe that although we detected a statistically significant decrease in PSA use with time, the absolute decrease was small and the clinical significance of our findings is uncertain," said Dr. Abouassaly and his associates. Further studies should investigate the recommendation’s effects on screening, diagnosis, treatment, and prognosis of prostate cancer, they said.

A National Institute of Diabetes and Digestive and Kidney Diseases award supported the study. No investigator disclosures were reported.

Routine screening for prostate cancer decreased in Ohio after the U.S. Preventive Services Task Force recommended against it, with a more immediate and pronounced decrease in the urban/academic setting and a less gradual change in suburban and rural settings, researchers reported online in the Journal of Urology.

The decreases in ordering the test were observed in all specialties, the investigators reported. "Interestingly, the greatest impact was seen among urologists," said Dr. Robert Abouassaly and his associates at University Hospitals Case Medical Center, Cleveland.

The incidence of diagnosed prostate cancer rose dramatically in the United States after the Food and Drug Administration approved routine PSA screening in men aged 50 years and older. With that increase came debate about possible overdiagnosis and overtreatment of "clinically insignificant" prostate cancer, the investigators said (J. Urol. 2013 [doi:10.1016/j.juro.2013.12.010]).

Screening trial results published in 2009 led the USPSTF to recommend against routine PSA testing in May 2012, saying the potential risks outweighed the benefits. To assess the impact of the task force recommendations, Dr. Abouassaly and his colleagues performed a regression analysis of all PSA screening tests (n = 43,498) at University Hospitals Case Medical Center and affiliated hospitals in Northeastern Ohio from January 2008 to December 2012.

They found that testing of men aged 50 and older increased significantly across all fields of practice until the first screening trial results were published in March 2009 (P less than .001). After that, screening decreased significantly until May 2012 (P less than .001), when the USPSTF recommendations were published. Screening continued to decrease after that, but the decrease was nonsignificant.

Specialists in internal medicine ordered the most tests (64.9%), followed by family medicine (23.7%), urology (6.1%), and hematology/oncology (1.3%), the investigators said.

Ordering of the screening test declined most at an urban teaching hospital and among urologists, for whom "prostate cancer is a focal point of daily practice," the researchers added.

"Overall we believe that although we detected a statistically significant decrease in PSA use with time, the absolute decrease was small and the clinical significance of our findings is uncertain," said Dr. Abouassaly and his associates. Further studies should investigate the recommendation’s effects on screening, diagnosis, treatment, and prognosis of prostate cancer, they said.

A National Institute of Diabetes and Digestive and Kidney Diseases award supported the study. No investigator disclosures were reported.

Routine screening for prostate cancer decreased in Ohio after the U.S. Preventive Services Task Force recommended against it, with a more immediate and pronounced decrease in the urban/academic setting and a less gradual change in suburban and rural settings, researchers reported online in the Journal of Urology.

The decreases in ordering the test were observed in all specialties, the investigators reported. "Interestingly, the greatest impact was seen among urologists," said Dr. Robert Abouassaly and his associates at University Hospitals Case Medical Center, Cleveland.

The incidence of diagnosed prostate cancer rose dramatically in the United States after the Food and Drug Administration approved routine PSA screening in men aged 50 years and older. With that increase came debate about possible overdiagnosis and overtreatment of "clinically insignificant" prostate cancer, the investigators said (J. Urol. 2013 [doi:10.1016/j.juro.2013.12.010]).

Screening trial results published in 2009 led the USPSTF to recommend against routine PSA testing in May 2012, saying the potential risks outweighed the benefits. To assess the impact of the task force recommendations, Dr. Abouassaly and his colleagues performed a regression analysis of all PSA screening tests (n = 43,498) at University Hospitals Case Medical Center and affiliated hospitals in Northeastern Ohio from January 2008 to December 2012.

They found that testing of men aged 50 and older increased significantly across all fields of practice until the first screening trial results were published in March 2009 (P less than .001). After that, screening decreased significantly until May 2012 (P less than .001), when the USPSTF recommendations were published. Screening continued to decrease after that, but the decrease was nonsignificant.

Specialists in internal medicine ordered the most tests (64.9%), followed by family medicine (23.7%), urology (6.1%), and hematology/oncology (1.3%), the investigators said.

Ordering of the screening test declined most at an urban teaching hospital and among urologists, for whom "prostate cancer is a focal point of daily practice," the researchers added.

"Overall we believe that although we detected a statistically significant decrease in PSA use with time, the absolute decrease was small and the clinical significance of our findings is uncertain," said Dr. Abouassaly and his associates. Further studies should investigate the recommendation’s effects on screening, diagnosis, treatment, and prognosis of prostate cancer, they said.

A National Institute of Diabetes and Digestive and Kidney Diseases award supported the study. No investigator disclosures were reported.