Prostatic Neoplasms: Nadler RB

Kawachi MH, Bahnson RR, Barry M, Carroll PR, Carter HB, Catalona WJ, Epstein JI, Etzioni RB, Hemstreet GP, Howe RJ, Kopin JD, Lange PH, Lilja H, Mohler J, Moul J, Nadler RB, Patterson S, Pollack A, Presti JC, Stroup AM, Urban DA, Wake R, Wei JT, Anonymous00333. · No affiliation provided · J Natl Compr Canc Netw. · Pubmed #17692177 No free full text.

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Nadler RB. · No affiliation provided · Cancer. · Pubmed #18661528 No free full text.

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Loeb S, Nadler RB. · Northwestern Medical Faculty Foundation, 675 North Saint Clair Street, Suite 20-150, Chicago, IL 60611, USA. · Curr Urol Rep. · Pubmed #16630523 No free full text.

Abstract: External beam radiation therapy (EBRT) and brachytherapy are common treatment modalities for newly diagnosed prostate cancer. What complications can patients and physicians expect following these therapies? How are these conditions diagnosed and treated? In this article, we examine several of the most common acute and delayed complications of radiation therapy for prostate cancer. In addition, we discuss appropriate follow-up diagnostics for these patients and our suggestions for management of the main complications that may develop.

Meeks JJ, Zhao L, Greco KA, Macejko A, Nadler RB. · Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60611, USA. · Urology. · Pubmed #19022491 No free full text.

Abstract: OBJECTIVES: Robotic-assisted laparoscopic prostatectomy (RALP) is becoming widely used for the management of prostate cancer. Although prostate size does not affect operative times for RALP, the effect of a large median prostate lobe has not been described. METHODS: One hundred fifty-four men underwent RALP by one surgeon between 2005 and 2007. Patients were categorized into 2 groups based on the presence or absence of a large median prostate lobe identified during RALP. The RALP was divided into sections from bladder mobilization to vesicourethral anastomosis. Operative times and outcomes were recorded prospectively. RESULTS: Of the 154 patients, 29 (18%) of the men had large median prostate lobes. Men with large median lobes were slightly older, but had similar prostate-specific antigen, body mass index, clinical and pathologic stage, biopsy and prostatectomy Gleason grade, tumor volumes, and surgical margin rate compared with men without median lobes. Yet, prostate weight, estimated blood loss, and hospital stay was significantly greater in men with large median lobes. The overall operative time for the RALP was greater in men with a large median lobe caused by an increased time required for posterior bladder neck and seminal vesicle dissection. There was no difference in complications such as urine leaks, bladder neck contractures, and migration of Hem-o-lok clips into the bladder. Continence at 3 and 6 months after RALP were not significantly different in men with large median lobes. CONCLUSIONS: Despite equivalent oncological outcomes, we demonstrate a significant increase in operative times among men with large median lobes.

Loeb S, Roehl KA, Catalona WJ, Nadler RB. · Department of Urology, Johns Hopkins School of Medicine, Baltimore, MD, USA. · BJU Int. · Pubmed #18321315 No free full text.

Abstract: OBJECTIVE: To determine whether prostate-specific antigen velocity (PSAV) is useful for prostate cancer detection in men from different age groups, and whether the same PSAV thresholds can reasonably be applied to all men aged >or=40 years. PATIENTS AND METHODS: From a large prostate cancer screening study, 13,615 men had data on age and a calculable PSAV. We used statistical analysis to examine the ability of PSAV to predict prostate cancer risk in each age decade. RESULTS: For men of all ages, the median PSAV was 0.6-0.7 ng/mL/year in men with prostate cancer, and 0-0.1 ng/mL/year in men with no prostate cancer (P < 0.005 for all). On receiver operating characteristic (ROC) analysis, the area under the curve was 0.800, 0.697, 0.693, and 0.668 for predicting prostate cancer risk using PSAV for men aged 40-49, 50-59, 60-69 and >or=70 years, respectively. In the multivariate model controlling for race, family history, and the total PSA level, both PSA and PSAV were significant independent predictors of prostate cancer risk in men of all ages. CONCLUSIONS: The PSAV is significantly higher in men of all ages with prostate cancer compared with men with no prostate cancer; although on ROC analysis it performed the best in young men. Interestingly, the median PSAV in men with prostate cancer was <0.75 ng/mL/year regardless of age, suggesting that this threshold may be too high. Overall, this data confirms that PSAV is a useful tool for prostate cancer detection for men aged >or=40 years.

Loeb S, Roehl KA, Nadler RB, Yu X, Catalona WJ. · Department of Urology, the James Buchanan Brady Urological Institute, the Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. · J Urol. · Pubmed #17936844 No free full text.

Abstract: PURPOSE: A prostate specific antigen velocity threshold of 0.75 ng/ml per year has commonly been used to distinguish men with prostate cancer from those with benign prostate conditions. In addition, a prostate specific antigen velocity greater than 2 ng/ml per year has been linked to an increased prostate cancer specific mortality rate after radical prostatectomy and after radiation therapy. However, both of these frequently cited thresholds were determined largely in groups of men with a prostate specific antigen greater than 4 ng/ml. MATERIALS AND METHODS: Of approximately 26,000 men who participated in a prostate cancer screening study 22,019 had a prostate specific antigen of 4 ng/ml or less. Of these men 501 were diagnosed with prostate cancer and had sufficient data for a prostate specific antigen velocity calculation. We performed univariate and multivariate analyses to compare cancer detection rates and performance characteristics using various prostate specific antigen velocity thresholds in these men. RESULTS: In men with a prostate specific antigen less than 4 ng/ml, a prostate specific antigen velocity threshold of 0.4 ng/ml per year was most useful for recommending prostate biopsy. Overall prostate cancer was diagnosed in 223 (2%) men with a prostate specific antigen velocity less than 0.4 ng/ml per year compared to 278 (13%) men with a prostate specific antigen velocity greater than 0.4 ng/ml per year (p <0.0001). On multivariate analysis a prostate specific antigen velocity greater than 0.4 ng/ml per year was a stronger independent predictor of prostate cancer diagnosis than age, race or a family history of prostate cancer. CONCLUSIONS: The traditional prostate specific antigen threshold of 0.75 ng/ml per year was determined largely in men with a total prostate specific antigen of 4 to 10 ng/ml. Prostate specific antigen velocity thresholds in the range of 0.4 ng/ml per year should be used to help guide the need for biopsy in men with a total prostate specific antigen less than 4 ng/ml.

Loeb S, Nadler RB, Roehl KA, Antenor JA, Catalona WJ. · Department of Urology, Georgetown University School of Medicine, Washington, DC, USA. · J Urol. · Pubmed #17437803 No free full text.

Abstract: PURPOSE: We previously reported that the median prostate specific antigen for men 40 to 49 years old is 0.7 ng/ml and that a baseline prostate specific antigen between 0.7 and 2.5 ng/ml is associated with a 14.6-fold increased risk of prostate cancer. Although this suggests the need for close followup of men in their 40s with a prostate specific antigen level greater than 0.7 ng/ml, the appropriate screening strategy for men with a level less than the age specific median is unclear. MATERIALS AND METHODS: From a large prostate cancer screening study 581 participants 40 to 49 years old with a baseline prostate specific antigen level less than 0.7 ng/ml were identified. All men were classified as high risk due to a positive family history and/or black heritage. Changes in prostate specific antigen over time, the cancer detection rate and pathological tumor features were examined as a function of the baseline prostate specific antigen. RESULTS: At a median followup of 13 months 2 patients with an initial prostate specific antigen level less than 0.7 ng/ml reached the threshold for biopsy, and a single patient was diagnosed with prostate cancer. A significantly greater proportion of men with a baseline prostate specific antigen level greater than the age specific median had a prostate specific antigen velocity greater than 0.75 ng/ml per year (9% vs 3%, p=0.009) and were diagnosed with prostate cancer before age 50 (4.6% vs 0.16%, p<0.0001). CONCLUSIONS: Men 40 to 49 years old with a prostate specific antigen less than the age specific median have a low risk of prostate cancer in the short term. Performing a baseline prostate specific antigen measurement in the fifth decade led to few additional biopsies, and was extremely useful for risk stratification since men with levels greater or less than the age specific median had strikingly different risk profiles.

Loeb S, Roehl KA, Catalona WJ, Nadler RB. · Department of Urology, Georgetown University School of Medicine, Washington, DC, USA. · J Urol. · Pubmed #17296371 No free full text.

Abstract: PURPOSE: Longitudinal changes in prostate specific antigen are increasingly used to guide the recommendation for biopsy. Prostate specific antigen velocity 0.75 ng/ml yearly has been proposed to distinguish prostate cancer from benign prostate conditions. However, this threshold might be too high in young men with lower total prostate specific antigen. MATERIALS AND METHODS: In a large prostate cancer screening study 6,844 men were 60 years or younger at study entry and prostate specific antigen velocity calculation was possible. Of these men 346 (5%) were subsequently diagnosed with prostate cancer and various prostate specific antigen velocity thresholds were examined for prediction of prostate cancer risk. Multivariate analysis was performed to determine whether prostate specific antigen velocity is an independent predictor of prostate cancer in men younger than 60 years. RESULTS: Median prostate specific antigen velocity was significantly higher in men who were later diagnosed with prostate cancer than in those who were not (0.840 vs 0.094 ng/ml yearly, p<0.0001). On multivariate analysis prostate specific antigen velocity greater than 0.4 ng/ml yearly was more predictive of prostate cancer than age, total prostate specific antigen, family history or race. Multivariate analysis in the subgroup of men with total prostate specific antigen less than 2.5 ng/ml had similar results. Overall a cutoff of 0.4 ng/ml yearly was associated with 67.3% sensitivity, 81.2% specificity, 16% positive predictive value and 98% negative predictive value for prostate cancer detection in young men. CONCLUSIONS: The traditional prostate specific antigen velocity threshold of 0.75 ng/ml yearly is too high for men younger than 60 years and it misses 48% of prostate cancers. Young men with prostate specific antigen velocity greater than 0.4 ng/ml yearly are at significantly greater risk for prostate cancer and close followup is warranted.

Loeb S, Yu X, Nadler RB, Roehl KA, Han M, Hawkins SA, Catalona WJ. · Department of Urology, Georgetown University School of Medicine, Washington, DC, USA. · J Urol. · Pubmed #17162013 No free full text.

Abstract: PURPOSE: Several studies suggest that obesity may be associated with more aggressive prostate cancer. Similarly the rate of serum prostate specific antigen change is associated with adverse tumor features and prostate cancer specific mortality rates after radical prostatectomy and radiation therapy. We examined the associations among obesity, prostate specific antigen velocity and adverse tumor features in men treated with radical prostatectomy. MATERIALS AND METHODS: A total of 587 men with documented preoperative height and weight measurements underwent radical prostatectomy. Prostate specific antigen velocity and other clinicopathological features were compared among men with a body mass index of less than 25, 25 to 29.9 and 30 or greater. RESULTS: Although Gleason score and prostate volume were similar among groups, there was a significantly lower proportion with organ confined disease and fewer low volume tumors as body mass index increased. Of patients with a body mass index of 30 or greater 52% had a preoperative prostate specific antigen velocity of more than 2 ng/ml yearly compared to 34% with a body mass index of 25 to 29.9 and 26% with a body mass index of less than 25 (p = 0.04). Although on univariate analysis body mass index was associated with adverse clinical and pathological tumor features, on multivariate analysis with other preoperative variables body mass index did not add significant independent predictive information concerning pathological stage (OR 1.02, 95% CI 0.96-1.08). CONCLUSIONS: Obesity was significantly associated with several adverse pathological features. However, it did not provide independent predictive information concerning final pathological tumor stage. Nevertheless, obesity was significantly associated with increased preoperative prostate specific antigen velocity. Additional studies are needed to further clarify the links between body mass index, prostate specific antigen velocity and prostate cancer progression, and determine whether weight reduction could lead to improved outcomes.

Loeb S, Roehl KA, Antenor JA, Catalona WJ, Suarez BK, Nadler RB. · Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA. · Urology. · Pubmed #16442597 No free full text.

Abstract: OBJECTIVES: Limited data are available concerning the extent to which the initial prostate-specific antigen (PSA) measurement in men younger than age 60 predicts for the risk of prostate cancer (CaP) and how this compares to other known risk factors. METHODS: From 1991 to 2001, 13,943 men younger than 60 years old participated in a CaP screening study. Men aged 40 to 49 years were eligible for the study if they had a positive family history or African-American heritage, and men older than 50 years were screened without respect to risk factors. The CaP detection rate, PSA velocity, pathologic features, and treatment outcomes were evaluated as a function of the baseline PSA level. RESULTS: The median PSA level was 0.7 ng/mL for men aged 40 to 49 years and 0.9 ng/mL for men aged 50 to 59. A baseline PSA level between the median and 2.5 ng/mL was associated with a 14.6-fold and 7.6-fold increased risk of CaP in men aged 40 to 49 and 50 to 59 years, respectively. A greater baseline PSA value was also associated with a significantly greater PSA velocity, more aggressive tumor features, a greater biochemical progression rate, and a trend toward a greater cancer-specific mortality rate. CONCLUSIONS: In men younger than 60, a baseline PSA value between the age-specific median and 2.5 ng/mL was a significant predictor of later CaP and was associated with a significantly greater PSA velocity. A young man's baseline PSA value was a stronger predictor of CaP than family history, race, or suspicious digital rectal examination findings. A greater baseline PSA level was associated with significantly more adverse pathologic features and biochemical progression.

Nadler RB, Loeb S, Roehl KA, Antenor JA, Eggener S, Catalona WJ. · Department of Urology, Feinberg School of Medicine, Northwestern University Medical Faculty Foundation, 675 North Saint Clair Street, Chicago, IL 60611, USA. · J Urol. · Pubmed #16280754 No free full text.

Abstract: PURPOSE: Since the United States Food and Drug Administration approved the prostate specific antigen (PSA) blood test as an aid to early prostate cancer detection, using a cutoff of 4.0 ng/ml in 1994, this cutoff has been widely adopted to recommend prostate biopsy. There has been recent investigation into lowering the PSA prompt for biopsy, especially in men younger than 60 years. We determined how a lower cutoff would perform in men older than 60 years. MATERIALS AND METHODS: From a prostate cancer screening study we studied 782 consecutive men who underwent prostate biopsy for PSA greater than 2.5 ng/ml or suspicious digital rectal examination. Biopsy results were evaluated as a function of patient age. RESULTS: Clinical and pathological characteristics of cancers detected in the PSA range 2.6 to 4.0 ng/ml were similar regardless of patient age. Overall PSA between 2.6 and 4.0 ng/ml was associated with a cancer detection rate of 16.2% using a sextant biopsy technique. PSA velocity was similar in men with prostate cancer in all age groups. CONCLUSIONS: More than 15% of men with PSA 2.6 to 4.0 ng/ml who are 40 years or older have prostate cancer detected with sextant needle biopsies. PSA velocity, tumor stage, Gleason grade and tumor volume were similar in all age groups.

Knight SJ, Siston AK, Chmiel JS, Slimack N, Elstein AS, Chapman GB, Nadler RB, Bennett CL. · Mental Health Service, Research and Development, Department of Veterans Affairs Medical Center, San Francisco 94121, USA. · Clin Prostate Cancer. · Pubmed #15279688 No free full text.

Abstract: Ethnic variations that may influence the preferences and outcomes associated with prostate cancer treatment are not well delineated. Our objective was to evaluate prospectively preferences, optimism, involvement in care, and quality of life (QOL) in black and white veterans newly diagnosed with localized prostate cancer. A total of 95 men who identified themselves as black/African-American or white who had newly diagnosed, localized prostate cancer completed a "time trade-off" task to assess utilities for current health and mild, moderate, and severe functional impairment; importance rankings for attributes associated with prostate cancer (eg, urinary function); and baseline and follow-up measures of optimism, involvement in care, and QOL. Interviews were scheduled before treatment, and at 3 and 12 months after treatment. At baseline, both blacks and whites ranked pain, bowel, and bladder function as their most important concerns. Optimism, involvement in care, and QOL were similar. Utilities for mild impairment were lower for blacks than whites, but were similar for moderate and severe problems. Decline in QOL at 3 and 12 months compared to baseline occurred for both groups. However, even with adjustment for marital status, education level, and treatment, blacks had less increase in nausea and vomiting and more increase in difficulty with sexual interest and weight gain compared with whites. Black and white veterans entered localized prostate cancer treatment with similar priorities, optimism, and involvement in care. Quality-of-life declines were common to both groups during the first year after diagnosis, but ethnic variation occurred with respect to nausea and vomiting, sexual interest, and weight gain.

Antenor JA, Han M, Roehl KA, Nadler RB, Catalona WJ. · Departments of Neurology, Washington University, School of Medicine, St. Louis, Missouri, USA. · J Urol. · Pubmed #15201744 No free full text.

Abstract: PURPOSE: Previous studies of archived blood samples from nonscreened populations have shown an association between the prostate specific antigen (PSA) and the subsequent detection of prostate cancer. In the current study we evaluated the relationship between the initial screening PSA and the subsequent risk of prostate cancer detected in a prospective, longitudinal screening study. We also examined the relationship between initial PSA and the clinicopathological features of the cancers detected. MATERIALS AND METHODS: Between May 1991 and November 2001 we enrolled 26,111 volunteers in our PSA and digital rectal examination based prostate cancer screening study. The men were followed biannually or annually depending on the results of previous screening tests. The chi-square and Kruskal-Wallis tests were used to compare the clinical stage, pathological stage and Gleason score of subsequently detected prostate cancers as well as the time to cancer detection in different initial screening PSA strata. RESULTS: The initial screening PSA stratum was strongly associated with the subsequent detection of prostate cancer as well as the clinicopathological stage and grade of the cancers detected. CONCLUSIONS: Even in the lower PSA ranges initial screening serum PSA can help identify men at increased risk for subsequent prostate cancer detected in a longitudinal screening study.

Elstein AS, Chapman GB, Chmiel JS, Knight SJ, Chan C, Nadler RB, Kuzel TM, Siston AK, Bennett CL. · Department of Medical Education, University of Illinois at Chicago, Chicago, IL, USA. · Health Expect. · Pubmed #15117386 No free full text.

Abstract: PURPOSE: To examine the agreement between prostate cancer patients' utilities for selected health states and their rankings of the importance of six attributes of the health states and the clinicians' judgements of what would be in the patients' best interests. METHOD: Patients with newly diagnosed localized prostate cancer individually completed a time trade-off utility assessment shortly after being diagnosed. The health states evaluated were constructed from a multi-attribute utility model that incorporated six aspects of living with the disease and outcomes of treatment. Each patient assessed his current health state and three hypothetical states that might occur in the future, and provided rankings of the importance of the six attributes. The clinicians caring for each patient independently provided their views of what utilities and importance rankings would be in the patient's best interest. RESULTS: The across-participant correlations between patients' and clinicians' utilities were very low and not statistically significant. Across-participant correlations between patient and clinician importance rankings for the six attributes were also low. Across-health state and across-attribute correlations between utilities or importance rankings were highly variable across patient-clinician pairs. CONCLUSION: In the clinical settings studied, there is not a strong relationship between valuations of current and possible future health states by patients with newly diagnosed prostate cancer and their clinicians. Implications of these results for substituted judgement, when clinicians advise their patients or recommend a treatment strategy, are discussed.

Siston AK, Knight SJ, Slimack NP, Chmiel JS, Nadler RB, Lyons TM, Kuzel TM, Moran EM, Sharifi R, Bennett CL, Anonymous00277. · Department of Psychiatry and Behavioral Sciences, Northwestern University Medical School, Chicago, Illinois 60611, USA. · Urology. · Pubmed #12559291 No free full text.

Abstract: OBJECTIVES: To evaluate prospectively the health-related and disease-specific quality of life (QOL) at diagnosis and during the first year thereafter for patients with newly diagnosed prostate cancer who received care at Veterans Affairs Medical Centers. METHODS: Interviewers administered the European Organization for Research and Treatment of Cancer-QOL Questionnaire, a valid and reliable measure of health status, to 140 patients with prostate cancer at baseline (at diagnosis, before the initiation of treatment) and at 3 and 12 months thereafter at five Veterans Affairs Medical Centers. The mean changes from baseline values were analyzed statistically for patients with localized disease stratified by treatment group and separately for patients with metastatic disease. RESULTS: Among the 98 men with localized prostate cancer, significant disease-specific QOL changes noted at 3 and 12 months included worsening of urinary and sexual function among men treated with radical prostatectomy or radiotherapy and worsening of urinary function among those who opted for watchful waiting (each P <0.05). Among the 42 men with metastatic prostate cancer, significant decrements in role and social and sexual function were noted at 3 months, but had resolved on average by 12 months of follow-up. CONCLUSIONS: At 12 months, disease-specific QOL decrements persisted for patients with localized disease, but for patients with metastatic disease, disease-specific QOL appeared to return to near baseline (at diagnosis, before treatment initiation) function. Our study, among the first to assess the QOL at baseline before treatment, provides meaningful information on general treatment effects, which are directly relevant to clinicians when discussing treatment options with patients.

Kim SP, Knight SJ, Tomori C, Colella KM, Schoor RA, Shih L, Kuzel TM, Nadler RB, Bennett CL. · Division of Hematology/Oncology, Medical School, Chicago, Illinois, USA. · Cancer Invest. · Pubmed #11577809 No free full text.

Abstract: Quality of life (QOL) considerations are important in the treatment decision making process for prostate cancer patients. Although patient involvement in the treatment decision process has been encouraged, low health literacy can limit patient understanding of the complex information about treatments and their probable QOL outcomes and is a barrier to patient participation in the decision-making process. The objectives of the study were to evaluate (i) knowledge, level of satisfaction, and treatment preferences and intentions of men newly diagnosed with prostate cancer after participation in a CD-ROM shared decision making program; and (ii) the relationship between prostate cancer knowledge and health literacy. Thirty newly diagnosed prostate cancer patients from two Veteran's Administration (VA) hospitals in Chicago completed a demographic questionnaire and participated in an interactive CD-ROM shared decision making program. Subsequently, knowledge of prostate cancer, satisfaction with the information in the computer CD-ROM program, treatment preferences, and likelihood of following treatment preferences were assessed using interviewer-administered questionnaires. Health literacy was assessed using the Rapid Estimate of Adult Literacy in Medicine (REALM). The Pearson correlation test was used to assess the relationship between health literacy and prostate cancer knowledge. The chi2 test and the Fischer exact test were used to evaluate relationships between patient demographics and other variables. More than three-quarters of the patients rated the information in the CD-ROM as "very satisfactory" (highest possible rating). Two-thirds of the patients (21 of 30) selected a treatment after participation in the CD-ROM program and 90.5% of these patients stated that they were very or somewhat likely to adhere to their selection. However, prostate cancer knowledge was variable, with one-third of the patients scoring 69.9% or lower. Participants' health literacy was equivalent to a 7th-8th grade reading level (mean = 57.1+/-10.9), and more than one-third of participants (36.7%) had lower than 9th grade literacy levels. Participants' prostate cancer knowledge was correlated with health literacy (Pearson correlation rhor = 0.65, rhop = 0.0001). Patients were satisfied with the interactive shared decision making CD-ROM program, and two-thirds of patients were able to select a preferred treatment based on the information presented in the program that they intended to follow. However, prostate cancer knowledge scores varied among participants after participation in the CD-ROM program, raising doubts that patients were adequately informed to make appropriate choices regarding their treatment. Lower prostate cancer knowledge scores corresponded to lower literacy scores, indicating that low literacy may have hindered patient understanding of the shared decision making program. The development of shared decision making tools should include collaborative efforts with the target population to improve the success of shared decision making programs among patients with low health literacy.

Knight SJ, Chmiel JS, Sharp LK, Kuzel T, Nadler RB, Fine R, Moran EM, Sharifi R, Bennett CL. · Veterans Affairs Chicago Health Care System, Lakeside Division, Chicago, Illinois, USA. · Urology. · Pubmed #11182336 No free full text.

Abstract: OBJECTIVES: To examine the reliability and validity of spousal assessments by evaluating the collateral quality-of-life (QOL) ratings of patients of lower socioeconomic status with metastatic prostate cancer because collateral ratings provide supplemental information when advanced cancer limits patient self-report. METHODS: Patients with Stage D2 prostate cancer (n = 36) of lower socioeconomic status completed validated QOL instruments (Functional Assessment of Cancer Therapy-General [FACT-G], European Organization for Research and Treatment of Cancer-Quality of Life-30, and Quality of Life Index). Spouses completed a modified FACT-G, and physicians rated performance status using Karnofsky's scale. RESULTS: The internal consistency reliability was moderate to high for patient ratings on all FACT-G subscales and for spousal ratings on the modified FACT-G physical, functional, and emotional subscales. The spouses' ratings of the patients on the social and doctor relationship subscales were below the accepted criterion for a measure's use in group comparisons. The comparisons of the mean values of the FACT-G revealed agreement between patients and spouses, except that the spouses rated the patients as having poorer emotional function than did the patients. The intraclass correlations were moderate to high for the functional and emotional subscales and were low, but significant, for the physical and social subscales. The patient and spouse FACT-G ratings correlated with the patient ratings and physician ratings across the instruments for the functional and physical domains (r = 0.48 to 0.77, for patients; r = 0.31 to 0.70, for spouses), with less consistent relationships for the social and emotional domains. CONCLUSIONS: The collateral QOL assessments from spouses are potentially useful in assessing the functional status in patients of lower socioeconomic status with metastatic prostate cancer. For subjective domains, such as the social domain, direct patient assessments are needed.

Chapman GB, Elstein AS, Kuzel TM, Nadler RB, Sharifi R, Bennett CL. · Rutgers University, Department of Psychology, Piscataway, NJ 08854-8020, USA. · Qual Life Res. · Pubmed #10472149 No free full text.

Abstract: Multi-attribute utility theory (MAUT) provides a way to model decisions involving trade-offs among different aspects or goals of a problem. We used MAUT to model prostate cancer patients' preferences for their own health state and we compared this model to patients' global judgments of health state utility. 57 patients with prostate cancer (mean age = 70) at two Chicago Veterans Administration health clinics were asked to evaluate health states described in terms of five health attributes affected by prostate cancer: pain, mood, sexual function, bladder and bowel function, and fatigue and energy. Each attribute had three levels that were used to form three clinically realistic health state descriptions (A = high, B = moderate, C = low). A fourth personalized health description (P) matched the patient's current health. We first measured patients' preferences using time trade-off (TTO) judgments for the three health states (A, B, and C) and for their own current health state (P). The TTO for the patient's own health state (P) was standardized by comparing it to TTO judgments for states A and C. We next constructed a multi-attribute model using the relative importance of the five attributes. The MAU scores were moderately correlated with the TTO preference judgments for the personalized state (Pearson r = 0.38, N = 57, p < 0.01). Thus, patients' preference judgments are moderately consistent and systematic. MAUT appears to be a potentially feasible method for evaluating preferences of prostate cancer patients and may prove helpful in assisting with patient decision making.

Gann PH, Klein KG, Chatterton RT, Ellman AE, Grayhack JT, Nadler RB, Lee C. · Department of Preventive Medicine and Robert H. Lurie Cancer Center, Northwestern University Medical School, Chicago, Illinois, USA. · Prostate. · Pubmed #10420153 No free full text.

Abstract: BACKGROUND: Although growth factors such as epidermal growth factor (EGF), transforming growth factor (TGF)-alpha, and TGF-beta are important regulators of prostate cell growth in vitro and in animal models, evidence to support their role in human prostate cancer development remains sparse. We previously showed that men without prostate cancer have concentrations of EGF and TGF-alpha in expressed prostatic fluid (EPF) that are individually distinct and stable over time. This study addressed whether growth factor levels in EPF are associated with the presence or progression of prostate cancer. METHODS: We measured levels of immunoreactive EGF, TGF-alpha, and TGF-beta1 in stored EPF samples from three age-matched groups: 19 men with untreated, histologically diagnosed prostate cancer (CaP), 38 with benign prostate hyperplasia (BPH), and 19 with normal prostate glands (NPD). RESULTS: Median TGF-alpha was lower in the BPH group (0.45 ng/ml) than in either CaP (0.63 ng/ml) or NPD (0.58 ng/ml) groups (P = 0.03 and 0.12, respectively). For EGF, the median was lowest in the CaP group and highest in the NPD group (92.5 ng/ml vs. 175.5 ng/ml, P = 0.006). For TGF-beta1, the median level in CaP was 2.7 times higher than the median level among all controls (6.65 ng/ml vs. 2.46 ng/ml, P = 0.002). Growth factor levels were not associated with tumor stage or Gleason score. However, the single case with distant metastases had TGF-beta1 levels 23-fold higher than the CaP median. CONCLUSIONS: The results suggest that at the time of CaP diagnosis, EGF levels in EPF are significantly lower, and TGF-beta1 levels significantly higher, than normal. Marked overexpression of TGF-beta1 in advanced CaP might be reflected in extremely high EPF levels.