Abiraterone for Prostate Cancer Not Previously Treated with Hormone Therapy.

BACKGROUND: Abiraterone acetate plus prednisolone improves survival in men with relapsed prostate cancer. We assessed the effect of this combination in men starting long-term androgen-deprivation therapy (ADT), using a multigroup, multistage trial design. METHODS: We randomly assigned patients in a 1:1 ratio to receive ADT alone or ADT plus abiraterone acetate (1000 mg daily) and prednisolone (5 mg daily) (combination therapy). Local radiotherapy was mandated for patients with node-negative, nonmetastatic disease and encouraged for those with positive nodes. For patients with nonmetastatic disease with no radiotherapy planned and for patients with metastatic disease, treatment continued until radiologic, clinical, or prostate-specific antigen (PSA) progression; otherwise, treatment was to continue for 2 years or until any type of progression, whichever came first. The primary outcome measure was overall survival. The intermediate primary outcome was failure-free survival (treatment failure was defined as radiologic, clinical, or PSA progression or death from prostate cancer). RESULTS: A total of 1917 patients underwent randomization from November 2011 through January 2014. The median age was 67 years, and the median PSA level was 53 ng per milliliter. A total of 52% of the patients had metastatic disease, 20% had node-positive or node-indeterminate nonmetastatic disease, and 28% had node-negative, nonmetastatic disease; 95% had newly diagnosed disease. The median follow-up was 40 months. There were 184 deaths in the combination group as compared with 262 in the ADT-alone group (hazard ratio, 0.63; 95% confidence interval [CI], 0.52 to 0.76; P<0.001); the hazard ratio was 0.75 in patients with nonmetastatic disease and 0.61 in those with metastatic disease. There were 248 treatment-failure events in the combination group as compared with 535 in the ADT-alone group (hazard ratio, 0.29; 95% CI, 0.25 to 0.34; P<0.001); the hazard ratio was 0.21 in patients with nonmetastatic disease and 0.31 in those with metastatic disease. Grade 3 to 5 adverse events occurred in 47% of the patients in the combination group (with nine grade 5 events) and in 33% of the patients in the ADT-alone group (with three grade 5 events). CONCLUSIONS: Among men with locally advanced or metastatic prostate cancer, ADT plus abiraterone and prednisolone was associated with significantly higher rates of overall and failure-free survival than ADT alone. (Funded by Cancer Research U.K. and others; STAMPEDE ClinicalTrials.gov number, NCT00268476 , and Current Controlled Trials number, ISRCTN78818544 .).

Ultra-morphological studies on enamel-universal adhesive interface.

OBJECTIVES: Nowadays, the universal adhesives are often used for silane application prior to application of self-adhesive resin cements. The purpose of this study was to evaluate enamel surface roughness and to observe the enamel-adhesive interface after acid-base challenge using three different self-adhesive resin cements combined with universal adhesives. MATERIALS AND METHODS: Three self-adhesive resin cements: PANAVIA SA Luting Cement Plus (SA), Calibra Universal (CA) and MaxCem Elite Chroma (MC) which in conjunction with the particular universal adhesives: Clearfil Universal Bond Quick (UQ), Prime&Bond Universal (PB) and Optibond Universal (OB) were tested. Thirty enamel surfaces from caries-free human premolars were ground and bonded with the tested self-adhesive resin cements combined with universal adhesives. The surface roughness test (Sa) with or without applying adhesives was performed with 3D-CLSM. The interface of the bonded specimens after acid-base challenge was also examined by SEM. RESULTS: The Sa of OB was significantly higher than those of PB and UQ. There were statistically significant differences among all of the groups (p < 0.05). An acid-base resistant zone (ABRZ) was observed in all groups, however, formation of the ABRZ was material dependent. CONCLUSION: OB provided most etching performance to enamel of human premolars and MC group with OB presented durability against acid-base challenge. CLINICAL SIGNIFICANCE: Nowadays, the combination of self-adhesive resin cement and universal adhesive may be a viable option for a reliable bonding performance and bonding durability in indirect restorative dentistry.

Effects of alumina-blasting pressure on the bonding to super/ultra-translucent zirconia.

OBJECTIVES: Translucent zirconia has brought the advantages such as less tooth preparation, biological compatibility, high strength, good mechanical properties, and less antagonist wear. This study's aim was to elucidate how clinically relevant surface treatments; alumina-abrasion and priming effect on bond strength of Y-PSZ in three different translucency grades after long-term water storage. MATERIALS AND METHODS: Three highly translucent Y-PSZ grades were ground flat with #600-grit SiC paper. Four different surface treatments (untreated, alumina blasting at 0.1 MPa or 0.2 MPa or 0.4 MPa) and two resin cements (PANAVIA V5 and PANAVIA SA CEMENT PLUS AUTOMIX) were tested. The bonded specimens were stored in water for 1 day, 30 days and 150 days and tensile bond strength (TBS) were measured with universal testing machine at a crosshead speed of 2 mm/min (n=10). The surface roughness (Sa) measurement and surface morphology analysis without alumina-blasting pressure (untreated) and with alumina-blasting pressures (0.1 MPa, 0.2 MPa and 0.4 MPa) for three different zirconia grades were evaluated with 3D-Laser Scanning Confocal Microscope. RESULTS: Different alumina-blasting pressures and different storage periods affected the bonding of resin cement to translucent zirconia. The Weibull moduli increased in some groups after 150 days storage. After 1 day and 30 days storage, 0.4 MPa alumina-blasting pressure provided superior bond strength, however, after 150 days, 0.2 MPa gave reliable and stable bond strength. SIGNIFICANCE: Alumina-blasting pressure of 0.2 MPa was the most effective for reliable and durable bonding performance to translucent zirconia after long-term water storage.

Adhesion durability of dual-cure resin cements and acid-base resistant zone formation on human dentin.

OBJECTIVES: Bond durability and resistance to acid-base challenge of dentin with dual-cure resin cement have been rarely investigated. The purpose of this study was to evaluate dentin bond strength and observe the adhesive-dentin interface after acid-base challenge using three different dual-cure resin cements. METHODS: Thirty dentin surfaces from caries-free human premolars were ground and bonded with one of three dual-cure resin cements: PANAVIA V5 (V5), ESTECEM II (E II) and Rely X Ultimate (RXU) and thermocycled for 0, 5,000 and 10,000 cycles. A microtensile bond strength (µTBS) test was undertaken and the interface of the bonded specimens after acid-base challenge was examined by SEM. RESULTS: The µTBS of V5 exhibited a stable bond strength despite thermal cycling while the bond of EII and RXU after 10,000 cycles dropped significantly among all thermal cycle periods (p<0.05). An acid-base resistant zone (ABRZ) was observed in all groups, however, the morphology of the bonded interface differed among the tested cements. CONCLUSION: Bonding durability to dentin and ABRZ morphologies differed among the cements evaluated. PANAVIA V5 cement system with tooth primer provided the most reliable bond strength and was best able to resist the acid-base challenge.