Prostate cancer chemoprevention: update of the prostate cancer prevention trial findings and implications for clinical practice.

This article updates the findings of the Prostate Cancer Prevention Trial (PCPT) based on recent publications and reviews of the PCPT. New evidence shows that finasteride reduces the overall risk of prostate cancer by 30% and reduces the risk of clinically significant prostate cancer, including high-grade tumors. For tumors with Gleason scores of < or = 6, men in the finasteride arm had a relative risk reduction (RRR) of 34% (RR, 0.66; 95% CI, 0.55-0.80; P < or = 0.0001); tumors with Gleason scores of > or = 7 had an RRR of 27% (RR, 0.73; 95% CI, 0.56-0.96; P = 0.02). The effect of finasteride on sexual function appears to be minimal as men on finasteride had an average 3.21 point increase on the 100 point Sexual Activity Scale compared with men on placebo. With an excellent safety profile and minimal side effects, men aged 55 years or older should be informed of the opportunity to reduce their risk of prostate cancer with finasteride.

Practice patterns of ureteral stenting after routine ureteroscopic stone surgery: a survey of practicing urologists.

BACKGROUND: Controversy exists regarding the need for ureteral stent insertion after routine ureteroscopic stone surgery. We designed a questionnaire to assess and better understand the practice patterns of urologists for stent applications. MATERIALS AND METHODS: A 26-question survey was distributed to 570 community and academic urologists. The answers were anonymously tabulated to determine the practice patterns for stent placement. RESULTS: Of the 173 respondents, 97.7% performed ureteroscopic surgery, with the majority (77%) performing 1 to 10 procedures per month. Sixty-eight percent of urologists considered more than 70% of their ureteroscopic procedures "routine." Only 21% of urologists dilated the ureteral orifice more than 90% of the time. Those who dilated the ureteral orifice used a balloon (43%), ureteral access sheath (13.5%), or both (21%). The use of an access sheath did not change stenting practices for 75% of urologists. Patterns vary with regard to length of indwelling time, with 85% of urologists maintaining the stent for fewer than 7 days. Most urologists use either cystoscopy (42%) or pull-suture in clinic (37%) to remove stents. Patient tolerance is the most significant problem with stents reported by 97.6% of urologists. The respondents were divided into three experience-based groups: group 1, <2 years of experience; group 2, 2 to 10 years; and group 3, >10 years. Using Fisher's exact test, there were no statistically significant differences between the groups. CONCLUSION: A wide variability exists among urologists in the practice patterns of stent insertion after routine ureteroscopic surgery. Most consider their procedures routine and are more likely to place stents after ureteral dilation despite growing evidence to the contrary. Knowledge of the varied practices may aid less experienced urologists in their decision to insert a stent after ureteroscopy.

Genomic characterization of testis cancer: association of alterations with outcome of clinical stage 1 mixed germ cell nonseminomatous germ cell tumor of the testis.

OBJECTIVE: To identify genomic markers that are reliable in predicting lymph node metastases in clinical stage 1 non-seminomatous germ cell tumors (NSGCTs). METHODS: Comparative genomic array technology was used to identify regions of genomic amplification or deletion in clinical stage 1 NSGCTs. Twelve stage 1 mixed germ cell testicular tumors were analyzed, which were obtained from 8 patients who had no evidence of nodal metastasis when retroperitoneal lymph node dissection (RPLND) had been performed (ie, were RPLND negative) and 4 patients who had nodal metastases (ie, were RPLND positive). RESULTS: Differences between the genomic alterations associated with the two classes of tumors were identified. Genomic alterations previously reported in other subtypes of testicular tumors were observed in both metastatic and nonmetastatic cases. Statistically suggestive differences in mean copy number of the Y chromosome were found between metastatic and nonmetastatic cases (P = .0142). CONCLUSION: This finding suggests the presence of chromosome Y deletions to be a potential genetic marker for prediction of mixed germ cell tumor progression. This is a first step toward identifying chromosomal markers of progression in testicular cancer in clinical stage 1 mixed germ cell NSGCT.

Myeloid (granulocytic) sarcoma of epididymis as rare manifestation of recurrent acute myelogenous leukemia.

Myeloid sarcoma involving the genitourinary system is a rare complication associated with acute myelogenous leukemia or other myeloproliferative disorders. The diagnosis is made by pathologic findings of diffuse infiltration of intermediate-size neoplastic cells and fibrosis of the affected organ. Immunohistochemically, the cells stain positive for myeloperoxidase, CD45, and CD117 but negative for CD34. Treatment involves local surgical extirpation, radiotherapy, and chemotherapy. We report the second known case of myeloid sarcoma involving the epididymis in a patient with a history of acute myelogenous leukemia.

United States military contributions to the National Cancer Institute.

OBJECTIVE: To review contributions from the Department of Defense and the United States military to cancer research and the National Cancer Institute. FINDINGS: The Department of Defense and the military have a number of programs aimed at cancer research with significant dedication to prostate cancer, such as the Prostate Cancer Research Program and Center for Prostate Disease Research. In addition, the military has significant involvement with the National Cancer Institute (NCI) through the various Cooperative Research Groups. The military has played a critical role in large NCI sponsored multi-institutional clinical trials such as the Prostate Cancer Prevention Trial (PCPT) and the Servicemen's Testicular Tumor Environmental Endocrine Determinants Study (STEED). CONCLUSION: The Department of Defense has demonstrated a consistent commitment to cancer research.

Androgens and prevention of prostate cancer.

PURPOSE OF REVIEW: This review provides a description of recent insights into the role of androgens in prostate cancer prevention. RECENT FINDINGS: Many studies have elucidated a variety of molecular mechanisms involved in the initiation and progression of prostate cancer with many directly or indirectly related to the androgen signaling pathway. Both well known and novel agents for targeting the androgen pathway are under investigation, though very few are in clinical trials. After a review of recent papers describing these mechanisms, their results and implications were summarized. SUMMARY: Finasteride remains the only agent proven to reduce the risk of prostate cancer, though there are currently two other ongoing phase III trials with vitamin E, selenium, and dutasteride. An enhanced understanding of complex interactions with the androgen pathways is leading to the exploration of additional promising approaches to mitigating the risk of prostate cancer.