Benefits of early salvage therapy on oncological outcomes in high-risk prostate cancer with persistent PSA after radical prostatectomy

BackgroundPatients with prostate-specific antigen (PSA) persistence are at the increased risk of disease progression. The aim of our study was to evaluate the impact of early salvage therapy on oncological outcomes in patients with persistent PSA after radical prostatectomy (RP).MethodsWithin a single tertiary centre database, we identified men with persistent (≥ 0.1 ng/ml) versus undetectable (< 0.1 ng/ml) PSA 4–8 weeks after RP for high-risk prostate cancer (HRPCa). The cumulative incidence function was used to estimate cancer-specific survival (CSS) and clinical progression-free survival (CPFS). The Kaplan–Meier method was used to estimate overall survival (OS). The effects on oncological outcomes of salvage radiotherapy (SRT) ± androgen deprivation therapy (ADT) vs. ADT monotherapy were tested in the subgroup of patients with persistent PSA.ResultsOf 414 consecutive patients who underwent RP for HRPC, 125 (30.2%) had persistent PSA. Estimated 10-year CPFS, CSS and OS for men with persistent vs. undetectable PSA were 63.8% vs. 93.5%, 78.5% vs. 98.3% and 54% vs. 83.2% (all p < 0.0001), respectively. In men with persistent PSA, ADT alone was associated with higher risk (hazard ratio (HR) for worse CSS (HR 3.9, p = 0.005) and OS (HR 4.7, p < 0.0001) but not for CP (HR 1.6, p = 0.2) when compared with SRT ± ADT.ConclusionIn patients who underwent RP for HRPCa, persistent PSA was associated with poor oncological outcomes. Early SRT ± ADT resulted in significantly improved CSS and OS in men with persistent PSA comparing with early androgen deprivation monotherapy.

Benefits of early salvage therapy on oncological outcomes in high-risk prostate cancer with persistent PSA after radical prostatectomy.

BACKGROUND: Patients with prostate-specific antigen (PSA) persistence are at the increased risk of disease progression. The aim of our study was to evaluate the impact of early salvage therapy on oncological outcomes in patients with persistent PSA after radical prostatectomy (RP). METHODS: Within a single tertiary centre database, we identified men with persistent (≥ 0.1 ng/ml) versus undetectable (< 0.1 ng/ml) PSA 4-8 weeks after RP for high-risk prostate cancer (HRPCa). The cumulative incidence function was used to estimate cancer-specific survival (CSS) and clinical progression-free survival (CPFS). The Kaplan-Meier method was used to estimate overall survival (OS). The effects on oncological outcomes of salvage radiotherapy (SRT) ± androgen deprivation therapy (ADT) vs. ADT monotherapy were tested in the subgroup of patients with persistent PSA. RESULTS: Of 414 consecutive patients who underwent RP for HRPC, 125 (30.2%) had persistent PSA. Estimated 10-year CPFS, CSS and OS for men with persistent vs. undetectable PSA were 63.8% vs. 93.5%, 78.5% vs. 98.3% and 54% vs. 83.2% (all p < 0.0001), respectively. In men with persistent PSA, ADT alone was associated with higher risk (hazard ratio (HR) for worse CSS (HR 3.9, p = 0.005) and OS (HR 4.7, p < 0.0001) but not for CP (HR 1.6, p = 0.2) when compared with SRT ± ADT. CONCLUSION: In patients who underwent RP for HRPCa, persistent PSA was associated with poor oncological outcomes. Early SRT ± ADT resulted in significantly improved CSS and OS in men with persistent PSA comparing with early androgen deprivation monotherapy.

Diversity, not uniformity: slaughter and electrical waterbath stunning procedures in Belgian slaughterhouses.

Data on slaughter and stunning protocols in Belgian poultry abattoirs were collected, and subsequently the survival rate after electrical waterbath stunning in 1,400 animals across 7 selected slaughterhouses was determined. The majority of the abattoirs applied electrical waterbath stunning (72%), whereas the other methods were gas stunning (13%), head-only stunning (6%), and dry stunning (3%). In 6% of the slaughterhouses, the birds were killed without previous stunning, according to religious rites (i.e., ritual or religious slaughter). Although religious slaughter occurred in a substantial number of abattoirs, the customers of the majority of them allowed stunning, provided the animals were not killed by the stunning procedure. Substantial variation both in electrical waterbath devices and technical settings (electrical current type, wave type, voltage, frequency) combinations was observed. These settings did not only differ between slaughterhouses, but also between subsequent visits to the same slaughterhouse. Despite this variation, all systems comprised a constant voltage, multiple bird stunner. The minimum average electrical current that every chicken should receive at a certain frequency, as stated by the European Regulation No 1099/2009, was not achieved for each animal monitored due to the bird's characteristics and the different applied stunning settings, with the exception of all ISA laying hens and broiler breeders in one particular slaughterhouse. The survival rate ranged from 96.0 to 100%, 97.0 to 100%, 68.0%, 72.0 to 85.1%, and 5.6 to 52.4% in 5-wk-old broilers, 6-wk-old broilers, LSL laying hens, ISA laying hens, and broiler breeders, respectively. Monitoring of unconsciousness after passing through the waterbath was not always performed and when it was, there was no uniformity in the applied criteria. It was concluded that a large variation in slaughter and stunning practices exists among slaughterhouses in Belgium. Further research should explore the effect of the different settings on inducing a successful stun and on carcass quality, and assess if the observed variation also exists in other EU member states.

High seroprevalence of respiratory pathogens in hobby poultry.

Seroprevalence studies on respiratory pathogens have been done extensively in commercial laying hens, broilers, and, to a lesser extent, backyard poultry. In Europe, seroprevalence studies in backyard and fancy breed poultry flocks are scarce and limited to a few pathogens, such as Mycoplasma gallisepticum (MG); others, such as Ornithobacterium rhinotracheale (ORT), are missing. A commercial ELISA for detection of antibodies against six selected pathogens was performed on 460 serum samples from chickens across Flanders. Anti-ORT antibodies were, by far, the most prevalent, with a prevalence of 95.4%. Infectious bronchitis virus, Mycoplasma synoviae, and avian metapneumovirus antibodies were found in 75.6%, 76.3%, and 63.5% of the animals, respectively. Antibodies against MG and infectious laryngotracheitis virus were found in 36.7% and 30% of the animals, respectively. These data demonstrate the high seroprevalence of respiratory pathogens among hobby poultry; therefore, it is possible that this group could act as a reservoir for commercially kept poultry.

[Bronchiolitis obliterans organizing pneumonia associated with dermatomyositis and antiphospholipid syndrome]. / Bronchiolite oblitérante avec pneumopathie organisée associée à une dermatomyosite et à un syndrome des antiphospholipides.

Dermatomyositis and antiphospholipid syndrome are rare diseases that can be associated pulmonary damage. We report a case of anti-phospholipid syndrome that presented with bilateral pulmonary embolism and subsequently developed pulmonary infiltrates in association with the characteristic muscular and cutaneous features of dermatomyositis. Histological examination of trans-bronchial biopsies revealed bronchiolitis obliterans organizing pneumonia.

Reproducibility of volume-adjusted bone mineral density of spine and hip from dual X-ray absorptiometry.

Skeletal size has a confounding effect on areal bone mineral density (aBMD) related to differences in skeletal volume. Several methods have been proposed for calculating volumetric BMD (vBMD), but in vivo precision data are limited for the spine and have not been published for the hip. We prospectively performed duplicate dual X-ray absorptiometry measurements of the anteroposterior spine and hip (n = 121) in a diverse female population referred for initial clinical BMD testing. Each scan pair was performed and analyzed by two different technologists (mean interval of 4 d) to obtain standard aBMD. Scan data were reprocessed at a later date to calculate vBMD for the lumbar spine (L2-L4), femoral neck, and total hip in the 87 spines and 82 hips for which we had complete analyzable scan data. We found much worse precision in femoral neck volume (5.2% coefficient of variation [CV]) than in spine volume (2.6% CV; p < 0.003). This contributed to greater error in femoral neck vBMD (3.9% CV) than aBMD (2.3= CV; p < 10(-6)). Total hip aBMD had better precision than vBMD (1.0 and 1.3-2.5% CV; p < 10(-5)). The reverse pattern was seen in the spine with slightly better precision for vBMD than aBMD (1.1 and 1.5% CV; p < 0.002). Volumetric measures of lumbar spine density can be obtained with high precision. Because of poor reproducibility in the femoral neck, the total hip region may be preferable for measuring volumetric bone density in the proximal femur.