The Informational Needs of Prostate Cancer Patients Treated with Radical Prostatectomy Regarding Adjuvant or Salvage Radiotherapy: Determinants of Community Health Pilot Project.

BACKGROUND: Prostate cancer patients face important treatment decisions. The role of adjuvant and salvage radiotherapy (RT) is now less controversial in terms of the timing of the treatment after radical prostatectomy, because few randomized trials demonstrated the benefit of early RT in terms of biochemical control and improved survival. PURPOSE: To evaluate the informational needs of prostate patients referred to Odette Cancer Centre for post-prostatectomy adjuvant or salvage RT. In addition, we investigated how social determinants of health, such as income and education affected these needs. METHODS: A needs assessment questionnaire was developed and piloted among 10 prostate cancer patients. A 4-point Likert scale was used to examine patients' knowledge and understanding of various aspects of post-prostatectomy RT. RESULTS: The most frequent patient response corresponded to having "some" knowledge about the topic (Likert scale 3), except for two items, which included knowledge about survival rates for different treatment options and management of side effects related to radiation treatment (Likert scale 2: "a little"). No causative relationship was found between the patients' income and/or education, and their knowledge of various treatment aspects. CONCLUSIONS: This study demonstrated that even though our patients had some knowledge about prostate cancer and its treatments, they may still require more information regarding the management of RT-related side effects, local recurrence, and survival rates after post-prostatectomy RT. These findings will be used to conduct a thorough informational needs assessment to aid in the future development and testing of an educational tool for patients with prostate cancer after radical prostatectomy, that will assist them in making decisions about their adjuvant or salvage treatment options.

The effect of impression volume and double-arch trays on the registration of maximum intercuspation.

STATEMENT OF PROBLEM: The type of double-arch trays used may affect occlusion. PURPOSE: The purpose of this study was to determine what effect, if any, double-arch tray design and impression material volume had on the registration of maximum intercuspation (MI). MATERIAL AND METHODS: Quadrant impressions were made on articulated fracture-resistant dental casts mounted in maximum intercuspation occlusion. Three types of sideless double-arch impression trays were used: First Bite with nylon webbing, Sultan's 3-Way with double crosshatch webbing, and Premium's 3-in-1 Tray with single crosshatch webbing. Vinyl polysiloxane impression material (Aquasil Ultra Rigid Fast Set) was distributed at 2 different volumes (5.4 ml and 8.3 ml), and 60 impressions were made (n=10). A weight of 1.2 kg was placed on the upper arm of an Artex articulator, ensuring complete closure. The impressions were allowed to polymerize for 5 minutes. After polymerization, specimens were placed on a light box, and a camera set at a fixed distance was used to capture the light transmission that was projected through the impression material. The camera transferred the information to an image analysis program (ImageJ). This system allowed the different amounts of light projected through the impression to be translated into a gray scale value (GSV), which was assigned a thickness value, in millimeters, of a specified occlusal contact area. To assess reliability of the experimental design, 10 control impressions were made by directly applying impression material onto the typodont. These were analyzed in the same manner as the impressions made with trays. A 2-way ANOVA comparing volume by tray type was used (alpha=.05). This was followed by a Tukey HSD test. RESULTS: There was no main effect for volume of impression material (P=.71). Tray type was significantly different (P<.001). Impressions made with Sultan trays were significantly less accurate than impressions made with First Bite or Premium impression trays. The Premium tray type had the highest mean (SD) GSV, 179.8 (8.1), significantly higher than First Bite (164.7 (19.8); P<.001) or Sultan (82.8 (7.4); P<.001) trays. CONCLUSIONS: This in vitro study demonstrated that certain trays hinder closure into MI, which may negatively affect the accuracy of record making.

Castration induces autoantibody and T cell responses that correlate with inferior outcomes in an androgen-dependent murine tumor model.

We recently reported that hormone therapy induces antigen-specific autoantibody responses in prostate cancer patients. However, the contribution of autoantibody responses to clinical outcomes is unknown. We used an animal model to test the hypothesis that hormone therapy-induced immune responses may be associated with delayed tumor recurrence. Male DD/S mice bearing established tumors from the androgen-dependent Shionogi carcinoma line were castrated to induce tumor regression. Tumor-specific autoantibody responses were measured by immunoblot, and the underlying antigen was identified by serological screening of a cDNA expression library. T cell responses were assessed by immunohistochemistry and IFN-gamma ELISPOT. Following castration, 97% of mice underwent complete tumor regression. Of these, 72% experienced tumor recurrence 18-79 days postcastration, whereas the remaining 28% remained tumor-free for the duration of the experiment. In 55% of mice, castration induced autoantibody responses to an antigen identified as poly(A) binding protein nuclear 1 (PABPN1). Castration also induced PABPN1-specific T cell responses, which were highly correlated to autoantibody responses, and this was accompanied by dense infiltration of tumors by CD3+ T cells 1-2 weeks after castration. Unexpectedly, mice that developed autoantibody and T cell responses to PABPN1 showed a higher rate and shorter latency of tumor recurrence. In mice with recurrent tumors, T cell responses to PABPN1 were still detectable; however, T cell infiltrates were restricted to the peripheral stroma of tumors. In conclusion, castration-induced immune responses are associated with inferior outcomes in the Shionogi carcinoma model, raising concerns about the influence of treatment-induced immune responses on clinical outcomes in humans.

Endocrine disorders associated with holoprosencephaly.

OBJECTIVE: To investigate the incidence of endocrinopathies in holoprosencephaly (HPE) and correlate the severity of the endocrinopathies with the neuroanatomic abnormalities. STUDY DESIGN: We reviewed the histories and medical records of 117 children with HPE for endocrinopathies and related treatments. Neuroimaging studies were graded for severity of HPE, hypothalamus non-separation, and pituitary abnormalities. RESULTS: Diabetes insipidus (DI) occurred in 70% of patients with classic HPE. The severity of the DI correlated with the grade of HPE and hypothalamic non-separation (p < 0.0001). Anterior pituitary dysfunctions were much less common. Hypothyroidism was identified in 11% of patients, hypocorticism in 7%, and growth hormone deficiency in 5%. Only one patient with middle interhemispheric variant of holoprosencephaly (MIH) had any of these disorders. CONCLUSIONS: Patients with HPE have a high incidence of DI that may be related to the failure of cleavage of hypothalamic nuclei. Anterior pituitary dysfunctions are much less common than DI.