New-onset psychosis following androgen deprivation therapy for prostate cancer.

Androgen deprivation therapy (ADT) is commonly used in the treatment of prostate cancer and is associated with several side effects including psychiatric disorders. We present an unusual case of a 62-year-old man with high risk prostate cancer that developed de novo psychosis after starting luteinizing hormone-releasing hormone (LHRH) agonists and discuss possible mechanisms to explain such findings. This case report highlights the importance of continuing assessment and monitoring of potential emotional and behavioral symptoms in prostate cancer patients treated with ADT.

Stereotactic radiosurgery in the management of brain metastases from primary thyroid cancers.

Patients with metastatic well-differentiated thyroid cancer have a generally favorable long-term outcome although multi-organ involvement is a known marker of poor prognosis. Brain metastases are rare, occurring in less than 1% of patients with thyroid cancer. Few patients have been managed with stereotactic radiosurgery (SRS). A retrospective database of 5,067 patients treated for brain metastases between 1985 and 2007 was generated from 11 institutions. Thyroid cancer patients were identified in this database and, when possible, additional information was obtained from further chart review. Patients were excluded if they had incomplete treatment or follow-up information. Two validated prognostic indices, Graded prognostic Assessment (GPA) and Recursive Partitioning Analysis (RPA), were calculated for each patient. The overall survival times were calculated by the Kaplan-Meier method. Twenty-three thyroid cancer patients were identified (51% male, 48% female). Median age was 63 years (range 20-81). Pathology of the primary thyroid disease was available for twelve patients; the majority were diagnosed with differentiated thyroid cancer (n = 9 papillary, n = 2 Hürthle cell; 92%) and one had medullary subtype (8%). Median time from diagnosis of primary disease to brain metastasis was 41.8 months (range 0-516). Fifteen (65%) patients underwent SRS as part of their initial treatment with a median number of lesions treated of 1.5 (range 1-9). The median follow-up time for living patients was 35.2 months. Overall median survival time was 20.8 months (40% alive at last follow-up) and 37.4 months for SRS-treated patients (P = NS). A poor Karnofsky performance status was predictive of worse outcome (P = 0.001). GPA and RPA did not provide additional prognostic information. In conclusion, patients treated with SRS for brain metastases from primary thyroid cancer have a favorable prognosis with an expected median survival greater than 3 years. It is unclear as to whether current prognostic indices are relevant to this patient population.

Protein expression of MEF2C during the critical period for visual development in vervet monkeys.

During the early development of the visual cortex, there is a critical period when neuronal connections are highly sensitive to changes in visual input. Deprivation of visual stimuli during the critical period elicits robust anatomical and physiological rearrangements in the monkey visual cortex and serves as an excellent model for activity-dependent neuroplasticity. DNA microarray experiments were previously performed in our lab to analyze gene expression patterns in area V1 of vervet monkeys subjected to monocular deprivation (MD). An interesting candidate identified in its screen was myocyte enhancer-binding factor 2C (MEF2C), a transcription factor linked to neuronal survival. Consistent with the microarray data, we show that there is a qualitative increase in MEF2C protein expression in area V1 of infant as compared to adult vervet monkeys. Our results suggest that the regulation of neuronal survival is one of the molecular mechanisms underlying the critical period for visual cortical neuroplasticity.