The Clinical Significance of Bone Mineral Density Changes Following Long-Term Androgen Deprivation Therapy in Localized Prostate Cancer Patients.

PURPOSE: Long-term androgen deprivation therapy has been associated with decreased bone mineral density in men with prostate cancer. Some evidence suggests that there is no impact on fracture risk despite this bone mineral density loss. Our study aimed to quantify changes in bone mineral density in men with high risk prostate cancer on long-term androgen deprivation therapy and calcium and vitamin D supplementation. MATERIALS AND METHODS: Bone mineral density analysis was conducted for localized high risk prostate cancer patients enrolled in the phase III randomized trial PCS-V (Prostate Cancer Study 5), comparing conventional and hypofractionated radiation therapy. Patients received 28 months of luteinizing hormone-releasing hormone agonist and calcium and vitamin D supplementation (500 mg calcium BID+400 IU vitamin D3 BID). The areal density and T-scores (spine, femoral neck and total femur) at baseline and 30 months of followup were extracted, and the absolute change was calculated. Clinical bone density status (normal, osteopenia, osteoporosis) was monitored. RESULTS: The lumbar spine, femoral neck and total femoral bone mineral density were measured for 226, 231, and 173 patients, respectively. The mean percent change in bone mineral density was -2.65%, -2.76% and -4.27% for these respective sites (p <0.001 for all). The average decrease in bone mineral density across all sites was -3.2%, with no decline in bone mineral density category in most patients (83%). Eight patients (4%) became osteoporotic. CONCLUSIONS: Despite a mild decline in bone mineral density, the change in clinical bone mineral density category remained low with long-term androgen deprivation therapy. Consequently, calcium and vitamin D supplementation alone may suffice for most localized prostate cancer patients on long-term androgen deprivation therapy.

A comparison of field methods to assess body composition in a diverse group of sedentary women.

Accurate assessment of body composition is essential in the evaluation of obesity. While laboratory methods are commonly used to assess fat mass, field measures (e.g., skinfold thickness [SKF] and bioelectrical impedance [BIA]) may be more practical for screening large numbers of individuals in intervention studies. In this study, a correlational design was used among 46 racially and ethnically diverse, sedentary women (mean age = 25.73 years) to (a) compare the percentage of body fat as determined by SKF and the upper body BIA and (b) examine the effects of body mass index (BMI), racial/ethnic background, age, and stage of the menstrual cycle on differences in the estimated percentage of body fat obtained using the SKF and BIA. Overall, a significant correlation between SKF and BIA (r = .98, p < .001) was found, with similar findings among Black, Hispanic and White non-Hispanic women. The mean differences between BIA and SKF were not significantly correlated with BMI, age, race/ethnicity or stage of the menstrual cycle. Data from this study suggest that BIA showed similar body fat prediction values compared with SKF and may be a viable alternative to SKF among diverse groups of healthy women. Additional testing and comparison of these field methods with the laboratory methods of hydro-densitometry or dual energy X-ray absorptiometry is recommended to further determine whether BIA devices can be routinely recommended as an alternative to the SKF.

A comparison of field methods to assess cardiorespiratory fitness among neophyte exercisers.

There is evidence to suggest that aerobic fitness levels among adults have declined markedly over the past 2 to 3 decades. Submaximal field measures of aerobic fitness, such as step tests, may now be seen as aversive by contemporary neophyte exercisers. In this study, a single-factor within-subjects (repeated measures) factorial design was used to compare three field measures of cardiorespiratory fitness among sedentary women: (a) the Queen's College step test (QCST), (b) the Rockport 1-mile walk (RW), and (c) a nonexercise estimation of VO(2) max (NE). The sample consisted of 31 racially and ethnically diverse female college students (mean age of 24.8 years). No significant within-subjects differences were found in the three measures of V0(2) max (F = 1.89, p = .17) among Black, Hispanic, White non-Hispanic, or Asian women, but relative perceived exertion scores were significantly higher for the QCST than for the RW (t = 9.79, p < .001) for all groups. The mean calculated VO(2) max for the QCST was 35.90 ml/kg/min for the subset of women ages 18 to 25 and 31.85 for those ages 26 to 46. These values represent a "poor" to "below average" score for aerobic capacity among women in both age groups. Data from this preliminary study suggest that both the RW test and the NE test are comparable to the QCST as valid and reliable field measures of aerobic fitness and appear to be good alternatives to step testing among sedentary individuals.

Determinants of delay for breast cancer diagnosis.

BACKGROUND: A study was conducted to identify determinants of diagnostic delay in order to develop strategies to reduce the waiting time for breast cancer diagnosis. METHODS: A cohort of 696 women diagnosed with early breast cancer was recruited in two radiation oncology centers of Quebec, Canada, in 2002-2003. A structured questionnaire was administered to identify potential determinants of diagnostic delay. Dates for all of the breast procedures were extracted from medical records. "Diagnostic delay" was defined as a time interval of more than 5 weeks between the first breast specific procedure and the final diagnostic procedure. A logistic regression model was used to estimate adjusted odds ratios (OR) of diagnostic delay and their 95% confidence intervals (CI). RESULTS: The two main determinants of diagnostic delay were the medical indication for the breast investigation and the scheduling of the diagnostic procedures. Compared to screened women, those referred because of clinical findings had an OR of diagnostic delay of 0.34 (95% CI=0.22-0.54). Women who underwent breast procedures during visits on at least four separate days had an OR of 6.31 (95% CI=3.85-10.34) compared to those who completed their investigation during visits on at most two separate days. Women who had complementary procedures the day of the first procedure were less likely to experience a diagnostic delay (OR=0.51, 95% CI=0.31-0.82). Finally, diagnostic delay was also significantly associated with the interpretation of the first diagnostic procedure, type of final diagnostic procedure, size of tumor, and family income. CONCLUSIONS: This study suggests that a promising strategy for reducing the waiting time for breast cancer diagnosis is to better integrate the services during the investigation period.