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James E Montie

Publications and source records attributed to James E Montie.

At least 19 recordsLinked to original sources
PubMed2006

Association between family history of prostate and breast cancer among African-American men with prostate cancer.

OBJECTIVES: To explore the familial aggregation of prostate and breast cancer using data from a population-based case-control study of African-American men participating in the Flint Men's Health Study. METHODS: A detailed family history questionnaire was administered to 121 African-American men with prostate cancer and 179 African-American male controls. The family history data of prostate and breast cancer in first-degree relatives were compared between men with and without prostate cancer using standard statistical methods. RESULTS: In the Flint Men's Health Study, men with prostate cancer were more likely than controls to report having a brother with prostate cancer (age-adjusted odds ratio 4.80, 95% confidence interval 2.01 to 11.44) or a sister with breast cancer (age-adjusted odds ratio 3.80, 95% confidence interval 1.57 to 9.22). CONCLUSIONS: Although a family history of prostate cancer is a recognized prostate cancer risk factor consistent across different races, few studies have examined the co-clustering of breast and prostate cancer within African-American families. Future studies should focus on racially heterogeneous populations to further explore the observation from the Flint Men's Health Study that having a brother with prostate cancer or a sister with breast cancer may be associated with prostate cancer occurrence. This research may have implications for both gene identification and early detection strategies.

Adult↗
PubMed2006

Incidence of initial local therapy among men with lower-risk prostate cancer in the United States.

BACKGROUND: The frequently indolent nature of early-stage prostate cancer in older men and in men with low- or moderate-grade tumors and the demonstration that the survival benefits of radical prostatectomy are primarily among men younger than 65 years have led to concerns about prostate cancer overtreatment. METHODS: Using data from 13 Surveillance, Epidemiology, and End Results registries, we performed a retrospective cohort study of 71,602 men who were diagnosed with localized or regional prostate cancer between 2000 and 2002. We quantified the incidence of initial curative therapy (i.e., surgery or radiation therapy) among men with lower-risk cancers as defined by their limited likelihood of either dying from expectantly managed prostate cancer or achieving a survival benefit from local therapy. Stratified analyses and multinomial logistic regression models were used to quantify the absolute and relative rates of curative therapy among men in various age-grade strata. All statistical tests were two-sided. RESULTS: We identified 24,405 men with lower-risk prostate cancers and complete data for the first course of treatment. Initial curative therapy was undertaken in 13,537 of these men (55%); 81% of treated men received radiation therapy. The likelihood of curative therapy, relative to expectant management, varied statistically significantly among lower-risk age-grade strata (all P<.05). Assuming that initial expectant management is appropriate for all lower-risk cancers, 2564 men (10%) in this population-based sample were overtreated with radical prostatectomy and 10,973 (45%) with radiation therapy. CONCLUSIONS: These data quantify a target population for whom greater use of expectant approaches may reduce overtreatment and improve the quality of localized prostate cancer care.

Aged↗
PubMed2006

A common variant associated with prostate cancer in European and African populations.

With the increasing incidence of prostate cancer, identifying common genetic variants that confer risk of the disease is important. Here we report such a variant on chromosome 8q24, a region initially identified through a study of Icelandic families. Allele -8 of the microsatellite DG8S737 was associated with prostate cancer in three case-control series of European ancestry from Iceland, Sweden and the US. The estimated odds ratio (OR) of the allele is 1.62 (P = 2.7 x 10(-11)). About 19% of affected men and 13% of the general population carry at least one copy, yielding a population attributable risk (PAR) of approximately 8%. The association was also replicated in an African American case-control group with a similar OR, in which 41% of affected individuals and 30% of the population are carriers. This leads to a greater estimated PAR (16%) that may contribute to higher incidence of prostate cancer in African American men than in men of European ancestry.

Alleles↗
PubMed2006

Risk factors for adverse outcomes after transurethral resection of bladder tumors.

BACKGROUND: Risk factors for adverse outcomes after transurethral resection of bladder tumors (TURBT) have not been identified to date. Such information would facilitate preoperative risk stratification and case-mix-adjusted outcome comparison, and lead to the development of processes of care directed at improving outcomes and ultimately the quality of care for bladder carcinoma patients. METHODS: The National Surgical Quality Improvement Program (NSQIP) is a prospective quality management initiative of 123 Veterans Affairs Medical Centers nationwide. Since 1991, a total of 21,515 TURBTs have been prospectively registered by the NSQIP; these cases compose the current study population. Using multivariable logistic regression, the authors determined the independent association between preoperative patient risk factors and perioperative elements of structure/process and morbidity, mortality, and prolonged length of stay (LOS) outcomes. RESULTS: The postoperative complication, 30-day, and 90-day mortality rates were 4.3%, 1.3%, and 3.3%, respectively. The median, 75th percentile, and 90th percentile for LOS among patients undergoing TURBT was 2 days, 3 days, and 8 days, respectively. Robust preoperative patient risk factors that were found to be uniformly associated with all adverse outcomes included the presence of disseminated disease (odds ratio [OR], 1.9-5.2) weight loss (OR, 1.8-3.8), low serum albumin (OR, 2.3-7.1), elevated serum creatinine (OR, 1.3-2.9), a dependent functional status (OR, 1.5-2.7), and emergent case status (OR, 1.8-3.1). Compared with models using preoperative patient factors alone, models including perioperative structure and process measures explained further variation in surgical outcomes (each likelihood ratio test, P < .0001). CONCLUSIONS: The findings of the current study highlight the fact that there are a wide array of patient risk factors that are associated with adverse outcomes after TURBT. Validation of those processes implemented to modify such elements can provide a basis for quality metrics in the context of TURBT.

Aged↗
PubMed2006

Sexual behavior, sexually transmitted diseases and prostatitis: the risk of prostate cancer in black men.

PURPOSE: Black men are diagnosed with prostate cancer more often than white men, present with more advanced disease and have worse stage specific survival. Given the high risk of incidence and mortality in this population, determining potentially modifiable factors is important. Recent studies have suggested a link between chronic inflammation and development of prostate cancer. In concurrence, population based studies of white men have revealed an increased risk of prostate cancer with history of sexually transmitted diseases and prostatitis. MATERIALS AND METHODS: We explored the chronic inflammation hypothesis of prostate cancer development among black men by examining sexual activity, sexually transmitted diseases and prostatitis in a population based study of 129 patients and 703 controls 40 to 79 years old. RESULTS: After adjusting for age, income, cigarette smoking, and history of digital rectal examination and prostate specific antigen tests in the last 5 years, we observed that a history of gonorrhea infection and prostatitis increased the odds of prostate cancer 1.78-fold (95% CI 1.13, 2.79) and 4.93-fold (95% CI 2.79, 8.74), respectively. Men reporting 25 or more sexual partners were 2.80 (95% CI 1.29, 6.09) times more likely to be diagnosed with cancer compared to men with 5 or fewer partners. CONCLUSIONS: Our findings support the significance of prior sexual practices, exposure to sexually transmitted microbial agents and history of prostatic infection in the natural history of prostate cancer in black men. Additional prospective research incorporating serological markers of infectious agents or predictive markers of chronic inflammation should serve to elucidate the possible causal pathway of recurring or persistent infection in the etiology of prostate cancer in black men.

Adult↗
PubMed2006

The effects of adjusting for case mix on mortality and length of stay following radical cystectomy.

PURPOSE: Prior studies evaluating quality of care following radical cystectomy have been constrained by the use of retrospective reviews of single institutional series and limited ability to examine risk factors in a comprehensive manner. Characterization of these factors could enhance preoperative patient counseling and facilitate perioperative management, thereby improving the quality of patient care. MATERIALS AND METHODS: The National Surgical Quality Improvement Project is a prospective quality management initiative at 123 Veterans Affairs Medical Centers nationwide. The project collects preoperative clinical and intraoperative data, and outcomes on a wide variety of surgical procedures from multiple surgical disciplines. Since 1991, 2,538 radical cystectomies have been captured by the National Surgical Quality Improvement Project. Modeling using logistic regression was performed to identify preoperative risk factors associated with mortality and prolonged length of stay (greater than 90th percentile) after radical cystectomy. RESULTS: The 30 and 90-day mortality rates following cystectomy were 2.9% and 6.8%, respectively, and median hospital stay was 11 days (90th percentile 30). Robust preoperative factors associated with mortality and prolonged length of stay that uniformly increased risk were older patient age (OR 1.2 to 1.4), American Society of Anesthesiologists class 3 or greater (OR 1.5 to 3.3), dependent functional status (OR 1.7 to 2.0) and low serum albumin (OR 2.1 to 12.0). CONCLUSIONS: A defined set of preoperative risk factors is independently associated with greater mortality and hospital stay following radical cystectomy. The breadth of these factors suggests that complex case mix adjustment is mandatory when comparing outcomes. Implementation of novel processes directed toward minimizing patient risk has the potential to improve outcomes following cystectomy.

Age Factors↗
PubMed2006

Initial therapy with radical prostatectomy for high risk localized prostate cancer.

PURPOSE: This study provides a perspective on initial treatment in select patients with high risk, localized prostate cancer. MATERIALS AND METHODS: A select literature review was done with commentary on the philosophy of initial surgery followed by adjuvant or salvage therapies. RESULTS: Early detection and associated stage migration identify a cadre of men with unfavorable but apparently localized prostate cancer who historically would not have been viewed as appropriate candidates for radical prostatectomy. Decreased morbidity from radical prostatectomy and data demonstrating improved outcomes in some patients treated with multimodal therapy protocols provide a rationale for including radical prostatectomy as part of an aggressive treatment plan to achieve optimal local elimination of cancer. Data suggest that radical prostatectomy and adjuvant or possibly even salvage radiation therapy may provide the best elimination of large local cancers. Whether such an approach provides results that are better than or even as good as those of the common standard of radiation therapy plus androgen deprivation therapy remains to be seen and, if so, at what cost to the patient in terms of adverse effects. However, it is likely that optimal elimination of local disease is needed to achieve the maximum benefit from adjuvant systemic endocrine, chemotherapy or targeted treatments. In other words optimal local therapy may be necessary but not sufficient. CONCLUSIONS: Initial radical prostatectomy may have a role for treating high risk localized prostate cancer.

Humans↗
PubMed2006

Preoperative and intraoperative risk factors associated with 30-day morbidity following urological surgery: the National Surgical Quality Improvement Program.

PURPOSE: The National Surgical Quality Improvement Program was established in 1994 to measure and enhance of the quality of surgical care. Since its inception, 30-day postoperative morbidity after major surgery in the Veterans Administration has decreased by 45%. We performed a pilot study to assess risk factors associated with 30-day morbidity using National Surgical Quality Improvement Program indicators in a private setting. MATERIALS AND METHODS: A total of 643 subjects were accrued by a trained surgical reviewer from our institution between December 2003 and December 2004. Patient preoperative, intraoperative and nonNational Surgical Quality Improvement Program data elements were abstracted from clinical records. Bivariate relationships between preoperative risk factors, intraoperative process measures and 30-day postoperative morbidity were determined. Multiple variable logistic regression analysis was used to identify patient preoperative and intraoperative risk factors associated with 30-day morbidity. RESULTS: On multivariate analysis the preoperative risk factors history of congestive heart failure (OR 14.42, 95% CI 2.66 to 78.30), diabetes with end organ damage (OR 12.56, 95% CI 2.09 to 75.53), angioplasty (OR 2.75, 95% CI 1.27 to 5.93), quadriplegia (OR 4.39, 95% CI 1.36 to 14.14), low albumin (OR 2.49, 95% CI 1.18 to 5.24) and hydronephrosis (OR 2.51, 95% CI 1.11 to 5.69) were statistically significant predictors of 30-day postoperative morbidity. Intraoperative process measures, that is operative time in hours (OR 1.24, 95% CI 1.12 to 1.37) and transfusion (OR 3.11, 95% CI 1.49 to 6.50), were also significant contributors to postoperative morbidity. CONCLUSIONS: We found that patient preoperative risk factors and intraoperative process measures were important determinants of postoperative morbidity. Implementation of the National Surgical Quality Improvement Program in urology may be used to measure processes of care that are associated with surgical outcomes and, thereby, improve the quality of urological care.

Humans↗
PubMed2006

The role of imaging in the surveillance of urologic malignancies.

Urologic malignancies are common, accounting for approximately 25% of all new cancer cases in the United States. Patients with urologic malignancies require long-term surveillance to detect progression or recurrence as early as possible. The urologist is faced with the task of balancing patient safety and cost-effectiveness, while finding the most practical follow-up regimen. For each urologic malignancy, this article reviews the commonly used radiologic techniques for surveillance and offers recommended follow-up schedules.

Carcinoma, Renal Cell↗
PubMed2006

Use of medications or devices for erectile dysfunction among long-term prostate cancer treatment survivors: potential influence of sexual motivation and/or indifference.

OBJECTIVES: To evaluate the potential association between sexual motivation and patterns of erectile dysfunction (ED) therapy among a large cohort of localized prostate cancer treatment survivors. METHODS: The use of medications and devices to improve erections and sexual health-related quality of life (HRQOL) were evaluated using a mailed Expanded Prostate Cancer Index Composite survey administered to 896 men 4 to 8 years after brachytherapy, three-dimensional conformal external beam radiotherapy (3D-CRT), or radical prostatectomy and 112 control men. The responding participants (73% of those surveyed) were classified by prostate cancer treatment, sexual motivation, and ED therapy use. Bivariate and multivariate analyses were used to identify the factors associated with ED therapy use and sexual HRQOL outcome. RESULTS: The quality of erections unassisted by medications or devices was not different among the treatment groups. Prostate cancer survivors used medications or devices for ED more commonly than did the control men (30% versus 13%; P <0.01). One half of the prostate cancer survivors with ED reported indifference regarding their ED (small to no sexual bother despite absent or poor unassisted erections). Conversely, among men who were bothered by poor erections, 48% of the brachytherapy, 61% of the 3D-CRT, and 23% of radical prostatectomy subjects had never tried commonly available medications or devices to improve their erections (P <0.01). The current use of at least one erection aid was an independent determinant of more favorable sexual HRQOL (P <0.01). CONCLUSIONS: Many men who are bothered by posttreatment ED reported never having tried medications or devices to improve their erections. The lack of ED therapy was more prevalent among patients with erectile concerns after brachytherapy or 3D-CRT than after radical prostatectomy, suggesting possible opportunities for improving sexual HRQOL among long-term survivors.

Aged↗
PubMed2006

Comparing performance of Morbidity and Mortality Conference and National Surgical Quality Improvement Program for detection of complications after urologic surgery.

OBJECTIVES: The detection of postoperative complications is a necessary quality-of-care endeavor. Despite its historical role, the Morbidity and Mortality (M&M) Conference depends on voluntary reporting and may be an insufficient mechanism for comprehensive complication surveillance. In response to this concern, we compared the concordance between complications voluntarily reported at the M&M Conference and those identified prospectively by the National Surgical Quality Improvement Program (NSQIP). METHODS: For a single calendar year (2004), we compiled a comprehensive list of complications that were either identified and voluntarily entered into our department's electronic M&M Conference database and/or identified prospectively (from an explicit sample of cases) by a trained research associate-based NSQIP protocol. For analytic purposes, we treated NSQIP as the reference standard for the detection of complications. We then determined the sensitivity of the M&M Conference for the identification of complications at a patient and event level. Logistic regression modeling was used to evaluate for an association between complication category (ie, organ system affected) and detection by the M&M Conference. RESULTS: The NSQIP detected 347 complications in 176 patients. Using this reference standard, the patient-level and event-level sensitivity of the M&M Conference was 25% (44 of 176) and 14% (47 of 347), respectively. The sensitivity of the M&M Conference varied by NSQIP complication category (P = 0.08). Circulatory events were 11 times more likely to be reported at the M&M Conference than urinary complications (odds ratio 11.3, 95% confidence interval 2.4 to 53.7). CONCLUSIONS: Compared with the NSQIP, the M&M Conference has a low (but variable) sensitivity for the detection of postoperative complications. Therefore, despite its limitations, the NSQIP may provide a better foundation for urologic quality improvement endeavors.

Adolescent↗
PubMed2006

Cystectomy delay more than 3 months from initial bladder cancer diagnosis results in decreased disease specific and overall survival.

PURPOSE: Some groups hypothesize that a delay in cystectomy may result in higher pathological stage and possibly alter survival in patients with bladder cancer. The timing of this delay has been somewhat arbitrary. We evaluated the timing from T2 bladder cancer diagnosis to cystectomy, its impact on survival and potential causes of delay. MATERIALS AND METHODS: A contemporary cohort of 214 consecutive patients presented with clinical T2 bladder cancer and underwent radical cystectomy as primary therapy. Clinicopathological parameters were maintained in an institutional database. A review of time to cystectomy, pathological stage, disease specific survival and OS was performed. Variables were tested in univariate and multivariate analyses. The log rank test was used for exploratory analyses to determine meaningful delay cutoff points. RESULTS: Mean followup and time to cystectomy in the entire cohort was 40 months and 60 days, respectively. A significant disease specific survival and OS advantage was observed in patients undergoing cystectomy by 93 days or less (3.1 months) compared to greater than 93 days (p = 0.05 and 0.02, respectively). Pathological staging was similar between the groups (p = 0.15). A multivariate benefit in OS was observed in patients treated with timely cystectomy. The most common factor contributing to cystectomy delay was scheduling delay, as seen in 46% of cases. CONCLUSIONS: A cystectomy delay of 3.1 months undermines patient survival, likely through the development of micrometastases, since local stage progression is not apparent at this point. Most delays are avoidable and should be minimized. Despite the need for second opinions and the impact of busy surgical schedules clinicians must strive to schedule patients efficiently and complete surgical treatment within this time frame.

Aged↗
PubMed2006

Obesity adversely affects health related quality of life before and after radical retropubic prostatectomy.

PURPOSE: Obesity adversely affects surgical procedures and outcomes. We used a validated health related quality of life measure to examine the effects of obesity on disease specific health related quality of life before and following radical retropubic prostatectomy. MATERIALS AND METHODS: From June 2000 to April 2003, 575 consecutive patients with prostate cancer were approached to participate in a prospective, health related quality of life study. Health related quality of life was assessed before surgery, and 1, 4, 12, 24 and 36 months postoperatively. Repeated measures mixed models were constructed to determine the independent effects of body mass index on health related quality of life. RESULTS: Of 472 consenting subjects 376 (80%) completed a baseline and at least 1 followup survey. Higher body mass index was associated with worse preoperative hormonal/vitality function (p = 0.0009) and bother (p = 0.02), and delayed recovery of bowel function (p = 0.01) and bother (p = 0.01) health related quality of life. There were no measurable differences postoperatively in hormonal/vitality, urinary or sexual health related quality of life associated with higher body mass index. Increased body mass index was associated with prostate specific antigen recurrence (p = 0.05) and adjuvant treatment (p = 0.02). Adjuvant treatment was independently associated with worse bowel function (p = 0.01) and bother (p = 0.01) health related quality of life in obese patients. At 24 months bowel health related quality of life in obese patients no longer significantly differed from that in nonobese patients. CONCLUSIONS: Obesity is associated with worse preoperative hormonal/vitality health related quality of life, slower recovery of bowel function and bother health related quality of life after radical retropubic prostatectomy, and prostate specific antigen recurrence. Impaired health related quality of life recovery in obese patients is influenced by disease recurrence and resultant adjuvant therapies. Despite these findings obese patients should not be dissuaded from considering prostatectomy as definitive treatment for localized prostate cancer.

Body Mass Index↗
PubMed2005

Recurrent fusion of TMPRSS2 and ETS transcription factor genes in prostate cancer.

Recurrent chromosomal rearrangements have not been well characterized in common carcinomas. We used a bioinformatics approach to discover candidate oncogenic chromosomal aberrations on the basis of outlier gene expression. Two ETS transcription factors, ERG and ETV1, were identified as outliers in prostate cancer. We identified recurrent gene fusions of the 5' untranslated region of TMPRSS2 to ERG or ETV1 in prostate cancer tissues with outlier expression. By using fluorescence in situ hybridization, we demonstrated that 23 of 29 prostate cancer samples harbor rearrangements in ERG or ETV1. Cell line experiments suggest that the androgen-responsive promoter elements of TMPRSS2 mediate the overexpression of ETS family members in prostate cancer. These results have implications in the development of carcinomas and the molecular diagnosis and treatment of prostate cancer.

Androgens↗
PubMed2005

Autoantibody signatures in prostate cancer.

BACKGROUND: New biomarkers, such as autoantibody signatures, may improve the early detection of prostate cancer. METHODS: With a phage-display library derived from prostate-cancer tissue, we developed and used phage protein microarrays to analyze serum samples from 119 patients with prostate cancer and 138 controls, with the samples equally divided into training and validation sets. A phage-peptide detector that was constructed from the training set was evaluated on an independent validation set of 128 serum samples (60 from patients with prostate cancer and 68 from controls). RESULTS: A 22-phage-peptide detector had 88.2 percent specificity (95 percent confidence interval, 0.78 to 0.95) and 81.6 percent sensitivity (95 percent confidence interval, 0.70 to 0.90) in discriminating between the group with prostate cancer and the control group. This panel of peptides performed better than did prostate-specific antigen (PSA) in distinguishing between the group with prostate cancer and the control group (area under the curve for the autoantibody signature, 0.93; 95 percent confidence interval, 0.88 to 0.97; area under the curve for PSA, 0.80; 95 percent confidence interval, 0.71 to 0.88). Logistic-regression analysis revealed that the phage-peptide panel provided additional discriminative power over PSA (P<0.001). Among the 22 phage peptides used as a detector, 4 were derived from in-frame, named coding sequences. The remaining phage peptides were generated from untranslated sequences. CONCLUSIONS: Autoantibodies against peptides derived from prostate-cancer tissue could be used as the basis for a screening test for prostate cancer.

Aged↗