Plenary debate of randomized phase III trial of neoadjuvant MVAC plus cystectomy versus cystectomy alone in patients with locally advanced bladder cancer.
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Michael J Droller
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Association between American Urologic Association (AUA) urinary symptom score and disease stage in men with localized prostate cancer.
UNLABELLED: We assessed the relationship of American Urological Association (AUA) urinary symptom score and tumor stage in men treated for localized prostate cancer. METHODS: Participants in our study were found through urology and radiation oncology clinics, and all eligible patients were asked to take part. All patients had been initially diagnosed on the basis of rising PSA or abnormal physical examination. Histological confirmation of diagnosis was obtained for all subjects. Tumor stage was determined by digital rectal examination. 265 men with prostate cancer were studied. RESULTS: There was a significant difference in AUA symptom score in the three disease stages (p = 0.035, one way anova). Tukey's multiple range B test showed a significant difference between the AUA symptom scores of patients with t3 disease, when compared to patients with t1 and t2 disease (p = 0.05). The range test showed no significant difference between the AUA symptom scores of patients with t1 and t2 disease (p = 0.897). There was a significant difference in mean age of men with t1, t2, and t3 disease (p < 0.001). Men with t2 disease had a mean age of 69 years, as opposed to men with t1 and t3 disease (mean ages 66 and 64, respectively). Tukey's multiple range B test showed a significant difference (p = 0.05) between the ages of the men with t2 disease and the men with t1 or t3 disease. But there was no significant difference between the ages of the men with t1 and t3 disease. There was no relationship between age and AUA symptom score (r = 0.008, P = 0.89). The AUA symptom score index classifies the symptoms of men with a score of 0 to 7 as mild, 8 to 19 moderate, and 20 and above as severe. According to this classification, 55.6% of the prostate cancer patients we studied had mild symptoms, 37.1% had intermediate symptoms, and 7.3% had severe symptoms. CONCLUSIONS: The majority (approximately 80%) of prostate cancers are found in the peripheral zone. But prostate cancers associated with urinary symptoms might arise in the periurethral transition zone, where almost all symptomatic benign prostatic hypertrophy originates. We hypothesize that symptomatic and non-symptomatic prostate cancer may be two distinct disease entities, each with its own characteristic genetic complement. In addition, urologists are actively seeking additional indicators of prostate cancer aggressiveness. Many prostate cancers are quite indolent and may never cause a problem, but it is impossible to identify such tumors with certainty. Further studies of AUA symptom score and outcome would be worthwhile. If AUA symptom score is a predictor of outcome that is independent of t stage, AUA score might be clinically valuable in disease management.
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Elevated serum triiodothyronine (t3) in Ashkenazi Jewish prostate cancer patients carrying the I1307k allele of the APC (adenopolyposis coli) gene.
PURPOSE: The risk of developing any cancer in carriers of the I1307K mutation of the adenopolyposis coli (APC) gene is significantly increased (odds ratio 1.5, P = 0.01). One of the cancers associated with the I1307K mutation is prostate cancer (odds ratio 2.0, P = 0.14). Also, there is an association of APC mutations with thyroid cancer. In this study, we measured triiodothyronine (t3) levels in Ashkenazi Jewish prostate cancer patients, with and without the I1307K mutation of the APC gene. MATERIALS AND METHODS: Participants in our study were found through urology and radiation oncology clinics in 1999 and 2000. All eligible patients were asked to take part. All patients had been initially diagnosed on the basis of rising PSA or abnormal physical examination. Histological confirmation of diagnosis was obtained for all subjects. Ethnic background was confirmed for all subjects by self-report or interview. The I1307K allele of the APC gene was detected by amplification of DNA isolated from peripheral blood according to standard polymerase chain reaction (PCR) and dot blot procedures. Serum t3 level was determined by fluorescent immunoassay with a standard, commercially available instrument. RESULTS: We studied 77 patients. The youngest patient was 46, the oldest 88, average age 67 +/- 7.2 (mean +/- SD). Eleven males carrying the APCI 1307K allele had significantly higher serum t3 levels than 66 males carrying the wild type allele. There were no homozygotes for the I1307K allele. None of the males had a t3 level that was above the normal range for our laboratory (137 ng/dl). CONCLUSIONS: Our findings of increased serum t3 level with the APC I1307K allele in prostate cancer patients is not surprising, given the mitogenic potential of t3. Further studies may clarify whether t3 elevation is the mechanism whereby APC gene mutations increase the risk of prostate cancer, or whether other pathophysiologic abnormalities are involved.
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