Thomas L. Jang

Physician visits prior to treatment for clinically localized prostate cancer

BACKGROUND The 2 primary therapeutic interventions for localized prostate cancer are delivered by different types of physicians, urologists, and radiation oncologists. We evaluated how visits to specialists and primary care physicians (PCPs) by men with localized prostate cancer are related to treatment choice. METHODS Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database, we identified 85 088 men with clinically localized prostate cancer diagnosed at age 65 years or older, between 1994 and 2002. Men were categorized by primary treatment received within 9 months of diagnosis: radical prostatectomy (n = 18 201 [21%]), radiotherapy (n = 35 925 [42%]), androgen deprivation (n = 14 021 [17%]), or expectant management (n = 16 941 [20%]). Visits to specialists and PCPs were analyzed by patient characteristics and primary therapies received and were identified using Medicare claims and the American Medical Association Physician Masterfile. RESULTS Overall, 42 309 men (50%) were seen exclusively by urologists, 37 540 (44%) by urologists and radiation oncologists, 2329 (3%) by urologists and medical oncologists, and 2910 (3%) by all 3 specialists. There was a strong association between the type of specialist seen and primary therapy received. Visits to PCPs were infrequent between diagnosis and receipt of therapy (22% of patients visited any PCP and 17% visited an established PCP) and were not associated with a greater likelihood of specialist visits. Irrespective of age, comorbidity status, or specialist visits, men seen by PCPs were more likely to be treated expectantly. CONCLUSIONS Specialist visits relate strongly to prostate cancer treatment choices. In light of these findings, prior evidence that specialists prefer the modality they themselves deliver and the lack of conclusive comparative studies demonstrating superiority of one modality over another, it is essential to ensure that men have access to balanced information before choosing a particular therapy for prostate cancer.

Surgical Management of Advanced and Metastatic Renal Cell Carcinoma: A Multidisciplinary Approach

The past decade has seen a rapid proliferation in the number and types of systemic therapies available for renal cell carcinoma. However, surgery remains an integral component of the therapeutic armamentarium for advanced and metastatic kidney cancer. Cytoreductive surgery followed by adjuvant cytokine-based immunotherapy (predominantly high-dose interleukin 2) has largely given way to systemic-targeted therapies. Metastasectomy also has a role in carefully selected patients. Additionally, neoadjuvant systemic therapy may increase the feasibility of resecting the primary tumor, which may be beneficial for patients with locally advanced or metastatic disease. Several prospective trials examining the role of adjuvant therapy are underway. Lastly, the first immune checkpoint inhibitor was approved for metastatic renal cell carcinoma (mRCC) in 2015, providing a new treatment mechanism and new opportunities for combining systemic therapy with surgery. This review discusses current and historical literature regarding the surgical management of patients with advanced and mRCC and explores approaches for optimizing patient selection.

Impact of robot-assisted radical prostatectomy on health-related quality of life in patients with lower urinary tract symptoms

Objective:  Lower urinary tract symptoms (LUTS) are a common complaint in patients with prostate cancer. We attempted to elucidate the effect of robot‐assisted radical prostatectomy (RARP) on patients having different preoperative LUTS severity through analysis of postoperative health‐related quality of life.

Industry Payments to Urologists in 2014: an Analysis of the Open Payments Program

Introduction: Physician‐industry relationships are common in the U.S. and a source of considerable public scrutiny. The Open Payments program is a public database of all physician‐industry financial interactions in the U.S. administered by the Centers for Medicare & Medicaid Services. In this study we describe payments received by urologists for research and nonresearch purposes. Methods: The number and value of payments to urologists were determined using Open Payments program data. The nature of each payment and identity of industry partners were analyzed. Descriptive statistics were calculated separately for research and nonresearch payment data. The total number of practicing physicians per specialty was obtained from the Association of American Medical Colleges Physician Specialty Data Book for 2014. Results: In 2014, 8,620 urologists had nonresearch financial relationships with industry for a total value of

Abstract 4038: Human prostate cancer invasion could be suppressed by 5-Aza-2′-deoxycytidine which can inhibit the TGF-β induced DNA methyltransferase (DNMT)

32.4 million, with 2,698 urologists receiving more than

Polypoid endometriosis presenting as a renal cortical tumor

1,000 in total nonresearch payments. Urologists as a whole had the 8th highest total value received of all specialties. A total of

Effect of alvimopan on gastrointestinal recovery and length of hospital stay after retroperitoneal lymph node dissection for testicular cancer

22.4 million was spent by industry for urology directed research funding, representing a small proportion of the more than

Comparative Effectiveness of Radical Prostatectomy With Adjuvant Radiotherapy Versus Radiotherapy Plus Androgen Deprivation Therapy for Men With Advanced Prostate Cancer

3 billion spent by industry on medical research in 2014. The majority (93.1%) of urology directed research funding was provided to nonteaching institutions. Conclusions: The Open Payments program database is an important public database of financial transactions between industry and physicians. A large proportion of urologists received nonresearch related transfers of value from industry sources. Industry supported research funding is primarily awarded to nonteaching institutions.

Performing all major surgical procedures robotically will prolong wait times for surgery

Proceedings: AACR Annual Meeting 2014; April 5-9, 2014; San Diego, CA Introduction and Objective: We previously reported that loss of sensitivity to TGF-s growth inhibition is partially due to promoter methylation and subsequent down regulation of TGF-s receptors (TsRs) expression; a characteristic of aggressive PCa phenotypes. In this study, we address whether TGF-s induced DNMT expression contributes to its receptors promoter methylation and loss of sensitivity to this cytokine, and a more agressive phenotype. We also explored the effects of 5-Aza-2′-deoxycytidine (5-Aza), a DNMT inhibitor, on CaP cell invasion. Methods: PC3 human PCa line and its variants with different invasive abilities were used. Expression of TsRs, DNMT and vimentin under the treatment of TGF-s (10ng/mL), or 5-aza was evaluated by Western Blot and Real-Time PCR analysis. Methylation specific PCR (MSP) was performed to evaluate the status of TsRs promoters. Matrigel cell invasion assays were conducted using a 24-well transwell chamber (8-um pore size). Four different treatment groups were assigned to each cell line: Group 1- no treatment (control); Group 2- treatment with TGF-s (10ng/mL) for 24 hours; Group 3- treatment with 5-Aza (2 µg/ml) for 24 hours; and Group 4- treatment with TGF-s plus 5-Aza for 24 hours. The invaded cells were stained and counted under high magnification objective (100x). [3H] Thymidine incorporation assay were used to evaluate cell growth under the treatment of 5-Aza. Results: Both TsRI and TsRII expresion was significantly increased (2-2.5 folds) after treatment with 5-Aza in PC-3 cells. In contrast, treatment of TGF-s signficantly increased the expression of DNMT by 3.2 fold and suppressed the expression of TsRI and TsRII by 46% and 29% respectively. This suppression and promoter methylation was recovered following treatment with 5-Aza. 5-Aza treatment also resulted in a significant inhibition of cell proliferation, regardless of whether cells were exposed to exogenous TGF-s. An average of 82 cells/field were found to invade in the control group (Group 1). In Group 2, there was a significant increase in the number of invaded cells (139/field) with TGF-β treatment. Invasion of PC-3 cells was significantly inhibited by treatment of 5-aza, (only 10 /field). After treatment with 5-Aza, the expression of vimentin decreased by 50% fold, as well as DNMTs was inhibited significantly. Conclusion: Tumor derived TGF-s-induced DNMTs mediates promoter hypermethylation and downregulation of its receptors of its own receptors. Knockdown of DNMT by 5-aza result in the demethylation of the TGF-s receptors gene promoters, restoration of TGF-s inhibition of cell growth, and inhibition of invasion of CaP cells by inhibiting the expression of DNMT and vimentin induced by TGF-s. This results indicated 5-Aza may be a candidate for novel antitumor metastasis strategies in men with aggressive CaP. Citation Format: Qiang Zhang, Brian Helfand, Xiao Lin, Thomas Jang, Yinglu Guo, Janardan Khandekar, Timothy Michael Kuzel, Chung Lee. Human prostate cancer invasion could be suppressed by 5-Aza-2′-deoxycytidine which can inhibit the TGF-β induced DNA methyltransferase (DNMT). [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 4038. doi:10.1158/1538-7445.AM2014-4038

Striving Toward a Cure for Prostate Cancer

A 41-year-old female patient presented with left-sided flank pain and gross hematuria temporally unrelated to her menstrual cycle. Abdominal computed tomography scan showed a large left-sided solid, enhancing kidney mass radiographically consistent with renal cell carcinoma. Following surgical resection, histopathological examination revealed polypoid endometriosis. Polypoid endometriosis is rare and mimics a neoplasm clinically, radiographically, and on gross examination. Patients with polypoid endometriosis often present with symptoms related to mass effect rather than classic endometriosis hallmark symptoms such as dyspareunia, dysmenorrhea, and cyclic abdominal pain. Treatment includes surgical resection.