Willie Underwood

American Cancer Society prostate cancer survivorship care guidelines.

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RENAL nephrometry score predicts surgical outcomes of laparoscopic partial nephrectomy

Study Type – Therapy (case series)

Racial treatment trends in localized/regional prostate carcinoma: 1992-1999.

African‐American men have a greater incidence of and mortality from prostate carcinoma compared with white men, and they are less likely to receive definitive therapy (radical prostatectomy or external beam radiation therapy). During the 1990s, the use of brachytherapy increased; however, its influence on racial and ethnic prostate carcinoma treatment trends remains unclear. The objective of this study was to describe treatment trends over the period 1992–1999 for localized/regional prostate carcinoma among white, Hispanic, and African‐American men.

Prospective Clinical Trial of Preoperative Sunitinib in Patients With Renal Cell Carcinoma

PURPOSE Sunitinib is an approved treatment for metastatic renal cell carcinoma. We performed a prospective clinical trial to evaluate the safety and clinical response to sunitinib administered before nephrectomy in patients with localized or metastatic clear cell renal cell carcinoma. MATERIALS AND METHODS Patients with biopsy proven clear cell renal cell carcinoma were enrolled in the study and treated with 37.5 mg sunitinib malate daily for 3 months before nephrectomy. The primary end point was safety. RESULTS In an 18-month period 20 patients were enrolled. The most common toxicities were gastrointestinal symptoms and hematological effects. Grade 3 toxicity developed in 6 patients (30%). No surgical complications were attributable to sunitinib treatment. Of the 20 patients 17 (85%) experienced reduced tumor diameter (mean change -11.8%, range -27% to 11%) and cross-sectional area (mean change -27.9%, range -43% to 23%). Enhancement on contrast enhanced computerized tomography decreased in 15 patients (mean HU change -22%, range -74% to 29%). After tumor reduction 8 patients with cT1b disease underwent laparoscopic partial nephrectomy. Surgical parameters, such as blood loss, transfusion rate, operative time and complications, were similar to those in patients who underwent surgery during the study period and were not enrolled in the trial. CONCLUSIONS Preoperative treatment with sunitinib is safe. Sunitinib decreased the size of primary renal cell carcinoma in 17 of 20 patients. Future trials can be considered to evaluate neoadjuvant sunitinib to maximize nephron sparing and decrease the recurrence of high risk, localized renal cell carcinoma.

Interplay of Race, Socioeconomic Status, and Treatment on Survival of Patients With Prostate Cancer

OBJECTIVES To compare overall and prostate cancer-specific survival, using the Detroit Surveillance, Epidemiology, and End Results registry data, among 8679 Detroit area black and white men with localized or regional stage prostate cancer diagnosed from 1988 to 1992 to determine whether racial disparities in long-term survival remained after adjusting for treatment type and socioeconomic status (SES). METHODS The cases were geocoded to the census block-group, and SES data were obtained from the 1990 U.S. Census. Cox proportional hazards regression analysis was used to estimate the hazard ratio of death from any cause. The median follow-up was 16.5 years. RESULTS Of the 7770 localized stage cases (22% black and 78% white) and 909 regional cases (24% black and 76% white), black men were more likely to receive nonsurgical treatment (P < .001) and to be of low SES (P < .0001). The survival analyses were stratified by stage. For both stages, black men had poorer survival than white men in the unadjusted model. The adjustment for age and tumor grade had little effect on the survival differences, but adjustment for SES and treatment removed the survival differences. CONCLUSIONS Low SES and nonsurgical treatment were associated with a greater risk of death among men with prostate cancer, explaining much of the survival disadvantage for black men with prostate cancer.

Perceived Cancer Risk: Why Is It Lower Among Nonwhites than Whites?

Background: We explored racial/ethnic differences in perceived cancer risk and determinants of these differences in a nationally representative sample of whites, blacks, Hispanics, and Asians. Methods: Multiple regression techniques, including mediational analyses, were used to identify determinants and quantify racial/ethnic differences in the perception of the risk of developing cancer among 5,581 adult respondents to the 2007 Health Information Trends Survey (HINTS). Results: Blacks, Hispanics, and Asians reported lower perceived cancer risk than whites [Bs = −0.40, −0.34, and −0.69, respectively; (Ps < 0.001)]. Contributing factors included relatively lower likelihood of reporting a family history of cancer, lower likelihood of having smoked, and a less strong belief that everything causes cancer among nonwhites than among whites. Racial/ethnic differences in perceived risk were attenuated in older respondents because perceived cancer risk was negatively associated with age for whites but not for nonwhites. Conclusions: Nonwhites had lower perceptions of cancer risk than whites. Some of the racial/ethnic variability in perceived risk may be due to racial and ethnic differences in awareness of ones family history of cancer and its relevance for cancer risk, experiences with behavioral risk factors, and salience of cancer risk information. Cancer Epidemiol Biomarkers Prev; 19(3); 746–54

Breast Cancer Racial Disparities: Unanswered Questions

Breast cancer is the most common noncutaneous cancer diagnosed in women in the United States and is second only to lung cancer as the leading cause of cancer-related mortality. Although mortality rates have been dropping steadily due to a variety of factors including improved treatment modalities and screening, substantial racial differences in outcome between blacks and whites persist. Although differences in health care utilization and access, tumor biology, and cancer management have been elucidated as possible reasons for disparities seen, it is likely that other interactions exist. The purpose of this review is, therefore, to present a comprehensive overview of the literature on racial disparities in breast cancer outcome and highlight potential causative factors that may contribute to disparities seen among blacks and whites with breast cancer. In addition, we make research recommendations by discussing some of the remaining gaps in knowledge that may lead to further understanding of disparities and consequently improved outcomes for all women with breast cancer.

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

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.

Personality predicts prostate cancer treatment decision-making difficulty and satisfaction.

Objective: Prostate cancer (PCa) patients often must decide between several treatment modalities considered equally efficacious, but associated with different benefits and side‐effects. For some, the decision‐making process can be difficult, but little is known about patient characteristics and cognitive processes that might influence the difficulty of such decisions. This study investigated the roles of dispositional optimism and self‐efficacy in PCa treatment decision‐making difficulty and satisfaction.

Race/Ethnicity and the Perception of the Risk of Developing Prostate Cancer

BACKGROUND Although the higher risk of prostate cancer for African-American men is well known in the medical community, it is not clear how prevalent this knowledge is among African-American men themselves. Both the side effects of treatment and the lack of a demonstrated mortality benefit of routine screening with the prostate-specific antigen test among men in the general population have increased the focus on patient participation in decision making about prostate cancer screening. METHODS Data on 1075 male respondents to the 2003 Health Information National Trends Study were collected from October 2002 to April 2003 and analyzed in 2008 to examine the associations among race/ethnicity, demographic characteristics, and the perception of the risk of developing prostate cancer for African-American, Hispanic, and non-Hispanic white men aged >or=45 years without a history of prostate cancer. RESULTS Nearly 50% of African-American men, 47.4% of Hispanic men, and 43.3% of non-Hispanic white men perceived their likelihood of getting prostate cancer as somewhat or very low. Nearly 18% of African-American men, 21.6% of Hispanic men, and 12.9% of non-Hispanic white men perceived themselves to be more likely to get prostate cancer than the average man of the same age. CONCLUSIONS Despite statistics to the contrary, few African-American men perceived themselves to have a higher-than-average risk of prostate cancer, while a higher percentage of Hispanic men perceived their risk to be higher than that of the average man of the same age. These findings suggest that all men, but particularly African-American and Hispanic men, could benefit from information regarding their specific risk of developing prostate cancer before making a decision about prostate cancer screening.