Prostate Cancer Surveillance Criteria May Not Be Accurate for African American Men

“A new study published in The Journal of Urology revealed that African American men with Gleason score 3+3=6 prostate cancer (PCa) produce less prostate specific antigen (PSA) and have significantly lower PSA density (PSAD) than Caucasian men. These findings could have important implications when selecting patients for inclusion in active PCa surveillance programs.

“Prostate cancer remains the second leading cause of  among  in the U.S., with nearly 30,000 deaths annually. According to the latest recommendations by the American Urological Association, PSA remains the only screening test to select men with unremarkable digital rectal examination in whom prostate biopsy should be considered. Deaths from  have declined by about 40% since the advent of PSA screening in the late 1980s, and 40-70% of that decline may be attributable to screening. For early stage low grade disease, active surveillance, commonly called watchful waiting, is considered appropriate.”

Clinical, Behavioral Factors Predict Lung Cancer Recurrence

“Several factors, including the presence of a nodule on CT scan and persistent metaplasia, served as significant predictors of lung cancer recurrence or the development of secondary primary lung cancers, according to study results presented at the American Thoracic Society International Conference.

“ ‘This suggests that aggressive ongoing surveillance of lung cancer survivors may be needed for extended periods of time,’ Samjot Dhillon, MD, associate professor of oncology at Roswell Park Cancer Institute, and colleagues wrote.

“Lung cancer accounts for approximately 27% of all cancer deaths, and more than 158,000 Americans are expected to die of the disease this year, according to the American Lung Association. About half of patients with lung cancer have advanced disease at the time of diagnosis.”

Researchers Predict ADH Patients at Low Risk for Breast Cancer

“Researchers have identified a group of women with atypical ductal hyperplasia found on core needle biopsy who should be considered to be at low risk for disease upgrade. These women should be considered for prevention therapy and surveillance rather than undergoing surgical excision, according to Alvaro Pena, MD, of the Mayo Clinic, Rochester, Minn., who presented the results of a retrospective analysis (Abstract 3) at the 2014 American Society of Clinical Oncology (ASCO) Breast Cancer Symposium.

“Atypical ductal hyperplasia is found in between 8% to 17% of all core needle biopsies. ADH is a high-risk lesion increasing a woman’s long-term risk for breast cancer.

“In this analysis, Pena and colleagues attempted to create a model using clinical, mammographic, and histologic features to identify a subgroup of women with atypical ductal hyperplasia found on core needle biopsy who may be at low risk of cancer upgrade.”

Low-Risk Adenoma Removal Associated with Reduced Colorectal Cancer Mortality

Editor’s note: This article is about the results of a research study for colorectal cancer. The researchers looked at the medical records of people who had high- and low-risk adenomas removed to see which patients later died of colorectal cancer. They found that people who had high-risk adenomas removed were more likely to die of colorectal cancer within 8 years. People who had low-risk adenomas removed were no more likely to die of colorectal cancer than the general population. Based on the results, people who have low-risk adenomas removed might not need to undergo surveillance after surgery. Surveillance can involve invasive colonoscopies, so many of these patients might actually be better off without surveillance.

“Patients who had low-risk adenomas removed demonstrated lower rates of long-term colorectal cancer mortality than those who had high-risk adenomas removed, according to results of a population-based study.

“The low mortality rate associated with low-risk adenomas may obviate the need for post-colonoscopy surveillance in this population, researchers wrote.

“Magnus Løberg, MD, of the department of health management and health economics at University of Oslo, and colleagues used Norway’s cancer registry and cause of death registry to assess colorectal cancer mortality among 40,826 adults who had colorectal adenomas removed between 1993 and 2007.

“Patients with high-risk adenomas — or those with high-grade dysplasia, a villous component or a size ≥10 mm — underwent colonoscopy after 10 years, whereas those with three or more adenomas underwent colonoscopy after 5 years in compliance with Norwegian guidelines.”

Fewer Die from Colorectal Cancer

“Patients with intestinal polyps have a lower risk of dying from cancer than previously thought, according to Norwegian researchers.

“This group of patients may therefore need less frequent colonoscopic surveillance than what is common today. As a potential concequence, the researchers argue, health service resources may be diverted to other, patient groups.

“The findings were released today in The New England Journal of Medicine (NEJM).”

Digital Surveillance, Photography Aided Early Melanoma Diagnosis

“Surveillance with total body photography and sequential digital dermoscopy imaging helped improve early detection of primary melanomas, according to study results.

“ ‘Whereas encouraging vigilance and self–skin examination is important, there is increasing evidence that interventions such as dermoscopy, sequential digital dermascopic imaging, and baseline total-body photography can aid early detection of melanoma,’ Fergal J. Moloney, MD, of the University of Sydney at Sydney Cancer Center in Australia, and colleagues wrote.

“To determine the impact of full-body examinations on melanoma detection, the researchers enrolled 311 patients (179 men, 132 women) seen at the Sydney Diagnostic Centre and Melanoma Institute Australia.”

PCPs Commonly Fail to Offer HCC Screen to Patients with Cirrhosis

“Various primary care physicians in North Carolina who examine patients with cirrhosis do not offer a screening for hepatocellular carcinoma, according to results from a recent study.

“Researchers from the University of North Carolina, including Paul H. Hayashi, MD, MPH, used the North Carolina Medical Board database and mailed a letter and 12-item survey to 1,000 randomly assigned PCPs to address their knowledge of HCC surveillance and screening and whether they recommend it or perform it on their patients with cirrhosis. In all, 391 PCPs completed the survey and two were not included. Ninety percent of the 389 PCPs (n=345) saw patients with cirrhosis.”

Genetic Mutations Warn of Skin Cancer Risk

“Researchers have discovered that mutations in a specific gene are responsible for a hereditary form of melanoma.

“Every year in the UK, almost 12,000 people are diagnosed with melanoma, a form of skin cancer. About 1 in 20 people with melanoma have a strong family history of the disease. In these patients, pinpointing the genetic mutations that drive disease development allows dermatologists to identify people who should be part of melanoma surveillance programmes.

“The team found that people with specific mutations in the POT1 gene were extremely likely to develop melanoma. These mutations deactivate the POT1 gene that protects the ends of our chromosomes from damage.”

Prostate Cancer Cell Telomere Length Variability and Stromal Cell Telomere Length as Prognostic Markers for Metastasis and Death

“Current prognostic indicators are imperfect predictors of outcome in men with clinically-localized prostate cancer. Thus, tissue-based markers are urgently needed to improve treatment and surveillance decision-making. Given that shortened telomeres enhance chromosomal instability and such instability is a hallmark of metastatic lesions, we hypothesized that alterations in telomere length in the primary cancer would predict risk of progression to metastasis and prostate cancer death. To test this hypothesis, we conducted a prospective cohort study of 596 surgically treated men who participated in the ongoing Health Professionals Follow-up Study.”