5-alpha-reductase inhibitors for prostate cancer prevention

5-alpha-reductase inhibitors for prostate
cancer prevention

Five-alpha-reductase inhibitor drugs, such as finasteride or dutasteride, reduce the risk
prostate cancer in men who have routine prostate cancer screening
Five-alpha-reductase inhibitor drugs have potential as chemopreventive agents. Reduction of
prostate cancer was similar between racial groups, age groups (aged 65 years or older compared to younger age groups) and those with or without a family history of prostate cancer. Reduction of prostate cancer was limited to men who had a baseline prostate specific antigen (PSA) values less than 4.0 ng/mL. However, use of five-alpha-reductase inhibitors may also increase the risk of high- grade prostate cancer in men undergoing prostate cancer screening. Future research is needed to determine if the use of five-alpha-reductase inhibitors can reduce prostate cancer in men who are not being regularly screened for prostate cancer. Future studies should also determine whether five- alpha-reductase inhibitors can reduce death and prostate cancer death and further evaluate the risk of developing high-grade prostate cancer.
Hospital lymph node counts and survival after radical cystectomy
Brent K. Hollenbeck, MD, MS 1 2 *, Zajoun Ye, MS 2, Sandra L. Wong, MD 1 3, James E. Montie, MD 2, John
D. Birkmeyer, MD 1 3
1Michigan Surgical Collaborative for Outcomes Research and Evaluation, University of Michigan, Ann Arbor, Michigan 2Department of Urology, University of Michigan, Ann Arbor, Michigan 3Department of Surgery, University of Michigan, Ann Arbor, Michigan *Correspondence to Brent K. Hollenbeck, Department of Urology, University of Michigan, TC3875 Box 0330, 1500 E. Medical The views expressed herein do not necessarily represent the views of Center for Medicare and Medicaid Services or the United States Fax: (734) 936-9127Funded by:
American Cancer Society Pennsylvania Division - Dr. William and Rita Conrady Mentored Research Scholar Grant; Grant Number: American Urological Association Foundation National Cancer Institute; Grant Number: 1 R01 CA098481-01A1 lymphadenectomy • mortality • hospital quality • cancer • lymph node count Several studies suggest that patients in whom more lymph nodes are examined have improved survival after radical cystectomy for bladder cancer. Despite growing calls for using lymph node counts as a hospital quality indicator, it has not been established that hospitals that obtain more lymph node have better outcomes. Using the national Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database (1992- 2003), all patients undergoing radical cystectomy for cancer were identified (n = 3603). Hospitals were ranked and sorted into 3 evenly sized groups: low (no patients with 10 lymph nodes removed), medium (up to 20% of patients), and high (greater than 20% of patients). Survival rates were assessed for each hospital group, adjusting for potentially confounding patient and hospital characteristics. On average, low lymph node count hospitals had higher observed mortality rates compared with high lymph node count hospitals (unadjusted hazards ratio [HR], 1.25; 95% confidence interval [95% CI], 1.13-1.39). Low lymph node count hospitals tended to treat patients who were older, had more comorbidity, were of lower socioeconomic status, had higher admission acuity, and had lower procedure volumes. After adjusting for these differences, low lymph node count hospitals tended to have slightly higher mortality (adjusted HR, 1.12; 95% CI, 0.99-1.27), although this finding did not reach statistical significance. Similar findings were evident when other thresholds (lymph node counts 5, 14, and 20) were used. Hospitals with high lymph node counts tend to have higher survival rates after radical cystectomy for bladder cancer. However, this effect is modest and is explained, in large part, by confounding patient and hospital factors. Cancer 2008. 2007 American Cancer Society.

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