Personalised Management of Prostate Cancer

Despite recent advances, prostate cancer continues to be a leading cause of cancer-related death among men. While the standard management options of surgery, radiotherapy, and androgen deprivation therapy are well established, there are still significant unmet needs. For example, which patients would best be served by active surveillance at the time of diagnosis versus proceeding with definitive therapy is still not well understood. Additionally, more accurate means of monitoring patients’ responses to therapy and remission statuses following therapy are needed. Since all patients with metastatic disease ultimately progress to castration-resistant prostate cancer, new treatment options for this population are also required. As in other areas of oncology, greater personalisation of care holds the potential for more effective treatment while also reducing the risk of adverse effects and morbidity. This review addresses three topics currently under investigation related to the personalised management of prostate cancer: the use of circulating tumour cells in both diagnosis and treatment at all stages of the disease, the introduction of poly(adenosine diphosphate-ribose) polymerase inhibitors for the treatment of castration-resistant prostate cancer, and the emerging role of genomic assays for risk stratification at the time of diagnosis

Cumulative Burden of Morbidity Among Testicular Cancer Survivors After Standard Cisplatin-Based Chemotherapy: A Multi-Institutional Study

Purpose In this multicenter study, we evaluated the cumulative burden of morbidity (CBM) among > 1,200 testicular cancer survivors and applied factor analysis to determine the co-occurrence of adverse health outcomes (AHOs). Patients and Methods Participants were ≤ 55 years of age at diagnosis, finished first-line chemotherapy ≥ 1 year previously, completed a comprehensive questionnaire, and underwent physical examination. Treatment data were abstracted from medical records. A CBM score encompassed the number and severity of AHOs, with ordinal logistic regression used to assess associations with exposures. Nonlinear factor analysis and the nonparametric dimensionality evaluation to enumerate contributing traits procedure determined which AHOs co-occurred. Results Among 1,214 participants, approximately 20% had a high (15%) or very high/severe (4.1%) CBM score, whereas approximately 80% scored medium (30%) or low/very low (47%). Increased risks of higher scores were associated with four cycles of either ifosfamide, etoposide, and cisplatin (odds ratio [OR], 1.96; 95% CI, 1.04 to 3.71) or bleomycin, etoposide, and cisplatin (OR, 1.44; 95% CI, 1.04 to 1.98), older attained age (OR, 1.18; 95% CI, 1.10 to 1.26), current disability leave (OR, 3.53; 95% CI, 1.57 to 7.95), less than a college education (OR, 1.44; 95% CI, 1.11 to 1.87), and current or former smoking (OR, 1.28; 95% CI, 1.02 to 1.63). CBM score did not differ after either chemotherapy regimen ( P = .36). Asian race (OR, 0.41; 95% CI, 0.23 to 0.72) and vigorous exercise (OR, 0.68; 95% CI, 0.52 to 0.89) were protective. Variable clustering analyses identified six significant AHO clusters (χ2 P < .001): hearing loss/damage, tinnitus (OR, 16.3); hyperlipidemia, hypertension, diabetes (OR, 9.8); neuropathy, pain, Raynaud phenomenon (OR, 5.5); cardiovascular and related conditions (OR, 5.0); thyroid disease, erectile dysfunction (OR, 4.2); and depression/anxiety, hypogonadism (OR, 2.8). Conclusion Factors associated with higher CBM may identify testicular cancer survivors in need of closer monitoring. If confirmed, identified AHO clusters could guide the development of survivorship care strategies

Abiraterone-induced rhabdomyolysis resulting in acute kidney injury: A case report and review of the literature

Abiraterone, a CYP17 inhibitor, blocks androgen biosynthesis in multiple tissue types. In combination with prednisone, it is approved as a first-line treatment for metastatic castration-resistant prostate cancer. We present a case of rhabdomyolysis associated with abiraterone therapy resulting in acute on chronic kidney injury in a patient with metastatic castration-resistant prostate cancer. Strict monitoring should be employed in patients started on abiraterone who have additional risk factors for developing rhabdomyolysis

Captioning and Indian Sign Language as Accessibility Tools in Universal Design

Universal Design in Media as a strategy to achieve accessibility in digital television started in Spain in 1997 with the digitalization of satellite platforms (MuTra, 2006). In India, a conscious effort toward a strategy for accessible media format in digital television is yet to be made. Advertising in India is a billion dollar industry (Adam Smith, 2008) and digital television provides a majority of the space for it. This study investigated the effects of advertisement in accessible format, through the use of captioning and Indian sign language (ISL), on hearing and deaf people. “Deaf (capital letter ‘D’ used for culturally Deaf) and hearing” viewers watched two short recent advertisements with and without accessibility formats in a randomized order. Their reactions were recorded on a questionnaire developed for the purpose of the study. Eighty-four persons participated in this study of which 42 were deaf persons. Analysis of the data showed that there was difference in the effects of accessible and nonaccessible formats of advertisement on the “Deaf and Hearing” viewers. The study showed that accessible formats increased the comprehension of the message of the advertisement and use of ISL helped deaf persons to understand concepts better. While captioning increased the perception of the hearing persons to correlate with listening and understanding the concept of the advertisement, the deaf persons correlated watching the ISL interpreter with understanding the concept of the advertisement. Placement of the ISL interpreter in the screen and color of the fonts used for captioning were also covered under the study. However, the placement of the ISL interpreter and color of fonts in the screen and their correlation with comprehension of the advertisement by hearing and deaf persons did not show much of significance in the result of the study.n

Ipilimumab-Induced Neutropenia in Melanoma

Ipilimumab is a human monoclonal IgG1 antibody against CTLA-4 that has been shown to prolong the overall survival of advanced melanoma. The most common adverse events associated with ipilimumab are immune-related. Severe hematological toxicity is rare. We report a case of severe neutropenia following ipilimumab therapy that fully resolved after the administration of prednisone, cyclosporine, and anti-thymocyte globulin therapies

A case series of transformation of teratoma to primitive neuroectodermal tumor: evolving management of a rare malignancy

Primitive neuroectodermal tumor (PNET) is a pathologic diagnosis that encompasses several different tumor types, including central nervous system tumors and Ewing’s sarcomas. Teratoma, a common element of germ cell tumor (GCT), has the ability to transform to malignant PNET in a small number of patients. Making a definitive diagnosis of PNET is difficult given its deviation from elements of GCT and its non-specific pathologic findings. Establishing the diagnosis is crucial as PNETs respond poorly to standard platinum-based chemotherapy used for treatment of GCT. Primary treatment for PNET is surgical, though this is often not feasible in many patients due to extensive disease at diagnosis. As an alternative, chemotherapy regimens traditionally used for Ewing’s sarcoma, such as vincristine, doxorubicin and cyclophosphamide alternating with ifosfamide and etoposide, have shown limited efficacy in the neoadjuvant, adjuvant, and palliative settings. Future research should delineate the genetic underpinnings of PNET and develop therapeutic options accordingly