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Particle Therapy Clinical Trials
Published in Manjit Dosanjh, Jacques Bernier, Advances in Particle Therapy, 2018
Cai Grau, Damien Charles Weber, Johannes A. Langendijk, James D. Cox, Tadashi Kamada, Hirohiko Tsujii
Similarly, cancer of the prostate is common but less often life-threatening. Because prostate cancer was the one type of cancer treated in large numbers at the Harvard Cyclotron Lab, it has been approved by insurance carriers as part of their standard policies. Nevertheless, because so many men who are covered by Medicare refer themselves for proton treatment, it is quite difficult to mount randomised studies. One trial compares proton therapy with and without androgen suppression for intermediate-risk prostate cancer (NCT01492972). Another compares hypo-fractionated versus standard-fractionation radiation therapy with protons and photons for low-risk prostate cancer (NCT01230866). ‘Level I’ evidence is virtually impossible because of the required periods of observation.
Artificial Neural Networks and Prognosis in Prostate Cancer
Published in Raouf N.G. Naguib, Gajanan V. Sherbet, Artificial Neural Networks in Cancer Diagnosis, Prognosis, and Patient Management, 2001
In addition to established clinical prognostic markers, several new factors are emerging which may have a varying degree of significance in predicting outcome. Amongst these novel experimental markers are the genes regulating programmed cell death, otherwise known as apoptosis. These include the tumour suppressor gene p53 and the proto-oncogene bcl-2. It is now evident that the effects of androgen suppression in prostate cancer are mediated via apoptosis. Deregulation of the genetic pathway leading to programmed cell death may confer hormone-resistant prostate cancer which is incurable. Our group has demonstrated previously that the combination of bcl-2 overexpression and p53 nuclear accumulation by immunohistochemistry correlates strongly with hormone refractory prostate cancer [1,2]. In the study described herein, we incorporated experimental with conventional markers to assess the sensitivity of neural networks in predicting outcome following appropriate training. The results were compared with those obtained from conventional statistical methods.
The Association between Sex Hormones, Pubertal Milestones and Benzophenone-3 Exposure, Measured by Urinary Biomarker or Questionnaire
Published in International Journal of Environmental Health Research, 2022
Courtney M Giannini, Bin Huang, Donald W Chandler, Cecily S Fassler, Richard C Schwartz, Frank M Biro, Susan M Pinney
Results did not suggest that higher levels of the BP-3 urinary biomarker were associated with lower levels of sex hormones during any of the time windows evaluated (before, during, or after thelarche). An increase in the number of days of reported sunscreen use over the past year was associated with a decrease in testosterone levels during thelarche. However, because of the many comparisons performed during these analyses, we believe that this association is likely due to a random finding. In addition, although the finding that a decrease in testosterone with increased number of days of sunscreen use was statistically significant, the finding is unlikely to have clinical significance. With a beta coefficient (−0.0163), an increase of 1 day per month that sunscreen was associated with a 2% decrease in testosterone level (exp(−0.0163) = 0.98). For a testosterone level of 5 ng/dL (approximate mean during thelarche) this would be about 0.08 ng/dL change (Fassler et al. 2019). We also found an inverse association between past 30-day sunscreen use and estrone levels during thelarche, a finding that is not consistent with the previously postulated androgen suppression activity of BP-3 (Ma et al. 2003).
Prostate cancer high dose-rate brachytherapy: review of evidence and current perspectives
Published in Expert Review of Medical Devices, 2018
Sunil W. Dutta, Clayton E. Alonso, Bruce Libby, Timothy N. Showalter
Prostate brachytherapy, which involves placing a sealed radiation source directly into the prostate, has higher conformality than EBRT, potentially improving the therapeutic ratio [9]. For patients with high risk disease, the Androgen Suppression Combined with Elective Nodal and Dose Escalated Radiation Therapy (ASCENDE-RT) trial demonstrated that patients who received low dose-rate (LDR) brachytherapy boost (compared to 78 Gy EBRT alone) were twice as likely to be free of biochemical failure, with an absolute estimated improvement of 21% with the use of brachytherapy by 9 years follow-up [10]. However, the ASCENDE-RT trial results also showed that patients who received LDR brachytherapy were at substantially higher risk of severe urinary toxicity, such as urethral stricture, potentially counterbalancing the gains in biochemical control [11]. As of a result of the improved cancer control outcomes from ASCENDE-RT and other clinical studies, the American Society of Clinical Oncology (ASCO) and Cancer Care Ontario issued joint guidelines in 2017 to recommend that all eligible patients with intermediate to high risk prostate cancer should be offered brachytherapy [12]. Similarly, the 2017 National Comprehensive Cancer Network (NCCN) guidelines list EBRT plus brachytherapy as a standard treatment option for intermediate to high risk prostate cancer [5].