Faculty Bibliography

PURPOSE: The objective of this study is to determine the natural history of pathologically benign multi-parametric MRI (mpMRI) cancer suspicious regions (CSR) following targeted biopsy. MATERIALS AND METHODS: Between January 2012 and September 2014, 330 men underwent prostate mpMRI. 533 CSRs were identified and scored on a Likert scale of 1-5 based on suspicion for malignancy (5=highest suspicion level). Following mpMRI, all men underwent MRI-US fusion-targeted prostate biopsy using the Profuse software and ei-Nav|Artemis system and a computer-generate 12-core random biopsy. This study analyzes a cohort of 34 men with 51 CSRs with benign prostate biopsies who underwent repeat mpMRI and PSA testing at one year. Changes in greatest linear measurement (GLM), suspicion score (ss) and serum PSA were ascertained. RESULTS: Over one year, both the ss distribution and mean GLM of the CSRs decreased significantly (p<0.0001), while mean PSA did not significantly change (p=0.632). Overall, 2 (3.9%), 15 (29.4%) and 34 (66.7%) CSRs showed an increase, no change or decrease in ss, respectively. None (0%), 21 (42.0%) and 29 (58.0%) showed an increase (>/=20%), no change or decrease (>/=20%) in GLM, respectively. Of the two CSRs exhibiting increases in ss, neither showed a PSA increase >/=0.5 ng/mL. CONCLUSIONS: Our study provides compelling evidence that few benign CSRs increase in ss and/or GLM within one year, independent of baseline ss. Therefore, routinely repeating the mpMRI at one year in men with pathologically benign CSRs should be discouraged since it is unlikely to influence management decisions.

Second-hand smoke (SHS) is associated with 20-30% of cigarette-smoke related diseases, including cancer. Majority of SHS (>80%) originates from side-stream smoke (SSS). Compared to mainstream smoke, SSS contains more tumorigenic polycyclic aromatic hydrocarbons and acrolein (Acr). We assessed SSS-induced benzo(a)pyrene diol epoxide (BPDE)- and cyclic propano-deoxyguanosine (PdG) adducts in bronchoalveolar lavage (BAL), lung, heart, liver, and bladder-mucosa from mice exposed to SSS for 16 weeks. In SSS exposed mice, Acr-dG adducts were the major type of PdG adducts formed in BAL (p < 0.001), lung (p < 0.05), and bladder mucosa (p < 0.001), with no significant accumulation of Acr-dG adducts in heart or liver. SSS exposure did not enhance BPDE-DNA adduct formation in any of these tissues. SSS exposure reduced nucleotide excision repair (p < 0.01) and base excision repair (p < 0.001) in lung tissue. The levels of DNA repair proteins, XPC and hOGG1, in lung tissues of exposed mice were significantly (p < 0.001 and p < 0.05) lower than the levels in lung tissues of control mice. We found that Acr can transform human bronchial epithelial and urothelial cells in vitro. We propose that induction of mutagenic Acr-DNA adducts, inhibition of DNA repair, and induction of cell transformation are three mechanisms by which SHS induces lung and bladder cancers.

OBJECTIVE: To provide insight into the impact of radical prostatectomy (RP) on prostate cancer-specific mortality (PCSM) in a primarily PSA screen-detected cohort of men with localized prostate cancer. METHODS: Between 2000 and 2013, 1864 men consented to participate in a prospective longitudinal outcomes study following RP for localized prostate cancer (PCa) by a single surgeon. Men lost to follow-up were queried to the National Death Index to acquire mortality data. RESULTS: From our cohort of 1864 men (median age 59 years, median pre-operative PSA 5.0, median follow-up 9.1 years), Kaplan-Meier analysis demonstrated 10-year all-cause mortality and PCSM of 4.6% and 1.4%, respectively. Ten-year PCSM for low, intermediate, and high D'Amico risk were 0.9%, 1.0%, and 7.4%, respectively (p<0.001). For men with post-operative Gleason score 4-6, 7, and 8-10, 10-year PCSM was 0.8%, 1.0%, and 11.5%, respectively (p<0.001). Men with pT2, pT3a, and pT3b disease had 10-year PCSM of 0.7%, 2.6%, and 9.5%, respectively (p<0.001). Pathological stage and grade were the only significant independent predictor of PCSM at 10 years (p=0.002, p=0.025, respectively). CONCLUSIONS: In our series with up to 13 years of follow-up from the National Death Index, 10-year PCSM following RP for clinically localized PCa was very low and strongly predicted by pathological stage and grade. Death unrelated to PCa was a rare event, suggesting that we are identifying candidates for RP who are likely to live long enough to benefit from surgical intervention.

OBJECTIVE: To examine public and media response to the United States Preventive Services Task Force's (USPSTF) draft (October 2011) and finalized (May 2012) recommendations against prostate-specific antigen (PSA) testing using Twitter, a popular social network with over 200 million active users. MATERIALS AND METHODS: We used a mixed methods design to analyze posts on Twitter, called "tweets." Using the search term "prostate cancer," we archived tweets in the 24 hour periods following the release of the USPSTF draft and finalized recommendations. We recorded tweet rate per hour and developed a coding system to assess type of user and sentiment expressed in tweets and linked articles. RESULTS: After the draft and finalized recommendations, 2042 and 5357 tweets focused on the USPSTF report, respectively. Tweet rate nearly doubled within two hours of both announcements. Fewer than 10% of tweets expressed an opinion about screening, and the majority of these were pro-screening during both periods. In contrast, anti-screening articles were tweeted more frequently in both draft and finalized study periods. From the draft to the finalized recommendations, the proportion of anti-screening tweets and anti-screening article links increased (p= 0.03 and p<0.01, respectively). CONCLUSIONS: There was increased Twitter activity surrounding the USPSTF draft and finalized recommendations. The percentage of anti-screening tweets and articles appeared to increase, perhaps due to the interval public comment period. Despite this, most tweets did not express an opinion, suggesting a missed opportunity in this important arena for advocacy.

OBJECTIVE: To determine the association between baseline factors, post-treatment factors, and long-term satisfaction after radical prostatectomy (RP). METHODS: Between January 2000 and March 2009, 1425 men who underwent RP by a single surgeon were enrolled in an institutional review board-approved, prospective, longitudinal outcomes study. Baseline characteristics and post-treatment functional and oncologic outcomes were captured through 2013. Patient survey responses from 875 (61.4%) of these men were used to evaluate satisfaction with treatment outcome and treatment decision. RESULTS: Overall, 88.2% and 91.0% men were satisfied to very satisfied with treatment outcome and treatment decision, respectively. Baseline sexual function was associated with satisfaction with both treatment outcome (adjusted odds ratio [aOR] = 1.40; 95% confidence interval [CI], 1.01-1.93) and treatment decision (aOR = 1.47; 95% CI, 1.08-2.01). Among post-treatment factors, higher University of California, Los Angeles Prostate Cancer Sexual Function (aOR = 2.95; 95% CI, 2.06-4.22), University of California, Los Angeles Prostate Cancer Urinary Function (aOR = 2.38; 95% CI, 1.66-3.40), and lower urinary tract symptom scores (aOR = 1.91; 95% CI, 1.19-3.06) were predictors of satisfaction with outcome. Bother due to incontinence and sexual dysfunction, and perception of cure were independent predictors of both satisfaction with treatment outcome and treatment decision. CONCLUSION: Nearly 90% of men are satisfied with both their treatment outcome and treatment decision after open RP. Improving long-term satisfaction after RP requires efforts to provide realistic expectations and improve functional outcomes.

Retroperitoneal schwannoma is a rare tumor that is often misdiagnosed as malignancy due to a concerning appearance on cross-sectional imaging. Pathology and immunohistochemistry form the gold standard for diagnosis; as such, local excision is the treatment of choice for this disease. We present two cases of juxta-adrenal ancient schwannoma that were treated with adrenalectomy and discuss the current literature regarding this entity.