Faculty Bibliography

What's known on the subject? and What does the study add? Androgen stimulation of prostate cancer (PCa) cells has been the basis for extensive studies evaluating the role of androgen in PCa but the diagnostic measurement of androgen as well as androgen values that potentially influence prognosis are unclear in patients with PCa. The 50 ng/dL threshold has been questioned as a result of reports indicating worse outcomes for levels between 20 and 50 ng/dL. Instead, a 20 ng/dL threshold for serum testosterone after androgren deprivation therapy in patients with advanced PCa was recommended. OBJECTIVE: * Androgen stimulation of prostate cancer (PCa) cells has been extensively studied. The increasing trend of using serum testosterone as an absolute surrogate for castration state means that the diagnostic measurement of testosterone and the values potentially influencing prognosis must be better understood. This is especially important when PCa progresses from an endocrine to an intracrine status. PATIENTS AND METHODS: * We performed a literature review using the MEDLINE database for publications on: (i) hormonal changes with androgen deprivation therapy (ADT); (ii) monitoring hormonal therapy with testosterone measurement; (iii) the efficacy of intermittent androgen deprivation (IAD) compared with continuous androgen deprivation; (iv) the underlying mechanisms of castration-resistance; and (v) novel treatments for castration-resistant PCa (CRPCa). RESULTS: * The optimum serum castration levels to be achieved with ADT are still debated. Recently, the 50 ng/dL threshold has been questioned because of reports indicating worse outcomes when levels between 20 and 50 ng/dL were studied. Instead, a 20 ng/dL threshold for serum testosterone after ADT in patients with advanced prostate cancer was recommended. CONCLUSION: * Understanding the mechanisms of androgen biosynthesis relating to PCa as well as prognostic implications might achieve a consensus regarding the role of ADT for both the androgen-sensitive and -insensitive disease state.

OBJECTIVE: The purpose of this study is to retrospectively compare 1D, 2D, and 3D measurements on CT for detection of growth of solid renal masses on active surveillance. MATERIALS AND METHODS: Forty solid renal masses measuring at least 1 cm in patients who underwent two CT studies at least 3 months apart were included. Two radiologists independently assessed the studies for interval growth using gestalt visual assessment and 1D, 2D, and 3D measurements. Prospective reports were also evaluated for indications of growth. The summation-of-areas technique was used to calculate volumes of lesions, which served as reference standard in determination of growth. Logistic regression analysis for correlated data was used to compare accuracy of methodologies for detection of lesion growth. Interreader agreement was assessed using kappa coefficients and intraclass correlation coefficients. RESULTS: The accuracy of gestalt visual, 1D, 2D, and 3D assessments for detection of interval growth was 72.5%, 70.0%, 82.5%, and 85% for reader 1 and 77.5%, 70.0%, 90.0%, and 95.0% for reader 2. These differences were significant or nearly significant (p = 0.003-0.054) for the greater accuracy of 2D or 3D measurements than for 1D measurements for reader 1 as well as the greater accuracy of 2D measurements than 1D measurements and 3D measurements than gestalt visual assessment or 1D measurements for reader 2. The accuracy of prospective reports for detection of growth was 65.0%. Reader agreement was fair for gestalt visual assessment (kappa = 0.31) and nearly perfect for 1D, 2D, and 3D measurements (intraclass correlation coefficient = 0.97-0.99). CONCLUSION: Our results show that 2D or 3D measurements may be preferable to 1D measurements on CT in assessment for growth of solid renal masses on active surveillance.