Prostate Cancer Screening in Men of African Descent: 15-year Results of the Tobago Prostate Cancer Survey / Tamización del cáncer de próstata en hombres de ascendencia africana: resultados de 15 años de la Encuesta de Cáncer de Próstata de Tobago

ABSTRACT Objective: To compare all-cause-mortality in screening-detected prostate cancer cases versus non-cases after a median 12.2-year follow-up. Methods: In this prospective, population-based study of 3089 Afro-Caribbean men aged 40-79 years in Tobago, Trinidad and Tobago, West Indies, all men were screened for prostate cancer (serum prostate specific antigen and/or digital rectal exam) one to three times between 1997 and 2007 and followed for mortality to 2012. Among 502 men diagnosed with prostate cancer, 81 younger men underwent radical retropubic prostatectomy. Minimal treatment was available for older men. Survival curves compared all-cause-mortality in cases versus non-cases within 10-year age groups at first screening. Results: There were 350 all-cause-deaths over 34 089 person-years of follow-up. All-cause-survival curves in men aged 60 years or above at first screening did not diverge between cases and non-cases until after 10-12 years of follow-up (p > 0.36). In contrast, among men first screened at age 50-59 years, survival was lower in cases, with survival curves diverging at seven years (p = 0.003). Survival in men aged 50-59 years who underwent prostatectomy was similar to survival in non-cases (p = 0.63). Conclusion: Among men aged 60 years or above, the absence of excess all-cause-mortality among screening-detected prostate cancer cases provides argument against the utility of routine prostate cancer screening in this older population of African descent. However, the significantly poorer survival in men aged 50-59 years with screening-detected prostate cancer, compared with screened men without prostate cancer, along with the potential for prostate cancer treatment to improve survival, supports the continuation of prostate cancer screening in this age group, pending further research to assess the risks and benefits.

RESUMEN Objetivo: Comparar la mortalidad por todas las causas en casos de cáncer de próstata frente a no casos tras un seguimiento medio de 12.2 años. Métodos: En este estudio prospectivo poblacional de 3089 hombres afrocaribeños de 40-79 años en Tobago, Trinidad y Tobago, West Indies, todos los hombres fueron expuestos a tamizaje de cáncer de próstata (antígeno prostático específico en suero y/o examen rectal digital) de una a tres veces entre 1997 y 2007, y a un seguimiento de la mortalidad hasta 2012. De entre los 502 hombres diagnosticados con cáncer de próstata, a 81 hombres de los más jóvenes se les practicó una prostatectomía retropúbica radical. El tratamiento mínimo estuvo disponible para los hombres mayores. Las curvas de supervivencia compararon la mortalidad por todas las causas en los casos frente a los no casos dentro de los grupos de edades de 10 años en la primera tamización. Resultados: Hubo 350 muertes por todas las causas con más de 34 089 persona-años de seguimiento. Las curvas de supervivencia por todas las causas en hombres de 60 años o más en el primer tamizaje, no divergieron entre casos y no casos hasta después de 10 a 12 años de seguimiento (p > 0.36). En cambio, entre los hombres tamizados por primera vez a la edad 50-59 años, la supervivencia fue menor en los casos, con curvas de supervivencia divergentes a los siete años (p = 0.003). La supervivencia en los hombres de 50-59 años que tuvieron prostatectomía fue similar a la supervivencia en los no casos (p = 0.63). Conclusión: Entre los hombres de 60 años o más, la ausencia de exceso de mortalidad por todas las causas entre los casos de cáncer de próstata detectados por tamizaje proporciona argumentos contra la utilidad de la tamización rutinaria del cáncer de próstata en esta población mayor de ascendencia africana. Sin embargo, la supervivencia significativamente más pobre en hombres de 50 a 59 años con cáncer de próstata detectado mediante tamizaje - en comparación con los hombres tamizados sin cáncer de próstata, además de las posibilidades de tratamiento del cáncer de próstata para mejorar la supervivencia - respalda la continuación del tamizaje del cáncer de próstata en este grupo etario, quedando pendiente una investigación ulterior a fin de evaluar sus riesgos y beneficios.

Orbital neurofibrosarcoma: a case report.

Malignant peripheral nerve sheath tumours of orbit is rare entity. Only sixteen cases are reported in world literature. Bengin schwannomas of the orbit are found in 1.5 to 18 percent of patients with von Recklinghausen's disease (VRD) and form 1 percent of all orbital tumours1. The incidence of malignant transformation in VRD is varies from 5-15 percent of all the cases1.

Large myofascial fibromatosis involving the shoulder girdle.

An 11 year old girl presented with gradually increasing swelling over left scapular region and limitation of movements. On examination, a mass with firm to hard consistency was found fixed to the scapula. Clinical diagnosis of fibromatosis was confirmed by needle biopsy. Radical excision of the tumor was carried out and the resultant large exposed area was covered by transpositional rotation of trapezius myocutaneous flap. Microscopic examination of excised tumor revealed spindle shaped elongated cells in the form of whorls and trabeculae. The post operative course of the patient was uneventful with no evidence of recurrence at the end of 22 months.

Primary cerebellopontine angle choroid plexus papilloma: a case report and review of literature.

A case of primary choroid plexus papilloma of the cerebellopontine (CP) angle is described in a 28 years old man. He presented with hearing loss, right facial palsy and spastic quadriparesis (4/5). He also had markedly increased intracranial pressure. CT scan revealed a large high attenuating lesion in right CP angle with gross hydrocephalus. The patient was operated with the clinical and radiological diagnosis of right sided acoustic tumor with brainstem compression. Radical tumour excision was performed, seven days following VP shunt. Patient had immediate postoperative deterioration followed by a steady recovery. The possibility of a secretory choroid plexus papilloma is discussed.

Epithelioid sarcoma of the upper extremity with cerebral metastases.

A forty year old male patient presented with swollen, deformed right hand with multiple irregular ulcers. The axillary lymph nodes were enlarged, firm and tender. The biopsy of nodules present on the hand revealed areas of haemorrhage and necrosis. The histopathological examination confirmed the clinical diagnosis of epithelioid sarcoma. Following below-elbow amputation, patient failed to regain consciousness and expired. On autopsy, distant metastases were found in the regional lymph nodes, pleura, kidney and cerebrum.

Dystrophin test in differential diagnosis of childhood muscular dystrophies.

Two cases of childhood muscular dystrophy are described. One of them had clinical features suggestive of Emery-Dreifuss muscular dystrophy and the other with some features of Prader-Willi syndrome, besides proximal muscle weakness. Muscle biopsy from both cases revealed a clear abnormality of dystrophin, and were diagnosed as having Duchenne muscular dystrophy (DMD) by immunofluorescence examination; that is, absent dystrophin at the membrane of the muscle fibers. The clinical spectrum of DMD-related myopathies and the importance of dystrophin testing in childhood muscular dystrophies is discussed.

Natural course of hematogenous pyogenic osteomyelitis (a retrospective study of 110 cases).

Hundred and ten consecutive cases in acute and various stages of chronicity were studied. Incidence regarding age, sex, bone affected and complications was established. The optimum way to manage osteomyelitis in different stages was sought. It was found that in acute stage early decompression of bone leads to resolution of disease. Hip involvement leads to necrosis of capital epiphysis and should be treated on an emergency basis. In the sub-acute stage it is necessary to protect the weakened bone. In chronic stage, we suggest sequestrectomy only after adequate involucrum has formed properly. Antibiotics in acute stage should be instituted as early as possible and should be continued for three weeks after the fever subsides. Antibiotics in sub-acute and chronic stage are given only in cases of reactivation of infection and around the time of surgery. Surgery, when required should be performed without too much soft tissue damage especially the covering periosteum. But repeated surgery should be avoided as they lead to cicatrization of muscles and further sequestration of bone.

An unusual case of hip disability--(a case report).

An unusual case of postero-superior periarticular irritation of the hip joint of six months' duration due to an extension of a pre-sacral foreign body granuloma in an 18 year old unmarried girl is presented. Two wooden sticks which probably were inserted pervaginally by a village midwife to induce an abortion for an unwanted pregnancy had found its way to presacral region. The scanning of the vaginal fornix indicated a possible route through which the sticks might have been migrated.

Short term chemotherapy of paucibacillary leprosy.

Twenty freshly diagnosed, previously untreated, adult male patients with paucibacillary leprosy were treated with Multi drug therapy (MDT) according to WHO regimen (1982). The patients remained in the hospital throughout the course of the study. At the end of six months treatment, they were evaluated clinicobacteriologically and histologically for evidence of the disease activity. Active disease was present in 55% of the patients at the end of six months treatment. DDS had to be discontinued in one patient who developed hepatitis.