Race is associated with discontinuation of active surveillance of low-risk prostate cancer: results from the Duke Prostate Center.

BACKGROUND: Active surveillance (AS) is increasingly utilized in low-risk prostate cancer (PC) patients. Although black race has traditionally been associated with adverse PC characteristics, its prognostic value for patients managed with AS is unclear. METHODS: A retrospective review identified 145 patients managed with AS at the Duke Prostate Center from January 2005 to September 2011. Race was patient-reported and categorized as black, white or other. Inclusion criteria included PSA <10 ng ml(-1), Gleason sum ≤ 6, and ≤ 33% of cores with cancer on diagnostic biopsy. The primary outcome was discontinuation of AS for treatment due to PC progression. In men who proceeded to treatment after AS, the trigger for treatment, follow-up PSA and biopsy characteristics were analyzed. Time to treatment was analyzed with univariable and multivariable Cox proportional hazards models and also stratified by race. RESULTS: In our AS cohort, 105 (72%) were white, 32 (22%) black and 8 (6%) another race. Median follow-up was 23.0 months, during which 23% percent of men proceeded to treatment. The demographic, clinical and follow-up characteristics did not differ by race. There was a trend toward more uninsured black men (15.6% black, 3.8% white, 0% other, P = 0.06). Black race was associated with treatment (hazard ratio (HR) 2.93, P = 0.01) as compared with white. When the analysis was adjusted for socioeconomic and clinical parameters at the time of PC diagnosis, black race remained the sole predictor of treatment (HR 3.08, P = 0.01). Among men undergoing treatment, the trigger was less often patient driven in black men (8 black, 33 white, 67% other, P = 0.05). CONCLUSIONS: Black race was associated with discontinuation of AS for treatment. This relationship persisted when adjusted for socioeconomic and clinical parameters.

Changes in event-related potentials in a three-stimulus auditory oddball task after mild head injury.

Previous research has demonstrated changes in event-related potentials in a variety of cognitive tasks after severe closed head injury. We sought to establish if similar changes were present in patients who had sustained only apparently mild head injury (MHI) by recording event-related potentials in a group of 24 mild head injured and 24 control participants during a three-stimulus auditory target detection task. For this "oddball" task participants were required to press a button every time they heard a rare target tone and to ignore rare novel sounds and frequent non-target tones. Neuropsychological test results indicated that the mild head injured group had mild memory and attention impairments. Analysis of behavioural performance on the three-stimulus "oddball" task showed no difference in reaction times or error rates between the two groups. Target condition N2 deflections appeared to be larger in the mild head injured but peak amplitude measures revealed that this effect was not significant. There were no significant differences in the amplitude or latency of the P3b evoked by target stimuli or the P3a evoked by novel stimuli. However, a putative "O-wave" or "reorienting negativity" following the P3a was more negative in the mild head injured group suggesting increased activation of components of the attention network. These findings lend support to the hypothesis that MHI can cause subtle cognitive impairments that are associated with abnormal allocation of attention resources in the context of normal behavioural performance.

Mycotic aneurysm of the internal carotid artery. A surgical emergency.

A 17-year-old man presented with signs of rupture of a high cervical internal carotid aneurysm. Following angiographic demonstration of the aneurysm, he was immediately treated by balloon catheter occlusion. Eight days later the ligation of the supraclinoid portion of the internal carotid on the left was prompted by the formation of blood clots and emboli from this segment. The patient tolerated both procedures well.

Patterns of nutritional deficiency in head and neck cancer.

A nutritional assessment battery consisting of anthropometric measurements, skin tests, laboratory assessment of visceral and somatic proteins, and a questionnaire was used to characterize the nutritional status of 50 consecutive new head and neck tumor patients. Forty percent of our patients had good nutrition, 20% fair, and 40% poor, with elements of both protein-calorie and protein malnutrition. There was, as expected, a positive relationship between tumor stage and nutritional impairment, but this fell short of statistical significance. There was a just significant tendency for patients with pharyngeal tumors to exhibit poorer scores than did those with oral or laryngeal tumors. Age, sex, smoking history, admitted alcohol consumption, and type of hospital (university, private multispecialty, or Veterans Administration) were not correlated with nutritional status. The best predictor of impaired nutritional status was the patient's description of his recent diet: a normal diet predicted a good score (0-2), and a soft or liquid diet predicted a fair or poor score (3-5), with an overall accuracy of 72%.