Urinary estrogen metabolites, prostate specific antigen, and body mass index among African-American men in South Carolina.

INTRODUCTION: Estrogen metabolites have been linked to risk of breast cancer, and we were interested in whether they are associated with prostate specific antigen (PSA) and other factors associated with prostate cancer. African-American (AA) men in South Carolina have among the highest prostate cancer rates in the world, and thus provide an ideal population in which to investigate this hypothesis. METHODS: We recruited AA men attending prostate cancer screenings in and around Columbia, South Carolina. Because very few men had elevated PSAs, we restricted our study to the 77 men whose PSA was below the cutpoint used by the screening program to indicate need for diagnostic workup. These men provided spot urine samples and answered demographic and lifestyle questions including self-reported body weight, height, exercise, tobacco use, medications, cancer history and age. Levels of urinary 2-hydroxyestrone (2-OHE1) and 16alpha-hydroxyestrone (16alpha-OHE1), and their ratio (2/16) and blood PSA levels were determined. RESULTS: After adjusting for a statistically significant interaction between age and BMI, we found a reduction of 14.2% in 2-OHE1 for each 1.0 ng/ml increase in PSA (p=0.05). For obese AA men only (BMI> or =30 kg/m2), 2-OHE1 increased by 36% for each decade of age (p=0.009). CONCLUSIONS: Estrogen metabolites may be related to PSA level in AA men. Older men with BMIs greater than 30 kg/m2 had an unexpected increase in 2-OHE1, suggesting a dysregulation of this estrogen metabolism pathway. Further studies of estrogen metabolites may provide insights into prostate cancer risk factors.

Role of esophagogastroscopy in application and follow-up of high-dose-rate brachytherapy (HDRB) for treatment of esophageal carcinoma.

Flexible esophagogastroscopy (EG) and external beam radiotherapy (EBR) have become important means of diagnosing and treating both squamous and adenocarcinoma of the esophagus and gastroesophageal (GE) junction. Recently, new technology, termed high-dose-rate brachytherapy (HDRB), utilizing the placement of radioisotopes in the esophagus by endoscopic techniques has been introduced. This report describes the endoscopic application of the brachytherapy afterloading catheters and the additional role of EG in the posttreatment assessment of these patients. Twenty-four patients (21 esophageal, 3 GE junction) were treated using HDRB delivered by afterloading catheter techniques utilizing flexible EG. Radiation dosages ranged from 5 Gy (500 rads) to 8 Gy (800 rads) delivered to the tumor bed over an average of three applications. All patients were followed to assess swallowing ability, endoscopic evidence of tumor reduction, and complications resulting from intraluminal radiation therapy. Fifteen patients had reduction in intraluminal tumor based on endoscopic evaluation. Seven had partial or complete relief of dysphagia. Nine patients required gastrostomy tube placement for alimentation before or after therapy. Four patients had complications of perforation (1), fistula (1), or bleeding (2) after HDRB. Overall survival ranged from 2 to 27 months (mean = 8.9 months) after the first HDRB treatment. EG proved to be an efficient and safe technique for the introduction of intraluminal esophageal radiation therapy.

Carcinoma of the uterine cervix: results of radiation therapy at a regional community teaching hospital.

We analyzed the results of radiation therapy for carcinoma of the uterine cervix in 144 patients treated at a regional referral hospital. The local control was good in early stage disease, with only two pelvic failures in 92 stages I and II patients. Survival at 40 months was 86%, 83%, 48%, and 75% for stages I, IIa, IIb, and IIb (barrel-shaped lesions), respectively. Many IIb lesions could have been staged as IIb (barrel-shaped lesions). Control and survival in late disease was poor. The complications were minimal.

Radiation dermatitis: a case report.

A unique form of vasculitis occurring six months after radiation therapy for postoperative breast cancer is described herein. This rare, unexplainable reaction is a very unusual occurrence.