Urinary bladder metastasis from suspected second primary breast cancer presenting with ambiguous lower urinary tract symptoms: A case report and literature review.

Common urinary symptoms may arise from metastases from uncommon sites. In patients with a history of cancer, the focus should be on the currently affected organ and the status of the underlying malignancy.

Medical appointment no-shows associated with poor glycaemic control among Taiwanese aborigines.

OBJECTIVE: To determine whether diabetes control is less optimal in Taiwanese aborigines and identify the risk factors associated with poor glycaemic control. DESIGN: Cross-sectional analysis of data from Taiwan Diabetes Shared Care Program SETTING: A rural hospital in central Taiwan. METHODS: Patients enrolled in Diabetes Shared Care Program in 2010 were surveyed. The average HbA1c in 2010 was compared between the aboriginal and non-aboriginal groups. Age, gender, body mass index and disease duration were selected to represent biological factors. Combined with the existence of geographic barrier to medical service and rate of medical appointment no-shows, multivariate linear regression model was applied to determine the predictive power of each factor to glycaemic status. RESULTS: Only 26% of patients achieved average HbA1c of less than 7%. The average HbA1c of the aboriginal group is significantly higher than that of the non-aboriginal group (8.73% versus 7.93%, P < 0.001). However, in multivariate linear regression model, racial background was no longer a risk factor for poor glycaemic control. Medical appointment no-shows was found as the most significant risk factor for poor glycaemic control (b = 1.48, P < 0.001). CONCLUSION: Taiwanese aboriginal diabetes patients as a group have poorer glycaemic control than the non-aboriginal group. Medical appointment no-shows may significantly contribute to the development of hyperglycaemia among Taiwanese aborigines.

Pathological results and rates of treatment failure in high-risk prostate cancer patients after radical prostatectomy.

OBJECTIVE: • To investigate the pathological characteristics and the rates of biochemical recurrence (BCR) -free survival after radical prostatectomy (RP) in men with high-risk prostate cancer. METHODS: • Of 4760 patients treated with RP for prostate cancer at three institutions, 293 patients (6.2%) had clinical stage T3, 269 (5.7%) had a biopsy Gleason sum ≥ 8, 370 (7.8%) had preoperative PSA ≥ 20 ng/mL and 887 (18.6%) were considered high-risk according to the D'Amico classification (clinical stage ≥ T2c or prostate-specific antigen (PSA) ≥ 20 ng/mL or biopsy Gleason sum ≥ 8). • Actuarial BCR-free survival probabilities after RP and the rate of favourable pathology (organ-confined cancer, negative surgical margin and Gleason ≤ 7) were assessed. RESULTS: • Median follow up was 2.4 years and 1179 (24.8%) patients had follow up beyond 5 years. • The rate of favourable pathology increased in the following order: clinical stage T3 (13.7%), biopsy Gleason ≥ 8 (16.4%), the D'Amico high-risk group (21.4%) and PSA ≥ 20 ng/mL (21.6%). • The 5-year BCR-free survival probabilities were 35.4% for Gleason ≥ 8, 39.8% for PSA ≥ 20 ng/mL, 47.4% for D'Amico high-risk group and 51.6% for clinical stage T3. • Patients with only one risk factor had the most favourable 5-year BCR-free survival (50.3%), relative to patients with two or more risk factors (27.5%) CONCLUSIONS: • Men with clinically localized high-risk prostate cancer do not have a uniformly poor prognosis after RP. • The rate of favourable pathology and of BCR-free survival may vary substantially, depending on the definition used. • RP should be considered a valid treatment modality for high-risk prostate cancer patients, as many can be surgically down-staged.

Correlations between age, Charlson score and outcome in clinical unilateral T3a prostate cancer / 亚洲男科学杂志(英文版)

According to the European Association of Urology (EAU) guidelines, a life expectancy of > 10 years is considered an important factor in the treatment of prostate cancer. The Charlson score is used to predict mortality based on comorbidities. The purpose of this study was to investigate the relationship between age, Charlson score and outcome in patients with cT3a prostate cancer. Between 1987 and 2004, 200 patients, who were with clinical T3a prostate cancer and who underwent radical prostatectomy (RP), were previously detected by digital rectal examination (DRE). Patients were categorized into two age groups (< 65 and >or= 65 years old). Patients were also divided into two groups according to Charlson score ( = 0 and >or= 1). Both age and Charlson score were analyzed regarding their predictive power of patients' outcomes. The mean follow-up period was 70.6 months, and the mean age of patients was 63.3 years. In all, 106 patients were < 65 years old and 94 patients were >or= 65 years old. Age was a significant predictor of overall survival (OS). A Charlson score of 0 was found in 110 patients, and of >or= 1 in 90 patients. Charlson score was not a significant predictor of biochemical progression-free survival (BPFS), clinical progression-free survival (CPFS) or OS. Cox multivariate analysis showed that margin status was a significant independent factor in BPFS, and cancer volume was a significant independent factor in CPFS. Charlson score does not influence the outcome in patients with clinical locally advanced prostate cancer. Age may influence OS. RP can be performed in motivated healthy older patients. However, the patients need to be counseled regarding possible surgery-related side effects, such as urinary incontinence and erectile dysfunction, which are age- and comorbidity-dependent.