The Use of Removed Mesquite Brush as a Fiber Replacement in Silage Production.

Mesquite (Prosopis L.) is considered an invasive browse species in most of the American Southwest. Mechanical intervention removes yields an excess of organic debris. Anecdotal evidence in the past has supported using such browse as feed for livestock. Thus, our objectives were to (1) determine the nutritive value and fermentation characteristics of silage produced with mesquite biomass, and (2) evaluate solvent treatment of mesquite biomass prior to ensiling. In Experiment 1, we evaluated mesquite inclusion rate (0, 250, 500, 750, or 1000 g kg−1 DM), length of fermentation (28, 56, or 84 d), and silage inoculant. In Experiment 2, we evaluated the effects of mesquite pre-treatment with acid (H2SO4) or alkali (NaOH) solutions. Concentrations of NDF, ADF, and ADL, as well as IVTD, decreased (p < 0.05) with increasing mesquite inclusion. However, 250 g mesquite kg−1 DM did not differ from grass silage. There was no effect (p > 0.05) of inoculation, though increasing length of incubation did increase (p < 0.05) VFA production and decrease (p < 0.05) silage pH. Solvent treatment did not improve ensiling properties. Results are interpreted to mean that mesquite biomass may be effectively incorporated into silage at levels up to 250 g kg−1.

Intensive lifestyle changes may affect the progression of prostate cancer.

PURPOSE: Men with prostate cancer are often advised to make changes in diet and lifestyle, although the impact of these changes has not been well documented. Therefore, we evaluated the effects of comprehensive lifestyle changes on prostate specific antigen (PSA), treatment trends and serum stimulated LNCaP cell growth in men with early, biopsy proven prostate cancer after 1 year. MATERIALS AND METHODS: Patient recruitment was limited to men who had chosen not to undergo any conventional treatment, which provided an unusual opportunity to have a nonintervention randomized control group to avoid the confounding effects of interventions such as radiation, surgery or androgen deprivation therapy. A total of 93 volunteers with serum PSA 4 to 10 ng/ml and cancer Gleason scores less than 7 were randomly assigned to an experimental group that was asked to make comprehensive lifestyle changes or to a usual care control group. RESULTS: None of the experimental group patients but 6 control patients underwent conventional treatment due to an increase in PSA and/or progression of disease on magnetic resonance imaging. PSA decreased 4% in the experimental group but increased 6% in the control group (p = 0.016). The growth of LNCaP prostate cancer cells (American Type Culture Collection, Manassas, Virginia) was inhibited almost 8 times more by serum from the experimental than from the control group (70% vs 9%, p <0.001). Changes in serum PSA and also in LNCaP cell growth were significantly associated with the degree of change in diet and lifestyle. CONCLUSIONS: Intensive lifestyle changes may affect the progression of early, low grade prostate cancer in men. Further studies and longer term followup are warranted.

Orthotopic urinary diversion after cystectomy for bladder cancer: implications for cancer control and patterns of disease recurrence.

PURPOSE: The impact of orthotopic urinary diversion on the quality of cystectomy and ensuing cancer control has not been adequately studied. We analyzed our experience with this clinical problem. MATERIALS AND METHODS: The records of 214 patients who underwent cystectomy and orthotopic diversion for bladder cancer were retrospectively evaluated and compared with those of 269 treated with an ileal conduit. Analyzed end points included overall and cancer specific survival. We specifically assessed the patterns of relapse and their association with pathological findings at cystectomy in the neobladder group. RESULTS: No cancer specific survival difference was identified in the neobladder and ileal conduit cohorts when adjusting for pathological stage. Patterns of relapse in 62 of the 214 patients with a neobladder (29%) included local recurrence in 23 (11%), distant recurrence in 19 (9%), and combined local and distant recurrence in 18 (8%). Urethral recurrence was rare (2%). Of 10 patients (4.6%) diagnosed with upper tract recurrence 6 and 4 initially had relapse in the ureteroenteric anastomosis and renal pelvis, respectively. Five of the 6 patients with anastomotic relapse had evidence of disease in the intramural or juxtavesical ureter that was removed en bloc with the cystectomy specimen. Only 1 patient required neobladder takedown after such anastomotic recurrence. CONCLUSIONS: These results indicate that neobladders do not compromise the quality of preceding cystectomy or interfere with management in the presence of local or distant disease relapse. Our data suggest that involvement of the intramural or juxtavesical ureteral segment at cystectomy irrespective of surgical margin status may identify patients at higher risk for anastomotic recurrence, which is associated with an ominous prognosis.

Role of advanced 2 and 3-dimensional ultrasound for detecting prostate cancer.

PURPOSE: We explored the clinical usefulness of spectrum analysis and neural networks for classifying prostate tissue and identifying prostate cancer in patients undergoing transrectal ultrasound for diagnostic or therapeutic reasons. MATERIALS AND METHODS: Data on a cohort of 215 patients who underwent transrectal ultrasound guided prostate biopsies at Memorial-Sloan Kettering Cancer Center, New York, New York were included in this study. Radio frequency data necessary for 2 and 3-dimensional (D) computer reconstruction of the prostate were digitally recorded at transrectal ultrasound and prostate biopsy. The data were spectrally processed and 2-D tissue typing images were generated based on a pre-trained neural network classification. We used manually masked 2-D tissue images as building blocks for generating 3-D tissue images and the images were tissue type color coded using custom software. Radio frequency data on the study cohort were analyzed for cancer probability using the data set pre-trained by neural network methods and compared with conventional B-mode imaging. ROC curves were generated for the 2 methods using biopsy results as the gold standard. RESULTS: The mean area under the ROC curve plus or minus SEM for detecting prostate cancer for the conventional B-mode and neural network methods was 0.66 +/- 0.03 and 0.80 +/- 0.05, respectively. Sensitivity and specificity for detecting prostate cancer by the neural network method were significantly increased compared with conventional B-mode imaging. In addition, the 2 and 3-D prostate images provided excellent visual identification of areas with a higher likelihood of cancer. CONCLUSIONS: Spectrum analysis could significantly improve the detection and evaluation of prostate cancer. Routine real-time application of spectrum analysis may significantly decrease the number of false-negative biopsies and improve the detection of prostate cancer at transrectal ultrasound guided prostate biopsy. It may also provide improved identification of prostate cancer foci during therapeutic intervention, such as brachytherapy, external beam radiotherapy or cryotherapy. In addition, 2 and 3-D images with prostate cancer foci specifically identified can help surgical planning and may in the distant future be an additional reliable noninvasive method of selecting patients for prostate biopsy.

Disease specific survival as endpoint of outcome for bladder cancer patients following radical cystectomy.

OBJECTIVE: To directly compare disease specific and overall survival as endpoints in the outcome analysis of a large number of cystectomy patients and to define predictors for survival. MATERIALS AND METHODS: We retrospectively analyzed the records of 686 patients who underwent bilateral pelvic lymph node dissection (PLND) and radical cystectomy from 1980 to 1990 at Memorial Sloan-Kettering Cancer Center. RESULTS: Disease specific survival characterized a clearly more favorable patient outcome than overall survival in the entire patient population as well as patients with organ confined (OC) and non-organ-confined disease (NOC): 10-year disease specific and overall survival rates for patients with OC disease (or=P3b) were 72.9% versus 49.1%, 61.7% versus 40.8% and 33.3% versus 22.8%, respectively. In node positive (N+) patients 10-year disease specific and overall survival rates were 27.7% and 20.9%, respectively. In a multivariate analysis organ confinement and nodal status were the strongest independent predictors of disease specific survival in all patient categories. However, stratification according to organ confinement and nodal status revealed additional prognostic parameters. CONCLUSION: Organ-confined bladder cancer translates into high disease specific survival rates following radical cystectomy. Outcome is best characterized by disease-specific survival versus overall survival, which underestimates the impact of treatment in patients with favorable tumor and nodal stage. Subgroup analysis of patients with organ confinement and nodal status identified additional prognostic variables within the more favorable patient categories not apparent in the entire population. The poor prognosis of patients with NOC and/or N+ tumors emphasized the importance of future randomized trials in which such stratification variables may be of value.

Analysis of clinical stage T2 prostate cancer: do current subclassifications represent an improvement?

PURPOSE: The purpose of this study was to determine whether the extent of palpable cancer within the prostate predicts outcome after radical prostatectomy. PATIENTS AND METHODS: We combined prospectively collected data on 1,755 consecutive clinical stage T2 patients treated with radical prostatectomy alone at four institutions. According to the 1992 American Joint Committee on Cancer tumor-node-metastasis system, 645 (37%) were T2a, 758 (43%) were T2b, and 352 (20%) were T2c. Kaplan-Meier and proportional hazards regression analyses were performed on the 1992 and 1997 T2 subclassifications. After controlling for the effects of prostate-specific antigen (PSA) and biopsy Gleason sum, the two staging systems were compared for their ability to predict recurrence-free survival (RFS). Adjusted RFS curves were constructed using the corrected group prognosis method. RESULTS: Follow-up ranged from 1 to 166 months (median, 26 months). Cancer recurred in 417 (24%) of the T2 patients. The 1992 (P =.005) but not the 1997 (P =.100) T2 subclassification predicted outcome after controlling for PSA and Gleason sum. After covariate adjustment, RFS was 7% higher at 5 years in the 1992 T2a subcategory relative to the T2b subcategory. CONCLUSION: The 1992 American Joint Committee on Cancer system is superior to the 1997 system, and the former adds prognostic information to a model containing pretreatment PSA and Gleason sum. These results suggest that 1992 T2 subclassification derived from palpable findings improves prognostication over the 1997 subclassification.

Ultrasonic spectrum-analysis and neural-network classification as a basis for ultrasonic imaging to target brachytherapy of prostate cancer.

Conventional B-mode ultrasound is the standard means of imaging the prostate for guiding prostate biopsies and planning brachytherapy of prostate cancer. Yet B-mode images do not allow adequate visualization of cancerous lesions of the prostate. Ultrasonic tissue-typing imaging based on spectrum analysis of radiofrequency echo signals has shown promise for overcoming the limitations of B-mode imaging for visualizing prostate tumors. Tissue typing based on radiofrequency spectrum analysis uses nonlinear methods, such as neural networks, to classify tissue by using spectral-parameter and clinical-variable values. Two- and three-dimensional images based on these methods show potential for improving the guidance of prostate biopsies and the targeting of radiotherapy of prostate cancer. Two-dimensional images have been imported into instrumentation for real-time biopsy guidance and into commercial dose-planning software for brachytherapy planning. Three-dimensional renderings seem to be capable of depicting locations and volumes of cancer foci.