Breast conservation: trends in a major southern metropolitan area compared with surrounding rural counties.

Despite randomized prospective studies and National Institutes of Health recommendations, surgeons especially in the southern United States have been slow to adopt breast conservation surgery (BCS). Data were analyzed regarding 3,349 cases of stage 0, I, and II breast cancer (1991-1998) from Charlotte-Mecklenburg County, NC; 1057 cases from six surrounding rural counties (1995-1997); and 90,398 cases (1995) from the National Cancer Data Base. During 1995 through 1997 Charlotte-Mecklenburg County had statistically significantly higher rates of BCS compared with six surrounding rural counties for stage I (59% and 42% respectively, P = 0.001) and stage II (37% and 19%, respectively, P = 0.001) breast cancer. The BCS rates in Charlotte-Mecklenburg County (1991-1998) showed the following: Stage 0 rate increased from 17 per cent in 1991 to 78 per cent in 1998 (P = 0.001), stage I rate increased from 31 per cent in 1991 to 65 per cent in 1998 (P = 0.001), and stage II rate increased from 18 per cent in 1991 to 42 per cent in 1998 (P = 0.001). BCS rates for early-stage breast cancer in Charlotte-Mecklenburg County have increased over the last 8 years and now equal national rates; however, patients in surrounding rural counties are not receiving BCS as frequently. There is a need for more widespread education of surgeons, other health care providers, and the general public to increase the use of BCS.

Detection and clearance of prostate cells subsequent to ultrasound-guided needle biopsy as determined by multiplex nested reverse transcription polymerase chain reaction assay.

OBJECTIVES: To determine if circulating prostate cells are detectable subsequent to transrectal ultrasound (TRUS)-guided biopsy, and if so, whether cells remain in circulation for up to 4 weeks. METHODS: Blood samples were drawn from 90 patients with elevated serum prostate-specific antigen (PSA) levels and/or abnormal digital rectal examination. Two samples were drawn from all patients immediately prior to TRUS and 30 minutes postbiopsy. Blood samples were also obtained 1 week postbiopsy from 83 patients, and 1 month postbiopsy from 61 patients. Multiplex nested reverse transcription polymerase chain reaction assay (RT-PCR) for PSA and prostate-specific membrane antigen (PSM) was performed on total ribonucleic acid (RNA) from each sample. Results were reported as positive if at least one of the targets was detected. RESULTS: Of 45 patients with biopsy-proven adenocarcinoma, 22 were RT-PCR positive prebiopsy and all remained positive 30 minutes postbiopsy. Of 23 patients with adenocarcinoma who were RT-PCR negative prebiopsy, 5 (22%) converted to positive 30 minutes postbiopsy (P < 0.001). Four of these 5 patients returned to negative after 1 week or 1 month. Of 45 patients without cancer at biopsy, 32 were RT-PCR negative prebiopsy and 6 (19%) converted to positive 30 minutes postbiopsy (P < 0.001). Although four of six available samples were still positive at 1 week, all four samples available 1 month postbiopsy were negative. CONCLUSIONS: Detection of circulating prostate cells subsequent to biopsy occurred in 11 of 55 (20%) previously RT-PCR negative patients, a proportion twice that reported in the literature. We attribute this higher proportion to the simultaneous detection of PSA and PSM mRNA in our multiplex assay. Conversion rates were similar in patients regardless of biopsy result. Testing of serial postbiopsy blood demonstrates clearing of these cells by 4 weeks in most patients.

Oncologic emergencies: implications for nurses.

Oncologic emergencies can be grouped into the following categories: neurologic, cardiopulmonary, metabolic, hematologic, infectious, gastrointestinal, genitourinary, and infusion-related. Each crisis produces characteristic symptoms, physical findings, and laboratory abnormalities. Skills required of nurses include patient assessment by organ system, management of intravenous lines, monitoring of laboratory results, and recognition of allergic reactions and extravasation. Anticipating these clinical syndromes allows for prevention or early detection with better outcomes.

Simultaneous detection of circulating prostate specific antigen (PSA)-expressing and prostate specific membrane antigen (PSM)-expressing cells by a multiplex reverse transcriptase polymerase chain reaction (RT-PCR) assay.

It has yet to be determined whether the detection of prostate specific antigen (PSA)-expressing or prostate specific membrane antigen (PSM)-expressing cells in the circulation of prostate cancer patients is a more accurate predictor of clinical outcome. A method of evaluating both markers simultaneously would aid in the determination of the clinical relevance of reverse transcriptase polymerase chain reaction (RT-PCR) as a staging tool for prostate cancer. We describe the development of a multiplex RT-PCR assay that simultaneously detects the presence of both PSA-expressing cells and PSM-expressing cells, as well as a ubiquitously expressed internal control all within a single reaction. Both PSA cDNA and PSM cDNA were concurrently amplified by multiplex PCR using LNCaP mRNA as the starting template. When used as part of a nested PCR system, the multiplex RT-PCR assay identified one prostate cancer cell when placed in a background of one million cultured B lymphocytes. The multiplex assay was then applied to mRNA isolated from metastatic prostate cancer patients and from healthy male and female volunteers. While all were positive for the internal control G3PDH, three of seven prostate cancer patients were positive for both PSA and PSM expression and two more were positive for either PSA or PSM. None of the male or female volunteers were positive for either PSA or PSM. Multiplex RT-PCR allows for the amplification of both PSA and PSM cDNA within a single RT-PCR reaction, and this approach should allow a consistent comparison of the clinical utility of both PSA and PSM markers as staging tools and predictors of response to therapy.