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Keating et al.[1]demonstrated, among men with no comorbidities, ADT was associated with an increase of MI. Risks of MI and diabetes were similarly increased among men with and without specific comorbid illnesses. Previous risk factors for... more
Keating et al.[1]demonstrated, among men with no comorbidities, ADT was associated with an increase of MI. Risks of MI and diabetes were similarly increased among men with and without specific comorbid illnesses. Previous risk factors for MI were associated with new MI and diabetes, and obesity and rheumatologic disease were also associated with diabetes. This demonstrated traditional risk factors for MI and diabetes were also associated with developing these conditions during ADT but did not significantly modify the risk attributable to ADT. This paper also highlighted the important of screening for cardiovascular disease and diabetes in the ADT population. This was confirmed by Ziaran et al. [2] who also discovered after 12 months of ADT, BMI, waist to hip ratio, low-density lipoprotein, overall cholesterol increased significantly and (4.2%) were diagnosed with new onset diabetes. This demonstrated ADT leads into unfavourable changes in body composition and unfavourable lipoprotein profile.
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Patients themselves are open to new techniques of management [1]. So the question arises, what are the needs of this cohort and what can we do to support them?
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Research Interests: Medicine and Ethnic Group
Sivarajan et al., [1] examined psychosexual outcomes up to 7 years post operatively with initiation of medical therapy (n = 1896) [1]. What was demonstrated was erectile dysfunction, persisting beyond 2 years. However, the time point at... more
Sivarajan et al., [1] examined psychosexual outcomes up to 7 years post operatively with initiation of medical therapy (n = 1896) [1]. What was demonstrated was erectile dysfunction, persisting beyond 2 years. However, the time point at which erectile dysfunction therapy was initiated is not mentioned—this is something which should be taken into account with pathway development. This is because, the sooner the treatment is initiated, the better the erectile function outcomes. However, the study is of a high quality due to its inclusion of risk stratification prior to assessment of erectile dysfunction (Level 2b, recommendation A) [1]. The study highlights a requirement for psychosexual pathways in order to manage patients with progressive disease, and manage them early to avoid delays in psychosexual care.
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A cancer survivorship conference can play a central part in survivorship care. The initial concept of patients learning from each other started during World War 1. The injured soldiers drew strength from those around them, learnt from... more
A cancer survivorship conference can play a central part in survivorship care. The initial concept of patients learning from each other started during World War 1. The injured soldiers drew strength from those around them, learnt from them and motivated themselves to get better. In the same way, with a group of patients, who have been through a similar experience together, can draw strength from each other. A cancer survivorship conference can be held to give a patients’ information regarding their condition, give them access to other patients and health care professionals. Armed with this information, patients will then be able to further self- manage themselves.
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Objective: The formation of multidisciplinary teams (MDTs) was formalised for urological cancer services by the National Institute for Health and Care Excellence (NICE) in the 2002 Improving Outcomes in Urological Cancer guidance. This... more
Objective: The formation of multidisciplinary teams (MDTs) was formalised for urological cancer services by the National Institute for Health and Care Excellence (NICE) in the 2002 Improving Outcomes in Urological Cancer guidance. This project aimed to assess the variability of MDT recommendations when presented with the same patient. It covered the type and grade of tumour, recorded stage, treatment recommendations and whether clinical trials were considered. Materials and methods: Anonymised details of 10 patients were sent to South West Trust MDTs in two tranches. Details included age, clinical history, haematology and biochemistry results, digital radiology, and pathology text. A panel of representative urologists and urological oncologists from the region decided on optimal treatment and key points of management decisions. Results: The MDTs were not consistent in decision making. This agrees with a previous survey of urologists which also showed inconsistent decision making, an...
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Prostate cancer screening research in the UK is based upon a 2013 Cochrane review of evidence. This demonstrated that a prostate cancer screening programme did not improve or worsen mortality from prostate cancer. As a result, the... more
Prostate cancer screening research in the UK is based upon a 2013 Cochrane review of evidence. This demonstrated that a prostate cancer screening programme did not improve or worsen mortality from prostate cancer. As a result, the evidence is inconclusive as to whether a screening programme is required or not.
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ObjectiveDietary factors and physical activity may alter prostate cancer progression. We explored the feasibility of lifestyle interventions following radical prostatectomy for localised prostate cancer.DesignPatients were recruited into... more
ObjectiveDietary factors and physical activity may alter prostate cancer progression. We explored the feasibility of lifestyle interventions following radical prostatectomy for localised prostate cancer.DesignPatients were recruited into a presurgical observational cohort; following radical prostatectomy, they were offered randomisation into a 2×3 factorial randomised controlled trial (RCT).SettingA single National Health Service trust in the South West of England, UK.ParticipantsThose with localised prostate cancer and listed for radical prostatectomy were invited to participate.RandomisationRandom allocation was performed by the Bristol Randomised Trial Collaboration via an online system.InterventionsMen were randomised into both a modified nutrition group (either increased vegetable and fruit, and reduced dairy milk; or lycopene supplementation; or control) and a physical activity group (brisk walking or control) for 6 months.BlindingOnly the trial statistician was blind to alloc...
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The incidence of many common cancers varies between different populations and appears to be affected by a Western lifestyle. Highly proliferative malignant cells require sufficient levels of nutrients for their anabolic activity.... more
The incidence of many common cancers varies between different populations and appears to be affected by a Western lifestyle. Highly proliferative malignant cells require sufficient levels of nutrients for their anabolic activity. Therefore, targeting genes and pathways involved in metabolic pathways could yield future therapeutics. A common pathway implicated in energetic and nutritional requirements of a cell is the LKB1/AMPK pathway. Metformin is a widely studied anti-diabetic drug, which improves glycaemia in patients with type 2 diabetes by targeting this pathway. We investigated the effect of metformin on prostate cancer cell lines and evaluated its mechanism of action using DU145, LNCaP, PC3 and VCaP prostate cancer cell lines. Trypan blue dye-exclusion assay was used to assess levels of cell death. Western immunoblotting was used to determine the abundance of proteins. Insulin-like growth factor-binding protein-2 (IGFBP-2) andAMPKgenes were silenced using siRNA. Effects on ce...
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277 Background: Cancer is associated with an increased risk of venous and arterial thrombo-embolic events (TEEs), including deep vein thrombosis, pulmonary embolism, cerebrovascular accident and unstable angina/myocardial infarction.... more
277 Background: Cancer is associated with an increased risk of venous and arterial thrombo-embolic events (TEEs), including deep vein thrombosis, pulmonary embolism, cerebrovascular accident and unstable angina/myocardial infarction. Several factors are known to influence the incidence of TEEs including chemotherapy agents, particularly cisplatin. Czaykowski et al reported 12.9% of patients receiving multiagent cisplatin based chemotherapy for transitional cell carcinoma between 1986 and 1996 developed TEE. Moore et al found that the rate of TEE in a similar cohort of patients receiving the same treatment to be 18.2% (6/33 patients). Methods: Retrospective case note review from an electronic database of patients allocated a cisplatin based neo-adjuvant chemotherapy regimen for transitional cell carcinoma of the bladder between April 2009 and April 2012. TEE was recorded as a chemotherapy related event if it occurred between the first dose of cisplatin and 4 weeks after the last admi...
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Research Interests: Nephrology, Oncology, Mental Health, Cancer, Life Style, and 15 moreProstate Cancer, Cancer Survivorship, Medicine, Humans, Internal Medicine, Reproductive health, Survivors, Male, Exercise, Clinical Sciences, Physical Fitness, Rc, Survivorship curve, Surveys and Questionnaires, and Prostatic neoplasms
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Background Evidence from observational studies have shown that moderate intensity physical activity can reduce risk of progression and cancer-specific mortality in participants with prostate cancer. Epidemiological studies have also shown... more
Background Evidence from observational studies have shown that moderate intensity physical activity can reduce risk of progression and cancer-specific mortality in participants with prostate cancer. Epidemiological studies have also shown participants taking metformin to have a reduced risk of prostate cancer. However, data from randomised controlled trials supporting the use of these interventions are limited. The Prostate cancer–Exercise and Metformin Trial examines that feasibility of randomising participants diagnosed with localised or locally advanced prostate cancer to interventions that modify physical activity and blood glucose levels. The primary outcomes are randomisation rates and adherence to the interventions over 6 months. The secondary outcomes include intervention tolerability and retention rates, measures of insulin-like growth factor I, prostate-specific antigen, physical activity, symptom-reporting, and quality of life. Methods Participants are randomised in a 2 ×...
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PURPOSE Salvage radical prostatectomy (sRP) historically yields poor functional outcomes and high complication rates. However, recent reports on robotic sRP have demonstrated improved results. In this study, we assessed sRP functional... more
PURPOSE Salvage radical prostatectomy (sRP) historically yields poor functional outcomes and high complication rates. However, recent reports on robotic sRP have demonstrated improved results. In this study, we assessed sRP functional outcomes and complications, comparing robotic and open approaches. MATERIALS AND METHODS We retrospectively collected data of sRP for recurrent prostate cancer (PCa) after local non-surgical treatment at 18 tertiary referral centers, from 2000 to 2016. The Clavien-Dindo classification was employed to classify complications. Complications and functional outcomes were evaluated in a uni- and multivariable analysis. RESULTS We included 395 sRP (n=186 open; n=209 robotic). The robotic-sRP yielded lower BL (p<0.0001) and shorter HS (p<0.0001). No significant differences emerged in major (10.1%, p=0.16) and overall complications (34.9%, p=0.67), including an overall low risk of rectal injuries and fistulas (1.58% and 2.02% respectively); however, anastomotic stricture was more frequent for open-sRP (16.57% vs 7.66%; p<0.01). Overall 24.6% had severe (≥3pads/day) incontinence (12 or 6mo). On multivariable analysis robotic-sRP was an independent predictor for continence preservation (OR 0.411, 95% CI 0.232-0.727, p=0.022). Limitations include the retrospective nature and absence of standardized surgical technique. CONCLUSIONS In a contemporary series, sRP showed a low risk of major complications and better functional outcomes than previously reported. Robotic-sRP may reduce anastomotic strictures, blood loss, and hospital stay, and improve continence outcomes.