Prostate cancer in men of African origin McGinley, Kathleen F; Tay, Kae Jack; Moul, Judd W
Nature reviews. Urology,
02/2016, Volume:
13, Issue:
2
Journal Article
Peer reviewed
Men of African origin are disproportionately affected by prostate cancer: prostate cancer incidence is highest among men of African origin in the USA, prostate cancer mortality is highest among men ...of African origin in the Caribbean, and tumour stage and grade at diagnosis are highest among men in sub-Saharan Africa. Socioeconomic, educational, cultural, and genetic factors, as well as variations in care delivery and treatment selection, contribute to this cancer disparity. Emerging data on single-nucleotide-polymorphism patterns, epigenetic changes, and variations in fusion-gene products among men of African origin add to the understanding of genetic differences underlying this disease. On the diagnosis of prostate cancer, when all treatment options are available, men of African origin are more likely to choose radiation therapy or to receive no definitive treatment than white men. Among men of African origin undergoing surgery, increased rates of biochemical recurrence have been identified. Understanding differences in the cancer-survivorship experience and quality-of-life outcomes among men of African origin are critical to appropriately counsel patients and improve cultural sensitivity. Efforts to curtail prostate cancer screening will likely affect men of African origin disproportionately and widen the racial disparity of disease.
Tropical forest management increasingly is challenged by multiple, complex, intersecting, and in many cases unprecedented changes in the environment that are triggered by human activity. Many of ...these changes are associated with the Anthropocene—a new geologic epoch in which humans have become a dominating factor in shaping the biosphere. Ultimately, as human activity increasingly influences systems and processes at multiple scales, we are likely to see more extraordinary and surprising events, making it difficult to predict the future with the level of precision and accuracy needed for broad-scale management prescriptions. In this context of increasing surprise and uncertainty, learning, flexibility, and adaptiveness are essential to securing ecosystem resilience and sustainability, particularly in complex systems such as tropical forests. This article examines the experience to date with and potential for collaborative, adaptive land and resource management in the El Yunque National Forest (EYNF)—the only tropical forest in the U.S. National Forest System. The trajectory of EYNF policy and practice over time and its capacity for learning, flexibility, and adaptiveness to change and surprise are analyzed through an historical institutionalism approach. EYNF policies and practices have shifted from an early custodial approach that focused mostly on protection and prevention to a top-down, technical approach that eventually gave way to an ecosystem approach that has slowly incorporated more flexible, adaptive, and active learning elements. These shifts in EYNF management mostly have been reactive and incremental, with some rarer, rapid changes primarily in response to significant changes in national-level policies, but also to local level conditions and changes in them. Looking to the future, it seems the EYNF may be better positioned than ever before to address increasing uncertainty and surprise at multiple scales. However, it must be able to count on the resources necessary for implementing adaptive, collaborative forest management in a tropical setting and on the institutional and organizational space and flexibility to make swift adjustments or course corrections in response to system changes and surprises.
Forests across the U.S. and U.S. affiliated islands of the Caribbean and Pacific constitute rich and dynamic social-ecological systems that, while heterogeneous in many ways, share certain ...characteristics and trends that underscore the utility of sustainability assessments that go beyond single jurisdictional efforts. This paper summarizes a recent effort to assess the sustainability of tropical island forests of and politically affiliated with the U.S. using the Montréal Process criteria and indicator framework (MP C&I), which address ecological, social, economic, and institutional dimensions of forests. Forests cover 45 percent of the total area and more than 50 percent of each island jurisdiction, except Hawaii (36 percent). Forest cover is generally stable over much of the area in terms of recent reference conditions. The history of human occupation and land alteration is a prominent determinant of current conditions throughout the islands, which exhibit relatively high rates of threatened species in comparison to mainland counterparts and particularly where endemism is high. The islands also harbor significant areas of new or novel assemblages of native and non-native forest species, predominately on abandoned agricultural lands cleared of native forests long ago, which have been shown to contribute to the restoration of these degraded lands and provide many other ecosystem services at levels as high as and in some cases higher than native forests. Although industrial-level commercial timber harvest is small to nonexistent on most islands, socioeconomic and cultural linkages to forests are extensive but difficult to quantify. Amassing a foundation of data sufficient to address the MP C&I was challenging, in part due to the heterogeneity of the islands, island geography, and limited reporting capacities. We document significant improvements in the availability of data important for sustainability assessments in the last decade or so, especially with the extension of the U.S. Department of Agriculture Forest Service Forest Inventory and Analysis program to the islands. Likewise, we find the MP C&I to be a useful tool for organizing and presenting information important for assessing forest sustainability. Nevertheless, considerable data gaps remain in the areas of biodiversity, forest functions and processes, and socioeconomic conditions of forests, which are critical elements to track across the islands, particularly in the context of climate change and ongoing anthropogenic pressures.
Abstract
Current trends in the nation’s forest-sector research capacity were analyzed in terms of funding and number of scientists, and compared with prior data in the National Research Council’s ...2002 report, National Capacity in Forestry Research. The total number of professors at institutions with academic programs accredited by the Society of American Foresters, research scientists at the USDA Forest Service, and forest researchers in forest industry decreased approximately 12 percent since 2002. In 2016, there were an estimated 1,224 professors and 540 Forest Service research scientists, for a total of 1,764 scientists. Total estimated research funding in 2015 for universities, private sector, and USDA Forest Service, including appropriations from federal grant programs from the USDA National Institute for Food and Agriculture, National Science Foundation, National Aeronautics and Space Administration, and Department of Energy was US$598 million—a nominal increase over 2002, but a decrease when accounting for inflation. The proportion of reported scientists’ disciplines shifted notably from production subjects to broader ecosystem services and forest health subjects, as well as from more applied to more fundamental or basic research. The data indicated that the nation’s forest research capacity continues to erode, leading to declines in research development and innovation, and putting at increasing risk the future health and productivity of America’s forests.
Over time, community forests (CFs) have been established across the globe to meet various social, economic, and ecological needs. Benefits of CFs include conserving resilient forests and natural ...resources and ecosystem services, enhancing social and economic capital, and leveraging local and indigenous knowledge in forest and natural resource management and decision-making. Research on CFs in the U.S. is quite limited, and cases that have been assessed show a wide spectrum in terms of CF ownership, organizational structure, governance, property rights, and uses. Through an exploratory research approach, this study enhances the understanding of the characteristics of CFs in the U.S. and the ecosystem services and other benefits that they provide. Through online web searches, we compiled one of the first comprehensive lists of CFs in the Eastern U.S. Prior to this study, there was no publicly available comprehensive database or list of CFs in the country. Subsequently, we conducted comparative case study research, which included semi-structured in-person interviews with key stakeholders from four CFs in the Eastern U.S. to understand CF ownership, governance, uses, and benefits. CFs benefits frequently included cultural services, such as recreation and education, and regulating and supporting services, such as water quality and wildlife habitat. Much less common was a focus on provisioning services such as timber or non-timber forest products. Maintaining collaboration and funding for CF efforts in the long run without significant CF revenues remains a challenge for most forests. Overall, this research sheds lights on CF characteristics and capacities in the Eastern U.S. and identifies potential opportunities and needs for the U.S. in the future. CFs researchers, managers, and community members.
Abstract We completed targeted exome sequencing of the tumors of 50 patients with pTis–pT4b bladder cancer. Mutations were categorized by type, stratified against previously identified cancer loci in ...the Catalogue of Somatic Mutations in Cancer and The Cancer Genome Atlas databases, and evaluated in pathway analysis and comutation plots. We analyzed mutation associations with receipt of neoadjuvant chemotherapy, nodal involvement, metastatic disease development, and survival. Compared with The Cancer Genome Atlas, we found higher mutation rates in genes encoding products involved in epigenetic regulation and cell cycle regulation. Of the pathways examined, PI3K/mTOR and Cell Cycle/DNA Repair exhibited the greatest frequencies of mutation. RB1 and TP53 , as well as NF1 and PIK3CA were frequently comutated. We identified no association between mutations in specific genes and key clinical outcomes of interest when corrected for multiple testing. Discovery phase analysis of the somatic mutations in 50 high-risk bladder cancer patients revealed novel mutations and mutational patterns, which may be useful for developing targeted therapy regimens or new biomarkers for patients at very high risk of disease metastasis and death. Patient summary In this report we found known, as well as previously unreported, genetic mutations in the tumors of patients with high-risk bladder cancer. These mutations, if validated, may serve as actionable targets for new trials.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPUK, ZRSKP
Citizen science, also known as participatory research, combines the efforts of professional researchers and community volunteers to collect data. We have established one such collaborative project in ...eastern North Carolina, near the 79,000-acre Hofmann Forest, called the Hofmann Open-Water Laboratory (HOWL) citizen science project. The White Oak River, New River, and Trent River all flow out of the Hofmann. The Hofmann is an ecological keystone in the region, acting as a natural filtration system for harmful runoff that occurs in the coastal plain of North Carolina. Our purposes for this study were twofold: (a) to evaluate the HOWL project by assessing the perceptions of HOWL participants and determining whether the project achieved its goals of individual development and community engagement and (b) to provide recommendations for the HOWL project as well as suggestions for other participatory research projects in their beginning phases. We interviewed 12 HOWL citizen scientists who participated in the project, and we drew two major conclusions from our research. First, we recognized that community engagement and collaboration drastically increased in rural eastern North Carolina due to the community members’ participation in water monitoring and natural resource management. Second, citizen scientists achieved their personal goals and objectives by participating in the HOWL project: Participants reported that they learned new skills, gained knowledge of scientific and research procedures, developed an attachment to their community and region, and acted as environmental stewards.
Objectives
To examine if there is a subset of men with grade group 2 prostate cancer who could be potential candidates for active surveillance.
Methods
We used the Shared Equal Access Regional Cancer ...Hospital database to identify 776 men undergoing radical prostatectomy from 2006 to 2015 with >8 biopsy cores obtained and complete information. We compared men who fulfilled low‐risk disease criteria (clinical stage T1c/T2a; grade group 1; prostate‐specific antigen ≤10 ng/mL) with the exception of grade group 2 versus men who met all three low‐risk criteria. Logistic regression was used to test the association between grade group and radical prostatectomy pathological features. Biochemical recurrence was examined using Cox models. To examine whether there was a subset of men with low‐volume grade group 2 with comparable outcomes to low‐risk men, we repeated all analyses limiting the percentage of positive cores in the grade group 2 group to ≤33%, and positive cores to ≤4, ≤3 or ≤2.
Results
Grade group 2 low‐risk men had increased risk of pathological grade group 3 or higher (P < 0.001), extraprostatic extension (P < 0.001), seminal vesicle invasion (P < 0.001) and higher risk of biochemical recurrence (hazard ratio = 1.76, P = 0.006). Using increasingly strict definitions of low‐volume disease, at ≤2 positive cores there was no difference in adverse pathology between groups (all P > 0.2), except higher pathological grade group (P = 0.006). Biochemical recurrence was similar in men in grade group 1 and grade group 2 (hazard ratio = 1.24; P = 0.529).
Conclusions
Among men with prostate‐specific antigen ≤10 ng/mL and clinical stage T1c/T2a, those in grade group 2 with ≤2 total positive cores have similar rates of adverse pathology and biochemical recurrence as men with grade group 1.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract Objectives In the present study, we report on the clinical and pathological characteristics of African American (AA) patients with surgically excised renal masses and assess the associations ...between race and oncological outcomes. Methods and materials We conducted a retrospective review of patients who underwent partial or radical nephrectomy for renal masses at our institution between 2000 and 2010. Patients were divided into 2 groups based on self-reported race: AA and non-AA. Patient demographics and disease characteristics, and overall, cancer-specific, recurrence-free, distant, and local recurrence-free survival for localized renal cell carcinoma (RCC) were compared between AA and non-AA patients. Multivariable proportional hazard analyses were used to assess the associations of race with oncological outcomes. Results A total of 1,467 patients, of whom 359 (24.5%) were AA, were included. Rates of benign disease were comparable between AA patients and non-AA (18.2% vs. 17.6%, P = 0.556). AA patients presented with higher rates of localized disease (83% vs. 71%, P <0.001). Papillary subtype accounted for 40.8% of RCCs in AA patients compared with 11.6% in non-AA patients ( P <0.001). The high proportion of papillary RCC in AA patients was maintained across disease stages. On univariable analyses, AA patients had better recurrence-free and cancer-specific survival. On multivariable analyses, AA race was not a significant predictor of oncological outcomes after adjusting for patient and disease characteristics. Conclusion In this study, AA patients presented with more localized disease than non-AA patients, whereas rates of benign disease were comparable between the groups. Furthermore, AA patients had roughly 3 times higher rates of papillary RCC across disease stages. On univariable analyses, AA patients appeared to have more favorable oncological outcomes. However, this association is likely explained by tumor stage, grade, and histology as outcomes were similar across races when the analyses were adjusted for these and other characteristics.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPUK
Objective
To evaluate performance of pelvic lymph node dissection during radical prostatectomy within an equal access care setting over a period of time, and stratified by prostate cancer risk group ...and surgical technique.
Methods
We identified men in the Shared Equal Access Regional Cancer Hospital database who had open or robotic‐assisted radical prostatectomy from 2006 to 2013. Univariable logistic regression was used to test the association between age, race, body mass index, total biopsy cores, number of positive biopsy cores, risk group, year, center, surgical volume and surgical technique on pelvic lymph node dissection use. Multivariable logistic analysis was used to examine surgical technique and pelvic lymph node dissection performance. Spearman's correlation examined temporal changes in pelvic lymph node dissection utilization stratified by risk group and surgical technique.
Results
A total of 1425 men met inclusion criteria; 67% of them underwent pelvic lymph node dissection. On multivariable analysis, robotic‐assisted radical prostatectomy was associated with an 92% decreased use of pelvic lymph node dissection in low‐risk, 84% decreased in intermediate‐risk and 91% decreased in high‐risk men (all P < 0.001). In robotic‐assisted radical prostatectomy, there was a trend for increased pelvic lymph node dissection utilization over time in high‐risk men (Spearman; P = 0.077) reaching ~85% in 2012–2013, which was accompanied by increased use in low‐risk men (P = 0.016). For open radical prostatectomy, fewer pelvic lymph node dissections were carried out in low‐risk men over time, decreasing to ~35% (P = 0.047) in 2012–2013, whereas rates remained high for high‐risk men throughout (~95%; P = 0.621).
Conclusion
Regardless of risk group, pelvic lymph node dissection is carried out significantly less during robotic‐assisted radical prostatectomy. For robotic‐assisted radical prostatectomy, pelvic lymph node dissection utilization increased over time for high‐risk men, but rates also increased for low‐risk men. Further attention to the discrepancy between provided and guideline recommended pelvic lymph node dissection performance is required to improve prostate cancer care.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
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