Blog Updates for July 2009

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July 24/09. In Biochemical PSA Recurrence we added: Local Recurrence vs. Systemic Disease. Local recurrence refers to rising PSA without further spread of the disease (i.e. without metastases). If the disease has spread then it is referred to as systemic. At the 2009 ASCO meeting John Hopkins researchers reported on a 25 year follow up to patients who had surgery and subsequent recurrence. They found that PSA doubling time (PSADT), Gleason score, and time to PSA progression were "strong independent predictors of metastasis-free survival". Of the patients experiencing recurrence, patients with with PSADT of less than 3 months, 9 months and 15 months had 20x, 6.3x and 2.4x the risk of systemic disease relative to those whose PSADT was longer respectively. Also patients with a Gleason score of 8 or more had double the risk of those with a lower Gleason score. Those for whom progression was evidenced within 3 years of surgery had roughly 3x the risk of those whose recurrence occurred later than 3 years. See [abstract] and [Science Daily News]. For more about PSADT see this [4 part post on PSADT]. (Note that the ratios (20x, etc.) described above were actually hazard ratios rather than relative risks. [PMID: 15273082] [Free Full Text]. To take the example of Gleason scores, the hazard ratio of 2 cited means that the odds that a patient with recurrence and Gleason score of at least 8, say, exhibits systemic disease before a patient with recurrence and a lower Gleason score is 2. Hazard ratios measure relative risk but are not necessarily numerically equal to the relative risk. See references just cited for details.)

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July 23/09. In Prostate Cancer Calculators we added:
PSA Velocity. This site provides a raw PSA velocity as well as one adjusted for hemodilution (i.e. taking into account a lower than otherwise PSA value due dilution in a large amount of blood normally associated with obesity). The PSA Velocity Calculator is also mentioned in this Medical News Today article.

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July 9/09. In AUA 2007 Conference Summaries we added: There is a video summary by Christopher Logothetis ((papers) of the 2009 ASCO highlights here.

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July 1/09. In Links to the right on the Benchmarking line we added a link
to a Barron's blog post on US government efforts to assess cost effectiveness of medical treatments: [Costs]