Search

Background: The optimal duration of androgen suppression for men with locally advanced prostate cancer receiving radiotherapy with curative intent is yet to be defined. Zoledronic acid is effective in preventing androgen suppression-induced bone loss, but its role in preventing castration-sensitive bone metastases in locally advanced prostate cancer is unclear. The RADAR trial assessed whether the addition of 12 months of adjuvant androgen suppression, 18 months of zoledronic acid, or both, can improve outcomes in men with locally advanced prostate cancer who receive 6 months of androgen suppression and prostatic radiotherapy. This report presents 10-year outcomes from this trial., Methods: For this randomised, phase 3, 2 × 2 factorial trial, eligible men were 18 years or older with locally advanced prostate cancer (either T2b-4, N0 M0 tumours or T2a, N0 M0 tumours provided Gleason score was ≥7 and baseline prostate-specific antigen [PSA] concentration was ≥10 μg/L). We randomly allocated participants in a 2 × 2 factorial design by computer-generated randomisation (using the minimisation technique, and stratified by centre, baseline PSA concentration, clinical tumour stage, Gleason score, and use of a brachytherapy boost) in a 1:1:1:1 ratio to four treatment groups. Patients in the control group received 6 months of neoadjuvant androgen suppression with leuprorelin (22·5 mg every 3 months, intramuscularly) and radiotherapy alone (short-term androgen suppression [STAS]); this treatment was either followed by another 12 months of adjuvant androgen suppression with leuprorelin (22·5 mg every 3 months, intramuscularly; intermediate-term androgen suppression [ITAS]), or accompanied by 18 months of zoledronic acid (4 mg every 3 months, intravenously) starting at randomisation (STAS plus zoledronic acid), or both (ITAS plus zoledronic acid). All patients received radiotherapy to the prostate and seminal vesicles, starting from the end of the fifth month of androgen suppression; dosing options were 66, 70, and 74 Gy in 2-Gy fractions per day, or 46 Gy in 2-Gy fractions followed by a high-dose-rate brachytherapy boost dose of 19·5 Gy in 6·5-Gy fractions. Treatment allocation was open label. The primary endpoint was prostate cancer-specific mortality and was analysed according to intention-to-treat using competing-risks methods. The trial is closed to follow-up and this is the final report of the main endpoints. This trial is registered with ClinicalTrials.gov, number NCT00193856., Findings: Between Oct 20, 2003, and Aug 15, 2007, 1071 men were enrolled and randomly assigned to STAS (n=268), ITAS (n=268), STAS plus zoledronic acid (n=268), and ITAS plus zoledronic acid (n=267). Median follow-up was 10·4 years (IQR 7·9-11·7). At this 10-year follow-up, no interactions were observed between androgen suppression and zoledronic acid so the treatment groups were collapsed to compare treatments according to duration of androgen suppression: 6 months of androgen suppression plus radiotherapy (6AS+RT) versus 18 months of androgen suppression plus radiotherapy (18AS+RT) and to compare treatments according to whether or not patients received zoledronic acid. The total number of deaths was 375 (200 men receiving 6AS+RT and 175 men receiving 18AS+RT), of which 143 (38%) were attributable to prostate cancer (81 men receiving 6AS+RT and 62 men receiving 18AS+RT). When analysed by duration of androgen suppression, the adjusted cumulative incidence of prostate cancer-specific mortality was 13·3% (95% CI 10·3-16·0) for 6AS+RT versus 9·7% (7·3-12·0) for 18AS+RT, representing an absolute difference of 3·7% (95% CI 0·3-7·1; sub-hazard ratio [sHR] 0·70 [95% CI 0·50-0·98], adjusted p=0·035). The addition of zoledronic acid did not affect prostate cancer-specific mortality; the adjusted cumulative incidence of prostate cancer-specific mortality was 11·2% (95% CI 8·7-13·7) with zoledronic acid vs 11·7% (9·2-14·1) without, representing an absolute difference of -0·5% (95% CI -3·8 to 2·9; sHR 0·95 [95% CI 0·69-1·32], adjusted p=0·78). Although safety analysis was not prespecified for this 10-year analysis, one new serious adverse event (osteonecrosis of the mandible, in a patient who received 18 months of androgen suppression plus zoledronic acid) occurred since our previous report, bringing the total number of cases of this serious adverse event to three (<1% out of 530 patients who received zoledronic acid evaluated for safety) and the total number of drug-related serious adverse events to 12 (1% out of all 1065 patients evaluable for safety). No treatment-related deaths occurred during the study., Interpretation: 18 months of androgen suppression plus radiotherapy is a more effective treatment option for locally advanced prostate cancer than 6 months of androgen suppression plus radiotherapy, but the addition of zoledronic acid to this treatment regimen is not beneficial. Evidence from the RADAR and French Canadian Prostate Cancer Study IV trials suggests that 18 months of androgen suppression with moderate radiation dose escalation is an effective but more tolerable option than longer durations of androgen suppression for men with locally advanced prostate cancer including intermediate and high risk elements., Funding: National Health and Medical Research Council of Australia, Novartis Pharmaceuticals Australia, AbbVie Pharmaceuticals Australia, New Zealand Health Research Council, New Zealand Cancer Society, Cancer Standards Institute New Zealand, University of Newcastle (Australia), Hunter Medical Research Institute, Calvary Mater Newcastle Radiation Oncology Fund, and Maitland Cancer Appeal., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Aim: To compare the burden and outcomes of cancer in New Zealand with those in Australia., Methods: For the years 1996-1997 and 2006-2007, the incidence and mortality of cancer in New Zealand and Australia was compared to determine if differences between the two countries had changed over the decade under study. Summarised cancer data from New Zealand and Australia, age standardised to the 2002 World Health Organisation's standard population, were used to make the comparisons., Results: For the 11 year timeframe of this study, total rates of cancer incidence reduced in New Zealand and increased in Australia. The incidence of cancer in New Zealand, relative to Australia, changed from an excess of +10.3 to a deficit of -27.5 per 100,000 people. When considering the excess in terms of gender, the annual excess of cancer registrations for New Zealand females fell from +19.9 to +0.9 per 100,000, and male cancer registration fell from an excess of +3.7 to a deficit of -58.0 per 100,000, due almost entirely to a surge in prostate cancer registration in Australia. Over the same 11-year timeframe, cancer-specific mortality rates decreased in both countries, but there was no change in the difference between New Zealand and Australian rates, which remained 10% higher in New Zealand. Similar to findings on 1996/7 data, the main cancer sites responsible for the overall excess mortality in 2006/7 were colorectal cancer in both sexes, and lung and breast cancer in females., Conclusion: The persisting different cancer mortality rates between the two countries is likely to have been partly due to lifestyle and ethnic differences in the populations, and partly due to New Zealanders presenting with more advanced cancers and having less easy access to some treatments. Until we know the relative contributions of these factors, it will be difficult for New Zealand to plan interventions in the future which have a good chance of lifting our cancer survival rates to those of our closest neighbour. The collection of clinical stage on all new cancer registrations would provide the base information required.

Background: This study, investigating ethnic differences in the diagnosis and treatment of prostate cancer, was performed because of a perceived paucity of Măori men receiving treatment for localised prostate cancer in the greater Wellington region. It was considered that if real differences could be demonstrated between Măori and non-Măori, it would raise questions as to whether cancer services were equally accessible to all sections of the population, one of the main objectives of the New Zealand Cancer Control Strategy., Patients and Methods: The database for this study includes men from the greater Wellington region, presenting with clinically localised prostate cancer between 1996 and 2007, who were treated using three defined protocols. There were 271 men with low-risk prostate cancer treated with brachytherapy (permanent iodine seed implantation), and 188 men with intermediate- or high-risk prostate cancer who were entered into sequential clinical trials run by the Trans-Tasman Radiology Oncology Group (96.01 and RADAR 03.04) and treated with radical external beam radiotherapy. Each man on the database was allocated to a major ethnic group based on ethnic categories defined in the 2006 New Zealand Census. Comparisons were then made of the observed ethnic mix of men in the low- and intermediate/high-risk groups with the expected percentages derived from Census and Cancer Registry data., Results: Ten Măori men were on the database, compared to 44 expected, and one Pacific man, compared to 37 expected. The same pattern of under-representation of these ethnic minorities was seen for both low-risk and intermediate/high-risk localised prostate cancer., Conclusion: As Cancer Registry data indicate that Măori have a lower incidence of prostate cancer compared to non-Măori, but a higher mortality rate and ratio (deaths/registrations), it is probable that during the period covered by this study, Măori were more likely to present with advanced cancer no longer confined to the prostate. The most likely explanation for this is that Măori have a cultural reluctance to present for health care until forced to by disabling symptoms. Longstanding negative messages from government agencies on the value of prostate cancer screening have done little to encourage the attitudinal change necessary for earlier, and more beneficial, engagement with health services.

Aims: To determine whether age-adjusted levels of serum total (tPSA) and complexed (cPSA) prostate specific antigen and the ratio of free to tPSA (%fPSA) differ by ethnic group independent of symptomatic disease., Methods: The serum levels of tPSA, cPSA, and %fPSA in relation to age, ethnicity and obstructive urinary symptoms were examined in 1405 Maori, Pacific Island and New Zealand European men in the Wellington region of New Zealand, and indicative reference range estimates produced. Participants were non-randomly selected from two study populations., Results: tPSA and cPSA increased with age while %fPSA decreased with age in all ethnic groups. Maori showed higher tPSA values in the 60-69 age group than other ethnic groups. cPSA increased more rapidly with age in Maori than in New Zealand Europeans or Pacific Islanders. %fPSA differed according to age across all three ethnic groups. The median and 5th percentile Pacific Island %fPSA values were higher in comparison to the %fPSA reference ranges of all other ethnic groups and were also higher than those reported in other studies. Once adjusted for urinary symptom score, only %fPSA in Pacific Island subjects remained significantly higher than that in New Zealand Europeans (P<0.001)., Conclusions: Our study indicates that %fPSA differs by ethnicity independent of symptomatic prostate disease.

Context: Vasectomy is a common method of contraception, but concern exists about a reported association with risk of prostate cancer., Objective: To examine whether vasectomy increases risk of prostate cancer., Design, Setting, and Participants: National population-based case-control study of 923 new cases of prostate cancer among men aged 40 to 74 years from the New Zealand Cancer Registry who were on the general electoral roll. Controls (n = 1224) were randomly selected from the general electoral roll, with frequency matching to cases in 5-year age groups. Cases (3-15 months after diagnosis) and controls were interviewed by telephone between January 1997 and November 1999., Main Outcome Measures: Relative risk (RR) of prostate cancer for men who had had a vasectomy vs those who had not., Results: There was no association between prostate cancer and vasectomy (RR, 0.92; 95% confidence interval [CI], 0.75-1.14) nor with time since vasectomy (RR, 0.92; 95% CI, 0.68-1.23 for > or = 25 years since vasectomy). Adjustment for social class, geographic region, religious affiliation, and a family history of prostate cancer did not affect these RRs., Conclusions: Vasectomy does not increase the risk of prostate cancer, even after 25 years or more.

Papillary renal cell carcinoma is the second most common carcinoma of the renal tubules and has been characterized genetically. Its morphologic features are incompletely characterized. It has been suggested that the presence of cytokeratin 7 is specific for papillary renal cell carcinoma. Collecting duct carcinoma might have papillary architecture, and it has been suggested that reaction with the Ulex europaeus lectin is specific for it. Sections from 105 papillary renal cell carcinomas larger than 12 mm in diameter from 100 patients were studied, and immunohistochemical reactions were performed on 91. The tumors formed two morphologic groups. Type 1 (67 tumors) consisted of papillae and tubular structures covered by small cells with pale cytoplasm and characterized by small oval nuclei with inconspicuous nucleoli, frequent glomeruloid papillae, papillary edema, foamy macrophages in papillary cores, and psammoma bodies. Type 2 (38 tumors) consisted of papillae covered by large cells with abundant eosinophilic cytoplasm and characterized by pseudostratification and large spherical nuclei with prominent nucleoli, glomeruloid papillae, psammoma bodies, edematous papillae, and foamy macrophages in papillary cores are uncommon. Type 2 tumors were larger, more common in patients younger than age 40, and more frequently Stages 3 or 4 than were Type 1 tumors. Pseudocapsules were common in both and often were infiltrated by carcinoma. Sarcomatoid foci were found in five tumors. Eleven were stage T1, 54 T2, 23 T3, and 12 T4. Reaction for cytokeratin 7 was strong or moderate in 48 of 61 Type 1 tumors, and reaction was null in 24 of 30 Type 2 tumors. No tumor reacted with U. europaeus lectin.

Objectives: Data from a community-based sample of 515 men were used to assess the prevalence and presentation of voiding symptoms in Caucasian, Maori, and Pacific Island men in the city of Porirua, New Zealand., Methods: A random sample, stratified by age groups of 10 years, was obtained for men 40 years and older. Two hundred men were entered into each 10-year age stratum. Frequency of symptoms and quality of life were measured using the International Prostate Symptom Score (IPSS) questionnaire. Bothersomeness of symptoms was assessed using questions from the American Urological Association symptom bother index. Data were analyzed according to age and ethnic group with differences between groups measured by analysis of variance., Results: Symptom score was found to increase with increasing age of subjects, with men in the 40 to 49 years age group recording a mean score (+/- SE) of 2.9 +/- 0.3, increasing to a mean score of 4.8 +/- 0.4 for men aged 50 to 59 years, 7.4 +/- 0.9 for men aged 60 to 69 years, and 7.4 +/- 0.9 for men in the 70 year and older age group. Significant symptoms, represented by a symptom score of 8 or greater, were found in 12.9% of men aged 40 to 49 years, 22.3% of men aged 50 to 59 years, 33.7% of men aged 60 to 69 years, and 33.3% in the 70 year and older age group. No difference was demonstrated in the prevalence of symptoms between Caucasian, Maori, and Pacific Island men., Conclusions: Despite having a similar prevalence of voiding symptoms to Caucasian men, few Maori or Pacific Island men seek help for their urinary symptoms. The level of understanding of the underlying disease process is poor for men of all ethnic backgrounds and emphasizes the important need for greater public awareness and education with respect to prostate disease.

Objective: To evaluate occupational risk factors for renal cell carcinoma., Subjects and Methods: A case control design was employed using data reported to the New Zealand Cancer Registry from 1978 to 1986 inclusive. The occupational risk for renal cell carcinoma was derived by comparison with the occupation of cases of non-urinary tract malignancy reported to the Registry over the same period., Results: An active occupational code was derived for 86.2% of all cases and 98.9% (710) of male cases. In a series of case-control studies for selected occupational groups, adjusting for patient age and smoking history, a significantly increased relative risk for the development of renal cell carcinoma among firefighters (RR 4.89, 95% CI 2.47-8.93) and painters (RR 1.79, 95% CI 1.31-3.44) was demonstrated., Conclusion: The data suggest that both firefighters and painters may be at an increased risk of developing renal cell carcinoma, which is likely to be of significance as both occupational groups are frequently exposed to known carcinogens.

Coiled globose female nematodes and larvae, identified as Phlyctainophora lamnae Steiner, 1921, were found in tumour-like lesions on the tail fin of spiny dogfish Squalus acanthias L. (Squalidae) caught off southern New Zealand. Nematodes provoke a chronic inflammatory response by the host. No male nematodes were recovered. This is the first record of the genus from New Zealand and the first record of adult Phlyctainophora from the Southern Hemisphere. Phlyctainophora squali Mudrey & Dailey, 1969 is considered a synonym of P. lamnae.

Testicular cancer is the most common malignancy in young men and is frequently associated with delays in presentation. It has been postulated that ignorance and poor awareness of this type of cancer may contribute to such delays, which may result in high stage disease and subsequent treatment-related morbidity. This study was undertaken to assess the level of awareness of testicular cancer in a sample of 500 men from Wellington, New Zealand, and to specifically examine awareness related to the age, race, and socio-economic level of the respondents. Sixty-one per cent of men returned a satisfactorily completed questionnaire. Most (70%) were unaware that cancer of the testis could develop. Of those who correctly identified testis cancer as occurring, half recognized the most commonly affected age group, 40% understood testis cancer could be treated, and 14% believed testis cancer could be cured with treatment. The lowest awareness score (mean +/- s.d.) were found in the 18-30 age group. The score in this group (2.82 +/- 1.47) was significantly lower than that seen in the 31-40 (mean 3.66 +/- 1.81, P = 0.009) or 41-50 (mean 3.57 +/- 2.16, P = 0.036) age groups. Differences were also seen between ethnic groups, with Maori having significantly lower scores than non-Maori (Maori, mean 2.69 +/- 1.52; non-Maori, 3.45 +/- 1.83; P = 0.044). Higher scores were associated with higher socio-economic grouping. The overall poor awareness of men in this study supports the need for a public education programme aimed at encouraging men to seek early advice following the recognition of testicular masses.

Objective: To determine clinical and pathologic prognostic factors for renal cell carcinoma (RCC) using cases reported to a population-based cancer registry., Methods: All cases of RCC reported to the New Zealand Cancer Registry between 1976 and 1986 were retrieved and data analyzed to determine parameters of prognostic importance., Results: In eleven years, 1,308 cases of RCC (66.7% males and 33.3% females) were reported to the New Zealand Cancer Registry. The age-standardized incidence rate was 3.78 per 10(5) person-years and showed no significant trend over the period of the study. There was a significant difference in the age at presentation between the largest racial groups (Maori 52.2 years; non-Maori 63.2 years), which is accounted for by increased predisposing risk factors among Maori. The five-year actuarial survival rate was 42.4 percent with 63 percent of patients reported dead in follow-up to December 1990. In the series, patient gender (female > male), tumor laterality (right > left), stage (intrarenal > localized > disseminated), grade (1 > 2 > 3 > 4), and treatment modality (surgery > nonsurgery) were found to be significant prognostic factors, although only tumor stage and treatment modality were of independent significance. Tumor laterality was of prognostic significance for Stage II (localized) surgically treated tumors only., Conclusions: The results of the study emphasize the paramount importance of tumor stage as a prognostic parameter for RCC. The prognostic significance of laterality for localized, surgically treated tumors suggests that radical nephrectomy is less likely to result in tumor clearance for left-sided RCC than for tumors on the right side.

Aims: to evaluate attitudes and preferred mechanisms in the establishment of specialist recertification for pathologists., Methods: a national survey was conducted amongst the membership of the New Zealand Society of Pathologists., Results: responses were received from 54 (62%) financial members of the society. The majority of respondents agreed with the concept of compulsory periodic recertification. The ideal recertification period should be 10 years and the system should be supervised by the New Zealand Society of Pathologists. The favoured recertification mechanism was by continuing medical education which should be funded by the individual candidate. The majority of respondents supported the establishment of voluntary recertification on a trial basis., Conclusions: the survey suggested a favourable attribute amongst pathologists to the introduction of continuing education based periodic recertification.

Between 1960 and 1986, 177 cases of Wilms' tumour were reported to the New Zealand National Cancer Registry. There was an equal sex distribution and 93.2% of patients were in the paediatric age group with a mean age of 3.4 years. The mean symptom interval was 2.0 months and the majority of patients presented with localised disease, although the incidence of advanced disease was greater than that reported from other series. The 5-year survival rate for all cases was 52.5%. Data were divided into patients presenting before and after the publication of the first National Wilms' Tumour Study (NWTS) in the United States in 1976. In patients presenting after 1976 the diagnosis was based on histology in 100%, compared to 58.6% in patients before 1977. Treatment was considered curative in a greater proportion of the post-1976 group. Treatment modalities reflected the recommendations of the NWTS and the 5-year survival rate of this group was 78.3%, this being similar to that reported from the NWTS. Multivariate analysis showed patient age, symptom interval, tumour stage and treatment (pre- and post-NWTS) to be independent predictors of survival.

Eight hundred and sixty patients were preassessed for elective varicose vein and inguinal hernia surgery at Wellington Hospital ion 1975 and 1976. Eight were refused operation on the grounds that they were unfit for general anaesthesia. Forty-nine went forward to operation with no investigations. The remaining 803 underwent a total of 1792 routine radiological and laboratory tests (chest x-ray, Coulter screen and ESR, plasma urea, creatinine and electrolytes). Abnormal test results were noted in 172 patients, 63 of these being unpredicted. Apart from one death (test results normal) there was no respiratory, renal or significant wound pathology. In no case did an unexpected abnormal result alter patient management. It is suggested that there is no justification for the routine preoperative laboratory investigation of asymptomatic and clinically normal patients who are undergoing elective minor surgery.