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Mulhall J.P.,Memorial Sloane Kettering Cancer Center | Parker M.,Loyola University | Waters B.W.,Loyola University | Flanigan R.,Loyola University
BJU International | Year: 2010

OBJECTIVE To define if erectile function (EF) outcomes were better in men with early institution of penile rehabilitation after radical prostatectomy (RP), as one of the mechanisms by which patients fail to recover EF after RP is collagenization of corporal smooth muscle with subsequent venous leak development, and rehabilitation is aimed at preventing these structural alterations. PATIENTS AND METHODS The study population comprised patients who: (i) had clinically organ-confined prostate cancer; (ii) had fully functional erections, corroborated by the partner; (iii) had bilateral nerve-sparing RP; and (iv) committed to pharmacological penile rehabilitation. Patients completed the International Index of Erectile Function (IIEF) serially after RP. Patients were instructed to obtain three erections/week using initially sildenafil, and if unsuccessful, then intracavernous injections. Patients were subdivided into those starting rehabilitation at <6 months after RP (early) and those starting at ≥6 months after RP (delayed). RESULTS There were 48 patients in the early group and 36 in the delayed group; patients in both groups were matched for age, comorbidity status and baseline EF. The mean duration after RP at the time of starting penile rehabilitation was 2 and 7 months in the early and delayed groups, respectively (P < 0.01). At 2 years after surgery there was a highly statistically significant difference in IIEF EF domain score between the early and delayed groups (22 vs 16, P < 0.001). There were also statistically significant differences between the groups in the percentage of men at 2 years after RP who had unassisted functional erections and sildenafil-assisted functional erections (58% vs 30%, P < 0.01; 86% vs 45%, P < 0.01, respectively). CONCLUSIONS These data suggest that delaying the start of penile rehabilitation after RP is associated with poorer outcomes for EF. © 2009 BJU International.


Kale A.,Yeshiva University | Li W.,Yeshiva University | Li W.,Memorial Sloane Kettering Cancer Center | Lee C.-H.,Yeshiva University | Baker N.E.,Yeshiva University
Cell Death and Differentiation | Year: 2015

Heterozygosity for mutations in ribosomal protein genes frequently leads to a dominant phenotype of retarded growth and small adult bristles in Drosophila (the Minute phenotype). Cells with Minute genotypes are subject to cell competition, characterized by their selective apoptosis and removal in mosaic tissues that contain wild-type cells. Competitive apoptosis was found to depend on the pro-apoptotic reaper, grim and head involution defective genes but was independent of p53. Rp/+ cells are protected by anti-apoptotic baculovirus p35 expression but lacked the usual hallmarks of 'undead' cells. They lacked Dronc activity, and neither expression of dominant-negative Dronc nor dronc knockdown by dsRNA prevented competitive apoptosis, which also continued in dronc null mutant cells or in the absence of the initiator caspases dredd and dream/strica. Only simultaneous knockdown of dronc and dream/strica by dsRNA was sufficient to protect Rp/+ cells from competition. By contrast, Rp/Rp cells were also protected by baculovirus p35, but Rp/Rp death was dronc-dependent, and undead Rp/Rp cells exhibited typical dronc-dependent expression of Wingless. Independence of p53 and unusual dependence on Dream/Strica distinguish competitive cell death from noncompetitive apoptosis of Rp/Rp cells and from many other examples of cell death. © 2015 Macmillan Publishers Limited.


Chambers S.K.,Griffith University | Chambers S.K.,Edith Cowan University | Zajdlewicz L.,Cancer Council Queensland | Youlden D.R.,Cancer Council Queensland | And 3 more authors.
Psycho-Oncology | Year: 2014

Background The Distress Thermometer (DT) is widely recommended for screening for distress after cancer. However, the validity of the DT in men with prostate cancer and over differing time points from diagnosis has not been well examined. Method Receiver operating characteristics analyses were used to evaluate the diagnostic accuracy of the DT compared with three commonly used standardised scales in two prospective and one cross-sectional survey of men with prostate cancer (n = 740, 189 and 463, respectively). Comparison scales included the Impact of Event Scale - Revised (IES-R, Study 1), the Hospital Anxiety and Depression Scale (HADS, Study 2) and the Brief Symptom Inventory-18 (BSI-18, Study 3). Results Study 1: the DT showed good accuracy against the IES-R at all time points (area under curves (AUCs) ranging from 0.84 to 0.88) and sensitivity was high (>85%). Study 2: the DT performed well against both the anxiety and depression subscales for HADS at baseline (AUC = 0.84 and 0.82, respectively), but sensitivity decreased substantially after 12 months. Study 3: validity was high for the anxiety (AUC = 0.90, sensitivity = 90%) and depression (AUC = 0.85, sensitivity = 74%) subscales of the BSI-18 but was poorer for somatization (AUC = 0.67, sensitivity = 52%). A DT cut-off between ≥3 and ≥6 maximised sensitivity and specificity across analyses. Conclusions The DT is a valid tool to detect cancer-specific distress, anxiety and depression among prostate cancer patients, particularly close to diagnosis. A cut-off of ≥4 may be optimal soon after diagnosis, and for longer-term assessments, ≥3 was supported. © 2013 The Authors. Psycho-Oncology published by John Wiley & Sons, Ltd. © 2013 The Authors. Psycho-Oncology published by John Wiley & Sons, Ltd.


Osterwalder U.,BASF | Herzog B.,BASF | Wang S.Q.,Memorial Sloane Kettering Cancer Center
Expert Review of Dermatology | Year: 2011

The availability of potent and broad-spectrum sunscreens can protect the skin from harmful effects induced by UV radiation. Aside from avoiding sunburn, modern-day sunscreen also has the potential to prevent skin cancer and slow photoaging, if it is used appropriately. This article traces through the evolution of sunscreens and highlights the clinical benefits, specifically in preventing skin cancers. Besides improved UV filter technology, development of UVA assessment methods and the regulatory standards are instrumental in the advancement of sunscreen efficacy. Lastly, compliance remains the most crucial factor for optimal sun protection. Sunscreen is often applied in too little amount, too late or not at all. Compliance may not improve if users do not change their behaviors and habits. © 2011 Expert Reviews Ltd.


Dunn J.,Griffith University | Dunn J.,University of Queensland | Ng S.K.,Griffith University | Breitbart W.,Memorial Sloane Kettering Cancer Center | And 8 more authors.
Health and Quality of Life Outcomes | Year: 2013

Background: This longitudinal study describes the five year trajectories of health-related quality of life (HR-QOL) and life satisfaction in long term colorectal cancer survivors.Patients and methods: A population-based sample of 1966 colorectal cancer survivors were surveyed at six time points from five months to five years post-diagnosis. Predictor variables were: socio-demographic variables, optimism; cancer threat appraisal; perceived social support. Quality of life was assessed with the Functional Assessment of Cancer Therapy-Colorectal (HR-QOL); and the Satisfaction with Life Scale. Growth mixture models were applied to identify trajectory classes and their predictors.Results: Distinct adjustment trajectories were identified for HR-QOL and life satisfaction. Lower optimism, poorer social support, a more negative cognitive appraisal, and younger age were associated with poorer life satisfaction, while survivors with less than 8 years of education had higher life satisfaction. This pattern was similar for overall HR-QOL except that educational level was not a significant predictor and later stage disease and female gender emerged as related to poorer outcomes. One in five survivors reported poorer constant HR-QOL (19.2%) and a small group had poor life satisfaction (7.2%); 26.2% reported constant high HR-QOL and 48.8% had high constant life satisfaction. Socioeconomic disadvantage and remoteness of residence uniquely predicted poorer outcomes in the colorectal cancer specific HR-QOL sub domain.Conclusion: Although HR-QOL and subjective cognitive QOL share similar antecedents their trajectory patterns suggested they are distinct adjustment outcomes; with life satisfaction emerging as temporally stable phenomenon. Unique patterns of risk support suggest the need to account for heterogeneity in adjustment in longitudinal QOL studies with cancer survivors. © 2013 Dunn et al.; licensee BioMed Central Ltd.

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