610 research outputs found
Metastatic disease of screen-detected prostate cancer: Characteristics at diagnosis
No full textMetastatic disease of screen-detected prostate cancer
Characteristics at diagnosis
Stijn Roemeling, MD 1 *, Ries Kranse, PhD 2, Andr\ue9 N. Vis, MD, PhD 1, Claartje Gosselaar, MD 1, Theo H. van der Kwast, MD, PhD 3 4, Fritz H. Schr\uf6der, MD, PhD 1
1Department of Urology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
2Comprehensive Cancer Centre, Rotterdam, The Netherlands
3Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Canada
4Department of Pathology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
email: Stijn Roemeling ([email protected])
*Correspondence to Stijn Roemeling, Department of Urology, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
The study received approval from the institutional review boards of the Erasmus MC and the Ministry of Health.
Fax: (011) 31 10 463 5315
Funded by:
Dutch Cancer Society
Netherlands Organization for Health Research and Development
European Union
Beckman Coulter Hybritech Inc., San Diego, CA
Keywords
prostate cancer \u95 mass screening \u95 neoplasm metastasis \u95 prognostic factors \u95 survival
Abstract
BACKGROUND.
Screening for prostate cancer has not only led to a stage migration, but also to a higher incidence of the disease. A decrease in mortality has occurred in several countries during the same time period. Risk stratification of screen-detected cancers at diagnosis has become more important for the anticipation and interpretation of changing incidence/mortality ratios.
METHODS.
From 1993 to 1998, 633 men were diagnosed with nonmetastatic prostate cancer in the prevalence screen of the Rotterdam section of the European Randomized study of Screening for Prostate Cancer (ERSPC). The characteristics at diagnosis of men who developed metastatic disease were compared with men without evidence of metastases during follow-up.
RESULTS.
During the median follow-up of 7.5 years, 41 men developed metastatic disease. After 10 years the metastasis-free survival rate was 89.6%, the overall survival 64.7%. In a Cox-model 2logPSA (prostate-specific antigen), biopsy Gleason score and the number of biopsy cores with prostate cancer were independent predictors for the development of metastases; the latter only predicted metastases that presented within 60 months of follow-up.
CONCLUSIONS.
The metastasis-free survival of men with prostate cancer detected in a prevalence screening was very high. Whether this was related to the beneficial effects of screening or to overdiagnosis due to screening (or both) remains unclear. The prognostic factors known for clinically diagnosed disease also hold for screen-detected disease. Cancer 2006. \ua9 2006 American Cancer Society
Oil price instability, hedging, and an oil stabilization fund : the case of Venezuela
Full text linkThe Venezuelan government and PDVSA (Venezuela's state oil companies) are both exposed to oil price instability. Given the existing tax structure, PDVSA has a higher exposure than the government, especially when prices drop below $18-20 a barrel. The authors show that the volatility of prices for crude oil is higher (but not significant) than the volatility of prices for refined oil products. And both prices are highly correlated. So, there is not much strength to the argument that Venezuela, being now mainly an exporter of refined products, faces less volatility than when it was exporting mainly crude oil. The basis risk for hedging Venezuelan crude oil was founded to be higher than for other crudes of comparable quality in the region. One explanation could be the pricing policies Venezuela follows, which leads Venezuelan crude oil prices to deviate for long periods from international prices. The basis risk in Venezuelan refined products is much lower and at acceptable levels for risk management. The issue of liquidity is concentrated in contracts for periods of less than a year. For products, the liquidity is concentrated in the nearest 4-5 months. So, for short-term hedges (6-9 months ahead), there is sufficient liquidity for Venezuela to hedge a substantial part of its exports. For longer-term hedges, the over-the-counter market is the more appropriate vehicle. In either case, it will not usually be the case that all production or exports should be hedged. The authors also examined the issue of an oil stabilization fund. For an oil stabilization fund to be effective several preconditions must be met. Most notably: oil prices should not follow a random walk; financial markets are incomplete; and there are large adjustment costs. These conditions do likely apply in Venezuela. Venezuela's best strategy would be to remove as much short-term oil price risk as possible by using short-dated hedging instruments (such as futures, options, or short-dated swaps) and to also do some longer term hedging (using mainly over-the-counter options and long-dated swaps). They also find that an oil stabilization fund should be complemented by using market-based risk management tools. The oil stabilization fund could then be used to manage any remaining interperiod oil price risk to the extent considered necessary.Markets and Market Access,Environmental Economics&Policies,Oil Refining&Gas Industry,Energy and Environment,Energy Demand
Screening and prostate-cancer mortality in a randomized European study
No full textBACKGROUND: The European Randomized Study of Screening for Prostate Cancer was initiated in the early 1990s to evaluate the effect of screening with prostate-specific-antigen (PSA) testing on death rates from prostate cancer.METHODS: We identified 182,000 men between the ages of 50 and 74 years through registries in seven European countries for inclusion in our study. The men were randomly assigned to a group that was offered PSA screening at an average of once every 4 years or to a control group that did not receive such screening. The predefined core age group for this study included 162,243 men between the ages of 55 and 69 years. The primary outcome was the rate of death from prostate cancer. Mortality follow-up was identical for the two study groups and ended on December 31, 2006.RESULTS: In the screening group, 82% of men accepted at least one offer of screening. During a median follow-up of 9 years, the cumulative incidence of prostate cancer was 8.2% in the screening group and 4.8% in the control group. The rate ratio for death from prostate cancer in the screening group, as compared with the control group, was 0.80 (95% confidence interval [CI], 0.65 to 0.98; adjusted P=0.04). The absolute risk difference was 0.71 death per 1000 men. This means that 1410 men would need to be screened and 48 additional cases of prostate cancer would need to be treated to prevent one death from prostate cancer. The analysis of men who were actually screened during the first round (excluding subjects with noncompliance) provided a rate ratio for death from prostate cancer of 0.73 (95% CI, 0.56 to 0.90).CONCLUSIONS: PSA-based screening reduced the rate of death from prostate cancer by 20% but was associated with a high risk of overdiagnosis. (Current Controlled Trials number, ISRCTN49127736.)</p
Screening for Prostate Cancer: Intermediate Outcome Measures and Active Surveillance
Full text linkProstate cancer is the most frequently diagnosed cancer in men in the Western world. The increasing use of PSA as a screening test for this disease has contributed to a marked increase in the number of newly diagnosed prostate cancers in countries where screening is prevalent. Whether screening actually influences prostate cancer mortality is still unclear. Regardless of the conclusions of ongoing trials on this question, it is likely that opportunistic screening will continue to be used. A confirmed positive effect of screening on the disease specific mortality would give a population based screening program a stronger scientific basis. The disputable performance of the PSA test, the high prevalence of the disease in older men, together with a high incidence-to mortality ratio have confronted the medical community and especially the urological world with new dilemmas.
Until new predictors become available which are capable of only detecting the significant prostate cancers, the high incidence, the serious side effects of prostate cancer treatments, costs, and especially the ethical aspects oblige us to consider the disadvantages of the currently used screening tools for prostate cancer. Overdiagnosis is one of the main problems. Ideally, detection of insignificant cancers could be avoided, but that is not presently possible, and therefore a likely by-product of a PSA screening program will be the frequent diagnosis of insignificant cancers.
This thesis focuses on active surveillance as a way out of the screening dilemma described above. Active surveillance manages selected men with prostate cancer expectantly with curative intent. These carefully selected men are actively observed in order to have the possibility to offer them deferred curative treatment once the tumour seems to progress. This thesis explores what kind of cancers are diagnosed by screening, how to subsequently risk-stratify those and what the best strategy is for active surveillance of a subset of these cancers
Corrigendum: CT Angiography or Cardiac MRI for Detection of Coronary Artery Aneurysms in Kawasaki Disease (Frontiers in Pediatrics, (2021), 9, (630462), 10.3389/fped.2021.630462)
No full textAn author name was incorrectly spelled as Diana van Stijn-Bringas Dimitriades. The correct spelling is Diana van Stijn. The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated
Correction to: Coronary artery assessment in Kawasaki disease with dual-source CT angiography to uncover vascular pathology (European Radiology, (2020), 30, 1, (432-441), 10.1007/s00330-019-06367-6)
No full textThe original version of this article, published on 19 August 2019, unfortunately contained a mistake. The following correction has therefore been made in the original: The author name D. van Stijn–Bringas Dimitriades was changed to D. van Stijn. The corrected author list is given above. The original article has been corrected
Screening and prostate-cancer mortality in a randomized European study
No full textBACKGROUND: The European Randomized Study of Screening for Prostate Cancer was initiated in the early 1990s to evaluate the effect of screening with prostate-specific-antigen (PSA) testing on death rates from prostate cancer. METHODS: We identified 182,000 men between the ages of 50 and 74 years through registries in seven European countries for inclusion in our study. The men were randomly assigned to a group that was offered PSA screening at an average of once every 4 years or to a control group that did not receive such screening. The predefined core age group for this study included 162,243 men between the ages of 55 and 69 years. The primary outcome was the rate of death from prostate cancer. Mortality follow-up was identical for the two study groups and ended on December 31, 2006. RESULTS: In the screening group, 82% of men accepted at least one offer of screening. During a median follow-up of 9 years, the cumulative incidence of prostate cancer was 8.2% in the screening group and 4.8% in the control group. The rate ratio for death from prostate cancer in the screening group, as compared with the control group, was 0.80 (95% confidence interval [CI], 0.65 to 0.98; adjusted P=0.04). The absolute risk difference was 0.71 death per 1000 men. This means that 1410 men would need to be screened and 48 additional cases of prostate cancer would need to be treated to prevent one death from prostate cancer. The analysis of men who were actually screened during the first round (excluding subjects with noncompliance) provided a rate ratio for death from prostate cancer of 0.73 (95% CI, 0.56 to 0.90). CONCLUSIONS: PSA-based screening reduced the rate of death from prostate cancer by 20% but was associated with a high risk of overdiagnosis. (Current Controlled Trials number, ISRCTN49127736.
Banking reform in transition countries
Full text linkIn reforming the financial sector in transition economies, one important debate is whether governments should try to reform existing state-owned banks (the rehabilitation approach) or whether a new private banking system should be allowed to emerge (a new entry approach). Or should there be a mix of the two approaches, in which the state bank activities are restricted while a parallel private banking system develops? The authors'cross-country comparison of banks'institutional development in 25 transitional economies suggests that progress can be faster under the new entry approach, especiallyrelative to initial conditions. Progress under the rehabilitation approach appears to be inhibited by poor incentives. In most countries, even those with a good banking infrastructure and a large segment of good banks, a two track process has evolved, with differences between weak and strong banks. Weak banks have moved little beyond central planning. Regression estimates suggest that slow progress of weak banks is associated with: cover concentration, government preferential treatment, and limited new banks entry. The causality direction is often unclear. Policies and structural conditions can affect bank quality. The role of banks will remain limited in many transition economies due to weak legal infrastructures, much uncertainty and inside information, and problems associated with highly leveraged financial intermediaries - including fraud, political interference, and implicit guarantees. In the short run, self-finance and intermediation among enterprises and through nonbank financial institutions may prevail.Financial Intermediation,Banks&Banking Reform,Payment Systems&Infrastructure,Financial Crisis Management&Restructuring,Municipal Financial Management,Banks&Banking Reform,Financial Intermediation,Financial Crisis Management&Restructuring,Municipal Financial Management,Settlement of Investment Disputes
Revenue-productive income tax structures and tax reforms in emerging market economies - evidence from Bulgaria
Full text linkUsing a household budget survey for 1992, The author shows the poor revenue performance and distributional impact of Bulgaria's personal income tax system. He explores the implications for revenue and income distribution of two alternative tax systems - a flat tax and a progressive but simpler three-brackets tax system. He demonstrates that simpler tax structures with lower tax rates could achieve at least equal revenue and distributional objectives and are superior in terms of efficiency and equity. (The findings are robust when Bulgaria's significant tax evasion is included). But tax changes since 1992 have, if anything, moved Bulgaria even further from a simple income tax system: the number of rates and brackets increased from 7 to 10, and the levels of exemption remain unchanged. (Complex, higher rates complicate administration and enforcement and provide incentives for tax evasions. And in the alternative systems the author explores, the poor are protected with higher exemptions.) Fortunately, the country's personal income tax structure began to move toward less nominal progressivity after Bulgaria's 1997 tax reform program. The tax rate in thetop income bracket was reduced from 52 percent to 40 percent, the number of tax brackets was halved, and the exemption level was increased 20 percent (reducing tax burdens on the poor).Environmental Economics&Policies,Public Sector Economics&Finance,Regional Governance,Tax Policy and Administration,Economic Theory&Research,Governance Indicators,Economic Theory&Research,Public Sector Economics&Finance,Environmental Economics&Policies,Tax Policy and Administration
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