This document discusses several predictive models and nomograms for prostate cancer outcomes:
- The CAPRA nomogram predicts outcomes after radical prostatectomy using clinical factors.
- The J-CAPRA nomogram was designed for patients receiving primary androgen deprivation therapy and predicts cancer progression and mortality.
- Nomograms have been developed to predict survival for patients with metastatic castration-resistant prostate cancer using PSA kinetics and other clinical variables.
- Additional nomograms aim to predict outcomes after specific therapies like docetaxel or abiraterone. Prospective validation of these tools is still needed to help guide treatment decisions.
Usefulness of Serum Carcinoembryonic Antigen (CEA) in evaluating response to ...Enrique Moreno Gonzalez
High serum carcinoembryonic antigen (CEA) levels are an independent prognostic factor for recurrence and survival in patients with non-small cell lung cancer (NSCLC). Its role as a predictive marker of treatment response has not been widely characterized.
EAU - Guidelines on Prostate Cancer dr. ali mujtabaDr Ali MUJTABA
EAU - Guidelines on Prostate Cancer Organ Confined by Dr. Ali Mujtaba, Sindh Institute of Urology and Transplantation (SIUT)
https://www.youtube.com/watch?v=kXX9ItF4as4
https://www.youtube.com/watch?v=0m4YUI6Rr5w
Usefulness of Serum Carcinoembryonic Antigen (CEA) in evaluating response to ...Enrique Moreno Gonzalez
High serum carcinoembryonic antigen (CEA) levels are an independent prognostic factor for recurrence and survival in patients with non-small cell lung cancer (NSCLC). Its role as a predictive marker of treatment response has not been widely characterized.
EAU - Guidelines on Prostate Cancer dr. ali mujtabaDr Ali MUJTABA
EAU - Guidelines on Prostate Cancer Organ Confined by Dr. Ali Mujtaba, Sindh Institute of Urology and Transplantation (SIUT)
https://www.youtube.com/watch?v=kXX9ItF4as4
https://www.youtube.com/watch?v=0m4YUI6Rr5w
The dream of any physician and consequently every patient is to receive the right treatment in the right time with cost effectiveness. To achieve this goal, the 3 pillars: evidence based medicine, clinical research innovation & resources utilization should be integrated efficiently.
In this presentation, I'll try to comprehensively review the following:
1- How are we used to perform clinical trials in Oncology?
2- Does it fits in today’s needs?
3- Integration of biology knowledge in shaping drug development
4- New Clinical trial designs “Can they offer solution for accelerating drug development?”
5- The supporting infrastructure role in clinical trial execution
Association between genomic recurrence risk and well-being among breast cance...Enrique Moreno Gonzalez
Gene expression profiling (GEP) is increasingly used in the rapidly evolving field of personalized medicine. We sought to evaluate the association between GEP-assessed of breast cancer recurrence risk and patients’ well-being.
The dream of any physician and consequently every patient is to receive the right treatment in the right time with cost effectiveness. To achieve this goal, the 3 pillars: evidence based medicine, clinical research innovation & resources utilization should be integrated efficiently.
In this presentation, I'll try to comprehensively review the following:
1- How are we used to perform clinical trials in Oncology?
2- Does it fits in today’s needs?
3- Integration of biology knowledge in shaping drug development
4- New Clinical trial designs “Can they offer solution for accelerating drug development?”
5- The supporting infrastructure role in clinical trial execution
Association between genomic recurrence risk and well-being among breast cance...Enrique Moreno Gonzalez
Gene expression profiling (GEP) is increasingly used in the rapidly evolving field of personalized medicine. We sought to evaluate the association between GEP-assessed of breast cancer recurrence risk and patients’ well-being.
The Impact of Lymph Node Dissection on Survival in Intermediate- and High-Ris...semualkaira
Aimed to evaluate the therapeutic effect of pelvic lymph node dissection (PLND) on survival and determine the predictors of lymph node involvement (LNI) in patients with intermediate- or high-risk prostate cancer (PCa) treated with Radical Prostatectomy
The Impact of Lymph Node Dissection on Survival in Intermediate- and High-Ris...semualkaira
Aimed to evaluate the therapeutic effect of pelvic lymph node dissection (PLND) on survival and determine the
predictors of lymph node involvement (LNI) in patients with intermediate- or high-risk prostate cancer (PCa) treated with Radical
Prostatectomy
Detailed Information regarding MSKCC,IMDC score with evidence .
SSIGN Score, Fuhrman's grading described .
Prognostic significance of risk score explained
Сравнение эффективности препаратов Карбоплатин (Carboplatin) и Паклитаксел (P...oncoportal.net
Сравнение эффективности препаратов Карбоплатин (Carboplatin) и Паклитаксел (Paclitaxel) при добавлении препарата Бевацизумаб (Bevacizumab) и без него для лечения одной их форм рака легкого у пациентов старше 65 лет
in Older Patients With Advanced Non–Small Cell Lung Cancer
Advances in risk assessment, differential diagnosis between aggressive and non-aggressive tumors, and the development of novel/optimized treatment for advanced disease are discussed.
This slide deck is made available for patients/caregivers. It is not a substitute for seeking medical help. Please check original sources listed in the deck and consult your physician for the latest information and advice.
Early diagnosis of cancers is a major requirement for patients and a
complicated job for the oncologist. If it is diagnosed early, it could have made
the patient more likely to live. For a few decades, fuzzy logic emerged as an
emphatic technique in the identification of diseases like different types of
cancers. The recognition of cancer diseases mostly operated with inexactness,
inaccuracy, and vagueness. This paper aims to design the fuzzy expert system
(FES) and its implementation for the detection of prostate cancer. Specifically,
prostate-specific antigen (PSA), prostate volume (PV), age, and percentage
free PSA (%FPSA) are used to determine prostate cancer risk (PCR), while
PCR serves as an output parameter. Mamdani fuzzy inference method is used
to calculate a range of PCR. The system provides a scale of risk of prostate
cancer and clears the path for the oncologist to determine whether their
patients need a biopsy. This system is fast as it requires minimum calculation
and hence comparatively less time which reduces mortality and morbidity and
is more reliable than other economic systems and can be frequently used by
doctors.
advancements in the diagnostics help detect states like oligometastasis ,which can lead to selection of patients for local and MDT and prolong the time to adjuvant therapy, at present There is no consensus on the treatment of oligometastatic cancer and clinical trials can help in evidence formation.
Comparative analysis of primary repair vs resection and anastomosis, with lap...Enrique Moreno Gonzalez
The objective is to compare primary repair vs intestinal resection in cases of intestinal typhoid perforations. In addition, we hypothesised the usefulness of laparostomy for the early diagnosis and treatment of complications.
The modified Glasgow prognostic score in prostate cancer: results from a retr...Enrique Moreno Gonzalez
As the incidence of prostate cancer continues to rise steeply, there is an increasing need to identify more accurate prognostic markers for the disease. There is some evidence that a higher modified Glasgow Prognostic Score (mGPS) may be associated with poorer survival in patients with prostate cancer but it is not known whether this is independent of other established prognostic factors. Therefore the aim of this study was to describe the relationship between mGPS and survival in patients with prostate cancer after adjustment for other prognostic factors.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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NY Prostate Cancer Conference - J. Bellmunt - Panel discussion D: Do we need better predictive models in advanced prostate cancer?
1. April 7-9, 2011 Memorial Sloan-Kettering Cancer Center New York, US
2. Nomograms currently represent one of the most accurate and discriminating tools for predicting outcomes in patients with Pca Despite limitations, predictive tools can provide individualized, evidence-based estimates for a number of PCa endpoints, thereby helping in the complex decision-making process. Predictive tools can facilitate medical decision-making by showing patients tailored predictions of their outcomes with various alternatives There are no prospective randomized studies that clearly demonstrate that the use of prediction tools improve patient care or reduce patient anxiety, decisional conflict, or regret PREDICTIVE TOOLS AND NOMOGRAMS
4. Three polymorphisms in separate genes ( CYP19A1, HSD3B1, and HSD17B4) were significantly ( P .01) associated with time to progression (TTP) during ADT,
5.
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7. CAPRA (Cancer of the Prostate Risk Assessment ) Predict pathological and biochemical outcomes after radical prostatectomy, predict metastases, predict prostate cancer–specific mortality, and all-cause mortality. CAPRA scores were calculated at diagnosis from the PSA level, Gleason score, percentage of biopsy cores that were positive for cancer, clinical tumor stage, and age at diagnosis. Each single-point increase in the CAPRA score was associated with increased bone metastases cancer-specific mortality and all-cause mortality. Patients with clinically localized prostate cancer who were managed with one of five primary modalities, the CAPRA score predicted clinical prostate cancer endpoints with good accuracy
8. The first instrument that uses information available at time of diagnosis to predict accurately the development of metastases, cancer-specific mortality, and all-cause mortality, irrespective of primary treatment
9. Comparison of risk features between large disease registries from the United States and Japan, aiming to build and validate a risk prediction model applicable to primar androgen deprivation therapy (PADT ) patients. Risk Assessment [J-CAPRA]) was designed and validated to be specifically applicable to PADT patients, and more relevant to high-risk patients than existing instruments J-CAPRA—scored 0 to 12 based on Gleason score, PSA level, and clinical stage—predicts progression-free survival among PADT patients in J-CaP with a c-index of 0.71, and cancer-specific survival among PADT patients in CaPSURE with a c-index of 0.84. Applicable to those with both localized and advanced disease, and performs well in diverse populations
10. A PSA of 4 ng/mL or less after 7 months of AD is a strong predictor of survival.
11. PSA-P, defined as an increase of 25% greater than the nadir and an absolute increase of at least 2 or 5 ng/mL, predicts OS in HSPC and CRPC and may be a suitable end point for phase II studies in these settings.
14. Halabi et al., JCO 21:1232-7, 2003 Useful to predict individual survival probabilities and to stratify metastatic HRPC patients in randomized phase III trials
19. Nomogram Development PSADT has emerged as an easily obtainable and clinically relevant prognostic marker in several stages of prostate cancer,including pre-prostatectomy, pre-radiation therapy, rising PSA after local therapy, nonmetastatic CRPC, and... -------- in metastatic CRPC
20. Survival by PSADT 0.25 0.50 0.75 1.00 Survival (%) 0 5 10 15 20 25 30 35 40 45 50 Survival (months) PSADT <1 month PSADT 1–2 months Log-rank p<0.001 0 Eisenberger M, et al. J Clin Oncol 2007; 25: abstract # 5058 & PSADT is an Independent Risk Factor for Death in HRPC PSADT 4–6 months PSADT >6 months PSADT 2–3 months
21. Purpose: To develop a prognostic model and nomogram using baseline clinical variables to predict death among men with metastatic hormone-refractory prostate cancer (HRPC)
23. Nomograms provide the clinician with an overall assessment of a patient’s prognosis, but do not directly impact on decisions for the ideal starting point for docetaxel-based therapy, given that all patients in these nomograms had received therapy Additional factors are also likely to contribute to OS (covered in other nomograms,) - LDH and albumin, serum biomarkers for vascular endothelial growth factor and other cytokines, CTCs, and other unmeasured prognostic factors.
26. They analyzed predictors of postprogression survival according to both prechemotherapy and postchemotherapy variables with adjustment for potential confounders. The nomogram may also improve the information delivered to men with CRPC about prognosis. The prognostic factors identified in this study include both known prechemotherapy factors and type of progression and duration of chemotherapy. Predicting post chemo survival
27.
28. They investigated pre-treatment factors that predicted a > 30% PSA decline (30% PSAD) within 3 months of starting chemotherapy, Assessed performance of a risk group classification in predicting PSA declines and overall survival (OS) in men with mCRPC. Four independent risk factors predicted 30% PSAD: pain, visceral metastases, anemia and bone scan progression. Risk groups (good: 0–1 factors, intermediate: 2 factors and poor: 3–4 factors) were developed may facilitate evaluation of new systemic regimens warranting definitive testing in comparison with docetaxel and prednisone
29. Kaplan–Meier estimates of overall survival according to risk group classification. Median survival figures are represented in the legend
30. Normalization of ALP remained prognostic for OS after adjusting for PSA decline > 30% by day 90 (HR 0.79, 95% CI 0.65– 0.97, P 0.022).
31. In patients with CRPC, the association of measurable tumor responses with overall survival (OS) is unknown Four hundred twelve patients enrolled on the TAX327 trial had measurable tumors (CR/PR, 9.0%) PRs demonstrated longer median OS (29.0 months) than patients with SD (22.1 months) or those with PD (10.8 months) or those who were not assessed (12.7 months) Radiologic response remained a significant but modest post-treatment prognostic factor for OS after adjusting for treatment, pain response, and 30% PSA decline (P = .009)
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Editor's Notes
10 627 men with clinically localized prostate cancer, who underwent primary radical prostatectomy, radiation therapy (external beam or interstitial), androgen deprivation monotherapy, or watchful waiting/active surveillance, and had at least 6 months of follow-up after treatment.
The ability of the new instrument, designated the Japan Cancer of the Prostate Risk Assessment (J-CAPRA) score, to predict clinical progression-free survival (PFS) was assessed with Kaplan-Meier analysis, Cox proportional hazards regression, and calculation of Harrell’s c-index.
For phase III trials, the stratification of patients ensures that the treatment groups are balanced with respect to the known or possible factors to avoid the possibility of confounding. Furthermore, the utility of risk stratification may help identify subsets of patients that may have prolonged survival duration. Indeed, it is possible that some treatment will be beneficial for only a subgroup of patients but not for others.
have not been shown conclusively to be an independent prognostic factor in HRPC (retrospective reviews, small size)
The most significant predictors of mortality in the HRPC database are the presence of liver metastases , number of metastatic sites , and clinically significant pain (present pain inventory (PPI) >2 and/or an analgesic score (AS) > 10) (data not included in previous nomograms)
The importance of a prognostic model rests on its ability to capture clinically relevant and measurable variables for routine use by clinicians to inform patients, improve palliation and treatment decisions, and create homogeneous prognostic strata for randomized comparative trials of therapeutic agents. may be useful for clinical prognostication or stratification of subjects in clinical trials in this population. Prospective external validation of this model is planned and will be essential for more widespread clinical application.
The prognostic ability of this classification remains modest, and thus this classification should not be used to guide therapy nor to judge the survival benefit of docetaxel chemotherapy
Retrospective studies of the Southwest Oncology Group (SWOG)-9916 and the TAX327 trials, which compared docetaxel-based with mitoxantrone-based chemotherapy, demonstrated that a prostate-specific antigen (PSA) decline 30% or 50% within 3months had a moderate degree of surrogacy for extended overall survival (OS) in the setting of cytotoxic chemotherapy.3,4 Retrospective analyses of these trials have also demonstrated that an increase in PSA at 3 months correlates with poor overall survival (OS).5,6 A recent retrospective study demonstrated that progression-free survival (PFS), defined by a composite endpoint (progression by bone scan, PSA criteria by PSA working group, and measurable tumor progression), also correlates with poorer OS.7
Porter et al. developed a tool for prediction of cause-specific survival in patients exposed to hormonal therapy after RP failure (n=114) [89]. The internally validated discrimination of the tool was only 66%. Among the three prediction tools for AIPC patients, those of Smaletz et al [90] and of Halabi et al [91] were developed and externally validated in heavily pretreated patients, who had been exposed to one to several experimental agents. In external validation, the accuracy of the prediction tool of Smaletz et al. was 67% and that of Halabi et al. was 67% and 68%. Svatek et al. devised a contemporary prediction tool using a population with a median survival of 52 months who had not received experimental therapies. This prediction tool relies predominantly on PSA doubling time and PSA level at hormone therapy initiation. Internal validation of this prediction tool yielded a discrimination of 81%. The contemporaneity and homogeneity of the patient population make this prediction tool very attractive when survival needs to be assessed in patients with AIPC.