Diab OM

Background: Prostate cancer is the second leading cause of cancer death in American men, diagnosed mainly in older men. Treatment options for stage 3 prostate cancer include external beam radiation plus hormone therapy (HT) vs external beam radiation plus brachytherapy vs radical prostatectomy in selected cases.

Methodology: A total of 52,384 patients with stage 3 prostate cancer have been studied from national cancer database comparing Veterans Affairs Hospital (VAH) vs Academic Centers from years 2003-2013. Fisher exact test was used to make direct comparisons between centers and treatment type. We used a Bonferroni-adjusted P.

Results: Within both the 50-59 and 60-69-year-old age groups, when compared to Academic hospitals, VAH performed surgery alone at a lower rate (87.6% vs 77.4% and 86.1% vs 77.7%, respectively) and performed Surgery + Radiation and Radiation + Hormone therapy at a significantly higher rate (8.2% vs 15.0% and 6.8% vs 10.0%, respectively). In 70-79 year age group, when compared to Academic hospitals, VAH performed surgery alone at a lower rate (73.5% vs 43.1%) and Hormone therapy only and Radiation + Hormone therapy at significantly higher rate (3.7% vs 17.3% and 20.8% vs 33.9%, respectively) (all P < .001).

Conclusion: In VAH, people within age groups of 50-59, 60-69 years had more surgery plus radiation, radiation plus HT and less surgery alone than Academic centers. In 70-79 age group, VAH performed much more HT only, radiation plus HT and less surgery alone than Academic Centers.

Background: Prostate cancer is the second leading cause of cancer death in American men, diagnosed mainly in older men. Treatment options for stage 3 prostate cancer include external beam radiation plus hormone therapy (HT) vs external beam radiation plus brachytherapy vs radical prostatectomy in selected cases.

Methodology: A total of 52,384 patients with stage 3 prostate cancer have been studied from national cancer database comparing Veterans Affairs Hospital (VAH) vs Academic Centers from years 2003-2013. Fisher exact test was used to make direct comparisons between centers and treatment type. We used a Bonferroni-adjusted P.

Results: Within both the 50-59 and 60-69-year-old age groups, when compared to Academic hospitals, VAH performed surgery alone at a lower rate (87.6% vs 77.4% and 86.1% vs 77.7%, respectively) and performed Surgery + Radiation and Radiation + Hormone therapy at a significantly higher rate (8.2% vs 15.0% and 6.8% vs 10.0%, respectively). In 70-79 year age group, when compared to Academic hospitals, VAH performed surgery alone at a lower rate (73.5% vs 43.1%) and Hormone therapy only and Radiation + Hormone therapy at significantly higher rate (3.7% vs 17.3% and 20.8% vs 33.9%, respectively) (all P < .001).

Conclusion: In VAH, people within age groups of 50-59, 60-69 years had more surgery plus radiation, radiation plus HT and less surgery alone than Academic centers. In 70-79 age group, VAH performed much more HT only, radiation plus HT and less surgery alone than Academic Centers.

Background: Prostate cancer is the second leading cause of cancer death in American men, diagnosed mainly in older men. Treatment options for stage 3 prostate cancer include external beam radiation plus hormone therapy (HT) vs external beam radiation plus brachytherapy vs radical prostatectomy in selected cases.

Methodology: A total of 52,384 patients with stage 3 prostate cancer have been studied from national cancer database comparing Veterans Affairs Hospital (VAH) vs Academic Centers from years 2003-2013. Fisher exact test was used to make direct comparisons between centers and treatment type. We used a Bonferroni-adjusted P.

Results: Within both the 50-59 and 60-69-year-old age groups, when compared to Academic hospitals, VAH performed surgery alone at a lower rate (87.6% vs 77.4% and 86.1% vs 77.7%, respectively) and performed Surgery + Radiation and Radiation + Hormone therapy at a significantly higher rate (8.2% vs 15.0% and 6.8% vs 10.0%, respectively). In 70-79 year age group, when compared to Academic hospitals, VAH performed surgery alone at a lower rate (73.5% vs 43.1%) and Hormone therapy only and Radiation + Hormone therapy at significantly higher rate (3.7% vs 17.3% and 20.8% vs 33.9%, respectively) (all P < .001).

Conclusion: In VAH, people within age groups of 50-59, 60-69 years had more surgery plus radiation, radiation plus HT and less surgery alone than Academic centers. In 70-79 age group, VAH performed much more HT only, radiation plus HT and less surgery alone than Academic Centers.

Abstract: Docetaxel is a commonly used chemotherapeutic agent used in a variety of cancer treatment plans. We present a case of apparent docetaxel-induced Stevens-Johnson syndrome (SJS) in a patient recently treated with docetaxel for metastatic prostate cancer. This medication is not classically associated with the development of SJS.

A 63-year-old gentleman with a past medical history of hypertension, hyperlipidemia, and metastatic prostate adenocarcinoma to retroperitoneal lymph nodes, lung, and bone presented to the emergency room with a one-week history of a rash affecting his hands, feet, back, and chest. It developed into blisters that later ruptured. it was especially painful in the hands and feet. He also reported red eyes and difficulty eating for a week.

Vital Signs: Temp 36.4°C, 83/min, R.R 12/min, BP 121/60 mm Hg. Physical examination of the patient revealed a severe rash covering less than 30% of the body, oral ulcers, and conjunctival redness.

The patient’s cancer treatment regimen included active hormonal therapy with leuprolide and active chemotherapy with docetaxel. He had received 2 cycles of docetaxel therapy (75 mg/m2), with the last dose of docetaxel received 2 weeks prior to presentation.

Treatment of the patient included intravenous fluid replacement, prednisone, piperacillin/tazobactam, ondansetron, and morphine. The skin lesions were kept clean with regular dressing changes.

Because our searches for an established association between SJS and docetaxel were in vain, we elected to obtain a punch biopsy of the lesions to establish pathological evidence of our diagnosis. The punch biopsies were obtained from the edges of lesions on the left forearm and left medial foot. Light microscopy confirmed the diagnosis of SJS (clinical pics, pathology slides are available).

Discussion: Docetaxel is a widely used chemotherapeutic agent in the treatment of breast, lung, prostate and other cancers. The classically known side effects of docetaxel therapy include alopecia, pancytopenia, hepatotoxicity, nausea, vomiting, and diarrhea. A number of popular clinical pharmacology resources do not include Stevens-Johnson syndrome (SJS) as a known complication of docetaxel chemotherapy. However, the current case and the cases written by a handful of other clinicians may provide clinical evidence that docetaxel therapy is associated with the development of this potentially life-threatening dermatologic condition.

Abstract: Docetaxel is a commonly used chemotherapeutic agent used in a variety of cancer treatment plans. We present a case of apparent docetaxel-induced Stevens-Johnson syndrome (SJS) in a patient recently treated with docetaxel for metastatic prostate cancer. This medication is not classically associated with the development of SJS.

A 63-year-old gentleman with a past medical history of hypertension, hyperlipidemia, and metastatic prostate adenocarcinoma to retroperitoneal lymph nodes, lung, and bone presented to the emergency room with a one-week history of a rash affecting his hands, feet, back, and chest. It developed into blisters that later ruptured. it was especially painful in the hands and feet. He also reported red eyes and difficulty eating for a week.

Vital Signs: Temp 36.4°C, 83/min, R.R 12/min, BP 121/60 mm Hg. Physical examination of the patient revealed a severe rash covering less than 30% of the body, oral ulcers, and conjunctival redness.

The patient’s cancer treatment regimen included active hormonal therapy with leuprolide and active chemotherapy with docetaxel. He had received 2 cycles of docetaxel therapy (75 mg/m2), with the last dose of docetaxel received 2 weeks prior to presentation.

Treatment of the patient included intravenous fluid replacement, prednisone, piperacillin/tazobactam, ondansetron, and morphine. The skin lesions were kept clean with regular dressing changes.

Because our searches for an established association between SJS and docetaxel were in vain, we elected to obtain a punch biopsy of the lesions to establish pathological evidence of our diagnosis. The punch biopsies were obtained from the edges of lesions on the left forearm and left medial foot. Light microscopy confirmed the diagnosis of SJS (clinical pics, pathology slides are available).

Discussion: Docetaxel is a widely used chemotherapeutic agent in the treatment of breast, lung, prostate and other cancers. The classically known side effects of docetaxel therapy include alopecia, pancytopenia, hepatotoxicity, nausea, vomiting, and diarrhea. A number of popular clinical pharmacology resources do not include Stevens-Johnson syndrome (SJS) as a known complication of docetaxel chemotherapy. However, the current case and the cases written by a handful of other clinicians may provide clinical evidence that docetaxel therapy is associated with the development of this potentially life-threatening dermatologic condition.

Abstract: Docetaxel is a commonly used chemotherapeutic agent used in a variety of cancer treatment plans. We present a case of apparent docetaxel-induced Stevens-Johnson syndrome (SJS) in a patient recently treated with docetaxel for metastatic prostate cancer. This medication is not classically associated with the development of SJS.

A 63-year-old gentleman with a past medical history of hypertension, hyperlipidemia, and metastatic prostate adenocarcinoma to retroperitoneal lymph nodes, lung, and bone presented to the emergency room with a one-week history of a rash affecting his hands, feet, back, and chest. It developed into blisters that later ruptured. it was especially painful in the hands and feet. He also reported red eyes and difficulty eating for a week.

Vital Signs: Temp 36.4°C, 83/min, R.R 12/min, BP 121/60 mm Hg. Physical examination of the patient revealed a severe rash covering less than 30% of the body, oral ulcers, and conjunctival redness.

The patient’s cancer treatment regimen included active hormonal therapy with leuprolide and active chemotherapy with docetaxel. He had received 2 cycles of docetaxel therapy (75 mg/m2), with the last dose of docetaxel received 2 weeks prior to presentation.

Treatment of the patient included intravenous fluid replacement, prednisone, piperacillin/tazobactam, ondansetron, and morphine. The skin lesions were kept clean with regular dressing changes.

Because our searches for an established association between SJS and docetaxel were in vain, we elected to obtain a punch biopsy of the lesions to establish pathological evidence of our diagnosis. The punch biopsies were obtained from the edges of lesions on the left forearm and left medial foot. Light microscopy confirmed the diagnosis of SJS (clinical pics, pathology slides are available).

Discussion: Docetaxel is a widely used chemotherapeutic agent in the treatment of breast, lung, prostate and other cancers. The classically known side effects of docetaxel therapy include alopecia, pancytopenia, hepatotoxicity, nausea, vomiting, and diarrhea. A number of popular clinical pharmacology resources do not include Stevens-Johnson syndrome (SJS) as a known complication of docetaxel chemotherapy. However, the current case and the cases written by a handful of other clinicians may provide clinical evidence that docetaxel therapy is associated with the development of this potentially life-threatening dermatologic condition.

Ocular melanoma is the most common primary intraocular malignancy and can often be fatal. It is relatively uncommon and presents in about 5.1 cases per million population per year. Oftentimes, the patient is asymptomatic at diagnosis and the presentation is highly variable. We present a case of ocular melanoma.

A 68-year-old man with a history of hypertension, osteoarthritis, and coronary artery disease came in after having worsening pain in multiple joints. Review of systems revealed worsening blurry vision and eye floaters. He denied eye pain or other associated complaints. He had no past history of any ocular pigmented lesions or history of skin cancer. Ophthalmology evaluation a few years earlier did not identify any abnormalities. Approximately 10 years prior to presentation, he did have LASIK surgery on both eyes. Subsequent ophthalmological evaluation showed an iris mass, elevated pressure, intra-retinal hemorrhages, and evidence of involvement in the choroid and conjunctivae. This was highly suspicious for iris melanoma of the right eye. He was started on intraocular pressure lowering medications and further workup was initiated. Biopsy confirmed the diagnoses of choroidal melanoma with an iris mass measuring 1 mm radially by 4 mm circumferentially. The mass extended posteriorly and involved well over half his iridocorneal angle resulting in very high intraocular pressure. A metastatic workup was done and was negative at the time. He underwent successful enucleation surgery with prostheses placement. Patient did well until about 1.5 years later when he was found to have multiple liver lesions suggestive of metastasis. This is currently being further evaluated.

No current guidelines exist for the screening of primary ocular melanoma as well as for screening for metastasis in those already diagnosed. Unfortunately, up to 50% of patients with ocular melanoma develop metastases. This case opens the discussion of needing current guidelines for screening and better surveillance in ocular melanomas. It highlights the importance of looking into screening using genomics and also developing targeted therapies, as well as focusing on immunotherapies for these cases.

Ocular melanoma is the most common primary intraocular malignancy and can often be fatal. It is relatively uncommon and presents in about 5.1 cases per million population per year. Oftentimes, the patient is asymptomatic at diagnosis and the presentation is highly variable. We present a case of ocular melanoma.

A 68-year-old man with a history of hypertension, osteoarthritis, and coronary artery disease came in after having worsening pain in multiple joints. Review of systems revealed worsening blurry vision and eye floaters. He denied eye pain or other associated complaints. He had no past history of any ocular pigmented lesions or history of skin cancer. Ophthalmology evaluation a few years earlier did not identify any abnormalities. Approximately 10 years prior to presentation, he did have LASIK surgery on both eyes. Subsequent ophthalmological evaluation showed an iris mass, elevated pressure, intra-retinal hemorrhages, and evidence of involvement in the choroid and conjunctivae. This was highly suspicious for iris melanoma of the right eye. He was started on intraocular pressure lowering medications and further workup was initiated. Biopsy confirmed the diagnoses of choroidal melanoma with an iris mass measuring 1 mm radially by 4 mm circumferentially. The mass extended posteriorly and involved well over half his iridocorneal angle resulting in very high intraocular pressure. A metastatic workup was done and was negative at the time. He underwent successful enucleation surgery with prostheses placement. Patient did well until about 1.5 years later when he was found to have multiple liver lesions suggestive of metastasis. This is currently being further evaluated.

No current guidelines exist for the screening of primary ocular melanoma as well as for screening for metastasis in those already diagnosed. Unfortunately, up to 50% of patients with ocular melanoma develop metastases. This case opens the discussion of needing current guidelines for screening and better surveillance in ocular melanomas. It highlights the importance of looking into screening using genomics and also developing targeted therapies, as well as focusing on immunotherapies for these cases.

Ocular melanoma is the most common primary intraocular malignancy and can often be fatal. It is relatively uncommon and presents in about 5.1 cases per million population per year. Oftentimes, the patient is asymptomatic at diagnosis and the presentation is highly variable. We present a case of ocular melanoma.

A 68-year-old man with a history of hypertension, osteoarthritis, and coronary artery disease came in after having worsening pain in multiple joints. Review of systems revealed worsening blurry vision and eye floaters. He denied eye pain or other associated complaints. He had no past history of any ocular pigmented lesions or history of skin cancer. Ophthalmology evaluation a few years earlier did not identify any abnormalities. Approximately 10 years prior to presentation, he did have LASIK surgery on both eyes. Subsequent ophthalmological evaluation showed an iris mass, elevated pressure, intra-retinal hemorrhages, and evidence of involvement in the choroid and conjunctivae. This was highly suspicious for iris melanoma of the right eye. He was started on intraocular pressure lowering medications and further workup was initiated. Biopsy confirmed the diagnoses of choroidal melanoma with an iris mass measuring 1 mm radially by 4 mm circumferentially. The mass extended posteriorly and involved well over half his iridocorneal angle resulting in very high intraocular pressure. A metastatic workup was done and was negative at the time. He underwent successful enucleation surgery with prostheses placement. Patient did well until about 1.5 years later when he was found to have multiple liver lesions suggestive of metastasis. This is currently being further evaluated.

No current guidelines exist for the screening of primary ocular melanoma as well as for screening for metastasis in those already diagnosed. Unfortunately, up to 50% of patients with ocular melanoma develop metastases. This case opens the discussion of needing current guidelines for screening and better surveillance in ocular melanomas. It highlights the importance of looking into screening using genomics and also developing targeted therapies, as well as focusing on immunotherapies for these cases.