Postoperative statin use and risk of biochemical recurrence following radical prostatectomy: results from the Shared Equal Access Regional Cancer Hospital (SEARCH) database.

OBJECTIVE: To investigate the effect of statin use after radical prostatectomy (RP) on biochemical recurrence (BCR) in patients with prostate cancer who never received statins before RP. PATIENTS AND METHODS: We conducted a retrospective analysis of 1146 RP patients within the Shared Equal Access Regional Cancer Hospital (SEARCH) database. Multivariable Cox proportional hazards analyses were used to examine differences in risk of BCR between post-RP statin users vs nonusers. To account for varying start dates and duration of statin use during follow-up, post-RP statin use was treated as a time-dependent variable. In a secondary analysis, models were stratified by race to examine the association of post-RP statin use with BCR among black and non-black men. RESULTS: After adjusting for clinical and pathological characteristics, post-RP statin use was significantly associated with 36% reduced risk of BCR (hazard ratio [HR] 0.64, 95% confidence interval [CI] 0.47-0.87; P = 0.004). Post-RP statin use remained associated with reduced risk of BCR after adjusting for preoperative serum cholesterol levels. In secondary analysis, after stratification by race, this protective association was significant in non-black (HR 0.49, 95% CI 0.32-0.75; P = 0.001) but not black men (HR 0.82, 95% CI 0.53-1.28; P = 0.384). CONCLUSION: In this retrospective cohort of men undergoing RP, post-RP statin use was significantly associated with reduced risk of BCR. Whether the association between post-RP statin use and BCR differs by race requires further study. Given these findings, coupled with other studies suggesting that statins may reduce risk of advanced prostate cancer, randomised controlled trials are warranted to formally test the hypothesis that statins slow prostate cancer progression.

The influence of hepatic function on prostate cancer outcomes after radical prostatectomy.

Prostate growth is dependent on circulating androgens, which can be influenced by hepatic function. Liver disease has been suggested to influence prostate cancer (CaP) incidence. However, the effect of hepatic function on CaP outcomes has not been investigated. A total of 1181 patients who underwent radical prostatectomy (RP) between 1988 and 2008 at four Veterans Affairs hospitals that comprise the Shared Equal Access Regional Cancer Hospital database and had available liver function test (LFT) data were included in the study. Independent associations of LFTs with unfavorable pathological features and biochemical recurrence were determined using logistic and Cox regression analyses. Serum glutamic oxaloacetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGPT) levels were elevated in 8.2 and 4.4% of patients, respectively. After controlling for CaP features, logistic regression revealed a significant association between SGOT levels and pathological Gleason sum > or =7(4+3) cancer (odds ratio=2.12; 95% confidence interval=1.11-4.05; P=0.02). Mild hepatic dysfunction was significantly associated with adverse CaP grade, but was not significantly associated with other adverse pathological features or biochemical recurrence in a cohort of men undergoing RP. The effect of moderate-to-severe liver disease on disease outcomes in CaP patients managed non-surgically remains to be investigated.

Facts and Fictions: Feminist Literary Criticism and Cultural Critique, 1968-2012

"Facts and Fictions: Feminist Literary Criticism and Cultural Critique, 1968-2012" is a critical history of the unfolding of feminist literary study in the US academy. It contributes to current scholarly efforts to revisit the 1970s by reconsidering often-repeated narratives about the critical naivety of feminist literary criticism in its initial articulation. As the story now goes, many of the most prominent feminist thinkers of the period engaged in unsophisticated literary analysis by conflating lived social reality with textual representation when they read works of literature as documentary evidence of real life. As a result, the work of these "bad critics," particularly Kate Millett and Andrea Dworkin, has not been fully accounted for in literary critical terms.

This dissertation returns to Dworkin and Millett's work to argue for a different history of feminist literary criticism. Rather than dismiss their work for its conflation of fact and fiction, I pay attention to the complexity at the heart of it, yielding a new perspective on the history and persistence of the struggle to use literary texts for feminist political ends. Dworkin and Millett established the centrality of reality and representation to the feminist canon debates of "the long 1970s," the sex wars of the 1980s, and the more recent feminist turn to memoir. I read these productive periods in feminist literary criticism from 1968 to 2012 through their varied commitment to literary works.

Chapter One begins with Millett, who de-aestheticized male-authored texts to treat patriarchal literature in relation to culture and ideology. Her mode of literary interpretation was so far afield from the established methods of New Criticism that she was not understood as a literary critic. She was repudiated in the feminist literary criticism that followed her and sought sympathetic methods for reading women's writing. In that decade, the subject of Chapter Two, feminist literary critics began to judge texts on the basis of their ability to accurately depict the reality of women's experiences.

Their vision of the relationship between life and fiction shaped arguments about pornography during the sex wars of the 1980s, the subject of Chapter Three. In this context, Dworkin was feminism's "bad critic." I focus on the literary critical elements of Dworkin's theories of pornographic representation and align her with Millett as a miscategorized literary critic. In the decades following the sex wars, many of the key feminist literary critics of the founding generation (including Dworkin, Jane Gallop, Carolyn Heilbrun, and Millett) wrote memoirs that recounted, largely in experiential terms, the history this dissertation examines. Chapter Four considers the story these memoirists told about the rise and fall of feminist literary criticism. I close with an epilogue on the place of literature in a feminist critical enterprise that has shifted toward privileging theory.