Failure-Free Survival and Radiotherapy in Patients With Newly Diagnosed Nonmetastatic Prostate Cancer: Data From Patients in the Control Arm of the STAMPEDE Trial

Importance: The natural history of patients with newly diagnosed high-risk nonmetastatic (M0) prostate cancer receiving hormone therapy (HT) either alone or with standard-of-care radiotherapy (RT) is not well documented. Furthermore, no clinical trial has assessed the role of RT in patients with node-positive (N+) M0 disease. The STAMPEDE Trial includes such individuals, allowing an exploratory multivariate analysis of the impact of radical RT.

Objective: To describe survival and the impact on failure-free survival of RT by nodal involvement in these patients.

Design, Setting, and Participants: Cohort study using data collected for patients allocated to the control arm (standard-of-care only) of the STAMPEDE Trial between October 5, 2005, and May 1, 2014. Outcomes are presented as hazard ratios (HRs) with 95% CIs derived from adjusted Cox models; survival estimates are reported at 2 and 5 years. Participants were high-risk, hormone-naive patients with newly diagnosed M0 prostate cancer starting long-term HT for the first time. Radiotherapy is encouraged in this group, but mandated for patients with node-negative (N0) M0 disease only since November 2011.

Exposures: Long-term HT either alone or with RT, as per local standard. Planned RT use was recorded at entry.

Main Outcomes and Measures: Failure-free survival (FFS) and overall survival.

Results: A total of 721 men with newly diagnosed M0 disease were included: median age at entry, 66 (interquartile range [IQR], 61-72) years, median (IQR) prostate-specific antigen level of 43 (18-88) ng/mL. There were 40 deaths (31 owing to prostate cancer) with 17 months' median follow-up. Two-year survival was 96% (95% CI, 93%-97%) and 2-year FFS, 77% (95% CI, 73%-81%). Median (IQR) FFS was 63 (26 to not reached) months. Time to FFS was worse in patients with N+ disease (HR, 2.02 [95% CI, 1.46-2.81]) than in those with N0 disease. Failure-free survival outcomes favored planned use of RT for patients with both N0M0 (HR, 0.33 [95% CI, 0.18-0.61]) and N+M0 disease (HR, 0.48 [95% CI, 0.29-0.79]).

Conclusions and Relevance: Survival for men entering the cohort with high-risk M0 disease was higher than anticipated at study inception. These nonrandomized data were consistent with previous trials that support routine use of RT with HT in patients with N0M0 disease. Additionally, the data suggest that the benefits of RT extend to men with N+M0 disease.

Trial Registration: clinicaltrials.gov Identifier: NCT00268476; ISRCTN78818544.

Reliability of reports of childhood trauma in bipolar disorder: A test–retest study over 18 months

This study aimed to explore the reliability of self-reported trauma histories in a population with a diagnosis of Bipolar Disorder using the Childhood Trauma Questionnaire. Previous studies in other populations suggest high reliability of trauma histories over time and it was postulated that a similar high reliability would be demonstrated in this population. Thirty-nine patients with a confirmed diagnosis (DSM-IV criteria) were followed-up and re-administered the Childhood Trauma Questionnaire after 18 months. Cohen's kappa scores and intraclass correlations suggest reasonable test-retest reliability over the 18-month time period of the study for all types of childhood abuse, namely emotional, physical, sexual, and physical abuse and emotional neglect. Intraclass correlations ranged from r = .50 to (sexual abuse) to r = .96 (physical abuse). Cohen's kappas ranged from .44 (sexual abuse) to .76 (physical abuse). Retrospective reports of childhood trauma can be seen as reliable and are in keeping with results found with other mental health populations.

Photoionization cross sections for the trans-iron element Se + from 18 to 31 eV

Absolute photoionization cross-section calculations are presented for Se + using large-scale close-coupling calculations within the Breit--Pauli and Dirac--Coulomb R -matrix approximations. The results from our theoretical work are compared with recent measurements (Esteves 2010 PhD Thesis publication number AAI3404727, University of Reno, NV, USA; Sterling et al 2011 J. Phys. B: At. Mol. Opt. Phys. 44 025701; Esteves et al 2011 Phys. Rev. A 84 013406) made at the advanced light source (ALS) radiation facility in Berkeley, CA, USA. We report on results for the photon energy range 18.0--31.0 eV, which spans the ionization thresholds of the 4 S o 3/2 ground state and the low-lying 2 D o 5/2,3/2 and 2 P o 3/2,1/2 metastable states. Metastable fractions are inferred from our present work. Resonance energies and quantum defects of the prominent Rydberg resonances series identified in the spectra are compared for the 4p → n d transitions with the recent ALS experimental measurements made on this complex trans-iron element.

Experimental and theoretical photoionization cross sections for Se + from 18 eV to 31 eV

Absolute Se photoionization cross-section measurements and Dirac-Coulomb R -matrix calculations are reported for the photon energy range 18.0 eV – 31.0 eV, which spans the ionization thresholds of the 4 S 0 3/2 ground state and the low-lying 2 D 0 3/2,5/2 and 2 P 0 1/2,3/2 metastable states. The determination of the photoionization and recombination properties of n -capture element ions is motivated by their astrophysical detection and the importance of their elemental abundances in testing theories of nucleosynthesis and stellar structure.