BACKGROUND. Active surveillance (AS) with deferred treatment is an established management option for patients with prostate cancer and favorable clinical parameters. The impact of repeat biopsy after diagnosis was examined in a cohort of men with prostate cancer on AS. METHODS. In all, 186 men with prostate cancer with favorable parameters or who refused treatment were conservatively managed by AS. Of these, 92 patients had at least 1 biopsy after diagnosis. Patients were followed every 3 to 6 months with prostate‐specific antigen (PSA) and physical examination and were offered rebiopsy annually or if there were any changes on physical examination or in the PSA value. Disease progression while on AS was defined as having ≥1 of the following: ≥cT2b disease, ≥3 positive cores, >50% of cancer in at least 1 core, or a predominant Gleason pattern of 4 in rebiopsies. RESULTS. The median age of the patients at the time of diagnosis was 67 years (range, 49–78 years). The median follow‐up was 76 months (range, 20–169 months). Of the 92 patients who underwent repeat biopsies, 42 patients, 25 patients, 13 patients, 10 patients, and 2 patients had 1, 2, 3, 4, and 5 rebiopsies, respectively. A total of 34 patients (36%) demonstrated disease progression on rebiopsy. The first rebiopsy was positive for cancer in 48 patients (52.2%) and negative in 44 patients (47.8%). The 5‐year actuarial progression‐free probability was 82% for patients with a negative first repeat biopsy compared with 50% for patients with a positive first rebiopsy (P = .02). A PSA doubling time <67 months was associated an increased risk of disease progression on biopsy. CONCLUSIONS. Negative rebiopsy in patients with prostate cancer on AS is associated with low‐volume disease. The result of first repeated biopsy appears to have a strong impact on disease progression. Patients with a positive first repeated biopsy should be considered for treatment. An intensive biopsy protocol within the first 2 years is required to identify and treat those patients. Cancer 2008. © 2008 American Cancer Society.

Background: Many studies have suggested that nutritional factors may affect prostate cancer development. The aim of our study was to evaluate the relationship between dietary habits and prostate cancer detection. Methods:We studied 917 patients who planned to have transrectal ultrasonography-guided prostatic biopsy based on an elevated serum prostatespecific antigen (PSA) level, a rising serum PSA level or an abnormal digital rectal examination. Before receiving the results of their biopsy, all patients answered a self-administered food frequency questionnaire. In combination with pathology data we performed univariable and multivariable logistic regression analyses for the predictors of cancer and its aggressiveness.Results: Prostate cancer was found in 42% (386/917) of patients. The mean patient age was 64.5 (standard deviation [SD] 8.3) years and the mean serum PSA level for prostate cancer and benign cases, respectively, was 13.4 (SD 28.2) µg/L and 7.3 (SD 4.9) µg/L. Multivariable analysis revealed that a meat diet (e.g., red meat, ham, sausages) was associated with an increased risk of prostate cancer (odds ratio [OR] 2.91, 95% confidence interval [CI] 1.55-4.87, p = 0.027) and a fish diet was associated with less prostate cancer (OR 0.54, 95% CI 0.32-0.89, p = 0.017). Aggressive tumours were defined by Gleason score (≥ 7), serum PSA level (≥ 10 µg/L) and the number of positive cancer cores (≥ 3). None of the tested dietary components were found to be associated with prostate cancer aggressivity. Conclusion:Fish diets appear to be associated with less risk of prostate cancer detection, and meat diets appear to be associated with a 3-fold increased risk of prostate cancer. These observations add to the growing body of evidence suggesting a relationship between diet and prostate cancer risk.

245The detection rate of HGPIN in TRUSguided needle biopsies performed owing to an elevated PSA level or an abnormal digital rectal examination (DRE), was found to be between 4% and 25% of patients 1-4 and the cancer detection rate on repeated biopsy was reported from 2% to 47% of patients. 1,3,[5][6][7] Conversely, the rate of ASAP on initial biopsy was reported to range from 2.4% to 3.7% 3,8,9 ; the cancer detection rate on repeated biopsy was found to be as high as 52% in isolated ASAP 3,8,10 and 72% in ASAP associated with HGPIN.

Background: The province of Quebec has the highest incidence of urothelialtumours in Canada. Radical cystectomy remains the standard treatment for invasivebladder cancer. We have previously observed that prolonged delays betweentransurethral resection of bladder tumour (TURBT) and radical cystectomy leadto worse survival in Quebec.Objective: The aim of our study was to characterize the various periods of delaysustained by bladder cancer patients before radical cystectomy across Quebecand to determine their relation to survival.Methods: We obtained the billing records for all patients treated with radicalcystectomies for bladder cancer across Quebec from 1990 to 2002. Collectedinformation included patient age and sex; dates of family physician (FP) andspecialist visits with accompanying diagnoses; dates of cystoscopy, TURBT andCT scanning; surgeon age; surgical volume and dates of death.Results: We analyzed a total of 25 862 visits for 1633 patients. Median diagnosticdelays from FP to specialist, then to cystoscopy, then to TURBT and finallyfrom TURBT to CT were 20, 11, 4 and 14 days, respectively, over the entirestudy period. Median overall delay from FP visit to radical cystectomy was93 days. In addition, median FP to radical cystectomy delay progressivelyincreased from 1990 to 2000 from 58 to 120 days (p < 0.01). Multivariate analysesshowed that patients with an overall delay of either < 25 or > 84 dayshad a 2.1 and 1.4 times increased risk of dying, respectively (p ≤ 0.01).Conclusion: Preoperative delays have been progressively increasing over time.Overall, delays from FP to radical cystectomy of < 25 and > 84 days may translateinto worse outcomes. Poor survival in cases with < 25 days delay maybe attributed to case selection, with more advanced cases being managed muchquicker. Poor survival in cases with delays of > 84 days may be attributed todisease progression while awaiting completion of management.

Researchers know relatively little about the normative development of children's behaviors aimed at alleviating distress or discomfort in others. In this article, the authors aim to describe the continuity and discontinuity in the degree to which young children in the general population are reported to exhibit specific prosocial behaviors. Data came from the Québec Longitudinal Study of Child Development. Consistent with Hay's model of prosocial development, the results show that there were about as many children who stopped exhibiting prosocial behaviors between 29 and 41 months of age as there were children who started doing so during this period. Further, gender differences (girls > boys) in prosocial behaviors are either emerging or at least increasing in magnitude, with girls being more likely to start and boys being more likely to stop exhibiting these behaviors between 29 and 41 months of age. Consistent with the early-onset hypothesis, children who exhibit prosocial behaviors at 17 months of age are less likely to stop exhibiting the same behaviors between 29 and 41 months of age. Otherwise, if they did not exhibit prosocial behaviors at 29 months of age, they are also more likely to start doing so in the following year.