Breast cancer screening with mammography has been shown to reduce breast cancer mortality. However the frequency and the age range for screening eligibility has been controversial. Individual risk based screening regimens have recently been proposed to overcome some of the weaknesses of screening mammography. However, it is not possible to evaluate the full impact of such risk based individualized screening strategies in Canadian context. Therefore a mathematical cancer control model for breast cancer using care paths and cancer control data from the province of BC is being developed to model different early detection strategies. The model will incorporate the incidence, detection, diagnosis, progression, and case fatality of breast cancer in BC as baseline to make projections of the population health and economic impacts of different early detection methods for breast cancer. Once the model is validated, it will be possible to test early detection pathways and strategies, frequencies and durations, as well as any health care costs associated with detection, diagnosis, treatment and on-going care of breast cancer patients.

A population-based prospective database targeting 15 key radiation therapy (RT) features was initiated in British Columbia in 1984. This 25-year outcome report assessed the utility of the database and demonstrated that such a database can be used to (1) describe population-based utilization of a health service, (2) inform treatment policy recommendations, (3) inform system planning and resource allocation, (4) audit regional and individual oncology practices, (5) assess whether new observations from randomized trials have been translated into population health gains and (6) produce peer-reviewed publications. Health system managers and researchers could benefit from the development and support of such databases.

Study Type – Therapy (case series)Level of Evidence 4What's known on the subject? and What does the study add?Previous reports, with small numbers of patients, have described the problem of incomplete testosterone suppression (>1.1 or 1.7 nmol/L) with LHRH agonists. Various predisposing factors have been suggested: different drug agents and patient factors such as age, pretreatment testosterone levels and weight. Such incomplete testosterone suppression has been shown in one small report to be associated with increased PSA failure rates and in another report in those with metastases, with worse survival.This study used testosterone assays that are more accurate at low levels than those used in most previous reports in a large dataset of 2196 men, and confirmed incomplete testosterone suppression (breakthrough) rates >1.7 nmol/L of 3.4% and >1.1 nmol/L of 6.6%. We showed that younger age was strongly associated with the risk of breakthrough, with a minor effect of increasing body mass index. Repeated breakthroughs were more common (16%) in those who had already had one breakthrough. Interim measures of cancer control (PSA kinetics during LHRH therapy) were inferior in those with a breakthrough, and those with breakthroughs between 1.1 and 1.7 nmol/L had worse long‐term biochemical control rates.OBJECTIVES To describe breakthrough rates above castrate levels of testosterone, in a population‐based series of men undergoing adjuvant luteinizing hormone‐releasing hormone (LHRH) agonist therapy with curative radiation therapy. To explore the predisposing factors for such breakthroughs and their impact on subsequent outcomes. PATIENTS AND METHODS All men treated for prostate cancer between 1998 and 2007 with curative radiation in the province of British Columbia, Canada were potentially eligible (n= 11 752). Of these, 2196 fulfilled the eligibility criteria. Serial testosterone measurements were obtained during continuous LHRH therapy. Breakthrough rates >1.1 nmol/L and >1.7 nmol/L were calculated for each LHRH injection and for each patient course. Predisposing factors were identified, and early surrogates of oncological outcome (neoadjuvant nadir and post‐treatment nadir) were determined. RESULTS The risk of a breakthrough >1.1 nmol/L was 6.6%, and >1.7 nmol/L was 3.4% per patient course and 5.4% and 2.2% per LHRH injection (inclusive ranges). Repeated breakthroughs occurred in 16% of patients. Younger men were more liable to breakthroughs (P < 0.001). Early PSA kinetic surrogates of cancer control were inferior in those with breakthroughs. Neither overall biochemical non‐evidence of disease (bNED) nor survival were compromised, although subgroup analysis showed inferior 5‐year bNED in those with breakthroughs of 1.1–1.7 nmol/L vs those without (58% vs 73%, respectively; P= 0.048). CONCLUSIONS Breakthroughs with LHRH agonists occur occasionally per injection, but occur commonly per patient course of treatment, and adversely affect early surrogate measures of outcome. The monitoring of testosterone levels during therapy is therefore advised.

BACKGROUND Prostate cancer has a propensity to metastasize to the bone. Currently, there are no curative treatments for this stage of the disease. Sensitive biomarkers that can be monitored in the blood to indicate the presence or development of bone metastases and/or response to therapies are lacking. Surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF MS) is an affinity-based approach that allows sensitive and high-throughput protein profiling and screening of biological samples. METHODS We used SELDI-TOF MS for protein profiling of sera from prostate cancer patients (n = 38) with and without bone metastases in our effort to identify individual or multiple serum markers that may be of added benefit to those in current use. Serum was applied to ProteinChip surfaces (H4 and IMAC) to quickly screen samples and detect peaks predominating in the samples obtained from patients with bone metastases. Unique proteins in the bone metastasis cohort observed by SELDI-TOF MS were identified by two-dimensional gel electrophoresis, in-gel trypsin digestion, and tandem MS. The identities of the proteins were confirmed by ELISA and immunodepletion assays. RESULTS The cluster of unique proteins in the sera of patients with bone metastases was identified as isoforms of serum amyloid A. Machine-learning algorithms were also used to identify patients with bone metastases with a sensitivity and specificity of 89.5%. CONCLUSIONS SELDI-TOF MS protein profiling in combination with other proteomic approaches may provide diagnostic tools with potential clinical applications and serve as tools to aid in the discovery of biomarkers associated with various diseases.