In and the Sabratha Cancer Registry in

In 2006 and 2007, the Sabratha Cancer Registry in western Libya, which had been set up in 2006 by the African Oncology Institute (AOI) in Sabratha, published two online reports on oral cancer (see Table 2b, Abusaa et al., 2006, 2007). This registry, which covers approximately 9% of Libyan population, consists of two units: a population-based cancer registry covering western Libya (Alegelat, Aljameil, Zwara, Sabratha, Zawia, Surman, Altawaila, Zulten, Rigdalen, Abukamash, and Alassa) and a hospital-based cancer registry at the African Oncology Institute. These reports revealed head and neck cancer accounted for 5% and 4.8% of all cancers patients, respectively in 2006 and 2007. The most common cancer site in 2006 was the oral cavity followed by the nasopharynx while in 2007 the nasopharynx was the most common site which was in agreement with the eastern Libya 2003 findings (Abusaa et al., 2006, 2007; El Mistiri et al., 2006). Fig. 2 shows the comparison of specific oral cavity and pharyngeal cancer site’s distribution between 2003 eastern and 2007 western Libya reports (Abusaa et al., 2007; El Mistiri et al., 2006).
As for the other geographic regions of Libya, there are no cancer registries either in the Tripoli region nor in the southern part of Libya, which combined account for nearly 60% of the total Libyan population. Consequently the descriptive picture of oral cancer in the Tripoli region and in the southern part of Libya remains unclear, and thus for the country as a whole the picture is quite incomplete. While a few cohort studies and case reports have been published about the Sulfo-NHS-Biotin of these two regions (Akhtar et al., 1993; Moona and Mehdi, 2001; Mohammed et al., 2013), the data from these two types of epidemiological studies do not permit meaningful comparisons with the current descriptive picture of oral cancer in the western and eastern regions of Libya.
In 2008–2009 (see Table 2a), three articles (Elarbi et al., 2009; El-Gehani et al., 2009; Subhashraj et al., 2009)—also by the Faculty of Dentistry at Benghazi—formed a series of reports describing the findings from one retrospective study on different benign and malignant oral tumors with the detailed distribution of biopsied lesion type from these articles reported in Table 3 and illustrated in Fig. 3. These articles reported on data from the medical reports and biopsy files of 2390 patients who had maxillofacial biopsies performed at the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry at Benghazi during a period of 17years between 1991 and 2007. In this study, primary malignant tumors constituted 8% of all cases and premalignant epithelial lesions of mucosa and skin 6% of all cases, while benign odontogenic/non-odontogenic tumors constituted 16% of all cases. Of the primary malignant tumors (i.e., cancer cases), 82% were tumors of epithelial origin (carcinoma), 11% were tumors of immune system and 7% were tumors of mesenchymal origin (sarcoma). For malignant tumors, the male to female ratio was 1.4:1 and the mean age of these cancer patients was 46years for males and females combined. Squamous cell carcinoma (SCC) accounted for 41% of all primary malignant tumors, or 3.4% of all biopsied cases. Among the epithelial tumors, SCC was the most common neoplasm (50.6%), with a male: female ratio of 1.6:1 (El-Gehani et al., 2009; Subhashraj et al., 2009). One of these three articles reported on orofacial tumors in 213 Libyan children patients who had been treated at the Faculty of Dentistry at Benghazi over this time period. They found that malignant tumors constituted only 3.7% of the 213 cases, a finding they described as being low in comparison to other reports from Africa and Israel, which they attributed specifically to the low number of children found with Burkitt’s lymphoma in Libya (Elarbi et al., 2009).
Another retrospective study published in 2010 addressed the pattern of occurrence of oral SCC in Libya based upon the hospital records of all 122 patients subsequently diagnosed with oral SCC who had been referred to the Department of Oral and Maxillofacial Surgery at the Faculty of Dentistry at Benghazi in the period 1979–2004 from different regions of Libya (see Table 2a). The study found that tongue and floor of the mouth were the most common sites for SCC with ulceration and swelling being the most common clinical signs. It was noted that most of the patients presented for examination between 6 and 12months after their initial symptoms of SCC, and were found to be at TNM Stages III and IV and already exhibited tumor metastasis to lymph nodes and distant metastatic spread as the most common clinical stages at time of presentation to clinic. Among the 84.4% (n=103) of the oral SCC patients for whom tobacco smoking records were available, most were either regular or occasional tobacco smokers (Jaber and Abu-Fanas, 2010).

We observed lower rates of skeletal

We observed lower rates of skeletal-related events than expected based on previous studies. This is likely due to differences in patient Sulfo-NHS-Biotin and time period. Shahinian et al examined all patients with prostate cancer including those with metastatic disease, whereas we examined only patients with clinically localized disease. Further, they assessed patients diagnosed between 1992 and 1997, whereas we assessed those diagnosed between 2000 and 2008 for whom management practices to prevent adverse events of ADT may have been employed.
Recent work has shown that even short durations of ADT (median 6 months) may increase the risk of cardiovascular events in patients undergoing radiotherapy for localized prostate cancer. However, a post hoc analysis of the RTOG 94-08 demonstrated no increased risk of cardiovascular mortality among patients treated with 4 months of ADT compared with radiotherapy alone. Similarly, there was no increase in cardiovascular mortality for patients receiving 3 years of ADT in addition to radiotherapy in the European Organisation for Research and Treatment of Cancer 22863 study. Our results support the conclusion that short durations of ADT may be associated with a risk of cardiovascular and skeletal-related events similar to longer durations of therapy.
We included patients treated with conformal, intensity-modulated radiotherapy, and brachytherapy in aggregate in our primary analysis. As we, and others, have shown no increased risk for patients treated with brachytherapy, these results likely underestimate the radiation-attributable risk for patients treated with external beam radiotherapy. Although we considered orchiectomy and medication castration in aggregate, orchiectomy was very infrequent and this is unlikely to have affected our findings.
There are a number of limitations imposed by the use Medicare data. First, we could examine only patients older than the age of 65. This preferentially includes patients treated with radiotherapy as younger men are more likely to undergo surgery. Further, as age is an independent risk factor for cardiovascular and skeletal-related events, these results may not be generalizable to younger men. In any observational study, selection bias and residual confounding are concerns and may result in overestimation of the true effect. Use of the Charlson score may incompletely control for the effect of comorbidity because of heterogeneity within categories. We addressed ascomycetes in our sensitivity analysis restricted to men aged 65-69 with a Charlson score of 0 and found similar results. Finally, although we included all commonly used radiotherapy modalities, we were unable to assess many details of radiotherapy treatment, including dosage, fractionation, prostate volume, and beam orientation. Chart review would be required to obtain this information.

Acknowledgments
This work was supported by the Amjera Family Chair in Urologic Oncology, which is held by R.K.N. The funding organization had no role in the design or conduct of the study; the collection, management, analysis, and interpretation of the data; nor the preparation, review, or approval of the manuscript.

Statins may inhibit the growth of prostate cancer by decreasing serum cholesterol, which is a known precursor for androgen synthesis. Both in vitro and animal studies have demonstrated not only that cholesterol promotes survival for prostate cancer cells, but also that decreasing cholesterol reduces androgen levels and slows prostate cancer growth. Whether statin use translates into a clinical benefit for men with prostate cancer, however, is controversial.
The existing data regarding the impact of preoperative statin use on recurrence following radical prostatectomy (RP) are mixed. Two meta-analyses have concluded that preoperative statin use has no effect on the rate of biochemical recurrence (BCR) after RP. Conversely, work by several others has found that both preoperative and postoperative statin use are associated with a decreased risk of BCR. Preoperative statin use has also been linked to more favorable pathologic features, including lower risk of non-organ-confined disease as well as lower prostate-specific antigen (PSA) levels at diagnosis, smaller tumor volume, lower percentage of tumor in gland, and decreased risk of positive surgical margins. These data suggest there may also be a decreased risk of pathologic upgrading among statin users diagnosed with Gleason 3 + 3 = 6 disease on biopsy, which could impact men considering active surveillance.