Some prostate cancer patients more likely to die after weekend ER visits

Patients with prostate cancer that has metastasized, or spread, to other parts of the body face a significantly higher risk of dying when visiting a hospital emergency department on the weekend instead of on a weekday, according to researchers at Henry Ford Hospital in Detroit.

The new study focused on metastatic prostate cancer in examining the so-called "weekend effect" of higher patient mortality, subject of numerous studies for about a decade.

Results from the study will be presented May 5 at the annual meeting of the American Urological Association in San Diego.

Khurshid R. Ghani, M.D., of Henry Ford's Vattikuti Urology Institute and lead author of the study, said he and his colleagues can only speculate on the reasons why this phenomenon appears to affect metastatic prostate cancer patients.

"Our data clearly show they have higher mortality rates after weekend visits to emergency departments," Dr. Ghani says. "But as to why, there is only a suggestion that they're more likely being treated at hospitals outside of metropolitan areas, places that may have limited access to advanced care."

The researchers identified their study group – metastatic prostate cancer patients who visited emergency rooms from the beginning of 2006 through the end of 2009 – in the Nationwide Emergency Department Sample, the largest such database in the U.S., approximating about 20 percent of hospital-based emergency departments across the country.

The prostate is a glandular organ of the male reproductive system. It is often described as the same size of a walnut, normally about 3 cm long (slightly more than 1 inch); it weighs about 30 g (1 ounce) and is located at the neck of the bladder and in front of the rectum. The prostate surrounds the urethra, which is a tubular structure that carries the urine (produced by the kidney and stored in the bladder) out of the penis during voiding, and the sperm (produced in the testicle) during ejaculation. In addition, during ejaculation a thin, milky fluid produced by the prostate is added to the mix. This ejaculate that also includes fluid from the seminal vesicles, constitutes the male semen.

Physiopathology:

In prostate cancer, normal cells undergo a transformation in which they not only grow and multiply without normal controls, but they also differentiate and can invade adjacent tissues. Tumors overwhelm surrounding tissues by invading their space and taking vital oxygen and nutrients. Tumors can eventually invade remote organs via the bloodstream and the lymphatic system.

This process of invading and spreading to other organs is called metastasis. Common metastatic locations include pelvic lymph nodes, bones, lung, and the liver.

Almost all prostate cancers arise from the secretory glandular cells in the prostate. Cancer arising from a glandular cell is known as adenocarcinoma. Therefore, the most common type of prostate cancer is an adenocarcinoma and accounts for more than 95% of all prostate cancer. The most common nonadenocarcinoma is transitional cell carcinoma. Other rare types include small cell carcinoma and sarcoma.