Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0007112 (prostatic adenocarcinoma)
 2,574 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This report describes the effects of neoadjuvant hormonal therapy on 16 patients (mean age = 65 y) with clinical stage C adenocarcinoma of the prostate (CaP) who underwent radical prostatectomy from December 1991 to June 1993 at the University of Colorado Health Sciences Center. Staging of CaP was determined by digital rectal exam, transrectal ultrasonography (TRUS), radionuclide bone scanning, abdominal and pelvic computed tomography scanning, transrectal coil magnetic resonance imaging, and serum acid phosphatase. Most patients underwent a laparoscopic lymph node dissection to rule out micrometastasis. Every patient was treated for 4 months with a combination of a gonadotrophin-releasing hormone (GnRH) agonist (Lupron) and an anti-androgen (flutamide, Eulexin). Serial prostate-specific antigen (PSA) levels, post-treatment prostate volume measured by TRUS, and whole-mount sectioning of the surgical specimen were studied. The PSA levels decreased from a mean of 39.1 ng/ml (Hybritech method) to a mean of 0.43 ng/ml; (p < 0.0001). Prostate volumes in all patients demonstrated a mean decrease of 52% (p < 0.0001), and pathological effects of hormonal deprivation were observed in all patients. By whole-mount sectioning of the radical prostatectomy specimens, 3 patients had organ-confined disease (stage B), 6 showed invasion of the capsule with surgical margins free of tumor (stage C1), 3 had extracapsular extension with positive surgical margins (stage C2), and 4 had extracapsular extension with seminal vesicle involvement (stage C3). We conclude that by downsizing and markedly decreasing serum PSA values, neoadjuvant hormonal therapy offers an alternative treatment for stage C carcinoma of the prostate.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Neoadjuvant hormonal therapy in stage C adenocarcinoma of the prostate. 751 35

Prostate-specific antigen is the most important, accurate, and clinically useful biochemical marker in the prostate. It is manufactured by the secretory epithelial cells and drains into the ductal system, where it catalyzes the liquefaction of the seminal coagulum after ejaculation. Serum levels are normally less than 4 ng/mL (monoclonal) but vary according to patient age and race; any process that disrupts the normal architecture of the prostate allows diffusion of prostate-specific antigen into the stroma and microvasculature. Elevated serum prostate-specific antigen levels are seen with prostatitis, infarcts, hyperplasia, and transiently after biopsy, but the most clinically important increases are seen with prostatic adenocarcinoma. Cancer produces less prostate-specific antigen per cell than benign epithelium, but the greater number of malignant cells and the stromal disruption associated with cancer account for the increased serum prostate-specific antigen level. Serum prostate-specific antigen level correlates positively with clinical stage, tumor volume, histologic grade, and the presence of capsular perforation and seminal vesicle invasion; despite these strong correlations, its value is limited in predicting stage for individual patients. It may also predict the presence of lymph node metastases, bone metastases, and survival after androgen-deprivation therapy. The use of prostate-specific antigen has resulted in an increase in the early detection rate of cancer, and it is now advocated for annual routine use in men older than 40 years who are at increased risk and in all men older than 50 years. It is a test with high sensitivity and specificity that is rapid, inexpensive, minimally invasive, and acceptable to patients. In addition to serum prostate-specific antigen level, five derivatives of serum prostate-specific antigen were recently described that may increase the predictive value by accounting for confounding variables such as patient age, prostate volume, and cancer volume: age-specific reference ranges, prostate-specific antigen density, prostate-specific antigen velocity, prostate-specific antigen cancer density, and prostate-specific antigen doubling times. Serum prostate-specific antigen detects a heterogeneous group of cancers (clinical stage T1c) that are clinically important and potentially curable. Immunohistochemical expression of prostate-specific antigen in tissue sections allows determination of the prostatic origin of some metastatic adenocarcinomas, although extraprostatic expression of prostate-specific antigen has been reported in several tissues and tumors, including periurethral gland adenocarcinoma in women, rectal carcinoid, and extramammary Paget disease.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Prostate-specific antigen. Current role in diagnostic pathology of prostate cancer. 752 5

Skene's (periurethral) gland carcinoma is a rare neoplasm accounting for less than 0.003% of all genital tract malignancies in females. Generally, adenocarcinomas of the female urethra are assumed to arise from the periurethral glands, the female homologue of the prostate. A case of Skene's gland adenocarcinoma without mucosal urethral involvement is presented. The histologic features of this tumor closely resembled those of prostatic adenocarcinoma. In contrast, clear cell and columnar/mucinous variants of female urethral adenocarcinomas have been described previously. Perhaps this signifies different biologic processes in the development of Skene's/periurethral and urethral adenocarcinomas in females. Additionally, we performed immunohistochemical staining that was reactive for prostate-specific antigen (PSA). Preoperatively, the serum level of PSA was increased and promptly decreased after surgical excision of the lesion. Therefore, preoperative and postoperative monitoring of serum PSA titers in patients with adenocarcinomas of the female urethra or periurethral glands (or both) should be considered.
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PMID:Skene's gland adenocarcinoma with increased serum level of prostate-specific antigen. 752 28

To study the mechanisms by which androgens intervene in the regulation of growth and differentiation of human prostatic epithelial cells, cDNA clones encoding putative prostate-secreted proteins were characterized and tested as potential markers for androgen action. One of the isolated cDNAs expressed diazepam-binding inhibitor/acyl-CoA-binding protein (DBI/ACBP), suggesting that this polypeptide, that has been implicated in a large number of biochemical processes, is expressed and secreted by prostate cells. As demonstrated by Northern blot analysis, the mRNA encoding DBI/ACBP was expressed in prostate tissue and in the three human prostatic adenocarcinoma cell lines tested: LNCaP, PC-3 and DU-145. In androgen-sensitive LNCaP cells, the synthetic androgen R1881 stimulated the DBI/ACBP steady state mRNA levels with half maximal effects at a concentration of 0.2 nM. Increases were a maximal 12 h after addition of the synthetic hormone. DBI/ACBP mRNA levels could also be stimulated by the synthetic androgen mibolerone and by the natural androgens testosterone and dihydrotestosterone. In agreement with the altered steroid specificity of the androgen receptor in LNCaP cells, estradiol and progesterone also exerted a stimulatory effect. Cortisol and the synthetic glucocorticoid dexamethasone were without effect. Androgen stimulation of DBI/ACBP mRNA levels was abolished in the presence of the protein synthesis inhibitor cycloheximide, implying a role for labile or androgen-induced proteins in this androgen stimulation. This is in contrast to the androgen stimulation of the mRNA encoding prostate-specific antigen (PSA), suggesting that different mechanisms are involved in the androgen regulation of these two genes. Although further experiments are required to confirm that DBI/ACBP is secreted by prostatic epithelial cells, these data demonstrate that the mRNA encoding DBI/ACBP is expressed in prostate cells and is affected by androgens in androgen-responsive LNCaP cells.
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PMID:Androgen regulation of the messenger RNA encoding diazepam-binding inhibitor/acyl-CoA-binding protein in the human prostatic adenocarcinoma cell line LNCaP. 752 52

A total of 58 patients have undergone bilateral pelvic lymphadenectomy as a staging procedure for clinically localized adenocarcinoma of the prostate. Of these, 19 patients (33%) had pelvic lymph node involvement. When a cutoff value of 50 ng/ml was used, the preoperative prostate-specific antigen (PSA) value had a positive predictive value of 57% for pelvic lymph node metastasis. Of the patients with PSA < 20 ng/ml, only 1 (4%) had evidence of lymph node metastasis. None of the patients with well-differentiated tumor (Gleason 2-4) had lymphatic spreading. In contrast, 82% of patients with poorly differentiated tumor (Gleason 8-10) had positive pelvic lymph nodes. Those patients with high PSA (> or = 20 ng/ml) and high Gleason's score (> or = 8) had the highest incidence of nodal extension (90%).
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PMID:Prediction of lymphatic spreading in prostatic cancer by prostate-specific antigen and Gleason's score. 752 61

The standard staging evaluation of prostate cancer includes digital rectal examination, measurement of serum tumor markers, radionuclide bone scan, and abdominal pelvic computed tomography (CT) or nuclear magnetic resonance imaging (MRI). We retrospectively reviewed 300 cases of newly diagnosed, untreated adenocarcinoma of the prostate to evaluate the ability of serum prostate-specific antigen (PSA) to predict results of staging radiographic studies (bone scan, CT/MRI). The medical records of 300 newly diagnosed, untreated prostate cancer patients were reviewed. The following information was collected on a standard data form: age, clinical stage based on digital rectal examination, method of diagnosis, histological grade, serum PSA level, results of radionuclide bone scan and additional radiographic studies to confirm bone scan results, results of abdominal pelvic CT/MRI, and presence or absence of bone pain. The results of this review were tabulated and analyzed with regard to the ability of serum PSA level to predict positive results of radiographic staging studies. The mean PSA level of the study group was 24.6 ng/ml. Ten patients (3.6%) presented with positive bone scan results with 5 of these having serum PSA levels greater than 20 ng/ml (range 27.6 ng/ml-144 ng/ml, mean 66.3 ng/ml). The 5 remaining patients all had elevated PSA levels ranging between 4.1 and 20.0 ng/ml. No patient with a positive staging bone scan presented with a normal serum PSA. Ten patients (4.0%) presented with a positive abdominal/pelvic CT/MRI (adenopathy only; no patients had radiographic evidence of abnormalities of the upper urinary tract). Eight had serum PSA levels greater than 20 ng/ml, ranging from 30.0 to 234 ng/ml. No patient with a positive study presented with a normal serum PSA level. No patient with either positive bone scan or abdominal pelvic CT/MRI presented with bone pain. We conclude that in asymptomatic patients with newly diagnosed, untreated prostate cancer and serum PSA levels of less than 10 ng/ml, a staging radionuclide bone scan may not be necessary. Likewise, in patients with serum PSA levels of less than 20 ng/ml the likelihood of positive findings on abdominal/pelvic CT/MRI is extremely low. Abdominal/pelvic CT/MRI does not appear necessary in this setting. With over 130,000 cases of newly diagnosed prostate cancer each year in the United States, elimination of staging radiographic studies in the patients outlined above could result in economic savings on the order of 30-80 million dollars per year.
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PMID:Serum prostate-specific antigen as a predictor of radiographic staging studies in newly diagnosed prostate cancer. 753 May 90

Prostate-specific antigen (PSA) is widely used as a tumor marker of prostatic adenocarcinoma. We recently found that 30% of breast tumors produce PSA and that PSA is a favorable prognostic marker in female breast cancer. We measured immunoreactive PSA in cytosolic extracts of normal breast tissue from eight women receiving no medication and one woman who was receiving no medication and one woman who was receiving the progestin-containing oral contraceptive Brevicon. None of the eight cytosolic extracts of normal breast tissue contained appreciable amounts of immunoreactive PSA. However, left and right breast tissues from the woman receiving Brevicon contained high levels of PSA. This immunoreactive species was shown to have a molecular weight identical to that of seminal PSA. Furthermore, reverse transcription of RNA and polymerase chain reaction amplification produced a 571-base pair cDNA that hybridized to a labeled cDNA PSA probe. Upon sequencing, the cDNA polymerase chain reaction product was found to have 100% homology with cDNA from prostatic tissue. PSA production by breast carcinoma cell lines was achieved after in vitro stimulation with norethindrone and ethinylestradiol. Our data suggest that PSA can no longer be regarded as a specific prostatic protein because it is produced by breast tumors with good prognosis and by normal breast tissue after steroid hormone stimulation.
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PMID:Oral contraceptive-induced expression of prostate-specific antigen in the female breast. 753 65

Prostate-specific antigen (PSA) is thought to be produced exclusively by prostatic epithelial cells and is currently used as a tumor marker of prostatic adenocarcinoma. We recently found that 30% of breast cancers contain PSA immunoreactivity (IR-PSA). To examine the prognostic value of PSA in female breast cancer, we measured IR-PSA in tumor cytosols of 174 breast cancer patients and classified the breast cancers as either PSA positive or PSA negative based on an IR-PSA cutoff level of 0.03 ng/mg. IR-PSA was present in 27% of the patients. IR-PSA presence was associated with early disease stage, small tumors, and estrogen receptor-positive tumors. We used the Cox proportional hazards regression model to analyze survival of patients in association with PSA status and found that patients with IR-PSA-positive tumors had a reduced risk for relapse and death in univariate analysis (P = 0.02 and 0.06, respectively) and a reduced risk for relapse in multivariate analysis (P = 0.03). Further analysis indicated that the effect of IR-PSA on relapse-free survival was evident in node-positive or estrogen receptor-negative patients. Our study suggests that IR-PSA is an independent favorable prognostic marker for breast cancer and may be used to identify a subgroup of estrogen receptor-negative and/or node-positive patients who have good prognoses.
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PMID:Prostate-specific antigen is a new favorable prognostic indicator for women with breast cancer. 753 47

Most studies examining the issue of 'early detection of prostate cancer' advocate the combined use of serum prostate-specific antigen (PSA) and digital rectal examination (DRE). As a result, a significant number of new prostate cancers are diagnosed on the basis of an elevated serum PSA when the DRE is unremarkable. The purpose of this study is to determine if the PSA-detected tumors that are visible on transrectal ultrasound (TRUS) have the same pathological characteristics as PSA-detected tumors that are invisible on TRUS. One hundred and ninety-four patients with an elevated serum PSA concentration and nonpalpable prostate cancer who underwent radical retropubic prostatectomy (RRP) at our institution between March 1988 and December 1991 were reviewed. The patients were divided into two groups: 97 (50%) had no identifiable lesion on TRUS, and 97 (50%) had at least one hypoechoic area consistent with adenocarcinoma of the prostate. The pathological characteristics of the RRP specimens from the two groups were compared. There was no significant difference in the age (p = 0.14) or the preoperative serum PSA values (p = 0.18) between the groups. Also, there was no significant difference between the groups with regard to tumor volume (p = 0.89), focality of the cancer (p = 0.43), Gleason score (p = 0.81), DNA ploidy status (p = 0.96), pathological stage (p = 0.92), surgical margin involvement (p = 0.27), and tumor location (p = 0.64). These findings suggest that the clinical TNM staging system for prostate cancer may be simplified by eliminating the distinction between PSA-detected cancers visible on TRUS and PSA detected cancers not visible on TRUS.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Prostate-specific antigen detected prostate cancer: pathological characteristics of ultrasound visible versus ultrasound invisible tumors. 753 82

Two hundred and three male patients underwent transrectal ultrasonography (TRUS) examination because of palpable nodule or hard consistency of the prostate. Of these, 56 of 65 (86.2%) digital rectal examination (DRE)-abnormal and 34 of 138 (24.6%) DRE-normal patients received transrectal sonoguided core needle biopsy. Among the DRE-abnormal patients, 18 (32.1%) had prostatic adenocarcinoma by biopsy with 2 additional patients who had initial negative biopsies eventually found to have cancer by transurethral resection of the prostate. In contrast, only 2 (5.9%) of 34 DRE-normal patients had cancers that were both hypoechoic and peripheral zone located. In 13 patients with transitional zone located lesions (hypoechoic 9, isoechoic 4), none had cancer. Of 27 patients who had normal DRE and unsuspected TRUS and received transurethral prostatectomy because of bladder outlet obstruction, 4 (14.8%) had cancer. In this study, hypoechoic lesions were found in 68 patients, among them 60 (88.2%) underwent biopsy but only 14 (23.3%) had cancer. From the results of this study, we concluded that TRUS can be a useful adjunct of DRE in detecting prostatic malignancy, especially when there has been an abnormal DRE, but its role on a digitally normal prostate requires further evaluation. Serum prostate-specific antigen can be an additional indicator to increase the prostate cancer detection rate.
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PMID:The role of transrectal ultrasonography on the palpable and impalpable abnormal prostate. 753 84


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