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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A retrospective study of five years' experience with fourth-generation computerized tomography (CT) scan was undertaken to assess the frequency of understaging in prostate cancer. A total of 160 patients with preoperative scans were surgically staged. In 10 patients, the operation was aborted after pelvic node dissection had revealed unsuspected metastatic involvement. Based on the histopathologic evidence of local tumor invasion, extension into seminal vesicles or pelvic lymph nodes, restaging was required in 78 percent of cases. Accuracy was 24 percent for capsular extension, 69 percent for seminal vesicle invasion, and 72 percent for lymphadenopathy. The poor yield of CT scan as a preoperative staging modality is demonstrated. Recent advances in the understanding and management of prostatic cancer require reassessing patient benefit and cost effectiveness of available imaging techniques, focusing on the problem of detecting nodal metastases, and predicting tumor spread to regional lymph nodes by accurately evaluating the primary neoplasm. We conclude that CT scan fails to demonstrate the required precision needed to evaluate local tumor spread; therefore, this goal must be pursued with newer imaging modalities.
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PMID:Preoperative assessment of prostatic carcinoma by computerized tomography. Weaknesses and new perspectives. 141 54

A total of 277 patients with apparently localised prostatic cancer (T2-T4 NXMO) were allocated at random to receive radiotherapy alone (88), orchiectomy alone (90) and combined therapy (99) between 1980 and 1985. The main outcome measures were survival, time to appearance of metastases and treatment of local disease progression by further transurethral resection. Orchiectomy, whether alone or with radiotherapy, produced a significant delay in detection of metastases when compared with radiotherapy alone. There were no statistically significant differences between the 3 treatment groups in local disease control or in overall survival.
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PMID:Treatment of advanced localised prostatic cancer by orchiectomy, radiotherapy, or combined treatment. A Medical Research Council Study. Urological Cancer Working Party--Subgroup on Prostatic Cancer. 1007 76

The incidence of many cancers shows a sharp increase with age. This is particularly true of prostate cancer, which arises in many older males. Little or no morbidity is observed as the tumor develops in situ in the prostate. However, once malignant cells escape from the primary lesion and metastasize, the disease assumes a much more serious course. Here we report on the activity of human prostate cancer cells in culture as well as their behavior when transplanted into nude mice. In vitro, several lines of prostate carcinoma cells obtained from metastatic lesions were embedded in reconstituted basement membrane proteins (Matrigel) and found to exhibit highly invasive activity as observed with malignant cells from other types of tumors. Also, we report an improved method for obtaining an increased growth of human prostate cancer cells in nude mice by injecting these cells in Matrigel. Since there are no adequate animal models of prostate cancer, the systems described here may prove useful in defining events underlying the development and progression of the tumor cells to malignant status, as well as facilitate the analyses of novel therapeutic agents to prevent the growth and the spread of this cancer.
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PMID:New models to define factors determining the growth and spread of human prostate cancer. 142 88

In a series of 51 patients with prostate cancer and obstructive uropathy, unilateral or bilateral obstruction was identified in 22 (43%) and 29 (57%) respectively. This included a non-functioning kidney in 12 patients. In 86% of patients the T category was advanced. Bone metastases were present in 36 cases (71%); 19 patients (37%) had chronic retention. All patients with metastatic disease underwent hormonal manipulation and 43 underwent transurethral resection of the prostate. External beam radiotherapy, percutaneous nephrostomy and ureteric reimplantation were performed in 4, 5 and 1 patient respectively. Actuarial survival of all 51 patients was 57 and 25% at 2 and 5 years. Presentation with bilateral or non-function did not predict a worse prognosis in comparison with patients with unilateral hydroureteronephrosis. Raised alkaline phosphatase and prostatic acid phosphatase were of no prognostic value, while creatinine reached marginal significance. A positive bone scan and raised urea were strongly predictive of a poor outlook. It was concluded that prostate cancer and obstructive uropathy should not uniformly imply a terminal event, and interventional therapy is justified with a 25% 5-year survival rate.
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PMID:Outcome and prognostic factors in patients with advanced prostate cancer and obstructive uropathy. 145 Aug 51

Although current hormonal therapy of prostate cancer may not appear to have altered survival appreciably, there have been considerable changes that may significantly affect the future management of this disease. A number of new hormonal agents have been introduced that still require definition of their therapeutic efficacy. Megestrol acetate, a hormonal agent with multiple sites of action in androgen metabolism, has recently been investigated in the treatment of patients with metastatic and locally advanced disease, and in those patients whose disease progresses with other hormonal therapies. Megestrol acetate plus mini-dose diethylstilbestrol (DES) is associated with fewer side effects than standard-dose DES and has equivalent therapeutic efficacy in the treatment of patients with metastatic disease. In patients with locally advanced disease that may benefit from hormonal cytoreduction, megestrol acetate is effective and well tolerated. Megestrol acetate has a role in the palliation of patients with progressive disease despite initial hormonal therapy. Considerable controversy surrounds the therapy of carcinoma of the prostate; further studies are required to define optimal hormonal therapy.
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PMID:Megestrol acetate in the treatment of metastatic carcinoma of the prostate. 146 22

Screening chest radiographs do not reduce mortality from lung cancer. Should an incidental noncalcified pulmonary parenchymal nodule be discovered, chest CT will demonstrate one third of such patients to, in fact, have the multiple nodules of metastatic disease. CT is very helpful to guide fine needle aspiration biopsy of lung lesions and to assist in evaluation for resectability. MR can be helpful in special circumstances, including the definition of the extent of paravertebral, superior sulcus, and diaphragmatic lesions. Endorectal ultrasound is not sensitive enough to function as a screening tool for prostate cancer but is used routinely to guide biopsies. CT and MR are rarely helpful in staging this disease. Given the highly characteristic trait of bone metastasis in prostate cancer, a bone scan is mandatory in all patients. Double contrast barium enema can be used as an adjunct or alternative to sigmoidoscopy for colorectal cancer screening, in the preoperative evaluation of patients, and in postoperative surveillance. CT and MR can detect macroscopic adenopathy and liver metastases; CT is generally the preferred study. Screening mammography can have a major impact in reducing breast cancer mortality. It is recommended that a baseline study be obtained at age 35. Annual or biannual examinations should commence at age 40. Any palpable lesion, whether or not it is demonstrated mammographically, must be subjected to biopsy. Ultrasound is the most useful initial imaging study for evaluating pelvic masses. MR will, on occasion, identify the origin of a mass not determinable from ultrasound scan. MR is particularly valuable to identify parametrial spread (inoperability) of cervical cancer, and has been underused for this purpose. Surgery remains the mainstay for the staging of ovarian and endometrial cancer, although CT can be helpful to identify macroscopic relapse, ascites, or liver metastases. Bone scan and liver CT remain the standard procedures for detecting metastases in these respective organ systems. MR can be invaluable in the imaging of epidural metastasis and spinal cord compression in patients with vertebral metastatic disease. Contrast-enhanced MR is more sensitive than contrast-enhanced CT for detecting brain metastases, but the latter remains a useful tool. Chest CT can improve the detection of pulmonary metastases when this is of crucial importance.
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PMID:Diagnostic imaging in cancer. 146 83

In a phase II study, 24 patients with metastatic prostatic cancer were treated with mitomycin C 15 mg/m2 i.v. every 6 weeks, combined with aminoglutethimide 250 mg twice a day. A low dose of 37.5 mg cortisone acetate was supplied daily to compensate for adrenal cortical suppression. A partial response was demonstrated in 4 of 24 evaluable patients with bi-dimensionally measurable metastases. Stable disease occurred in 8 patients over a period of more than 6 months. Within the maximum cumulative dose limit of 2 mg/kg body weight mitomycin C, toxicity was observed in 21 cases, including 2 deaths due to treatment toxicity. The poor response rate and high toxicity suggest that the addition of aminoglutethimide does not enhance the effect of mitomycin C in these patients.
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PMID:Mitomycin C and aminoglutethimide in the treatment of metastatic prostatic cancer: a phase II study. 146 62

Normal bone marrow MRI has a distinct pattern with STIR pulse sequence MRI. The central low signal intensity area corresponds to fatty marrow. The red marrow is distributed in the peripheral portion of the vertebrae and shows a high signal intensity. Prostatic cancer metastases to the bone marrow revealed a high signal intensity with STIR. Prior to the appearance of an abnormal scintigram and radiograph, MRI was able to depict an abnormality.
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PMID:Bone marrow MRI in prostate cancer. 149 18

Patients with prostate cancer frequently have osseous metastases which are qualitatively assessed with bone scannings. We have studied the quantitative evaluation of skeletal diseases by measuring bone mineral density (BMD) in the lumbar vertebrae and radius. Forty-four patients with prostate cancer, nine with non-prostatic urogenital cancer and 90 controls were entered in this study. Among the patients with prostate cancer, the values of BMD in the lumbar vertebrae were significantly higher in patients with osseous metastasis than in those without metastasis, whereas the values of BMD in the radius were insignificantly different. Most of the patients with high levels of BMD in the lumbar vertebrae had osseous metastatic disease with no relationship between BMD in the lumbar vertebrae and the radius. The values of BMD in the lumbar vertebrae where hot spot scans were observed were related to X-ray findings. The alterations of BMD levels in the lumbar vertebrae were quantitatively evaluable as responses to androgen deprivation therapy. Measurement of BMD is useful for the accurate diagnosis of osteosclerotic lesions. BMD measurements of the lumbar vertebrae compared with those in the radius were variable in individuals.
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PMID:Bone mineral density for patients with bone metastasis of prostate cancer: a preliminary report. 149 19

A total of 75 prostate cancer and 67 lung cancer patients with positive bone scintigrams were studied. The patterns of spread in the axial skeleton and pelvis were different between the groups. The differences in the distribution of bony metastases between prostate and lung are explained by the role of Batson's vertebral venous plexus. We developed an animal model of spinal bone metastasis to prove this route. As suspension of tumor cells was injected into the tail vein of mice with vena caval occlusion. This procedure reproducibly resulted in metastatic tumor growth in the lumbar region of the vertebral column. The prevalence of spinal bone metastasis is attributed to passage of tumor cells via the vertebral venous plexus.
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PMID:Clinical significance of the vertebral vein in prostate cancer metastasis. 149 29


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