Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

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

The discovery of the new markers for the diagnosis and therapy of the carcinoma of the prostate, the prostatic acid phosphatase (PAP) and the prostatic specific antigen (PSA), and their correlation has opened new horizons in the field of the neoplastic prostatic pathology. The PAP fails have a rule in the diagnosis of a prostatic tumour in the initial phase, and therefore as a test of screening. It increases considerably only in the bone metastases. The PSA is highly specific, and together with the PAP is very useful in the check of the patients in treatment and in the surveillance of the appearance of metastases. We have considered over a period of 10 months, 70 patients with prostatic pathology. 22 were affected with carcinoma of the prostate. 48 were affected with benign prostatic hyperplasia. In both groups the simultaneous dosage of the PAP and PSA has been carried out with the RIA method. In the patients with BPH the simultaneous dosage of the 2 markers was elevated only in two cases. On the contrary, in the patients with carcinoma of the prostate we have noticed univocal data of increasing of both the markers. In the patients with metastases, the 2 markers behave in a very similar way, and progressively increase with the progressively increase with the evolution of the clinical stage of the tumour. The control after 3 months of treatment with analogues of the LH-RH and flutamide has showed a reduction of the serum levels of the 2 markers varying between 65 and 85% and over.
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PMID:[The importance of tumor markers in adenocarcinoma of the prostate]. 148 86

Prostate cancer is extremely rare in men under 35 years of age. The tumour is invariably poorly differentiated and aggressive, with rapidly growing bulky soft tissue metastases and negative tumour markers. Bone metastases develop late and are usually osteolytic. The disease responds poorly to radiation or hormonal therapy and is too advanced at presentation for radical surgery. Chemotherapy appears to be of some benefit, though in the majority of cases death occurs within a year. We describe a 31-year-old man with carcinoma of the prostate. A review of the literature is presented. This is the first patient in whom the epithelial origin of the prostate cancer was confirmed by immunoperoxidase staining with prostatic specific antigen. Plasma prostatic specific antigen was normal despite a large tumour burden and widespread metastases. He did not respond to conventional treatment. The phenotypic expression and biological behaviour of these tumours are distinct from those occurring in men beyond the fourth decade.
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PMID:Natural history and prognosis of prostate carcinoma in adolescents and men under 35 years of age. 162 84

The origin of this unusual variant of carcinoma of the prostate has provoked discussion ever since its first description in 1967. This is of both embryological interest and therapeutic importance. Four cases have been reviewed, and all have demonstrated immunohistochemical features consistent with an origin from prostatic tissue. In addition, three had evidence of disseminated disease which responded well to androgen ablation. It is concluded that the term endometrioid carcinoma is of descriptive value only, and these tumours are a variant of primary duct prostatic carcinoma. Patients should be treated by androgen ablation when metastases are present.
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PMID:Endometrioid carcinoma of the prostate: a misnomer? 162 47

We evaluated the location of recurrent disease in 63 patients with carcinoma of the prostate who had abnormal levels of prostate specific antigen (greater than 0.4 ng./ml., Tandem-R assay) 6 to 240 months after radical prostatectomy but who were otherwise considered to be without evidence of disease. The evaluation involved physical examination including digital rectal examinations by 3 urologists, isotopic bone scans, computerized tomography scans of the abdomen and pelvis, cystoscopy, and random needle biopsies of the urethrovesical anastomotic area. In 6 patients metastatic disease to the bone and/or lymph nodes was found and local prostate cancer was discovered in 5. Among 57 patients without evidence of disease by the usual methods of evaluation needle biopsies of the anastomosis revealed local disease in 42%. No local disease was discovered in 30 post-radical prostatectomy patients with normal prostate specific antigen levels. There was a wide range of transrectally palpable contours after radical prostatectomy in patients with and without elevated prostate specific antigen levels. We conclude that prostate specific antigen but not digital rectal examination is an excellent early indicator of possible local recurrence after radical prostatectomy. Whether the prevalence of local disease after radical prostatectomy using prostate specific antigen levels and needle biopsies of the anastomosis is greater than heretofore has been appreciated will require further study.
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PMID:Prostate specific antigen and local recurrence after radical prostatectomy. 169 17

We report a case of carcinoma of the prostate in a 30-year-old man. Serum acid phosphatase was normal. A transrectal biopsy of the prostate demonstrated an undifferentiated carcinoma. Total prostatocystectomy was performed and subsequent pathologic report stated that the mass was an undifferentiated carcinoma of the prostate gland. Metastases to the intrapelvic lymph node were present. Although immunohistochemical prostatic acid phosphatase (PAP) activity was not demonstrated, prostatic specific antigen (PSA) staining revealed a positive reaction within the tumor cells, confirming prostatic carcinoma. The patient's course has been uneventful without any recurrence by the intermittent adjuvant chemotherapy 8 months postoperatively. Review of the literature in Japan disclosed 16 cases (including our case) of carcinoma of the prostate in patients under 40 years of age.
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PMID:[Prostatic carcinoma in a young adult: a case report]. 169 13

Although multiple bony metastases from carcinoma of the prostate are common, widespread pain is a much less frequent complication but one which nevertheless presents considerable difficulties in management. Pain may be severe requiring large doses of narcotic analgesics and may render the patient virtually immobile. A total of 53 treatments with radioactive phosphorus-32 were assessed in 46 patients; in addition, five patients died before response was assessable. A worthwhile response in terms of pain reduction and improved mobility was obtained in 87%. Response was subdivided into good and moderate, with response rates of 53% and 34% respectively. The mean age of patients at treatment was 64.6 years, the median 65 years, and 30% of treated patients were 60 years or under. Median survival in the good, moderate and no response groups was 8, 6.5 and 4.5 months respectively. These differences in survival are not statistically significant. Five-year survival was 4.3%. The treatment is not intended to improve survival but with 87% of patients achieving pain relief, 32P should be considered for the treatment of severe bony pain when other options are limited by the widespread nature of the disease.
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PMID:Phosphorus-32 for intractable bony pain from carcinoma of the prostate. 170 16

Treatment of carcinoma of the prostate with hormones can be carried out as partial or complete androgen deprivation. As primary therapy it may be administered palliatively in advanced carcinomas (almost always metastatic), as adjuvant treatment following radical prostatectomy, as "salvage" treatment in post-irradiation recurrent disease, or secondarily after unsuccessful primary treatment. In the case of primary treatment, androgen deprivation is more effective than chemotherapy (NPCP Protocol 1300). LHRH analogues (of the gosereline acetate type) are equally as effective as orchiectomy (standard therapy), but cause a flare-up of the patient's symptoms within the first two weeks, and are therefore given in combination with an antiandrogen. The use of a pure antiandrogen (of the flutamide type) is equally as effective as the standard therapy, but in contrast to the latter, impotence does not occur. Complete androgen deprivation (LHRH analogues plus pure antiandrogens) is more effective in the case of low-volume metastases--in terms of time-to-progression--than standard therapy.
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PMID:[Conservative therapy of prostate cancer]. 172 88

Prostatic carcinoma metastatic to the penis is a rare phenomenon. We report two cases of acute urinary retention due to penile metastases from a prostatic carcinoma. Patients may have a penile mass or diffuse swelling of the penis. Some patients develop priapism and urinary retention can be rarely observed. The most effective treatment seems to be local excision with wide resection and, if necessary, total penectomy. The prognosis remains poor regardless of the type of therapy employed.
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PMID:[Acute urinary retention secondary to cavernous metastases from a prostatic tumor]. 184 36

The study evaluates the effect of the locally recurring tumor on the incidence of metastatic disease in early stage carcinoma of the prostate. The probability of distant metastases was studied in 679 patients with Stage B-C/N0 carcinoma of the prostate treated at MSKCC between 1970 and 1985 (median follow-up of 97 months). Patients were staged with pelvic lymph node dissection and treated with retropubic 125I implantation. The actuarial distant metastases free survival (DMFS) for patients at risk at 15 years after initial therapy was 37%. Cox proportional hazard regression analysis of covariates affecting the metastatic outcome showed that local failure, used in the model as a time dependent variable, was the most significant covariate, although stage, grade, and implant volume were also found to be independent variables. The relative risk of metastatic spread subsequent to local failure was 4-fold increased compared to the risk without evidence of local relapse. The 15-year actuarial DMFS in 351 patients with local control was 77% compared to 24% in 328 patients who developed local relapses (p less than 0.00001). The relation of distant spread to the local outcome was observed regardless of stage, grade, or implant dose. Even stage B1/N0-Grade I patient with local control showed a 15-year actuarial DMFS of 82%, compared to 22% in patients with local relapse; p less than 0.00001). The median local relapse-free survival (LRFS) in the 268 patients with local recurrences who did not receive hormonal therapy before distant metastases were detected was 51 months, compared to a median of 71 months for DMFS in the same patients (p less than 0.001), consistent with the possibility that distant dissemination may develop secondary to local failure. Furthermore, distant metastases in patients with local control, apparently already existing as micrometastases before treatment, were detected earlier (median DMFS of 37 months) than in patients with local relapse (median DMFS of 54 months; p = 0.009). These data suggest that the existence and re-growth of local residual disease in localized prostatic carcinoma promotes an enhanced spread of metastatic disease, and that early and complete eradication of the primary tumor is required if a long term cure is to be achieved, although the clinical expression of secondary metastases may not become apparent for 6.5 years or more in one-half of the patients.
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PMID:The effect of local control on metastatic dissemination in carcinoma of the prostate: long-term results in patients treated with 125I implantation. 186 52


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