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)

A 58-year-old male complaining of pollakisuria, miction pain and back pain visited us Dec. 26, 1979. Rectal examination revealed the prostate enlarged by 5 digital width, stony hard and irregular. Transrectal needle biopsy revealed moderately differentiated adenocarcinoma of the prostate. Bladder neck invasion, pelvic and mediastinal lymph node metastases and multiple bone metastases were found. The case was diagnosed with prostatic adenocarcinoma T3N2M1 (OSS, LYM) stage D2. Three courses of chemotherapy using ifosfamide applied from Feb. 2, 1980 showed no marked effect except for partial pain relief. Hormonal treatment with diethylstilbestrol diphosphate was started from May 28 and arterial infusion chemotherapy using CDDP and 5-FU was performed 2 months later, resulting in size reduction of the prostate and pelvic lymph node metastases and disappearance of mediastinal lymph node metastases. Needle biopsy of the prostate was negative for cancer cells. After 8 months, Tegafur was started, and 12 months later radiotherapy was added to the prostate and pelvic lymph nodes. The abnormal accumulation in bone scan began to decrease after 14 months and achieved complete remission 28 months after the initial therapy. We discontinued the hormonal therapy 31 months later because of his complaint of chest discomfort and palpitation. At the present time, 14 years after the initial therapy, the prostate was 35 x 29 x 19 mm in size on transrectal ultrasonography with undetectable serum PSA level and no tumor cells but only mass fibrosis has been seen by pathological examinations. We considered this patient to be with no evidence of disease.
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PMID:[A case of completely responding stage D2 prostatic cancer with no evidence of disease 14 years after diagnosis]. 780 48

The indication for curative radical prostatectomy in a patient with prostatic cancer clinically confined to the prostate (stage T1, T2) and the absence of any detectable metastases, is associated with a postoperative recurrence rate of 24 to 51% after a mean follow-up of 3 years. Certain preoperative criteria allow the selection of patient groups in which the risk of postoperative tumour recurrence is higher: presence of more than 4 positive biopsies out of 6 systematized biopsies associated with a Gleason score greater than or equal to 7 and a PSA higher than 15 ng/ml (normal value for monoclonal test < 4 ng/ml). The indication for curative radical prostatectomy is doubtful in this group of patients.
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PMID:[Can we improve the selection of patients for curative radical prostatectomy?]. 785 43

Based on a retrospective study of 52 patients with prostatic adenocarcinoma and bone metastases (stage M1b), the authors analysed the following prognostic factors at the time of diagnosis: age, general status, bone pain, haemoglobin, local tumour volume, ureteric repercussions, pre and post-treatment PAP and PSA levels, Gleason score, and metastatic spread on bone scan. This study demonstrated two predominant prognostic factors for the appearance of early or late therapeutic escape: tumour differentiation established by the Gleason score (P = 0.003), stage of the disease, i.e. local tumour volume (p = 0.001) and bone mass invaded on bone scan (p = 0.0002). The other prognostic factors can be deduced from these two parameters. Qualitative analysis of the initial bone scan allowed patients with peripheral bone metastases to be distinguished from those with exclusively axial involvement. The two-year survival was 50% in patients with peripheral metastases versus 93% in patients without peripheral metastases (p < 0.05). Although bone metastasis constitutes a decisive prognostic factor, the detection of peripheral bone metastases appears to be a factor of poor prognosis.
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PMID:[Stage M1b prostatic adenocarcinoma: prognostic factors, value of bone scintigraphy]. 787 87

Laparoscopic pelvic lymphadenectomy has been proposed for staging of prostate cancer and it might be used, in selected cases, also in bladder cancer. On a total of 31 laparoscopic lymphadenectomies (LPND), 18 for prostate cancer and 13 for bladder cancer, we found positive nodes in 8 cases (26.1%), 4 in prostate and 4 in bladder cancer group. We had no intraoperative complications and negligible postoperative complications (in 10% of cases shoulder-tip pain and in 24% subcutaneous emphysema); all these spontaneously disappeared after 24-36 hours. Patients with negative nodes underwent radical surgery except two prostate cancer patients who underwent radiotherapy, and patients with positive nodes underwent hormonal therapy (for prostate cancer) or chemoradiotherapy protocol (for bladder cancer). In conclusion, laparoscopic lymphadenectomy proved to be a feasible and safe method for staging urological malignancies, being less invasive, with shorter hospitalization and postoperative convalescence than open lymphadenectomy. It should be mainly indicated in high risk prostate cancer patients (elevated PSA and/or Gleason score). In bladder cancer patients, it could be proposed in bladder sparing investigational protocols, as the percentage of pelvic nodes metastases in T2/T3 bladder cancer is sufficiently high to justify an additional staging procedure.
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PMID:Laparoscopic pelvic lymphnodes dissection for prostate and bladder cancer: indication, techniques and results. 792 Jul 41

Radical perineal prostatectomy despite its many advantages over the past decade had decreased in popularity compared with the retropubic approach and was limited to a few specific indications. The primary reason for this trend was in the ability to first evaluate pelvic lymph node metastases by frozen section using only one retropubic incision. Recently our institution has developed an alternative method which combines laparoscopic lymph node dissection (LLND) with radical perineal prostatectomies (RPP). From January 1990 to January 1992, 30 patients with a mean age of 64 were identified as having clinical stage B prostatic carcinoma. From this population a total of 36 procedures were performed by the senior author. 9 patients underwent LLND alone (group 1), 13 patients underwent RPP alone (group 2) and 14 patients underwent combination LLND and RPP (group 3). The mean EBL for groups 1, 2 and 3 were 1.2, 5 and 5.6 days respectively. Number of transfusions for patients requiring blood in groups 2 and 3 were 1.2 units and 1.5 units respectively. There were no significant differences in post-operative stay, post-operative complications, day tolerating diet or days of analgesia despite the difference in operating room and anesthesia time: group 2 (2:25) and group 3 (5:29). All levels of PSA in groups 2 and 3 remain trace at 1, 3, 6 and 12 months post operatively except for one patient.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Celioscopic lymphatic excision and perineal radical prostatectomy: a strategy for the treatment of prostatic cancer]. 850 2

Optimal treatment for patients with localized carcinoma of prostate is controversial. Radiation therapy is an established modality; reports indicate that results are comparable to those of radical prostatectomy. A retrospective review was carried out of 963 patients with carcinoma of the prostate treated with definitive irradiation (65 to 71 Gy in 6.5 to 7 weeks). Survival, incidence of local recurrence and distant metastases, and postirradiation PSA data were analyzed. Ten-year disease-free survival with external irradiation was 100% for clinical stage A1 (T1a), 69% for stage A2 (T1b,c), 57% for clinical stage B (T2), and 41% for stage C (T3). Initial PSA level closely correlated with probability of freedom from chemical failure (PSA elevation) after definitive irradiation in 317 patients with stage T1b,c and T2 tumors (96% and 89%, respectively, with initial PSA of < 10 ng/ml and 75% and 65% with higher PSA levels). Although modern irradiation techniques produce results comparable to those of radical prostatectomy in localized prostate carcinoma, we must continue to critically assess treatment policies, develop appropriately designed prospective clinical trials, and define optimal management of these patients.
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PMID:Radiation therapy in the treatment of localized prostate cancer: an alternative to an emerging consensus. 856 72

A 25-year-old patient with a rapidly growing sarcomatoid carcinoma of the urinary bladder is reported. The diagnosis was made on the basis of extended atypical proliferations of spindle or pleomorphic cells in the area of pelvic floor and the radix of the penis. The tumor showed invasion of the blood and a high Ki-67 growth fraction up to 40%. Immunohistochemically, the reactions with antibodies against cytokeratin, EMA, and vimentin were positive, while negative results were obtained in reactions with antibodies against desmin, actin, PSA, S 100, human epithelial antigen (Ber-EP4), and cytokeratin 13. The differential diagnosis against myosarcomas, pseudosarcomatous lesions, and inflammatory pseudotumours is discussed. After radical surgery a pelvic recurrence and pulmonary metastases developed, which led to the patient's death 3 months later. This case shows that sarcomatoid carcinomas of the urinary bladder can be found even in young people.
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PMID:[Sarcomatoid carcinoma of the bladder in a 25-year-old man]. 857 May 63

The dynamic evaluation of tumor markers is a promising area of investigation which is expected to provide clinical information when serial samples are available from the same patient. This is feasible in the post-operatory evaluation, during the follow-up after the treatment for to the primary tumor and in the monitoring of the treatment for metastatic disease. Variations among serial samples may be assessed using both empirical and mathematical approaches. Empirical approaches rely on overcoming a given percentage usually chosen on the base of arbitrary decisions. Mathematical approaches include the actual half-life, the doubling time, a dose/time regression analysis and the calculation of the critical difference. The two former are currently used in clinical practice whereas the two latter are still matter of investigation. As concerns the assessment of the radicality of the surgery for the primary tumor, the serum markers are used in germ cell tumors and in prostate cancer. The half-life of the markers is the decision criteria used in germ cell cancers, while in prostate cancer PSA is expected to be undetectable more than 30 days after the radical prostatectomy. Tumor markers are currently used during the follow-up of several malignancies after the treatment for primary tumor. Although several samples are available, decision criteria are still based on positive/negative cut-off values in several instances. Promising dynamic approaches are under investigation and are expected to lead to earlier and probably more accurate information concerning the disease progression. A critical point still under debate is the actual impact of tumor markers on patients' survival in malignancies incurable when metastatic, such as colorectal cancer and breast cancer. This matter urgently demands perspective clinical studies. Finally, the dynamic use of tumor markers is now commonly applied in the monitoring of the therapy for metastatic malignancies. In this clinical setting mathematical criteria are used for ovarian and and germ cell tumors with promising results. Nevertheless, the use of empirical criteria, namely the percentage of variation between two consecutive samples, is successfully used for the monitoring of the therapy of metastatic breast cancer. In conclusion, when several samples are available from an individual patient they may be evaluated according to dynamic criteria instead of referring to a conventional positive/negative cut-off point. Although mathematical decision criteria are expected to provide more reliable data, empirical approaches are used as well and provide useful information in decision making.
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PMID:Dynamic use of tumor markers, rationale-clinical applications and pitfalls. 869 56

To investigate the efficacy and safety of bicalutamide (Casodex) with its clinically recommended dose, the randomized early phase II study was performed in 124 patients with prostatic cancer (stage C, D). The patients were given 50, 80 or 100 mg of bicalutamide orally once a day in fixed doses for 12 weeks; 122 patients were eligible for evaluation. The overall response rate was 50.0% (20/40), 61.0% (25/41) and 53.7% (22/41) in the 50 mg, 80 mg and 100 mg groups, respectively. The response rate in prostate lesion, bone and lymph node metastases was slightly higher in the 80 mg group than in the 50 mg and 100 mg groups. The proportion of patients showing a response with regard to serum PSA (CR and PR) was 84.2, 92.7 and 97.6% in the 50, 80 and 100 mg groups, respectively. The incidence of adverse reactions was 65.0, 61.0 and 61.0% in the 50, 80 and 100 mg groups, respectively, and there was no significant difference in overall safety rating in the three groups. Frequent adverse reactions were gynecomastia and breast pain. Only one patient in the 80 mg group was withdrawn due to shortness of breath. Serum concentrations of LH, testosterone and estradiol increased significantly after treatment. Bicalutamide was concluded to be effective and well tolerated in patients with prostatic cancer, and its recommended dose was 80 mg once daily.
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PMID:[Clinical early phase II study of bicalutamide (Casodex) in patients with prostatic cancer]. 871 92

We report a rare case of bilateral primary seminal vesicle carcinoma in a 73 yr old Australian man. To our knowledge this case report is the 48th histologically confirmed case of primary seminal vesicle neoplasia and only the fourth reported case of primary bilateral seminal vesicle carcinoma. Macroscopically the tumor was localized to both seminal vesicles and the adjacent right lobe of the prostate. Histologically the tumor and metastases displayed a PSA, PAP and CEA negative, well differentiated papillary adenocarcinoma resembling the pattern of normal seminal vesicle epithelium. No other primary carcinoma in the body was demonstrated. The patient survived for 3 yrs and 4 mths without recurrence of tumor. The pathological criteria for acceptance of primary seminal vesicle carcinoma, difficulties in clinical/radiological detection of seminal vesicle tumors and CA-125 immunoreactivity are discussed.
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PMID:Bilateral primary seminal vesicle carcinoma. 874 30


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