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 series of 287 patients referred by their family doctors with symptoms of bladder outflow obstruction were asked to attend the hospital for "pre-clinic" screening for carcinoma of prostate (CaP). Blood samples were collected from 211 patients and analysed for serum prostate specific antigen (PSA) and prostatic acid phosphatase (PAP). Thirty-six patients had a serum PSA greater than 10 micrograms/l and 7 had PAP levels greater than 5 iu/l. In no instance was the PAP elevated without an associated increase in PSA concentration. Patients with raised markers underwent further investigations which included prostatic biopsy and/or resection; 17 patients were proved to have carcinoma of the prostate, 9 of whom had distant metastases. The specificity of PSA for detecting prostate cancer in this study was 90% with a sensitivity of 89.5%, in contrast to values for PAP of 100% and 36.8%. The routine use of PAP as a marker for prostatic cancer should be abandoned. The use of PSA as a screening test in a group of patients with prostatism appears justified, but with a positive predictive value of only 47%, its use in a mass unselected screening programme is not recommended.
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PMID:Prostate specific antigen--a screening test for prostatic cancer? 248 12

Morphometric reconstructions of 68 consecutive radical prostatectomies were analyzed for cancer volume, extent of complete capsular penetration, microscopic seminal vesicle and lymph node invasion, and histological differentiation, all of which were strongly interrelated. At less than 3.0 cc cancer volume, only 6 of 34 prostates (18 per cent) showed capsular penetration compared to 27 of 34 (79 per cent) with tumors of greater than 3.0 cc. Seminal vesicle invasion occurred once in 34 tumors of less than 3.0 cc and 15 times in those greater than 3.0 cc. All 6 patients with metastases to lymph nodes, 2 with early postoperative development of bone metastases and 4 of 5 with reappearance of detectable prostate specific antigen postoperatively had cancer volumes of greater than 4.0 cc. Correlation of digital rectal examination with cancer volume showed that of 39 palpable nodules in prostates with a cancer volume of less than 4.0 cc 30 (77 per cent) occupied 50 per cent or less of the length of 1 lobe (clinical stage B1 in our classification). Of 22 palpable lesions in tumors of greater than 4.0 cc 21 (95 per cent) exceeded 50 per cent of 1 lobe in the longitudinal extension (stage B2) or they represented bilaterally palpable disease (stage B3). Capsular penetration into the periprostatic fat occurred most commonly in the dorsolateral area of the neurovascular bundle, including 10 of 12 tumors less than 4.0 cc in volume (stage B1) and 19 of 21 with greater than 4.0 cc in tumor volume (stages B2 and B3). All 10 of the stage B1 cancers were free of contralateral lobe capsular penetration while 1 of the 13 stage B2 nodules had minimal contralateral capsule penetration in the area of the neurovascular bundle. We believe that the modified nerve-sparing radical prostatectomy should be limited to the contralateral side in stage B disease.
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PMID:Morphometric and clinical studies on 68 consecutive radical prostatectomies. 337 94

This paper reports a rare primary prostatic adenocarcinoid tumor confirmed by electron microscopy as well as immunohistochemical method including prostate specific antigen and prostatic acid phosphatase. Electron microscopy showed the presence of neuroendocrine granules in the cytoplasm of some tumor cells and the latter method ruled out the possibility of secondary tumor from other organs. It is noted that prostatic adenocarcinoid tumor is one of the diffuse neuroendocrine system tumors. Although the histogenesis of these tumors is not entirely clear, it is believed to be of multiple origins, and may transform through metaplasia into neoplasm.
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PMID:[Prostatic carcinoid and neuroendocrine tumors--a case report]. 341 5

Prostate carcinoma occasionally can present with rectal obstructive symptoms and an annular constricting lesion of the rectum. Discriminating between primary rectal carcinoma and prostate carcinoma locally invasive to the rectum is of obvious importance because of the different treatments and prognoses. History and physical examination play only a marginal role in differentiating between these two lesions. The diagnosis of prostatic malignancy in patients in this circumstance can be supported by an elevated serum acid phosphatase as well as a bone scan that demonstrates a pelvic/vertebral distribution of bony metastases. The rectal mucosa is usually spared, and a barium enema often will demonstrate tapered margins as opposed to a tumor edge in primary rectal malignancy. Excretory urography often demonstrates hydronephrosis. Rectal biopsy with immunohistochemical staining for prostate specific antigen can direct the origin of a poorly differentiated adenocarcinoma to the prostate. Treatment involves hormonal manipulation with estrogen therapy or orchiectomy. Radiation therapy to the obstructed rectum has provided satisfactory palliation when hormonal manipulation fails.
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PMID:Invasive carcinoma of prostate presenting as rectal carcinoma. 394 39

Immunoperoxidase staining for prostate specific antigen (PSA) and prostatic acid phosphatase (PAP) help to identify patients with prostatic carcinoma presenting as metastatic disease from an occult primary source. To clarify further the reliability of these prostatic tissue antigens, we have examined the primary tumor and metastatic sites in 16 autopsy cases. Eleven of these had diffusely positive findings for PSA and PAP in the primary and all metastatic sites, and 1 case lacked both antigens in all locations. Four cases demonstrated variability between these antigens and among various sites. Prostatic primary lesions contained PAP and PSA in 13 (81%) and 12 (75%) cases, respectively. The most reliable metastatic sites were lymph nodes, seminal vesicles, lung, bone, and kidney; while liver, adrenal, and colorectal sites were less reliable. No relationship existed between serum PAP levels and tissue detectability of PAP. The use of both PAP and PSA increases the likelihood of properly identifying the prostate as the organ of origin of metastatic disease. In spite of the use of both markers, however, three primary lesions would have been misdiagnosed, and 1 case lacked both antigens in all metastatic sites as well. In poorly differentiated lesions, the lack of both antigens does not unequivocally eliminate the possibility of prostatic carcinoma.
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PMID:Immunoperoxidase localization of prostatic antigens. Comparison of primary and metastatic sites. 620 96

The peroxidase-anti-peroxidase technique was used to stain for prostate specific acid phosphatase and prostate specific antigen in 12 patients with primary tumors and in 12 patients with metastases in whom the nature of the tumor was in doubt after routine histopathological studies. Nine of the primary tumors were positive for both markers and an additional 2 tumors stained for prostate specific antigen only. Six metastatic lesions stained for both markers and a seventh for prostate specific antigen alone. Thus, 11 of 12 primary tumors and 7 of 12 metastases studied were proved to be of prostatic orgin. While the peroxidase staining was sometimes weak and uneven this method, using prostate specific antigen and prostate specific acid phosphatase, allowed for ready identification of metastases. The heterogeneity of the tumors in regard to these 2 prostate markers is demonstrated, and the value of staining for prostate specific acid phosphatase and prostate specific antigen is emphasized.
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PMID:Evaluation of prostate specific acid phosphatase and prostate specific antigen in identification of prostatic cancer. 633 42

In a series of 166 patients undergoing radical prostatectomy and bilateral pelvic lymph node dissection for clinical stage A and B prostate cancer we found that 83% of patients with lymph node metastases had a final tumour Gleason score > or = 7. Gleason scoring of the pre-operative biopsy demonstrated 3 groups of patients with biopsy scores < or = 5, 6, and > or = 7, and a prevalence of lymph node metastases of 2, 13 and 23% respectively. The pre-operative serum prostate specific antigen (PSA) was of marginal value in predicting either the presence of lymph node metastases or the presence of cancer, since 15% of patients with nodal metastases had normal pre-operative PSA levels, as did 54% of patients with tumour Gleason scores < or = 5. It was concluded that the need for pelvic lymph node dissection in patients with low grade tumours is questionable because of the low prevalence of lymph node metastases, and that the pre-operative biopsy can identify those patients who are at low risk for lymph node metastases.
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PMID:Re-evaluation of the need for pelvic lymphadenectomy in low grade prostate cancer. 750 92

Within a prospective protocol initiated in 1977, 100 patients with locally extensive prostate cancer (stage T3, 1982 tumor, nodes and metastasis classification) were treated by pelvic node dissection and radical prostatectomy as monotherapy. Adjuvant treatment was not given until disease progression. Radical prostatectomy, except for 3 young patients with a single micrometastasis, was not done if positive lymph nodes were found at frozen section. Six patients had positive lymph nodes at permanent sections but not at frozen section. Average followup was 43.9 months (range 1 to 155 months). Histological grade was determined according to the Mostofi system. Progression was determined biochemically (prostate specific antigen elevation) and clinically by evidence of metastatic disease, either histologically proved or evidenced as new hot spots on bone scan or chest x-rays. Of the 100 patients 41 did not undergo radical prostatectomy: 39 because of positive lymph nodes and 2 because of evidence of a stage pT4 tumor at surgical exploration. Of those 59 patients who underwent radical prostatectomy 9 had positive lymph nodes, while 2 had stage pT4, 39 stage pT3 and 9 stage pT2 tumors. Only 1 of the 9 patients with lymph node metastases is free of biochemical or clinical progression. Disease also progressed in both stage pT4, 27 of 39 stage pT3 and none of the 9 stage pT2 cases. A total of 22 patients was free of clinical or biochemical progression. Clinical progression was evidenced in approximately half of the cases as distant and local progression. Data on stage T3 disease were compared to those of 129 patients with stages T0 to T2 disease. There was a significant difference in interval to clinical progression for these 2 groups (p = 0.001). However, if grade 3 cases were excluded from the stage T3 group, this difference disappeared. Prognostic factors analyzed were pretreatment and posttreatment grade, pretreatment prostate specific antigen and prostatic acid phosphatase levels, positive margins, seminal vesicle invasion and nodal status. The analysis allows one to identify groups of patients who may benefit and others who certainly do not benefit from radical prostatectomy in this disease category. In the latter group effective adjuvant treatment is urgently indicated.
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PMID:Radical prostatectomy as a monotherapy for locally advanced (stage T3) prostate cancer. 750 23

The efficacy of radionuclide bone scans in monitoring metastatic bone activity remains controversial. Objective measurement of bone tumor burden would be useful for the evaluation of new therapies for metastatic carcinoma of the prostate. The recent discovery of the urinary excretion of pyridinoline (cross-link of mature collagen found in cartilage and bone) and deoxypyridinoline (collagen cross-link specific to bone) measured by high pressure liquid chromatography has provided sensitive specific indexes of cartilage and bone breakdown in rheumatoid arthritis, osteoporosis and metabolic bone diseases. We compared the urinary excretion of deoxypyridinoline,pyridinoline and hydroxyproline relative to urinary creatinine (nmol./mmol.creatinine) in 27 patients with benign prostatic hyperplasia (patient age 70.0 +/- 8.5 years, standard deviation), 29 with clinically confined prostate cancer (age 70.2 +/- 9.7 years), and 26 with prostate cancer and bone metastases (age 71.1 +/- 7.7 years). No diurnal variation of deoxypyridinoline or pyridinoline urinary excretion was detected in 5 patients with metastases. Urinary excretion of pyridinoline and deoxypyridinoline was significantly greater in patients with metastatic carcinoma of the prostate compared with patients with either benign prostatic hyperplasia (Mann-Whitney-Wilcoxon rank sum analysis, p < 0.00004 and 0.002, respectively) or localized prostate cancer (Mann-Whitney-Wilcoxon, p < 0.00001 and 0.00005, respectively). Urinary hydroxyproline levels failed to separate the 3 groups. Pyridinoline and deoxypyridinoline excretion in prostate cancer patients with metastases directly correlated with bone scan Soloway scores (r = 0.55, p < 0.005 and r = 0.57, p < 0.004 respectively), whereas serum prostate specific antigen did not (r = 0.36, p = 0.08). Serial measurements of pyridinoline and deoxypyridinoline progressively increased in 3 patients with clinical progression documented by new metastatic lesions by bone scan. Measurement of pyridinoline and deoxypyridinoline excretion cannot diagnose metastatic disease. However, these markers should be evaluated further for quantitative assessment of bone metastases.
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PMID:Collagen cross-link metabolites in urine as markers of bone metastases in prostatic carcinoma. 751 Mar 46

To determine if the preoperative variables of serum prostate specific antigen (PSA), primary Gleason grade from the biopsy specimen and local clinical stage as determined from digital rectal examination can accurately predict the pelvic lymph node status in patients with clinically localized prostate cancer, we reviewed the medical records of 1,632 patients who underwent bilateral pelvic lymphadenectomy at our institution between January 1988 and December 1991. Using logistic regression analysis, serum PSA was found to be the best predictor of pelvic lymph node metastases (p < 0.0001). The predictive power of serum PSA could be enhanced considerably by taking into account the Gleason grade (p < 0.001) and local clinical stage (p < 0.001). A statistical model using all 3 variables was developed that allows the practicing urologist to estimate on an individual basis the probability of pelvic lymph node involvement. Using a conservative cutoff point of less than 3% as an acceptable false-negative rate, 61% of the patients with clinical stages T1a to T2b (A1 to B1) disease and 29% of those with clinical stages T1a to T2c (A1 to B2) prostate cancer may be spared an open or laparoscopic staging bilateral pelvic lymphadenectomy. As a result, patient morbidity can be decreased and a significant economic savings to the health care system can be realized. This observation has particular importance for prostate cancer patients being managed with radical perineal prostatectomy or definitive radiation therapy.
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PMID:Eliminating the need for bilateral pelvic lymphadenectomy in select patients with prostate cancer. 815 79


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